July 19, 2013

John Williams, M.D. President SUNY Downstate Medical Center 450 Clarkson Avenue, Box 1 Brooklyn, New York 11203-2098 Dear Dr. Williams: In accordance with 10 NYCRR 401.3 (g), SUNY Downstate Medical Center (SUNY Downstate), submitted the closure plan for the Long Island College Hospital (LICH) on July 17, 2013. The New York State Department of Health (Department) has reviewed the closure plan, and approves the following actions: As expressly set forth in Section A (Acute Care Inpatient Services), on Page 7 of SUNY Downstates Closure Plan for LICH, LICH will cease admitting patients from its Emergency Department (ED) at noon on July 22, 2013. It is understood that LICH will continue to operate its ED with all supportive ancillary services, including laboratory, radiology, social work and pharmacy, until July 29, 2013. As expressly set forth in Section A (Acute Care Inpatient Services), on Page 7 of SUNY Downstates Closure Plan for LICH, LICH will transfer or discharge all remaining inpatients on or before July 28th, 2013. All patients will be discharged in accordance with applicable Federal and State requirements for discharge planning. As expressly set forth in Section C (Surgical Services), on Page 7 of SUNY Downstates Closure Plan for LICH, LICH will cancel its elective surgery schedule, effective July 22, 2013. All patients and their physicians will be notified of the cancellations so that procedures can be rescheduled at other facilities.

SUNY Downstate may begin to take steps to implement the above approved actions. We will continue to work with you on the approval and implementation of the remainder of the closure plan. Should you have questions or require assistance, please contact Robert Welch, Deputy Director of the Division of Hospitals and Diagnostic and Treatment Centers at 518-402-1004. Sincerely,

Ruth Leslie Director Division of Hospitals and Diagnostic and Treatment Centers