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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
NORTH SHORE-LONG ISLAND JEWISH
HEALTH SYSTEM INC
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
972 BRUSH HOLLOW ROAD 5TH FLOOR
Suite
Room/suite
City or town, state or country, and ZIP + 4
WESTBURY, NY11590
D Employer identification number

11-3418133
E Telephone number

G Gross receipts $ 0
F Name and address of principal officer:
MICHAEL J DOWLING
145 COMMUNITY DRIVE
GREAT NECK,NY11021
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
northshorelij.com
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: 1999
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: NORTH SHORE LIJ HEALTH SYSTEM STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES AND IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CLINICAL CARE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 136
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 128
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6  
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
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) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 0
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 0 0
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) 0 0
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–24e).... 0 0
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 0 0
19 Revenue less expenses. Subtract line 18 from line 12....... 0 0
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 8,940,130 21,819,529
21 Total liabilities (Part X, line 26)............. 0 0
22 Net assets or fund balances. Subtract line 21 from line 20..... 8,940,130 21,819,529
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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: MISSION: NORTH SHORE LIJ HEALTH SYSTEM 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 HEALTH CARE PROFESSIONALS; SEARCHING FOR NEW ADVANCES IN MEDICINE THROUGH THE CONDUCT OF BIMEDICAL RESEARCH; PROMOTING HEALTH EDUCATION; AND CARING FOR THE ENTIRE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. VISION TO BE A NATIONAL HEALTH CARE LEADER, COMMITTED TO EXCELLENCE, COMPASSION AND IMPROVING THE HEALTH OF THE COMMUNITY.
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 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 $ 0 including grants of $   ) (Revenue $   )
NA
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet0
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? ...
2
 
No
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 I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
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 III............................
5
 
No
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 for escrow or custodial account liability; 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
 
No
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, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
 
No
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 VIIClick 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 VIIIClick to see attachment.......
11c
 
No
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 IXClick 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 XClick to see attachment
11e
 
No
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 XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII 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 and XII 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, Parts I and IV.........
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 United States? If “Yes,” complete Schedule F, Parts II and IV
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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 hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
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, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
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........
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...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
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.........
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 ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
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 direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
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
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part 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
 
No
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
0
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
 
 
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
0
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
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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, securities account, or other financial 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 as charitable contributions?...
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
 
No
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
No
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
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
No
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
No
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
No
Form 990 (2012)
Form 990 (2012)
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 .....................
1a
136
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
128
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
 
No
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 this 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:
MediumBulletNORTH SHORE-LIJ HEALTH SYSTE972 BRUSH HOLLOW RDWESTBURYNY11590 (516) 876-6061
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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) MICHAEL DOWLING........................................................................
PRESIDENT & CEO
  
.......................50.0 		X   X       0 2,823,350 1,128,235
(2) RALPH A NAPPI........................................................................
TRUSTEE AND PRES NSLIJ FOUND.
  
.......................50.0 		X           0 2,276,547 60,770
(3) RICHARD D GOLDSTEIN........................................................................
CHAIRMAN
 3.0
.......................   		X   X       0 0 0
(4) WILLIAM L MACK........................................................................
VICE CHAIRMAN
 2.0
.......................   		X   X       0 0 0
(5) BARRY RUBENSTEIN........................................................................
VICE CHAIRMAN
 2.0
.......................   		X   X       0 0 0
(6) ALAN I GREENE........................................................................
TREASURER
 2.0
.......................   		X   X       0 0 0
(7) DONALD ZUCKER........................................................................
SECRETARY
 2.0
.......................   		X   X       0 0 0
(8) MARK CLASTER........................................................................
VICE CHAIRMAN
 2.0
.......................   		X   X       0 0 0
(9) ANTHONY C FERRERI........................................................................
TRUSTEE AND PRES/CEO SIUH
  
.......................50.0 		X           0 1,049,046 387,210
(10) KEVIN F LAWLOR........................................................................
TRUSTEE AND PRES/CEO HUNT HOSP
  
.......................50.0 		X           0 799,176 280,574
(11) NON-COMPENSATED TRUSTEES........................................................................
SEE SCHEDULE 0
 2.0
.......................   		X           0 0 0
(12) HOWARD GOLD........................................................................
SR VP MANAGED CARE & BUS DEV
  
.......................50.0 		    X       0 1,299,856 298,209
(13) MARK J SOLAZZO........................................................................
EVP, CHIEF OPERATING OFFICER
  
.......................50.0 		    X       0 1,698,389 216,113
(14) ROBERT S SHAPIRO........................................................................
EVP, CHIEF FINANCIAL OFFICER
  
.......................50.0 		    X       0 1,139,452 231,819
(15) LAWRENCE SMITH MD........................................................................
EVP/PHYSICIAN IN CHIEF
  
