Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2019 , and ending 12-31-2019
BCheck if applicable:
CName of organization
Central Suffolk Hospital
 
% NORTHWELL HEALTH INC
Doing business as
PECONIC BAY MEDICAL CENTER
 
Number and street (or P.O. box if mail is not delivered to street address)
1 HEROES WAY
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
RIVERHEAD, NY11901
D Employer identification number

11-1661359
E Telephone number

G Gross receipts $ 230,860,131
F Name and address of principal officer:
MICHAEL O'DONNELL
1 HEROES WAY
RIVERHEAD,NY11901
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.PBMCHEALTH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation:  
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CENTRAL SUFFOLK HOSPITAL ("CSH") IS A NOT-FOR-PROFIT HOSPITAL, A SKILLED NURSING FACILITY, AND A CERTIFIED HOME CARE AGENCY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 16
5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) ...... 5 1,432
6 Total number of volunteers (estimate if necessary) ............. 6 170
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 22,167,813 1,825,013
9 Program service revenue (Part VIII, line 2g) ......... 199,992,496 219,414,487
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 356,106 1,380,245
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,724,431 1,253,984
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 224,240,846 223,873,729
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 117,532,406 130,433,736
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet242,368    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 84,287,709 91,664,430
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 201,820,115 222,098,166
19 Revenue less expenses. Subtract line 18 from line 12....... 22,420,731 1,775,563
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 200,846,927 251,031,020
21 Total liabilities (Part X, line 26)............. 109,819,400 137,103,332
22 Net assets or fund balances. Subtract line 21 from line 20..... 91,027,527 113,927,688
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2019)
Form 990 (2019)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: CENTRAL SUFFOLK HOSPITAL ("CSH") D/B/A PECONIC BAY MEDICAL CENTER ("PBMC") IS A NOT-FOR-PROFIT HOSPITAL CONSISTING OF 122 ACUTE CARE BEDS, A 60-BED SKILLED NURSING FACILITY AND A CERTIFIED HOME CARE AGENCY. CSH PROVIDES A FULL RANGE OF HEALTH CARE SERVICES TO THE LOCAL COMMUNITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 184,067,172 including grants of $   ) (Revenue $ 219,414,487 )
CENTRAL SUFFOLK HOSPITAL ("CSH") IS A PROVIDER OF COMPREHENSIVE HEALTHCARE SERVICES INCLUDING EMERGENCY, SURGICAL, MEDICAL, ICU AND OBSTETRICS/GYNECOLOGICAL. IN 2019, CSH HAD 8,536 INPATIENT DISCHARGES, DELIVERED 389 BABIES, PROVIDED 35,931 EMERGENCY DEPARTMENT VISTS, AND PERFORMED 3,864 AMBULATORY SURGERIES INCLUDING ENDOSCOPIES AND CARDIAC CATHETERIZATIONS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet184,067,172
Form 990 (2019)
Form 990 (2019)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
Yes
 
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
Form 990 (2019)
Form 990 (2019)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I .... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part IIClick to see attachment...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part IIIClick to see attachment.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................Click to see attachment
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV..................... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
82
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
1
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2019)
Form 990 (2019)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,432
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
No
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
No
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
No
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
No
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
Form 990 (2019)
Form 990 (2019)
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 or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
22
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
16
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
NY
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletNORTHWELL HEALTH INC972 BRUSH HOLLOW RD 5TH FL   WESTBURY,NY11590 (516) 321-6058
Form 990 (2019)
Form 990 (2019)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) ANDREW MITCHELL......................................................................
President & CEO
 50.0
.................
0.0 		X   X       1,130,652 0 53,335
(2) RALPH NAPPI......................................................................
Trustee/EVC Northwell
 0.0
.................
50.0 		X           0 951,213 53,335
(3) MICHAEL O'DONNELL......................................................................
CFO
 50.0
.................
0.0 		    X       468,758 0 64,303
(4) STEPHEN JOHN......................................................................
Physician/Hospitalist
 50.0
.................
0.0 		        X   429,926 0 42,351
(5) AMY LOEB......................................................................
CNO
 50.0
.................
0.0 		X   X       377,837 0 64,254
(6) SUSAN SOMERVILLE......................................................................
VP, Strategic Initiatives
 0.0
.................
50.0 		      X     0 386,635 53,335
(7) STEVEN OUZOUNIAN......................................................................
Trustee/Physician
 0.0
.................
50.0 		X           0 391,249 30,800
(8) AGOSTINO CERVONE......................................................................
Trustee/Physician
 0.0
.................
50.0 		X           0 374,999 30,800
(9) LAWRENCE WALSER......................................................................
Dir, Critical Care
 50.0
.................
0.0 		        X   333,705 0 48,825
(10) ARTHUR CROWE......................................................................
COO
 50.0
.................
0.0 		    X       303,935 0 53,724
(11) MARIE DORVAL-DORCELY......................................................................
Physician/Hospitalist
 50.0
.................
0.0 		        X   291,420 0 52,103
(12) APRIL CAPERNA......................................................................
Dir, Geriatric & Palliative Md
 50.0
.................
0.0 		        X   276,186 0 64,254
(13) MAHMOOD AFGHANI......................................................................
Physician/Hospitalist
 50.0
.................
0.0 		        X   264,733 0 64,254
(14) RONALD MCMANUS......................................................................
Former COO
 0.0
.................
0.0 		          X 318,238 0 10,651
(15) SAMANTHA VIGLIOTTA......................................................................
VP, Foundation & Extnl Affairs
 50.0
.................
0.0 		      X     238,843 0 64,254
(16) MONICA RAULS......................................................................
VP, Human Resources
 50.0
.................
0.0 		      X     234,732 0 31,400
(17) SHARON PATTERSON......................................................................
Chairman
 0.0
.................
3.0 		X   X       0 0 0
Form 990 (2019)
Form 990 (2019)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) ANDREW MENDELSON........................................................................
Vice Chairman
 0.0
.......................2.0 		X   X       0 0 0
(19) J GORDON HUSZAGH........................................................................
Vice Chairman, Treasurer
 0.0
.......................2.0 		X   X       0 0 0
(20) REV GEORGE SUMMERS........................................................................
Secretary
 0.0
.......................2.0 		X   X       0 0 0
(21) NON COMPENSATED TRUSTE........................................................................
SEE SCHEDULE O
 0.0
.......................2.0 		X           0 0 0


















