TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) PETER M LARSEN BOARD CHAIRMAN	1.30	X	X	0	0
(2) RICHARD J HIEGEL ESQ BOARD CO-CHAIR	1.30	X	X	0	0
(3) KENNETH B WRIGHT BOARD CO-CHAIR	1.30	X	X	0	0
(4) STANLEY D FRIEDMAN BOARD VP	1.30	X	X	0	0
(5) LAWRENCE A WILLIS BOARD TREASURER	1.30	X	X	0	0
(6) PATRICIA STEWART BOARD SECRETARY	1.30	X	X	0	0
(7) JOHN WAMBOLD TRUSTEE	1.30	X		0	0
(8) RICHARD BRUCE TRUSTEE	1.30	X		0	0
(9) JAMES FORBES TRUSTEE	1.30	X		0	0
(10) CHARLES HOLMES TRUSTEE	1.30	X		0	0
(11) MICHAEL B ISRAEL MD TRUSTEE	38.80	X		177,077	30,055
(12) GEORGE P KAZDIN TRUSTEE	1.30	X		0	0
(13) LISA KOMBRINK TRUSTEE	1.30	X		0	0
(14) JACK LENTZ - TRUSTEE THRU 07/06/10	1.30	X		0	0
(15) JOHN MCGOWAN TRUSTEE	1.30	X		0	0
(16) STEPHEN H SHAPOFF TRUSTEE	1.30	X		0	0
(17) R TIMOTHY MARAN TRUSTEE	1.30	X		0	0

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) PHILLIP A PIRO JR MD TRUSTEE	1.30	X				0	0
(19) DOROTHY LEWIS TRUSTEE	1.30	X				0	0
(20) JEAN REMMEL FITZSIMMONS TRUSTEE	1.30	X				0	0
(21) JOHN E GRIM III TRUSTEE	1.30	X				0	0
(22) PETER COLLINS TRUSTEE	1.30	X				0	0
(23) STEVEN R GOLDFARB MD TRUSTEE	1.30	X				0	0
(24) FLORENCE ROLSTON MD TRUSTEE	1.30	X				0	0
(25) MARTIN L STONE MD TRUSTEE	1.30	X				0	0
(26) MICHAEL F SMITH TRUSTEE	1.30	X				0	0
(27) GEORGE F BIONDO ESQ TRUSTEE	1.30	X				0	0
(28) JAY K LEVINE TRUSTEE	1.30	X				0	0
(29) ROBERT S CHALONER PRESIDENT & CEO	38.80	X	X			615,461	39,804
(30) HOWARD M LORBER TRUSTEE	1.30	X				0	0
(31) FREDERIC I WEINBAUM CHIEF MEDICAL OFFICER & COO	37.50		X			419,788	36,265
(32) CHRISTOPHER J SCHULTHEIS CHIEF FINANCIAL OFFICER	37.50		X			191,863	30,745
(33) PATRICIA A DARCEY CHIEF NURSING OFFICER	37.50			X		192,438	30,495
(34) PAUL R DAVIN DIRECTOR, HUMAN RESOURCES	37.50			X		190,347	30,261
(35) EDNA KAPENHAS-VALDES DIRECTOR, BREAST SERVICE	37.50				X	312,370	34,008
(36) CHARLES ARCOLEO DIRECTOR	37.50				X	247,829	33,694
(37) ANGELA SOTERIOU HOSPITALIST	37.50				X	193,954	18,637
(38) ALEX APONTE PHYSICIAN	37.50				X	189,736	30,738
(39) TOVIA LENT HOSPITALIST	37.50				X	192,376	29,016

(A) Name and business address	(B) Description of services	(C) Compensation
MORRISON MANAGEMENT SPECIALIST 4721 MORRISON DRIVE STE 300 MOBILE,AL36609	FOOD SERVICE MGMT & SUPPLIES	928,873
HAMPTONS GYNECOLOGY OB 595 HAMPTON ROAD SOUTHAMPTON,NY11968	OB COVERAGE & PRECEPTING	896,990
CANDESCENT HEALING INC 220 WHITE PLAINS ROAD TARRYTOWN,NY10591	OUTPATIENT SERVICES	624,614
LONG ISLAND PATHOLOGY PC PO BOX 2098 SOUTHAMPTON,NY11968	PATHOLOGY SERVICES	431,520
BDO SEIDMAN LLP PO BOX 642743 PITTSBURGH,PA152642743	ACCOUNTING	215,266
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 17

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,778,066		1,778,066
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	45,219,072	38,888,402	6,330,670
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	2,866,444	2,465,142	401,302
9	Other employee benefits .......	9,390,533	8,075,858	1,314,675
10	Payroll taxes ...........	3,424,529	2,945,095	479,434
11	Fees for services (non-employees):
a	Management ......	769,587	661,845	107,742
b	Legal .........	140,934		140,934
c	Accounting ...........	250,409		250,409
d	Lobbying ...........	43,486	37,398	6,088
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......
g	Other ..........
12	Advertising and promotion ....	11,435	9,834	1,601
13	Office expenses .......	13,495,240	11,605,906	1,889,334
14	Information technology ......	626,592	538,869	87,723
15	Royalties ..
16	Occupancy ...........	2,867,194	2,465,787	401,407
17	Travel ............	158,083		158,083
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	5,144		5,144
20	Interest ...........	2,897,623	2,491,956	405,667
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	4,171,159	3,587,197	583,962
23	Insurance ..............	2,347,906	2,019,199	328,707
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	BAD DEBTS	8,406,000	8,406,000
b	OTHER PURCHASE SERVICES	4,842,065	4,164,176	677,889
c	OTHER PROFESSIONAL SERV	3,361,298	2,890,716	470,582
d	OTHER DIRECT EXPENSES	1,530,845	1,316,527	214,318
e	MISCELLANEOUS	710,526	355,263	355,263
f	All other expenses	673,725	673,725
25	Total functional expenses. Add lines 1 through 24f	109,987,895	93,598,895	16,389,000	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	4,228,363	1	1,064,887
2	Savings and temporary cash investments .......	1,075,153	2	8,276,962
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	13,025,057	4	11,221,858
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............	2,744,016	7
8	Inventories for sale or use ..............	1,396,307	8	1,426,697
9	Prepaid expenses and deferred charges ............	198,721	9	224,215
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	126,828,225
b	Less: accumulated depreciation. .....	10b	91,916,023	29,498,686	10c	34,912,202
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......	27,403,543	12	26,969,470
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	1,504,377	15	3,110,482
16	Total assets. Add lines 1 through 15 (must equal line 34)...	81,074,223	16	87,206,773
	17	Accounts payable and accrued expenses .	22,206,091	17	16,191,326
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	36,317,011	20	35,558,409
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	7,653,718	23	8,916,102
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	17,572,651	25	18,846,777
26	Total liabilities. Add lines 17 through 25.....	83,749,471	26	79,512,614
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	-10,420,273	27	-374,818
28	Temporarily restricted net assets .....	4,911,008	28	5,234,960
29	Permanently restricted net assets .....	2,834,017	29	2,834,017
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	-2,675,248	33	7,694,159
34	Total liabilities and net assets/fund balances .....	81,074,223	34	87,206,773

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization SOUTHAMPTON HOSPITAL ASSOCIATION
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization SOUTHAMPTON HOSPITAL ASSOCIATION
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Yes

43,486

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Total. lines 1c through 1i ...................................

43,486

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES:	PART II-B, LINE 1I:	SOUTHAMPTON HOSPITAL PAYS MEMBERSHIP DUES TO THE ORGANIZATIONS LISTED BELOW. A PERCENTAGE OF THESE DUES ARE THEN USED TO REIMBURSE THE ORGANIZATION FOR THE COST OF LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE HOSPITAL. THE FUNDS ARE USED FOR LOBBYING PURPOSES IN CONNECTION WITH NEW YORK STATE AND FEDERAL POLICY ISSUES. MEMBERSHIP DUES PAID TO OTHER ORGANIZATIONS AND USED FOR LOBBYING PURPOSES: HEALTHCARE ASSOCIATION OF NEW YORK STATE $ 14,040 NASSAU SUFFOLK HOSPITAL COUNCIL 1,297 GREATER NY HOSPITAL ASSOCIATION 28,149 --------- $ 43,486 =========

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back
1a	Beginning of year balance ....	3,943,577	4,031,782	4,235,635
b	Contributions ........
c	Investment earnings or losses ...	371,238	73,511	-146,059
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	95,021	23,873	30,806
f	Administrative expenses ....	6,028	137,843	26,988
g	End of year balance ......	4,213,766	3,943,577	4,031,782

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

32.000 %

Permanent endowment: SchDMd Bullet

68.000 %

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,335,585		1,335,585
b	Buildings ................	37,906,615	15,718,387	22,188,228
c	Leasehold improvements ............
d	Equipment ................	10,854,427	3,086,703	7,767,724
e	Other .................	76,731,598	73,110,933	3,620,665
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				34,912,202

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) SHORT TERM INVESTMENTS	1,071,240	F
(B) ASSETS SUBJECT TO DONOR RESTRICTIONS	8,068,977	F
(C) DEBT SERVICE RESERVE FUND	5,706,009	F
(D) MALPRACTICE SELF INSURANCE-FUND	5,718,000	F
(E) INVESTMENT IN SHA PROPERTIES	6,300,000	C
(F) INVESTMENT IN JOINT VENTURE - HAMPTON IMAGING LLC	105,244	F



Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)	26,969,470

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DUE FROM RELATED PARTY - MEETINGHOUSE LANE MEDICAL PRACTICE				2,080,612
(2) UNAMORTIZED BOND DISCOUNT & ISSUE COST				1,029,870







Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........				3,110,482

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes
MALPRACTICE SELF-INSURANCE		5,718,000
DUE FROM THIRD PARTY PAYORS		5,374,442
PENSION LIABILITY		7,430,050
DUE FROM RELATED PARTY - MEETINGHOUSE LANE MEDICAL PRACTICE		324,285





Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		18,846,777
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	110,809,101
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	109,987,895
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	821,206
4	Net unrealized gains (losses) on investments ..........................	4	581,461
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7	1,390,345
8	Other (Describe in Part XIV) .................................	8	7,576,395
9	Total adjustments (net). Add lines 4 - 8 .............................	9	9,548,201
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	10,369,407

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	114,293,425
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	581,461
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d	3,576,588
e	Add lines 2a through 2d .....................			2e	4,158,049
3	Subtract line 2e from line 1.....................			3	110,135,376
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b	673,725
c	Add lines 4a and 4b.......................			4c	673,725
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	110,809,101

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	109,907,806
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d	593,636
e	Add lines 2a through 2d......................			2e	593,636
3	Subtract line 2e from line 1.....................			3	109,314,170
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b	673,725
c	Add lines 4a and 4b.......................			4c	673,725
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......			5	109,987,895

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:	PART V, LINE 4:	SOUTHAMPTON HOSPITAL CURRENTLY REPORTS ENDOWMENT FUNDS WITHIN ITS DECEMBER 31, 2010 FINANCIAL STATEMENTS. THE GOVERNING BODY INTENDS TO USE THESE FUNDS TO OFFSET THE COST OF INDIGENT CARE, EMERGENCY SERVICES AND NURSING EDUCATION.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X:	THE HOSPITAL IS INCORPORATED IN THE STATE OF NEW YORK AND IS EXEMPT FROM FEDERAL, STATE AND LOCAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"), AND THEREFORE HAVE MADE NO PROVISION FOR INCOME TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL EARNS INCOME FROM ITS LABORATORY EXTENDED SERVICES PROGRAM. SUCH INCOME IS CLASSIFIED AS UNRELATED BUSINESS INCOME ("UBI") BY THE CODE AND IS SUBJECT TO INCOEM TAXES. UBI IS DEFINED AS INCOME DERIVED FROM AN ACTIVITY THAT CONSTITUTES A TRADE OR BUSINESS THAT IS REGULARLY CARRIED ON AND IS NOT SUBSTANTILALLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE. THE LABORATORY EXTENDED SERVICES PROGRAM HAS BEEN OPERATING AT A LOSS AND, ACCORDINGLY, THERE IS NO UBI TAX RECORDED FOR THE YEAR ENDED DECEMBER 31, 2010. THE HOSPITAL HAVE NOT TAKEN AN UNSUNSTANTIATED TAX POSITION THAT WOULD REQUIRE PROVISION OF A LIABILIOTY UNDER ASC 740-10.
PART XI, LINE 8 - OTHER ADJUSTMENTS:		CHANGE IN MINIMUM PENSION LIABILITY - $1,266,824 NET ASSETS REL FROM RESTRICTIONS - CAPITAL ACQUIS FOUNDATION - $5,993,546 CHANGE IN EXPECTED INTEREST IN TRUSTS CHANGE IN VALUE OF POOLED INCOME FUND OTHER ADJUSTMENTS
PART XII, LINE 2D - OTHER ADJUSTMENTS:		RELATED PARTY INCOME - S.H.A PRPERTIES, INC. - $374,091 INTEREST IN SOUTHAMPTON HOSPITAL FOUNDATION M- $2,441,825 RENTAL EXPENSES REPORTED ON FORM 990, PART VIII, LINE 6B - $436,720 CHANGE IN EXPECTED INEREST IN TRUSTS - $317,933 CHANGE IN VALUE OF POOLED INCOME FUND - $6,019
PART XII, LINE 4B - OTHER ADJUSTMENTS:		NET PATIENT SERVICE REVENUE RECLASSIFICATION - $673,725
PART XIII, LINE 2D - OTHER ADJUSTMENTS:		RENTAL EXPENSES REPORTED ON FORM 990, PART VIII, LINE 6B - $436,720 RELATED PARTY EXPENSES - S.H.A PROPERTIES, INC. - $156,916
PART XIII, LINE 4B - OTHER ADJUSTMENTS:		NET PATIENT SERVICE REVENUE RECLASSIFICATION - $673,725
		PART XI, LINE 7 - EXPLANATION FOR PRIOR PERIOD ADJSUTMENTS: THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR 2009 HAVE BEEN RESTATED TO CORRECT AN UNDERSTATEMENT OF UNRESTRICTED NET ASSETS AS A RESULT OF CONSOLIDATION OF THE MEETING HOUSE LANE MEDICAL PRACTICE PC, WHICH WAS CREATED IN 2008, BUT EXCLUDED FROM THE CONSOLIDATED FINANCIAL STATEMENTS.