.......................50.0 		    X       0 848,130 683,709
(16) KEITH THOMPSON........................................................................
SR VP & GENERAL COUNSEL
  
.......................50.0 		    X       0 2,868,822 533,031
(17) JEFFERY KRAUT........................................................................
SR VP STRATEGIC PLANNING
  
.......................50.0 		    X       0 826,861 201,661
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(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) KATHLEEN GALLO RN PHD........................................................................
SR VP & CHF LEARNING OFFICER
  
.......................50.0 		    X       0 747,445 271,298
(19) DONNA DRUMMOND........................................................................
SVP, CHIEF ADMIN OFFICER
  
.......................50.0 		    X       0 571,767 42,600
(20) HARRY GINDI........................................................................
ASSISTANT SECRETARY
  
.......................50.0 		    X       0 284,559 42,600




















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 17,233,400 4,377,829
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet0
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
NONE,      
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 0
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 0      
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
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            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 0      
Form 990 (2012)
Form 990 (2012)
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).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 .... 0      
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 0 0 0 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 0      
10 Payroll taxes ........... 0      
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 0      
12 Advertising and promotion .... 0      
13 Office expenses ....... 0      
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 0      
17 Travel ............ 0      
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 0      
23 Insurance .............. 0      
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 0 0 0 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 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 0 4 0
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation ..... 10b   0 10c  
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 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 8,940,130 15 21,819,529
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 8,940,130 16 21,819,529
Liabilities 17 Accounts payable and accrued expenses ......... 0 17 0
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other 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 .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
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.................... 0 25 0
26 Total liabilities. Add lines 17 through 25......... 0 26 0
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 8,940,130 27 21,819,529
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 8,940,130 33 21,819,529
34 Total liabilities and net assets/fund balances ........ 8,940,130 34 21,819,529
Form 990 (2012)
Form 990 (2012)
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
0
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
0
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
0
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
8,940,130
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
12,879,399
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
21,819,529
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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
 
No
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
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
NORTH SHORE-LONG ISLAND JEWISH
HEALTH SYSTEM INC
Employer identification number

11-3418133
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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
(A) NORTH SHORE UNIVERSITY HOSPITAL
  		111562701 03 Yes           0
(B) LONG ISLAND JEWISH MEDICAL CENTER
  		112241326 03 Yes           0
(C) GLEN COVE HOSPITAL
  		111633487 03 Yes           0
(D) PLAINVIEW HOSPITAL
  		113241243 03 Yes           0
(E) FOREST HILLS HOSPITAL
  		112163522 03 Yes           0
(F) FRANKLIN HOSPITAL
  		112296824 03   No         0
(G) SOUTHSIDE HOSPITAL
  		111667761 03   No         0
(H) HUNTINGTON HOSPITAL
  		111630914 03   No         0
(I) STATEN ISLAND UNIVERSITY HOSPITAL
  		112868878 03   No         0
(J) LENOX HILL HOSPITAL
  		131624070 03   No         0
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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
2012
Open to Public Inspection
Name of the organization
NORTH SHORE-LONG ISLAND JEWISH
HEALTH SYSTEM INC
Employer identification number

11-3418133
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
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)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII 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 .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet  
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) INVESTMT IN NSHS ENT & AFFIL 8,232,903
(2) INVESTMT IN NSH ENT & AFFIL 480,055
(3) INVESMT IN LHH 13,106,571






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 21,819,529
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 0
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
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 XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
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 XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2012

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
2012
Open to Public Inspection
Name of the organization
NORTH SHORE-LONG ISLAND JEWISH
HEALTH SYSTEM INC
Employer identification number

11-3418133
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 of 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 filing organization used 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
 
