TY 2012 Form 990

- TIN:

Form990

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)

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: Address change Name change Initial return Terminated Amended return Application pending

CName of organization
STATEN ISLAND UNIVERSITY HOSPITAL

Doing Business As

Number and street (or P.O. box if mail is not delivered to street address)
475 SEAVIEW AVENUE
Suite

Room/suite

City or town, state or country, and ZIP + 4
STATEN ISLAND, NY10305

D Employer identification number

11-2868878

E Telephone number

G Gross receipts $ 838,881,263

F Name and address of principal officer:
ANTHONY C FERRERI
475 SEAVIEW AVENUE
STATEN ISLAND,NY10305

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

www.siuh.edu

H(a)

Is this a group return for
affiliates? Yes No

H(b)

Are all affiliates included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1869

M State of legal domicile: NY

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: Staten Island University Hospital is part of the North Shore-LIJ Health System, WHICH STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITies IT SERVES. SEE PART III.
2	Check this box
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	6,679
6	Total number of volunteers (estimate if necessary) .............	6	918
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	8,987,748
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-105,387

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,676,168	3,971,783
9	Program service revenue (Part VIII, line 2g) .........	783,155,014	825,262,856
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,987,289	4,083,113
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,267,929	5,563,511
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	794,086,400	838,881,263
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)	502,034,828	525,486,600
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	265,494,006	270,285,594
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	767,528,834	795,772,194
19	Revenue less expenses. Subtract line 18 from line 12.......	26,557,566	43,109,069
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	676,230,590	744,558,374
21	Total liabilities (Part X, line 26).............	487,447,058	498,952,883
22	Net assets or fund balances. Subtract line 21 from line 20.....	188,783,532	245,605,491

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

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

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) ............YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y

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 ...............

Briefly describe the organization’s mission: STATEN ISLAND UNIVERSITY HOSPITAL IS PART OF THE NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM ("THE SYSTEM"), WHICH STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES AND IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CLINICAL CARE; EDUCATING THE CURRENT AND FUTURE GENERATIONS OF HEALTHCARE PROFESSIONALS; SEARCHING FOR NEW ADVANCES IN MEDICINE THROUGH THE CONDUCT OF BIOMEDICAL RESEARCH; PROMOTING HEALTH EDUCATION; AND CARING FOR THE ENTIRE COMMUNITY REGARDLESS OF THE ABILITY TO PAY.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ...................... Yes No

If “Yes,” describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................ Yes No

If “Yes,” describe these changes on Schedule O.

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 $ 537,900,232 including grants of $ 0 ) (Revenue $ 669,319,043 )
	STATEN ISLAND UNIVERSITY HOSPITAL PROVIDES ACUTE CARE HOSPITAL SERVICES AT TWO FACILITIES IN RICHMOND COUNTY. NORTH AND SOUTH SITE CAMPUSES PROVIDE SERVICES IN CARDIOLOGY, BURN CARE, TRAUMA, ORTHOPEDICS, ONCOLOGY, GERIATRICS, OBSTETRICS, PEDIATRICS, REHABILITATION, PRIMARY CARE, COMMUNITY OUTREACH, HOSPICE, AND HOME CARE REGARDLESS OF ABILITY TO PAY. IN 2012 THE COMBINED CAMPUSES OF THE HOSPITAL HAD 42,172 DISCHARGES, (EXCLUDING NORMAL NEWBORN DISCHARGES); 2,904 DELIVERIES; 124,552 EMERGENCY DEPARTMENT VISITS (includes 31,632 admits); AND 15,392 AMBULATORY SURGERY CASES.

4b	(Code: ) (Expenses $ 65,715,923 including grants of $ 0 ) (Revenue $ 58,227,826 )
	EXPENSES INCURRED IN PROVIDING EMERGENCY DEPARTMENT SERVICES TO ALL INDIVIDUALS, 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR, IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.

4c	(Code: ) (Expenses $ 45,591,133 including grants of $ 0 ) (Revenue $ 42,262,541 )
	EXPENSES INCURRED IN PROVIDING AMBULATORY SURGERY SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 33,928,086 including grants of $ 0 ) (Revenue $ 55,453,446 )
4e	Total program service expenses683,135,374

Form 990 (2012)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A Click to see attachment

........................

Yes

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment

...

Yes

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 Click to see attachment

..........

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 Click to see attachment

........

Yes

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 Click to see attachment

............................

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 I Click to see attachment

........................

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 II Click to see attachment

...

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

....................

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 IV Click to see attachment

..............

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 V Click to see attachment

......

Yes

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.

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

Yes

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII Click to see attachment

.......

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII Click to see attachment

.......

11c

Yes

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX Click to see attachment

............

11d

Yes

Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X Click to see attachment

11e

Yes

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X Click to see attachment

.........................

11f

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

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

Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....

14a

Did the organization maintain an office, employees, or agents outside of the United States?.....

14a

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......... Click to see attachment

14b

Yes

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 Click to see attachment

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... Click to see attachment

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)....

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............

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...................

20a

Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment

20a

Yes

If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment

20b

Yes

Form 990 (2012)

Page 4

Part IV

Checklist of Required Schedules (continued)

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...

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........

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

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................ Click to see attachment

24a

Yes

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

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

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........ Click to see attachment

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment

25b

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.......................... Click to see attachment

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment

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 current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment

28a

A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment

28b

Yes

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... Click to see attachment

28c

Yes

Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............

Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................

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

Yes

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

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment

35b

Yes

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

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 VI Click to see attachment

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. ............

Yes

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

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..

402

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

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 ..................

6,679

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)

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?...

Yes

If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....

Yes

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)?..........................

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.

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............

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?...

If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................

Organizations that may receive deductible contributions under section 170(c).

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?....................

If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................

If “Yes,” indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................

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?............

Sponsoring organizations maintaining donor advised funds.

Did the organization make any taxable distributions under section 4966?..........

Did the organization make a distribution to a donor, donor advisor, or related person?.......

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

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

If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

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

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

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..

14b

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

Enter the number of voting members of the governing body at the end of the tax year .....................

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.

Enter the number of voting members included in line 1a, above, who are independent ...................

128

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? .................

Yes

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? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

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? ....................

Yes

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Yes

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .........................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

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.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

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

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

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

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

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

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?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

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

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

List the States with which a copy of this Form 990 is required to be filed MediumBullet

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.

Own website Another's website Upon request Other (explain in Schedule O)

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.

State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBullet

THOMAS RECAONE EDGEWATER PLAZASTATEN ISLANDNY10305 (718) 226-1148

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.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

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.

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.

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
(A) Name and Title
(1) RICHARD D GOLDSTEIN........................................................................ CHAIRMAN - TRUSTEE	.......................3.0	X	X	0	0	0
(2) JOHN W ALEXANDER........................................................................ TREASURER - TRUSTEE	.......................2.0	X	X	0	0	0
(3) RICHARD S ABRAMSON........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(4) WILLIAM ACHENBAUM........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(5) PHILIP S ALTHEIM........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(6) STANLEY A APPLEBAUM........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(7) MICHAEL L ASHNER........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(8) BEVERLY BANKER........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(9) RALPH M BARUCH........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(10) FRANK J BESIGNANO........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(11) ELISE M BLOOM........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(12) ERIC S BLUMENCRANZ........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(13) ROGER A BLUMENCRANZ........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(14) DAVID BLUMENFELD........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(15) EDWARD BLUMENFELD........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(16) E STEVE BRAUN........................................................................ TRUSTEE	.......................2.0	X		0	0	0
(17) DAYTON T BROWN JR........................................................................ TRUSTEE	.......................2.0	X		0	0	0

