CENTRAL SUFFOLK HOSPITAL FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CENTRAL SUFFOLK HOSPITAL FOUNDATION (EIN 20-0714587)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201333189349308273
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T17:27:26-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 131517563 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LOEB & TROPER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 655 THIRD AVENUE 12TH FLOOR | AddressLine1 |
| City | NEW YORK | City |
| State | NY | State |
| ZIP Code | 10017 | 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 | 200714587 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL SUFFOLK HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CENT | NameControl |
| Phone | 6315486064 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1300 ROANOKE AVENUE | AddressLine1 |
| City | RIVERHEAD | City |
| State | NY | State |
| ZIP Code | 11901 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANDREW MITCHELL | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 6315486064 | Phone |
| Date Signed | 2013-11-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | FREDERICK H ROTHMAN | Name |
| PTIN | P01275277 | PTIN |
| Phone | 2128674000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE SCHEDULE O FOR DBA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ANDREW MITCHELL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1300 ROANOKE AVENUE | AddressLine1 |
| City | RIVERHEAD | City |
| State | NY | State |
| ZIP Code | 11901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2290440 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PBMEDICALCENTER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2004 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | THE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABRATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH THE HOSPITAL WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 9 | TotalNbrEmployees |
| Total Nbr Volunteers | 16 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2988253 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2247758 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 749 | InvestmentIncomePriorYear |
| Investment Income Current Year | 408 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -26483 | OtherRevenuePriorYear |
| Other Revenue Current Year | -70127 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2962519 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2178039 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 545417 | 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 | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 375000 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 393159 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1738410 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 809069 | OtherExpensePriorYear |
| Other Expenses Current Year | 1365154 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1729486 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1758313 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1233033 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 419726 | RevenuesLessExpensesCY |
| Total Assets BOY | 3589451 | TotalAssetsBOY |
| Total Assets EOY | 3910802 | TotalAssetsEOY |
| Total Liabilities BOY | 620833 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 522458 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2968618 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3388344 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE OTHE FOUNDATION'S MISSION IS TO DEVELOP AND CULTIVATE PHILANTHROPIC AND COLLABRATIVE RELATIONSHIPS THAT FOSTER PROGRAMS AND SERVICES OFFERED THROUGH THE HOSPITAL WHICH IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Description | THE SUPPORT OF HOSPITAL SERVICES OF CENTRAL SUFFOLK HOSPITAL | Description |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | 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 | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | 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 | 2 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 9 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicy |
| 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 | MICHAEL F O'DONNELL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6315486074 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1300 ROANOKE AVENUE | AddressLine1 |
| City | RIVERHEAD | City |
| State | NY | State |
| ZIP Code | 11901 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated |
|---|---|---|---|---|---|---|---|
| J GORDON HUSZAGH | |||||||
| CHAIRMAN | 10.00 | X | X | 0 | 0 | 0 | |
| IRWIN L GARSTEN | |||||||
| VICE CHAIRMAN | 10.00 | X | X | 0 | 0 | 0 | |
| EMILY ROY COREY | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| RICHARD ISRAEL | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| JOAN LEVAN | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| ANDREW MITCHELL | |||||||
| PRESIDENT/CEO | 10.00 | X | X | 191636 | 526998 | 53708 | 27.50 |
| JESSE R GOODALE III | |||||||
| PAST CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| KENNEY BARRA | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRUCE BARNET | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BABU EASOW MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD RUBENSTEIN MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOSEPH VAN DE WETERING | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| CAROLE G HANKIN PHD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVID J MCCANN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD L WINSLOW PHD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| STANLEY ZINBERG MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BARRY BRANDEIS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 191636 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 526998 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 53708 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL SUFFOLK HOSPITAL | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1300 ROANOKE AVENUE | AddressLine1 |
| City | RIVERHEAD | City |
| State | NY | State |
| ZIP Code | 11901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | ADMINISTRATIVE SERVICES | DescriptionOfServices |
| Compensation | 963799 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Fundraising Events | 348932 | FundraisingEvents |
| Related Organizations | 300000 | RelatedOrganizations |
| All Other Contributions | 1598826 | AllOtherContributions |
| Noncash Contributions | 254807 | NoncashContributions |
| Total Contributions | 2247758 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 408 | TotalRevenueColumn |
| Exclusion | $408 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 42274 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 348932 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 112401 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -70127 | TotalRevenueColumn |
| Exclusion | -$70,127 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2178039 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$69,719 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5900 | Total |
| Fundraising | 5900 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 393159 | Total |
| Fundraising | 393159 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 965299 | Total |
| Fundraising | 965299 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10190 | Total |
| Fundraising | 10190 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 195905 | Total |
| Fundraising | 195905 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7500 | Total |
| Fundraising | 7500 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10900 | Total |
| Fundraising | 10900 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|
| BAD DEBT EXPENSE | 19903 | 19903 | |
| PLAQUES | 10168 | 10168 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139389 | Total |
| Fundraising | 139389 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1758313 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 19903 | ManagementAndGeneral |
| Fundraising | 1738410 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 67299 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1072950 | BOY |
| EOY | 1806050 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2516501 | BOY |
| EOY | 2037453 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3589451 | BOY |