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 40000.0000000000 %

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	1	703	2,111,421	1,274,481	836,940	0.760 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .			10,147,209	6,064,511	4,082,698	3.720 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	1	703	12,258,630	7,338,992	4,919,638	4.480 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....
f Health professions education (from Worksheet 5) ..			3,396,595	885,893	2,510,702	2.230 %
g Subsidized health services (from Worksheet 6) ..	2	543	580,717	680,319	-99,602	0.530 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..
jTotal Other Benefits ...	2	543	3,977,312	1,566,212	2,411,100	2.760 %
kTotal. Add lines 7d and 7j. ..	3	1,246	16,235,942	8,905,204	7,330,738	7.240 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	360,289	360,289	0.350 %
9	Other
10	Total	360,289	360,289	0.350 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

8,406,000

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

139,924,937

Enter Medicare allowable costs of care relating to payments on line 5.....

102,192,979

Subtract line 6 from line 5. This is the surplus or (shortfall)........

37,731,958

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
11 HAMPTONS IMAGING	RADIOLOGY SERVICES	50.000 %	0 %	0 %
22 MEETINGHOUSE LANE PRACTICE	PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE	100.000 %	0 %	0 %
33 EAST HAMPTON MSO LLC	URGENT CARE PATIENT SERVICES	50.000 %	0 %	0 %
44 SHA PROPERTIES INC	REAL ESTATE HOLDING COMPANY	100.000 %	0 %	0 %
55 OLD TOWN MEDICAL PRACTICE PC	PRACTICE OF MEDICINE	100.000 %	0 %	0 %
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?15 Name and address			Other (Describe)
1	SOUTHAMPTON HOSPITAL 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968		X
2	DIALYSIS CENTER 184 W MONTAUK HIGHWAY HAMPTON BAYS,NY11946			X	DIALYSIS TREATMENT FACILITY
3	GREENPORT PRENATAL 300 ATLANTIC AVENUE GREENPORT,NY11944			X	PRENATAL/WOMEN'S SERVICES
4	LAB EAST 200 PANTIGO PLACE EAST HAMPTON,NY11937			X	LABORATORY SERVICES
5	IMAGING - EH 200 PANTIGO PLACE EAST HAMPTON,NY11937			X	RADIOLOGY SERVICES
6	WESTHAMPTON PRIMARY CARE 80 OLD RIVERHEAD ROAD WESTHAMPTON BEACH,NY11978			X	PRIMARY CARE PRACTICE
7	WESTHAMPTON SPORTS REHAB 74 OLD RIVERHEAD ROAD WESTHAMPTON BEACH,NY11978			X	SPORTS RHAB/PHYSICAL THERAPY SERVICES
8	LAB SOUTH 325 MEETING HOUSE LANE SOUTHAMPTON,NY11968			X	LABORATORY SERVICES
9	ATRIUM LAB 182 W MONTAUK HIGHWAY HAMPTONS BAYS,NY11946			X	LABORATORY SERVICES
10	DAVID ROGERS CENTER 335 D MEETINGHOUSE LANE SOUTHAMPTON,NY11968	X	HIV/AIDS CARE
11	SHINNECOCK HEALTH CHURCH STREET SOUTHAMTPON,NY11968	X	PRIMARY CARE/DENTAL SERVICES
12	SOUTHAMPTON CARE CENTER 240 MEETINGHOUSE LANE SOUTHAMPTON,NY11968		NURSING HOME (FACILITY CLOSED)
13	HAMPTONS IMAGING 182 W MONTAUK HIGHWAY HAMPTONS BAYS,NY11946	X	RADIOLOGY SERVICES
14	MEETINGHOUSE LANE PRACTICE PO BOX 2340 SOUTHAMPTON,NY11968	X	PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE
15	EAST HAMPTON MSO LLC 470 PANTIGO ROAD EAST HAMPTON,NY11937	X	URGENT CARE PATIENT SERVICES