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
(A) Name and Title
(18) ALLEN E BUSCHING........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(19) JONATHAN S CANNO........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(20) MICHAEL CARIDI........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(21) REV DEMETRIUS CAROLINA SR EDD........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(22) RUDOLPH C CARRYL........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(23) ROBERT W CHASANOFF........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(24) ALAN CHOPP........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(25) MARK CLASTER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(26) DIANA F COLGATE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(27) DANIEL M CROWN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(28) PHILIPPE P DAUMAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(29) DANIEL C DE ROULET........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(30) LORINDA DE ROULET........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(31) THOMAS E DEWEY JR........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(32) THOMAS E DOOLEY........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(33) MICHAEL J DOWLING........................................................................ TRUSTEE	.......................50.0	X				0	2,823,350	1,128,235
(34) ROBERT N DOWNEY........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(35) MELVIN DUBIN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(36) PATRICK R EDWARDS........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(37) MICHAEL A EPSTEIN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(38) LEONARD FEINSTEIN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(39) MICHAEL E FELDMAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(40) ANTHONY C FERRERI........................................................................ PRESIDENT/CEO - TRUSTEE	.......................50.0	X	X			0	1,049,046	387,210
(41) ARLENE LANE FISHER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(42) CATHERINE C FOSTER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(43) WILLIAM H FRAZIER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(44) EUGENE B FRIEDMAN MD........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(45) WILLIAM J FRITZ PHD........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(46) SY GARFINKEL........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(47) LLOYD MICHAEL GOLDMAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(48) J JOAQUIN GONZALEZ........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(49) MICHAEL GOULD........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(50) ALBERT L GRANGER DDS........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(51) ALAN I GREENE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(52) JAMES R GREENE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(53) STANLEY GREY........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(54) RICHARD GUARASCI PHD........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(55) PAUL B GUENTHER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(56) AMY M HAGEDORN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(57) IRA HAZAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(58) LINDA W HEANEY........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(59) MARLENE HESS........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(60) WILLIAM O HILTZ........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(61) GEDALE B HOROWITZ........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(62) RICHARD A HOROWITZ........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(63) M ALLAN HYMAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(64) MARK JACOBSON........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(65) JEFFREY JURICK........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(66) DAVID M KATZ........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(67) MICHAEL KATZ........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(68) SAUL B KATZ........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(69) LISA A KAUFMAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(70) ROBERT KAUFMAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(71) CARY KRAVET........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(72) STANLEY KREITMAN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(73) SETH KUPFERBERG........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(74) JEFFREY B LANE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(75) CURT N LAUNER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(76) LAURA LAURIA........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(77) KEVIN F LAWLOR........................................................................ TRUSTEE	.......................50.0	X				0	799,176	280,574
(78) DAVID W LEHR........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(79) JONATHAN W LEIGH........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(80) SYLVIA LESTER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(81) ARTHUR S LEVINE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(82) STUART R LEVINE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(83) SETH LIPSAY........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(84) DAVID S MACK........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(85) WILLIAM L MACK........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(86) LINDA MANFREDI........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(87) JAMES S MARCUS........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(88) BRADLEY MARSH DPM........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(89) JEFFREY S MAURER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(90) RONALD J MAZZUCCO........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(91) F J MCCARTHY........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(92) PATRICK F MCDERMOTT........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(93) JAMES MCMULLEN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(94) CHARLES MERINOFF........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(95) RICHARD D MONTI........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(96) RICHARD MURCOTT........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(97) RALPH A NAPPI........................................................................ TRUSTEE	.......................50.0	X				0	2,276,546	60,770
(98) RICHARD B NYE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(99) CLYDE I PAYNE ED D........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(100) ARNOLD S PENNER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(101) JOHN J RAGGIO........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(102) LEWIS S RANIERI........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(103) JAY R RAUBVOGEL........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(104) DENNIS RIESE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(105) TERRY P RIFKIN MD........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(106) ROBERT F ROSE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(107) ROBERT A ROSEN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(108) MARCIE ROSENBERG........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(109) ROBERT D ROSENTHAL........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(110) BERNARD M ROSOF MD........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(111) JACK J ROSS........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(112) BARRY RUBENSTEIN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(113) HERBERT RUBIN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(114) SCOTT RUDOLPH........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(115) MICHAEL H SAHN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(116) FRANK W SCARANGELLO SR........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(117) LOIS C SCHLISSEL........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(118) JOHN M SHALL........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(119) MARC V SHAW........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(120) SEAN G SIMON........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(121) RICHARD SIMS........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(122) MICHAEL C SLADE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(123) PHYLLIS HILL SLATER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(124) HOWARD D STAVE........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(125) RUSSELL STERN........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(126) JOHN B THOMSON JR........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(127) PETER TILLES........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(128) SANDRA TYTEL........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(129) FREDERICK A VOLK........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(130) NANCY WALDBAUM........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(131) EMMETT F WALKER JR........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(132) GARY WALTER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(133) LEWIS M WESTON........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(134) BARBARA HRBEK ZUCKER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(135) DONALD ZUCKER........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(136) ROY J ZUCKERBERG........................................................................ TRUSTEE	.......................2.0	X				0	0	0
(137) ARTHUR KLEIN........................................................................ EXECUTIVE DIRECTOR	.......................50.0		X			0	1,075,608	288,200
(138) KEITH C THOMPSON........................................................................ ASSISTANT SECRETARY	.......................50.0		X			0	2,868,822	533,031
(139) HARRY E GINDI........................................................................ ASSISTANT TREASURER	.......................50.0		X			0	284,558	42,600
(140) MARK P JARRETT MD........................................................................ CMO/VP CHIEF QUALITY OFFICER	8.0 .......................42.0		X			68,884	596,396	47,159
(141) ROBERT S SHAPIRO........................................................................ SVP/CFO NS-LIJ HEALTH SYSTEM	.......................50.0			X		0	1,139,453	231,819
(142) THOMAS RECA........................................................................ CHIEF FINANCIAL OFFICER	50.0 .......................			X		530,046	100,000	40,776
(143) DONNA PROSKE........................................................................ EVP - CHIEF NURSING EXECUTIVE	50.0 .......................			X		564,508	0	34,578
(144) GREGORY RADINSKY........................................................................ CHIEF COMPLIANCE OFFICER	.......................50.0			X		0	309,590	42,200
(145) JOSEPH T MCGINN MD........................................................................ PHYSICIAN	50.0 .......................				X	1,495,993	0	35,682
(146) JONATHON DEITCH MD........................................................................ PHYSICIAN	50.0 .......................				X	998,849	0	21,386
(147) MICHAEL L COOPER MD........................................................................ PHYSICIAN	50.0 .......................				X	936,524	0	35,422
(148) PHILIP M VIGNERI MD........................................................................ PHYSICIAN	50.0 .......................				X	919,968	0	37,494
(149) CHRISTOPHER DEMAS MD........................................................................ PHYSICIAN	50.0 .......................				X	915,959	0	30,899

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	6,430,731	13,322,545	3,278,035

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

798

Yes

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 ..............

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...........................

Yes

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 ........

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
MORRISON MANAGEMENT SPECIALISTS, 12975 COLLECTIONS CENTER DRIVECHICAGOIL60693	FOOD	6,902,713
ADVANTEDGE HEALTHCARE SOLUTIONS INC, 30 TECHNOLOGY DRIVEWARRENNJ07059	BILLING	3,459,800
UNIVERSITY PHYSICIANS GROUP PC, ONE EDGEWATER PLAZASTATEN ISLANDNY10305	MEDICAL	3,349,940
MCKESSON INFORMATION SOLUTIONS INC, 5995 WINDWARD PARKWAYALPHARETTAGA30005	IT CONSULTANTS	3,246,002
QUEST DIAGNOSTICS INC, 1 MALCOLM AVENUETETERBORONJ07608	LABORATORY	2,279,351
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 86

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
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		74,514
e	Government grants (contributions)1e		3,711,795

f	All other contributions, gifts, grants, and similar amounts not included above1f		185,474

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			3,971,783
			Business Code
2a	NET PATIENT SERVICE REVENUE		621500	781,278,630	772,290,882	8,987,748
b	PROFESSIONAL SERVICES REVENUE		621110	2,004,721	2,004,721
c	OTHER HEALTHCARE RELATED REVENUE		621990	41,979,505	41,979,505
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			825,262,856
3	Investment income (including dividends, interest, and other similar amounts).......			4,082,763			4,082,763
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	1,813,032
b	Less: rental expenses
c	Rental income or (loss)	1,813,032	0
d	Net rental income or (loss).......			1,813,032			1,813,032
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		350
b	Less: cost or other basis and sales expenses
c	Gain or (loss)		350
d	Net gain or (loss)..........			350			350
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..			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...			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..			0
Miscellaneous Revenue			Business Code
11a	CAFETERIA AND DIETARY		722514	2,422,977			2,422,977
b	PARKING REVENUE		812930	533,405			533,405
c	REBATES		812900	344,602			344,602
d	All other revenue ....			449,495			449,495
e	Total. Add lines 11a–11d ......			3,750,479
12	Total revenue. See Instructions......			838,881,263	816,275,108	8,987,748	9,646,624

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 ....	1,243,351		1,243,351
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	200,620	0	200,620	0
7	Other salaries and wages	400,463,510	359,907,302	40,556,208
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	25,391,566	23,540,562	1,851,004
9	Other employee benefits .......	69,104,313	64,058,341	5,045,972
10	Payroll taxes ...........	29,083,240	26,959,239	2,124,001
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	776,287		776,287
c	Accounting ...........	986,781		986,781
d	Lobbying ...........	99,071		99,071
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) ........	13,295,739	13,295,739
12	Advertising and promotion ....	944,158	944,158
13	Office expenses .......	14,750,934	10,699,935	4,050,999
14	Information technology ......	2,536,806	1,840,132	696,674
15	Royalties ..	0
16	Occupancy ...........	9,335,128	3,408,463	5,926,665
17	Travel ............	335,984	243,714	92,270
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	705,780	511,954	193,826
20	Interest ...........	7,796,775	5,655,573	2,141,202
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	32,616,205	23,658,927	8,957,278
23	Insurance ..............	30,035,466	29,206,933	828,533
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	MEDICAL EXPENSES	83,198,234	60,349,785	22,848,449
b	CONTRACTED SERVICES	45,252,826	44,944,458	308,368
c	UTILITIES	8,791,063	250,000	8,541,063
d	CENTRALIZED ADMIN. SVCS.	17,716,410	12,851,012	4,865,398
e	All other expenses	1,111,947	809,147	302,800
25	Total functional expenses. Add lines 1 through 24e	795,772,194	683,135,374	112,636,820	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 if following SOP 98-2 (ASC 958-720).

Form 990 (2012)

Page 11


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			60,201	1	60,984
2	Savings and temporary cash investments .........			108,844,454	2	35,565,305
3	Pledges and grants receivable, net ...........			1,906,377	3	1,522,765
4	Accounts receivable, net .............			88,732,941	4	83,763,758
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 ..............			7,975,381	8	9,156,502
9	Prepaid expenses and deferred charges ..........			1,378,627	9	1,053,041
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	685,542,830
b	Less: accumulated depreciation .....	10b	451,415,489	226,591,836	10c	234,127,341
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 .....			122,727,420	13	267,590,947
14	Intangible assets ...............			27,870,431	14	22,195,105
15	Other assets. See Part IV, line 11 ...........			90,142,922	15	89,522,626
16	Total assets. Add lines 1 through 15 (must equal line 34)......			676,230,590	16	744,558,374
17	Accounts payable and accrued expenses .........			94,261,683	17	99,378,036
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			62,626,865	20	61,359,786
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 ..			52,396,935	23	54,861,388
24	Unsecured notes and loans payable to unrelated third parties ....			25,902,787	24	18,300,000
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....................			252,258,788	25	265,053,673
26	Total liabilities. Add lines 17 through 25.........			487,447,058	26	498,952,883
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			178,518,820	27	232,262,508
28	Temporarily restricted net assets ...........			8,780,523	28	11,858,794
29	Permanently restricted net assets ...........			1,484,189	29	1,484,189
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			188,783,532	33	245,605,491
34	Total liabilities and net assets/fund balances ........			676,230,590	34	744,558,374

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 ...............

Total revenue (must equal Part VIII, column (A), line 12) ............

838,881,263

Total expenses (must equal Part IX, column (A), line 25) ............

795,772,194

Revenue less expenses. Subtract line 2 from line 1 ..............

43,109,069

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

188,783,532

Net unrealized gains (losses) on investments ...............

5,496,809

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

8,216,081

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))

245,605,491

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response to any question in this Part XII ..............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

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?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

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?

Yes

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

Yes

Form 990 (2012)

Form 990, Special Condition Description:

Special Condition Description

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I

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

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

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

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

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

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

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

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

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

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

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

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

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

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

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

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

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

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

Yes

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

11g(i)

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

11g(ii)

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

11g(iii)

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

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


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

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)		(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)		(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).

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 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)		(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)		(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.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

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

Schedule A (Form 990 or 990-EZ) 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:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2012

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization STATEN ISLAND UNIVERSITY HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization STATEN ISLAND UNIVERSITY HOSPITAL

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part III

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

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

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

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

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

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

Yes

99,071

Other activities? ..........................

