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        <ReturnReference>SCHEDULE J, PART I; QUESTION 7</ReturnReference>
        <Explanation>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, COLUMN B(II).</Explanation>
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        <ReturnReference>CORE FORM, PART VI, SECTION A; QUESTIONS 6 &amp; 7</ReturnReference>
        <Explanation>STATEN ISLAND UNIVERSITY HOSPITAL IS THE SOLE MEMBER OF THIS ORGANIZATION WHICH EXISTS THROUGH A PHYSICIAN NOMINEE AGREEMENT DUE TO STATE OF NEW YORK corporate practice of medicine RULES AND REGULATIONS. North Shore-Long Island Jewish Health Care, Inc. ("Health Care") IS THE SOLE MEMBER OF STATEN ISLAND UNIVERSITY HOSPITAL.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>DISCLOSURE INFORMATION</Identifier>
        <ReturnReference>CORE FORM, PART VI, SECTION B; QUESTION 11b</ReturnReference>
        <Explanation>THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF ITS GOVERNING BODY (ITS BOARD OF TRUSTEES) FOR REVIEW PRIOR TO THE FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE PERSONNEL AND OTHER INDIVIDUALS TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S internal finance personnel FOR REVIEW. THE ORGANIZATION'S internal finance personnel REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS provided TO EACH VOTING MEMBER OF THE ORGANIZATION'S BOARD OF TRUSTEES PRIOR TO THE FILING WITH THE IRS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>DISCLOSURE INFORMATION</Identifier>
        <ReturnReference>CORE FORM, PART VI, SECTION B; QUESTION 12</ReturnReference>
        <Explanation>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 fill 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.</Explanation>
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        <ReturnReference>CORE FORM, PART VI, SECTION B; QUESTION 15</ReturnReference>
        <Explanation>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 OTHER 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 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.</Explanation>
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      <GeneralExplanation>
        <Identifier>DISCLOSURE INFORMATION</Identifier>
        <ReturnReference>CORE FORM, PART VI, SECTION C; QUESTION 19</ReturnReference>
        <Explanation>CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.</Explanation>
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      <GeneralExplanation>
        <Identifier>RELATED HOURS INFORMATION</Identifier>
        <ReturnReference>CORE FORM, PART VII, SECTION A</ReturnReference>
        <Explanation>This organization is affiliated within 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.</Explanation>
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        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:PHYSICIAN FEES TOTAL FEES:31107006</Explanation>
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      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:4308593</Explanation>
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      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:BILLING &amp; CODING FEES TOTAL FEES:3833068</Explanation>
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      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:CONSULTING FEES TOTAL FEES:19734</Explanation>
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        <AddressUS>
          <AddressLine1>972 BRUSH HOLLOW RD</AddressLine1>
          <City>WESTBURY</City>
          <State>NY</State>
          <ZIPCode>11590</ZIPCode>
        </AddressUS>
        <EIN>461617561</EIN>
        <PrimaryActivity>Medical Services</PrimaryActivity>
        <LegalDomicileState>NY</LegalDomicileState>
        <DirectControllingEntityName>
          <BusinessNameLine1>NSUH</BusinessNameLine1>
        </DirectControllingEntityName>
        <TypeOfEntity>C CORPORATION</TypeOfEntity>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartIV>
      <Form990ScheduleRPartIV>
        <NameOfRelatedOrg>
          <BusinessNameLine1>NS-LIJ HEALTH PLANS INC</BusinessNameLine1>
        </NameOfRelatedOrg>
        <AddressUS>
          <AddressLine1>972 Brush Hollow Rd</AddressLine1>
          <City>Westbury</City>
          <State>NY</State>
          <ZIPCode>11590</ZIPCode>
        </AddressUS>
        <EIN>461617516</EIN>
        <PrimaryActivity>Medical Services</PrimaryActivity>
        <LegalDomicileState>NY</LegalDomicileState>
        <DirectControllingEntityName>
          <BusinessNameLine1>NS-LIJ HC</BusinessNameLine1>
        </DirectControllingEntityName>
        <TypeOfEntity>c corporation</TypeOfEntity>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartIV>
      <ReceiptOfIntAnnRentsRoyalties>false</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>false</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>false</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>false</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>false</LoansOrGuaranteesFromOtherOrg>
      <DividendsRelatedOrganization>false</DividendsRelatedOrganization>
      <SaleOfAssetsToOtherOrg>false</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>false</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>false</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>false</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>false</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>false</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>true</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>false</SharingOfFacilities>
      <SharingOfPaidEmployees>true</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>false</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>false</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>false</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>false</OtherTransferFromOtherOrg>
      <Form990ScheduleRPartVII>
        <Identifier>TRANSACTIONS WITH RELATED ORGANIZATIONS</Identifier>
        <ReturnReference>SCHEDULE R, PART V</ReturnReference>
        <Explanation>THIS ORGANIZATION IS AN AFFILIATE OF North Shore - long Island Jewish Health System ("sYSTEM"). ORGANIZATIONS WITHIN THE SYSTEM ROUTINELY PAY EXPENSES FOR VARIOUS AFFILIATES IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF THIS ORGANIZATION AND ITS AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY HEALTHCARE AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE SITUATED.</Explanation>
      </Form990ScheduleRPartVII>
    </IRS990ScheduleR>
  </ReturnData>
</Return>