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:NOT REQUIRED

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8		No
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9		No
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10		No
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11		No
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12		No
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13		No
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14		No
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16		No
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18		No
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
		PART I, LINE 3C: THERE ARE TWO LEVELS OF CHARITY CARE COVERAGE: PRIMARY SERVICE AREA AND NON-PRIMARY SERVICE AREA. A PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE WITHIN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. A NON-PRIMARY SERVICE AREA PATIENT IS A PATIENT WHO RESIDED IN NEW YORK STATE BUT NOT IN THE COUNTIES OF SUFFOLK OR NASSAU AT THE TIME OF SERVICE. ELIGIBLE SERVICES FOR A PRIMARY SERVICE AREA PATIENT:A PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: INPATIENT, AMBULATORY, EMERGENCY ROOM, EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), OUTPATIENT, AND DIAGNOSTIC CARE. UNDERINSURED PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES. ELIGIBLE SERVICES FOR A NON-PRIMARY SERVICE AREA PATIENT:A NON-PRIMARY SERVICE AREA PATIENT WHO MEETS THE FINANCIAL REQUIREMENTS IS ELIGIBLE FOR THE FOLLOWING MEDICALLY NECESSARY SERVICES: EMERGENCY ROOM, EMERGENT ADMISSIONS, AND EMERGENCY TRANSFERS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). UNDERINSURED NON-PRIMARY SERVICE AREA PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ON MEDICARE AND COMMERCIAL INSURANCE CARRIER CO-INSURANCES FOR ALL ABOVE LISTED SERVICES.INELIGIBLE SERVICES:THE FOLLOWING SERVICES AND/OR ITEMS ARE NOT COVERED BY CHARITY CARE FOR ANY PATIENT: NOT MEDICALLY NECESSARY SERVICES AS DETERMINED BY MEDICARE (E.G. COSMETIC SURGERY, BARIATRIC SURGERY), INSURANCE CO-PAYMENTS, INSURANCE DEDUCTIBLES, NON-COVERED SERVICES AS DETERMINED BY THE PATIENT'S INSURANCE CARRIER, PRIVATE ROOM RATES, AND PRIVATE PHYSICIAN FEES WHICH ARE NOT BILLED BY SOUTHAMPTON HOSPITAL (E.G. RADIOLOGY, PATHOLOGY, ANESTHESIOLOGY, EMERGENCY).FAMILY INFORMATION REQUIREMENTS:A PATIENT MUST PROVIDE ON THEIR CHARITY CARE APPLICATION A LIST OF THE FAMILY/HOUSEHOLD MEMBERS AND OR DEPENDENTS WITH WHOM THE PATIENT RESIDES. IF THE PATIENT IS AN ADULT, THE PATIENT MUST LIST THEIR SPOUSE OR DOMESTIC PARTNER, CHILDREN UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. IF THE PATIENT IS A CHILD UNDER THE AGE OF 21, THE APPLICANT MAY LIST THE PATIENT'S PARENTS, SIBLINGS UNDER THE AGE OF 21, AND ANY CLAIMED DEPENDENTS OR OTHER HOUSEHOLD MEMBERS THAT LIVE WITH THE PATIENT. A CLAIMED DEPENDENT IS DEFINED AS A PERSON WHO IS LISTED OR WOULD BE LISTED AS A DEPENDENT FOR THE PURPOSES OF AN INCOME TAX SUBMISSION TO THE IRS. FINANCIAL REQUIREMENTS:TO BE FINANCIALLY ELIGIBLE TO RECEIVE CHARITY CARE, A PATIENT MUST HAVE A GROSS FAMILY/HOUSEHOLD INCOME LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG) AND HAVE ASSETS LESS THAN OR EQUAL TO THE ALLOWABLE LIMIT AS DESCRIBED IN THE ASSET LEVEL PASSAGE. [SEE ASSETT LEVEL PASSAGE DESCRIBED ON PAGE 40 OF THE TAX RETURN]ELIGIBLE INCOME:THE FOLLOWING INCOME ITEMS WILL BE USED TO DETERMINE A PATIENT'S INCOME: EARNINGS FROM EMPLOYMENT, UNEMPLOYMENT COMPENSATION, WORKERS COMPENSATION, DISABILITY, SOCIAL SECURITY, ANNUITIZED PENSION PLAN, CHILD SUPPORT, ALIMONY, DIVIDENDS, INTEREST, RENTALS, ESTATES, TRUSTS, SALE OF ASSETS, AND OTHER MISCELLANEOUS INCOME. SOLE PROPRIETORSHIP, PARTNERSHIP, AND S CORPORATION INCOME WILL BE CALCULATED BY ITS GROSS PROFIT OR TOTAL INCOME PRIOR TO EXPENSES AND DEDUCTIONS; HOWEVER, COST OF GOODS SOLD MAY BE DEDUCTED FROM GROSS SALES.SALE OF ASSETS, SUCH AS REPORTED ON A SCHEDULE D OR ITS EQUIVALENT, WILL BE CALCULATED BY THEIR SALE PRICE AND NOT BY THEIR GAIN OR LOSS.ASSETS:THE FOLLOWING ASSETS WILL BE CONSIDERED WHEN DETERMINING A PATIENT'S CHARITY CARE ELIGIBILITY: CHECKING ACCOUNTS, SAVINGS ACCOUNTS, NON-PRIMARY RESIDENCES OR PROPERTY, CARS AND/OR VEHICLES NOT USED FOR PRIMARY TRANSPORTATION BY THE PATIENT OR HOUSEHOLD, STOCKS, BONDS, TRUSTS, AND OTHER MISCELLANEOUS ASSETS. THE FOLLOWING ASSETS WILL NOT BE CONSIDERED WHEN DETERMINING A PATIENT'S CHARITY CARE ELIGIBILITY: THE PATIENT'S PRIMARY RESIDENCE, CARS AND/OR VEHICLES REGULARLY USED FOR PRIMARY TRANSPORTATION BY THE PATIENT OR HOUSEHOLD, ASSETS HELD IN A TAX-DEFERRED OR COMPARABLE RETIREMENT SAVINGS ACCOUNT, IRA'S, BULK-PAYMENT PENSIONS, OR COLLEGE SAVINGS ACCOUNTS.ASSET LEVELS:PATIENTS WITH A GROSS FAMILY INCOME AT OR BELOW 150% OF THE FPG MAY NOT HAVE ASSETS TOTALING OVER THE AMOUNT LISTED ON THE CHART BELOW. (EFFECTIVE JANUARY 1, 2009)PATIENTS WITH A GROSS FAMILY INCOME OVER 150% OF THE FPG MAY NOT HAVE ASSETS TOTALING OVER THE AMOUNT LISTED ON THE CHART BELOW. (EFFECTIVE IMMEDIATELY)SIZE OF FAMILY MAX ALLOWABLE ASSETS1 $4,2002 $5,4003 $6,6004 $6,6505 $6,7006 $6,8007 $7,6508 $8,500EACH ADDITIONAL $850ASSET SPEND-DOWN :A PATIENT HAVING LIQUID ASSETS OVER THE ALLOWABLE LIMIT BUT OTHERWISE QUALIFYING FOR CHARITY CARE MAY SPEND-DOWN THEIR ASSET LEVEL TOWARD THEIR SOUTHAMPTON HOSPITAL BILL(S). ONCE THEIR ASSETS ARE WITHIN THE ALLOWABLE LIMITS, THEY WOULD BE FULLY ENTITLED TO THE CHARITY CARE DISCOUNT TO WHICH THEIR FAMILY INCOME LEVEL CORRELATES. FINANCIAL DOCUMENTATION REQUIREMENTS:A PATIENT MUST BE ABLE TO PROVE THEIR STATED FAMILY/HOUSEHOLD INCOME AND ASSET LEVEL. THE FOLLOWING DOCUMENTS ARE ACCEPTABLE AS PROOF: FEDERAL INCOME TAX FORM FOR THE PREVIOUS YEAR, COPIES OF SIX CONSECUTIVE RECENT PAY STUBS (THREE FOR BI-WEEKLY PAY PERIODS), A RECENT UNEMPLOYMENT OR DISABILITY STATEMENT. IF NONE OF THE ABOVE IS AVAILABLE, A STATEMENT ON COMPANY LETTERHEAD FROM THE PERSON'S EMPLOYER MAY BE ACCEPTABLE IN CERTAIN CIRCUMSTANCES AND WILL BE ACCEPTED AT SOUTHAMPTON HOSPITAL'S DISCRETION. A PATIENT MAY BE REQUIRED TO SUBMIT ADDITIONAL DOCUMENTATION AT SOUTHAMPTON HOSPITAL'S REQUEST IN ORDER TO SUBSTANTIATE THEIR STATED INCOME OR ASSET LEVEL SUCH AS BANKING STATEMENTS. A PATIENT'S FAILURE TO SUBSTANTIATE THEIR STATED INCOME OR ASSET LEVEL IS GROUNDS FOR THE DENIAL OF THEIR CHARITY CARE APPLICATION. IF A PATIENT IS CLAIMING ZERO INCOME, THE PATIENT WILL BE REQUIRED TO SUBMIT A VERIFICATION OF NON-FILING LETTER FROM THE IRS. THIS LETTER IS OBTAINED THROUGH IRS FORM 4506-T WHICH WILL BE MADE AVAILABLE TO THE PATIENT UPON REQUEST. THE PATIENT MUST ALSO SUBMIT A LETTER DESCRIBING THE MEANS BY WHICH THEY ARE SUPPORTED. IF THE PATIENT IS UNABLE TO FILE IRS FORM 4506-T DUE TO NOT HAVING A SOCIAL SECURITY NUMBER, THE PATIENT MUST SUBMIT THE ABOVE-MENTIONED LETTER. APPLICABLE RATES:THE APPLICABLE RATE FOR AN INPATIENT VISIT IS THE MEDICARE DIAGNOSIS RELATED GROUP (DRG) RATE FOR THAT VISIT. THE APPLICABLE RATE FOR AN AMBULATORY, EMERGENCY ROOM, OUTPATIENT, OR DIAGNOSTIC CARE VISIT IS THE MEDICARE HCPCS/CPT PAYMENT PLUS MINIMUM UNADJUSTED CO-PAYMENT FOR THAT VISIT. THE APPLICABLE RATE FOR LAB TESTS ON OUTPATIENT AND EMERGENCY ROOM VISITS WILL BE 10% OF THE CHARGE PER TEST. CO-INSURANCE:PATIENTS WHO ARE ELIGIBLE FOR A DISCOUNT ON MEDICARE OR COMMERCIAL INSURANCE CARRIER CO-INSURANCES WILL HAVE THOSE BALANCES REDUCED ACCORDING TO THE FOLLOWING SCALE. PERCENTAGE OF FPG: PERCENT OF CO-INSURANCE RESPONSIBLY :0% TO 100% 0%>100% TO 125% 9%>125% TO 150% 15%>150% TO 175% 21%>175% TO 200% 27%>200% TO 225% 33%>225% TO 250% 39%>250% TO 275% 45%>275% TO 300% 51%>300% TO 325% 57%>325% TO 350% 63%>350% TO 375% 69%>375% TO 400% 75%
		PART I, LINE 6A: RELATED PARTY INDENTIFICATION: PLEASE SEE FORM 990, SCHEDULE R FOR MORE RELATED PARTY INFORMATION.(1) SHA PROPERTIES, INC, - 11-2563612(2) SOUTHAMPTON CARE CENTER - 11-2658403(3) THE SOUTHAMPTON HOSPITAL FOUNDATION - 11-3466516(4) EAST HAMPTON MSO LLC C/O 24/7 EMERGENCY CARE PC - 26-2636086(5) HAMPTON IMAGING, LLC - 20-1353646(6) MEETING HOUSE LANE PRACTICE - 20-8853938(7) OLD TOWN MEDICAL PRACTICE, P.C. - 45-2430883
		PART I, LINE 7G: HEALTHCARE INFORMATION: SOUTHAMPTON HOSPITAL PROVIDES FREE HEALTH EDUCATION/ INFORMATION PROGRAMS THROUGH ITS WELL-ATTENDED "HEALTH INSIGHTS" PROGRAM. PATIENT SATISFACTION SURVEYS: IN ADDITION, SOUTHAMPTON HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. RESULTS FROM THESE SURVEYS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE. THE DAVID E. ROGERS CENTER FOR HIV/AIDS CARE (DRC): THE DRC IS ANOTHER IMPORTANT COLLABORATIVE EFFORT BETWEEN SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER AND TOWN AND COMMUNITY ORGANIZATIONS OF THE EAST END OF LONG ISLAND. MAJOR FUNDING FOR THE DRC IS PROVIDED THROUGH RYAN WHITE PART A FEDERAL FUNDS AND PROVIDES SUPPORT SERVICES AND PREVENTION EDUCATION TO PARTNERS AND FAMILY MEMBERS AFFECTED BY AIDS. THE DRC IS A MEMBER OF THE PECONIC COMMUNITY COUNCIL, A NOT-FOR-PROFIT COALITION OF ORGANIZATIONS AND INDIVIDUALS DEDICATED TO THE PROMOTION AND PRESERVATION OF HEALTH AND HUMAN SERVICES FOR THE ENTIRE EAST END COMMUNITY. THE CENTER FOR PRENATAL CARE: THE CENTER FOR PRENATAL CARE AT GREENPORT IS AN IMPORTANT OUTREACH ACTIVITY THAT PERMITS THE HOSPITAL TO TAILOR ITS PROGRAMS TO COMMUNITY NEEDS. THE CENTER REACHES OUT TO THE COMMUNITY THROUGH COLLABORATIVE EFFORTS WITH A NUMBER OF LOCAL ORGANIZATIONS, INCLUDING CAST, A LOCAL SOUTHOLD SOCIAL SERVICE AGENCY, THE PERINATAL COALITION, EASTERN LONG ISLAND HOSPITAL, SUFFOLK COUNTY DEPARTMENT OF HEALTH AND LOCAL CHURCHES. THE CENTER HAS SUCCESSFULLY WORKED WITH THE LOCAL TOWN GOVERNMENT TO OBTAIN THE AGREEMENT OF LOCAL GROCERS TO ACCEPT WIC VOUCHERS. STAFF ALSO UTILIZES FLYERS, BROCHURES, AND POSTERS TO INCREASE AWARENESS OF HOSPITAL SERVICES AND OFFERS TRANSLATION SERVICES TO THE SIGNIFICANT NUMBER OF HISPANIC WOMEN SEEKING CARE AT THE CENTER. COMMUNITY ORGANIZATION PARTICIPATION: THE HOSPITAL ALSO RECEIVES INPUT FROM THE COMMUNITY THROUGH HOSPITAL STAFF AND HOSPITAL TRUSTEE PARTICIPATION ON COMMUNITY SERVICE ORGANIZATIONS AND OPEN DIALOGUE WITH RESPECTED COMMUNITY LEADERS. PARTICIPATION INCLUDES: AMERICAN ACADEMY OF DERMATOLOGY LONG ISLAND BLOOD SERVICES AMERICAN CANCER SOCIETY LUCIA'S ANGELS AMERICAN HEART/LUNG/DIABETES ASSOC. NASSAU-SUFFOLK CARE NETWORK CATHOLIC CHARITIES NASSAU-SUFFOLK HOSPITAL COUNCIL CHAMBERS OF COMMERCE NEW YORK ORGAN DONORS CHILDREN MUSEUM OF EAST END SOUTH FORK BREAST HEALTH COALITION DOMINICAN SISTERS SOUTH FORK COMMUNITY HEALTH INITIATIVE EAST END HOSPICE SOUTHAMPTON SCHOOL BOARD EAST END ONCOLOGY PARTNERSHIP SPECIAL EVENTS SALON (BREAST CANCER) EAST HAMPTON HEALTHCARE FOUNDATION ST. ROSALIE CHARITY CARE ELLEN'S RUN SUFFOLK COMMUNITY COLLEGE ELLEN'S WELL SCDHS EMERGENCY MEDICAL CORPS SUFFOLK COUNTY OFFICE FOR THE AGING FAMILY SERVICE LEAGUE TOWN OF EAST HAMPTON FIGHTING CHANCE TOWN OF SOUTHAMPTON LION'S EYE BANK WOMEN'S HEALTH PARTNERSHIP OF LONG ISLAND ALZHEIMER'S FOUNDATION SUFFOLK COUNTY ROGERS MEMORIAL LIBRARYSOUTHAMPTON HOSPITAL ALSO SPONSORS A MONTHLY PUBLIC ACCESS TELEVISION SHOW ON SEA-TV, FOCUS ON: SOUTHAMPTON HOSPITAL, THAT COVERS INFORMATION RANGING FROM DIALYSIS CARE TO BREAST CARE TO CARDIAC REHABILITATION SERVICES AND OTHER HEALTHCARE SERVICES PROVIDED BY THE HOSPITAL. IN COLLABORATION WITH THE EAST END HEALTH ALLIANCE, THE HOSPITALS HAVE ALSO USED A NUMBER OF RESOURCES TO ASSESS COMMUNITY NEED AND PROVIDED THIS INFORMATION THROUGH A NUMBER OF ORGANIZED ADVISORY BOARDS WITH PARTICIPATION FROM PHYSICIAN GROUPS THAT INCLUDE A STRATEGIC PLANNING COMMITTEE WITH REPRESENTATIVES FROM COMMUNITY TRUSTEES, LEADERSHIP FROM THE HOSPITALS' MEDICAL STAFF, PHYSICIAN TRUSTEES AND CHIEF MEDICAL OFFICERS. THE ALLIANCE ALSO HAS A CANCER ADVISORY COMMITTEE AND A CARDIAC ADVISORY COMMITTEE TO ASSESS COMMUNITY NEEDS AND RECOMMEND STRATEGIES TO ADDRESS THESE HEALTH CARE NEEDS. THE HOSPITALS HAVE PROVIDED THESE GROUPS WITH INFORMATION RELATED TO THE INCIDENCE AND PREVALENCE OF DISEASE IN THE SERVICE AREA, PREVENTABLE QUALITY INDICATORS, PATTERNS OF ACCESSING HEALTH CARE SERVICES AND USE RATES. STRATEGIC PLANNING COMMITTEE THE STRATEGIC PLANNING COMMITTEE HAS BEEN MEETING SINCE THE BEGINNING OF THE FORMATION OF THE EAST END HEALTH ALLIANCE AND ADOPTED A STRATEGIC PLAN THAT FOCUSED ON NEAR AND MID-TERM OPPORTUNITIES FOR IMPROVING MANAGEMENT EFFICIENCIES AND STRATEGIES FOR WORKING MORE CLOSELY WITH OUR RESPECTIVE PHYSICIAN COMMUNITIES. THE STRATEGIES IDENTIFIED IN THE FIRST STRATEGIC PLAN ARE WELL ON THEIR WAY TO COMPLETION. THE COMMITTEE HAS EXPANDED ITS MEMBERSHIP TO INCLUDE MORE TRUSTEE AND PHYSICIAN REPRESENTATION AND HAS BEGUN TO DETERMINE WHAT THE COMMUNITY NEEDS OF THE EAST END HEALTH ALLIANCE'S SERVICE WILL BE OVER THE NEXT THREE YEARS. THE COMMITTEE WILL BE ASSESSING THESE NEEDS THROUGH MEANS OF THE FOLLOWING: ANALYSIS OF SPARCS DATA REVIEW OF PREVENTION QUALITY INDICATORS EVALUATION OF REPORTS FROM COMMUNITY, LOCAL, STATE, AND FEDERAL GOVERNMENT AGENCIES COMMUNICATION AND COLLABORATION WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH COMMUNICATION AND COLLABORATION WITH SUFFOLK COUNTY OFFICE FOR HE AGING ASSESSMENT OF INFORMATION SOLICITED FROM PATIENTS THROUGH PATIENT SATISFACTION SURVEYS REVIEW OF HOSPITAL GENERATED STATISTICAL INFORMATION REVIEW OF CURRENT INDUSTRY JOURNALS, PERIODICALS AND NEWSLETTERS ANALYSIS OF TRENDS IDENTIFIED IN HEALTHCARE JOURNALS AND PERIODICALS ONGOING ADMINISTRATIVE STAFF PLANNING SESSION *MONTHLY BOARD OF TRUSTEE MEETINGS