No
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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 DOWLINGPRESIDENT & CEO (i)
(ii)		 0
1,172,902 		0
1,628,000 		0
22,448 		0
1,107,110 		0
21,125 		0
3,951,585 		0
0
(2)HOWARD GOLDSR VP MANAGED CARE & BUS DEV (i)
(ii)		 0
928,383 		0
340,000 		0
31,473 		0
283,109 		0
15,100 		0
1,598,065 		0
0
(3)MARK J SOLAZZOEVP, CHIEF OPERATING OFFICER (i)
(ii)		 0
974,451 		0
700,000 		0
23,938 		0
198,500 		0
17,613 		0
1,914,502 		0
0
(4)ROBERT S SHAPIROEVP, CHIEF FINANCIAL OFFICER (i)
(ii)		 0
921,946 		0
190,000 		0
27,506 		0
209,519 		0
22,300 		0
1,371,271 		0
0
(5)LAWRENCE SMITH MDEVP/PHYSICIAN IN CHIEF (i)
(ii)		 0
720,972 		0
100,000 		0
27,158 		0
667,034 		0
16,675 		0
1,531,839 		0
0
(6)KEITH THOMPSONSR VP & GENERAL COUNSEL (i)
(ii)		 0
724,853 		0
113,000 		0
2,030,969 		0
511,950 		0
21,081 		0
3,401,853 		0
313,468
(7)JEFFERY KRAUTSR VP STRATEGIC PLANNING (i)
(ii)		 0
695,349 		0
101,010 		0
30,502 		0
186,561 		0
15,100 		0
1,028,522 		0
0
(8)KATHLEEN GALLO RN PHDSR VP & CHF LEARNING OFFICER (i)
(ii)		 0
622,472 		0
93,240 		0
31,733 		0
256,198 		0
15,100 		0
1,018,743 		0
0
(9)DONNA DRUMMONDSVP, CHIEF ADMIN OFFICER (i)
(ii)		 0
479,026 		0
35,742 		0
56,999 		0
27,500 		0
15,100 		0
614,367 		0
0
(10)RALPH A NAPPITRUSTEE AND PRES NSLIJ FOUND. (i)
(ii)		 0
672,088 		0
150,000 		0
1,454,459 		0
41,995 		0
18,775 		0
2,337,317 		0
1,389,266
(11)HARRY GINDIASSISTANT SECRETARY (i)
(ii)		 0
280,028 		0
0 		0
4,531 		0
27,500 		0
15,100 		0
327,159 		0
0
(12)ANTHONY C FERRERITRUSTEE AND PRES/CEO SIUH (i)
(ii)		 0
873,895 		0
155,000 		0
20,151 		0
372,110 		0
15,100 		0
1,436,256 		0
0
(13)KEVIN F LAWLORTRUSTEE AND PRES/CEO HUNT HOSP (i)
(ii)		 0
665,596 		0
104,400 		0
29,180 		0
263,381 		0
17,193 		0
1,079,750 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PART I, LINE 4B Certain individuals participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. Accordingly, the individual 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, Column C for Michael J Dowling ($1,079,610), Mark Solazzo ($171,000), Robert S Shapiro ($182,019), Howard Gold ($255,609), Keith Thompson ($484,450), Lawrence Smith ($639,534), Jeffrey Kraut ($159,061), Kathleen Gallo ($228,698), Ralph Nappi ($14,495), Anthony Ferreri ($344,610) and Kevin Lawlor ($233,853).
BONUS AND INCENTIVE COMPENSATION PART I, LINE 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, Part I, B (ii).
Schedule J (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
NORTH SHORE-LONG ISLAND JEWISH
HEALTH SYSTEM INC
Employer identification number

