2012-11-14T11:23:00-06:00 2011-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2011-01-01 112665457 SHORE ROAD RADIOLOGY ASSOCIATES PC SHOR 7186307611 150 55TH STREET NO 2-36 BROOKLYN NY 11220 JAYANTH RAO 7186307611 2012-11-13 1 5169187000 2012-11-13 2011 2016-02-24 21:20:13Z JAYANTH RAO MD 150 55TH STREET NO 2-36 BROOKLYN NY 11220 5925481 0 X N/A X 1984 NY HEALTHCARE PROVIDER OF RADIOLOGY IN CONJUNCTION WITH, AND IN SUPPORT OF, LUTHERAN MEDICAL CENTER. 1 0 10 0 0 0 0 0 6279946 5922860 586 490 0 2131 6280532 5925481 0 0 0 0 4529273 3602879 0 0 0 3480371 2924059 8009644 6526938 -1729112 -601457 676871 795566 1008227 884296 -331356 -88730 X SEE SCHEDULE O. 0 0 6045538 5922860 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 2011, SRR RADIOLOGISTSREAD APPROXIMATELY 165,000 TESTS PERFORMED ON LUTHERAN MEDICALCENTER PATIENTS, WITHOUT REGARD FOR THE PATIENT'S ABILITY TO PAY. 6045538 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 7 0 1 10 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 NY X ALAN SICKLES 7186307611 150 55TH STREET BROOKLYN NY 11220 JAYANTH RAO MD 40.00 X X 641757 0 25149 WILLIAM NGUYEN MD 40.00 X 432248 0 26577 JEN-FONG SHEN MD 40.00 X 423229 0 27115 YEVGENIY MARGUILIS MD 40.00 X 382205 0 15796 KOPRESH A GUDI MD 40.00 X 367784 0 22111 2247223 0 116748 9 0 1 0 BARTON & ASSOCIATES 10 DEARBORN ROAD PEABODY MA 01960 LOCUM TENENS 926764 TELERADIOLOGY LLC 3520 PIEDMONT ROAD NE SUITE 250 ATLANTA GA 30305 LOCUM TENENS 335450 NIGHTHAWK PROS 341 TEN TH AVENUE SUITE 207 ROYERSFORD PA 19468 PHYSICIAN SERVICES 265081 MD EVERYWHERE 26 CENTRAL AVENUE HAUPPAUGE NY 11788 BILLING SERVICES 260863 XP RADIOLOGY 62 STONE HILL DRIVE SOUTH MANHASSET NY 11030 PHYSICIAN SERVICES 137470 6 PATIENT SERVICE REVENU 622110 5922860 5922860 5922860 490 490 MISCELLANEOUS INCOME 2131 2131 2131 5925481 5922860 0 2621 3293931 3293931 82459 82459 103155 103155 123334 123334 104915 104915 3422 3422 11777 11777 1967785 1967785 55874 15996 39878 458878 458878 BILLING EXPENSES 260863 260863 STAFF CHARGE BACK 55121 55121 PAYROLL FEES 1349 1349 FILING FEES 1225 1225 2850 2850 6526938 6045538 481400 0 65007 10532 511642 673210 100222 111824 676871 795566 781816 526009 226411 358287 1008227 884296 X -331356 -88730 -331356 -88730 676871 795566 X -601457 844083 X 0 1 1 X 0 X X X X 0 0 0 LUTHERAN MEDICAL CENTER 111839567 HOSPITAL 1 1 1 63607 1 63607 0 DUE TO AFFILIATES 358287 358287 X X X X X 0 0 0 0 0 0 0 0 0 JAYANTH RAO MD 641757 0 0 0 0 0 12868 0 12281 0 666906 0 0 0 WILLIAM NGUYEN MD 406041 0 0 0 26207 0 9684 0 16893 0 458825 0 0 0 JEN-FONG SHEN MD 403679 0 0 0 19550 0 10194 0 16921 0 450344 0 0 0 YEVGENIY MARGUILIS MD 381887 0 0 0 318 0 10151 0 5645 0 398001 0 0 0 KOPRESH A GUDI MD 349269 0 0 0 18515 0 10321 0 11790 0 389895 0 0 0 HEMALATHA RAO EMPLOYEE 114100 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, 2011 WAS $114,100. 0 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, 2011. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFERS OF NET ASSETS FROM RELATED ENTITIES 844,083. TOTAL TO FORM 990, PART XI, LINE 5: 844,083. LUTHERAN MEDICAL CENTER 150 55TH STREET BROOKLYN NY 11220 111839567 HEALTHCARE NY 501(C)(3) 3 N/A 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0