		PART I, L7 COL(F): THE ORGANIZATION BASE BAD DEBTS OFF EXPECTED WRITE-OFFS OF ACTUAL ACCOUNTS, NET OF EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE.
		PART II: NEEDS ASSESSMENT/PROMOTION OF COMMUNITY HEALTH SOUTHAMPTON HOSPITAL HAS AN EXTENSIVE PROGRAM OF COMMUNITY OUTREACH, COMPLEMENTED BY THE EAST END HEALTH ALLIANCE, THE HOSPITAL'S ACTIVE PARENT. COMMUNITY SERVICE PLAN INPUT IS RECEIVED FROM BOTH INTERNAL AND EXTERNAL SOURCES. NEEDS ARE ASSESSED ANNUALLY BY THE BOARD OF TRUSTEES, HOSPITAL MANAGEMENT AND STAFF, VOLUNTEERS, AND LEADERS OF LOCAL NOT-FOR-PROFIT ORGANIZATIONS AND GOVERNMENTAL AGENCIES. THE HOSPITAL HAS SIGNIFICANT REPRESENTATION ON A WIDE-RANGE OF COMMUNITY ORGANIZATIONS THAT FACILITATE INPUT FROM RESIDENTS, CORPORATE AND COMMUNITY LEADERS, PATIENTS AND ALLIED HEALTH PROFESSIONS. THESE COMMUNITY PARTNERSHIPS ARE LISTED BELOW. THE HOSPITAL PRESIDENT AND CHIEF EXECUTIVE OFFICER AND OTHER SENIOR STAFF REGULARLY MEET WITH COMMUNITY GROUPS FROM THE EAST END REGION OF LONG ISLAND TO KEEP AREA RESIDENTS INFORMED ABOUT HOSPITAL PROGRAMS AND TO RECEIVE FEEDBACK AND FIELD QUESTIONS FROM THE COMMUNITY. THE HOSPITAL'S SATELLITE CARE CENTERS, INCLUDING THE SHINNECOCK INDIAN HEALTH CLINIC, THE DAVID E. ROGERS, M.D. CENTER FOR HIV/AIDS CARE, THE EAST HAMPTON HEALTHCARE CENTER, AND HOSPITAL REGIONAL DIALYSIS CENTER CLOSELY COLLABORATE WITH COMMUNITY ADVISORY COMMITTEES THAT HELP WITH PLANNING AND DECISION MAKING RELATED TO THE SERVICES OFFERED. THE HOSPITAL'S WEB SITE, "WWW.SOUTHAMPTONHOSPITAL.ORG," PROVIDES INFORMATION ABOUT HOSPITAL SERVICES AND PROGRAMS. THE SITE ALLOWS FOR PHYSICIAN SEARCHES, ON-LINE INQUIRIES AND ON-LINE JOB APPLICATIONS. IN MARCH 2010, THE HOSPITAL LAUNCHED A NEW AND IMPROVED WEBSITE. THE NEW SITE BOASTS A CLEANER DESIGN, GREATER EASE OF NAVIGATION, AND IS A PATIENT-FRIENDLY RESOURCE GUIDE. THE SITE IS UPDATED WEEKLY, AND ENCOURAGES THE END USER TO CONTACT THE HOSPITAL FOR ANY ADDITIONAL INFORMATION NEEDED.SERVICES FOR SHORT-TERM AND LONG-TERM CARE FOR CHRONIC AND ACUTE ILLNESS ARE CONTINUALLY EVALUATED THROUGH STATISTICAL DATA THAT INCLUDE QUALITY INDICATORS AND PATIENT OUTCOMES. THIS DATA IS COMPARED NATIONALLY WITH OTHER HEALTH FACILITIES AND INFORMS THE HOSPITAL'S STRATEGIC PLAN AND COMMUNITY SERVICE PLAN. THE HOSPITAL'S STRATEGIC PLANNING COMMITTEE INCLUDES COMMUNITY MEMBERS, HOSPITAL STAFF AND HOSPITAL AND FOUNDATION BOARD MEMBERS WHO WORK COLLABORATIVELY TO ASSESS COMMUNITY NEEDS AND DEVELOP STRATEGIES TO MEET THESE NEEDS. THE HOSPITAL'S PUBLIC AFFAIRS COMMITTEE WAS ESTABLISHED TO ENHANCE COMMUNICATION BETWEEN THE HOSPITAL AND THE COMMUNITIES IT SERVES. MEMBERS OF THE COMMITTEE INCLUDE A CROSS-SECTION OF PHYSICIANS, NURSES, HOSPITAL MANAGEMENT, HOSPITAL EMPLOYEES AND COMMUNITY VOLUNTEERS. THE HOSPITAL ALSO ROUTINELY SEEKS FEEDBACK FROM COMMUNITY MEMBERS WHO PARTICIPATE IN OUR COMMUNITY OUTREACH PROGRAMS. HEALTH FAIRS: SOUTHAMPTON HOSPITAL'S BREAST HEALTH CENTER PROVIDES EXTENSIVE OUTREACH TO WOMEN IN THE HOSPITAL'S COMMUNITY, INCLUDING BREAST CANCER SURVIVORS, AS DESCRIBED BELOW. THIS OUTREACH IS BASED ON THE HOSPITAL'S ASSESSMENT OF COMMUNITY NEED FROM ANALYSIS OF CANCER INCIDENCE AND FROM INPUT FROM THE COMMUNITY. THE PROGRAMS OUTREACH COORDINATOR REVIEWS RESULTS FROM SURVEYS, COMPLETED BY EVENT PARTICIPANTS, TO IDENTIFY WHAT TYPES OF INFORMATION AND SERVICES WOULD BE HELPFUL. THE HOSPITAL THEN MODIFIES PROGRAMS AS APPROPRIATE BASED ON THIS INPUT. HEALTH FAIR, FITNESS PROGRAM AND LONG ISLAND TWO DAY WALK (JUNE) HEALTH FAIR, LOOK GOOD, FEEL BETTER PROGRAM (APRIL) GENETIC COUNSELING LECTURE, WELLNESS PROGRAM, SPANISH OUTREACH (MARCH) HEALTH FAIR, CELEBRATING SURVIVORSHIP, LOOK GOOD FEEL BETTER PROGRAM (FEBRUARY) HEALTH FAIR, WELLNESS PROGRAM, PINK TUESDAY (JANUARY) ADDITIONAL HEALTH FAIRS WERE HELD AS A PART OF THE HOSPITAL'S INFECTIOUS DISEASE OUTREACH AT THE EAST HAMPTON AND WESTHAMPTON BEACH HIGH SCHOOLS. THE HOSPITAL ALSO SPONSORS A LECTURE SERIES FOR EMS AND OBTAINS FEEDBACK TO RESPOND TO THE NEEDS OF THE LOCAL CORPS. HEALTHCARE INFORMATION: SOUTHAMPTON HOSPITAL PROVIDES FREE HEALTH EDUCATION/ INFORMATION PROGRAMS THROUGH ITS WELL-ATTENDED "HEALTH INSIGHTS" PROGRAM. THIS LECTURE SERIES FOR 2010, DETAILED BELOW, PROVIDES AN IMPORTANT OPPORTUNITY TO PROVIDE THE COMMUNITY WITH RELEVANT INFORMATION AND TO COLLECT INFORMATION PROVIDED BY THE EVALUATION FORMS THAT ARE DISTRIBUTED AFTER EACH LECTURE TO ENSURE THAT THE HOSPITAL IS RESPONDING TO COMMUNITY NEEDS. THE PROGRAM SCHEDULE FOR 2010 IS: MIDWIVES (MARCH)TICK ILLNESS (APRIL)KIDNEYS (APRIL)STROKE (MAY)GENETIC COUNSELING (MAY)SLEEP DISORDERS (MAY)OSTEOPOROSIS (JUNE)*IMPORTANCE OF LIGHT (OCTOBER)THE LECTURE SERIES IS DEVELOPED IN PARTNERSHIP WITH ORGANIZATIONS SUCH AS FIGHTING CHANGE, ELLEN'S RUN, THE AMERICAN HEART ASSOCIATION, EAST HAMPTON LIONS CLUB, NEW YORK ORGAN DONOR NETWORK, AND SOUTHAMPTON'S ROGERS MEMORIAL LIBRARY. THESE ORGANIZATIONS DEMONSTRATE THAT THEY ARE CONNECTED TO THE COMMUNITY AND THEIR NEEDS. PATIENT SATISFACTION SURVEYS: THE HOSPITAL CONTINUALLY SOLICITS PATIENT INPUT THROUGH ITS PATIENT SATISFACTION SURVEY PROCESS, WHICH INCLUDES EVERY INPATIENT, AMBULATORY SURGERY PATIENT AND EMERGENCY ROOM PATIENT. THE DATA COLLECTED FROM THESE COMPREHENSIVE SURVEYS PROVIDES VALUABLE INFORMATION ON A WIDE RANGE OF QUALITY INDICATORS AND AREAS OF INTEREST TO THE HOSPITAL'S PATIENTS. SURVEY RESULTS ARE REGULARLY DISTRIBUTED TO HOSPITAL AND MEDICAL STAFFS AND THE BOARD OF DIRECTORS. THE QUALITY MANAGEMENT AND PUBLIC AFFAIRS DEPARTMENTS, AS WELL AS THE OFFICE OF THE PRESIDENT, CAREFULLY REVIEW CORRESPONDENCE FROM PATIENTS AND THE COMMUNITY AT LARGE. A MEMBER OF THE HOSPITAL STAFF PERSONALLY ANSWERS ALL CORRESPONDENCE.
		PART III, LINE 4: THE ORGANIZATION DETERMINE EXPECTED BAD DEBT WRITE-OFFS BASED ON ACTUAL ACCOUNTS, NET OF AN EXPECTED RATE OF RECOVERY. IT'S NOT BASED ON A PERCENTAGE OF REVENUE.
		PART III, LINE 8: SOUTHAMPTON HOSPITAL UTILIZED PAYMENTS RECEIVED FROM MEDICARE ($139,924,937) TO CALCULATE THE TOTAL REVENUE RECEIVED FROM MEDICARE. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING MEDICARE GROSS CHARGES (WHICH ARE 300% OF THE MEDICARE FEE SCHEDULE) MULTIPLIED BY A COST TO CHARGE RATIO OF 30%. (TOTAL MEDICARE GROSS CHARGES OF $139,924,937 MULTIPLIED BY 30% TO ARRIVE AT $41,977,481 OF MEDICARE ALLOWABLE COSTS FOR THE CALENDAR YEAR OF 2010.) THEREFORE, THE SHORTFALL OF $4,245,523 MAY BE DEEMED A COMMUNITY BENEFIT.
		PART III, LINE 9B: ACCOUNTS WITH UNCOLLECTABLE BALANCES ARE ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT OR WHO HAS DEMONSTRATED AN EXEMPTION FROM PAYMENT. THE REQUEST FOR PAYMENT &/OR THE EXEMPTION MUST MEET THE FOLLOWING CRITERIA:1. AT LEAST FOUR (4) CONSECUTIVE 120-DAY BILLS MUST HAVE BEEN GENERATED (OR NO LESS THAN 120 DAYS FROM FIRST BILL) AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR) BEFORE BEING SENT TO A COLLECTION AGENCY;OR2. THE PATIENT (GUARANTOR) HAS DECLARED BANKRUPTCY (DISCHARGE OF DEBTOR MUST HAVE BEEN RECEIVED); OR3. THE ESTATE OF THE PATIENT (GUARANTOR) HAS BEEN SETTLED AND THERE WERE NO FUNDS FOR PAYMENT LEFT IN THE ESTATE; OR4. MAIL HAS BEEN RETURNED AND OTHER METHODS OF CONTACTING THE PATIENT (GUARANTOR) HAVE FAILED. THE ACCOUNT IS THEN CONSIDERED AND HANDLED AS A BAD DEBT ACCOUNT.PATIENT FINANCIAL SERVICES MAY ELECT TO SEND THE ACCOUNT TO AN OUTSIDE AGENCY, UP TO AND INCLUDING LEGAL ACTION.BAD DEBT ACCOUNTS ARE PURE SELF PAY ACCOUNTS FOR A PATIENT (GUARANTOR) WHO HAS NOT RESPONDED TO REQUESTS FOR PAYMENT. THE REQUEST FOR PAYMENT MUST MEET THE FOLLOWING CRITERIA:AT LEAST FOUR (4) CONSECUTIVE 30-DAY BILLS MUST HAVE BEEN GENERATED AND SENT WITHOUT RESPONSE FROM THE PATIENT (GUARANTOR);ORMAIL HAS BEEN RETURNED AND ALL OTHER METHODS OF CONTACTING THE PATIENT (GUARANTOR) HAVE FAILED.ONCE IT IS DETERMINED AN ACCOUNT BALANCE CANNOT BE COLLECTED BY PATIENT FINANCIAL SERVICES, THE ACCOUNT MAY BE TURNED OVER FOR COLLECTION BY AN OUTSIDE AGENCY , UP TO AND INCLUDING LEGAL ACTION.THE OUTSIDE COLLECTION AGENCY, AFTER DUE DILIGENCE, MAY DETERMINE THE BALANCE ON AN ACCOUNT CANNOT BE COLLECTED, THE ACCOUNT BALANCE MAY BE WRITTEN OFF USING THE APPROPRIATE CODE FOR THE ACCOUNT.
		PART VI, LINE 2: ASSESSMENT OF PUBLIC HEALTH PRIORITIES SOUTHAMPTON HOSPITAL WAS AN ACTIVE PARTICIPANT IN THE COLLABORATIVE PLANNING PROCESS WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH AND COMMUNITY PARTNERS TO ASSESS COMMUNITY HEALTH NEEDS, TO IDENTIFY HEALTH PRIORITIES, AND TO DEVELOP PUBLIC HEALTH PROGRAMS TO MEET THE IDENTIFIED NEEDS. THIS COLLABORATIVE GROUP MET FROM THE FALL OF 2008 THROUGH AUGUST OF 2009, AND SELECTED TOBACCO USE AND UNINTENTIONAL INJURY AS THE TWO HEALTH PRIORITIES IDENTIFIED IN THE NEW YORK STATE PREVENTION AGENDA TOWARD THE HEALTHIEST STATE. SMOKING CESSATION UPDATEWE OFFER TOBACCO CESSATION PROGRAMS TO THE COMMUNITY AND EMPLOYEES THREE TIMES PER YEAR. THE PROGRAM IS BASED ON THE FORMAT USED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH. IT IS A SIX-WEEK PROGRAM THAT INCLUDES CONSULTATION WITH A NURSE PRACTITIONER AND MAKES TOBACCO REPLACEMENT THERAPIES (NICOTINE GUM, LOZENGES, AND PATCHES) AND PRESCRIPTIONS AVAILABLE TO PARTICIPANTS. THE PROGRAMS ARE FREE FOR EMPLOYEES. BY ENCOURAGING OUR EMPLOYEES AND COMMUNITY MEMBERS TO BECOME TOBACCO-FREE AND BY SUPPORTING THEM IN THEIR EFFORTS TO BECOME TOBACCO-FREE, WE FEEL THAT WE ARE CONTRIBUTING TO AN IMPROVEMENT IN COMMUNITY HEALTH BY REDUCING THE RISK ASSOCIATED WITH SMOKING AND EXPOSURE TO SECOND-HAND SMOKE.FALL PREVENTION UPDATESOUTHAMPTON HOSPITAL TREATS A NUMBER OF OUR SENIOR PATIENTS AT HIGH RISK FOR FALLS BOTH WITHIN THE COMMUNITY AND AS INPATIENTS AT THE HOSPITAL. ALL PATIENTS ADMITTED TO SOUTHAMPTON HOSPITAL ARE ASSESSED FOR FALL RISK AND AS NEEDED RECEIVE FALL PREVENTION INFORMATION, PHYSICAL THERAPY AND A DISCHARGE PLAN AIMED AT MEETING THEIR NEEDS. WITHIN THE HOSPITAL SETTING FALL PREVENTION BECAME AN ORGANIZATIONAL OBJECTIVE IN LATE 2006. A MULTIDISCIPLINARY TEAM WAS ESTABLISHED TO DECREASE THE NUMBER OF FALLS AND THE NUMBER OF FALLS WITH INJURY. IN 2008 OUR FALL PREVENTION PROGRAM NOT ONLY SIGNIFICANTLY DECREASED THE NUMBER OF FALLS AND THE NUMBER OF INJURY, IT RECEIVED RESIGNATION AS HONORABLE MENTION FOR THE HANYS PINNACLE AWARD. TODAY OUR PROGRAM CONTINUOUSLY AIMS AT KEEPING OUR PATIENTS SAFE AND IN 2010 WE BEGAN AN IHI MENTOR HOSPITAL FOR FALL PREVENTION.2009 AND PRIOR WORK GROUPSTHESE TWO PRIORITIES WILL BE A MAJOR OPERATIONAL COMMITMENT OF SOUTHAMPTON HOSPITAL OVER THE NEXT THREE YEARS. THE HOSPITAL WILL CONTINUE TO COLLABORATE WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH AND COMMUNITY PARTNERS IN ENSURING THAT WE REACH THE GOALS SET FOR THESE TWO PRIORITY AREAS, MEASURE PROGRESS IN ACHIEVING THESE GOALS AND ELIMINATING RACIAL, ETHNIC AND SOCIOECONOMIC HEALTH DISPARITIES WHERE THEY EXIST. ONCE THE PLANNING GROUP ADOPTED THESE PRIORITIES, REPRESENTATIVES