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

99,071

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
LOBBYING ACTIVITIES	SCHEDULE C, PART II-B; LINES 1G AND 1H	THE ORGANIZATION IS A MEMBER OF THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. IS A MEMBER OF THE GREATER NEW YORK HOSPITAL ASSOCIATION ("GNYHA"), THE HEALTH CARE ASSOCIATION OF NEW YORK STATE and THE AMERICAN HOSPITAL ASSOCIATION WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. PAYS DUES TO THESE ASSOCIATIONS ON BEHALF OF THIS ORGANIZATION. ADDITIONALLY, THROUGH GNYHA, THE ORGANIZATION PAYS DUES TO THE 1199 JOB SECURITY FUND. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING ACTIVITES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $99,071.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 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

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I

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

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

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

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds 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? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

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

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

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

Yes No

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

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

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

Yes No

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.

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.

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

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:

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

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

Page 2

Part III

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

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

If “Yes,” explain the arrangement in Part 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 ....	1,484,189	1,484,189	1,484,189	1,484,189	1,484,189
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	1,484,189	1,484,189	1,484,189	1,484,189	1,484,189

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

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

Yes

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

3a(i)

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

3a(ii)

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

Describe in Part 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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	4,107,673		4,107,673
b	Buildings ................	351,657,008	197,417,675	154,239,333
c	Leasehold improvements ............	247,563	18,654	228,909
d	Equipment ................	289,743,765	241,714,168	48,029,597
e	Other .................	39,786,821	12,264,992	27,521,829
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				234,127,341

Schedule D (Form 990) 2012

Page 3

Part VII

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

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

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

(a) Description of investment type	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) INVESTMENT IN HEALTHFIRST	10,467,815	F
(2) INVESTMENT IN VERIZON - AT&T	10,143	F
(3) U.S. GOVERNMENT OBLIGATIONS	17,403,000	F
(4) CORPORATE BONDS	3,371,000	F
(5) ACCRUED INTEREST RECEIVABLE	430,000	F
(6) FIXED INCOME MUTUAL FUNDS	7,442,000	F
(7) COMMINGLED FIXED INCOME FUNDS	2,870,000	F
(8) EQUITY SECURITIES	12,103,000	F
(9) EQUITY MUTUAL FUNDS	3,419,000	F
(10) FUNDS OF HEDGE FUNDS	3,341,000	F
(11) LIMITED USE	27,502,000	F
(12) CASH AND CASH EQUIVALENTS	179,231,989	F
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	267,590,947

Part IX

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

(a) Description				(b) Book value
(1) DUE FROM RELATED PARTIES				0
(2) OTHER ASSETS				232,794
(3) OTHER RECEIVABLES				935,224
(4) DEPOSITS				139,417
(5) ASU 2010-04				88,215,191




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				89,522,626

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes		0
PARTY PAYERS; CURRENT		22,476,845
LIABILITIES; CURRENT		6,839,142
INTEREST PAYABLE		921,276
OTHER LONG TERM LIABILITIES		45,233,378
LIABILITIES; NON-CURRENT		67,187,666
LIABILITIES; CURRENT		5,438,260
LIABILITIES; NON-CURRENT		23,951,091
INSURANCE PAYABLE		88,215,191
DUE TO RELATED PARTIES; NET		4,790,824
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		265,053,673
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

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	836,050,171
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	924,051
e	Add lines 2a through 2d .....................			2e	924,051
3	Subtract line 2e from line 1.....................			3	835,126,120
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	3,755,143
c	Add lines 4a and 4b.......................			4c	3,755,143
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	838,881,263

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	790,227,194
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	790,227,194
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	5,545,000
c	Add lines 4a and 4b.......................			4c	5,545,000
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	795,772,194

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
ENDOWMENT FUNDS	SCHEDULE D, PART V, QUESTION 4	ENDOWMENT FUNDS INCLUDED IN PERMANENTLY RESTRICTED NET ASSETS ARE USED TO SUPPORT THE CHARITABLE ACTIVITIES AND PROGRAMS OF THE ORGANIZATION AND ITS AFFILIATES.
TEXT OF FIN 48 AUDITED FINANCIAL STATEMENT FOOTNOTE	SCHEDULE D, PART X	Certain entities included in the System's consolidated financial statements are taxable entities under Federal or state laws. U.S. generally accepted accounting principles require that the asset and liability method of accounting for income taxes be utilized by these organizations. Under the asset and liability method, deferred income taxes are recognized for the tax consequences of temporary differences by applying enacted statutory tax rates applicable to future years to differences between the financial statement carrying amounts and the tax basis of existing assets and liabilities. The effect on deferred taxes of a change in tax rates is recognized in income in the period of enactment. At December 31, 2012 and 2011, the System has a deferred income tax asset which has been fully offset by a related valuation allowance. A valuation allowance is provided when it is more likely than not that some portion, or all of the deferred tax asset will not be realized. Significant components of the deferred tax asset relate to the allowance for doubtful accounts receivable and net operating loss carry forwards. Certain entities have net operating loss carry forwards aggregating approximately $149,000,000, which expire in varying amounts through 2032, and are available to offset future taxable income.
RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS	SCHEDULE D, PART XI; LINE 2D	OTHER RECONCILIATION ITEMS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 INCLUDE: - NET ASSETS RELEASED FROM RESTRICTION USED FOR OPERATIONS - $924,051.
RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS	SCHEDULE D, PART XI; LINE 4B	OTHER RECONCILIATION ITEMS INCLUDED ON FORM 990, PART VIII, LINE 12 BUT NOT ON LINE 1 INCLUDE: - INVESTMENT INCOME - $3,755,143.
RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS	SCHEDULE D, PART XII; LINE 4B	OTHER RECONCILIATION ITEMS INCLUDED ON FORM 990, PART IX, LINE 25 BUT NOT ON LINE 1 INCLUDE: - AMORTIZATION OF INTANGIBLE ASSET - $5,545,000.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I

General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of the grants or

assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award

the grants or assistance? ...................................

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	Central America and the Caribbean	1	Investments	3,364,982
	Central America and the Caribbean	1	Investments	12,043,338















3a	Sub-total .....	2		15,408,320
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)	2		15,408,320

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012

Schedule F (Form 990) 2012

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .... MediumBullet

Enter total number of other organizations or entities ....................... MediumBullet

Schedule F (Form 990) 2012

Schedule F (Form 990) 2012Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2012

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2012

Page 5

Part V

Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

Identifier	ReturnReference	Explanation

Schedule F (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other 500 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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

Did the organization prepare a community benefit report during the tax year? ..........

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	1	7,468	12,862,000	5,282,000	7,580,000	0.950 %
b	Medicaid (from Worksheet 3, column a) ....	1	367,918	153,393,427	128,810,613	24,582,814	3.130 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	2	375,386	166,255,427	134,092,613	32,162,814	4.080 %
Other Benefits		140	128,604	6,393,259		6,393,259	0.810 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	140	128,604	6,393,259		6,393,259	0.810 %
f	Health professions education (from Worksheet 5) ..	10	1,845	52,010,974	15,635,155	36,375,819	4.630 %
g	Subsidized health services (from Worksheet 6) ..	1	14,220	5,203,000	3,330,000	1,873,000	0.240 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	11	228	234,332		234,332	0.030 %
j	Total. Other Benefits ..	162	144,897	63,841,565	18,965,155	44,876,410	5.710 %
k	Total. Add lines 7d and 7j .	164	520,283	230,096,992	153,057,768	77,039,224	9.790 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support	2	53	8,224	8,224
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	3	1,050	2,443	2,443
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	6	1,366	10,667	10,667

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

7,774,000

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

188,724,591

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

171,133,423

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

17,591,168

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?2 Name, address, and primary website address						Facility reporting group
1	STATEN ISLAND UNIV HOSPITAL - NORTH 475 SEAVIEW AVENUE STATEN ISLAND,NY10305 WWW.SIUH.EDU	X	X	X	X	1
2	STATEN ISLAND UNIV HOSPITAL - SOUTH 375 SEGUINE AVENUE STATEN ISLAND,NY10309 WWW.SIUH.EDU	X	X	X	X	1

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	STATEN ISLAND UNIV HOSPITAL
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 100% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address		Type of Facility (describe)
1	SOUTH BEACH PSYCHIATRIC CENTER 777 SEAVIEW AVENUE STATEN ISLAND,NY10305	CLINIC
2	NEW DORP HIGH SCHOOL 465 NEW DORP LANE STATEN ISLAND,NY10306	CLINIC
3	AUDIOSPEECH PATHOLOGY CENTER 500 SEAVIEW AVENUE STATEN ISLAND,NY10305	CLINIC
4	CHEMICAL DEPENDENCE TREATMENT PROGRAM 111 WATER STREET STATEN ISLAND,NY10304	CLINIC
5	THE BAY STREET HEALTH CENTER 57 BAY STREET STATEN ISLAND,NY10301	CLINIC
6	PSYCHALCOHOLISM TREATMENT PROGRAM 450 SEAVIEW AVENUE STATEN ISLAND,NY10305	CLINIC
7	CANARSIE MULTI SERVICE CENTER 567 E 10TH STREET BROOKLYN,NY11218	CLINIC
8	SANFORD R NALITT INSTITUTUE FOR CANCER 256 MASON AVENUE STATEN ISLAND,NY10305	CLINIC
9	CONEY ISLAND MULTIPLE SERVICE CENTER 425-427 CONEY ISLAND AVENUE BROOKYLN,NY11218	CLINIC
10	CENTER FOR WOMENS HEALTH 440 SEAVIEW AVENUE STATEN ISLAND,NY10305	CLINIC

