Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
475 SEAVIEW AVENUE
 
Room/suite
City or town, state or country, and ZIP + 4
STATEN ISLAND, NY10305
D Employer identification number

11-2868878
E Telephone number

G Gross receipts $ 810,208,767
F Name and address of principal officer:
ANTHONY C FERRERI
475 SEAVIEW AVENUE
STATEN ISLAND,NY10305
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.siuh.edu
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1869
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Staten Island University Hospital is part of the North Shore-LIJ Health System, WHICH STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITies IT SERVES. SEE PART III.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 152
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 144
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 6,617
6 Total number of volunteers (estimate if necessary) .... 6 890
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 10,382,410
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,580,924 3,676,168
9 Program service revenue (Part VIII, line 2g) ......... 747,224,860 783,155,014
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,679,414 1,987,289
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 5,986,695 5,267,929
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 760,471,893 794,086,400
Expenses; 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) 472,344,760 502,034,828
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 261,087,391 265,494,006
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 733,432,151 767,528,834
19 Revenue less expenses. Subtract line 18 from line 12....... 27,039,742 26,557,566
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 548,865,872 676,230,590
21 Total liabilities (Part X, line 26)............. 388,588,775 487,447,058
22 Net assets or fund balances. Subtract line 21 from line 20..... 160,277,097 188,783,532
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: STATEN ISLAND UNIVERSITY HOSPITAL IS PART OF THE NORTH SHORE-Long Island Jewish HEALTH SYSTEM ("THE SYSTEM"), WHICH STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES AND IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CLINICAL CARE; EDUCATING THE CURRENT AND FUTURE GENERATIONS OF HEALTHCARE PROFESSIONALS; SEARCHING FOR NEW ADVANCES IN MEDICINE THROUGH THE CONDUCT OF BIOMEDICAL RESEARCH; PROMOTING HEALTH EDUCATION; AND CARING FOR THE ENTIRE COMMUNITY REGARDLESS OF THE ABILITY TO PAY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 512,905,294 including grants of $ 0 ) (Revenue $ 656,730,000 )
STATEN ISLAND UNIVERSITY HOSPITAL PROVIDES ACUTE CARE HOSPITAL SERVICES AT TWO FACILITIES IN RICHMOND COUNTY. NORTH AND SOUTH SITE CAMPUSES PROVIDE SERVICES IN CARDIOLOGY, BURN CARE, TRAUMA, ORTHOPEDICS, ONCOLOGY, GERIATRICS, OBSTETRICS, PEDIATRICS, REHABILITATION, PRIMARY CARE, COMMUNITY OUTREACH, HOSPICE, AND HOME CARE REGARDLESS OF ABILITY TO PAY. IN 2011 THE COMBINED CAMPUSES OF THE HOSPITAL HAD 42,105 DISCHARGES, (EXCLUDING NORMAL NEWBORN DISCHARGES), 3,069 DELIVERIES, 117,838 EMERGENCY DEPARTMENT VISITS, AND 16,264 AMBULATORY SURGERY CASES.
4b (Code:   ) (Expenses $ 55,892,864 including grants of $ 0 ) (Revenue $ 48,358,000 )
EXPENSES INCURRED IN PROVIDING EMERGENCY DEPARTMENT SERVICES TO ALL INDIVIDUALS, 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR, IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.
4c (Code:   ) (Expenses $ 48,823,213 including grants of $ 0 ) (Revenue $ 38,310,000 )
EXPENSES INCURRED IN PROVIDING AMBULATORY SURGERY SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.
4d Other program services (Describe in Schedule O.)
(Expenses $ 37,939,143 including grants of $ 0 ) (Revenue $ 39,757,014 )
4e Total program service expensesMediumBullet$ 655,560,514
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
Yes
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
481
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
6,617
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
152
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
144
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NY
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
THOMAS RECA
ONE EDGEWATER PLAZA
STATEN ISLAND,NY10305
(718) 226-1148
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) RICHARD D GOLDSTEIN
CHAIRMAN - TRUSTEE
 3.0 X   X       0 0 0
(2) JOHN ALEXANDER
TREASURER - TRUSTEE
 2.0 X   X       0 0 0
(3) RICHARD S ABRAMSON
TRUSTEE
 2.0 X           0 0 0
(4) WILLIAM ACHENBAUM
TRUSTEE
 2.0 X           0 0 0
(5) IRA I ALTFEDER
TRUSTEE
 2.0 X           0 0 0
(6) PHILIP S ALTHEIM
TRUSTEE
 2.0 X           0 0 0
(7) STANLEY A APPLEBAUM
TRUSTEE
 2.0 X           0 0 0
(8) MICHAEL L ASHNER
TRUSTEE
 2.0 X           0 0 0
(9) BEVERLY BANKER
TRUSTEE
 2.0 X           0 0 0
(10) RALPH M BARUCH
TRUSTEE
 2.0 X           0 0 0
(11) MORTON M BASS
TRUSTEE
 2.0 X           0 0 0
(12) FRANK J BESIGNANO
TRUSTEE
 2.0 X           0 0 0
(13) ELISE M BLOOM
TRUSTEE
 2.0 X           0 0 0
(14) ERIC S BLUMENCRANZ
TRUSTEE
 2.0 X           0 0 0
(15) ROGER A BLUMENCRANZ
TRUSTEE
 2.0 X           0 0 0
(16) DAVID BLUMENFELD
TRUSTEE
 2.0 X           0 0 0
(17) EDWARD BLUMENFELD
TRUSTEE
 2.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) E STEVE BRAUN
TRUSTEE
 2.0 X           0 0 0
(19) DAYTON T BROWN JR
TRUSTEE
 2.0 X           0 0 0
(20) ALLEN E BUSCHING
TRUSTEE
 2.0 X           0 0 0
(21) JONATHAN S CANNO
TRUSTEE
 2.0 X           0 0 0
(22) MICHAEL CARIDI
TRUSTEE
 2.0 X           0 0 0
(23) REVEREND DEMETRIUS S CAROLINA SR
TRUSTE
 2.0 X           0 0 0
(24) RUDOLPH C CARRYL
TRUSTEE
 2.0 X           0 0 0
(25) ROBERT W CHASANOFF
TRUSTEE
 2.0 X           0 0 0
(26) ALAN CHOPP
TRUSTEE
 2.0 X           0 0 0
(27) MARK CLASTER
TRUSTEE
 2.0 X           0 0 0
(28) DIANA F COLGATE
TRUSTEE
 2.0 X           0 0 0
(29) DANIEL M CROWN
TRUSTEE
 2.0 X           0 0 0
(30) PHILIPPE P DAUMAN
TRUSTEE
 2.0 X           0 0 0
(31) DANIEL C DE ROULET
TRUSTEE
 2.0 X           0 0 0
(32) LORINDA DE ROULET
TRUSTEE
 2.0 X           0 0 0
(33) THOMAS E DEWEY JR
TRUSTEE
 2.0 X           0 0 0
(34) THOMAS E DOOLEY
TRUSTEE
 2.0 X           0 0 0
(35) MICHAEL J DOWLING
TRUSTEE
 50.0 X           0 2,521,221 742,813
(36) ROBERT N DOWNEY
TRUSTEE
 2.0 X           0 0 0
(37) MELVIN DUBIN
TRUSTEE
 2.0 X           0   0
(38) PATRICK R EDWARDS
TRUSTEE
 2.0 X           0 0 0
(39) TONI J ELLIOTT
TRUSTEE
 2.0 X           0 0 0
(40) MICHAEL A EPSTEIN
TRUSTEE
 2.0 X                
(41) LEONARD FEINSTEIN
TRUSTEE
 2.0 X           0 0 0
(42) MICHAEL E FELDMAN
TRUSTEE
 2.0 X           0 0 0
(43) ANTHONY C FERRERI
PRESIDENT/CEO - TRUSTEE
 50.0 X   X       119,268 921,874 291,142
(44) ARLENE LANE FISHER
TRUSTEE
 2.0 X           0 0 0
(45) CATHERINE C FOSTER
TRUSTEE
 2.0 X           0 0 0
(46) WILLIAM H FRAZIER
TRUSTEE
 2.0 X           0 0 0
(47) EUGENE B FRIEDMAN MD
TRUSTEE
 2.0 X           0 0 0
(48) SY GARFINKEL
TRUSTEE
 2.0 X           0 0 0
(49) LLOYD MICHAEL GOLDMAN
TRUSTEE
 2.0 X           0 0 0
(50) J JOAQUIN GONZALEZ
TRUSTEE
 2.0 X           0 0 0
(51) MICHAEL GOULD
TRUSTEE
 2.0 X           0 0 0
(52) ALBERT L GRANGER DDS
TRUSTEE
 2.0 X           0 0 0
(53) ALAN I GREENE
TRUSTEE
 2.0 X           0 0 0
(54) JAMES R GREENE
TRUSTEE
 2.0 X           0 0 0
(55) STANLEY GREY
TRUSTEE
 2.0 X           0 0 0
(56) RICHARD GUARASCI PHD
TRUSTEE
 2.0 X           0 0 0
(57) PAUL B GUENTHER
TRUSTEE
 2.0 X           0 0 0
(58) HENRY L HACKMANN
TRUSTEE
 2.0 X           0 0 0
(59) AMY M HAGEDORN
TRUSTEE
 2.0 X           0 0 0
(60) STEPHEN L HAMMERMAN
TRUSTEE
 2.0 X           0 0 0
(61) IRA HAZAN
TRUSTEE
 2.0 X           0 0 0
(62) LINDA W HEANEY
TRUSTEE
 2.0 X           0 0 0
(63) MARLENE HESS
TRUSTEE
 2.0 X           0 0 0
(64) WILLIAM O HILTZ
TRUSTEE
 2.0 X           0 0 0
(65) MICHAEL HOFFMAN
TRUSTEE
 2.0 X           0 0 0
(66) GEDALE B HOROWITZ
TRUSTEE
 2.0 X           0 0 0
(67) RICHARD A HOROWITZ
TRUSTEE
 2.0 X           0 0 0
(68) M ALLAN HYMAN
TRUSTEE
 2.0 X           0 0 0
(69) MARK JACOBSON
TRUSTEE
 2.0 X           0 0 0
(70) JEFFREY JURICK
TRUSTEE
 2.0 X           0 0 0
(71) LYN JURICK
TRUSTEE
 2.0 X           0 0 0
(72) ARTHUR KALISH
TRUSTEE
 2.0 X           0 0 0
(73) STEVEN L KANTOR
TRUSTEE
 2.0 X           0 0 0
(74) DAVID M KATZ
TRUSTEE
 2.0 X           0 0 0
(75) MICHAEL KATZ
TRUSTEE
 2.0 X           0 0 0
(76) SAUL B KATZ
TRUSTEE
 2.0 X           0 0 0
(77) LISA A KAUFMAN
TRUSTEE
 2.0 X           0 0 0
(78) ROBERT KAUFMAN
TRUSTEE
 2.0 X           0 0 0
(79) CARY KRAVET
TRUSTEE
 2.0 X           0 0 0
(80) STANLEY KREITMAN
TRUSTEE
 2.0 X           0 0 0
(81) SETH KUPFERBERG
TRUSTEE
 2.0 X           0 0 0
(82) JEFFREY B LANE
TRUSTEE
 2.0 X           0 0 0
(83) CURT N LAUNER
TRUSTEE
 2.0 X           0 0 0
(84) LAURA LAURIA
TRUSTEE
 2.0 X           0 0 0
(85) KEVIN F LAWLOR
TRUSTEE
 50.0 X           0 744,807 313,444
(86) MICHAEL S LEEDS
TRUSTEE
 2.0 X           0 0 0
(87) DAVID W LEHR
TRUSTEE
 2.0 X           0 0 0
(88) JONATHAN W LEIGH
TRUSTEE
 2.0 X           0 0 0
(89) SYLVIA LESTER
TRUSTEE
 2.0 X           0 0 0
(90) ARTHUR S LEVINE
TRUSTEE
 2.0 X           0 0 0
(91) STUART R LEVINE
TRUSTEE
 2.0 X           0 0 0
(92) SETH LIPSAY
TRUSTEE
 2.0 X           0 0 0
(93) DAVID S MACK
TRUSTEE
 2.0 X           0 0 0
(94) WILLIAM L MACK
TRUSTEE
 2.0 X           0 0 0
(95) HOWARD S MAIER
TRUSTEE
 2.0 X           0 0 0
(96) LINDA MANFREDI
TRUSTEE
 2.0 X           0 0 0
(97) JAMES S MARCUS
TRUSTEE
 2.0 X           0 0 0
(98) BRADLEY MARSH DPM
TRUSTEE
 2.0 X           0 0 0
(99) JEFFREY S MAURER
TRUSTEE
 2.0 X           0 0 0
(100) RONALD J MAZZUCCO
TRUSTEE
 2.0 X           0 0 0
(101) F J MCCARTHY
TRUSTEE
 2.0 X           0 0 0
(102) PATRICK F MCDERMOTT
TRUSTEE
 2.0 X           0 0 0
(103) KATHERINE MCENROE
TRUSTEE
 2.0 X           0 0 0
(104) JAMES MCMULLEN
TRUSTEE
 2.0 X           0 0 0
(105) CHARLES MERINOFF
TRUSTEE
 2.0 X           0 0 0
(106) AIMEE MERSZEI
TRUSTEE
 2.0 X           0 0 0
(107) RICHARD D MONTI
TRUSTEE
 2.0 X           0 0 0
(108) TOMAS D MORALES PHD
TRUSTEE
 2.0 X           0 0 0
(109) RICHARD MURCOTT
TRUSTEE
 2.0 X           0 0 0
(110) RALPH A NAPPI
TRUSTEE
 50.0 X           0 774,818 534,580
(111) RICHARD B NYE
TRUSTEE
 2.0 X           0 0 0
(112) CLYDE I PAYNE ED D
TRUSTEE
 2.0 X           0 0 0
(113) ARNOLD S PENNER
TRUSTEE
 2.0 X           0 0 0
(114) JOHN J RAGGIO
TRUSTEE
 2.0 X           0 0 0
(115) LEWIS S RANIERI
TRUSTEE
 2.0 X           0 0 0
(116) JAY R RAUBVOGEL
TRUSTEE
 2.0 X           0 0 0
(117) COREY RIBOTSKY
TRUSTEE
 2.0 X           0 0 0
(118) DENNIS RIESE
TRUSTEE
 2.0 X           0 0 0
(119) TERRY P RIFKIN MD
TRUSTEE
 2.0 X           0 0 0
(120) ROBERT A ROSEN
TRUSTEE
 2.0 X           0 0 0
(121) MARCIE ROSENBERG
TRUSTEE
 2.0 X           0 0 0
(122) ROBERT D ROSENTHAL
TRUSTEE
 2.0 X           0 0 0
(123) BERNARD M ROSOF MD
TRUSTEE
 2.0 X           0 0 0
(124) JACK J ROSS
TRUSTEE
 2.0 X           0 0 0
(125) BARRY RUBENSTEIN
TRUSTEE
 2.0 X           0 0 0
(126) HERBERT RUBIN
TRUSTEE
 2.0 X           0 0 0
(127) SCOTT RUDOLPH
TRUSTEE
 2.0 X           0 0 0
(128) MICHAEL H SAHN
TRUSTEE
 2.0 X           0 0 0
(129) FRANK W SCARANGELLO SR
TRUSTEE
 2.0 X           0 0 0
(130) NORMAN SCHLANGER
TRUSTEE
 2.0 X           0 0 0
(131) LOIS C SCHLISSSEL
TRUSTEE
 2.0 X           0 0 0
(132) JOHN M SHALL
TRUSTEE
 2.0 X           0 0 0
(133) ROBERT F SHAPIRO
TRUSTEE
 2.0 X           0 0 0
(134) MARC V SHAW
TRUSTEE
 2.0 X           0 0 0
(135) SEAN G SIMON
TRUSTEE
 2.0 X           0 0 0
(136) RICHARD SIMS
TRUSTEE
 2.0 X           0 0 0
(137) MICHAEL C SLADE
TRUSTEE
 2.0 X           0 0 0
(138) PHYLLIS HILL SLATER
TRUSTEE
 2.0 X           0 0 0
(139) HOWARD D STAVE
TRUSTEE
 2.0 X           0 0 0
(140) RUSSELL STERN
TRUSTEE
 2.0 X           0 0 0
(141) MAGANLAL SUTARIA MD
TRUSTEE
 2.0 X           0 0 0
(142) JOHN B THOMSON JR
TRUSTEE
 2.0 X           0 0 0
(143) PETER TILLES
TRUSTEE
 2.0 X           0 0 0
(144) SANDRA TYTEL
TRUSTEE
 2.0 X           0 0 0
(145) NANCY WALDBAUM
TRUSTEE
 2.0 X           0 0 0
(146) GARY WALTER
TRUSTEE
 2.0 X           0 0 0
(147) HOWARD WEINGROW
TRUSTEE
 2.0 X           0 0 0
(148) LEWIS M WESTON
TRUSTEE
 2.0 X           0 0 0
(149) JON A WURTZBURGER
TRUSTEE
 2.0 X           0 0 0
(150) BARBARA HRBEK ZUCKER
TRUSTEE
 2.0 X           0 0 0
(151) DONALD ZUCKER
TRUSTEE
 2.0 X           0 0 0
(152) ROY J ZUCKERBERG
TRUSTEE
 2.0 X           0 0 0
(153) ARTHUR J FRIED ESQ
SECRETARY
 50.0     X       0 276,046 44,700
(154) KEITH C THOMPSON
ASSISTANT SECRETARY
 50.0     X       0 856,803 356,015
(155) HARRY E GINDI
ASSISTANT TREASURER
 50.0     X       0 304,339 42,050
(156) ROBERT S SHAPIRO
SVP/CFO NS-LIJ HEALTH SYSTEM
 50.0       X     0 1,047,340 262,780
(157) THOMAS RECA
CHIEF FINANCIAL OFFICER
 50.0       X     519,533 100,000 39,156
(158) MARK P JARRETT MD
CHIEF MEDICAL OFFICER
 50.0       X     503,417 0 35,980
(159) DONNA PROSKE
EVP - CHIEF NURSING EXECUTIVE
 50.0       X     537,697 0 39,708
(160) NICHOLAS CARUSELLE
EXECUTIVE VICE PRESIDENT
 50.0       X     406,417 0 16,688
(161) GREGORY RADINSKY
CHIEF COMPLIANCE OFFICER
 50.0       X     0 295,321 41,650
(162) JOSEPH T MCGINN MD
PHYSICIAN
 50.0         X   1,497,218 0 32,801
(163) MICHAEL L COOPER MD
PHYSICIAN
 50.0         X   1,005,545 0 32,801
(164) JONATHON DEITCH MD
PHYSICIAN
 50.0         X   998,808 0 6,106
(165) CHRISTOPHER DEMAS MD
PHYSICIAN
 50.0         X   893,107 0 19,116
(166) PHILLIP M VIGNERI MD
PHYSICIAN
 50.0         X   870,275 0 35,640
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 7,351,285 7,842,569 2,887,170
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet692
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MORRISON MANAGEMENT SPECIALISTS
12975 COLLECTIONS CENTER DRIVE
CHICAGO,IL60693 		FOOD 6,881,615
UNIVERSITY PHYSICIANS GROUP PC
ONE EDGEWATER PLAZA
STATEN ISLAND,NY10305 		MEDICAL 3,260,622
MCKESSON INFORMATION SOLUTIONS INC
5995 WINDWARD PARKWAY
ALPHARETTA,GA30005 		IT CONSULTANTS 2,977,470
QUEST DIAGNOSTICS INC
1 MALCOLM AVENUE
TETERBORO,NJ07608 		LABORATORY 2,739,239
OCEANSIDE INSTITUTIONAL INDUSTRIES
2325 LONG BEACH ROAD
OCEANSIDE,NY11572 		LAUNDRY 2,357,067
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet87
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 98,260
e Government grants (contributions)1e 3,577,908
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 3,676,168
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 621,500 745,356,637 734,974,227 10,382,410  
b PROFESSIONAL SERVICES REVENUE 621,110 2,573,226 2,573,226    
c OTHER HEALTHCARE RELATED REVENUE 621,990 35,225,151 35,225,151    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 783,155,014
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 2,110,868     2,110,868
4 Income from investment of tax-exempt bond proceeds..MediumBullet 835     835
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,543,876  
b Less: rental expenses    
c Rental income or (loss) 1,543,876  
d Net rental income or (loss).......MediumBullet 1,543,876     1,543,876
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 15,980,036 17,917
b Less: cost or other basis and sales expenses 16,122,367 0
c Gain or (loss) -142,331 17,917
d Net gain or (loss)..........MediumBullet -124,414     -124,414
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..MediumBullet 0    
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...MediumBullet 0      
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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA AND DIETARY 722,100 2,337,827     2,337,827
b PARKING REVENUE 812,930 562,270     562,270
c REBATES 812,900 317,215     317,215
d All other revenue .... 506,741     506,741
e Total. Add lines 11a–11d ......MediumBullet 3,724,053
12 Total revenue. See Instructions....MediumBullet 794,086,400 772,772,604 10,382,410 7,255,218
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,231,392 0 2,231,392  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 101,490   101,490  
7 Other salaries and wages 383,413,511 346,836,944 36,576,567  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 24,117,541 22,356,194 1,761,347  
9 Other employee benefits ....... 64,214,217 59,524,538 4,689,679  
10 Payroll taxes ........... 27,956,677 25,914,951 2,041,726  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,006,020   1,006,020  
c Accounting ........... 964,781   964,781  
d Lobbying ........... 247,981   247,981  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 16,121,943 16,121,943    
12 Advertising and promotion .... 1,510,180 1,510,180    
13 Office expenses ....... 98,257,351 73,356,519 24,900,832  
14 Information technology ...... 3,459,594 2,582,848 876,746  
15 Royalties .. 0      
16 Occupancy ........... 8,919,467 2,992,802 5,926,665  
17 Travel ............ 631,707 471,617 160,090  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 515,318 384,724 130,594  
20 Interest ........... 9,174,792 6,849,674 2,325,118  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 27,420,872 20,471,748 6,949,124  
23 Insurance .............. 30,958,596 30,240,543 718,053  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a CONTRACTED SERVICES 39,292,914 29,335,122 9,957,792 0
b UTILITIES 9,760,759 9,331,475 429,284 0
c CENTRALIZED ADMIN. SVCS. 7,591,361 66,498 7,524,863 0
d OTHER EXPENSES 9,660,370 7,212,194 2,448,176 0
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 767,528,834 655,560,514 111,968,320 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 59,755 1 60,201
2 Savings and temporary cash investments ....... 85,121,616 2 108,844,454
3 Pledges and grants receivable, net ......... 1,862,888 3 1,906,377
4 Accounts receivable, net ......... 89,529,445 4 88,732,941
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
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 .......... 0 6 0
7 Notes and loans receivable, net ............. 4,269,815 7 615,547
8 Inventories for sale or use .............. 7,711,768 8 7,975,381
9 Prepaid expenses and deferred charges ............ 1,148,465 9 1,378,627
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 396,919,108
b Less: accumulated depreciation. ..... 10b 170,327,272 228,295,550 10c 226,591,836
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 124,592,658 13 122,727,420
14 Intangible assets ......... 0 14 27,870,431
15 Other assets. See Part IV, line 11 ........... 6,273,912 15 89,527,375
16 Total assets. Add lines 1 through 15 (must equal line 34)... 548,865,872 16 676,230,590
Liabilities 17 Accounts payable and accrued expenses . 89,587,345 17 94,261,683
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 62,239,585 20 62,626,865
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 80,995,254 23 52,396,935
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 25,902,787
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 155,766,591 25 252,258,788
26 Total liabilities. Add lines 17 through 25..... 388,588,775 26 487,447,058
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 150,162,927 27 178,518,820
28 Temporarily restricted net assets ..... 8,629,981 28 8,780,523
29 Permanently restricted net assets ..... 1,484,189 29 1,484,189
Organizations that do not follow SFAS 117, check here MediumBullet 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 ..... 160,277,097 33 188,783,532
34 Total liabilities and net assets/fund balances ..... 548,865,872 34 676,230,590
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
794,086,400
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
767,528,834
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
26,557,566
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
160,277,097
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
1,948,869
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
188,783,532
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
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)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(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?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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 on line H of its
Form 990-EZ or on Part I, 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) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
STATEN ISLAND UNIVERSITY HOSPITAL
  		Employer identification number

11-2868878
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
STATEN ISLAND UNIVERSITY HOSPITAL
  		Employer identification number

11-2868878
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
STATEN ISLAND UNIVERSITY HOSPITAL
  		Employer identification number

11-2868878
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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) (2011)

Additional Data


Software ID:  
Software Version:  
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
2011
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, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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) 2011

Schedule C (Form 990 or 990-EZ) 2011
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 expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ......................................