FROM THE SUFFOLK COUNTY DEPARTMENT OF HEALTH, SUFFOLK COUNTY HOSPITALS, INCLUDING SOUTHAMPTON HOSPITAL, AND COMMUNITY REPRESENTATIVES DIVIDED INTO TWO WORK GROUPS. EACH WORK GROUP WAS CHARGED WITH DEVELOPING A SET OF RECOMMENDATIONS TO IMPLEMENT EFFECTIVE STRATEGIES TO ADDRESS BOTH HEALTH CARE PRIORITIES. UNINTENTIONAL INJURY WORK GROUP THIS WORK GROUP WAS CHARGED WITH DEVELOPING STRATEGIES TO PREVENT UNINTENTIONAL INJURIES, WITH A FOCUS ON FALL PREVENTION IN THOSE AGED SIXTY-FIVE AND OLDER. THE WORK GROUP ASSIGNED TO DEVELOP A WORK PLAN FOR ADDRESSING UNINTENTIONAL INJURIES HAD THE FOLLOWING MEMBERSHIP: DR. HUMAYUN CHAUDHRY, D.O., COMMISSIONER, SUFFOLK COUNTY DEPARTMENT OF HEALTH JANE CORRARINO, CHAIR, WORKING GROUP, PUBLIC HEALTH NURSE DR. ED NADEL, BIOSTATISTICIAN ADELE H. KLENK, AARP PAMELA ASH, DIRECTOR, DOMINICAN SISTERS FAMILY HEALTH SERVICE MARY JEAN MCKEVENY, COMMUNITY REPRESENTATIVE JULIET FORDELLA, EASTERN LONG ISLAND HOSPITAL (FOR SOUTHAMPTON HOSPITAL) DALE CHAIKIN, NORTH SHORE- LIJ HEALTH SYSTEM JUDY BEIZER, PHARMACIST MIRANDA CORCORAN, ST. CATHERINE'S HOSPITAL BILL HANNIGAN, ST. CHARLES REHABILITATION HOSPITAL LAUREL BREEN, ST. JOSEPH'S COLLEGE DR. CATHERINE NICASTRI, STONY BROOK UNIVERSITY MEDICAL CENTER THE GROUP ADOPTED BY THE FOLLOWING RECOMMENDATIONS FOR ACTION RELATED TO REDUCING UNINTENTIONAL FALLS: I. DESIGN AND DEVELOP HEALTH EDUCATION MATERIALS TO PREVENT FALLS IN THE ELDERLY THAT: A. INCLUDE IDEAS FROM BOTH THE TARGET POPULATION AND FROM EXPERTS AND COMMUNITY MEMBERS B. INCORPORATE STRATEGIES KNOW TO BE EFFECTIVE FOR THOSE WITH LOW LITERACY SKILLS C. DEVELOP COMPANION BOOKLETS, POSTERS AND CALENDARS (WITH PREVENTION STRATEGIES OUTLINED EACH MONTH OF CALENDAR YEAR) D. DEVELOP MATERIALS FOR ALL THE PARTNER AGENCIES WITH SPACE FOR THE LOGO OF A GIVEN ORGANIZATION/AGENCY WHO MAY BE PRINTING THE MATERIALS FOR THEMSELVES TO PROVIDE TO THEIR GIVEN TARGET GROUP OR COMMUNITY E. CONDUCT PRE AND POST-TESTING TO ENSURE THAT EDUCATIONAL INFORMATION IS EFFECTIVE IN INCREASING KNOWLEDGE II. INCORPORATE THESE MATERIALS INTO A COMMUNITY OUTREACH PLAN. THIS PLAN SHOULD BE COMMUNITY FOCUSED, WITH PARTICIPATION FROM ALL HOSPITALS, THE HEALTH DEPARTMENT, AND COMMUNITY AGENCIES AND ORGANIZATIONS III. COORDINATE THE ACTIVITY BETWEEN THE PARTNERS IV. THE OUTREACH PLAN SHOULD INCLUDE A. EDUCATION AT SENIOR CENTERS, MEALS ON WHEELS, ETC. B. EDUCATION OF PROVIDERS (E.G. PHYSICIANS, PHARMACISTS, NURSES, ETC.) C. DISTRIBUTION AND OUTREACH VIA SUPERMARKETS D. PARTICIPATION BY HOME HEALTH AGENCIES, HOSPITAL, ADULT DAY CARE E. ORGANIZATIONAL NEWSLETTERS AND MARKETING PLANS V. DEVELOP A DATA SUBCOMMITTEE THAT WILL ANALYZE PERTINENT SUFFOLK COUNTY DATA REGARDING DEMOGRAPHICS AND HIGH-RISK AREAS, IN ORDER TO TARGET HIGH-RISK AREAS AND SUBPOPULATIONS. SPECIFIC ASSISTANCE AND EXPERTISE FOR MOVING FORWARD WAS OFFERED AS FOLLOWS: DR. NICASRI, FROM STONY BROOK UNIVERSITY MEDICAL CENTER, OFFERED TO OVERSEE MEDICAL RESIDENTS AND FELLOWS WHO WILL BE AVAILABLE TO CONDUCT PROFESSIONAL AND COMMUNITY TEACHING. DR. BELZER OFFERED TO ASSIST WITH SESSION SIMILAR TO "BROWN BAG DAYS" AND "MEDICATION CHATS" THAT SHE CONDUCTS IN OTHER LOCALES. MS. CORRARINO OFFERED TO DESIGN HEALTH EDUCATION MATERIALS. MS. RHODES-TEAGUE OFFERED TO COORDINATE EFFORTS WITH SENIOR CENTERS AND NUTRITION SITES. IN ADDITION, THE GROUP WILL EXPLORE THE ABILITY OF HOME HEALTH AGENCIES TO BILL MEDICARE FOR ALL PREVENTION ACTIVITIES IN THE HOME. THE WORK GROUP WILL CONTINUE TO MEET. THEY WILL MEET IN SEPTEMBER TO REVIEW THE HEALTH EDUCATION MATERIALS THAT HAVE BEEN DEVELOPED AND CONTINUE TO MOVE FORWARD AND SOLIDIFY PLANS. SMOKING CESSATION WORK GROUP THIS GROUP WAS CHARGED WITH DEVELOPING STRATEGIES TO REDUCE THE NUMBER OF SUFFOLK COUNTY RESIDENTS WHO SMOKE. THE GROUP ASSIGNED TO REDUCE TOBACCO USE INCLUDED THE FOLLOWING: GRACE SPARACINO, ST. CHARLES HOSPITAL SABRA BOUGHTON, STONY BROOK UNIVERSITY MEDICAL CENTER JACK HOFFMAN, EASTERN LONG ISLAND HOSPITAL PAT FOLAN, NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM STEPHANIE PERFER, NORTH SHORE-LONG ISLAND JEWISH HEALTH CARE SYSTEM NANCE BODNAR, JOHN T. MATHER HOSPITAL ANN CUCCIA, SOUTHAMPTON HOSPITAL DONNA LOY MURINO, SOUTHSIDE HOSPITAL FELICE JONES LEE, SOUTHSIDE HOSPITAL JULIA MACCHIAROLI, HUNTINGTON HOSPITAL MARTHA KAHAN, EASTERN SUFFOLK BOCES SUSAN KENNEDY, TOBACCO ACTION COALITION OF LONG ISLAND LORI BENINCASA, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES WENDY D. DARWELL, NASSAU-SUFFOLK HOSPITAL COUNCIL, INC. LORI GINSBERG, NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM CRAIG HOMIS, SOUTHAMPTON HOSPITAL MICHAEL THOM, BROOKHAVEN NATIONAL LABORATORY. THE TOBACCO CESSATION WORKING GROUP DEVELOPED A RECOMMENDED TEMPLATE FOR A TOBACCO CONTROL POLICY TO BE CONSIDERED AND ADOPTED BY THE SUFFOLK COUNTY HOSPITALS. THE TEMPLATE IS AS FOLLOWS: I. POLICY STATEMENT (TO INCLUDE) A. WHY I. COMMITMENT TO HEALTH/STATISTICS - THE COST OF TOBACCO USE IN MORBIDITY, MORTALITY AND FINANCIAL LOSS II. HOSPITALS NEED TO SET EXAMPLE, LEAD THE WAY III. BASELINE DATA. CURRENT POLICIES AND PROCEDURES. RATES OF TOBACCO USE AND/OR CESSATION B. WHO I. POLICY MAY COVER STAFF, PATIENTS, VISITORS, COMMUNITY MEMBERS C. WHERE I. HOSPITAL II. COMPLETE BAN ON GROUNDS OR PARTIAL III. OTHER BUILDINGS AND/OR CLINICS LOCATED OFF SITE IV. EFFECTIVE DATA D. WHAT I. RESTRICTIONS - ALL TOBACCO PRODUCTS? II. PROCEDURES FOR IMPLEMENTATION - BRIEFLY WILL BE COVERED FULLY IN II III. EDUCATIONAL GOALS IV. COMMUNITY OUTREACH II. PROCEDURES A. COMMUNICATION OF POLICY I. EMPLOYEES 1. EXISTING 2. NEW - WILL TOBACCO USE AFFECT HIRING? II. PATIENTS
		PART VI, LINE 3: FINANCIAL AID PROGRAM SOUTHAMPTON HOSPITAL'S COMMITMENT AND DETERMINATION TO PROVIDE QUALITY HEALTHCARE AT AFFORDABLE RATES HAS LEAD US TO DESIGN A CHARITY CARE PROGRAM THAT GOES "ABOVE AND BEYOND" THE EXPECTATIONS AND MINIMUM REQUIREMENTS SET FORTH BY NEW YORK STATE LAW. IT IS THE HOSPITAL'S "ABOVE AND BEYOND" ATTITUDE THAT IS OUR PROGRAMS GREATEST STRENGTH AND CAN BEST BE SEEN IN OUR POLICY TO PROVIDE CHARITY CARE DISCOUNTED RATES TO PATIENTS MAKING UP TO 400% OF THE FEDERAL POVERTY LEVEL GUIDELINE (FPG) RATHER THAN THE MINIMUM REQUIREMENT OF 300% FPG. IN ADDITION, THE HOSPITAL INCLUDES A FORM TO APPLY FOR CHARITY CARE IN EVERY SELF-PAY BILL TO BE RETURNED TO PATIENT FINANCIAL SERVICES. DESPITE OUR COMMITMENT AND DETERMINATION, OUR CHARITY CARE POLICY IS NOT WITHOUT ITS CHALLENGES, AND AT TIMES, WEAKNESSES. HOWEVER, OUR GREATEST WEAKNESS IS NOT TREATED AS A WEAKNESS; IT IS TREATED AS A CHALLENGE. OUR GREATEST CHALLENGE IS TO ENSURE THAT ALL PATIENTS AT SOUTHAMPTON HOSPITAL RECEIVE THE SAME LEVEL OF DETAILED SCRUTINY OF THEIR APPLICATION TO KEEP THE PROCESS FAIR AND BALANCED FOR ALL APPLICANTS. THE CHALLENGE IS GREATEST WHEN PROCESSING APPLICATIONS FROM UNDOCUMENTED ALIENS WHOSE STATED INCOME LEVEL IS $0. PUBLIC INFORMATION SOUTHAMPTON HOSPITAL WILL DISSEMINATE A WRITTEN SUMMARY OF THE COMMUNITY SERVICE PLAN TO THE PUBLIC THROUGH PRODUCTION OF EITHER A BROCHURE OR PAMPHLET. THE PLAN WILL BE POSTED BOTH ON THE HOSPITAL'S WEB SITE AND ON THE EAST END HEALTH ALLIANCE'S WEB SITE. THE SUMMARY WILL INCLUDE FINANCIAL DATA THAT DEMONSTRATES OUR CURRENT AND FUTURE COMMITMENT TO PUBLIC HEALTH PROGRAMS AND FINANCIAL ASSISTANCE AND WILL HIGHLIGHT KEY INFORMATION REGARDING OUR PUBLIC HEALTH PROGRAMS, INCLUDING OUR TWO PREVENTION AGENDA PRIORITIES.
		PART VI, LINE 4: AS THE MAP BELOW INDICATES, SOUTHAMPTON'S SERVICE AREA EXTENDS FROM MONTAUK TO THE EAST TO WESTHAMPTON BEACH TO THE WEST AND THE SOUTHERN AREA OF RIVERHEAD IN THE CENTER OF THE EAST END OF LONG ISLAND. THE SERVICE AREA ACCOUNTS FOR APPROXIMATELY EIGHT-FIVE (85) PERCENT OF TOTAL ADMISSIONS TO THE HOSPITAL AND INCLUDES THE FOLLOWING ZIP CODES: EAST HAMPTON (11937); BRIDGEHAMPTON (11932); SOUTHAMPTON (11968); HAMPTON BAYS (11946); SAG HARBOR (11963); SAGAPONACK (11962); MONTAUK (11954); RIVERHEAD (11901); EAST QUOGUE (11942); QUOGUE (11959); REMSENBURG (11960); WATER MILL (11976); WESTHAMPTON BEACH (11978); AND WESTHAMPTON (11977). AS THE TABLE BELOW INDICATES, THIS SERVICE AREA HAS A YEAR ROUND POPULATION OF APPROXIMATELY 97,000 RESIDENTS. THE AREA IS PROJECTED TO SEE A SIGNIFICANT INCREASE IN POPULATION, MORE THAN 5.8 PERCENT OVER THE NEXT THREE YEARS. DEMOGRAPHIC CHARACTERISTICS SELECTED AREA USA 2000 TOTAL POPULATION 97,063 281,421,906 2010 TOTAL POPULATION 97,426 309,038,974 2015 TOTAL POPULATION 103,145 321,675,005 % CHANGE 2010 - 2015 5.54% 3.93% AVERAGE HOUSEHOLD INCOME $92,648 $71,071 THE POPULATION ON THE HOSPITAL'S SERVICE AREA, A RESORT DESTINATION, MORE THAN DOUBLES DURING THE SUMMER SEASON WHEN TOURISTS FROM ALL OVER THE WORLD VISIT THE SOUTH FORK OF LONG ISLAND. AS A RESULT, DEMAND FOR SOUTHAMPTON HOSPITAL SERVICES INCREASES SIGNIFICANTLY DURING THE SUMMER, IN PARTICULAR DEMAND FOR THE HOSPITAL'S EMERGENCY SERVICES. THE HOSPITAL HAS RESPONDED TO THIS NEED BY MAKING A CAPITAL INVESTMENT IN EXPANDING AND RENOVATING THE EMERGENCY DEPARTMENT AND IMPLEMENTING A STATE-OF-THE-ART EMERGENCY DEPARTMENT INFORMATION SYSTEMS THAT PERMITS THE HOSPITAL TO TRACK PATIENTS, AND READ AND INTERPRET LABORATORY AND RADIOLOGICAL RESULTS. AS THE TABLE BELOW INDICATES, THE SERVICE AREA HAS A SIGNIFICANT PERCENTAGE OF THEIR POPULATION AGED FIFTY-FIVE (55) AND OVER, A POPULATION THAT HAS GREATER NEED FOR HEALTH CARE SERVICES. AGE DISTRIBUTION AGE GROUP 2010 % OF TOTAL 2015 % OF TOTAL USA 2010 % OF TOTAL 0-14 15,425 15.8% 15,595 15.1% 20.1% 15-17 3,858 4.0% 3,790 3.7% 4.2% 18-24 8,170 8.4% 8,923 8.7% 9.7% 25-34 9,949 10.2% 11,164 10.8% 13.3% 35-54 27,620 28.3% 26,064 25.3% 28.1% 55-64 13,846 14.2% 16,034 15.5% 11.5% 65+ 18,558 19.0% 21,575 20.9% 13.2% TOTAL 97,426 100.0% 103,145 100.0% 100.0% THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH, DETAILED BELOW, TO RESPOND TO THE NEEDS OF THESE PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY. THERE ARE NO FIRM ESTIMATES OF THE NUMBER OF MIGRANT AGRICULTURAL WORKERS THAT COME INTO THIS AREA. AGRICULTURE IS ONE OF SUFFOLK COUNTY'S LEADING INDUSTRIES. ITS SUCCESS RELIES ON WORKERS WHO MOVE THROUGH THE EASTERN UNITED STATES IN RESPONSE TO THE AVAILABILITY OF SEASONAL WORK. SOUTHAMPTON HOSPITAL RECOGNIZES THAT THIS POPULATION PRESENTS SERIOUS HEALTH PROBLEMS AND IS COMMITTED TO PROVIDING CARE FOR ITS CULTURALLY DIVERSE PATIENT POPULATION. MANY OF THESE INDIVIDUALS ARE UNINSURED AND UNABLE TO SPEAK ENGLISH. THEY RELY ON THE HOSPITAL,S EMERGENCY DEPARTMENT, AS WELL AS THE SUFFOLK COUNTY HEALTH CLINIC, LOCATED ON THE HOSPITAL'S CAMPUS, FOR HEALTH CARE. AS A RESULT, THE HOSPITAL'S OFFICE OF CULTURAL DIVERSITY PROVIDES TRANSLATION AND INTERPRETATION SERVICES, AS WELL AS COUNSELING ON MEDICAL INSURANCE AND BILLING FOR THOSE INDIVIDUALS WHO DO NOT SPEAK ENGLISH. THE HOSPITAL PROVIDES BI-LINGUAL PUBLICATIONS AND SIGNAGE AND ACTIVELY ASSISTS THE CULTURALLY DIVERSE COMMUNITIES IT CARES FOR. RACE/ETHNICITY RACE/ETHNICITY DISTRIBUTION RACE/ETHNICITY 2010 POP % OF TOTAL USA % OF TOTAL WHITE NON-HISPANIC 70,409 72.3% 64.7% BLACK NON-HISPANIC 6,435 6.6% 12.1% HISPANIC 16,724 17.2% 15.8% ASIAN & PACIFIC IS. 1,271 1.3% 4.5% ALL OTHERS 2,587 2.7% 2.9% TOTAL 97,426 100.0% 100.0% IN ADDITION, THE HOSPITAL'S SERVICE AREA IS HOME TO THE SHINNECOCK NATION. SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 2,000 MEDICAL, 800 DENTAL AND 400 DENTAL HYGIENE VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE (CROWNS, FILLINGS AND BRIDGES) ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK SCHOOL OF MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS PER MONTH FOR CHILDREN. THESE SERVICES INCLUDE DENTAL SCREENING, PREVENTIVE TEACHING AND COMMUNITY EDUCATION, RADIOLOGICAL EXAMS, RESTORATIVE CARE INCLUDING CROWNS, FILLINGS AND BRIDGES AND DENTAL HYGIENE. IN ADDITION TO PRIMARY CARE, DENTAL SERVICES, NUTRITIONAL COUNSELING, PRENATAL CARE AND ENDOCRINE SERVICES, THE CLINIC PROVIDES SOCIAL WORK, MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING TO THE RESIDENTS OF THE RESERVATION. AN ANNUAL MAMMORAPHY SCREENING DAY WAS ALSO HELD, IN COLLABORATION WITH THE HOSPITAL'S ELLEN HERMANSON BREAST CENTER, AT THE SHINNECOCK NATION DURING SEPTEMBER OF 2010.