11-3418133
Identifier Return Reference Explanation
BOARD MEMBER RELATIONS PART VI, SECTION A - GOVERNING BODY, LINE 2 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. Philip Altheim has a business relationship with Eric Blumencranz. Stanley Applebaum has a business relationship with John Shall. Michael Ashner has a business relationship with William Mack and Scott Rudolph. Eric Blumencranz has as a family relationship with Roger Blumencranz. He has a business relationship with Roger Blumencranz, William Achenbaum, Philip Altheim, Arlene Lane Fisher, Richard D. Goldstein, Lloyd Goldman, Alan Greene, James Greene, Stanley Grey, Richard Guarasci, Richard Horowitz, M. Allan Hyman, Jeffrey Jurick, Arthur Levine, Stuart Levine, David Mack, Bradley Marsh, Charles Merinoff, Ralph Nappi, Dennis Riese, Michael Slade. Roger Blumencranz has a family relationship with Eric Blumencranz. He has a business relationship with Eric Blumencranz, William Achenbaum, Mark Claster, Alan Greene, James Greene, Stanley Grey, Richard D. Goldstein, Richard Horowitz, Jeffrey Jurick, Stuart Levine, David Mack, Ralph Nappi, Mark Solazzo, 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. He has a business relationship with Cary Kravet. Robert Chasanoff has a business relationship with Michael Sahn. Alan Chopp has a business relationship with Patrick McDermott. Mark Claster has a business relationship with Roger Blumencranz, Richard Goldstein, Saul Katz, Robert Rosenthal. Philippe Dauman has a business relationship with Thomas Dooley. Daniel deRoulet has a family relationship with Lorinda deRoulet. Lorinda deRoulet has a family relationship with Daniel deRoulet. Thomas Dooley has a business relationship with Philippe Dauman. Leonard Feinstein has a business relationship with William Mack. Anthony Ferreri has a family and business relationship with John Shall. Arlene Lane Fisher has a business relationship with Eric Blumencranz. 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 Eric and Roger Blumencranz. Richard Guarasci has a business relationship with Eric Blumencranz. William Hiltz has a business relationship with Jeff Maurer. Richard Horowitz has a business relationship with Eric and Roger Blumencranz and M. Allan Hyman. M. Allan Hyman has a business relationship with Eric Blumencranz, Richard Horowitz, Saul Katz and Donald Zucker. Jeffrey Jurick has a business relationship with Eric and Roger Blumencranz. David Katz has a family relationship with Saul Katz and Michael Katz. He has a business relationship with Saul Katz and Seth Lipsay. 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. Cary Kravet has a business relationship with Steve Braun. 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. Seth Lipsay has a business relationship with David Katz. 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, Richard Goldstein and Roy Zuckerberg. Bradley Marsh has a family relationship with Jack Ross. He has a business relationship with Eric 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 Blumencranz. Richard Murcott has a business relationship with Barry Rubenstein. Ralph Nappi has a business relationship with Eric and Roger Blumencranz. Dennis Riese has a business relationship with Eric Blumencranz. Robert Rosenthal has a business relationship with Mark Claster, F.J. McCarthy and Nancy Waldbaum. Jack Ross has a family relationship with Bradley Marsh. Barry Rubenstein has a business relationship with Mark Claster , Richard Goldstein, William Mack and Richard Murcott. Scott Rudolph has a business relationship with Michael Ashner. Michael Sahn has a business relationship with Robert Chasanoff. 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. Mark Solazzo has a business relationship with Roger Blumencranz. Nancy Waldbaum has a business relationship with Robert Rosenthal. 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.
EXECUTIVE COMMITTEE PART VI, SECTION B - POLICIES, LINE 11 All North Shore-LIJ 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 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.
CONFLICTS OF INTEREST POLICY PART VI, SECTION B - POLICIES, LINE 12C 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 filled 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.
OFFICERS COMPENSATION PART VI, SECTION B - POLICIES, LINE 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.
DISCLOSURES PART VI, SECTION C - DISCLOSURES, LINE 19 CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.
NON-COMPENSATED TRUSTEES PART VII, SECTION A - LINE 1A NON-COMPENSATED TRUSTEES Richard S. Abramson Lloyd M. Goldman F.J. McCarthy William Achenbaum Richard D. Goldstein Patrick F. McDermott John W. Alexander J. Joaquin Gonzalez James McMullen Philip S. Altheim Michael Gould Charles Merinoff Stanley A. Applebaum Albert L. Granger, DDS Richard D. Monti Michael L. Ashner Alan I. Greene Richard Murcott Beverly VP. Banker James R. Greene Ralph A. Nappi Ralph M. Baruch Stanley Grey Richard B. Nye Frank J. Besignano Richard Guarasci, PhD Clyde I. Payne, Ed.D. Elise M. Bloom Paul B. Guenther Arnold S. Penner Eric S. Blumencranz Amy M. Hagedorn John J. Raggio Roger A. Blumencranz Ira Hazan Lewis S. Ranieri David Blumenfeld Linda W. Heaney Jay R. Raubvogel Edward Blumenfeld Marlene Hess Dennis Riese E. Steve Braun William O. Hiltz Terry P. Rifkin, M.D. Dayton T. Brown, Jr Gedale B. Horowitz Robert F. Rose Allen E. Busching Richard A. Horowitz Robert A. Rosen Jonathan S. Canno M. Allan Hyman Marcie Rosenberg Michael Caridi Mark Jacobson Robert D. Rosenthal Rev.Carolina Sr, Ed.D Jeffrey Jurick Bernard M. Rosof, M.D. Rudolph C. Carryl David M. Katz Jack J. Ross Robert W. Chasanoff Michael Katz Barry Rubenstein Alan Chopp Saul B. Katz Herbert Rubin Mark Claster Lisa A. Kaufman Scott Rudolph Diana F. Colgate Robert Kaufman Michael H. Sahn Daniel M. Crown Cary Kravet Frank W. Scarangello, Sr. Philippe P. Dauman Stanley Kreitman Lois C. Schlissel Daniel C. de Roulet Seth Kupferberg John M. Shall Lorinda de Roulet Jeffrey B. Lane Marc V. Shaw Thomas E. Dewey, Jr. Curt N. Launer Sean G. Simon Thomas E. Dooley Laura Lauria Richard Sims Michael J. Dowling Kevin F. Lawlor Michael C. Slade Robert N. Downey David W. Lehr Phyllis Hill Slater Melvin Dubin Jonathan W. Leigh Howard D. Stave Patrick R. Edwards Sylvia Lester Russell Stern Michael A. Epstein Arthur S. Levine John B. Thomson, Jr. Leonard Feinstein Stuart R. Levine Peter Tilles Michael E. Feldman Seth Lipsay Sandra Tytel Anthony C. Ferreri David S. Mack Frederick A. Volk Arlene Lane Fisher William L. Mack Nancy Waldbaum Catherine C. Foster Linda Manfredi Emmett F. Walker, Jr William H. Frazier James S. Marcus Gary Walter Eugene B. Friedman, M.D.Bradley Marsh, D.P.M. Lewis M. Weston William J. Fritz, Ph.D. Jeffrey S. Maurer Barbara Hrbek Zucker Sy Garfinkel Ronald J. Mazzucco Donald Zucker Roy J. Zuckerberg
AVERAGE HOURS PART VI, SECTION A - LINE 1A, COLUMN (B) This organization is affiliated with the North Shore Long Island Jewish Health System (the "Health System"). The persons listed 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 PART XI, LINE 9 CHANGE IN INVEST IN NSHS ENTERPRISES INC. & AFFILIATE 128,555 CHANGE IN INVEST IN NSH ENTERPRISES INC & AFFILIATE (355,727) INVESTMENT IN LHH CORPORATION 13,106,571 TOTAL 12,879,399
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
NORTH SHORE-LONG ISLAND JEWISH
HEALTH SYSTEM INC
Employer identification number

11-3418133
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) NORTH SHORE-LIJ HEALTH CARE INC

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2965586 		SUPPORT NY 501(C)(3) 11, TYPE 1 NS-LIJHS
 
Yes
 
(2) NORTH SHORE UNIVERSITY HOSPITAL

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-1562701 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(3) LONG ISLAND JEWISH MEDICAL CENTER

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2241326 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(4) GLEN COVE HOSPITAL

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-1633487 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(5) FOREST HILLS HOSPITAL

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2163522 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(6) PLAINVIEW HOSPITAL

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-3241243 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(7) FRANKLIN HOSPITAL

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2296824 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(8) SOUTHSIDE HOSPITAL

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-1667761 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(9) NORTH SHORE-LIJ HEALTH SYSTEM LABS

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-3412370 		SUPPORT NY 501(C)(3) 11, TYPE 1 NS-LIJHS
 
Yes
 
(10) FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2673595 		RESEARCH NY 501(C)(3) 4 NS-LIJHS
 
Yes
 
(11) NORTH SHORE-LIJ HEALTH SYSTEM FDN

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2965575 		FUNDRAISING NY 501(C)(3) 7 NS-LIJHS
 
Yes
 
(12) NSLIJ STERN FAMILY CENTER FOR REHAB

972 BRUSH HOLLOW RD

WESTBURY,NY11590
23-7007485 		NURSING HOME NY 501(C)(3) 9 NS-LIJ HCI
 
 
No
(13) LIJ MEDICAL CENTER AT HOME PHARMACY

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-3251128 		SUPPORT NY 501(C)(3) 11, TYPE 1 NS-LIJHS
 
Yes
 
(14) LIJ FOUNDATION

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2661239 		SUPPORT NY 501(C)(3) 11, TYPE 1 NS-LIJHS
 
Yes
 
(15) NORTH SHORE-LIJ MEDICAL CARE CENTERS

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-3473923 		SUPPORT NY 501(C)(3) 11, TYPE 1 NS-LIJHS
 
Yes
 
(16) SSH INC

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2774102 		SUPPORT NY 501(C)(3) 11, TYPE 1 SOUTHSIDE
 
 
No
(17) NORTH SHORE COMMUNITY SERVICES INC

972 BRUSH HOLLOW RD

WESTBURY,NY11590
23-7273200 		HOUSING NY 501(C)(2) N/A NS-LIJHS
 
Yes
 
(18) NORTH SHORE UNIVERSITY HOSPITAL HOUSING

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2171903 		HOUSING NY 501(C)(2) N/A NS-LIJHS
 
Yes
 
(19) NSUH AT GLEN COVE HOUSING

972 BRUSH HOLLOW RD

WESTBURY,NY11590
23-7010468 		HOUSING NY 501(C)(2) N/A NS-LIJHS
 
Yes
 
(20) HILLSIDE HOSPITAL HOUSES

972 BRUSH HOLLOW RD

WESTBURY,NY11590
11-2113949 		HOUSING NY 501(C)(2) N/A NS-LIJHS
 
Yes
 
(21) SIUH SYSTEMS INC

475 SEAVIEW AVE

STATEN ISLAND,NY10305
06-1074604 		FUNDRAISING NY 501(C)(3) 7 NS-LIJ HCI
 
 
No
(22) STATEN ISLAND UNIVERSITY HOSPITAL

475 SEAVIEW AVE

STATEN ISLAND,NY10305
11-2868878 		HOSPITAL NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(23) STATEN ISLAND UNIVERSITY HOSPITAL FDN

360 SEAVIEW AVE

STATEN ISLAND,NY10305
87-0765787 		FUNDRAISING NY 501(C)(3) 7 SIUH
 
 
No
(24) THE HEART INSTITUTE

475 SEAVIEW AVE

STATEN ISLAND,NY10305
31-1757254 		INACTIVE NY 501(C)(3) 11, TYPE 1 NA
 
 
No
(25) CHAPS COMMUNITY HEALTH CENTER INC

1 EDGEWATER PLAZA

STATEN ISLAND,NY10305
11-3345477 		INACTIVE NY 501(C)(3) 9 SIUH
 
 
No
(26) HOSPICE CARE NETWORK

99 SUNNYSIDE BLVD

WOODBURY,NY11797
11-2925757 		HOSPICE NY 501(C)(3) 9 NS-LIJHS
 
Yes
 
(27) HUNTINGTON HOSPITAL

270 PARK AVENUE

HUNTINGTON,NY11743
11-1630914 		HEALTH CARE NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(28) HUNTINGTON HOSPITAL DOLAN FAMILY HEALTH

284 PULASKI RD

GREENLAWN,NY11740
11-3368503 		HEALTH CARE NY 501(C)(3) 3 HUNTINGTON
 
 
No
(29) PHYSICIANS OF UNIVERSITY HOSPITAL PC

1 EDGEWATER PLAZA 6TH FL

STATEN ISLAND,NY10305
20-0096809 		HEALTH CARE NY 501(C)(3) 11, TYPE 1 SIUH
 
 
No
(30) LENOX HILL HOSPITAL

100 EAST 77TH ST

NEW YORK,NY10021
13-1624070 		HEALTH CARE NY 501(C)(3) 3 NS-LIJ HCI
 
 
No
(31) LHH CORPORATION

100 EAST 77TH ST

NEW YORK,NY10021
13-3272016 		SUPPORT NY 501(C)(3) 11, TYPE 1 NS-LIJHS
 
Yes
 
(32) THE ELMEZZI GRADUATE SCHOOL OF MOLECULAR

972 BRUSH HOLLOW ROAD

WESTBURY,NY11590
11-3284934 		GRADUATE SCHO NY 501(C)(3) 2 RESEARCH
 
 
No
(33) SPORTS PHYSICAL THERAPY & REHAB SVCS

972 BRUSH HOLLOW RD

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

972 BRUSH HOLLOW RD

WESTBURY,NY11590
26-3727582 		HEALTH CARE NY 501(C)(3) 3 NA
 
 
No
(35) THE LONG ISLAND HOME

400 SUNRISE HIGHWAY

AMITYVILLE,NY11701
11-2837244 		HEALTH CARE NY 501(C)(3) 3 LHH
 
 
No
(36) THE LONG ISLAND HOME FOUNDATION

400 SUNRISE HIGHWAY

AMITYVILLE,NY11701
11-2049038 		SUPPORT NY 501(C)(3) 11, TYPE 1 LHH
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 CONSULTATIVE SERVICES LLC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
26-2838027 		CONSULTING NY NA
  		                 
(2) LONG ISLAND BEHAVIORAL HEALTH LLC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-3572263 		STATISTICS NY NS-LIJ HCI
  		                 










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) NORTH SHORE HEALTH SYSTEM ENTERPRISES

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3316922 		HOLDING COMP NY NS-LIJHS
  		C 27,546,005 8,232,903 100.000 % Yes  
(2) REGIONCARE INC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3052191 		HOMECARE NY NSHS ENTERPRISE
  		C         No
(3) NORTH SHORE HEALTH ENTERPRISES

972 BRUSH HOLLOW RD
WESTBURY,NY11590
06-1605319 		HOLDING COMPA NY NSHS ENTERPRISE
  		C 654,062 480,055 100.000 % Yes  
(4) CARE MANAGEMENT GROUP OF GREATER NY

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3336381 		BUSINESS SERV NY NSH ENTERPRISES
  		C         No
(5) REGIONAL INSURANCE COMPANY LTD

C/O CEDAR HOUSE 41 CEDAR AVE
HAMILTON,BERMUDAHM 12
BD
000000000 		INSURANCE BD NS-LIJ HCI
  		C         No
(6) ALETTA CORPORATION

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-2622371 		PHYSICIAN SER NY SOUTHSIDE
  		C         No
(7) NS-LIJ PHYSICIAN INSURANCE COMPANY RRG

100 BANK ST
BURLINGTON,VT05401
26-1487515 		INSURANCE VT NS-LIJ HCI
  		C         No
(8) NORTH SHORE-LIJ SERVICE ALLIANCE

972 BRUSH HOLLOW RD
WESTBURY,NY11590
26-3651575 		SUPPORT SERVI NY NA
  		C         No
(9) NORTH SHORE-LIJ HEALTH SYSTEM IPA #1

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3533659 		HEALTH CARE NY LIJ
  		C         No
(10) NORTH SHORE-LIJ HEALTH SYSTEM IPA #2

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3533670 		HEALTH CARE NY LIJ
  		C         No
(11) NORTH SHORE-LIJ HEALTH SYSTEM IPA #3