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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
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)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
247,981
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
247,981
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
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, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING ACTIVITIES SCHEDULE C, PART II-B; LINES 1G AND 1H THE ORGANIZATION IS A MEMBER OF THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. IS A MEMBER OF THE GREATER NEW YORK HOSPITAL ASSOCIATION ("GNYHA"), THE HEALTH CARE ASSOCIATION OF NEW YORK STATE and THE AMERICAN HOSPITAL ASSOCIATION WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. PAYS DUES TO THESE ASSOCIATIONS ON BEHALF OF THIS ORGANIZATION. ADDITIONALLY, THROUGH GNYHA, THE ORGANIZATION PAYS DUES TO THE 1199 JOB SECURITY FUND. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING ACTIVITES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $247,981.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
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 .......    
5
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? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can 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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? ....................................
9
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.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), 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.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 $  
2
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 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 1,484,189 1,484,189 1,484,189 1,484,189
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ...... 1,484,189 1,484,189 1,484,189 1,484,189
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   4,107,673 4,107,673
b Buildings ................   236,142,914 93,796,356 142,346,558
c Leasehold improvements ............   68,855 10,596 58,259
d Equipment ................   94,488,301 54,437,913 40,050,388
e Other .................   62,111,365 22,082,407 40,028,958
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 226,591,836
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other 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    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program 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
(1) INVESTMENT IN HEALTHFIRST 8,226,227 F
(2) INVESTMENT IN VERIZON - AT&T 10,143 F
(3) U.S. GOVERNMENT OBLIGATIONS 17,470,000 F
(4) CORPORATE BONDS 11,247,000 F
(5) ACCRUED INTEREST RECEIVABLE 183,000 F
(6) LIMITED USE 0 F
(7) LIMITED USE 51,649,050 F
(8) CASH AND CASH EQUIVALENTS 33,942,000 F
(9) MUNICIPAL BONDS 0 F
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 122,727,420
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) OTHER ASSETS, NET 201,254
(2) DEPOSITS 139,417
(3) ASU 2010-04 89,186,704






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 89,527,375
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
PARTY PAYERS; CURRENT 24,533,604
LIABILITIES; CURRENT 5,575,931
INTEREST PAYABLE 1,089,378
OTHER LONG TERM LIABILITIES 42,247,594
LIABILITIES; NON-CURRENT 56,844,069
LIABILITIES; CURRENT 5,438,260
LIABILITIES; NON-CURRENT 29,248,095
INSURANCE PAYABLE 87,281,857

Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 252,258,788
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) 2011

Schedule D (Form 990) 2011
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) .................... 1 794,086,400
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 767,528,834
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 26,557,566
4 Net unrealized gains (losses) on investments .......................... 4 1,710,848
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 88,479
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 1,799,327
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 28,356,893
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 793,181,993
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d 1,064,965
e Add lines 2a through 2d ..................... 2e 1,064,965
3 Subtract line 2e from line 1..................... 3 792,117,028
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 1,969,372
c Add lines 4a and 4b....................... 4c 1,969,372
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 794,086,400
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 762,907,622
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  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3 762,907,622
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 4,621,212
c Add lines 4a and 4b....................... 4c 4,621,212
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 767,528,834
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
ENDOWMENT FUNDS SCHEDULE D, PART V, QUESTION 4 ENDOWMENT FUNDS INCLUDED IN PERMANENTLY RESTRICTED NET ASSETS ARE USED TO SUPPORT THE CHARITABLE ACTIVITIES AND PROGRAMS OF THE ORGANIZATION AND ITS AFFILIATES.
REC. OF CHANGE IN NET ASSETS FROM 990 TO AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XI; LINE 8 OTHER CHANGES IN FUND BALANCE INCLUDE: - PENSION AND OTHER POSTRETIREMENT LIABILITY ADJUSTMENTS - ($33,398) - CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS DESIGNATED AS DERIVATIVE INSTRUMENTS - ($1,091,789) - MEDICAL RESIDENT TAX RECOVERY - $1,305,546 - NET ASSETS RELEASED FROM RESTRICTION FOR CAPITAL ASSET ACQUISITIONS - $1,912,222 - NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS - $1,064,965 - DEFEASEMENT OF LONG-TERM DEBT - ($3,070,067)
RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XII; LINE 2D OTHER RECONCILIATION ITEMS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 INCLUDE: - NET ASSETS RELEASED FROM RESTRICTION USED FOR OPERATIONS - $1,064,965
RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XIII; LINE 4B OTHER RECONCILIATION ITEMS INCLUDED ON FORM 990, PART VIII, LINE 12 BUT NOT ON LINE 1 INCLUDE: - INVESTMENT INCOME - $1,969,372
RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XIII; LINE 4B OTHER RECONCILIATION ITEMS INCLUDED ON FORM 990, PART IX, LINE 25 BUT NOT ON LINE 1 INCLUDE: - AMORTIZATION OF INTANGIBLE ASSET - $4,621,212
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
2011
Open to Public Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (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 Financial Assistance at cost
(from Worksheet 1) .. 		1 6,753 18,414,000 5,030,000 13,384,000 1.760 %
b Medicaid (from Worksheet 3, column a) ..... 1 365,216 171,178,132 119,242,824 51,935,308 6.810 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		2 371,969 189,592,132 124,272,824 65,319,308 8.570 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		207 86,512 4,484,596 183 4,484,413 0.590 %
f Health professions education
(from Worksheet 5) .. 		17 2,045 45,607,081 15,339,193 30,267,888 3.970 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) .... 7 1 339,877   339,877 0.040 %
jTotal Other Benefits ... 231 88,558 50,431,554 15,339,376 35,092,178 4.600 %
kTotal. Add lines 7d and 7j. .. 233 460,527 240,023,686 139,612,200 100,411,486 13.170 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 1 91 10,654   10,654  
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 2 4,050 2,584   2,584  
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total 3 4,141 13,238   13,238  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense........
2
5,238,000
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
176,906,621
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
175,352,519
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
1,554,102
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?2
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 STATEN ISLAND UNIVERSITY HOSPITAL-NORTH
475 SEAVIEW AVENUE
STATEN ISLAND,NY10305 		X X   X     X    
2 STATEN ISLAND UNIVERSITY HOSPITAL-SOUTH
375 SEGUINE AVENUE
STATEN ISLAND,NJ10309 		X X   X     X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
STATEN ISLAND UNIVERSITY HOSPITAL-NORTH
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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 FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
STATEN ISLAND UNIVERSITY HOSPITAL-SOUTH
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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 FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address Type of Facility (describe)
1 SOUTH BEACH PSYCHIATRIC CENTER
777 SEAVIEW AVENUE
STATEN ISLAND,NY10305 		CLINIC
2 NEW DORP HIGH SCHOOL
465 NEW DORP LANE
STATEN ISLAND,NY10306 		CLINIC
3 AUDIOSPEECH PATHOLOGY CENTER
500 SEAVIEW AVENUE
STATEN ISLAND,NY10305 		CLINIC
4 CHEMICAL DEPENDENCE TREATMENT PROGRAM
111 WATER STREET
STATEN ISLAND,NY10304 		CLINIC
5 THE BAY STREET HEALTH CENTER
57 BAY STREET
STATEN ISLAND,NY10301 		CLINIC
6 PSYCHALCOHOLISM TREATMENT PROGRAM
450 SEAVIEW AVENUE
STATEN ISLAND,NY10305 		CLINIC
7 CANARSIE MULTI SERVICE CENTER
567 E 10TH STREET
BROOKLYN,NY11218 		CLINIC
8 SANFORD R NALITT INSTITUTUE FOR CANCER
256 MASON AVENUE
STATEN ISLAND,NY10305 		CLINIC
9 CONEY ISLAND MULTIPLE SERVICE CENTER
425-427 CONEY ISLAND AVENUE
BROOKYLN,NY11218 		CLINIC
10 CENTER FOR WOMENS HEALTH
440 SEAVIEW AVENUE
STATEN ISLAND,NY10305 		CLINIC
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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
ELIGIBILITY FOR DISCOUNTED CARE PART I, LINE 3C This hospital is an affiliated entity of the North Shore-LIJ Health System, Inc. ("North Shore-LIJ") or ("the System"). North Shore-LIJ uses Federal Poverty Guidelines ("FPG') to determine eligibility. North Shore-LIJ utilizes the New York State Department of Health (NYSDOH) guidelines regarding the consideration of assets and will only review a patient's assets if they fall within the family size and income levels approved by New York State. Asset tests cannot be used to deny financial assistance, but only to "upgrade" a patient's level of obligation, up to the legal maximum permitted under the financial assistance law. In the consideration of assets, the following assets will not be included: primary residence, tax-deferred or comparable retirement accounts, college savings accounts and cars used by the patient or patient's family.
COMMUNITY BENEFIT REPORT SCHEDULE H, PART I; QUESTION 6A The Community Benefit report is prepared by the hospital, in conjunction with an affiliated entity (North Shore-LIJ Health System, Inc.) of the hospital. The Community Benefit Report is accessible to the public and can be accessed on the North Shore-LIJ website: http://www.northshorelij.com/NSLIJ/About+Us+Community+Service+Plans
SUBSIDIZED HEALTH SERVICES SCHEDULE H, PART I; QUESTION 7 Row (a) The cost of charity care was determined by utilizing the ratio of cost to charges (RCC) calculated on Worksheet 2 applied to gross charges written-off for patients qualifying for charity under the hospital's financial assistance policy. Bad Debt was not reported in any row of Part I, Line 7. Row (b) The Ratio of Cost to Charges method is used to determine the cost of ancillary services. A RCC is developed from these costs, and that RCC is applied to total Medicaid gross ancillary services charges to determine the cost of services provided to Medicaid patients. Row (e) Costs associated with Community Health Improvement Services were determined by adding indirect or overhead costs to the direct costs of the activity. Indirect costs were calculated as a percentage of direct costs. Direct costs for staff expenses were calculated using average hospital facility hourly rates, and were adjusted to account for fringe benefits, using a blended rate based on the ratio of total employee benefit expenses to total salary and wages. Row (f) The Bad Debt Expense that appears on Form 990, Part IX, Line 25 column (A) is not included for purposes of calculating the percent of total expense in column (f). The costs related to health professions education were determined by utilizing the step down method of cost finding. Row (h) Costs associated with research activities were determined by adding indirect, or overhead, costs to the direct costs of the activity. Indirect costs were calculated as a percentage of costs. Row (i) The cost of in-kind contributions to community groups is comprised of the direct costs of personnel whose hospital compensated time was donated to various charities and community groups. The salaries and wages were adjusted to include benefits using a rate based on the ratio of total employee benefit expenses to total salary and wages. Indirect costs were calculated as a percentage of direct costs. Column (a) The number of activities or programs was determined by counting unique community benefit activities or programs conducted throughout the year. Each activity or program may include multiple occurrences. In Part I line 7 (a)-(k), column (a) represents the total number of unique community benefit activities and programs; not the number of occurrences for each activity and program. Column (b) Persons served were determined by the unique number of community members that encountered a specific community benefit activity or program. Persons were reported multiple times when engaged in services in different categories of activity or programs. Column (f) for Rows (a)-(k) Theses percentages are calculated using Net Community Benefit Expenses divided by Total Expenses, excluding bad debt, for the hospital. Note: For the entire North Shore-LIJ Health System, Part I, Line 7 Row (k), Column (f) is approximately 10.5% as a percentage of expenses.
COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II All community building activities improve access to health services and address federal, state, or local public health priorities, as well as leverage public health department activities, and in doing so, they provide relief of government burden. These activities broadly serve low-income, underserved patients, and are open to the public. These activities include: collaboration with various community coalitions, system-wide recycling initiative, organizational response to worldly disasters, and bioterrorism efforts. The System's bioterrorism & disaster preparedness includes the Center for Emergency Medical Services, which is a state and federal planning resource on weapons of mass destruction, and is a designated Bioterrorism Resource Center. The System has conducted staff training for more than 100 hospitals and area first responders and invested heavily in the infrastructure needed for large-scale emergencies. During catastrophes North Shore-LIJ provides a safe haven for thousands of patients, outside nursing home residents, and community members seeking shelter. North Shore-LIJ ambulances will assist with the transport of patients throughout the metropolitan area, stand ready to distribute food, medicine, and blankets to numerous individuals who may lose power in their homes. Investment in a field hospital has furthered the public health infrastructure needed for mass casualties that could result from a terrorist attack, natural attack, or large-scale emergency.
BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A; QUESTION 4 For patients who were determined by the System to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. The bad debt expense is multiplied by the ratio of cost to charges for purposes of inclusion in the total uncompensated care amount identified. Bad debt expenses are determined by applying the ratio of cost to charges from Worksheet 2 to gross patient charges written-off to bad debt. The amount of gross charges written off is reduced by any charity care or other discounts provided to the patient, as well as any payments received. As a result of the fulfillment of the exemption under 501(c)(3) of the Internal Revenue Code, a portion of the bad debt is derived from the hospital's obligation not to turn away the community it serves, regardless of ability to pay.
COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B; QUESTION 8 Medicare costs are determined utilizing a combination of the step down method of cost findings to arrive at the routine costs of services provided for each patient type, and a cost per unit of service is used to calculate the routine cost of services provided to Medicare patients. The Ratio of Cost to Charges method is used to determine the cost of ancillary services. An RCC is developed from these costs, and that RCC is applied to total Medicare gross ancillary services charges to determine the cost of services provided to Medicare patients.
COLLECTION POLICY SCHEDULE H, PART III, SECTION B; QUESTION 9B The hospital's collection policy is standard to all accounts regardless of insurance status (e.g. insured, underinsured, and uninsured). The hospital's collection policy states that they will not send patient accounts to collection if a decision on a financial assistance application is pending, or if a patient is determined to be eligible for Medicaid at the time services were rendered and for which services Medicaid payment is available.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTIONS 1J, 3, 4, 5C, 6I & 7 NOT APPLICABLE.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 9 The hospital used the federal poverty guidelines (FPG) limit of 100% to determine eligibility for providing free care although in practice that percentage can be higher based on the facts and circumstances on a case by case basis.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 10 The hospital used the FPG limit of 500% to determine eligibility for providing discounted care. The amount of discounted care is based on the facts and circumstances on a case by case basis.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 11H The hospital used the following factors to determine the basis for calculating amounts charged to patients: (a) income level, (b) asset level, (d) insurance status, (e) uninsured discount, (f) Medicaid/Medicare, (g) state regulation, and (h) other - household size.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 13G The hospital used the following measures to publicize the policy within the community served by the hospital facility: (a) the policy is posted on the hospital facility's website, (b) the policy is attached to billing invoices, (c) the policy is posted in the hospital facility's emergency rooms or waiting rooms, (d) the policy is posted in the hospital facility's admissions offices, (e) the policy is provided, in writing, to patients on admission to the hospital facility, (f) the policy is available on request, (g) the policy is included in the hospital's Community Service Plan and (h) other - the policy is provided at health fairs and presentations open to the community at no cost, in addition to the mailing of financial policy summary brochures.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTIONS 15E NOT APPLICABLE.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 16E NOT APPLICABLE.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 17E Before initiating any of the actions checked in line 16, the hospital facility made the following efforts: (a) notified patients of the financial assistance policy on 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 patients were eligible for financial assistance under the hospital facility's financial assistance policy, and (e) other - letters and telephone calls and presumptive eligibility.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 18D The hospital facility had 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.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 19D The hospital used a blended Medicaid rate as a criterion during the tax year to determine the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care. Under NYS Health Law Section 2807-k (9a) indigent care pool requires a sliding fee scale from qualifying patients. A reduction from gross charges must result in an expected payment that does not exceed the amount paid for the same services by the hospital's highest volume payer (i.e. Medicare or Medicaid).
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 20 NOT APPLICABLE.
FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, QUESTION 21 In general, the hospital facility does not charge its FAP-eligible patients an amount equal to the gross charge for any service provided. The hospital may charge an amount equal to the gross charge when it is less than the Medicaid rate.
NEEDS ASSESSMENT SCHEDULE H, PART VI; QUESTION 2 Community Needs Assessment Strategies are done on an ongoing basis, North Shore-LIJ conducts and participates in population, demographic and health status evaluations of its respective hospitals' service areas and the regions they serve. Multi-year analyses, trends and projections are developed, which identify areas of need for the continuum of health care services. Ongoing input concerning the communities' needs is also obtained through: (1) the System's Board of Trustees/Directors who are all area residents and leaders in their respective communities, (2) Facility based Advisory Boards and Councils, (3) The feedback received by the facility administrators and clinicians that serve on local community agency boards, (4) Internal hospital data, including Prevention Quality Indicators (PQI), (5) Department of Health Community Health Assessments, (6) Community Health Assessments (Volume One, Two, and Three), (7) Local Public Meetings, (8) Local Regional New York State Prevention Agenda Meetings, (9) Community Based Prevention Agenda Needs Surveys, (10) 2010 E-BRFSS, and (11) Statewide Planning and Research System (SPARCS) data. The Committee on Community Health ("the Committee"), a committee of the Board of Trustees, serves as a forum for the identification and discussion of the health needs of the community. The Committee makes recommendations concerning community health interventions to be provided by the System independently or in cooperation with community based organizations and government. The Committee is staffed by the Office of Community and Public Health ("OCPH'). In fulfilling its charge, the Committee also seeks input from local Community Advisory Boards ("CABs") of the constituent hospitals within the System. Throughout the spring, at all scheduled meetings of the Committee and CABs, the Prevention Agenda was discussed and feedback was solicited regarding community needs. Access to care was frequently cited as a concern and staff was able to provide detailed information on the unique work that is underway within the Healthcare Access Center, in collaboration with finance. In addition, specific feedback on the priorities identified for the Prevention Agenda programs was also solicited. Regional Department of Health Community Health Assessments ("CHAs") - Regional stakeholders include: Nassau County Department of Health (NCDOH), Suffolk County Department of Health Services (SCDHS), and New York City Department of Health and Mental Hygiene (NYCDHMH). These regional partners implemented a community survey to solicit additional information on community need as part of the preparation of their CHAs. Public meetings were held to solicit information on the needs and concerns of local community residents. These events were open to the general public and were advertised through local media and posting on the regional DOHs' web sites. Additionally, each regional department of health organizations convened a series of meetings for regional providers to discuss the shared responsibility for public health planning within the New York State Prevention Agenda. Staff from the Office of Community Health of North Shore-LIJ participated in these meetings. These meetings were open to all area hospitals and provided an opportunity for general discussion regarding the public health goals of the Prevention Agenda and the selection of shared priorities for collaborative regional planning.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI; QUESTION 3 North Shore-LIJ is a regional leader in the development of financial assistance programs for the uninsured. The North Shore-LIJ financial assistance policy provides a uniformly-administered system of reduced fees for the uninsured residents of its service area. The current fee schedule includes patients with household incomes up to 500% of the FPG. While the fee schedule serves as a guide, all hardship cases are evaluated on a case-by-case basis, taking into account the individual's financial and personal circumstances. All medically necessary services are covered under the financial assistance program and the public is notified of the availability of the program through: (1) Multilingual signage throughout facilities (i.e. patient access & registration areas), (2) Multilingual educational brochures at key points of patient contact, (3) Centralized program administration accessible via phone (1-888-214-4065), (4) Staff outreach, and (5) Patient bills - all bills include a notice about the financial assistance program. North Shore-LIJ's FAP is streamlined to 1-page. Staff members use soft credit scoring software to reduce the administrative burden of compiling documentation for the application. This information is used to facilitate the application process, but is not used to deny an applicant. The Healthcare Access Center (HAC), staffed by bilingual employees, assists community residents' with referrals for enrollment into government-subsidized insurance programs such as Medicaid, Child Health Plus and Family Health Plus. In addition, the HAC staff refers patients to the Medicaid Prenatal Care Program and to the Senior Navigator Program within North Shore-LIJ for assistance with Medicaid for pregnant women and Medicare enrollment for seniors.
COMMUNITY INFORMATION SCHEDULE H, PART VI; QUESTION 4 The North Shore-LIJ has a service area of more than approximately 7.2 million people covering Long Island (Nassau and Suffolk counties) and the Metropolitan area covering the boroughs of Manhattan, Queens, and Staten Island. The demographics of the community show a broad range of cultural and ethnic diversity, particularly in Queens, the most multi-ethnic county in the country. Overall the area has shown an increase in the number of uninsured and underinsured. The other counties in the service area continue to show trends of increasing diversity, as well. By 2017, the service area population 65 and older will grow by 13.5%, while residents under 65 will decline less than 1% (Thomson Reuters, Market Planner Plus). The service area has also shown high rates of obesity, diabetes, asthma and heart/cerebrovascular disease mortality.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI; QUESTION 5 North Shore-LIJ's community outreach strategies identify health needs through education, community advocacy, partnerships and programs that result in improved access to care and health outcomes. The strategies and tactics for achieving this goal include: (A) Expand community representation on committees for educational events. (B) Provide cultural competence in-service training programs to outreach staff. (C) Inventory and quantify community benefit activities annually for all its facilities. (D) Educate and involve employees and medical staff in the provision of community benefit activities. (E) Assure compliance with New York State Limited English Proficiency standards. (F) Support community partnerships with sustainability strategies via identification of external funding streams. (G) Improve the effectiveness of the North Shore-LIJ Health Care Access Center by targeting outreach programs toward community and staff. (H) Collaborate with community partners to provide locations for community health prevention screenings. North Shore-LIJ recognizes that, to have an impact on community health status, it must collaborate, to the extent possible, with multiple partners who can address different components of program design, including: providing trust and "reach" into a community; access to capital and funding; policy guidance; and, best practices for program development. With thousands of community programs, the System's partners are many and varied. A representative sample of these partners includes: government, national/professional associations, area businesses, other area health care provider, philanthropies, civic organizations and CBOs. North Shore-LIJ provides community residents with a broad array of community benefit programs, such as: improving access to healthcare services and caring for the medically underserved, free screenings and health fairs, community education and outreach programs, support groups, and emergency medical services. The comprehensive list of these programs can be found in the Community Service Plans located on the North Shore-LIJ web site: Http://www.northshorelij.com/NSLIJ/About+Us+Community+Service+Plans.
AFFILIATED HEALTHCARE SYSTEM SCHEDULE H, PART VI; QUESTION 6 The hospital is an affiliate of the North Shore-LIJ Health System Inc., a NYS not-for-profit corporation. All North Shore-LIJ entities are considered to be under common control for antitrust and other legal purposes. Each hospital facility shares a common board and management in the System and as such is referred to as being commonly managed. As a not-for-profit hospital, the hospital facility: (i) Operates emergency rooms that are open to all persons regardless of ability to pay, (ii) Extends medical staff privileges to all qualified physicians in its community for some or all of its departments, (iii) Has a governing body in which independent persons representative of the community comprise a majority, (iv) Engages in medical or scientific research programs, (v) Engages in the training and education of health care professionals, (vi) Participates in government-sponsored health insurance programs including: Medicaid, Medicare, S-Child Health Plus, Family Health Plus, Cancer Services Program, and the Prenatal Program. The Committee on Community Health, a committee of the Board of Trustees, is charged with the overall health of the population served by the System through oversight of coordinated links between North Shore-LIJ's clinical services and the larger public health arena. Staffed by the System's Office of Community and Public Health, the objectives of the committee include: (a) Promote a dialogue about the obligations of a large health system to address the critical issues for the health of the public. (b) Review information which assesses the health status of the communities served. (c) Promote activities which have been shown to positively impact health. (d) Identify demographic studies regarding population disparities in morbidity and mortality. (e) Study and recommend community health interventions to be provided by the System either independently or as a collaborative effort. (f) Propose policy recommendations to guide current programs or develop new programs. (g) Identify opportunities to meet health care needs through improved delivery of health care. (h) Review North Shore-LIJ's service lines and evaluate them within the context of the Strategic Plan and national best practices (i) Make recommendations about resources based on program evaluation results. OCHP provides an infrastructure for the System to organize and promote existing and new community health activities. The office, whose leadership reports to the Community Health Committee, organizes, implements, and reports activities that promote this goal. The scope of OCHP encompasses programs and partnerships that: (1) Facilitate access to primary and specialty care, (2) Educate the public and professionals about health and mental health issues, (3) Promote prevention and screening for common conditions, (4) Reach out to special and vulnerable populations, and (5) Advocate for public policies that support healthier communities. North Shore-LIJ is an integrated health care delivery system which includes 15 hospitals, two long-term care facilities, a world renowned children's medical center, a hospice network, a major research center and many other related entities. With a service area of 7 million persons, encompassing the New York metropolitan, the System has become the nation's second-largest nonprofit, secular health care system and one of the largest clinically integrated health care networks in the country. The System's 15 hospitals contain more than 5,600 beds and include five tertiary, two specialty and eight community hospitals as well as affiliated and clinical relationships with a number of area hospitals. The System's five major tertiary teaching hospitals include North Shore University Hospital (NSUH) in Manhasset (804 beds), Staten Island University Hospital's North Campus on Staten Island (SIUH) (714 beds), Lenox Hill Hospital in Manhattan (652 beds), Southside Hospital in Suffolk (341 beds), and Long Island Jewish Medical Center (LIJMC) in New Hyde Park (888 beds). The LIJMC campus is also home to two free-standing specialty hospitals: Steven and Alexandra Cohen Children's Medical Center (488 beds), and The Zucker Hillside Hospital (236 beds), a psychiatric hospital. As a market share leader, the System, headquartered in Great Neck, New York, provided the following continuum of services in 2011: 283,700 inpatient discharges; 133,400 ambulatory care surgeries; 25,600 deliveries; 640,000 emergency department visits (including emergency admits); and 503,600 home health visits. The System has more than 9,430 physicians and 10,000 nurses, and has a total workforce of more than 43,000 employees. It is the largest employer on Long Island and the third-largest private employer in New York City. Additionally, it has the nation's sixth-largest physician group practice with more than 2,400 full-time physicians in the North Shore-LIJ Medical Group. Clinical programs that are currently coordinated across the health system include: Behavioral Health, Cancer Services, Cardiovascular Services, Children's Health Services, Home Care, Hospice, Rehabilitation, Skilled Nursing, Diagnostic Imaging Services, Emergency Services, Laboratory Services, Physical Medicine and Rehabilitation, Radiation Oncology, Research, Neurosciences, Orthopedics, Urology, and Women's Health Services. North Shore-LIJ is currently expanding centers of excellence system-wide in neurosciences, women's health and orthopedics. North Shore-LIJ has established a free-standing research institute, The Feinstein Institute for Medical Research ("the Institute'), which is comprised of more than 1,500 scientists who work in their laboratories on clinical reasarch programs and closely with clinicians and patients throughout the health system. The Institute ranks in the top 5 percent of all research institutions that receive NIH support and is also chartered to confer doctoral (PhD) degrees through its Elmezzi Graduate School of Molecular Medicine. Hofstra University and North Shore-LIJ entered into a joint academic partnership to develop an allopathic medical school, known as the Hofstra North Shore-LIJ School of Medicine which is the first new allopathic medical school in the New York metropolitan area in more than 35 years. The academic partnership enhanced recruitment of faculty, leadership, and researchers; furthered the expansions of residencies and fellowships; increased North Shore-LIJ's competitiveness for grants and referrals for patient care; and enhanced integration of clinical and translational science. Hofstra North Shore-LIJ School of Medicine welcomed its inaugural class of 40 students in the summer of 2011. The System's hospitals, programs and services support one of the largest resident and fellowship training programs in the United States. It directly sponsors approximately 115 accredited graduate medical education (GME) programs and trains more than 1,500 medical residents and fellows annually. The hospitals and facilities collectively serve as teaching sites for more than 1,200 rotations for medical students from five medical schools.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI; QUESTION 7 New York.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
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
2011
Open to Public Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
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? ....
2
 