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 4,668,965 2,104,096 781,978
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet255
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Sodexo Inc Affiliates,
135 Santilli Highway
EVERETT,MA02149 		Cafeteria Services 1,783,273
Partners in Critical Care LLP,
32 Cedar Avenue Ext
ISLIP,NY11751 		Physicians 1,120,765
Eugene S Krauss MD PC,
20 Horseshoe Road
OLD WESTBURY,NY11568 		Consulting Svcs 1,084,584
Titan Global LLC,
1757 Veterans Memorial Highway
ISLANDIA,NY11749 		Security Svcs 1,069,593
Crothall Facilities Management Inc,
1500 Liberty Ridge Drive Ste 210
WAYNE,PA19087 		Facility Mgmt Svcs 1,009,814
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet50
Form 990 (2019)
Form 990 (2019)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c 346,433
d Related organizations1d 149,641
e Government grants (contributions)1e 807,472
f All other contributions, gifts, grants, and similar amounts not included above1f 521,467
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 1,825,013
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 621300 125,125,860 125,125,860    
b PHYSICIAN PRACTICE REVENUE 621300 4,908,213 4,908,213    
c MEDICARE/MEDICAID PAYMENTS 621300 89,380,414 89,380,414    
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 219,414,487
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 1,288,658     1,288,658
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents   116,376 6a
b Less: rental expenses   0 6b
c Rental income or (loss) 0 116,376 6c
d Net rental income or (loss).......MediumBullet 116,376 116,376    
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   7,004,805 7a
b Less: cost or other basis and sales expenses   6,913,218 7b
c Gain or (loss)   91,587 7c
d Net gain or (loss).........MediumBullet 91,587     91,587
8a Gross income from fundraising events (not including $ 346,433of contributions reported on line 1c). See Part IV, line 18 ....
8a 128,533
b Less: direct expenses ... 8b 73,184
c Net income or (loss) from fundraising events..MediumBullet 55,349    
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a 0
b Less: direct expenses ... 9b 0
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
10a 0
b Less: cost of goods sold .. 10b 0
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a CAFETERIA 624210 622,000     622,000
b CLINIC 900099 220,806     220,806
c MEDICAL SCHOOL 900099 55,053 55,053    
d All other revenue .... 184,400 184,400    
e Total. Add lines 11a–11d ...... MediumBullet 1,082,259
12 Total revenue. See instructions.....MediumBullet 223,873,729 219,770,316   2,223,051
Form 990 (2019)
Form 990 (2019)
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 or note to any line 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 domestic organizations and domestic governments. See Part IV, line 21 .... 0  
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 ........... 3,072,995 3,072,995    
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 0      
7 Other salaries and wages........ 96,160,413 78,639,962 17,520,451  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 7,242,471 5,922,891 1,319,580  
9 Other employee benefits ....... 16,713,703 13,668,462 3,045,241  
10 Payroll taxes ........... 7,244,154 5,924,267 1,319,887  
11 Fees for services (non-employees):        
a Management ...... 674,845   674,845  
b Legal ......... 31,432   31,432  
c Accounting ........... 321,005   321,005  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 10,917,925 8,928,676 1,989,249  
12 Advertising and promotion .... 942,884 700,516   242,368
13 Office expenses ....... 38,348,610 31,361,484 6,987,126  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 2,663,932 2,178,563 485,369  
17 Travel ............ 281,914 281,914    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0      
19 Conferences, conventions, and meetings .... 302,629 302,629    
20 Interest ........... 1,735,972   1,735,972  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization .. 6,926,820 5,664,752 1,262,068  
23 Insurance ... 2,404,493 2,404,493    
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 PURCHASED SERVICES 17,268,720 17,268,720    
b BAD DEBT 4,577,873 4,577,873    
c CENTRALIZED ADMIN EXPENSE 391,028   391,028  
d DUES & SUBSCRIPTIONS 155,711 127,340 28,371  
e All other expenses 3,718,637 3,041,635 677,002  
25 Total functional expenses. Add lines 1 through 24e 222,098,166 184,067,172 37,788,626 242,368
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2019)
Form 990 (2019)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 10,143,000 1 8,379,717
2 Savings and temporary cash investments ......... 3,059,201 2 3,059,201
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 21,605,943 4 27,251,373
5 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 0 7 0
8 Inventories for sale or use ............ 4,441,195 8 4,297,067
9 Prepaid expenses and deferred charges ...... 1,702,609 9 129,866
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 157,911,083
b Less: accumulated depreciation 10b 23,076,948 114,964,990 10c 134,834,135
11 Investments—publicly traded securities . 23,320,064 11 29,890,134
12 Investments—other securities. See Part IV, line 11 ..... 549,311 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 5,230,000 14 5,230,000
15 Other assets. See Part IV, line 11 ........... 15,830,614 15 37,959,527
16 Total assets. Add lines 1 through 15 (must equal line 33)... 200,846,927 16 251,031,020
Liabilities 17 Accounts payable and accrued expenses ..... 35,595,179 17 37,466,229
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
20 Tax-exempt bond liabilities ......... 25,565,000 20 24,245,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .. 11,295,092 24 13,556,838
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 37,364,129 25 61,835,265
26 Total liabilities. Add lines 17 through 25.. 109,819,400 26 137,103,332
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 83,274,520 27 101,965,327
28 Net assets with donor restrictions ........... 7,753,007 28 11,962,361
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 91,027,527 32 113,927,688
33 Total liabilities and net assets/fund balances ........ 200,846,927 33 251,031,020
Form 990 (2019)
Form 990 (2019)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
223,873,729
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
222,098,166
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
1,775,563
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
91,027,527
5
Net unrealized gains (losses) on investments ...............
5
7,795
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
21,116,803
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
113,927,688
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2019)
Form 990 (2019)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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 VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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 VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2019 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2019 		(iii)
Distributable
Amount for 2019
1 Distributable amount for 2019 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2019:
a From 2014.......  
b From 2015.......  
c From 2016.......  
d From 2017.......  
e From 2018.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2019 distributable amount  
i Carryover from 2014 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2019 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2019 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2019, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2019. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2020. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2015.....  
b Excess from 2016.....  
c Excess from 2017.....  
d Excess from 2018.....  
e Excess from 2019.....  
Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2019


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2
Name of organization
Central Suffolk Hospital
  		Employer identification number
11-1661359
Part I
Contributors
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


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

$  


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 3
Name of organization
Central Suffolk Hospital
  		Employer identification number

11-1661359
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) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 4
Name of organization
Central Suffolk Hospital
  		Employer identification number

11-1661359
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

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

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2019

Schedule C (Form 990 or 990-EZ) 2019
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2016 (b) 2017 (c) 2018 (d) 2019 (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) 2019


Schedule C (Form 990 or 990-EZ) 2019
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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
Yes
 
10,491
i
Other activities? ...................................................................................................................
 