| EOY | 3910802 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77102 | BOY |
| EOY | 2351 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 543731 | BOY |
| EOY | 520107 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 620833 | BOY |
| EOY | 522458 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 721492 | BOY |
| EOY | 1484331 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2247126 | BOY |
| EOY | 1904013 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2968618 | BOY |
| EOY | 3388344 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3589451 | BOY |
| EOY | 3910802 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 419726 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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 Separate | X | FinancialStatementSeparate |
| 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) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1240829 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 967777 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1419214 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2988253 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2247758 | CurrentTaxYear |
| Total | 8863831 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1240829 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 967777 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1419214 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2988253 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2247758 | CurrentTaxYear |
| Total | 8863831 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 2332580 | AmountsSubstContributorsTotal |
| Public Support Total170 | 6531251 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3300 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1634 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2791 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 749 | CurrentTaxYearMinus1Year |
| Current Tax Year | 408 | CurrentTaxYear |
| Total | 8882 | Total |
Net UBI NetUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 17936 | CurrentTaxYearMinus3Years |
| Total | 17936 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 8890649 | TotalSupport |
| Public Support Pertcentage170 | 0.73460 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.73620 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER | $452,666 |
| CONTRIBUTIONS HELD ON BEHALF OF WOMEN'S HEALTH PARTNERSHIP | $67,441 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 520107 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 2178039 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 2178039 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2178039 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1758313 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1758313 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1758313 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | UNCERTAINTY IN INCOME TAXES - THE FOUNDATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2009 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. | Explanation |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| Email Solicitations | X | EmailSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | ActivityActivity | Fundraiser Control Of FundsFundraiserControlOfFunds | Gross ReceiptsGrossReceipts | Amount Retained By ContractorAmountRetainedByContractor | Net To OrganizationNetToOrganization |
|---|---|---|---|---|---|---|---|---|
| COMMUNITY COUNSELING SERVICES LLC | ||||||||
| 461 FIFTH AVENUE | NEW YORK | NY | 10017 | CONSULTING FOR CAPITAL CAMPAIGN | 0 | 0 | 359087 | 0 |
| HARRIS CONNECT LLC | ||||||||
| 1511 ROUTE 22 SUITE 25 | BREWSTER | NY | 10509 | CONSULTING FOR CAPITAL CAMPAIGN | 0 | 0 | 34072 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | 393159 | TotalRetainedByContractors |
| Licensed States | NY | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | BLACK AND WHITE | NameOfEvent1 |
| Gross Receipts Event1 | 287396 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 250172 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 37224 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 10000 | CashPrizesEvent1 |
| Rent Facility Costs Event1 | 21589 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 26824 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 2125 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 14948 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GARDEN FESTIVAL | NameOfEvent2 |
| Gross Receipts Event2 | 103810 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 98760 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 5050 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 9979 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 2137 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 24799 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 391206 | GrossReceiptsTotal |
| Charitable Contributions Total | 348932 | CharitableContributionsTotal |
| Gross Revenue Total Events | 42274 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 10000 | CashPrizesTotalEvents |
| Rent Facility Costs Total Events | 31568 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 28961 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 2125 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 39747 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 112401 | DirectExpenseSummaryEvents |
| Net Income Summary | -70127 | NetIncomeSummary |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ANDREW MITCHELL | NamePerson |
| Title | PRESIDENT/CEO | Title |
| Base Compensation Filing Org | 141290 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 388548 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 45600 | BonusFilingOrg |
| Bonus Related Orgs | 125400 | BonusRelatedOrgs |
| Other Compensation Filing Org | 4746 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 13050 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 6533 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 17967 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 7789 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 21419 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 205958 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 566384 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 3 | CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER, A RELATED ORGANIZATION, UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS PERFORMED IN 2012. |
| PART I, LINE 7 | PERFORMANCE BASED ON BOARD DISCRETION. AN EMPLOYMENT AGREEMENT IS IN PLACE WITH THE HOSPITAL WITH THE CEO. |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 3 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 254807 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | SELLING PRICE | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of8283 Received | 0 | NumberOf8283Received |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: | Identifier |
| Return Reference | PART I, COLUMN (B): | ReturnReference |
| Explanation | NUMBER OF CONTRIBUTORS | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE CEO/PRESIDENT, AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL REVIEW THE 990. A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. | |
| FORM 990, PART VI, SECTION B, LINE 12 | THE FOUNDATION FOLLOWS THE HOSPITAL'S CONFLICT OF INTEREST POLICY. | |
| FORM 990, PART VI, SECTION B, LINE 15 | CENTRAL SUFFOLK HOSPITAL D/B/A PECONIC BAY MEDICAL CENTER, A RELATED ORGANIZATION, UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS PERFORMED IN 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART IX, LINE 11G | SPECIAL EVENT PHOTOGRAPHY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 1,500. TOTAL EXPENSES 1,500. ADMINISTRATIVE SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 963,799. TOTAL EXPENSES 963,799. | OTHER FEES |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL SUFFOLK HOSPITAL DBA PECONIC BAY MEDICAL CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1300 ROANOKE | AddressLine1 |
| City | RIVERHEAD | City |
| State | NY | State |
| ZIP Code | 11901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 111661359 | EIN |
| Primary Activities | HOSPITAL CARE | PrimaryActivities |
| Legal Domicile State | NY | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| 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 | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | 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 | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |