To benefit Southampton Hospital s Westhampton Primary Care Center. Sunday, May 27, 2012

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2 To benefit Southampton Hospital s Westhampton Primary Care Center Sunday, May 27, 2012 Cocktails Dinner Dancing on the Terrace Silent Auction 6:30 pm Westhampton Country Club 35 Potunk Lane Westhampton Beach, NY

3 Benefit Chair Melissa Cook Board Liaison Dorothy D. Lewis Junior Committee Chairs Caitlin Confort Emily Gurskis Auction Committee Linda Filardi Tara Liddle Christine Frissora, MD Annie Petrocelli Laurie Hallen Laraine Rothenberg Colleen Haskell Cynthia Rutherford Patry Anastasia Kehoe Vita Reinoso Inna Koehler Farida Khan Singh Karen Towey Committee Marcey Becker Joanne Johnson Lauren Beuerlein Sonia Kapoor Kimberly Bohner Maureen Leness Sarah Bramwell Elysa Newman Elizabeth Byrne Anna Lynn Oppenheimer Susan Cushing Linda Pennfield Margeau Dyer Linda Perrotta Allyson Galishoff Carrie Spero Christiane Hiegel Pat Tolan

4 Southampton Hospital Foundation Board of Trustees Officers Howard M. Lorber, Chairman Gilbert W. Harrison, Treasurer Jean Remmel FitzSimmons, Secretary Steven M. Bernstein* Paul C. Brennan Robert S. Chaloner* Alan D. Glatt John E. Grimm, III Trustees Bettina A. Stelle John M. Hadlock, Esq. Michael B. Israel, MD* Charles B. Krusen Peter M. Larsen* Michael Minikes Southampton Hospital Board of Directors Officers Peter M. Larsen, Chairman Richard J. Hiegel, Esq., Co-Vice Chair Kenneth B. Wright, Co-Vice Chair Stanley D. Friedman, Esq., Vice President Patricia Stewart, Secretary Lawrence A. Willis, Treasurer George F. Biondo, Esq. Barbara Borsack Richard Bruce Robert S. Chaloner* Jean Remmel FitzSimmons James Forbes David Gillespie Steven R. Goldfarb, MD John E. Grimm, III Gilbert W. Harrison* Michael B. Israel, MD* George P. Kazdin Directors Lisa C. Kombrink, Esq. Jay K. Levine Dorothy Downie Lewis Howard M. Lorber* R. Timothy Maran John T. McGowan Philip A. Piro, Jr., MD Florence Rolston, MD Stephen H. Shapoff Michael F. Smith Martin L. Stone, MD John Wambold *ex-officio

5 Angel Sponsors Mr. and Mrs. Richard J. Hiegel Mrs. Sherman R. Lewis, Jr. Benefactor Sponsors Anne and Charles Mott Patron Sponsors Mr. and Mrs. Pat Haskell Guardian Sponsors Allison Conway Carey Mrs. Theodore B. Conklin, Jr. Mr. and Mrs. Michael Cook Leslie C. Feldman Linda Filardi and Gary Talarico Laurie and John Hallen Adele C. Haney Greg and Carolyn Hoogkamp Joanne E. Johnson and Edward A. Reilly, Jr. Maureen and Anthony V. Leness Amanda and Tom Moran Joseph and Linda Perrotta Peter and Laurie Rothenberg Tom and Bette Sturges Mr. and Mrs. Kelso F. Sutton Mr. and Mrs. Sheldon J. Tannen List in formation as of March 19, 2012

6 RSVP may 27, 2012

7 Havana Nights TANGO SPONSOR ($20,000) 10 Tickets Name displayed at the event and on the ANGEL SPONSOR ($10,000) 8 Tickets Name displayed at the event and on the BENEFACTOR ($5,000) 6 Tickets Name displayed at the event and on the PATRON ($2,500) 4 Tickets Name displayed at the event and on the GUARDIAN ($1,000) 2 Tickets Name displayed on the TICKETS at $250 each JUNIOR TICKETS (under 30) at $125 each Cocktails Only (6:30 to 8 PM) at $125 in advance, $150 at the door DANCING, DRINKS AND DESSERT (admission at 9:30 pm) at $75 each For more information, please call Kathy Lucas, Director of Special Events, Southampton Hospital Foundation at x3 klucas@southamptonhospital.org

8 Name Address Daytime Telephone Evening Telephone Address I (we) will attend Havana Nights at the level indicated. I (we) are unable to attend, but wish to support the event with a gift of $ I (we) will help underwrite the event in the amount of $ My check is enclosed. Please bill my credit card in the amount of $ Visa Mastercard American Express Account No. Expiration Date Signature Please make checks payable to Southampton Hospital Foundation. According to IRS regulations, the fair market value of each dinner ticket is $125, each cocktail ticket and each late admission ticket $50. Contributions are fully deductible. Please list guests names on the reverse side of this card.

9 All tickets will be held at the event entrance g u e s t s I (We) wish to be seated with I (We) wish to be seated by the committee I (We) will be staying for cocktails only. No seating arrangements are necessary