No
 
j
Total. Add lines 1c through 1i ....................................................................................................
10,491
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
LOBBYING ACTIVITY CENTRAL SUFFOLK HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND OTHER HEALTH CARE ASSOCIATIONS WHICH ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS.
Schedule C (Form 990 or 990EZ) 2019


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on 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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB 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)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance .... 786,908 765,857 777,416 786,908 786,908
b Contributions ...     21,460 20,485  
c Net investment earnings, gains, and losses 349,092 213,986 -33,019 22,979  
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		349,092 192,935   52,956  
f Administrative expenses ....          
g End of year balance ...... 786,908 786,908 765,857 777,416 786,908
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
No
(ii) Related organizations .................
3a(ii)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   16,205,000 16,205,000
b Buildings ....   55,810,249 10,751,763 45,058,486
c Leasehold improvements   3,291,741 846,899 2,444,842
d Equipment ....   30,570,283 11,305,764 19,264,519
e Other .....   52,033,810 172,522 51,861,288
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 134,834,135
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 3
Part VII
Investments—Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)EQUITY INTEREST IN THE CSH FDN 14,447,057
(2)SECURITY DEPOSITS 169,971
(3)OTHER RECEIVABLES 3,218,270
(4)INSURANCE CLAIM RECEIVABLE 601,889
(5)RIGHT OF USE ASSET 19,458,418
(6)OTHER ASSETS 63,922
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 37,959,527
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes 0
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 61,835,265
2. Liability for uncertain tax positions. 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) 2019

Schedule D (Form 990) 2019
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 221,116,105
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a 7,795
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d -2,838,603
e Add lines 2a through 2d ..................... 2e -2,830,808
3 Subtract line 2e from line 1.................. 3 223,946,913
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 -73,184
c Add lines 4a and 4b.................... 4c -73,184
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 223,873,729
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 218,210,454
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 73,184
e Add lines 2a through 2d.................... 2e 73,184
3 Subtract line 2e from line 1................... 3 218,137,270
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 3,960,896
c Add lines 4a and 4b..................... 4c 3,960,896
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 222,098,166
Part XIII
Supplemental Information
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.
Return Reference Explanation
PART III, LINE 4 - DESCRIPTION OF ORGANIZATION'S COLLECTIONS THE DONATED ARTWORK PROVIDES A SOOTHING AND CALMING ENVIRONMENT TO THE PATIENTS AND THEIR FAMILIES WHEN THEY ATTEND CSH FOR MEDICAL SERVICES. CSH HOPES THAT WITH A GOOD EXPERIENCE, THEIR PATIENTS CONTINUE TO UTILIZE CSH TO PROVIDE MEDICAL SERVICES.
PART V, LINE 4 - INTENDED USE OF ENDOWMENTS ENDOWMENT FUNDS HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY CSH IN PERPETUITY.
PART X, LINE 2 - FIN 48 Certain entities included in Northwell'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 and for unrelated business activities of the tax-exempt entities included in Northwell's consolidated financial statements. 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. At December 31, 2019 and 2018, Northwell has a deferred tax asset of approximately $112,000,000 and $118,000,000, respectively, both of which have 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 net operating loss (NOL) carryforwards. Certain entities have NOL carryforwards aggregating approximately $540,000,000 at December 31, 2019. NOL carryforwards generated prior to 2018 will expire in varying amounts through 2037 and are available to offset future taxable income of the respective entity. NOLs generated after 2017 can be carried forward indefinitely, but with limitations.
PART XI, LINE 2D & 4B - RECONCILIATION OF REVENUE REVENUE ON BOOKS NOT ON RETURN NON-OPERATING NET BENEFIT COST 71,196 PROVISION FOR BAD DEBT (4,577,873) NET ASSETS RELEASED FROM RESTRICTION 1,668,074 TOTAL (2,838,603) REVENUE ON RETURN NOT ON BOOKS SPECIAL EVENTS RECLASS (73,184) TOTAL (73,184)
Part XII, Line 2D & 4B - RECONCILIATION OF EXPENSES EXPENSE ON BOOKS NOT ON RETURN SPECIAL EVENTS RECLASS 73,184 TOTAL 73,184 EXPENSE ON RETURN NOT ON BOOKS PROVISION FOR BAD DEBT 4,577,873 ADDITIONAL MINIMUM PENSION LIAB ADJ (616,977) TOTAL 3,960,896
Schedule D (Form 990) 2019


Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Part I
Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.


(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2019
Schedule G (Form 990 or 990-EZ) 2019
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.









VerticalRevenue
(a) Event #1

SPRING GALA
(event type) 		(b) Event #2

 
(event type) 		(c) Other events

0
(total number) 		(d) Total events
(add col. (a) through col. (c))

1
Gross receipts . . . . .
346,433
 
 
346,433

2
Less: Contributions . . . .
217,900
 
 
217,900
3 Gross income (line 1 minus
line 2) . . . . . .
128,533
 
 
128,533



VerticalDirectExpenses
4 Cash prizes . . . . . 15,000     15,000
5 Noncash prizes . . . .        
6 Rent/facility costs . . . . 13,643     13,643
7 Food and beverages . . . 17,922     17,922
8 Entertainment . . . . 8,000     8,000
9 Other direct expenses . . . 18,619     18,619
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 73,184
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow 55,349
Part III
Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1
Gross revenue . . . . .
 
 
 
 
VerticalDirectExpenses

2
Cash prizes . . . . .
 
 
 
 

3
Noncash prizes . . . .
 
 
 
 

4
Rent/facility costs . . . .
 
 
 
 

5
Other direct expenses . . .
 
 
 
 


6

Volunteer labor . . . .
%
%
%


7
Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow
 

8
Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow
 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2019
Schedule G (Form 990 or 990-EZ) 2019
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2019
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) 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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    4,229,849 -252,802 4,482,651 1.870 %
b Medicaid (from Worksheet 3, column a) . . . . .     32,654,651 17,803,237 14,851,414 6.190 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     36,884,500 17,550,435 19,334,065 8.060 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     146,554   146,554 0.060 %
f Health professions education (from Worksheet 5) . . .     5,811,897 4,035,697 1,776,200 0.740 %
g Subsidized health services (from Worksheet 6) . . . .     24,751,161 24,751,161 0  
h Research (from Worksheet 7) .     865   865  
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     140,337   140,337 0.060 %
j Total. Other Benefits . .     30,850,814 28,786,858 2,063,956 0.860 %
k Total. Add lines 7d and 7j .     67,735,314 46,337,293 21,398,021 8.920 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     38,581   38,581 0.020 %
4 Environmental improvements     2   2  
5 Leadership development and
training for community members		            
6 Coalition building     2,701   2,701  
7 Community health improvement advocacy     229   229  
8 Workforce development     3,151   3,151  
9 Other            
10 Total     44,664   44,664 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,470,038
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
69,100,844
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
78,152,248
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-9,051,404
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(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) 2019
Schedule H (Form 990) 2019
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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Peconic Bay Medical Center
1300 Roanoke Avenue
Riverhead,NY11901 		X X   X     X X Trauma unit  
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 4
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)
Peconic Bay Medical Center
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 19
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.northwell.edu/education-and-resources/com
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2019
Schedule H (Form 990) 2019
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Peconic Bay Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.pbmchealth.org/admissions/bil
b
www.pbmchealth.org/admissions/billin
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 6
Part VFacility Information (continued)