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) MICHAEL B ISRAEL MD	(i) (ii)	176,658 0	0 0	419 0	22,000 0	8,055 0	207,132 0	0 0
(2) ROBERT S CHALONER	(i) (ii)	425,000 0	140,000 0	50,461 0	14,700 0	25,104 0	655,265 0	0 0
(3) FREDERIC I WEINBAUM	(i) (ii)	334,088 0	48,700 0	37,000 0	14,700 0	21,565 0	456,053 0	0 0
(4) CHRISTOPHER J SCHULTHEIS	(i) (ii)	188,863 0	3,000 0	0 0	11,400 0	19,345 0	222,608 0	0 0
(5) PATRICIA A DARCEY	(i) (ii)	189,438 0	3,000 0	0 0	11,400 0	19,095 0	222,933 0	0 0
(6) PAUL R DAVIN	(i) (ii)	183,609 0	3,000 0	3,738 0	11,143 0	19,118 0	220,608 0	0 0
(7) EDNA KAPENHAS-VALDES	(i) (ii)	312,053 0	0 0	317 0	14,700 0	19,308 0	346,378 0	0 0
(8) CHARLES ARCOLEO	(i) (ii)	240,000 0	0 0	7,829 0	14,400 0	19,294 0	281,523 0	0 0
(9) ANGELA SOTERIOU	(i) (ii)	191,361 0	0 0	2,593 0	11,520 0	7,117 0	212,591 0	0 0
(10) ALEX APONTE	(i) (ii)	189,564 0	0 0	172 0	11,510 0	19,228 0	220,474 0	0 0
(11) TOVIA LENT	(i) (ii)	170,687 0	0 0	21,689 0	10,320 0	18,696 0	221,392 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
	PART I, LINE 1A	THE HOSPITAL PROVIDES THE SPECIAL HOUSING AND/OR AUTOMOBILE ALLOWANCES/PERQUISITES TO THE PRESIDENT & CEO, AS WELL AS TO CERTAIN KEY EXECUTIVES. THESE ALLOWANCES FOR HOUSING AND AUTOMOBILE ARE STIPULATED IN THE EXECUTIVE'S EMPLOYMENT AGREEMENT AND TERMS AT THE TIME OF HIRE. ALL PAYMENTS OF THESE PERQUISITES ARE MADE IN A BI-WEEKLY BASIS WITH THE EMPLOYEE'S REGULAR PAYCHECK AND THEY ARE MADE IN ACCORDANCE WITH THE GUIDELINES OF A NON-ACCOUNTABLE EXPENSE PLAN.
SUPPLEMENTAL INFORMATION	PART III	PART II, COLUMN (II) BONUS COMPENSATION: THE PRESIDENT / CEO, AND THE EXECUTIVE VICE PRESIDENT / CHIEF MEDICAL OFFICER OF SOUTHAMPTON HOSPITAL WERE BOTH ELIGIBLE FOR A PERFORMANCE BONUS IN 2010 WHICH WAS BASED UPON CRITERIA THAT THE EXECUTIVE COMMITTEE OF THE BOARD ESTABLISHED. THE PRESIDENT / CEOS BONUS IS AN ANNUAL BONUS SET FORTH IN HIS EMPLOYMENT AGREEMENT AND IS DETERMINED AFTER A REVIEW OF HOW WELL HE PERFORMED IN THE PRIOR YEAR AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE EXECUTIVE COMMITTEE. THE EXECUTIVE VICE PRESIDENT / CMO WAS AWARDED A PERFORMANCE BONUS BASED UPON THE RECOMMENDATION OF THE PRESIDENT / CEO AS WELL AS A REVIEW OF HIS PERFORMANCE AGAINST GOALS AND OBJECTIVES ESTABLISHED BY THE PRESIDENT AND THE EXECUTIVE COMMITTEE. DURING 2010, THE HOSPITAL PRESIDENT / CEO AWARDED BONUSES TO MANAGEMENT / DEPARTMENT HEADS WHO WERE ASSIGNED TO AN OPERATIONAL IMPROVEMENT TEAMS AND WHO SATISFACTORILY COMPLETED THEIR PROJECTS. THE FOCUS AND GOALS OF THESE PROJECTS ARE DEFINED BY THE PRESIDENT AND ARE OVERSEEN AND MONITORED BY AN "EXECUTIVE SPONSOR". THE EXECUTIVE VICE PRESIDENT / CHIEF MEDICAL OFFICER MET PERIODICALLY WITH EACH TEAM TO ENSURE THAT THE PROJECT SCOPE AND OBJECTIVES WERE CLEARLY DEFINED. THE PROGRESS OF THE TEAMS IS MONITORED AND AT THE END OF THE PROJECTS, THE TEAMS ACCOMPLISHMENTS ARE REVIEWED AND VALIDATED BY THE EXECUTIVE VICE PRESIDENT/CMO AS WELL AS THE CHIEF FINANCIAL OFFICER. BONUS PAYMENTS OF BETWEEN $1,000 AND $3,000 WERE AWARDED TO INDIVIDUAL TEAM MEMBERS BASED UPON THE TEAM'S OVERALL RESULTS.
SUPPLEMENTAL INFORMATION	PART III	PART II, COLUMN (III) OTHER REPORTABLE COMPENSATION: SPECIAL PERQUISITES - ALLOWANCES: THE HOSPITAL PROVIDES THE FOLLOWING SPECIAL ALLOWANCES / PERQUISITES TO THE PRESIDENT & CEO, AS WELL AS TO CERTAIN KEY EXECUTIVES. THESE ALLOWANCES FOR HOUSING AND AUTOMOBILE ARE STIPULATED IN THE EXECUTIVES EMPLOYMENT AGREEMENT / TERMS AT TIME OF HIRE. ALL PAYMENTS OF THESE PERQUISITES ARE MADE ON A BI-WEEKLY BASIS WITH THE EMPLOYEES REGULAR PAYCHECK AND THEY ARE MADE IN ACCORDANCE WITH THE GUIDELINES OF A NON-ACCOUNTABLE EXPENSE PLAN. ANNUAL ALLOWANCES ARE AS LISTED BELOW: ROBERT CHALONER, PRESIDENT & CEO HOUSING ALLOWANCE: $38,000 AUTOMOBILE ALLOWANCE: $8,400 FREDRIC WEINBAUM,MD COO AND CMO HOUSING ALLOWANCE: $30,000 AUTOMOBILE ALLOWANCE: $7,000 PAUL DAVIN, VP, HUMAN RESOURCES AUTOMOBILE ALLOWANCE: $3,600

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Identifier	Return Reference	Explanation
SIGNIFICANT ACTIVITES FOR 2010 CONTINUED:	FORM 990, PART I, LINE 1:	PRIMARY MEDICAL CARE TO SPECIALIZED SURGICAL PROCEDURES, AND IS STAFFED BY MORE THAN 230 PHYSICIANS, DENTISTS AND ALLIED HEALTH PROFESSIONALS REPRESENTING 44 MEDICAL SPECIALTIES. THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH, DETAILED BELOW, TO RESPOND TO THE NEEDS OF THEIR PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY. SINCE THE HOSPITAL'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE CARE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THE COMMUNITY. THESE INCLUDE: MEETING HOUSE LANE MEDICAL PRACTICE: PROVIDING PRIMARY CARE AT LOCATIONS IN MONTAUK, SAG HARBOR, SOUTHAMPTON, AND WAINSCOTT. WESTHAMPTON PRIMARY CARE CENTER: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. LABORATORY AND IMAGING SERVICES: PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON. CENTER FOR PHYSICAL THERAPY AND REHABILITATION: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES. THE SHINNECOCK INDIAN HEALTH CLINIC: SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 1,600 MEDICAL AND 1,500 DENTAL VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE (CROWNS, FILLINGS AND BRIDGES) ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK UNIVERSITY SCHOOL OF MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. THE DAVID E. ROGERS MD CENTER FOR HIV/AIDS CARE: ANOTHER IMPORTANT COLLABORATION BETWEEN SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER AND TOWN AND COMMUNITY ORGANIZATIONS OF THE EAST END OF LONG ISLAND. MAJOR FUNDING IS PROVIDED THROUGH RYAN WHITE PART A FEDERAL FUNDS AND TO PROVIDE SUPPORT SERVICES AND PREVENTION EDUCATION TO PARTNERS AND FAMILY MEMBERS AFFECTED BY AIDS. THE CENTER IS A MEMBER OF THE PECONIC COMMUNITY COUNCIL, A NOT-FOR-PROFIT COALITION OF ORGANIZATIONS AND INDIVIDUALS DEDICATED TO THE PROMOTION AND PRESERVATION OF HEALTH AND HUMAN SERVICES FOR THE ENTIRE EAST END COMMUNITY. CENTER FOR PRENATAL CARE: LOCATED IN GREENPORT ON THE EASTERN END OF LONG ISLANDS NORTH FORK, THE CENTER PROVIDES PRENATAL CARE TO APPROXIMATELY 50 MOTHERS ANNUALLY IN AN UNDERSERVED AND GEOGRAPHICALLY REMOTE AREA. A MAJORITY OF THESE BABIES ARE BORN AT SOUTHAMPTON HOSPITALS KATHLEEN D. ALLEN MATERNITY CENTER. SOUTHAMPTON HOSPITAL IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE: THE ELLEN HERMANSON BREAST CENTER OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS AND BREAST CANCER TREATMENT AND SUPPORT. THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, ULTRASOUND AND BREAST BIOPSY. THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS AND CLASSES IN YOGA, TAI CHI, PILATES, SMOKING CESSATION, STRESS MANAGEMENT, ARE OFFERED, AS WELL AS NUTRITIONAL AND WEIGHT LOSS COUNSELING, MASSAGE THERAPY, AND MUCH MORE. THE JENNY AND JOHN PAUSON DEPARTMENT OF EMERGENCY MEDICINE SERVES MORE THAN 25,000 EMERGENCY PATIENTS ANNUALLY AND IS THE ONLY HOSPITAL-BASED EMERGENCY CARE ON THE SOUTH FORK OF LONG ISLAND. STAFFED 24/7 BY BOARD-CERTIFIED EMERGENCY PHYSICIANS AND SPECIALTY-TRAINED NURSES AND STAFF, IT HAS THE MOST SOPHISTICATED, NON-INVASIVE CARDIAC DIAGNOSTIC AND MONITORING TECHNOLOGY AVAILABLE AND, AS A NEW YORK STATE-DESIGNATED STROKE CENTER, IT IS THE DESTINATION OF AMBULANCES WHEN A HEART ATTACK OR STROKE IS SUSPECTED.
MISSION STATEMENT CONTINUED:	FORM 990, PART III, LINE 1:	THE VISION OF SOUTHAMPTON HOSPITAL IS TO MEET THE EVOLVING HEALTHCARE NEEDS OF ITS EASTERN LONG ISLAND COMMUNITY BY PROVIDING ACCESS TO A CONTINUUM OF HIGH QUALITY CLINICAL SERVICES. TO ACHIEVE THIS, THE HOSPITAL WILL FOCUS RESOURCES ON CONTINUOUSLY IMPROVING CLINICAL OUTCOMES, PATIENT SAFETY, SERVICE EXCELLENCE AND PROMOTING EDUCATIONAL OUTREACH AND PROFESSIONAL DEVELOPMENT OF ITS STAFF. SOUTHAMPTON HOSPITAL IS A MEMBER OF THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: 1. TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; 2. TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND 3. TO REALIZE MANAGEMENT EFFICIENCIES. SOUTHAMPTON HOSPITAL IS ALSO AFFILIATED WITH STONY BROOK UNIVERSITY MEDICAL CENTER, ALONG WITH THE OTHER TWO EAST END HEALTH ALLIANCE HOSPITALS. THE THREE ALLIANCE HOSPITALS ARE ACTIVELY WORKING WITH THE UNIVERSITY TO IDENTIFY OPPORTUNITIES FOR DEVELOPING CLINICAL AND EDUCATIONAL RELATIONSHIPS THAT WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. SOUTHAMPTON HOSPITAL IS A 125-BED, VOLUNTARY, NOT-FOR-PROFIT FACILITY ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. IT HAS RECEIVED 5-STAR RATINGS FROM HEALTHGRADES(TM), AN INDEPENDENT AUDITOR, IN HIP FRACTURE REPAIR, TREATMENT OF PNEUMONIA, AND GASTROINTESTINAL PROCEDURES AND SURGERIES, AND IS A RECIPIENT OF THE HEALTHGRADES PATIENT SAFETY AWARD IN 2008 AND 2010. IN ADDITION, THE HOSPITAL IS A BARIATRIC SURGERY CENTER OF EXCELLENCE. THE HOSPITAL OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM PRIMARY MEDICAL CARE TO SPECIALIZED SURGICAL PROCEDURES, AND IS STAFFED BY MORE THAN 230 PHYSICIANS, DENTISTS AND ALLIED HEALTH PROFESSIONALS REPRESENTING 44 MEDICAL SPECIALTIES. SOUTHAMPTON HOSPITAL HAS BEEN THE HEALTHCARE HEART OF ITS COMMUNITIES SINCE 1909, PROVIDING CRITICAL HEALTH CARE SERVICES FOR A GEOGRAPHICALLY ISOLATED REGION, WITH A POPULATION THAT MORE THAN DOUBLES DURING THE 3-MONTH SUMMER SEASON WITH PART-TIME RESIDENTS AND VISITORS TO THE SOUTH FORK OF LONG ISLAND.
FORM 990, PART VI, SECTION A, LINE 7A		SOUTHAMPTON HOSPITAL BECAME A MEMBER OF THE EAST END HEALTH ALLIANCE DURING 2007. THE EAST END HEALTH ALLIANCE (THE "ALLIANCE"), THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL, WAS CREATED IN RESPONSE TO THE RECOMMENDATIONS OF THE COMMISSION ON HEALTH CARE IN THE 21ST CENTURY. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND TO REALIZE MANAGEMENT EFFICIENCIES. AS A MEMBER OF THE EAST END HEALTH ALLIANCE, THE MEMBERS OF THE GOVERNING BOARD OF THE HOSPITAL ARE SUBJECT TO CONFIRMATION BY THE ALLIANCE.
FORM 990, PART VI, SECTION A, LINE 7B		THE HOSPITAL BECAME A MEMBER OF THE EAST END HEALTH ALLIANCE DURING 2007. THE EAST END HEALTH ALLIANCE, THE ARTICLE 28 PARENT OF EASTERN LONG ISLAND HOSPITAL, PECONIC BAY MEDICAL CENTER AND SOUTHAMPTON HOSPITAL, WAS CREATED IN RESPONSE TO THE RECOMMENDATIONS OF THE COMMISSION ON HEALTH CARE IN THE 21ST CENTURY. CONSISTENT WITH THE MISSION OF SOUTHAMPTON HOSPITAL, THE GOALS OF THE ALLIANCE ARE AS FOLLOWS: TO COLLABORATIVELY DEVELOP HIGH QUALITY, COMPREHENSIVE AND ACCESSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE COMMUNITY SERVED; TO RATIONALIZE HEALTH CARE SERVICES ACROSS THE SYSTEM; AND TO REALIZE MANAGEMENT EFFICIENCIES. THE FOLLOWING DECISIONS MADE BY THE GOVERNING BODY OF SOUTHAMPTON HOSPITAL REQUIRE EAST END HEALTH ALLIANCE APPROVAL: ADOPTION OF OPERATING BUDGETS, APPLICATION FOR NEW CERTIFICATES OF NEED, AND CERTAIN BORROWING TRANSACTIONS.
FORM 990, PART VI, SECTION B, LINE 11		SOUTHAMPTON HOSPITAL HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. UPON COMPLETION, THE FORM 990 IS REVIEWED BY MANAGEMENT AND IS THEN FORWARDED ELECTRONICALLY TO THE MEMBERS OF THE BOARD OF TRUSTEES FOR THEIR REVIEW. ANY QUESTIONS OR ISSUES ARE THEN ADDRESSED BY THE APPROPRIATE PARTIES PRIOR TO THE FILING OF THE RETURN.
	FORM 990, PART VI, SECTION B, LINE 12C	SOUTHAMPTON HOSPITAL CURRENTLY HAS A CONFLICT OF INTEREST POLICY AND A PROCEDURE FOR ANNUAL DISCLOSURE BY KEY EMPLOYEES, PHYSICIAN LEADERS, AND SENIOR MANAGEMENT. WHEN NEW/POTENTIAL CONFLICTS/RELATIONSHIPS ARE IDENTIFIED, THEY ARE INVESTIGATED BY THE CORPORATE COMPLIANCE OFFICER AND ANY RECOMMENDATIONS AND/OR CORRECTIVE ACTIONS ARE PRESENTED TO THE PRESIDENT AND CEO. AS APPROPRIATE, THESE POTENTIAL CONFLICTS/DISCLOSURES ARE ALSO REVIEWED WITH THE CFO AND MEDICAL DIRECTOR/COO. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, THE STAFF MEMBER IS PROHIBITED FROM TAKING PART IN ANY HOSPITAL DECISIONS THAT MAY RELATE TO THE INTEREST OR RELATIONSHIP, UNTIL THE REVIEW IS COMPLETED AND A DETERMINATION IS MADE THAT THERE IS NO CONFLICT. SIMILARLY, ON AN ANNUAL BASIS, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM. ALL POTENTIAL CONFLICTS OF INTEREST THAT MAY EXIST MUST BE DISCLOSED. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED AND THE EXECUTIVE COMMITTEE OF THE BOARD WILL INVESTIGATE AND MAKE THE DETERMINATION AS TO WHAT, IF ANY RECUSAL OR OTHER CORRECTIVE ACTION MAY BE REQUIRED TO AVOID ANY POTENTIAL CONFLICT. THE RESULTS OF THE INVESTIGATION WILL THEN BE REPORTED TO THE GOVERNING BODY. IF AN ACTUAL CONFLICT OF INTEREST EXISTS, THE AFFECTED MEMBER WILL BE NOTIFIED OF THIS DETERMINATION AND THEIR PARTICIPATION IN RELATED MATTERS AND/OR VOTING RIGHTS, PERTAINING TO THE AREA OF CONFLICT, WILL BE RELINQUISHED.
	FORM 990, PART VI, SECTION B, LINE 15	SOUTHAMPTON HOSPITAL HAS ESTABLISHED AN EXECUTIVE COMPENSATION POLICY WHICH SETS FORTH THE TERMS AND CRITERIA FOR THE REVIEW OF THE COMPENSATION OF THE PRESIDENT & CEO, THE CHIEF MEDICAL OFFICER / COO AND THE VICE PRESIDENT OF FINANCE / CFO AS WELL AS OTHER EXECUTIVE LEADERS. THE POLICY OUTLINES THE PROCEDURES AND CRITERIA THE EXECUTIVE COMMITTEE WILL FOLLOW IN EVALUATING THE CEO'S AND THE CMO / COO'S PERFORMANCE AGAINST ESTABLISHED GOALS. IT ALSO OUTLINES THE EXECUTIVE COMMITTEES' ROLE AND RESPONSIBILITY IN DETERMINING ALL ASPECTS OF THE CEO'S AND THE CHIEF MEDICAL OFFICER / COO'S COMPENSATION INCLUDING ANY INCENTIVE OR BONUS COMPENSATION. THE COMMITTEE REVIEWS CONTRACT TERMS WHICH COVER COMPENSATION AND BENEFITS INCLUDING, BUT NOT LIMITED TO, HOUSING ALLOWANCES, AUTOMOBILE ALLOWANCES, SEVERANCE OR CHANGE OF CONTROL PAYMENTS. ON A PERIODIC BASIS, THE EXECUTIVE COMMITTEE MEETS TO REVIEW THE TERMS OF COMPENSATION AND REVIEWS EXTERNAL COMPENSATION DATA AND STUDIES TO ENSURE THAT COMPENSATION DECISIONS ARE REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE. THE COMMITTEE DOCUMENTS THE FULL TERMS OF COMPENSATION APPROVED AND INCLUDES DATE OF THE DECISION, DETAILS OF THE COMPARABILITY DATA OBTAINED AND RELIED UPON, AND HOW THE DATA WAS OBTAINED. MEMBERS OF THE EXECUTIVE COMMITTEE MUST BE FREE FROM ANY CONFLICT OF INTEREST THAT MAY RELATE TO THE ARRANGEMENT. ALL MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING THE DISCUSSION OF THE ARRANGEMENT WILL BE DOCUMENTED IN THE MEETING MINUTES ALONG WITH THEIR VOTES. THE COMPENSATION REVIEW PROCESS FOR THE PRES. & CEO, CHIEF MEDICAL OFFICER AND TOP MANAGEMENT OFFICIALS WAS LAST UNDERTAKEN OCTOBER 21, 2010.
	FORM 990, PART VI, SECTION C, LINE 19	SOUTHAMPTON HOSPITAL'S FORM 990, AS WELL AS ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY, ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. INTERESTED PARTIES MAY REQUEST THE DOCUMENTS AT 240 MEETINGHOUSE LANE, SOUTHAMPTON, NY 11968 OR BY CALLING THE ORGANIZATION DIRECTLY AT (631)723-8301.
HOURS DESCRIBED FOR RELATED ORGANIZATIONS:	FORM 990, PART VII, SECTION A, AND COLUMN (A):	THE FOLLOWING ORGANIZATION, INCLUDING THE FILING ORGANIZATION, SOUTHAMPTON HOSPITAL ASSOCIATION (THE "HOSPITAL") HAVE SIMILAR INDIVIDUALS, WHO ARE MENTIONED BELOW, SERVING ON THEIR BOARDS: THE SOUTHAMPTON HOSPITAL FOUNDATION, INC. MICHAEL ISRAEL, TRUSTEE OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. JEAN REMMEL FITZSIMMONS, TRUSTEE OF THE HOSPITAL ALSO SERVES AS SECRETARY OF THE BOARD ON THE FOUNDATION AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. JOHN E. GRIM III, TRUSTEE OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. ROBERT S. CHALONER, PRESIDENT AND CEO OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION. HOWARD M. LORBER, TRUSTEE OF THE HOSPITAL ALSO SERVES ON THE BOARD OF THE FOUNDATION AS TRUSTEE AND SPENDS ON AVERAGE .50 HOUR PER WEEK DEVOTED TO THIS POSITION.
CHANGES IN NET ASSETS OR FUND BALANCES:	FORM 990, PART XI, LINE 5:	NET UNREALIZED GAINS ON INVESTMENTS: 581,461. PRIOR PERIOD ADJUSTMENTS: 1,390,345. CHANGE IN MINIMUM PENSION LIABILITY - $1,266,824 1,266,824. NET ASSETS REL FROM RESTRICTIONS - CAPITAL ACQUIS FOUNDATION - $5,993,546 5,993,546. CHANGE IN EXPECTED INTEREST IN TRUSTS 317,933. CHANGE IN VALUE OF POOLED INCOME FUND 6,019. OTHER ADJUSTMENTS -7,927. TOTAL TO FORM 990, PART XI, LINE 5: 9,548,201.
	FORM 990, PART XI, LINE 2C:	THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