Schedule H (Form 990) 2012

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
ELIGIBILITY FOR DISCOUNTED CARE	PART I, LINE 3C	This hospital is an affiliated entity of the North Shore-LIJ Health System ("North Shore-LIJ" or "the System"). North Shore-LIJ uses FPG to determine eligibility and utilizes the New York State Department of Health (NYSDOH) guidelines regarding the consideration of assets. Asset tests cannot be used to deny financial assistance, but only to "upgrade" a patient's level of obligation, up to the legal maximum permitted under the financial assistance law.
COMMUNITY BENEFIT REPORT	SCHEDULE H, PART I; QUESTION 6A	The Community Benefit report is prepared by the hospital, in conjunction with an affiliated entity (North Shore-Long Island Jewish Health System) of the hospital. The Community Benefit Report is accessible to the public and can be accessed on the North Shore-LIJ website: http://www.northshorelij.com.
SUBSIDIZED HEALTH SERVICES	SCHEDULE H, PART I; QUESTION 7	Row (a) The cost of charity care was determined by utilizing the ratio of cost to charges (RCC) calculated on Worksheet 2 applied to gross charges written off for patients qualifying for charity under the hospital's financial assistance policy. Bad Debt was not reported in any row of Part I, Line 7. Row (b) The Ratio of Cost to Charges method (or RCC) is used to determine the cost of ancillary services. A RCC is developed from these costs, and that RCC is applied to total Medicaid gross ancillary services charges to determine the cost of services provided to Medicaid patients. Row (e) Costs associated with Community Health Improvement Services were determined by adding indirect or overhead costs to the direct costs of the activity. Indirect costs were calculated as a percentage of direct costs. Direct costs for staff expenses were calculated using average hospital facility hourly rates, and were adjusted to account for fringe benefits, using a blended rate based on the ratio of total employee benefit expenses to total salary and wages. Row (f) The Bad Debt Expense that appears on Form 990, Part IX, Line 25 column (A), but not included for purposes of calculating the percentage in this column is equal to the amount reported on Form 990, Part X. The costs related to health professions education were determined by utilizing the step down method of cost finding. Row (h) Costs associated with research activities were determined by adding indirect, or overhead, costs to the direct costs of the activity. Indirect costs were calculated as a percentage of costs. Row (i) The cost of in-kind contributions to community groups is comprised of the direct costs of personnel whose compensated time was donated to various charities and community groups. The salaries and wages were adjusted to include benefits using a rate based on the ratio of total employee benefit expenses to total salary and wages. Indirect costs were calculated as a percentage of direct costs. Column (a) The number of activities or programs was determined by counting unique community benefit activities or programs conducted throughout the year. Each activity or program may include multiple occurrences. In Part I line 7a-k, column (a) represents the total number of unique community benefit activities and programs; not the number of occurrences for each activity and program. Column (b) Persons served were determined by the unique number of community members that encountered a specific community benefit activity or program. Persons were reported multiple times when engaged in services in different categories of activity or program. Column (f) for Rows (a)-(k) The percentage of Net Community Benefit Expense divided by Total Expense for the hospital (to calculate the percent of total expense). Note: For the entire North Shore-LIJ Health System, Part I, Line 7(Row K, Column F) is approximately 10.9% as a percentage of expenses.
COMMUNITY BUILDING ACTIVITIES	SCHEDULE H, PART II	All community building activities improve access to health services and address federal, state, or local public health priorities, as well as leverage public health department activities, and in doing so, they provide relief of government burden. These activities broadly serve low-income, underserved patients, and include: collaboration with various community coalitions, system-wide recycling initiative, organizational response to worldly disasters, and bioterrorism efforts. The System's bioterrorism & disaster preparedness includes Center for Emergency Medical Services, which is a state and federal planning resource on weapons of mass destruction, and a designated a Bioterrorism Resource Center. The System has conducted staff training for more than 100 hospitals and area first responders and invested heavily in the infrastructure needed for large-scale emergencies. During catastrophes, (i.e. Super storm Sandy), North Shore-LIJ provides a safe haven for thousands of patients, outside nursing home residents, and community members seeking shelter. North Shore-LIJ ambulances assists with the transport of patients throughout the metropolitan area and stand ready to contribute food, medicine and blankets to numerous individuals who may lose power in their homes, and assist both affiliated and non-affiliated hospital patients. Investment in a field hospital has furthered the public health infrastructure needed for mass casualties that could result from a terrorist attack, natural attack, or large-scale emergency.
BAD DEBT EXPENSE	SCHEDULE H, PART III, SECTION A; QUESTION 4	For patients who were determined by the System to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. Bad debt expenses are determined by applying the ratio of cost to charges from Worksheet 2 to gross patient charges written off to bad debt.
COMMUNITY BENEFIT	SCHEDULE H, PART III, SECTION B; QUESTION 8	Medicare costs are determined utilizing a combination of the step down method of cost findings and a cost per unit of service. Cost per unit of service is used to calculate the routine cost of services provided to Medicare patients. The Ratio of Cost to Charges method (or RCC) is used to determine the cost of ancillary services. An RCC is developed from these costs, and that RCC is applied to total Medicare gross ancillary services charges to determine the cost of services provided to Medicare patients.
COLLECTION POLICY	SCHEDULE H, PART III, SECTION B; QUESTION 9B	The organization's collection policy is standard to all accounts regardless of insurance status (e.g. insured, underinsured, and uninsured). The hospital's collection policy states that they will not send patient accounts to collection if a decision on a financial assistance application is pending, or if a patient is determined to be eligible for Medicaid at the time services were rendered and for which services Medicaid payment is available.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTIONS 1J, 3, 4, 5C, 6I & 7	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 9	The organization's financial assistance policy will review a patient's assets if they fall within the family size and income levels approved by the New York State to provide free or discounted care. Asset test cannot be used to deny financial assistance, but only to "upgrade" a patient's level of obligation, up to the legal maximum permitted under the financial assistance law.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 10	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 11	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 12H	The hospital also uses household size.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTIONS 14G	The policy is included in the hospital's Community Service Plan and provided at health fairs and presentations open to the community at no cost, in addition to mailing financial policy summary brochures.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 16E	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 17E	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 18E	Before initiating any of the actions, the hospital facility sends letters, makes telephone calls and utilizes presumptive eligibility.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTIONS 19C & 19D	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 20D	The hospital used a blended Medicaid rate as a criterion during the tax year to determine the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care. Under NYS Health Law Section 2807-k (9a) indigent care pool requires a sliding fee scale from qualifying patients. A reduction from gross charges must result in an expected payment that does not exceed the amount paid for the same services by the hospital's highest volume payer (i.e. Medicare or Medicaid).
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 21	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 22	In general, the hospital facility does not charge its FAP-eligible patients an amount equal to the gross charge for any service provided. The hospital may charge an amount equal to the gross charge when it is less than the Medicaid rate.
NEEDS ASSESSMENT	SCHEDULE H, PART VI; QUESTION 2	The Community Health Needs Assessment (CHNA) is performed on an ongoing basis. North Shore-LIJ conducts and participates in population, demographic, and health status evaluations of our respective hospitals' service areas based on county regions and the communities we serve. There is a special effort to include individuals with health disparities and organizations who serve these communities in the CHNA process. The CHNA includes the analysis of primary and secondary data. Multi-year analyses, trends and projections are developed, which identify areas of need for the continuum of health care services. Primary data is obtained through a combination of qualitative analysis of community-based organization (CBO), informant interviews and surveys, individual community member surveys, and participation in collaborative partner meetings. These meetings include representatives from the Departments of Health, CBOs, academic institutions, government agencies, and hospitals. Ongoing input concerning our communities' needs is also obtained through: our Board of Trustees/Directors who are all area residents and leaders in their respective communities; facility based advisory boards and councils, and; the feedback received by our facility administrators and clinicians that serve on local community agency boards. Secondary data analysis includes: internal hospital data, including Prevention Quality Indicators (PQI); Department of Health Community Health Assessments; local regional NYS Prevention Agenda data sources; E-BRFSS; 2010 US Census data and Statewide Planning and Research System (SPARCS) data. The Committee on Community Health, a committee of the Board of Trustees, provides recommendations that concern North Shore-LIJ's community health priorities and interventions based on the CHNA. Committee discussions focus on New York State (NYS) Prevention Agenda Priority Areas, including strategies and intervention outcomes related to chronic disease prevention, women and children's health, healthy safe environments, health access, mental health and substance abuse, HIV/AIDS/STDs and community immunizations. Regional departments of health (I.E. Nassau County Department of Health, Suffolk County Department of Health Services, and NYC Department of Health and Mental Hygiene) perform additional community health assessments (CHA) with the input of hospital and community stakeholders. These regional partners use strategies such as community member surveys, CBO surveys, and public listening sessions to solicit information on community needs. Together with other healthcare organizations and CBOs, North Shore-LIJ participates in meetings organized by these regional departments of health academic organizations to discuss the shared responsibility of public health planning within the NYS Prevention Agenda. These meetings provide an opportunity for general discussion regarding the public health goals of the NYS Prevention Agenda and the selection of shared priorities for collaborative regional planning. The partnership among local health departments, hospitals and CBOs, enables region wide leveraging of resources, consensus on health priorities and collaboration on health promotion strategies.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI; QUESTION 3	North Shore-LIJ is a regional leader in the development of financial assistance programs for the uninsured. The System's financial assistance policy provides a uniformly-administered system of reduced fees for the uninsured residents of our service area. The current fee schedule includes patients with household incomes up to 500% of the FPL. While the fee schedule serves as a guide, all hardship cases are evaluated on a case-by-case basis, taking into account the individual's financial and personal circumstances. All medically necessary services are covered under the financial assistance program and the public is notified of the availability of the program through: multilingual signage and educational brochures; centralized program administration accessible via phone ; staff outreach, and all bills include a notice about the financial assistance program. Soft credit scoring software is used to facilitate the application process, but is not used to deny an applicant. The Healthcare Access Center (HAC), staffed by bilingual employees, assists community residents' with referrals for enrollment into government-subsidized insurance programs such as Medicaid, Child Health Plus and Family Health Plus. In addition, the HAC staff refers patients to the Medicaid Prenatal Care Program and to the Senior Navigator Program within North Shore-LIJ for assistance with Medicaid for pregnant women and Medicare enrollment for seniors.
COMMUNITY INFORMATION	SCHEDULE H, PART VI; QUESTION 4	The North Shore-LIJ has a service area of more than approximately 7.2 million people covering Long Island (Nassau and Suffolk counties) and the Metropolitan area covering the boroughs of Manhattan, Queens, and Staten Island. The demographics of the community show a broad range of cultural and ethnic diversity, particularly in Queens, the most multi-ethnic county in the country. Overall the area has shown an increase in the number of uninsured and underinsured. The other counties in the service area continue to show trends of increasing diversity, as well. By 2018, our service area population 65 and older will grow by 14.5%, while residents under 65 will decline less than 1% (Thomson Reuters, Market Planner Plus). The service area has also shown high rates of obesity, diabetes, asthma and heart/cerebrovascular disease mortality.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI; QUESTION 5	North Shore-LIJ works to promote community health through education, community advocacy, partnerships, and programs that result in improved access to care and health outcomes. The activities and strategies for achieving this goal include: establishing collaborative partnerships with local CBOs, health-related organizations, business, and government to identify and address community health needs; advocating for policies that benefit the broader community at state and local levels; providing community health programs and services based on identified community health needs/priorities; delivering preventive care services and education; conducting community outreach and engagement activities and expanding community member representation and involvement on committees/boards for programming and educational events. North Shore-LIJ provides community residents with a broad array of community health programs, such as: access to healthcare services and caring for the medically underserved; screenings and immunizations; health forums and health fairs; community education and outreach programs; support groups and counseling and emergency medical services. A comprehensive list of programs can be found in the Community Service Plans located on the North Shore-LIJ public website. North Shore-LIJ recognizes that, to have an impact on community health status, it must collaborate, to the extent possible, with multiple partners who can address different components of program design, including: providing trust and "reach" into a community; access to capital and funding; policy guidance and best practices for program development. With thousands of community programs, our partners are many and varied; some of our partners include: government, national/professional associations, area businesses, other area health care providers, philanthropies, civic organizations and CBOs.
AFFILIATED HEALTHCARE SYSTEM	SCHEDULE H, PART VI; QUESTION 6	The organization is an affiliate of the North Shore-LIJ Health System Inc., an integrated health care delivery system which includes 16 hospitals, 3 skilled nursing facilities, a world renowned children's hospital, post-acute services, ambulatory network, rehabilitation network and a freestanding research institute, which is chartered to confer doctoral (PhD) degrees through its Elmezzi Graduate School of Molecular Medicine. All North Shore-LIJ entities are considered to be under common control for antitrust and other legal purposes. Each hospital facility shares a common board and management in the North Shore-LIJ Health System and as such is referred to as being commonly managed. Also, in a joint venture, the Hofstra North Shore-LIJ School of Medicine at Hofstra University provides an allopathic medical school for the benefit of the community. In keeping with its mission to improve the health and caring for the communities it serves, regardless of the ability to pay, North Shore-LIJ established the Office of Community and Public Health (OCPH) to promote health and wellness. The OCPH plays a key role in leading many of the mission-critical initiatives of the System and operates in alignment with the National Prevention Strategy and NYS Prevention Agenda. The OCPH is guided by the Committee on Community Health, a committee composed of the Board of Trustees, which is charged with identifying the overall health needs of the community and making recommendations for the population the System serves. The objectives of the Committee include: promoting a dialogue about the obligations of a large health system in addressing critical health issues of the public; reviewing information which assesses the health status of the communities served; promoting activities which have been shown to positively impact health; proposing policy recommendations to guide current programs or develop new ones; identifying opportunities to meet health care needs through improved delivery of health care; and recommending community health interventions to be provided by the System. North Shore-LIJ has established comprehensive and coordinated clinical programs that span across the enterprise. These programs not only provide a full continuum of services and seamless delivery of care, but offer community health activities, outreach and education as well; they include: Behavioral Health, Cancer, Cardiovascular Services, Dental Medicine, Emergency Medicine, Family Medicine, Hospice Care, Imaging/Radiology, Laboratory Medicine and Pathology, Medicine, Neurology, Neurosurgery, Obstetrics/Gynecology, Ophthalmology, Orthopedic Surgery, Otolaryngology, Pediatrics, Physical Medicine & Rehabilitation, Population Health, Senior Services, Surgery, Urology, and Women's Health. The System's hospitals, programs and services support one of the largest resident and fellowship training programs in the United States. It directly sponsors approximately 120 accredited graduate medical education (GME) programs and trains more than 1,500 medical residents and fellows annually. Our hospitals and facilities collectively serve as teaching sites for more than 1,200 rotations for medical students from five medical schools.
STATE FILING OF COMMUNITY BENEFIT REPORT	SCHEDULE H, PART VI; QUESTION 7	New York
FACILITY REPORTING GROUP(S)	SCHEDULE H, PART VI; QUESTION 8	For any facility reported in Section B, the answers provided in Question 1 are identical.