Billing and Collections
Peconic Bay Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 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 individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Peconic Bay Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Part V Section C - Supplemental Information Part V, Section B, line 2: N/A Part V, Section B, line 3j: N/A Part V, Section B, line 5: The CHNA was facilitated by committees established within each of the six county served by Northwell and its hospitals. External stakeholders included representatives from county health departments, area hospitals, academia, business, government agencies and community based organizations with an emphasis on those who serve communities with health disparities. Quantitative and qualitative data was collected from diverse community organizations that serve the population-at-large, as well as those communities with significant health disparities. Community partners were invited to participate via community member and community-based organization/provider surveys, facilitated focus groups and community-based organization summits. Part V, Section B, line 6a: For a detailed listing of other hospital facilities go to web link: https://www.northwell.edu/doctors-and-care/locations?type=hospitals Part V, Section B, line 6b: For a detailed listing of other organizations go to web link: https://www.northwell.edu/sites/northwell.edu/files/2019-12/Northwell-Heal th-2019-CHNA-FINAL.pdf Part V, Section B, line 7d: N/A Part V, Section B, line 11: The Northwell Health Implementation Plan for 2019-2021 includes the goals, objectives, activities, and performance measures planned to address the chosen New York State Prevention Agenda Priority Areas. The hospital identified and addressed primary needs based on an assessment of the highest ranked health priorities of the community, regulatory input and resources available. For further information go to web link: https://www.northwell.edu/sites/northwell.edu/files/2019-12/Northwell-NYSD OH-2019-chip-workplan.pdf Part V, Section B, line 13b: N/A Part V, Section B, line 13h: The hospital also uses household size. Part V, Section B, line 15e: N/A Part V, Section B, line 16j: 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. Part V, Section B, line 18e: N/A Part V, Section B, line 19e: N/A Part V, Section B, line 20e: Before initiating any of the actions, the hospital facility sends letters, makes telephone calls and utilizes presumptive eligibility. Part V, Section B, line 21c: N/A Part V, Section B, line 21d: N/A Part V, Section B, line 23: N/A Part V, Section B, line 24: N/A
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 9
Part VFacility Information (continued)

Section D. 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?1
Name and address Type of Facility (describe)
1 Peconic Bay Physical Therapy & Rehab Cen
64 Commerce Drive
Riverhead,NY11901 		Outpatient Physician Clinic
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
Part VI - Supplemental Information Question 1: Part I, Line 3c: This hospital is an affiliated entity of Northwell Health Inc. ("Northwell"). Northwell uses FPG to determine eligibility and utilizes the New York State Department of Health (NYSDOH) guidelines regarding the consideration of resources. Resource 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. Part I, Line 6a: The Community Benefit report is prepared by the hospital, in conjunction with an affiliated entity (Northwell) of the hospital. The Community Benefit Report is accessible to the public and can be accessed on the Northwell website https://www.northwell.edu/sites/northwell.edu/files/2020-10/nwh_community2 019-FINAL.pdf Part I, 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 system 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 (f) for Rows (c)-(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 Northwell Health Inc. and affiliates, Part I, Line 7 (Row K, Column F) is approximately 12.7 as a percentage of expenses. 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. Northwell has taken the lead in increasing awareness of gun violence as a public health issue. The Gun Violence Prevention Forum brought together physicians, researchers, policy experts, health care executives, NYPD counterterrorism and victims' advocates to share their thoughts on how leaders in health care can address this national public health crisis. Northwell's bioterrorism & disaster preparedness includes Center for Emergency Medical Services, has a designated Bioterrorism Resource Center, and 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 (both natural and terrorism), Northwell provides a safe haven for thousands of patients, outside nursing home residents, and community members seeking shelter. Northwell assists with the transport of patients and stand ready to contribute food, medicine, and blankets for 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. Part III, Line 2: For patients who were determined by Northwell to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. The amount of gross charges written off is reduced by any charity care or other discounts provided to the patient, as well as any payments received. Bad debt expense reported on this line is reported net of governmental or private offsetting funds. Part III, Line 3: N/A Part III, Line 4: For patients who were determined by Northwell to have the ability to pay but did not, the uncollected amounts are recorded as bad debt expense. Part III, Line 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. Part III, Line 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. Question 2: NEEDS ASSESSMENT: The Community Health Needs Assessment (CHNA) is performed on an ongoing basis. Northwell 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; and Statewide Planning and Research System (SPARCS) data. The Committee on Community Health, a committee of the Board of Trustees, provides recommendations that concern Northwell'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 especially in at risk and diverse communities (Cancer, Diabetes, CVD, Obesity), healthy safe environments, health access, changes in the built environment - housing and access to affordable food, mental health and substance abuse and need for better health literacy. 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 inform
Schedule H (Form 990) 2019
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
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 on 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 in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1AGOSTINO CERVONE
Trustee/Physician 		(i)

(ii)		 0
-------------
374,999 		0
-------------
  		0
-------------
  		0
-------------
30,800 		0
-------------
  		0
-------------
405,799 		0
-------------
0
2STEVEN OUZOUNIAN
Trustee/Physician 		(i)

(ii)		 0
-------------
391,249 		0
-------------
  		0
-------------
  		0
-------------
30,800 		0
-------------
  		0
-------------
422,049 		0
-------------
0
3RALPH NAPPI
Trustee/EVC Northwell 		(i)

(ii)		 0
-------------
754,221 		0
-------------
164,063 		0
-------------
32,929 		0
-------------
30,800 		0
-------------
22,535 		0
-------------
1,004,548 		0
-------------
0
4SUSAN SOMERVILLE
VP, Strategic Initiatives 		(i)

(ii)		 0
-------------
290,061 		0
-------------
86,780 		0
-------------
9,794 		0
-------------
30,800 		0
-------------
22,535 		0
-------------
439,970 		0
-------------
0
5ANDREW MITCHELL
President & CEO 		(i)

(ii)		 820,432
-------------
0 		286,912
-------------
0 		23,308
-------------
0 		30,800
-------------
0 		22,535
-------------
0 		1,183,987
-------------
0 		0
-------------
0
6MICHAEL O'DONNELL
CFO 		(i)

(ii)		 370,423
-------------
0 		70,084
-------------
0 		28,251
-------------
0 		30,800
-------------
0 		33,503
-------------
0 		533,061
-------------
0 		0
-------------
0
7AMY LOEB
CNO 		(i)

(ii)		 287,385
-------------
0 		86,780
-------------
0 		3,672
-------------
0 		30,800
-------------
0 		33,454
-------------
0 		442,091
-------------
0 		0
-------------
0
8RONALD MCMANUS
Former COO 		(i)

(ii)		 8,291
-------------
0 		 
-------------
0 		309,947
-------------
0 		 
-------------
0 		10,651
-------------
0 		328,889
-------------
0 		0
-------------
0
9ARTHUR CROWE
COO 		(i)

