HOSPITAL BALL CO-CHAIRS

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HOSPITAL BALL CO-CHAIRS Mark and Rosanne Mulholland Badri Nath, MD and Deepti Gupta, MD COMMITTEE (in formation) John Abreu Aurene C. Alcasabas, MD James Argutto Deborah A. Aviles, Esq. Steve Barbino Marisa A. Bisiani Janet and Frederick C. Braun, III Sean Callahan Kevin Conroy Paul Davin Paul Essner Brenda J. Farrell Phyllis Hartman Susan C. Hever Jason M. Hill Shahriar J. Khalili, MD William Kruger, MD Bill and Karen Laverty William R. Lehmann Richard T. and Kathy Margulis Karen R. Maust Kim Mendez Maureen Mennella Walter G. Metz, Esq. Karen O Kane Sharon Norton Remmer Robert Roche, MD Lisa Rose Sally Rose Barbara and Eric Russo Robert and Valerie Schwarz Frank T. Sconzo, MD Mrs. Gail Steiger Ronald Stephenson Dawn Turnbull Deborah E. Vlahov

Benefiting Memorial Hospital Medical Center Foundation HONORING Satyanarayana Tanguturi, MD Recipient of the Dr. Jacob Dranitzke Award AND Virtual Radiologic (vrad) AND New York Radiology Alliance Saturday, November 9, 2013 Cocktails at 7:00 p.m. Dinner and Dancing at 8:00 p.m. Silent Auction East Wind 5720 Route 25A Wading River, NY Black Tie

Brookhaven Memorial Hospital Medical Center Proudly Recognizes Our Corporate Partners Who Are Sponsors for All of Our Events: DIAMOND Knapp Swezey Foundation PLATINUM Brookhaven Anesthesia Associates, LLP Emergency Ambulance Service The Signature Group of Companies Paul Essner and Michael Waters GOLD B&G Industries, Ltd. James Giorgio, Sr. Brookhaven Health Care Facility Debi Gaines Damianos Realty Group LLC Cristofer, John, and Pelops Damianos Racanelli Construction Company, Inc. Nicholas H. Racanellis Lisa Rose TD Bank Emmett Conlon BRONZE Bridgehampton National Bank Putney, Twombly, Hall & Hirson LLP Daniel F. Murphy, Jr. and Mary Ellen Donnelly Wiedersum Associates Architects CHAMPION Capital One Bank Lewis Johs Avallone Aviles, LLP Deborah A. Aviles and Frederick Johs PATRON The Amato-Waldbauer Group UBS Financial Services BDO USA, LLP Fumuso, Kelly, DeVerna, Snyder, Swart & Farrell, LLP Mullooly, Jeffrey, Rooney, & Flynn LLP Route 112 Office Campus Mark Rose and Geppie Celauro SUPPORTER Swezey Fuel Co. Inc. Tritech Healthcare Management, LLC FRIEND Lakeview Rehabilitation and Care Center Oak Hollow Nursing Center Spectrum Physical Therapy To become a Corporate Partner, please contact Stephanie Sciara at 631.654.7759 or ssciara@bmhmc.org Brookhaven Memorial Hospital Medical Center 101 Hospital Road Patchogue, New York 11772 E-mail: hospitalball@bmhmc.org www.brookhavenhospital.org/hospitalball

MAKE A NIGHT OF IT As a courtesy to our guests, Brookhaven Memorial Hospital Medical Center has made arrangements to secure rooms at the East Wind Inn and Spa at a special rate of $169 per room for the night of the event. We have a limited number of rooms available on a first-come, first-served basis. Sunday Brunch will also be available to our guests at a special rate of $14.95 per person. For more information or to make a room reservation, contact The East Wind at 631.929.3500 by November 3, 2013.

SPONSORSHIPS & TICKETS All monies raised by The Hospital Ball will help fund the construction of new cardiac and operating suites and the programs and services associated with them. Brookhaven Memorial Hospital has received a challenge grant that will match the net proceeds of this event. PLATINUM - $50,000 Includes: Prominent seating for three tables of ten, special recognition at the Ball and in media announcements, prominent listing in program, and VIP Reception. GOLD - $25,000 Includes: Prominent seating for two tables of ten, special recognition at the Ball and in media announcements, prominent listing in program, and VIP Reception. SILVER - $15,000 Includes: Prime seating for one table of ten, recognition at the Ball and in media announcements, prominent listing in program, and VIP Reception. BRONZE - $10,000 Includes: Choice seating for one table of ten, recognition at the Ball, and prominent listing in program. PEWTER - $6,000 Includes: Six dinner tickets, recognition at the Ball, and prominent listing in the program. ADDITIONAL SPONSORSHIPS I am pleased to be able to support the Hospital as a sponsor of the Hospital Ball. Please include my name in the program for the evening. CHAMPION- $2,500 BENEFACTOR- $2,000 PATRON - $1,500 SUPPORTER- $1,000 FRIEND- $500 DONOR- $250 TICKETS Please reserve tables of ten at $5,000 per table. Please reserve tickets at $500 per ticket. I am unable to attend. I/We would like to make a contribution of $ to the BMH Foundation.

Name Title/Company Address City/State/Zip Telephone Fax E-mail We have enclosed a check for $ payable to the BMH Foundation in support of its programs and services. Please bill my credit card for $ Amex Visa MasterCard Credit Card # Exp. Date Security Code Signature Name (as it appears on card) Please return this form with your materials and payment to: Development Office Brookhaven Memorial Hospital Medical Center 101 Hospital Road Patchogue, New York 11772 Telephone: 631.654.7759 E-mail: hospitalball@bmhmc.org BMH Foundation is a tax-exempt 501 (c) 3 organization. Tax ID# 11-2950196. PLEASE RESPOND ON OR BEFORE OCTOBER 31, 2013

Please respond on or before October 31, 2013. We would like our listing to read: Our Guests/Seating Request:

Brookhaven Memorial Hospital Medical Center 101 Hospital Road Patchogue, New York 11772