SOUTHAMPTON HOSPITAL ASSOCIATION

Employer identification number

11-1667765

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) SOUTHAMPTON CARE CENTER 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 11-2658403	NURSING HOME PATIENT CARE (FACILITY CLOSED)	NY	501(C)(3)	509(A)(2)	N/A	Yes
(2) THE SOUTHAMPTON HOSPITAL FOUNDATION 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 11-3466516	TO SUPPORT SOUTHAMPTON HOSPITAL AS IT DELIVERS ITS HEALTHCARE SERVICES	NY	501(C)(3)	509(A)(1)	N/A	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) EAST HAMPTON MSO LLC CO 247 EMERGENCY CARE PC 10 MONTROSE LANE WATER MILL,NY11976 26-2636086	24/7 EMERGENCY CARE	NY	N/A	RELATED	35,639	19,613		No			No	50.000 %
(2) HAMPTON IMAGING LLC 1333 ROANOKE AVENUE RIVERHEAD,NY11901 20-1353646	RADIOLOGY SERVICES	NY	N/A	RELATED	-67,661	261,642		No			No	50.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) MEETING HOUSE LANE MEDICAL PRACTICE PO BOX 2340 SOUTHAMPTON,NY11968 20-8853938	PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE	NY	N/A	C	-749,893	601,152	100.000 %
(2) OLD TOWN MEDICAL PRACTICE PC 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 45-2430883	PRIMARY/SPECIALTY PHYSICIAN PATIENT CARE	NY	N/A	C			100.000 %
(3) SHA PROPERTIES INC 240 MEETING HOUSE LANE SOUTHAMPTON,NY11968 11-2563612	REAL ESTATE HOLDING COMPANY	NY	N/A	C	374,091	2,068,394	100.000 %

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) THE SOUTHAMPTON HOSPITAL FOUNDATION	C	2,399,326	CASH
(2) MEETING HOUSE LANE MEDICAL PRACTICE	D	100,000	CASH
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SOUTHAMPTON HOSPITAL OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	29
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	27
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	1,043
6	Total number of volunteers (estimate if necessary) ....	6	33
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	1,091,008
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-90,102

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	8,456,311	4,082,097
9	Program service revenue (Part VIII, line 2g) .........	99,057,831	106,304,350
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-248,465	385,561
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,594,001	37,093
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	108,859,678	110,809,101
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	57,652,607	62,678,644
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	47,193,085	47,309,251
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	104,845,692	109,987,895
19	Revenue less expenses. Subtract line 18 from line 12......	4,013,986	821,206
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	81,074,223	87,206,773
21	Total liabilities (Part X, line 26)............	83,749,471	79,512,614
22	Net assets or fund balances. Subtract line 21 from line 20 .....	-2,675,248	7,694,159

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4a	(Code: ) (Expenses $ 93,598,895 including grants of $ ) (Revenue $ 106,304,350 )
	THE SOUTHAMPTON HOSPITAL ASSOCIATION IS A NOT-FOR-PROFIT 125 LICENSED BED ACUTE-CARE FACILITY THAT PROVIDES INPATIENT AND OUTPATIENT SERVICES TO PATIENTS.SOUTHAMPTON HOSPITAL OFFERS A FULL CONTINUUM OF AMBULATORY AND INPATIENT SERVICES RANGING FROM PRIMARY MEDICAL CARE TO SPECIALIZED SURGICAL PROCEDURES, AND IS STAFFED BY MORE THAN 230 PHYSICIANS, DENTISTS AND ALLIED HEALTH PROFESSIONALS REPRESENTING 44 MEDICAL SPECIALTIES.THE HOSPITAL HAS DEVELOPED NUMEROUS SERVICES AND OUTREACH, DETAILED BELOW, TO RESPOND TO THE NEEDS OF THEIR PATIENTS, INCLUDING RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS AND IMPLEMENTING A GRADUATE MEDICAL EDUCATION PROGRAM THAT WILL HOPEFULLY ATTRACT THESE YOUNG PHYSICIANS TO STAY AND PRACTICE IN THE COMMUNITY.SINCE THE HOSPITAL'S SERVICE AREA EXTENDS FROM WESTHAMPTON BEACH TO MONTAUK, THE HOSPITAL HAS A NUMBER OF SATELLITE CARE OFFICES TO PROVIDE CONVENIENT, SPECIALIZED CARE TO THE COMMUNITY. THESE INCLUDE: WESTHAMPTON PRIMARY CARE CENTER: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES.LABORATORY AND IMAGING SERVICES:PROVIDING SERVICES IN EAST HAMPTON, HAMPTON BAYS AND SOUTHAMPTON.CENTER FOR PHYSICAL THERAPY AND REHABILITATION: PROVIDING CARE IN THE WESTHAMPTON, WESTHAMPTON BEACH, QUOGUE, AND REMSENBURG COMMUNITIES.THE SHINNECOCK INDIAN HEALTH CLINIC: SINCE APRIL OF 1995, SOUTHAMPTON HOSPITAL HAS WORKED WITH THE SHINNECOCK NATION TO PROVIDE SERVICES AT THE SHINNECOCK INDIAN HEALTH CLINIC THROUGH A CONTRACT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. ON AN ANNUAL BASIS, THE CLINIC PROVIDES APPROXIMATELY 1,600 MEDICAL AND 1,500 DENTAL VISITS FOR ELIGIBLE MEMBERS OF THE SHINNECOCK NATION. DENTAL SERVICES, INCLUDING COMMUNITY EDUCATION, SCREENING, RADIOLOGICAL EXAMS, DENTAL HYGIENE AND RESTORATIVE CARE (CROWNS, FILLINGS AND BRIDGES) ARE PROVIDED THROUGH A SUBCONTRACT WITH STONY BROOK UNIVERSITY SCHOOL OF MEDICINE. CURRENTLY, DENTAL SERVICES ARE AVAILABLE EIGHT DAYS PER MONTH FOR ADULTS AND TWO DAYS FOR CHILDREN. THE DAVID E. ROGERS MD CENTER FOR HIV/AIDS CARE: ANOTHER IMPORTANT COLLABORATION BETWEEN SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER AND TOWN AND COMMUNITY ORGANIZATIONS OF THE EAST END OF LONG ISLAND. MAJOR FUNDING IS PROVIDED THROUGH RYAN WHITE PART A FEDERAL FUNDS AND TO PROVIDE SUPPORT SERVICES AND PREVENTION EDUCATION TO PARTNERS AND FAMILY MEMBERS AFFECTED BY AIDS. THE CENTER IS A MEMBER OF THE PECONIC COMMUNITY COUNCIL, A NOT-FOR-PROFIT COALITION OF ORGANIZATIONS AND INDIVIDUALS DEDICATED TO THE PROMOTION AND PRESERVATION OF HEALTH AND HUMAN SERVICES FOR THE ENTIRE EAST END COMMUNITY.CENTER FOR PRENATAL CARE: LOCATED IN GREENPORT ON THE EASTERN END OF LONG ISLANDS NORTH FORK, THE CENTER PROVIDES PRENATAL CARE TO APPROXIMATELY 50 MOTHERS ANNUALLY IN AN UNDERSERVED AND GEOGRAPHICALLY REMOTE AREA. A MAJORITY OF THESE BABIES ARE BORN AT SOUTHAMPTON HOSPITALS KATHLEEN D. ALLEN MATERNITY CENTER.SOUTHAMPTON HOSPITAL IS PROUD OF THE EXCEPTIONAL SPECIALTY SERVICES IT PROVIDES TO THE COMMUNITY. THESE INCLUDE:THE ELLEN HERMANSON BREAST CENTER OFFERS A WIDE SPECTRUM OF BREAST HEALTH SERVICES, INCLUDING EDUCATION, EARLY DETECTION SCREENINGS AND BREAST CANCER TREATMENT AND SUPPORT. THE CENTER UTILIZES STATE-OF-THE-ART DIAGNOSTIC TECHNIQUES, INCLUDING COMPUTER-ASSISTED MAMMOGRAPHY, ULTRASOUND AND BREAST BIOPSY. THE ED & PHYLLIS DAVIS WELLNESS INSTITUTE OFFERS THE ONLY HOSPITAL-BASED INTEGRATIVE MEDICINE ON LONG ISLAND'S EAST END. INTEGRATIVE MEDICINE COMBINES MODERN SCIENCE, PSYCHOLOGY, NUTRITION, AND EXERCISE TO ENHANCE THE NATURAL HEALING CAPACITY OF THE BODY. SPECIAL PROGRAMS ARE AVAILABLE FOR PATIENTS SUFFERING FROM CHRONIC ILLNESS AND CLASSES IN YOGA, TAI CHI, PILATES, SMOKING CESSATION, STRESS MANAGEMENT, ARE OFFERED, AS WELL AS NUTRITIONAL AND WEIGHT LOSS COUNSELING, MASSAGE THERAPY, AND MUCH MORE.THE JENNY AND JOHN PAUSON DEPARTMENT OF EMERGENCY MEDICINE SERVES MORE THAN 25,000 EMERGENCY PATIENTS ANNUALLY AND IS THE ONLY HOSPITAL-BASED EMERGENCY CARE ON THE SOUTH FORK OF LONG ISLAND. STAFFED 24/7 BY BOARD-CERTIFIED EMERGENCY PHYSICIANS AND SPECIALTY-TRAINED NURSES AND STAFF, IT HAS THE MOST SOPHISTICATED, NON-INVASIVE CARDIAC DIAGNOSTIC AND MONITORING TECHNOLOGY AVAILABLE AND, AS A NEW YORK STATE-DESIGNATED STROKE CENTER, IT IS THE DESTINATION OF AMBULANCES WHEN A HEART ATTACK OR STROKE IS SUSPECTED.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 93,598,895

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,923,239	0	343,718

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a		114,753
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		2,399,326
e	Government grants (contributions)1e		1,409,416

f	All other contributions, gifts, grants, and similar amounts not included above1f		158,602
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			4,082,097
			Business Code
2a	INPATIENT SERVICES		900,099	55,471,355	55,471,355
b	EMERGENCY RM & OUTPATI		900,099	48,729,942	48,729,942
c	LABORATORY EXTENDED SE		621,500	1,091,008		1,091,008
d	LABORATORY REVENUE		900,099	607,726	607,726
e	BREAST CTR REVENUE		900,099	193,927	193,927
f	All other program service revenue .			210,392	210,392
g	Total. Add lines 2a–2f........			106,304,350
3	Investment income (including dividends, interest
	and other similar amounts).....			126,358			126,358
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross Rents	467,740
b	Less: rental expenses	436,720
c	Rental income or (loss)	31,020
d	Net rental income or (loss).......			31,020			31,020
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	15,352,531	2,558
b	Less: cost or other basis and sales expenses	15,095,886
c	Gain or (loss)	256,645	2,558
d	Net gain or (loss)..........			259,203			259,203
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	TELEPHONE REVENUE		900,099	52,601			52,601
b	VENDOR REBATES		900,099	26,775			26,775
c	MISCELLANEOUS		900,099	17,916			17,916
d	All other revenue ....			-91,219			-91,219
e	Total. Add lines 11a–11d ......			6,073
12	Total revenue. See Instructions....			110,809,101	105,213,342	1,091,008	422,654


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			4,228,363	1	1,064,887
2	Savings and temporary cash investments .......			1,075,153	2	8,276,962
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			13,025,057	4	11,221,858
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............			2,744,016	7
8	Inventories for sale or use ..............			1,396,307	8	1,426,697
9	Prepaid expenses and deferred charges ............			198,721	9	224,215
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	126,828,225
b	Less: accumulated depreciation. .....	10b	91,916,023	29,498,686	10c	34,912,202
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			27,403,543	12	26,969,470
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			1,504,377	15	3,110,482
16	Total assets. Add lines 1 through 15 (must equal line 34)...			81,074,223	16	87,206,773
17	Accounts payable and accrued expenses .			22,206,091	17	16,191,326
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			36,317,011	20	35,558,409
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			7,653,718	23	8,916,102
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			17,572,651	25	18,846,777
26	Total liabilities. Add lines 17 through 25.....			83,749,471	26	79,512,614
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			-10,420,273	27	-374,818
28	Temporarily restricted net assets .....			4,911,008	28	5,234,960
29	Permanently restricted net assets .....			2,834,017	29	2,834,017
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			-2,675,248	33	7,694,159
34	Total liabilities and net assets/fund balances .....			81,074,223	34	87,206,773