(ii)		 262,619
-------------
0 		36,780
-------------
0 		4,536
-------------
0 		30,800
-------------
0 		22,924
-------------
0 		357,659
-------------
0 		0
-------------
0
10SAMANTHA VIGLIOTTA
VP, Foundation & Extnl Affairs 		(i)

(ii)		 209,315
-------------
0 		26,348
-------------
0 		3,180
-------------
0 		30,800
-------------
0 		33,454
-------------
0 		303,097
-------------
0 		0
-------------
0
11MONICA RAULS
VP, Human Resources 		(i)

(ii)		 204,124
-------------
0 		27,820
-------------
0 		2,788
-------------
0 		30,800
-------------
0 		600
-------------
0 		266,132
-------------
0 		0
-------------
0
12STEPHEN JOHN
Physician/Hospitalist 		(i)

(ii)		 201,121
-------------
0 		 
-------------
0 		228,805
-------------
0 		30,800
-------------
0 		11,551
-------------
0 		472,277
-------------
0 		0
-------------
0
13LAWRENCE WALSER
Dir, Critical Care 		(i)

(ii)		 327,032
-------------
0 		 
-------------
0 		6,673
-------------
0 		30,800
-------------
0 		18,025
-------------
0 		382,530
-------------
0 		0
-------------
0
14MARIE DORVAL-DORCELY
Physician/Hospitalist 		(i)

(ii)		 206,129
-------------
0 		 
-------------
0 		85,291
-------------
0 		30,800
-------------
0 		21,303
-------------
0 		343,523
-------------
0 		0
-------------
0
15APRIL CAPERNA
Dir, Geriatric & Palliative Md 		(i)

(ii)		 264,526
-------------
0 		9,600
-------------
0 		2,060
-------------
0 		30,800
-------------
0 		33,454
-------------
0 		340,440
-------------
0 		0
-------------
0
16MAHMOOD AFGHANI
Physician/Hospitalist 		(i)

(ii)		 201,291
-------------
0 		 
-------------
0 		63,442
-------------
0 		30,800
-------------
0 		33,454
-------------
0 		328,987
-------------
0 		0
-------------
0
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
PART I, LINE 4A - SEVERANCE PAY INCLUDED IN THIS YEAR'S COMPENSATION IS SEVERANCE PAY FOR THE FOLLOWING LISTED EMPLOYEES: RONALD MCMANUS ($294,403).
PART I, LINE 7 On Form 990, Part VII, Section A, line 1A, the organization may provide non-fixed payments, not described on lines 5 and 6, to certain listed persons. The organization bases such payments on many performance based factors. Payments of this type appear on Schedule J, Part II, B (ii).
Schedule J (Form 990) 2019

Additional Data


Software ID:  
Software Version:  

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number
11-1661359
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A TOWN OF RIVERHEAD INDUSTRIAL DEVELOPMENT
  		11-2560077 000000000 05-06-2015 34,070,000 REFUND BONDS (6/23/06 & 6/27/07)   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 8,505,000      
2 Amount of bonds legally defeased .............. 0      
3 Total proceeds of issue .................. 34,070,000      
4 Gross proceeds in reserve funds ............. 0      
5 Capitalized interest from proceeds ............. 0      
6 Proceeds in refunding escrows ............... 0      
7 Issuance costs from proceeds ............... 0      
8 Credit enhancement from proceeds ............. 0      
9 Working capital expenditures from proceeds ............. 0      
10 Capital expenditures from proceeds ............. 0      
11 Other spent proceeds ............. 34,070,000      
12 Other unspent proceeds ............. 0      
13 Year of substantial completion .............
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2018, a current refunding issue)? ........ 		X              
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2018, an advance refunding issue)? ........ 		  X            
16 Has the final allocation of proceeds been made? .......... X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. 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            
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2019

Schedule K (Form 990) 2019
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            
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            
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 ....SchKMediumBullet 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 ......... SchKMediumBullet        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ... 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            
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            
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            
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X            
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X            
b Exception to rebate? ........ X              
c No rebate due? ......... X              
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? ..... X              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X              
b Name of provider .......... HSBC
  		 
  		 
  		 
 
c Term of hedge ......... 1720 %      
d Was the hedge superintegrated? ......   X            
e Was the hedge terminated? ........   X            
Schedule K (Form 990) 2019

Schedule K (Form 990) 2019
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            
b Name of provider .......... 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            
7 Has the organization established written procedures to monitor the requirements of section 148? ...   X            
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
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            
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Schedule K (Form 990) 2019

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting 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) 2019
Schedule L (Form 990 or 990-EZ) 2019
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) STEVEN OUZOUNIAN MD BOARD MEMBER 75,000 DIRECTORSHIP AGREEMENT   No
(2) RICHARD ISRAEL BOARD MEMBER 531,331 RENTAL PROPERTY   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2019


Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Return Reference Explanation
PART VI, SECTION A - GOVERNING BODY, LINE 6 & 7 NORTHWELL HEALTHCARE, INC. ("NORTHWELL HEALTHCARE") IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. NORTHWELL HEALTHCARE 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 NORTHWELL HEALTHCARE ARE PART OF NORTHWELL HEALTH, INC., AN INTEGRATED HEALTH CARE DELIVERY SYSTEM.
PART VI, SECTION B - POLICIES, LINE 11 THE ANNUAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) FOR NORTHWELL HEALTH, INC. AND AFFILIATED ENTITIES ARE PREPARED WITH INPUT FROM VARIOUS DEPARTMENTS INCLUDING CORPORATE COMPLIANCE, FINANCE, HUMAN RESOURCES, AND LEGAL. BEFORE FILING THE RETURNS, THE DOCUMENTS ARE ELECTRONICALLY MADE AVAILABLE TO ALL TRUSTEES THROUGH A SECURE ONLINE PORTAL. MEMBERS OF THE EXECUTIVE COMMITTEE ARE THEN INFORMED THE RETURNS ARE READY FOR REVIEW. 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.
PART VI, SECTION B - POLICIES, LINE 12C THE CONFLICTS OF INTEREST POLICY APPLIES TO MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, VICE PRESIDENTS, ASSISTANT VICE PRESIDENTS, DEPARTMENT HEADS, CLINICAL DIRECTORS OF DEPARTMENTS AND OTHER EMPLOYEES (INCLUDING PHYSICIANS) WHO ARE IN A POSITION TO INFLUENCE ANY SUBSTANTIVE BUSINESS DECISIONS BETWEEN CSH AND VENDORS. THE DIRECTOR OF CORPORATE COMPLIANCE CONTINUOUSLY MONITORS ALL TRANSACTIONS TO DETERMINE IF ANY POTENTIAL CONFLICT EXISTS. IF IT IS DETERMINED THAT A POTENTIAL CONFLICT EXISTS, THE INDIVIDUAL IS PROHIBITED FROM PARTICIPATING IN THE DECISION OF THE TRANSACTION.
PART VI, SECTION B - POLICIES, LINE 15A CENTRAL SUFFOLK HOSPITAL UTILIZES SALARY SURVEYS AND REVIEWS THEM WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE PROCESS WAS LAST PERFORMED IN 2018.
PART VI, SECTION C - DISCLOSURES, LINE 19 CURRENTLY THE ORGANIZATION PROVIDES GOVERNANCE DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.
PART VII, SECTION A - LINE 1A Marc Alessi, Esq Andrew J. Mitchell Agostino Cervone, MD Richard Musto Emilie Roy Corey, MSW Anne K. Nolon Michael Dempsey, MD Steven Ouzounian, MD Father Larry Duncklee Sharon Patterson J. Gordon Huszagh Rev. George Summers Richard Israel Carol Aspinall Joan Levan Richard Winslow, PHD Kareem Massoud Stanley Zinberg, MD Amy Loeb Ralph Nappi Andrew S. Mendelson Robert F. Rose
PART XI, LINE 9 - RECONCILIATION OF NET ASSETS NET ASSETS RELEASED FROM RESTRICTION 468,074 TRANSFER FROM AFFILIATES 15,899,413 CHANGE IN FAIR VALUE OF DERIVATIVES (579,820) CHANGE IN EQUITY UNDER FAS 136 5,478,780 PRIOR PERIOD ADJUSTMENT (149,644) TOTAL 21,116,803
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Central Suffolk Hospital
 
Employer identification number

11-1661359
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)Brightwaters Gynecology PC
972 Brush Hollow Rd

Westbury,NY11590
82-1883445 		Medical Servi NY 501(C)(3) 10 NSUH
 
 
No
(2)Brooklyn Ambulatory Care PC
972 Brush Hollow Rd

Westbury,NY11590
47-4447289 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(3)Carnegie Cardiovascular PC
972 Brush Hollow Rd

Westbury,NY11590
47-4377825 		Medical Servi NY 501(C)(3) 12, Type I Lenox Hill
 
 
No
(4)CLNY Alliance Inc
972 Brush Hollow Rd

Westbury,NY11590
46-3146870 		Laboratory NY 501(C)(3) 3 NW Labs
 
 
No
(5)Community Drive Surgery PC
972 Brush Hollow Rd

Westbury,NY11590
82-1672429 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(6)Glen Cove Hospital
972 Brush Hollow Rd

Westbury,NY11590
11-1633487 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(7)Harbor View Medical Services PC
75 North Country Rd

Port Jefferson,NY11777
26-4517010 		Supporting Or NY 501(C)(3) 12, Type I Mather
 
 
No
(8)Hillside Hospital Houses Inc
972 Brush Hollow Rd

Westbury,NY11590
11-2113949 		Housing Comp NY 501(C)(2) N/A Northwell He
 
 
No
(9)Hospice Care in Westchester and Putnam
540 White Plains Rd

Tarrytown,NY10591
13-3882602 		Hospice Care NY 501(C)(3) 10 VNA Hudson
 
 
No
(10)Hospice Care Network
99 Sunnyside Blvd

Woodbury,NY11797
11-2925757 		Hospice NY 501(C)(3) 9 Northwell He
 
 
No
(11)Huntington Hospital Association
270 Park Avenue

Huntington,NY11743
11-1630914 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(12)Huntington Hospital Dolan Family Health
284 Pulaski Rd

Greenlawn,NY11740
11-3368503 		Health Care NY 501(C)(3) 3 Huntington
 
 
No
(13)John T Mather Memorial Hospital
75 North Country Rd

Port Jefferson,NY11777
11-1639818 		Health Care NY 501(C)(3) 3 Healthcare
 
 
No
(14)Lakeville Surgery PC
972 Brush Hollow Rd

Westbury,NY11590
47-4377760 		Medical Servi NY 501(C)(3) 10 Lenox Hill
 
 
No
(15)Lenox Hill Hospital
972 Brush Hollow Rd

Westbury,NY11590
13-1624070 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(16)Lenox Hill Hospital Medical PC
972 Brush Hollow Rd

Westbury,NY11590
45-2661543 		Medical Servi NY 501(C)(3) 10 Lenox Hill
 
 
No
(17)Lenox Hill Pathology PC
972 Brush Hollow Rd

Westbury,NY11590
13-3644370 		Medical Servi NY 501(C)(3) 12, Type I Lenox Hill
 
 
No
(18)Lenox Otolaryngology Head & Neck Surgery
972 Brush Hollow Rd

Westbury,NY11590
20-8784395 		Medical Servi NY 501(C)(3) 12, Type I Lenox Hill
 
 
No
(19)LHH Corporation
972 Brush Hollow Rd

Westbury,NY11590
13-3272016 		Supporting Or NY 501(C)(3) 12, Type I Northwell He
 
 
No
(20)LIJ Foundation
972 Brush Hollow Rd

Westbury,NY11590
11-2661239 		Supporting Or NY 501(C)(3) 12, Type I Northwell He
 
 
No
(21)Long Island Jewish Medical Center
972 Brush Hollow Rd

Westbury,NY11590
11-2241326 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(22)Long Island Jewish Medical Center at Hom
972 Brush Hollow Rd

Westbury,NY11590
11-3251128 		Supporting Or NY 501(C)(3) 12, Type I Northwell He
 
 
No
(23)Marcus Avenue Medical PC
972 Brush Hollow Rd

Westbury,NY11590
81-0861452 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(24)Medical Care of Queens PC
972 Brush Hollow Rd

Westbury,NY11590
47-4377679 		Medical Servi NY 501(C)(3) 12, Type I Lenox Hill
 
 
No
(25)NORCORP Inc
400 East Main Street

Mount Kisco,NY10549
13-3366748 		Support Org NY 501(C)(3) 12, Type I NWHA
 
 
No
(26)North Shore Community Services Inc
972 Brush Hollow Rd

Westbury,NY11590
23-7273200 		Housing Comp NY 501(C)(2) N/A Northwell He
 
 
No
(27)North Shore-LIJ Medical Care Centers
972 Brush Hollow Rd

Westbury,NY11590
11-3473923 		Supporting Or NY 501(C)(3) 12, Type I Northwell He
 
 
No
(28)North Shore University Hospital
972 Brush Hollow Rd

Westbury,NY11590
11-1562701 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(29)North Shore University Hospital at Glen
972 Brush Hollow Rd

Westbury,NY11590
23-7010468 		Housing Comp NY 501(C)(2) N/A Northwell He
 
 
No
(30)North Shore University Hospital Housing
972 Brush Hollow Rd

Westbury,NY11590
11-2171903 		Housing Comp NY 501(C)(2) N/A Northwell He
 
 
No
(31)North Shore-LIJ Anesthesiology PC
972 Brush Hollow Rd

Westbury,NY11590
46-1617561 		Medical Servi NY 501(C)(3) 12, Type I SSIDE
 
 
No
(32)North Shore-LIJ Cardiology at Deer Park
972 Brush Hollow Rd

Westbury,NY11590
27-5078531 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(33)North Shore-LIJ Cardiovascular Medicine
972 Brush Hollow Rd