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3533678 		HEALTH CARE NY LIJ
  		C         No
(12) NORTH SHORE-LIJ HEALTH SYSTEM IPA #4

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3533677 		HEALTH CARE NY LIJ
  		C         No
(13) NORTH SHORE-LIJ HEALTH SYSTEM IPA #5

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3533675 		HEALTH CARE NY LIJ
  		C         No
(14) NORTH SHORE IPA 5 INC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3383468 		BUSINESS SERV NY NS-LIJ HCI
  		C         No
(15) NORTH SHORE-LIJ NETWORK INC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
32-0257193 		SUPPORT SERVI NY NS-LIJHS
  		C 0 0 100.000 % Yes  
(16) NORTH SHORE RADIOLOGY AT GLEN COVE PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
11-3301179 		MEDICAL SERVI NY NSUH
  		C         No
(17) NORTH SHORE-LIJ RADIOLOGY SERVICES PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
22-3970667 		MEDICAL SERVI NY NSUH
  		C         No
(18) STATEN ISLAND IMAGING CORP

1 EDGEWATER PLAZA
STATEN ISLAND,NY10305
13-3615474 		INACTIVE NY OVM
  		C         No
(19) OCEAN VIEW MANAGEMENT

1 EDGEWATER PLAZA
STATEN ISLAND,NY10305
13-3138888 		MANAGEMENT SV NY SIUH
  		C         No
(20) OCEAN BREEZE HOME CARE AGENCY

1 EDGEWATER PLAZA
STATEN ISLAND,NY10305
13-3773601 		INACTIVE NY OVM
  		C         No
(21) REGENCY ALLIANCE SERVICES INC

1 EDGEWATER PLAZA
STATEN ISLAND,NY10305
13-3277698 		MANAGEMENT SV NY OVM
  		C         No
(22) VERRAZANO RADIOLOGY ASSOCIATES PC

500 SEAVIEW AVE
STATEN ISLAND,NY10305
20-0011201 		RADIOLOGY SER NY SIUH
  		C         No
(23) SIUH PERINATOLOGY PC

475 SEAVIEW AVE
STATEN ISLAND,NY10305
13-4107082 		MEDICAL SERVI NY SIUH
  		C         No
(24) UNITED MEDICAL SURGICAL PC

256 MASON AVE BLDG B 2ND FL
STATEN ISLAND,NY10305
13-4038780 		SURGICAL SERV NY SIUH
  		C         No
(25) UNIVERSITY PHYSICIANS ONCOLOGYHEMATOLOG

500 SEAVIEW AVE
STATEN ISLAND,NY10305
13-3642729 		MEDICAL SERVI NY SIUH
  		S         No
(26) EMERGENCY MEDICINE SERVICES OF SI PC

1 EDGEWATER PLAZA
STATEN ISLAND,NY10305
13-4200899 		MEDICAL SERVI NY SIUH
  		C         No
(27) GOETHALS RADIOLOGY PC

500 SEAVIEW AVE
STATEN ISLAND,NY10305
20-0010287 		RADIOLOGY SER NY SIUH
  		C         No
(28) STATEN ISLAND HOSPITALISTS PC

475 SEAVIEW AVE
STATEN ISLAND,NY10305
33-1010283 		MEDICAL SERVI NY SIUH
  		C         No
(29) STATEN ISLAND NEONATOLOGY PC

500 SEAVIEW AVE
STATEN ISLAND,NY10305
13-3375474 		MEDICAL SERVI NY SIUH
  		C         No
(30) STATEN ISLAND MEDICAL INTENSIVIST PC

501 SEAVIEW AVE
STATEN ISLAND,NY10305
04-3716494 		MEDICAL SERVI NY SIUH
  		C         No
(31) VIVOHEALTH INC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
26-4118016 		INACTIVE NY NSH ENTERPRISE
  		C         No
(32) AUTOIMMUNE RESEARCH THERAPEUTICS

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-0701489 		INACTIVE NY RESEARCH
  		C         No
(33) NS-LIJ MEDICAL GROUP AT SYOSSET PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-3957752 		MEDICAL SERVI NY NSUH
  		C         No
(34) PALLIATIVE CAER MEDICAL SERVICES PC

99 SUNNYSIDE BLVD
WOODBURY,NY11797
27-3957835 		MEDICAL SERVI NY HOSPICE
  		C         No
(35) NORTH SHORE-LIJ MEDICAL GROUP PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-4384249 		MEDICAL SERVI NY NSUH
  		C         No
(36) NS-LIJ MEDICAL GROUP AT HUNTINGTON PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-4384049 		MEDICAL SERVI NY NSUH
  		C         No
(37) NS-LIJ MEDICAL GROUP AT NORTH NASSAU PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-4384146 		MEDICAL SERVI NY NSUH
  		C         No
(38) NORTH SHORE-LIJ PHYSICIANS GROUP PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-4384326 		MEDICAL SERVI NY NSUH
  		C         No
(39) LENOX HILL PHYSICIANS HOSPITAL ORG