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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? .......

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

Yes

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

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

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

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

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

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

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

Yes

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 .............................

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

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

Cat. No. 50053T

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)MICHAEL J DOWLINGTRUSTEE	(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)ANTHONY C FERRERIPRESIDENT/CEO - TRUSTEE	(i) (ii)	0 873,896	0 155,000	0 20,150	0 372,110	0 15,100	0 1,436,256	0 0
(3)KEVIN F LAWLORTRUSTEE	(i) (ii)	0 665,596	0 104,400	0 29,180	0 263,381	0 17,193	0 1,079,750	0 0
(4)RALPH A NAPPITRUSTEE	(i) (ii)	0 672,087	0 150,000	0 1,454,459	0 41,995	0 18,775	0 2,337,316	0 1,389,266
(5)ARTHUR KLEINEXECUTIVE DIRECTOR	(i) (ii)	0 871,740	0 169,000	0 34,868	0 273,100	0 15,100	0 1,363,808	0 0
(6)KEITH C THOMPSONASSISTANT SECRETARY	(i) (ii)	0 724,852	0 113,000	0 2,030,970	0 511,950	0 21,081	0 3,401,853	0 313,468
(7)HARRY E GINDIASSISTANT TREASURER	(i) (ii)	0 280,027	0 0	0 4,531	0 27,500	0 15,100	0 327,158	0 0
(8)ROBERT S SHAPIROSVP/CFO NS-LIJ HEALTH SYSTEM	(i) (ii)	0 921,947	0 190,000	0 27,506	0 209,519	0 22,300	0 1,371,272	0 0
(9)THOMAS RECACHIEF FINANCIAL OFFICER	(i) (ii)	468,317 0	42,443 0	19,286 100,000	27,000 0	13,776 0	570,822 100,000	0 0
(10)MARK P JARRETT MDCMO/VP CHIEF QUALITY OFFICER	(i) (ii)	67,485 544,552	0 0	1,399 51,844	3,654 27,500	905 15,100	73,443 638,996	0 0
(11)DONNA PROSKEEVP - CHIEF NURSING EXECUTIVE	(i) (ii)	496,339 0	44,443 0	23,726 0	27,000 0	7,578 0	599,086 0	0 0
(12)GREGORY RADINSKYCHIEF COMPLIANCE OFFICER	(i) (ii)	0 269,330	0 21,756	0 18,504	0 27,500	0 14,700	0 351,790	0 0
(13)JOSEPH T MCGINN MDPHYSICIAN	(i) (ii)	1,495,219 0	0 0	774 0	15,000 0	20,682 0	1,531,675 0	0 0
(14)JONATHON DEITCH MDPHYSICIAN	(i) (ii)	898,849 0	100,000 0	0 0	15,000 0	6,386 0	1,020,235 0	0 0
(15)MICHAEL L COOPER MDPHYSICIAN	(i) (ii)	936,524 0	0 0	0 0	15,000 0	20,422 0	971,946 0	0 0
(16)PHILIP M VIGNERI MDPHYSICIAN	(i) (ii)	728,016 0	175,000 0	16,952 0	25,000 0	12,494 0	957,462 0	0 0
(17)CHRISTOPHER DEMAS MDPHYSICIAN	(i) (ii)	795,959 0	120,000 0	0 0	11,077 0	19,822 0	946,858 0	0 0

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
COMPENSATION INFORMATION	CORE FORM, PART VII and SCHEDULE J, PART II; QUESTION 4B	TWO individuals' participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. THE AMOUNTS REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES PARTICIPATION IN A SERP FOR WHICH AMOUNTS ARE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN EACH INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: RALPH A. NAPPI, $1,389,266 AND KEITH C. THOMPSON, $313,468. SEVEN individuals' participate in a Supplemental Executive Retirement Plan ("SERP") which is subject to substantial risk of complete forfeiture. Accordingly, the individualS may never actually receive the unvested benefit amount and the amounts outlined herein were properly not reported in each individual's Form W-2, Box 5, AS TAXABLE MEDICARE WAGES. These amounts are included in Schedule J-II, Column C for Michael J. DowlinG, $1,079,610; ANTHONY C. FERRERI, $344,610; KEVIN F. LAWLOR, $233,853; Ralph A. Nappi, $14,495; ARTHUR KLEIN, $245,600; KEITH C. THOMPSON, $484,450 AND ROBERT S. SHAPIRO, $182,019.
COMPENSATION INFORMATION	SCHEDULE J, PART I; QUESTION 5A	PURSUANT TO THE PERSONS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A, THERE IS NO CONTRACTUAL OBLIGATION TO PAY OR ACCRUE ANY COMPENSATION TO OFFICERS OF THE NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM BASED ON THE REVENUE OF THE ORGANIZATION. A LISTED PERSON(S) THAT MAY QUALIFY UNDER THIS CONDITION COULD BE ONE OR MORE OF THE PHYSICIANS LISTED AS A HIGHLY COMPENSATED EMPLOYEE.
COMPENSATION INFORMATION	SCHEDULE J, PART I; QUESTION 7	ON FORM 990, PART VII, SECTION A, LINE 1A, THE ORGANIZATION MAY PROVIDE NON-FIXED PAYMENTS, NOT DESCRIBED ON LINES 5 AND 6, TO CERTAIN LISTED PERSONS. THE ORGANIZATION BASES SUCH PAYMENTS ON MANY PERFORMANCE BASED FACTORS. PAYMENTS OF THIS TYPE APPEAR ON SCHEDULE J-1, PART I, B (II).
COMPENSATION INFORMATION	SCHEDULE J, PART II, COLUMN F	THE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN F FOR THE FOLLOWING INDIVIDUALS INCLUDE VESTED BENEFITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") WHICH AMOUNTS ARE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THESE AMOUNTS WERE REPORTED IN SCHEDULE J, PART II, COLUMN C AS RETIREMENT AND OTHER DEFERRED COMPENSATION ON PRIOR YEAR'S FORMS 990. THE AMOUNTS WERE TREATED AS TAXABLE INCOME AND REPORTED ON EACH INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: RALPH A. NAPPI, $1,389,266 AND KEITH C. THOMPSON, $313,468.

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number
11-2868878

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	DORMITORY AUTHORITY - STATE OF NEW YORK	14-6000293	649906JT2	10-06-2011	62,381,682	CAPITAL IMPROVEMENT		X		X		X
B	DORMITORY AUTHORITY - STATE OF NEW YORK	14-6000293		08-19-2009	4,744,692	LEASE OF EQUIPMENT		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	909,984		770,782
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	62,439,590		4,744,692
4 Gross proceeds in reserve funds . . . . . . . . . . . .	5,021,231		0
5 Capitalized interest from proceeds . . . . . . . . . . .	517,772		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	0		0
7 Issuance costs from proceeds . . . . . . . . . . . .	1,104,871		83,250
8 Credit enhancement from proceeds . . . . . . . . . . .	0		0
9 Working capital expenditures from proceeds . . . . . . . . .	0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	10,277,334		4,661,442
11 Other spent proceeds . . . . . . . . . . . . . .	36,053,483		0
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0
13 Year of substantial completion . . . . . . . . . . . .	2010		2010
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X			X
15 Were the bonds issued as part of an advance refunding issue? . . . . .	X			X
16 Has the final allocation of proceeds been made? . . . . . . . .		X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2012

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		0%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .		X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.	%		%		%		%
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .	X		X
b Exception to rebate? . . . . . . . .	X		X
c No rebate due? . . . . . . . . . .		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider . . . . . . . . .	0		0
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . . . .
e Was a hedge terminated? . . . . . . .

Schedule K (Form 990) 2012

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X
b Name of provider . . . . . . . . .	0		0
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part VI

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

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) TONI A SPINELLA	DAUGHTER OF OFFICER	34,131	EMPLOYEE		No
(2) TARA MAZZUCCO	DAUGHTER OF TRUSTEE	39,942	EMPLOYEE		No
(3) SCARAN OIL	COMPANY/FAMILY OF TRUSTEE	333,874	OIL/UTILITY PRODUCT		No
(4) DONNA FERRERI	FAMILY MEMBER of officer	20,976	EMPLOYEE		No
(5) JAMES R WELLER	SON OF OFFICER	79,088	EMPLOYEE		No

Part V

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

Identifier	Return Reference	Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS	SCHEDULE L, PART IV	FRANK W. SCARANGELLO, SR. IS A TRUSTEE OF THE ORGANIZATION. THE ORGANIZATION UTILIZED THE SERVICES OF HIS COMPANY, SCARAN OIL, DURING 2012. TOTAL FEES PAID TO SCARAN OIL WERE $333,874. SERVICES WERE RENDERED AT FAIR MARKET VALUE RATES PURSUANT TO ARM'S LENGTH NEGOTIATIONS.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Identifier	Return Reference	Explanation
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	CORE FORM, PART III; LINE 4D	EXPENSES INCURRED IN PROVIDING VARIOUS OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.
BUSINESS AND FAMILY RELATIONSHIPS	CORE FORM, PART VI, SECTION A; QUESTION 2	FORM 990 SCHEDULE A, PART III STATEMENT ABOUT ACTIVITY ====================================================== ALL TRANSACTIONS WITH NORTH SHORE-LIJ HEALTH SYSTEM ENTITIES ARE AS FOLLOWS: (1) NEGOTIATED AT ARM'S LENGTH; (2) ALL PURCHASES ARE AT FAIR MARKET VALUE; AND (3) ALL PRODUCTS OR SERVICES ARE RENDERED ON AN "AS NEEDED" BASIS. William Achenbaum ----------------- has a business relationship with Eric Blumencranz 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 Goldstein, Lloyd Goldman, Alan Greene, James Greene, Stanley Grey, Richard Guarasci, Richard Horowitz, M. Allen Hyman, Jeffrey Jurick, Arthur Levine, Stuart Levine, David Mack, Bradley Marsh, Charles Merinoff, Ralph Nappi, Dennis Riese and Michael Slade. Roger Blumencranz ----------------- has a family relationship with Eric Blumencranz. He has a business relationship with Eric Blumencranz, William Achenbaum, mark claster, Alan Greene, James Greene, Stanley Grey, Richard Goldstein, Richard Horowitz, Jeffrey Jurick, Stuart Levine, David Mack, Ralph Nappi, Donald Zucker, Barbara Zucker. David Blumenfeld ---------------- has a family relationship with Edward Blumenfeld. Edward Blumenfeld ----------------- has a family relationship with David Blumenfeld. He has a business relationship with William Mack. Steve Braun ----------- has a family relationship with Richard Sims. he has a business relationship with cary kravet. Robert w. Chasanoff ------------------- has a business relationship with Michael h. Sahn. Alan Chopp ---------- has a business relationship with Patrick Mc Dermott. Mark Claster ------------ has a business relationship with Roger A. Blumencranz, Richard Goldstein, Saul Katz, robert d. rosenthal and Barry Rubenstein. Philippe Dauman --------------- has a business relationship with thomas dooley. Daniel de Roulet ---------------- has a family relationship with Lorinda de Roulet. Lorinda de Roulet ---------------- has a family relationship with Daniel de Roulet. 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 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 blumencranz and Roger Blumencranz. James R. Greene --------------- has a family relationship with Alan I. Green. He has a business relationship with Eric blumencranz and Roger Blumencranz. Stanley Grey ------------ has a business relationship with eric blumencranz 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 blumencranz, Roger Blumencranz and m. allen hyman. m. allen hyman -------------- has a business relationship with eric blumencranz, richard horowitz, saul katz and donald zucker. Jeffrey Jurick -------------- has a business relationship with Eric blumencranz 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, Michael Slade, m. allen hyman and david katz. 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 blumencranz and Roger blumencranz. David MACK ---------- has a family relationship with William Mack. He has a business relationship with William Mack, Eric Blumencranz, and Roger Blumencranz. William Mack ------------ has a family relationship with David Mack. He has business relationships with David Mack, Michael Ashner, Edward Blumenfeld, Leonard Feinstein, Lloyd Goldman, Jeffrey Lane, Barry Rubenstein, Richard Goldstein and Roy Zuckerberg. Bradley Marsh ------------- has a family relationship with Jack Ross. He has a business relationship with Eric Blumencranz. jeffrey maurer -------------- has a business relationship with william hiltz. 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 Blumencranz 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 waldenbaum. Jack Ross --------- has a family relationship with Bradley Marsh. Barry Rubenstein ---------------- has a business relationship with mark claster, richard goldstein, william mack and Saul Katz. Scott Rudolph ------------- has a business relationship with michael ashner. 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. nancy waldenbaum ---------------- 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 and m. allen hyman. Roy Zuckerberg -------------- has a business relationship with William Mack.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION A; QUESTION 7	North Shore-Long Island Jewish Health Care, Inc. ("Health Care") is the sole corporate member of the organization. Health Care has the right to elect or appoint members of the organization's governing body and has the right to approve or ratify certain corporate decisions. This organization and Health Care are part of the North Shore - long Island Jewish Health System, an integrated healthcare delivery system.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION b; QUESTION 11b	All North Shore-LONG ISLAND JEWISH Health System Inc. and affiliated entities prepare the annual Return of Organization Exempt Form Income Tax (Form 990) with input from various departments including Corporate Compliance, Finance, Human Resources, and Legal). Before filing the returns, the documents are electronically made available for review to members of the Executive Committee. The Executive Committee, which is a committee made up of members from the Board of Trustees, may exercise all of the authority of the Board of Trustees except as such authority is limited by applicable law and except to the extent, if any, that such authority would be inconsistent with any provision of these By-laws or is limited by any resolution to such effect adopted by the Board of Trustees.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION B; QUESTION 12	The North Shore-Long Island Jewish Health System ("Health System") has several control mechanisms to mitigate conflicts of interest. The Health System's Code of Ethical Conduct contains a detailed section educating individuals about how to avoid potential conflicts of interest. Specifically, our Code of Ethical Conduct requires individuals to conduct Health System business in a manner that places the interests of the Health System ahead of their personal interests. In addition, the Health System has a Conflicts of Interest Policy Statement further elaborating upon individuals' disclosure and recusal obligations. Individuals that are in a position to influence the business or other decisions of the Health System are required to filed out a conflicts of interest disclosure form on a regular basis. The Corporate Compliance Office reviews all disclosures of possible conflicts, including matters disclosed in any conflicts of interest disclosure report and takes any actions deemed required or appropriate to manage or resolve any actual or potential conflicts of interest. In appropriate cases these disclosures and responsive actions will be reported to the Health System's Audit and Corporate Compliance Committee and other applicable committees. In addition, the Health System provides training to individuals on an annual basis regarding conflicts of interest and other compliance related topics. If an individual violates the Code of Ethical Conduct or any related policy such as the Conflicts of Interest Policy Statement, appropriate disciplinary action is taken based upon the facts and circumstances of the situation.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION B; QUESTION 15	THE BY-LAWS OF THE HEALTH SYSTEM CREATE A COMMITTEE OF THE BOARD WITH FULL POWERS OF THE BOARD TO REVIEW AND APPROVE THE COMPENSATION OF OFFICERS AND OTHER KEY EMPLOYEES. THE COMMITTEE CONSISTS OF APPROXIMATELY 6 TRUSTEES WHO HAVE NO CONNECTION TO THE SYSTEM EXCEPT AS TRUSTEES AND THEY HAVE NO CONFLICTS AS TO MATTERS THEY CONSIDER. THE COMMITTEE MEETS SEVERAL TIMES A YEAR AS NEEDED BUT ALWAYS MEETS IN NOVEMBER/DECEMBER TO REVIEW AND DETERMINE OFFICER AND KEY EMPLOYEE COMPENSATION FOR THE FOLLOWING YEAR. FOR PURPOSES OF THEIR REVIEW THE COMMITTEE CONSIDERS THE RECOMMENDATIONS OF THE CEO FOR ALL PERSONS OTHER THAN THE CEO. FOR PURPOSES OF THE REVIEW EACH YEAR THE COMMITTEE RECEIVES INFORMATION FROM AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT AS TO COMPENSATION FOR COMPARABLE POSITIONS IN COMPARABLE ORGANIZATIONS AND MAKES ITS DECISIONS ON THIS BASIS, WITH THE OVERALL OBJECTIVE OF PAYING BASE SALARY AT THE 50TH PERCENTILE. ANY CONTRACTS OR OTHER COMPENSATION FOR OFFICERS OR KEY EMPLOYEES ARE SEPARATELY CONSIDERED AND NORMALLY ONLY APPROVED AFTER RECEIPT OF A "FAIRNESS OPINION" FROM THE INDEPENDENT CONSULTANT. ALL THE WORK AND PROCESS OF THE COMMITTEE IS STRUCTURED TO FALL WITHIN THE APPLICABLE SAFE HARBOR REGULATIONS.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION C; QUESTION 19	CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.
RELATED HOURS INFORMATION	CORE FORM, PART VII, SECTION A	This organization is affiliated with the North Shore - Long Island Jewish Health System (the "Health System"). The Officers, Directors and Trustees listed on Schedule J hold similar positions with both this organization and other affiliates of the Health System, and they do not separately allocate their time to this organization and such other affiliates. The hours shown for all such persons reflect time devoted to the entire Health System and its affiliates, including this organization. For Directors and Trustees, the hours shown reflect the estimated average weekly time. For officers, Key Employees and Highest Compensated Employees, the hours shown reflect the weekly hours used when determining compensation payments for services rendered and are, generally, less than the actual weekly hours devoted to the Health System and its affiliates.
OFFICER DISCLOSURE	CORE FORM, PART VII AND SCHEDULE J	MARK P. JARRETT, M.D., WAS EMPLOYEED AS THE CHIEF MEDICAL OFFICER OF THIS ORGANIZATION FROM JANUARY 1, 2012 THROUGH FEBRUARY 28, 2012. AS OF MARCH 1, 2013 MARK P. JARRETT, M.D. BECAME THE VICE PRESIDENT CHIEF QUALITY OFFICER AT NORTH SHORE - LONG ISLAND JEWISH. THEREFORE THIS RETURN SHOWS COMPENSATION FROM THIS ORGANIZATION AS WELL AS A TAX-EXEMPT RELATED CODE SECTION 501(C)(3) ORGANIZATION.
RECONCILIATION OF NET ASSETS	CORE FORM, PART XI; QUESTION 9	OTHER CHANGES IN FUND BALANCE INCLUDE: - NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS - $924,051; - CHANGE IN VALUE ON EQUITY METHOD INVESTMENTS - $3,171,541; - CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS DESIGNATED AS DERIVATIVE INSTRUMENTS - $172,273; - NET ASSETS RELEASED FROM RESTRICTION FOR CAPITAL ASSET ACQUISITIONS - $2,087,532; - PENSION AND OTHER POSTRETIREMENT LIABILITY ADJUSTMENTS - ($1,217,587); and - NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - $3,078,271.
AUDITED FINANCIAL STATEMENTS	CORE FORM, PART XII; QUESTION 2	THE ORGANIZATION IS AN AFFILIATE WITHIN THE NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. ("SYSTEM"), A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM WHICH INCLUDES STATEN ISLAND UNIVERSITY HOSPITAL. THE SYSTEM'S PARENT ENTITY IS NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF NORTH SHORE - LONG ISLAND JEWISH HEALTH SYSTEM, INC. AND ITS AFFILIATES FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; RESPECTIVELY. THESE CONSOLIDATED AUDITED FINANCIAL STATEMENTS INCLUDE CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE NORTH SHORE - LONG ISLAND JEWISH HEALTHCARE SYSTEM, INC. EXECUTIVE COMMITTEE HAS ASSUMED RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS, WHICH INCLUDES THIS ORGANIZATION, AND THE SELECTION OF AN INDEPENDENT AUDITOR.

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:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

STATEN ISLAND UNIVERSITY HOSPITAL

Employer identification number

11-2868878

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" 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
(1) CASTLETON AVENUE ASSOCIATES LLC 475 SEAVIEW AVENUE STATEN ISLAND,NY10305 13-3943199	INACTIVE	NY	0	0	SIUH

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) CHAPS Community Health Center Inc 1 Edgewater Plaza 6th Floor Staten Island,NY10305 11-3345477	Inactive	NY	501(C)(3)	9	SIUH	Yes
(2) Feinstein Institute for Medical Research 972 Brush Hollow Rd Westbury,NY11590 11-2673595	Research	NY	501(C)(3)	4	NS-LIJ HS		No
(3) Forest Hills Hospital 972 Brush Hollow Rd Westbury,NY11590 11-2163522	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(4) Franklin Hospital 972 Brush Hollow Rd Westbury,NY11590 11-2296824	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(5) Glen Cove Hospital 972 Brush Hollow Rd Westbury,NY11590 11-1633487	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(6) Hillside Hospital Houses Inc 972 Brush Hollow Rd Westbury,NY11590 11-2113949	Housing Comp	NY	501(C)(2)	N/A	NS-LIJ HS		No
(7) Hospice Care Network 99 Sunnyside Blvd Woodbury,NY11797 11-2925757	Hospice	NY	501(C)(3)	9	NS-LIJ HS		No
(8) Huntington Hospital 270 Park Avenue Huntington,NY11743 11-1630914	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(9) Huntington Hosp Dolan Family Health Ctr 284 Pulaski Rd Greenlawn,NY11740 11-3368503	HealthCare	NY	501(C)(3)	3	Huntington		No
(10) LIJ Foundation 972 Brush Hollow Rd Westbury,NY11590 11-2661239	support org	NY	501(C)(3)	11, TYPE I	NS-LIJ HS		No
(11) Long Island Jewish Medical Center 972 Brush Hollow Rd Westbury,NY11590 11-2241326	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(12) LIJ Medical Center at Home Pharmacy 972 Brush Hollow Rd Westbury,NY11590 11-3251128	support org	NY	501(C)(3)	11, TYPE I	NS-LIJ HS		No
(13) North Shore Community Services Inc 972 Brush Hollow Rd Westbury,NY11590 23-7273200	Housing Comp	NY	501(C)(2)	N/A	NS-LIJ HS		No
(14) North Shore University Hospital 972 Brush Hollow Rd Westbury,NY11590 11-1562701	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(15) NS Univ Hospital at Glen Cove Housing 972 Brush Hollow Rd Westbury,NY11590 23-7010468	Housing Comp	NY	501(C)(2)	N/A	NS-LIJ HS		No
(16) North Shore University Hospital Housing 972 Brush Hollow Rd Westbury,NY11590 11-2171903	Housing Comp	NY	501(C)(2)	N/A	NS-LIJ HS		No
(17) NSLIJ STERN FAMILY CENTER FOR REHAB 972 Brush Hollow Rd Westbury,NY11590 23-7007485	Nursing Home	NY	501(C)(3)	9	NS-LIJ HC		No
(18) North Shore-LIJ Health Care Inc 972 Brush Hollow Rd Westbury,NY11590 11-2965586	support org	NY	501(C)(3)	11, TYPE I	NS-LIJ HS		No
(19) North Shore-LIJ Health System 972 Brush Hollow Rd Westbury,NY11590 11-3418133	support org	NY	501(C)(3)	11, TYPE I	NA		No
(20) North Shore-LIJ Health System Foundation 972 Brush Hollow Rd Westbury,NY11590 11-2965575	Fundraising	NY	501(C)(3)	7	NS-LIJ HS		No
(21) North Shore-LIJ Health Sys Laboratories 972 Brush Hollow Rd Westbury,NY11590 11-3412370	Support Org	NY	501(C)(3)	11, TYPE I	NS-LIJ HS		No
(22) North Shore-LIJ Medical Care Centers 972 Brush Hollow Rd Westbury,NY11590 11-3473923	support org	NY	501(C)(3)	11, TYPE I	NS-LIJ HS		No
(23) Plainview Hospital 972 Brush Hollow Rd Westbury,NY11590 11-3241243	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(24) SIUH Systems Inc 475 Seaview Avenue Staten Island,NY10305 06-1074604	Fundraising	NY	501(C)(3)	7	NS-LIJ HC		No
(25) Southside Hospital 972 Brush Hollow Rd Westbury,NY11590 11-1667761	HealthCare	NY	501(C)(3)	3	NS-LIJ HC		No
(26) SSH Inc 972 Brush Hollow Rd Westbury,NY11590 11-2774102	support org	NY	501(C)(3)	11, TYPE I	SOUTHSIDE		No
(27) Staten Island Univ Hospital Foundation 360 Seaview Avenue Staten Island,NY10305 87-0765787	Fundraising	NY	501(C)(3)	7	SIUH	Yes
(28) THE HEART INSTITUTE 475 SEAVIEW AVENUE STATEN ISLAND,NY10305 31-1757254	inactive	NY	501(C)(3)	11, TYPE I	NA		No
(29) PHYSICIANS OF UNIVERSITY HOSPITAL PC 1 EDGEWATER PLAZA 6th floor STATEN ISLAND,NY10305 20-0096809	HEALTHCARE	NY	501(C)(3)	11, TYPE I	SIUH	Yes
(30) LENOX HILL HOSPITAL 100 EAST 77 STREET NEW YORK,NY10021 13-1624070	HEALTHCARE	NY	501(C)(3)	3	NS-LIJ HC		No
(31) LHH CORPORATION 100 EAST 77TH STREET NEW YORK,NY10021 13-3272016	SUPPORT ORG	NY	501(C)(3)	11, TYPE I	NS-LIJ HS		No
(32) THE ELMEZZI GRAD SCHOOL OF MOLECULAR MED 972 BRUSH HOLLOW RD WESTBURY,NY11590 11-3284934	GRADUATE SCH	NY	501(C)(3)	2	NS-LIJ HS		No
(33) SPORTS PHYSICAL THERAPY AND REHAB SVCS 972 BRUSH HOLLOW RD WESTBURY,NY11590 06-1655704	HEALTHCARE	NY	501(C)(3)	9	LIJ		No
(34) NORTH SHORE - LIJ ALLIANCE 972 BRUSH HOLLOW RD WESTBURY,NY11590 26-3727582	HEALTHCARE	NY	501(C)(3)	3	NA		No
(35) THE LONG ISLAND HOME 400 SUNRISE HIGHWAY AMITYVILLE,NY11701 11-2837244	HEALTHCARE	NY	501(c)(3)	3	LHH CORP		No
(36) THE LONG ISLAND HOME FOUNDATION 400 SUNRISE HIGHWAY AMITYVILLE,NY11701 11-2049038	SUPPORT	NY	501(C)(3)	11, TYPE 1	LHH CORP		No

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

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) KRASNOFF CONS SVCS 972 Brush Hollow ROAD WESTBURY,NY11590 26-2838027	CONSULTING	NY	CARE MGT GROUP	N/A				No
(2) LONG ISL BEHAV HLTH 972 BRUSH HOLLOW RD WESTBURY,NY11590 45-3572263	STATISTICS	NY	NS-LIJ HC	RELATED				No