 
3
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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
Yes
 
8
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 Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) MICHAEL J DOWLING (i)
(ii)		 0
1,173,096 		0
1,328,520 		0
19,605 		0
721,638 		0
21,175 		0
3,264,034 		0
0
(2) ANTHONY C FERRERI (i)
(ii)		 107,373
773,357 		0
140,660 		11,895
7,857 		10,821
262,514 		2,707
15,100 		132,796
1,199,488 		0
0
(3) KEVIN F LAWLOR (i)
(ii)		 0
597,817 		0
119,000 		0
27,990 		0
296,193 		0
17,251 		0
1,058,251 		0
0
(4) RALPH A NAPPI (i)
(ii)		 0
649,111 		0
100,000 		0
25,707 		0
515,655 		0
18,925 		0
1,309,398 		0
0
(5) ARTHUR J FRIED ESQ (i)
(ii)		 0
225,429 		0
25,863 		0
24,754 		0
26,950 		0
17,750 		0
320,746 		0
0
(6) KEITH C THOMPSON (i)
(ii)		 0
697,420 		0
130,000 		0
29,383 		0
340,418 		0
15,597 		0
1,212,818 		0
0
(7) HARRY E GINDI (i)
(ii)		 0
272,365 		0
28,591 		0
3,383 		0
26,950 		0
15,100 		0
346,389 		0
0
(8) ROBERT S SHAPIRO (i)
(ii)		 0
869,950 		0
155,520 		0
21,870 		0
244,560 		0
18,220 		0
1,310,120 		0
0
(9) THOMAS RECA (i)
(ii)		 486,112
0 		32,233
0 		1,188
100,000 		26,460
0 		12,696
0 		558,689
100,000 		0
0
(10) MARK P JARRETT MD (i)
(ii)		 470,712
0 		31,517
0 		1,188
0 		24,500
0 		11,480
0 		539,397
0 		0
0
(11) DONNA PROSKE (i)
(ii)		 505,215
0 		31,294
0 		1,188
0 		26,460
0 		13,248
0 		577,405
0 		0
0
(12) NICHOLAS CARUSELLE (i)
(ii)		 379,912
0 		25,731
0 		774
0 		16,688
0 		0
0 		423,105
0 		0
0
(13) GREGORY RADINSKY (i)
(ii)		 0
251,571 		0
26,980 		0
16,770 		0
26,950 		0
14,700 		0
336,971 		0
0
(14) JOSEPH T MCGINN MD (i)
(ii)		 1,496,444
0 		0
0 		774
0 		14,700
0 		18,101
0 		1,530,019
0 		0
0
(15) MICHAEL L COOPER MD (i)
(ii)		 953,623
0 		0
0 		51,922
0 		14,700
0 		18,101
0 		1,038,346
0 		0
0
(16) JONATHON DEITCH MD (i)
(ii)		 898,808
0 		100,000
0 		0
0 		0
0 		6,106
0 		1,004,914
0 		0
0
(17) CHRISTOPHER DEMAS MD (i)
(ii)		 797,482
0 		95,625
0 		0
0 		0
0 		19,116
0 		912,223
0 		0
0
(18) PHILLIP M VIGNERI MD (i)
(ii)		 745,275
0 		125,000
0 		0
0 		24,500
0 		11,140
0 		905,915
0 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
COMPENSATION INFORMATION CORE FORM, PART VII and SCHEDULE J, PART II; QUESTION 4B SIX individuals' participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. Accordingly, the individualS may never actually receive the unvested benefit amount and the amounts outlined herein were properly not reported in each individual's Form W-2, Box 5. These amounts are included in Schedule J-II, Column C for Michael J. DowlinG, $694,688; ANTHONY C. FERRERI, $235,564; KEVIN F. LAWLOR, $273,978; Ralph A. Nappi, $488,705; KEITH C. THOMPSON, $313,468 AND ROBERT S. SHAPIRO, $217,610.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 5A PURSUANT TO THE PERSONS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A, THERE IS NO CONTRACTUAL OBLIGATION TO PAY OR ACCRUE ANY COMPENSATION TO OFFICERS OF THE NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM BASED ON THE REVENUE OF THE ORGANIZATION. A LISTED PERSON(S) THAT MAY QUALIFY UNDER THIS CONDITION COULD BE ONE OR MORE OF THE PHYSICIANS LISTED AS A HIGHLY COMPENSATED EMPLOYEE.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 7 ON FORM 990, PART VII, SECTION A, LINE 1A, THE ORGANIZATION MAY PROVIDE NON-FIXED PAYMENTS, NOT DESCRIBED ON LINES 5 AND 6, TO CERTAIN LISTED PERSONS. THE ORGANIZATION BASES SUCH PAYMENTS ON MANY PERFORMANCE BASED FACTORS. PAYMENTS OF THIS TYPE APPEAR ON SCHEDULE J-1, PART I, B (II).
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number
11-2868878
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A DORMITORY AUTHORITY - STATE OF NEW YORK
  		14-6000293   11-09-2006 7,750,186 LEASE OF EQUIPMENT   X   X   X
B DORMITORY AUTHORITY - STATE OF NEW YORK
  		12-6000293   08-19-2009 4,744,692 LEASE OF EQUIPMENT   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 6,429,115 422,979    
2 Amount of bonds legally defeased . . . . . . . . . . 0 0    
3 Total proceeds of issue . . . . . . . . . . . . . 8,074,242 4,744,692    
4 Gross proceeds in reserve funds . . . . . . . . 0 0    
5 Capitalized interest from proceeds . . . . . . . . . . 0 0    
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0    
7 Issuance costs from proceeds . . . . . . . . . . . 40,524 83,250    
8 Credit enhancement from proceeds . . . . . . . . . . 0 0    
9 Working capital expenditures from proceeds . . . . . . . 0 0    
10 Capital expenditures from proceeds . . . . . . . . . . 8,033,718 4,661,442    
11 Other spent proceeds . . . . . . . . . . . 0 0    
12 Other unspent proceeds . . . . . . . . . . . 0 0    
13 Year of substantial completion . . . . . . . . . . . 2009 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X   X        
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X        
16 Has the final allocation of proceeds been made? . . . . . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X        
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X          
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000%   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0.00000%   %   %
7 Does the bond issue meet the private security or payment test? . . . X   X          
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue?   X   X        
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X        
b Name of provider . . . . . . . . 0
  		0
  		 
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X        
b Name of provider . . . . . . 0
  		0
  		 
  		 
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X        
6 Did the bond issue qualify for an exception to rebate? .   X X          
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X X          
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) TONI A SPINELLA DAUGHTER OF OFFICER 44,195 EMPLOYEE   No
(2) TARA MAZZUCCO DAUGHTER OF TRUSTEE 38,983 EMPLOYEE   No
(3) SCARAN OIL COMPANY/FAMILY OF TRUSTEE 403,711 OIL/UTILITY PRODUCT   No
(4) JAMES R WELLER SON OF OFFICER 42,115 EMPLOYEE   No
(5) DONNA FERRERI FAMILY MEMBER of officer 44,299 EMPLOYEE   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV FRANK W. SCARANGELLO, SR. IS A TRUSTEE OF THE ORGANIZATION. THE ORGANIZATION UTILIZED THE SERVICES OF HIS COMPANY, SCARAN OIL, DURING 2011. TOTAL FEES PAID TO SCARAN OIL WERE $403,711. SERVICES WERE RENDERED AT FAIR MARKET VALUE RATES PURSUANT TO ARM'S LENGTH NEGOTIATIONS.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




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
2011
Open to Public
Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
Identifier Return Reference Explanation
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS CORE FORM, PART III; LINE 4D EXPENSES INCURRED IN PROVIDING VARIOUS OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.
BUSINESS AND FAMILY RELATIONSHIPS CORE FORM, PART VI, SECTION A; QUESTION 2 FORM 990 SCHEDULE A, PART III STATEMENT ABOUT ACTIVITY ====================================================== ALL TRANSACTIONS WITH NORTH SHORE-LIJ HEALTH SYSTEM ENTITIES ARE AS FOLLOWS: (1) NEGOTIATED AT ARM'S LENGTH; (2) ALL PURCHASES ARE AT FAIR MARKET VALUE; AND (3) ALL PRODUCTS OR SERVICES ARE RENDERED ON AN "AS NEEDED" BASIS. William Achenbaum ----------------- has a business relationship with Eric and Roger Blumencranz. John Alexander -------------- has a business relationship with John Shall and Stanley Applebaum. Philip Altheim -------------- has a business relationship with Eric Blumencranz. Stanley Applebaum ----------------- has a business relationship with John Alexander and John Shall. Michael Ashner -------------- has a business relationship with William Mack. Eric Blumencranz ---------------- has as a family relationship with Roger Blumencranz. He has a business relationship with Roger Blumencranz, William Achenbaum, Philip Altheim, Richard D. Goldstein, Lloyd Goldman, Alan Greene, James Greene, Richard Guarasci, Richard Horowitz, Jeffrey Jurick, Lyn Jurick, Seth Kupferberg, Arthur Levine, Stuart Levine, David Mack, Bradley Marsh, Charles Merinoff, Ralph Nappi, Dennis Riese and Michael Slade. Roger Blumencranz ----------------- has a family relationship with Eric Blumencranz. He has a business relationship with Eric Blumencranz, William Achenbaum, Alan Greene, James Greene, Stanley Grey, Richard D. Goldstein, Richard Horowitz, Jeffrey Jurick, Lyn Jurick, Stuart Levine, David Mack, Bradley Marsh, Charles Merinoff, Ralph Nappi, Donald Zucker, Barbara Zucker. David Blumenfeld ---------------- has a family relationship with Edward Blumenfeld. Edward Blumenfeld ----------------- has a family relationship with David Blumenfeld. He has a business relationship with William Mack. Steve Braun ----------- has a family relationship with Richard Sims. Alan Chopp ---------- has a business relationship with Patrick Mc Dermott. Mark Claster ------------ has a business relationship with Robert Rosenthal, Richard Goldstein, Saul Katz and Barry Rubenstein. Philippe Dauman --------------- has a business relationship with Michael Hoffman. Daniel de Roulet --------------- has a family relationship with Lorinda de Roulet. Lorinda de Roulet ---------------- has a family relationship with Daniel de Roulet. Leonard Feinstein ----------------- has a business relationship with William Mack. Anthony Ferreri --------------- has a family and business relationship with John Shall. Lloyd Goldman ------------- has a business relationship with Eric Blumencranz, Richard Goldstein and William Mack. RICHARD D. GOLDSTEIN -------------------- has a business relationship with Roger Blumencranz, Eric Blumencranz, Mark Claster, Lloyd Goldman, William Mack, and Barry Rubenstein. Joaquin Gonzalez ---------------- has a business relationship with John Shall. Alan I. Greene -------------- has a family relationship with James R. Greene. He has a business relationship with Eric and Roger Blumencranz. James R. Greene --------------- has a family relationship with Alan I. Green. He has a business relationship with Eric and Roger Blumencranz. Stanley Grey ------------ has a business relationship with Roger Blumencranz. Richard Guarasci ---------------- has a business relationship with Eric Blumencranz. Paul Guenther ------------- has a business relationship with Michael Hoffman. MARLENE HESS ------------ HAS A BUSINESS RELATIONSHIP WITH michael hoffman. William Hiltz ------------- has a business relationship with Michael Hoffman. Michael Hoffman --------------- has a business relationship with Phillipe Dauman, Paul Guenther, Marlene Hess, William Hiltz and Richard Nye. Richard Horowitz ---------------- has a business relationship with Eric and Roger Blumencranz. Jeffrey Jurick -------------- has a family relationship with Lyn Jurick. He has a business relationship with Eric and Roger Blumencranz. Lyn Jurick ----------- has a family relationship with Jeffrey Jurick. She has a business relationship with Eric and Roger Blumencranz. David Katz ---------- has a family relationship with Saul Katz and Michael Katz. Michael Katz ------------ has a family relationship with Saul Katz and David Katz. He has a business relationship with Saul Katz, Curt Launer and Michael Slade. Saul Katz --------- has a family relationship with Michael Katz and David Katz. He has a business relationship with Mark Claster, Michael Katz, Curt Launer and Michael Slade. Seth Kupferberg --------------- has a business relationship with Eric Blumencranz. Jeffrey Lane ------------ has a business relationship with William Mack. Curt Launer ----------- has a business relationship with Michael Katz and Saul Katz. David Lehr ---------- has a business relationship with Ronald Mazzucco. Arthur Levine ------------- has a business relationship with Eric Blumencranz. Stuart Levine ------------- has a business relationship with Eric and Roger Blumencranz. David MACK ---------- has a family relationship with William Mack. He has a business relationship with William Mack, Eric Blumencranz, and Roger Blumencranz. William Mack ------------ has a family relationship with David Mack. He has business relationships with David Mack, Michael Ashner, Edward Blumenfeld, Leonard Feinstein, Lloyd Goldman, Jeffrey Lane, Barry Rubenstein, Scott Rudolph, Richard Goldstein and Roy Zuckerberg. Bradley Marsh ------------- has a family relationship with Jack Ross. He has a business relationship with Eric and Roger Blumencranz. Ronald Mazzucco --------------- has a business relationship with David Lehr. F.J. McCarthy ------------- has a business relationship with Robert Rosenthal. Patrick McDermott ----------------- has a business relationship with Alan Chopp and John Shall. Charles Merinoff ---------------- has a business relationship with Eric and Roger Blumencranz. Ralph Nappi ----------- has a business relationship with Eric Blumencranz. Richard Nye ----------- has a busienss relationship with Michael Hoffman. Dennis Riese ------------ has a business relationship with Eric Blumencranz. Robert Rosenthal ---------------- has a business relationship with Mark Claster and F.J. McCarthy. Dr Bernard Rosof ---------------- has a business relationship with Huntington Hospital Trustees. Jack Ross --------- has a family relationship with Bradley Marsh. Barry Rubenstein ---------------- has a business relationship with Saul Katz, Richard Goldstein, William Mack and Mark Claster. Scott Rudolph ------------- has a business relationship with William Mack. John Shall ---------- has a family relationship with Anthony Ferreri. He has a business relationship with Anthony Ferreri, Patrick McDermott, John Alexander, Stanley Applebaum, and Joaquin Gonzalez. Richard Sims ------------ has a family relationship with Steve Braun. Michael Slade ------------- has a business relationship with Eric Blumencranz, Saul Katz and Michael Katz. Barbara Hrbek Zucker -------------------- has a family relationship with Donald Zucker. She has a business relationship with Roger Blumencranz. Donald Zucker ------------- has a family relationship with Barbara Hrbek Zucker. He has a business relationship with Roger Blumencranz. Roy Zuckerberg -------------- has a business relationship with William Mack.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION A; QUESTION 4 The By-Law changes makes the corporation a member of an obligated group for financing purposes, with other member-hospitals of the North Shore-Long Island Jewish Health System.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION A; QUESTION 7 North Shore-Long Island Jewish Health Care, Inc. ("Health Care") is the sole corporate member of the organization. Health Care has the right to elect or appoint members of the organization's governing body and has the right to approve or ratify certain corporate decisions. This organization and Health Care are part of the North Shore - long Island Jewish Health System, an integrated healthcare delivery system.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION b; QUESTION 11b All North Shore-LONG ISLAND JEWISH Health System Inc. and affiliated entities prepare the annual Return of Organization Exempt Form Income Tax (Form 990) with input from various departments including Corporate Compliance, Finance, Human Resources, and Legal). Before filing the returns, the documents are electronically made available for review to members of the Executive Committee. The Executive Committee, which is a committee made up of members from the Board of Trustees, may exercise all of the authority of the Board of Trustees except as such authority is limited by applicable law and except to the extent, if any, that such authority would be inconsistent with any provision of these By-laws or is limited by any resolution to such effect adopted by the Board of Trustees.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 12 The North Shore-Long Island Jewish Health System ("Health System") has several control mechanisms to mitigate conflicts of interest. The Health System's Code of Ethical Conduct contains a detailed section educating individuals about how to avoid potential conflicts of interest. Specifically, our Code of Ethical Conduct requires individuals to conduct Health System business in a manner that places the interests of the Health System ahead of their personal interests. In addition, the Health System has a Conflicts of Interest Policy Statement further elaborating upon individuals' disclosure and recusal obligations. Individuals that are in a position to influence the business or other decisions of the Health System are required to filed out a conflicts of interest disclosure form on a regular basis. The Corporate Compliance Office reviews all disclosures of possible conflicts, including matters disclosed in any conflicts of interest disclosure report and takes any actions deemed required or appropriate to manage or resolve any actual or potential conflicts of interest. In appropriate cases these disclosures and responsive actions will be reported to the Health System's Audit and Corporate Compliance Committee and other applicable committees. In addition, the Health System provides training to individuals on an annual basis regarding conflicts of interest and other compliance related topics. If an individual violates the Code of Ethical Conduct or any related policy such as the Conflicts of Interest Policy Statement, appropriate disciplinary action is taken based upon the facts and circumstances of the situation.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 15 THE BY-LAWS OF THE HEALTH SYSTEM CREATE A COMMITTEE OF THE BOARD WITH FULL POWERS OF THE BOARD TO REVIEW AND APPROVE THE COMPENSATION OF OFFICERS AND OTHER KEY EMPLOYEES. THE COMMITTEE CONSISTS OF APPROXIMATELY 6 TRUSTEES WHO HAVE NO CONNECTION TO THE SYSTEM EXCEPT AS TRUSTEES AND THEY HAVE NO CONFLICTS AS TO MATTERS THEY CONSIDER. THE COMMITTEE MEETS SEVERAL TIMES A YEAR AS NEEDED BUT ALWAYS MEETS IN NOVEMBER/DECEMBER TO REVIEW AND DETERMINE OFFICER AND KEY EMPLOYEE COMPENSATION FOR THE FOLLOWING YEAR. FOR PURPOSES OF THEIR REVIEW THE COMMITTEE CONSIDERS THE RECOMMENDATIONS OF THE CEO FOR ALL PERSONS OTHER THAN THE CEO. FOR PURPOSES OF THE REVIEW EACH YEAR THE COMMITTEE RECEIVES INFORMATION FROM AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT AS TO COMPENSATION FOR COMPARABLE POSITIONS IN COMPARABLE ORGANIZATIONS AND MAKES ITS DECISIONS ON THIS BASIS, WITH THE OVERALL OBJECTIVE OF PAYING BASE SALARY AT THE 50TH PERCENTILE. ANY CONTRACTS OR OTHER COMPENSATION FOR OFFICERS OR KEY EMPLOYEES ARE SEPARATELY CONSIDERED AND NORMALLY ONLY APPROVED AFTER RECEIPT OF A "FAIRNESS OPINION" FROM THE INDEPENDENT CONSULTANT. ALL THE WORK AND PROCESS OF THE COMMITTEE IS STRUCTURED TO FALL WITHIN THE APPLICABLE SAFE HARBOR REGULATIONS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION C; QUESTION 19 CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.
RELATED HOURS INFORMATION CORE FORM, PART VII, SECTION A This organization is affiliated with the North Shore - Long Island Jewish Health System (the "Health System"). The Officers, Directors and Trustees listed on Schedule J hold similar positions with both this organization and other affiliates of the Health System, and they do not separately allocate their time to this organization and such other affiliates. The hours shown for all such persons reflect time devoted to the entire Health System and its affiliates, including this organization. For Directors and Trustees, the hours shown reflect the estimated average weekly time. For officers, Key Employees and Highest Compensated Employees, the hours shown reflect the weekly hours used when determining compensation payments for services rendered and are, generally, less than the actual weekly hours devoted to the Health System and its affiliates.
RECONCILIATION OF NET ASSETS CORE FORM, PART XI; QUESTION 5 OTHER CHANGES IN FUND BALANCE INCLUDE: - PENSION AND OTHER POSTRETIREMENT LIABILITY ADJUSTMENTS - ($33,398) - CHANGE IN NET UNREALIZED GAINS/(LOSSES) AND CHANGE IN VALUE ON EQUITY METHOD INVESTMENTS - $1,710,848 - CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS DESIGNATED AS DERIVATIVE INSTRUMENTS - ($1,091,789) - MEDICAL RESIDENT TAX RECOVERY - $1,305,546 - NET ASSETS RELEASED FROM RESTRICTION FOR CAPITAL ASSET ACQUISITIONS - $1,912,222 - NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS - $1,064,965 - NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - $150,542 - DEFEASEMENT OF LONG-TERM DEBT - ($3,070,067)
AUDITED FINANCIAL STATEMENTS CORE FORM, PART XII; QUESTION 2 THE ORGANIZATION IS AN AFFILIATE WITHIN THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. ("SYSTEM"), A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES STATEN ISLAND UNIVERSITY HOSPITAL. THE SYSTEM'S PARENT ENTITY IS NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. AND ITS AFFILIATES FOR THE YEARS ENDED DECEMBER 31, 2011 AND DECEMBER 31, 2010; RESPECTIVELY. THESE CONSOLIDATED AUDITED FINANCIAL STATEMENTS INCLUDE CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE NORTH SHORE - LONG ISLAND JEWISH HEALTHCARE SYSTEM, INC. EXECUTIVE COMMITTEE HAS ASSUMED RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS, WHICH INCLUDES THIS ORGANIZATION, AND THE SELECTION OF AN INDEPENDENT AUDITOR.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD D GOLDSTEIN TITLE:CHAIRMAN - TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN ALEXANDER TITLE:TREASURER - TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD S ABRAMSON TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM ACHENBAUM TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:IRA I ALTFEDER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILIP S ALTHEIM TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STANLEY A APPLEBAUM TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL L ASHNER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BEVERLY BANKER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RALPH M BARUCH TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MORTON M BASS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK J BESIGNANO TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELISE M BLOOM TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ERIC S BLUMENCRANZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROGER A BLUMENCRANZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID BLUMENFELD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EDWARD BLUMENFELD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:E STEVE BRAUN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAYTON T BROWN JR TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALLEN E BUSCHING TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JONATHAN S CANNO TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL CARIDI TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:REVEREND DEMETRIUS S CAROLINA SR TITLE:TRUSTE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RUDOLPH C CARRYL TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT W CHASANOFF TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALAN CHOPP TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK CLASTER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DIANA F COLGATE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL M CROWN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILIPPE P DAUMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL C DE ROULET TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LORINDA DE ROULET TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS E DEWEY JR TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS E DOOLEY TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL J DOWLING TITLE:TRUSTEE HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT N DOWNEY TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MELVIN DUBIN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATRICK R EDWARDS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TONI J ELLIOTT TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL A EPSTEIN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LEONARD FEINSTEIN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL E FELDMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARLENE LANE FISHER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CATHERINE C FOSTER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM H FRAZIER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EUGENE B FRIEDMAN MD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SY GARFINKEL TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LLOYD MICHAEL GOLDMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:J JOAQUIN GONZALEZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL GOULD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALBERT L GRANGER DDS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALAN I GREENE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES R GREENE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STANLEY GREY TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD GUARASCI PHD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAUL B GUENTHER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HENRY L HACKMANN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:AMY M HAGEDORN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHEN L HAMMERMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:IRA HAZAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA W HEANEY TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARLENE HESS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM O HILTZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL HOFFMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEDALE B HOROWITZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD A HOROWITZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M ALLAN HYMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK JACOBSON TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY JURICK TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LYN JURICK TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARTHUR KALISH TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEVEN L KANTOR TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID M KATZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL KATZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SAUL B KATZ TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LISA A KAUFMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT KAUFMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CARY KRAVET TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STANLEY KREITMAN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SETH KUPFERBERG TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY B LANE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CURT N LAUNER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LAURA LAURIA TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN F LAWLOR TITLE:TRUSTEE HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL S LEEDS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID W LEHR TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JONATHAN W LEIGH TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SYLVIA LESTER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARTHUR S LEVINE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STUART R LEVINE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SETH LIPSAY TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID S MACK TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM L MACK TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HOWARD S MAIER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA MANFREDI TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES S MARCUS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRADLEY MARSH DPM TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY S MAURER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RONALD J MAZZUCCO TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:F J MCCARTHY TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATRICK F MCDERMOTT TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KATHERINE MCENROE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES MCMULLEN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES MERINOFF TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:AIMEE MERSZEI TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD D MONTI TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TOMAS D MORALES PHD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD MURCOTT TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RALPH A NAPPI TITLE:TRUSTEE HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD B NYE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CLYDE I PAYNE ED D TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARNOLD S PENNER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN J RAGGIO TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LEWIS S RANIERI TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAY R RAUBVOGEL TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:COREY RIBOTSKY TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DENNIS RIESE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TERRY P RIFKIN MD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT A ROSEN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARCIE ROSENBERG TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT D ROSENTHAL TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BERNARD M ROSOF MD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JACK J ROSS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BARRY RUBENSTEIN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HERBERT RUBIN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT RUDOLPH TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL H SAHN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK W SCARANGELLO SR TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NORMAN SCHLANGER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LOIS C SCHLISSSEL TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN M SHALL TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT F SHAPIRO TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARC V SHAW TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SEAN G SIMON TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD SIMS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL C SLADE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHYLLIS HILL SLATER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HOWARD D STAVE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RUSSELL STERN TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MAGANLAL SUTARIA MD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN B THOMSON JR TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PETER TILLES TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SANDRA TYTEL TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NANCY WALDBAUM TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GARY WALTER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HOWARD WEINGROW TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LEWIS M WESTON TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JON A WURTZBURGER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BARBARA HRBEK ZUCKER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONALD ZUCKER TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROY J ZUCKERBERG TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARTHUR J FRIED ESQ TITLE:SECRETARY HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEITH C THOMPSON TITLE:ASSISTANT SECRETARY HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HARRY E GINDI TITLE:ASSISTANT TREASURER HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT S SHAPIRO TITLE:SVP/CFO NS-LIJ HEALTH SYSTEM HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS RECA TITLE:CHIEF FINANCIAL OFFICER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK P JARRETT MD TITLE:CHIEF MEDICAL OFFICER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONNA PROSKE TITLE:EVP - CHIEF NURSING EXECUTIVE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NICHOLAS CARUSELLE TITLE:EXECUTIVE VICE PRESIDENT HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GREGORY RADINSKY TITLE:CHIEF COMPLIANCE OFFICER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH T MCGINN MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL L COOPER MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JONATHON DEITCH MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHRISTOPHER DEMAS MD TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILLIP M VIGNERI MD TITLE:PHYSICIAN HOURS:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL
 
Employer identification number

11-2868878
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







(1) CASTLETON AVENUE ASSOCIATES LLC
475 SEAVIEW AVENUE
STATEN ISLAND,NY10305
13-3943199 		INACTIVE NY   0 SIUH
 










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
Yes No
(1) CHAPS Community Health Center Inc

1 Edgewater Plaza 6th Floor

Staten Island,NY10305
11-3345477 		Inactive NY 501(C)(3) 9 SIUH
 
Yes
 
(2) Feinstein Institute for Medical Research

972 Brush Hollow Rd

Westbury,NY11590
11-2673595 		Research NY 501(C)(3) 4 NS-LIJ HS
 
 
No
(3) Forest Hills Hospital

972 Brush Hollow Rd

Westbury,NY11590
11-2163522 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(4) Franklin Hospital

972 Brush Hollow Rd

Westbury,NY11590
11-2296824 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(5) Glen Cove Hospital

972 Brush Hollow Rd

Westbury,NY11590
11-1633487 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(6) Hillside Hospital Houses Inc

972 Brush Hollow Rd

Westbury,NY11590
11-2113949 		Housing Comp NY 501(C)(2) N/A NS-LIJ HS
 
 
No
(7) Hospice Care Network

99 Sunnyside Blvd

Woodbury,NY11797
11-2925757 		Hospice NY 501(C)(3) 9 NS-LIJ HS
 
 
No
(8) Huntington Hospital

270 Park Avenue

Huntington,NY11743
11-1630914 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(9) Huntington Hosp Dolan Family Health Ctr

284 Pulaski Rd

Greenlawn,NY11740
11-3368503 		HealthCare NY 501(C)(3) 3 Huntington
 
 
No
(10) LIJ Foundation

972 Brush Hollow Rd

Westbury,NY11590
11-2661239 		support org NY 501(C)(3) 11, TYPE I NS-LIJ HS
 
 
No
(11) Long Island Jewish Medical Center

972 Brush Hollow Rd

Westbury,NY11590
11-2241326 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(12) LIJ Medical Center at Home Pharmacy

972 Brush Hollow Rd

Westbury,NY11590
11-3251128 		support org NY 501(C)(3) 11, TYPE I NS-LIJ HS
 
 
No
(13) North Shore Community Services Inc

972 Brush Hollow Rd

Westbury,NY11590
23-7273200 		Housing Comp NY 501(C)(2) N/A NS-LIJ HS
 
 
No
(14) North Shore University Hospital

972 Brush Hollow Rd

Westbury,NY11590
11-1562701 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(15) NS Univ Hospital at Glen Cove Housing

972 Brush Hollow Rd

Westbury,NY11590
23-7010468 		Housing Comp NY 501(C)(2) N/A NS-LIJ HS
 
 
No
(16) North Shore University Hospital Housing

972 Brush Hollow Rd

Westbury,NY11590
11-2171903 		Housing Comp NY 501(C)(2) N/A NS-LIJ HS
 
 
No
(17) NS Univ Hospital Stern Family CECR

972 Brush Hollow Rd

Westbury,NY11590
23-7007485 		Nursing Home NY 501(C)(3) 9 NS-LIJ HC
 
 
No
(18) North Shore-LIJ Health Care Inc

972 Brush Hollow Rd

Westbury,NY11590
11-2965586 		support org NY 501(C)(3) 11, TYPE I NS-LIJ HS
 
 
No
(19) North Shore-LIJ Health System

972 Brush Hollow Rd

Westbury,NY11590
11-3418133 		support org NY 501(C)(3) 11, TYPE I NA
 
 
No
(20) North Shore-LIJ Health System Foundation

972 Brush Hollow Rd

Westbury,NY11590
11-2965575 		Fundraising NY 501(C)(3) 7 NS-LIJ HS
 
 
No
(21) North Shore-LIJ Health Sys Laboratories

972 Brush Hollow Rd

Westbury,NY11590
11-3412370 		Support Org NY 501(C)(3) 11, TYPE I NS-LIJ HS
 
 
No
(22) North Shore-LIJ Medical Care Centers

972 Brush Hollow Rd

Westbury,NY11590
11-3473923 		support org NY 501(C)(3) 11, TYPE I NS-LIJ HS
 
 
No
(23) Plainview Hospital

972 Brush Hollow Rd

Westbury,NY11590
11-3241243 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(24) SIUH Systems Inc

475 Seaview Avenue

Staten Island,NY10305
06-1074604 		Fundraising NY 501(C)(3) 7 NS-LIJ HC
 
 
No
(25) Southside Hospital

972 Brush Hollow Rd

Westbury,NY11590
11-1667761 		HealthCare NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(26) SSH Inc

972 Brush Hollow Rd

Westbury,NY11590
11-2774102 		support org NY 501(C)(3) 11, TYPE I SOUTHSIDE
 
 
No
(27) Staten Island Univ Hospital Foundation

360 Seaview Avenue

Staten Island,NY10305
87-0765787 		Fundraising NY 501(C)(3) 7 SIUH
 
Yes
 
(28) THE HEART INSTITUTE

475 SEAVIEW AVENUE

STATEN ISLAND,NY10305
31-1757254 		SUPPORT ORG NY 501(C)(3) 11, TYPE I NA
 
 
No
(29) PHYSICIANS OF UNIVERSITY HOSPITAL PC

1 EDGEWATER PLAZA 6th floor

STATEN ISLAND,NY10305
20-0096809 		HEALTHCARE NY 501(C)(3) 11, TYPE I SIUH
 
Yes
 
(30) LENOX HILL HOSPITAL

100 EAST 77 STREET

NEW YORK,NY10021
13-1624070 		HEALTHCARE NY 501(C)(3) 3 NS-LIJ HC
 
 
No
(31) LHH CORPORATION

100 EAST 77TH STREET

NEW YORK,NY10021
13-3272016 		SUPPORT ORG NY 501(C)(3) 11, TYPE I NS-LIJ HS
 
 
No
(32) THE ELMEZZI GRAD SCHOOL OF MOLECULAR MED

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-3284934 		GRADUATE SCH NY 501(C)(3) 2 NS-LIJ HS
 
 
No
(33) SPORTS PHYSICAL THERAPY AND REHAB SVCS

972 BRUSH HOLLOW RD

WESTBURY,NY11590
06-1655704 		HEALTHCARE NY 501(C)(3) 9 LIJ
 
 
No
(34) NORTH SHORE - LIJ ALLIANCE

972 BRUSH HOLLOW RD

WESTBURY,NY11590
26-3727582 		HEALTHCARE NY 501(C)(3) 3 NA
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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 V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) KRASNOFF CONS SVCS

972 Brush Hollow ROAD
WESTBURY,NY10305
26-2838027 		CONSULTING NY CARE MGT GROUP
  		N/A       No     No  
(2) POPULATION HLTH MGT

972 BRUSH HOLLOW
WESTBURY,NY11590
45-2409051 		ACO NY NS-LIJ HC
  		RELATED       No     No  
(3) LONG ISL BEHAV HLTH

972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-3572263 		STATISTICS NY NS-LIJ HC
  		REALTED       No     No  








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) Activity Works LLC
972 Brush Hollow Rd
Westbury,NY11590
26-4708923 		Medical ServiCES NY LIJ
  		C CORPORATION      
(2) Adv Heart Phys & Surgeons Network PC
130 East 77th St 4th Floor
New York,NY10021
13-3853125 		Medical ServiCES NY LENOX HILL
  		S CORPORATION      
(3) Adv Imag & Rad of Lenox Hill Hosp PC
100 East 77th St
New York,NY10021
20-0719612 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(4) Aletta Corporation
972 Brush Hollow Rd
Westbury,NY11590
11-2622371 		Physician SVCS NY SOUTHSIDE
  		C CORPORATION      
(5) Autoimmune Research Therapeutics
972 Brush Hollow Rd
Westbury,NY11590
27-0701489 		Inactive NY RESEARCH
  		C CORPORATION      
(6) Care Management Group of Greater NY
972 Brush Hollow Rd
Westbury,NY11590
11-3336381 		Business ServICES NY NSH ENTERPRISES
  		C CORPORATION      
(7) Emergency Med Svcs of Staten Island PC
1 Edgewater Plaza 6th floor
Staten Island,NY10305
13-4200899 		Medical ServiCES NY SIUH
  		C CORPORATION 3,050,673 11,277 100.000 %
(8) Goethals Radiology PC
500 Seaview Ave
Staten Island,NY10305
20-0010287 		Radiology SVCS NY SIUH
  		C CORPORATION 702,069 19,597 100.000 %
(9) Lenox Hill Cardiology Associates PC
100 East 77th St
New York,NY10021
13-3385163 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(10) Lenox Hill Int Card & Vasc Svcs PC
130 East 77th St 9th floor
New York,NY10021
20-1435770 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(11) Lenox Hill Pathology PC
100 East 77th St
New York,NY10021
13-3644370 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(12) Lenox Hill Phy Hospital Org Inc
122 East 76th St suite 3-a
New York,NY100212834
13-3775996 		Managed Care NY LENOX HILL
  		C CORPORATION      
(13) Lenox otolaryngology head & neck
186 East 76th St 2nd floor
New York,NY10021
20-8784395 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(14) Long Island Medical Care PC
972 Brush Hollow Rd
Westbury,NY11590
11-3217006 		Medical ServiCES NY NSUH
  		C CORPORATION      
(15) Manhattan Min Inv and Bar Surgery PC
186 East 76th St 1st Floor
New York,NY10021
20-0250107 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(16) North Shore Health Enterprises
972 Brush Hollow Rd
Westbury,NY11590
06-1605319 		Holding Comp NY NSHS ENTERPRISE
  		C CORPORATION      
(17) NS Health System Enterprises
972 Brush Hollow Rd
Westbury,NY11590
11-3316922 		Holding Comp NY NS-LIJ HS
  		C CORPORATION      
(18) NS IPA 5 Inc
972 Brush Hollow Rd
Westbury,NY11590
11-3383468 		Business ServICES NY NS-LIJ HC
  		C CORPORATION      
(19) NS Radiology at Glen Cove PC
972 Brush Hollow Rd
Westbury,NY11590
11-3301179 		Medical ServiCES NY NSUH
  		C CORPORATION      
(20) NS-LIJ Health System IPA #1
972 Brush Hollow Rd
Westbury,NY11590
11-3533659 		Health Care NY LIJ
  		C CORPORATION      
(21) NS-LIJ Health System IPA #2
972 Brush Hollow Rd
Westbury,NY11590
11-3533670 		Health Care NY LIJ
  		C CORPORATION      
(22) NS-LIJ Health System IPA #3
972 Brush Hollow Rd
Westbury,NY11590
11-3533678 		Health Care NY LIJ
  		C CORPORATION      
(23) NS-LIJ Health System IPA #4
972 Brush Hollow Rd
Westbury,NY11590
11-3533677 		Health Care NY LIJ
  		C CORPORATION      
(24) NS-LIJ Health System IPA #5
972 Brush Hollow Rd
Westbury,NY11590
11-3533675 		Health Care NY LIJ
  		C CORPORATION      
(25) NS-LIJ Medical Gr at Huntington PC
972 Brush Hollow Rd
Westbury,NY11590
27-4384049 		Medical ServiCES NY NSUH
  		C CORPORATION      
(26) NS-LIJ Medical Gr at North Nassau PC
972 Brush Hollow Rd
Westbury,NY11590
27-4384146 		Medical ServiCES NY NSUH
  		C CORPORATION      
(27) NS-LIJ Medical Gr at Syosset PC
972 Brush Hollow Rd
Westbury,NY11590
27-3957752 		Medical ServiCES NY NSUH
  		C CORPORATION      
(28) NS-LIJ Medical Group PC
972 Brush Hollow Rd
Westbury,NY11590
27-4384249 		Medical ServiCES NY NSUH
  		C CORPORATION      
(29) NS-LIJ Network Inc
972 Brush Hollow Rd
Westbury,NY11590
32-0257193 		Support ServiCES NY NS-LIJ HS
  		C CORPORATION      
(30) NS-LIJ Phys Ins Co Risk Ret Gp
100 Bank St
Burlington,VT05401
26-1487515 		FINANCIAL VEHICLE VT NS-LIJ HC
  		C CORPORATION      
(31) North Shore-LIJ Physicians Group PC
972 Brush Hollow Rd
Westbury,NY11590
27-4384326 		Medical ServiCES NY NSUH
  		C CORPORATION      
(32) North Shore-LIJ Radiology Services PC
972 Brush Hollow Rd
Westbury,NY11590
22-3970667 		Medical ServiCES NY NSUH
  		C CORPORATION      
(33) North Shore-LIJ Service Alliance Inc
972 Brush Hollow Rd
Westbury,NY11590
26-3651575 		Support ServiCES NY NA
  		C CORPORATION      
(34) Ocean Breeze Home Care Agency
1 Edgewater Plaza 6th Floor
Staten Island,NY10305
13-3773601 		Inactive NY OVM
  		C CORPORATION      
(35) Ocean View Management inc
1 Edgewater Plaza 6th Floor
Staten Island,NY10305
13-3138888 		Management SvCS NY SIUH
  		C CORPORATION 204,973 1,107,846 100.000 %
(36) Palliative Care Medical Services PC
99 Sunnyside Blvd
Woodbury,NY11797
27-3957835 		Medical ServiCES NY HOSPICE
  		C CORPORATION      
(37) Park Lenox Emergency Medicine PC
100 East 77th St
New York,NY10021
26-2661082 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(38) Park Lenox Medical PC
100 East 77th St
New York,NY10021
13-3575380 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(39) Park Lenox OBGYN PC
130 East 77th St 2nd Floor
New York,NY10021
13-3596988 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(40) Park Lenox Orthopedics PC
100 East 77th St
New York,NY10021
26-4634966 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(41) Park Lenox Pediatrics PC
100 East 77th St
New York,NY10021
13-3755683 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(42) Park Lenox Surgical PC
130 East 77th St 13th Floor
New York,NY10021
13-3397814 		Medical ServiCES NY LENOX HILL
  		C CORPORATION      
(43) Regency Alliance Services Inc
1 Edgewater Plaza 6th Floor
Staten Island,NY10305
13-3277698 		Management SvCS NY OVM
  		C CORPORATION      
(44) Regional Insurance Company LTD
41 Cedar Ave
Hamilton,BERMUDAHM 12
BD
FINANCIAL VEHICLE BD NS-LIJ HC
  		C CORPORATION      
(45) Regioncare Inc
972 Brush Hollow Rd
Westbury,NY11590
11-3052191 		Homecare NY NSHS ENTERPRISE
  		C CORPORATION      
(46) Staten Island Hospitalists PC
475 Seaview Ave
Staten Island,NY10305
33-1010283 		Medical ServiCES NY SIUH
  		C CORPORATION 1,034,543 207,565 100.000 %
(47) Staten Island Imaging Corp
1 Edgewater Plaza 6th Floor
Staten Island,NY10305
13-3615474 		Inactive NY OVM
  		C CORPORATION      
(48) Staten Island Medical Intensivist PC
501 Seaview Ave Suite 102
Staten Island,NY10305
04-3716494 		Medical ServiCES NY SIUH
  		C CORPORATION 2,702,836 2,261 100.000 %
(49) Staten Island Neonatology PC
500 Seaview Ave
Staten Island,NY10305
13-3375474 		Medical ServiCES NY SIUH
  		C CORPORATION 340,704 5,242 100.000 %
(50) SIUH Perinatology PC
475 Seaview Ave
Staten Island,NY10305
13-4107082 		Medical ServiCES NY SIUH
  		C CORPORATION     100.000 %
(51) United Medical Surgical PC
256 Mason Ave BLDG B 2nd FL
Staten Island,NY10305
13-4038780 		Surgical ServICES NY SIUH
  		C CORPORATION 8,990,300 515,509 100.000 %
(52) Univ Ph OncHematology Gp PC
500 Seaview Ave
Staten Island,NY10305
13-3642729 		Medical ServiCES NY SIUH
  		C CORPORATION 138,947 17,785 100.000 %
(53) Verrazano Radiology Assoc PC
500 Seaview Ave Suite 200
Staten Island,NY10305
20-0011201 		Radiology SVCS NY SIUH
  		C CORPORATION 10,903,724 3,146,744 100.000 %
(54) Vivohealth Inc
972 Brush Hollow Rd
Westbury,NY11590
26-4118016 		Inactive NY NSH ENTERPRISE
  		C CORPORATION      
(55) PARK LENOX PSYCHIATRY PC
130 EAST 77TH STREET
NEW YORK,NY10021
13-3424466 		Medical ServiCES NY LENOX HILL
  		C CORPoration      
(56) NS-LIJ CARDIOVASCULAR MEDICINE PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078717 		Medical ServiCES NY NSUH
  		C CORPORATION      
(57) NS-LIJ CARDIOLOGY PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078531 		Medical ServiCES NY NSUH
  		C CORPORATION      
(58) NS-LIJ HEART SURGERY PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078838 		Medical ServiCES NY NSUH
  		C CORPORATION      
(59) NS-LIJ INTERNAL MEDICINE PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078361 		Medical ServiCES NY NSUH
  		C CORPORATION      
(60) NS-LIJ MEDICAL GROUP URGENT MED CARE PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078426 		Medical ServiCES NY NSUH
  		C CORPORATION      
(61) LENOX HILL HOSPITAL MEDICAL PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-2661543 		Medical ServiCES NY NSUH
  		C CORPORATION      
(62) NS-LIJ MEDICAL PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-3023019 		Medical ServiCES NY NSUH
  		C CORPORATION      
(63) NS-LIJ OCCUPATIONAL MEDICINE PC
972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-1004103 		Medical ServiCES NY NSUH
  		C CORPORATION      
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
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) STATEN ISLAND UNIVERSITY HOSPITAL FOUNDATION

 C 98,260 COST
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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


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