Westbury,NY11590
27-5078717 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(34)North Shore-LIJ Health Plan Inc
972 Brush Hollow Rd

Westbury,NY11590
46-1617516 		Insurance NY 501(C)(3) 9 Health Plan
 
 
No
(35)Northwell Health Plans Holding Company
972 Brush Hollow Rd

Westbury,NY11590
46-2478147 		Holding Compa NY 501(C)(3) 12, Type II Northwell He
 
 
No
(36)North Shore-LIJ Heart Surgery PC
972 Brush Hollow Rd

Westbury,NY11590
27-5078838 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(37)North Shore-LIJ Internal Medicine at Lyn
972 Brush Hollow Rd

Westbury,NY11590
46-3475908 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(38)North Shore-LIJ Internal Medicine at New
972 Brush Hollow Rd

Westbury,NY11590
46-2822879 		Medical Servi NY 501(C)(3) 10 NSUH
 
 
No
(39)North Shore-LIJ Internal Medicine PC
972 Brush Hollow Rd

Westbury,NY11590
27-5078631 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(40)North Shore-LIJ Medical Group at Hunting
972 Brush Hollow Rd

Westbury,NY11590
27-4384049 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(41)North Shore-LIJ Medical Group at North N
972 Brush Hollow Rd

Westbury,NY11590
27-4384146 		Medical Servi NY 501(C)(3) 10 NSUH
 
 
No
(42)North Shore-LIJ Medical Group at Syosset
972 Brush Hollow Rd

Westbury,NY11590
27-3957752 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(43)North Shore-LIJ Medical Group PC
972 Brush Hollow Rd

Westbury,NY11590
27-4384249 		Medical Servi NY 501(C)(3) 10 NSUH
 
 
No
(44)North Shore-LIJ Medical Group Urgent Med
972 Brush Hollow Rd

Westbury,NY11590
27-5078426 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(45)North Shore-LIJ Medical PC
972 Brush Hollow Rd

Westbury,NY11590
45-3023019 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(46)North Shore-LIJ OB-GYN at Garden City P
972 Brush Hollow Rd

Westbury,NY11590
46-2886776 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(47)North Shore-LIJ OB-GYN at New Hyde Park
972 Brush Hollow Rd

Westbury,NY11590
47-3722278 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(48)North Shore-LIJ OB-GYN PC
972 Brush Hollow Rd

Westbury,NY11590
46-1382916 		Medical Servi NY 501(C)(3) 10 LIJMC
 
 
No
(49)North Shore-LIJ Occupational Medicine PC
972 Brush Hollow Rd

Westbury,NY11590
45-1004103 		Medical Servi NY 501(C)(3) 10 NSUH
 
 
No
(50)North Shore-LIJ Pediatrics of Suffolk Co
972 Brush Hollow Rd

Westbury,NY11590
46-5746956 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(51)North Shore-LIJ Radiology Services PC
972 Brush Hollow Rd

Westbury,NY11590
22-3970667 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(52)Northern Westchester Hospital Associatio
400 East Main Street

Mount Kisco,NY10549
13-1740118 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(53)Northern Westchester Hospital Center Fou
400 East Main Street

Mount Kisco,NY10549
13-4067064 		Foundation NY 501(C)(3) 9 NWHA
 
 
No
(54)Northern Westchester Realty Holding Comp
400 East Main Street

Mount Kisco,NY10549
91-2134215 		Holding Compa NY 501(C)(2) N/A NWHA
 
 
No
(55)Northwell Health Alliance Inc
972 Brush Hollow Rd

Westbury,NY11590
26-3727582 		Health Care NY 501(C)(3) 3 NA
 
 
No
(56)Northwell Health Foundation
972 Brush Hollow Rd

Westbury,NY11590
11-2965575 		Fundraising NY 501(C)(3) 7 Northwell He
 
 
No
(57)Northwell Health Laboratories
972 Brush Hollow Rd

Westbury,NY11590
11-3412370 		Supporting Or NY 501(C)(3) 12, Type I Northwell He
 
 
No
(58)Northwell Health Stern Family Center for
972 Brush Hollow Rd

Westbury,NY11590
23-7007485 		Nursing Home NY 501(C)(3) 9 Northwell He
 
 
No
(59)Northwell Health Inc
972 Brush Hollow Rd

Westbury,NY11590
11-3418133 		Supporting Or NY 501(C)(3) 12, Type I NA
 
 
No
(60)Northwell Healthcare Inc
972 Brush Hollow Rd

Westbury,NY11590
11-2965586 		Supporting Or NY 501(C)(3) 12, Type I Northwell He
 
 
No
(61)Northwell Proton Therapy PC
972 Brush Hollow Rd

Westbury,NY11590
81-2766298 		Medical Servi NY 501(C)(3) 10 NSUH
 
 
No
(62)Northwell Quality and Medical Affairs I
972 Brush Hollow Rd

Westbury,NY11590
82-4113233 		Supporting Or NY 501(C)(3) 12, Type I Healthcare
 
 
No
(63)Peconic Cardiology PC
972 Brush Hollow Rd

Westbury,NY11590
81-3149464 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(64)Phelps Medical Services PC
701 North Broadway

Sleepy Hollow,NY10591
27-4416017 		Medical Servi NY 501(C)(3) 12, Type I Phelps Memor
 
 
No
(65)Phelps Memorial Hospital Association
701 North Broadway

Sleepy Hollow,NY10591
13-1725076 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(66)Physicians of Univeristy Hospital PC
1 Edgewater Plaza 6th Fl

Staten Island,NY10305
20-0096809 		Health Care NY 501(C)(3) 12, Type I SIUH
 
 
No
(67)Plainview Hospital
972 Brush Hollow Rd

Westbury,NY11590
11-3241243 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(68)SIUH Systems Inc
475 Seaview Avenue

Staten Island,NY10305
06-1074604 		Fundraising NY 501(C)(3) 7 Northwell He
 
 
No
(69)Southside Hospital
972 Brush Hollow Rd

Westbury,NY11590
11-1667761 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(70)Sports Physical Therapy Occupational Th
972 Brush Hollow Rd