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?
(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		Yes	No
(1) Adv Heart Phys & Surgeons Network PC 130 East 77th St 4th Floor New York,NY10021 13-3853125	Medical Services	NY	LENOX HILL	C CORPORATION					No
(2) Adv Imag & Rad of Lenox Hill Hosp PC 100 East 77th St New York,NY10021 20-0719612	Medical ServiCES	NY	LENOX HILL	C CORPORATION					No
(3) Aletta Corporation 972 Brush Hollow Rd Westbury,NY11590 11-2622371	Physician svcs.	NY	SOUTHSIDE	C CORPORATION					No
(4) Autoimmune Research Therapeutics 972 Brush Hollow Rd Westbury,NY11590 27-0701489	Inactive	NY	RESEARCH	C CORPORATION					No
(5) Care Management Group of Greater NY 972 Brush Hollow Rd Westbury,NY11590 11-3336381	Business Services	NY	NSH ENTERPRISES	C CORPORATION					No
(6) Emergency Med Svcs of Staten Island PC 1 Edgewater Plaza 6th floor Staten Island,NY10305 13-4200899	Medical ServiCES	NY	SIUH	C CORPORATION	76,689	8,799	100.000 %	Yes
(7) Goethals Radiology PC 500 Seaview Ave Staten Island,NY10305 20-0010287	Radiology SVCs.	NY	SIUH	C CORPORATION	8,425	10,264	100.000 %	Yes
(8) Lenox Hill Cardiology Associates PC 100 East 77th St New York,NY10021 13-3385163	Medical ServiCES	NY	LENOX HILL	C CORPORATION					No
(9) Lenox Hill Int Card & Vasc Svcs PC 130 East 77th St 9th floor New York,NY10021 20-1435770	Medical ServiCES	NY	LENOX HILL	C CORPORATION					No
(10) Lenox Hill Pathology PC 100 East 77th St New York,NY10021 13-3644370	Medical ServiCES	NY	LENOX HILL	C CORPORATION					No
(11) Lenox Hill Phy Hospital Org Inc 122 East 76th St suite 3-a New York,NY100212834 13-3775996	Managed Care	NY	LENOX HILL	C CORPORATION					No
(12) Lenox otolaryngology head & neck surgery 186 East 76th St 2nd floor New York,NY10021 20-8784395	Medical Services	NY	LENOX HILL	C CORPORATION					No
(13) Manhattan Min Inv and Bar Surgery PC 186 East 76th St 1st Floor New York,NY10021 20-0250107	Medical Services	NY	LENOX HILL	C CORPORATION					No
(14) North Shore Health Enterprises 972 Brush Hollow Rd Westbury,NY11590 06-1605319	Holding Comp	NY	NSHS ENTERPRISE	C CORPORATION					No
(15) NS Health System Enterprises 972 Brush Hollow Rd Westbury,NY11590 11-3316922	Holding Comp	NY	NS-LIJ HS	C CORPORATION					No
(16) North Shore IPA 5 Inc 972 Brush Hollow Rd Westbury,NY11590 11-3383468	Business Services	NY	NS-LIJ HC	C CORPORATION					No
(17) NS Radiology at Glen Cove PC 972 Brush Hollow Rd Westbury,NY11590 11-3301179	Medical Services	NY	NSUH	C CORPORATION					No
(18) NS-LIJ Health System IPA #1 972 Brush Hollow Rd Westbury,NY11590 11-3533659	Health Care	NY	LIJ	C CORPORATION					No
(19) NS-LIJ Health System IPA #2 972 Brush Hollow Rd Westbury,NY11590 11-3533670	Health Care	NY	LIJ	C CORPORATION					No
(20) NS-LIJ Health System IPA #3 972 Brush Hollow Rd Westbury,NY11590 11-3533678	Health Care	NY	LIJ	C CORPORATION					No
(21) NS-LIJ Health System IPA #4 972 Brush Hollow Rd Westbury,NY11590 11-3533677	Health Care	NY	LIJ	C CORPORATION					No
(22) NS-LIJ Health System IPA #5 972 Brush Hollow Rd Westbury,NY11590 11-3533675	Health Care	NY	LIJ	C CORPORATION					No
(23) NS-LIJ Medical Gr at Huntington PC 972 Brush Hollow Rd Westbury,NY11590 27-4384049	Medical Services	NY	NSUH	C CORPORATION					No
(24) NS-LIJ Medical Gr at North Nassau PC 972 Brush Hollow Rd Westbury,NY11590 27-4384146	Medical Services	NY	NSUH	C CORPORATION					No
(25) NS-LIJ Medical Group at Syosset PC 972 Brush Hollow Rd Westbury,NY11590 27-3957752	Medical Services	NY	NSUH	C CORPORATION					No
(26) NS-LIJ Medical Group PC 972 Brush Hollow Rd Westbury,NY11590 27-4384249	Medical Services	NY	NSUH	C CORPORATION					No
(27) NS-LIJ Network Inc 972 Brush Hollow Rd Westbury,NY11590 32-0257193	Support Services	NY	NS-LIJ HS	C CORPORATION					No
(28) NS-LIJ Phys Insurance Co Risk Ret Group 100 Bank St Burlington,VT05401 26-1487515	INSURANCE	VT	NS-LIJ HC	C CORPORATION					No
(29) North Shore-LIJ Physicians Group PC 972 Brush Hollow Rd Westbury,NY11590 27-4384326	Medical Services	NY	NSUH	C CORPORATION					No
(30) North Shore-LIJ Radiology Services PC 972 Brush Hollow Rd Westbury,NY11590 22-3970667	Medical Services	NY	NSUH	C CORPORATION					No
(31) North Shore-LIJ Service Alliance Inc 972 Brush Hollow Rd Westbury,NY11590 26-3651575	Support Services	NY	NA	C CORPORATION					No
(32) Ocean Breeze Home Care Agency 1 Edgewater Plaza 6th Floor Staten Island,NY10305 13-3773601	Inactive	NY	OVM	C CORPORATION					No
(33) Ocean View Management inc 1 Edgewater Plaza 6th Floor Staten Island,NY10305 13-3138888	Management Svcs.	NY	SIUH	C CORPORATION	211,365	1,106,061	100.000 %	Yes
(34) Palliative Care Medical Services PC 99 Sunnyside Blvd Woodbury,NY11797 27-3957835	Medical Services	NY	HOSPICE	C CORPORATION					No
(35) Park Lenox Emergency Medicine PC 100 East 77th St New York,NY10021 26-2661082	Medical Services	NY	LENOX HILL	C CORPORATION					No
(36) Park Lenox Medical PC 100 East 77th St New York,NY10021 13-3575380	Medical Services	NY	LENOX HILL	C CORPORATION					No
(37) Park Lenox OBGYN PC 130 East 77th St 2nd Floor New York,NY10021 13-3596988	Medical Services	NY	LENOX HILL	C CORPORATION					No
(38) Park Lenox Orthopedics PC 100 East 77th St New York,NY10021 26-4634966	Medical Services	NY	LENOX HILL	C CORPORATION					No
(39) Park Lenox Pediatrics PC 100 East 77th St New York,NY10021 13-3755683	Medical Services	NY	LENOX HILL	C CORPORATION					No
(40) Park Lenox Surgical PC 130 East 77th St 13th Floor New York,NY10021 13-3397814	Medical Services	NY	LENOX HILL	C CORPORATION					No
(41) Regency Alliance Services Inc 1 Edgewater Plaza 6th Floor Staten Island,NY10305 13-3277698	inactive	NY	OVM	C CORPORATION					No
(42) Regional Insurance Company LTD 41 Cedar Ave Hamilton,BERMUDAHM 12 BD	insurance	BD	NS-LIJ HC	C CORPORATION					No
(43) Regioncare Inc 972 Brush Hollow Rd Westbury,NY11590 11-3052191	Homecare	NY	NSHS ENTERPRISE	C CORPORATION					No
(44) Staten Island Hospitalists PC 475 Seaview Ave Staten Island,NY10305 33-1010283	Medical Services	NY	SIUH	C CORPORATION	9,599	164,109	100.000 %	Yes
(45) Staten Island Imaging Corp 1 Edgewater Plaza 6th Floor Staten Island,NY10305 13-3615474	Inactive	NY	OVM	C CORPORATION					No
(46) Staten Island Medical Intensivist PC 501 Seaview Ave Suite 102 Staten Island,NY10305 04-3716494	Medical Services	NY	SIUH	C CORPORATION	278,391	2,110	100.000 %	Yes
(47) Staten Island Neonatology PC 500 Seaview Ave Staten Island,NY10305 13-3375474	Medical Services	NY	SIUH	C CORPORATION	29,438	5,100	100.000 %	Yes
(48) SIUH Perinatology PC 475 Seaview Ave Staten Island,NY10305 13-4107082	Medical Services	NY	SIUH	C CORPORATION			100.000 %	Yes
(49) United Medical Surgical PC 256 Mason Ave BLDG B 2nd FL Staten Island,NY10305 13-4038780	Surgical Services	NY	SIUH	C CORPORATION	10,039,871	548,848	100.000 %		No
(50) Univ Ph OncHematology Gp PC 500 Seaview Ave Staten Island,NY10305 13-3642729	Medical Services	NY	SIUH	s CORPORATION	808	16,051	100.000 %	Yes
(51) Verrazano Radiology Associates PC 500 Seaview Ave Suite 200 Staten Island,NY10305 20-0011201	Radiology Svcs.	NY	SIUH	C CORPORATION	9,114,742	2,010,280	100.000 %	Yes
(52) Vivohealth Inc 972 Brush Hollow Rd Westbury,NY11590 26-4118016	Inactive	NY	NSH ENTERPRISE	C CORPORATION					No
(53) PARK LENOX PSYCHIATRY PC 130 EAST 77TH STREET NEW YORK,NY10021 13-3424466	Medical Services	NY	LENOX HILL	C CORPoration					No
(54) NS-LIJ CARDIOVASCULAR MEDICINE PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 27-5078717	Medical Services	NY	NSUH	C CORPORATION					No
(55) NS-LIJ CARDIOLOGY PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 27-5078531	Medical Services	NY	NSUH	C CORPORATION					No
(56) NS-LIJ HEART SURGERY PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 27-5078838	Medical Services	NY	NSUH	C CORPORATION					No
(57) NS-LIJ INTERNAL MEDICINE PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 27-5078361	Medical Services	NY	NSUH	C CORPORATION					No
(58) NS-LIJ MEDICAL GROUP URGENT MED CARE PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 27-5078426	Medical Services	NY	NSUH	C CORPORATION					No
(59) LENOX HILL HOSPITAL MEDICAL PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 45-2661543	Medical Services	NY	lenox	C CORPORATION					No
(60) NS-LIJ MEDICAL PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 45-3023019	Medical Services	NY	NSUH	C CORPORATION					No
(61) NS-LIJ OCCUPATIONAL MEDICINE PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 45-1004103	Medical Services	NY	NSUH	C CORPORATION					No
(62) NS-LIJ OB-GYN PC 972 Brush Hollow Rd Westbury,NY11590 46-1382916	Medical Services	NY	nsuh	c corporation					No
(63) NS-LIJ ANESTHESIOLOGY PC 972 BRUSH HOLLOW RD WESTBURY,NY11590 46-1617561	Medical Services	NY	NSUH	C CORPORATION					No
(64) NS-LIJ HEALTH PLANS INC 972 Brush Hollow Rd Westbury,NY11590 46-1617516	Medical Services	NY	NS-LIJ HC	c corporation					No

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

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 . . . . . . . . . . . . . . . . . . . . . . .

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

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

Yes

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

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

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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
TRANSACTIONS WITH RELATED ORGANIZATIONS	SCHEDULE R, PART V	THIS ORGANIZATION IS AN AFFILIATE OF North Shore - long Island Jewish Health System ("sYSTEM"). ORGANIZATIONS WITHIN THE SYSTEM ROUTINELY PAY EXPENSES FOR VARIOUS AFFILIATES IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF THIS ORGANIZATION AND ITS AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY HEALTHCARE AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE SITUATED.

Additional Data

Software ID:
Software Version:

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................	Yes	No