122 EAST 76TH ST STE 3-A
NEW YORK,NY10021
13-3775996 		MANAGED CARE NY LENOX
  		C         No
(40) LENOX OTOLARYNGOLOGY HEAD & NECK SURGERY

186 EAST 76TH ST 2ND FL
NEW YORK,NY10021
20-8784395 		MEDICAL SERVI NY LENOX
  		C         No
(41) PARK LENOX OBGYN PC

130 EAST 77TH ST 2ND FL
NEW YORK,NY10021
13-3596988 		MEDICAL SERVI NY LENOX
  		C         No
(42) ADVANCED IMAGING & RADIOLOGY OF LHH PC

100 EAST 77TH ST
NEW YORK,NY10021
20-0719612 		MEDICAL SERVI NY LENOX
  		C         No
(43) ADVANCED HEART PHYSICIANS & SURGEONS NET

130 EAST 77TH ST 4TH FL
NEW YORK,NY10021
13-3853125 		MEDICAL SERVI NY LENOX
  		S         No
(44) LENOX HILL CARDIOLOGY ASSOCIATES PC

100 EAST 77TH ST
NEW YORK,NY10021
13-3385163 		MEDICAL SERVI NY LENOX
  		C         No
(45) LENOX HILL ICVS PC

130 EAST 77TH ST 9TH FL
NEW YORK,NY10021
20-1435770 		MEDICAL SERVI NY LENOX
  		C         No
(46) LENOX HILL PATHOLOGY PC

100 EAST 77TH ST
NEW YORK,NY10021
13-3644370 		MEDICAL SERVI NY LENOX
  		C         No
(47) PARK LENOX EMERGENCY MEDICINE PC

100 EAST 77TH ST
NEW YORK,NY10021
26-2661082 		MEDICAL SERVI NY LENOX
  		C         No
(48) MANHATTAN MINIMALLY INVASIVE & BARIATRIC

186 EAST 76TH ST 1ST FL
NEW YORK,NY10021
20-0250107 		MEDICAL SERVI NY LENOX
  		C         No
(49) PARK LENOX MEDICAL PC

100 EAST 77TH ST
NEW YORK,NY10021
13-3575380 		MEDICAL SERVI NY LENOX
  		C         No
(50) PARK LENOX ORTHOPEDICS PC

100 EAST 77TH
NEW YORK,NY10021
26-4634966 		MEDICAL SERVI NY LENOX
  		C         No
(51) PARK LENOX PEDIATRICS PC

100 EAST 77TH ST
NEW YORK,NY10021
13-3755683 		MEDICAL SERVI NY LENOX
  		C          
(52) PARK LENOX SURGICAL PC

130 EAST 77TH ST 13TH FL
NEW YORK,NY10021
13-3397814 		MEDICAL SERVI NY LENOX
  		C         No
(53) NORTH SHORE-LIJ CARDIOVASCULAR MEDICINE

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078717 		MEDICAL SERVI NY NSUH
  		C         No
(54) NORTH SHORE-LIJ CARDIOLOGY PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078531 		MEDICAL SERVI NY NSUH
  		C         No
(55) NORTH SHORE-LIJ HEART SURGERY PC

972 BRUSH HOLLOW
WESTBURY,NY11590
27-5078838 		MEDICAL SERVI NY NSUH
  		C         No
(56) NORTH SHORE-LIJ INTERNAL MEDICINE PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078361 		MEDICAL SERVI NY NSUH
  		C         No
(57) NS-LIJ MEDICAL GROUP URGENT MED CARE PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
27-5078426 		MEDICAL SERVI NY NSUH
  		C         No
(58) LENOX HILL HOSPITAL MEDICAL PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-2661543 		MEDICAL SERVI NY LENOX
  		C         No
(59) NORTH SHORE-LIJ MEDICAL PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-3023019 		MEDICAL SERVI NY NSUH
  		C         No
(60) NS-LIJ OCCUPATIONAL MEDICINE PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
45-1004103 		MEDICAL SERVI NY NSUH
  		C         No
(61) NORTH SHORE-LIJ OB-GYN PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
46-1382916 		MEDICAL SERVICES NY LIJ
  		C         No
(62) NORTH SHORE-LIJ ANESTHESIOLOGY PC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
46-1617561 		MEDICAL SERVICES NY SOUTHSIDE
  		C         No
(63) NORTH SHORE-LIJ HEALTH PLAN INC

972 BRUSH HOLLOW RD
WESTBURY,NY11590
46-1617516 		INSURANCE NY NSLIJ HCI
  		C         No
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (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
 
No
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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
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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