Westbury,NY11590
06-1655704 		Health Care NY 501(C)(3) 9 LIJ
 
 
No
(71)Staten Island Performing Provider System
972 Brush Hollow Rd

Westbury,NY11590
47-2544659 		DSRIP NY 501(C)(3) 10 NA
 
 
No
(72)Staten Island University Hospital
475 Seaview Avenue

Staten Island,NY10305
11-2868878 		Health Care NY 501(C)(3) 3 Northwell He
 
 
No
(73)Staten Island University Hospital Founda
360 Seaview Avenue

Staten Island,NY10305
87-0765787 		Fundraising NY 501(C)(3) 7 SIUH
 
 
No
(74)Suite 130 Plastic Surgery PC
972 Brush Hollow Rd

Westbury,NY11590
82-1772747 		Medical Servi NY 501(C)(3) 12, Type I LIJ
 
 
No
(75)The Calverton Foundation Inc
972 Brush Hollow Rd

Westbury,NY11590
83-1118138 		Medical Servi NY 501(C)(3) Applied For HCI
 
 
No
(76)The Elmezzi Graduate School of Molecular
972 Brush Hollow Rd

Westbury,NY11590
11-3284934 		Graduate Scho NY 501(C)(3) 2 Research
 
 
No
(77)The Feinstein Institute for Medical Rese
972 Brush Hollow Rd

Westbury,NY11590
11-2673595 		Research NY 501(C)(3) 4 Northwell He
 
 
No
(78)The Heart Institute
475 Seaview Avenue

Staten Island,NY10305
31-1757254 		Inactive NY 501(C)(3) 12, Type I NA
 
 
No
(79)The Long Island Home
400 Sunrise Hghwy

Amityville,NY11701
11-2837244 		Health Care NY 501(C)(3) 3 LHH Corporat
 
 
No
(80)True North Flexstaff Inc
972 Brush Hollow Rd

Westbury,NY11590
82-1446568 		Medical Servi NY 501(C)(3) Applied For HCI
 
 
No
(81)True North Patient Safety Organization
972 Brush Hollow Rd

Westbury,NY11590
83-1429773 		Medical Servi NY 501(C)(3) Applied For Northwell He
 
 
No
(82)Virtual Health Medicine PC
972 Brush Hollow Rd

Westbury,NY11590
27-4384326 		Medical Servi NY 501(C)(3) 10 NSUH
 
 
No
(83)Visiting Nurse Association of Hudson Val
540 White Plains Rd

Tarrytown,NY10591
13-1739952 		Home Health C NY 501(C)(3) 10 NW Healthcar
 
 
No
(84)VNA Home Health Services Inc
540 White Plains Rd

Tarrytown,NY10591
13-3690105 		Home Health C NY 501(C)(3) 10 VNA Hudson
 
 
No
(85)Westchester Health Medical PC
972 Brush Hollow Rd

Westbury,NY11590
47-4539584 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(86)True North Health Management Inc
972 Brush Hollow Rd

Westbury,NY11590
81-3428274 		Supporting Or NY 501(C)(3) 12, Type I Healthcare
 
 
No
(87)Wellbridge Psychiatry PC
972 Brush Hollow Rd

Westbury,NY11590
46-5495054 		Medical Servi NY 501(C)(3) 12, Type I NSUH
 
 
No
(88)Peconic Bay Medical Center Foundation
1 HEROES WAY

RIVERHEAD,NY11901
20-0714587 		FUNDRAISING/P NY 501(C)(3) 7 Peconic Bay
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Brooklyn Ambulatory Services LLC

972 Brush Hollow Rd
Westbury,NY11590
81-2910850 		Medical Svcs NY Northwell Healt
  		                 
(2) DHCH LLC

972 Brush Hollow Rd
Westbury,NY11590
81-1030907 		Medical Svcs NY Endoscopy Ventu
  		                 
(3) Endo Group LLC

972 Brush Hollow Rd
Westbury,NY11590
20-0248148 		Medical Svcs NY Ventures GCSC
  		                 
(4) Endoscopy Center of Long Island

972 Brush Hollow Rd
Westbury,NY11590
26-0000980 		Medical Svcs NY NS-LIJ Ventures
  		                 
(5) Formativ Health Intermediate LLC

972 Brush Hollow Rd
Westbury,NY11590
81-4614788 		Holding Co DE Formativ Health
  		                 
(6) Formativ Health LLC

972 Brush Hollow Rd
Westbury,NY11590
81-3121231 		Holding Co DE TN Health Svcs
  		                 
(7) Hospital City LLC

972 Brush Hollow Rd
Westbury,NY11590
47-4091780 		Inactive DE Northwell Healt
  		                 
(8) Krasnoff Consultative Services LLC

972 Brush Hollow Rd
Westbury,NY11590
26-2838027 		Consulting NY Care Mgmt Grp
  		                 
(9) Melville SC LLC

1895 Walt Whitman Rd
Melville,NY11747
20-3487522 		Medical Svcs NY Melville ASC
  		                 
(10) North Shore-LIJ and Yale New Haven Medic

972 Brush Hollow Rd
Westbury,NY11590
46-4858222 		Air Transport NY NSUH
  		                 
(11) North Shore-LIJ Contract Research Organi

972 Brush Hollow Rd
Westbury,NY11590
46-4469806 		Research NY Health Care
  		                 
(12) Northwell Genomics Alliance LLC

972 Brush Hollow Rd
Westbury,NY11590
81-0826710 		Inactive DE NWH Labs
  		                 
(13) Northwell Health Sleep Lab LLC

972 Brush Hollow Rd
Westbury,NY11590
82-1516748 		Medical Svcs NY Sleep Holdings
  		                 
(14) Phelps Professional Building Corp LP

777 North Broadway
Sleepy Hollow,NY10591
13-3645137 		Real Estate NY PMHA
  		                 
(15) South Shore Surgery Center LLC

972 Brush Hollow Rd
Westbury,NY11590
34-1997077 		Medical Svcs NY Multispecialty
  		                 
(16) Suffolk Surgery Center

972 Brush Hollow Rd
Westbury,NY11590
20-0080609 		Medical Svcs NY Multispecialty
  		                 
(17) Technopath Northwell Health North Americ

972 Brush Hollow Rd
Westbury,NY11590
82-2869458 		Lab Services NY Technopath USA
  		                 
(18) True North II DC LLC

972 Brush Hollow Rd
Westbury,NY11590
35-2568005 		Medical Svcs NY DC Holding
  		                 
(19) True North IV DC LLC

972 Brush Hollow Rd
Westbury,NY11590
61-1816900 		Medical Svcs NY DC Holding
  		                 
(20) True North Urgent Care LLC

972 Brush Hollow Rd
Westbury,NY11590
46-4113494 		Medical Svcs NY NSLIJ Urgent Ca
  		                 
(21) True North V DC LLC

972 Brush Hollow Rd
Westbury,NY11590
32-0518811 		Medical Svcs NY DC Holding
  		                 
(22) True North Rad-Onc MSO LLC

972 Brush Hollow Rd
Westbury,NY11590
83-4660846 		Medical Svcs NY Northwell Rad-O
  		                 
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Regional Insurance Company LTD

c/o Cedar House 41 Cedar Ave
Hamilton   HM 12
BD
000000000 		Insurance BD Healthcare
  		C         No












Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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






























Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2019

Additional Data


Software ID:  
Software Version: