2024-11-15T14:14:13-06:00 2023-12-31 PwC US Tax LLP 2001 MARKET STREET SUITE 1800 PHILADELPHIA PA 19103 990 2023-01-01 111888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER % CHS SERVICES GOOD 6313763000 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 JUSTIN LUNDBYE PRESIDENT 5167051919 2024-11-12 true true ERIC M MCNEIL P00460263 2673303000 2023 2024-10-15 13:58:12Z GOOD SAMARITAN UNIVERSITY HOSPITAL PATRICK O'SHAUGHNESSY DO 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 1122089518 false 0928 X HTTP://GOODSAMARITAN.CHSLI.ORG/ X 1959 NY WE, AT CH, HUMBLY JOIN TOGETHER TO BRING CHRISTS HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. 20 19 4624 455 1364475 0 4506105 19788559 827564013 807808583 933971 126745 25730665 30071535 858734754 857795422 268294 366002 0 0 386883745 383486979 0 0 0 450858861 499665651 838010900 883518632 20723854 -25723210 1037967992 1157550125 747374698 860503010 290593294 297047115 X SEE SCHEDULE O false false 777806883 360636 796819895 GOOD SAMARITAN UNIVERSITY HOSPITAL IS A 437 BED MEDICAL CENTER LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN WEST ISLIP, NEW YORK.A PREMIER HEALTHCARE FACILITY, PROVIDING QUALITY AND COST EFFECTIVE HEALTH CARE SERVICES EXTENDING ACROSS THE CONTINUUM OF CARE TO ALL DISCIPLINES, BOTH FOR INPATIENTS AND OUTPATIENTS. IN 2023 THE MEDICAL CENTER PROVIDED INPATIENT SERVICES FOR 26,618 DISCHARGED INDIVIDUALS, MANAGED 87,827 EMERGENCY DEPARTMENT VISITS AND 49,496 CLINIC VISITS. THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH COMMUNITY SERVICE AND CHARITABLE ACTIVITIES. 10125753 0 10988688 GOOD SAMARITAN NURSING HOME IS LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN SAYVILLE, NEW YORK. THE 100 BED FACILITY HAS BEEN PART OF GOOD SAMARITAN HOSPITAL MEDICAL CENTER SINCE 1980. THE RESIDENT POPULATION OF THE NURSING HOME IS MEDICALLY COMPLEX AND REQUIRES FULL-TIME CARE. SKILLED NURSING CARE AT THE FACILITY PROVIDES ONGOING MEDICALLY COMPLEX CARE ALONG WITH GERIATRIC CARE, REHABILITATIVE CARE, AND DEMENTIA DISEASE CARE. 2023 PATIENT DAYS FOR THE NURSING HOME TOTALED 26,519. 787932636 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true false false true 354 0 true 4624 true true true false false false false false false false false false true false X 20 19 false false false false true true true true true false false true true true true true true true true true true X CHS SERVICES 5167053700 992 NORTH VILLAGE AVE ROCKVILLE CENTRE NY 11570 X PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 50.0 0.0 X X 0 3177674 1470892 PATRICK MINICUS EVP & CFO 50.0 0.0 X 0 1220160 708505 BARAA ALLAF PHYSICIAN 50.0 0.0 X 1454461 0 78281 RUTH HENNESSEY PRESIDENT/CAO 50.0 0.0 X 1094062 0 293450 SAMI ALMASKEEN STAFF PHYSICIAN 50.0 0.0 X 1282826 0 71291 PADMALATHA GURRAM PHYSICIAN 50.0 0.0 X 1317332 0 30853 LEONID KOGAN PHYSICIAN 50.0 0.0 X 1080095 0 30029 JOHN VUOLLO PHYSICIAN 50.0 0.0 X 1034825 0 71671 DONALD TEPLITZ CMO 50.0 0.0 X 695552 0 56255 JOHN MCMURRAY COO 50.0 0.0 X 439666 0 65118 SALVATORE SODANO CHAIRMAN 2.0 0.0 X X 0 0 0 BRIAN MCGUIRE VICE CHAIR 2.0 0.0 X X 0 0 0 THOMAS CHRISTMAN SECRETARY 2.0 0.0 X X 0 0 0 ROBERT ZUCCARO TREASURER 2.0 0.0 X X 0 0 0 JERRY BALENTINE DO TRUSTEE AS OF 01/2023 2.0 0.0 X 0 0 0 PETER DAGHER TRUSTEE AS OF 09/2023 2.0 0.0 X 0 0 0 REV LEE DESCOTEAUX TRUSTEE AS OF 01/2023 2.0 0.0 X 0 0 0 HON VITO DESTEFANO TRUSTEE AS OF 06/2023 2.0 0.0 X 0 0 0 REV JASON GRISAFI TRUSTEE AS OF 01/2023 2.0 0.0 X 0 0 0 JOSEPH MATTONE ESQ TRUSTEE AS OF 03/2023 2.0 0.0 X 0 0 0 SUSAN O'HARA RN TRUSTEE AS OF 03/2023 2.0 0.0 X 0 0 0 RONALD SHINDEL TRUSTEE AS OF 03/2023 2.0 0.0 X 0 0 0 WILLIAM WARD TRUSTEE 2.0 0.0 X 0 0 0 PETER QUICK TRUSTEE 2.0 0.0 X 0 0 0 DEBRA DEL VECCHIO TRUSTEE 2.0 0.0 X 0 0 0 REGINA PISCAZZI TRUSTEE 2.0 0.0 X 0 0 0 JOHN ROMANELLI MD TRUSTEE 2.0 0.0 X 0 0 0 ANDREW ZUCARO TRUSTEE 2.0 0.0 X 0 0 0 REV JOHN MCCARTNEY TRUSTEE 2.0 0.0 X 0 0 0 8398819 4397834 2876345 1529 false true false EW HOWELL CO LLC 245 NEWTON RD SUITE 600 PLAINVIEW NY 11803 CONTRUCTING SRVCS 96755672 PROGRESSIVE EMERGENCY PHYS LLC 1236 RXR PLAZA UNIONDALE NY 11556 PHYSICIAN SERVICES 22498970 LONG ISLAND ANESTHESIOLOGISTS PLL 100 Merrick Road Suite 112 E ROCKVILLE CENTRE NY 11570 PHYSICIAN SERVICES 6250000 SERVICEDOCS LLC 327 STANLEY AVENUE BAYONNE NY 07002 PHYSICIAN SERVICES 5039284 REMI HOLDINGS LLC PO BOX 161593 ALTAMONTE SPRINGS FL 327161593 EQUIPMENT MAINTENANC 2149585 67 192658 16359802 3236099 19788559 NET PATIENT SERVICE REVENUE - 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OTHER LOBBYING ACTIVITIES AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON THE BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ASSOCIATIONS REPRESENT. 0 8673726 8673726 0 338835026 208437473 130397553 0 11699639 11278025 421614 0 329251350 284768036 44483314 195309029 0 195309029 379285236 OTHER RECEIVABLES 2770851 INSURANCE CLAIMS RECEIVABLE 111861473 RIGHT OF USE ASSETS 36139167 BOND INDENTURE AGREEMENTS 31197522 181969013 0 THIRD PARTY PAYOR LIABILITY 21370307 SELF INSURANCE RESERVE-MALPRACTICE 120346443 SELF INSURANCE RESERVE-LIABILITIES 39785083 OTHER NON-CURRENT LIABILITIES 15849579 OPERATING LEASE LIABILITIES 36037370 DUE TO RELATED PARTIES 109077681 342466463 X PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTE CH AND MOST OF ITS SUBSIDIARIES ARE 501(C)(3) ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THESE ENTITIES ARE ALSO EXEMPT FROM NEW YORK STATE INCOME TAXES. THERE ARE VARIOUS SUBSIDIARIES OF CH THAT ARE FOR-PROFIT ENTITIES. TAXABLE OPERATIONS AND THE POTENTIAL FOR INCOME TAXES FROM THESE ENTITIES AND FROM UNRELATED BUSINESS ACTIVITIES OF THE TAX EXEMPT ENTITIES ARE NOT SIGNIFICANT TO THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. true true X true X 300. true X true true true false true true 231 26397312 1099228 25298084 0.02860 128296050 49674874 78621176 0.08900 3719450 2718954 1000496 0.00110 231 158412812 53493056 104919756 0.11870 937701 0 937701 0.00110 11801932 5127874 6674058 0.00760 6614308 6286362 327946 0.00040 209351 0 209351 0.00020 19563292 11414236 8149056 0.00930 231 177976104 64907292 113068812 0.12800 true 31281571 172832757 198457197 -25624440 X true true 1 1 GOOD SAMARITAN HOSPITAL MEDICAL CTR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 HTTP://GOODSAMARITAN.CHSLI.ORG/ 5154001H X X X X HOSPITAL GOOD SAMARITAN HOSPITAL MED CTR 1 false false true X X X X X X X X 22 true true true true X goodsamaritan.chsli.org/ X www.chsli.org true 22 true www.chsli.org false true X 300. 400. X X X true true X X X true X www.chsli.org X www.chsli.org X www.chsli.org X X X X X X true X false X X X X X true X false false PART V, SECTION B, LINE 3E IN 2022, MEMBERS OF THE LONG ISLAND HEALTH COLLABORATIVE REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM HEALTH NEEDS PRIORITIES FOR THE 2022-2024 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. PART V, SECTION B, LINE 5 GOOD SAMARITAN HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ASSOCIATION WITH LONG ISLAND HEALTH COLLABORATIVE (LIHC) MEMBERS. THE LIHC IS A PARTNERSHIP OF LONG ISLAND'S HOSPITALS, COUNTY HEALTH DEPARTMENTS, HEALTH PROVIDERS, COMMUNITY-BASED SOCIAL AND HUMAN SERVICE ORGANIZATIONS, ACADEMIC INSTITUTIONS, HEALTH PLANS, LOCAL GOVERNMENT AND THE BUSINESS SECTOR, ALL ENGAGED IN IMPROVING THE HEALTH OF LONG ISLANDERS. THE LIHC IS THE MAIN WORKING GROUP ASSOCIATED WITH CARRYING OUT THE GOALS OF THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM. PRIMARY DATA SOURCES INCLUDE THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT SURVEY (CHAS) AND THE RESULTS FROM FOCUS GROUPS AND KEY COMMUNITY-BASED ORGANIZATION LEADER INTERVIEWS. SECONDARY DATA SOURCES COMPRISED PUBLICALLY-AVAILABLE DATA SETS WHICH WERE REVIEWED TO DETERMINE CHANGE IN HEALTH STATUS AND EMERGING ISSUES WITHIN NASSAU COUNTY. SOURCES OF SECONDARY DATA INCLUDED STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM (SPARCS), NEW YORK STATE PREVENTION AGENDA DASHBOARD, PREVENTION QUALITY INDICATORS (PQI), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), EXTENDED BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (EBRFSS), NEW YORK STATE COMMUNITY HEALTH INDICATOR REPORTS (CHIRS) AND NEW YORK STATE VITAL STATISTICS. THE ENGAGEMENT OF THE BROADER COMMUNITY, FOR ASSESSMENT PROCESSES, IS ACHIEVED THROUGH THE LIHC AND ITS PARTNERS' ONGOING DISTRIBUTION OF THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT (CHAS) SURVEY. THIS SURVEY IS OFFERED ONLINE VIA A SURVEYMONKEY LINK AND IS AVAILABLE TO RESIDENTS AT PUBLIC EVENTS, WORKSHOPS, EDUCATIONAL PROGRAMS, INTERVENTIONS, ETC., WHICH ARE OFFERED BY LIHC PARTNERS. IT IS ALSO DISTRIBUTED AMONG PHYSICIAN OFFICES, HOSPITAL WAITING AREAS, LIBRARIES, SCHOOLS, FEDERALLY-QUALIFIED HEALTH CLINICS, AND INSURANCE ENROLLMENT SITES, AMONG OTHER PUBLIC VENUES. THE LIHC AGGRESSIVELY PROMOTES THE SURVEY THROUGH SOCIAL MEDIA AND A LINK TO THE SURVEY IS ALSO AVAILABLE ON THE GOOD SAMARITAN UNIVERSITY HOSPITAL WEBSITE. RESULTS FROM THE CHAS ARE ANALYZED TWICE A YEAR. FINDINGS ARE SHARED WITH ALL LIHC PARTICIPANTS, WITH THE MEDIA AND POSTED ON THE LIHC WEBSITE. SURVEYS WERE DISTRIBUTED BY PAPER AND ELECTRONICALLY, THROUGH SURVEY MONKEY, TO COMMUNITY MEMBERS FROM JANUARY 2022 THROUGH DECEMBER 2022 WITH 529 SURVEYS COLLECTED. A CERTIFIED TRANSLATION OF THE SURVEY IS AVAILABLE IN THE FOLLOWING LANGUAGES: SPANISH, POLISH AND HAITIAN CREOLE. LARGE PRINT COPIES ARE ALSO AVAILABLE TO THOSE LIVING WITH VISION IMPAIRMENT. FOR THIS ASSESSMENT CYCLE, THE LIHC ALSO ENGAGED THE COMMUNITY THROUGH FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH LEADERS OF COMMUNITY-BASED ORGANIZATIONS (CBO). THE RESEARCH FIRM EUREKAFACTS, LLC., CONDUCTED THE FOCUS GROUPS AND CBO INTERVIEWS, INTERPRETED THE RESULTS, AND PRODUCED THE REPORT. FOCUS GROUPS WERE HELD IN LOW-INCOME COMMUNITIES, RIVERHEAD, AND WYANDANCH. PART V, SECTION B, LINE 6A LONG ISLAND COMMUNITY HOSPITAL, NORTHWELL HEALTH SYSTEM (HUNTINGTON HOSPITAL, SOUTH SHORE UNIVERSITY HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL, PECONIC BAY MEDICAL CENTER), ST. CHARLES HOSPITAL, ST. CATHERINE OF SIENA HOSPITAL, STONY BROOK SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY HOSPITAL AND VETERANS AFFAIRS MEDICAL CENTER. PART V, SECTION B, LINE 6B THE HOSPITAL'S CHNA WAS ALSO CONDUCTED WITH NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND MORE THAN 40 COMMUNITY-BASED ORGANIZATIONS, COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). PART V, SECTION B, LINE 11 COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. THE WORK PLAN FOR ADDRESSING THE IDENTIFIED NEEDS CAN BE FOUND IN THE CHNA APPENDIX E, PUBLICLY AVAILABLE ON THE HOSPITAL'S WEBSITE, HTTPS://GOODSAMARITAN.CHSLI.ORG/ PRIORITY 1: PREVENT CHRONIC DISEASE: GOOD SAMARITAN HOSPITAL OFFERS REGULARLY SCHEDULED PREVENTIVE HEALTH SCREENINGS IN LOCAL COMMUNITIES, PARTICULARLY THOSE IN MEDICALLY-UNDERSERVED COMMUNITIES. THESE INCLUDE BLOOD PRESSURE, BODY MASS INDEX (BMI), PROSTATE CANCER AND ORAL AND HEAD AND NECK CANCER SCREENINGS. THERE WERE 20, EVENTS PROVIDING 278 FREE BLOOD PRESSURE SCREENINGS. HOSPITAL STAFF ALSO PROVIDED BLOOD PRESSURE SCREENINGS AT THE SECOND ANNUAL VETERANS DRIVE-THROUGH RESOURCE EVENT, HEALTHY SUNDAYS AND THE BABYLON STREET FAIR. FREE PROSTATE CANCER SCREENING WERE PROVIDED ON JUNE 5TH, SEPTEMBER 27TH, AND OCTOBER 1ST, SCREENING A TOTAL OF 34 PEOPLE. HEALTHY SUNDAYS' COMMUNITY EVENTS ARE HELD IN COLLABORATION WITH HOUSES OF WORSHIP AND COMMUNITIES. THESE INCLUDE HEALTH SCREENINGS, EDUCATION AND REFERRALS TO CARE ALONG WITH SELECT PARTNERS OFFERING FREE OR DISCOUNTED SERVICES. VOLUNTEERS FROM GOOD SAMARITAN PARTICIPATED IN 6 HEALTHY SUNDAYS IN 2023 ACROSS VARIOUS CHURCHES. THERE WERE 43 LECTURES PROVIDED FROM JANUARY TO DECEMBER ON VARIOUS TOPICS, INCLUDING NUTRITION, BARIATRIC EDUCATION, STROKE, HEART HEALTH, AND BREAST HEALTH. THERE WAS A 2023 VIRTUAL CANCER SYMPOSIUM ON SEPTEMBER 18TH PRESENTED BY THE CANCER INSTITUTE AT GOOD SAMARITAN AND MONDAYS AT RACINE. THE SYMPOSIUM PROVIDED INFORMATION ON TRENDING MEN'S CANCER-RELATED TOPICS INCLUDING STRESS RELIEF, NUTRITION, GENETICS, AND RADIATION THERAPY FOR 41 PEOPLE. THE HOSPITAL HOSTED 21 TEDDY BEAR CLINICS, TEACHING FIRST AID TO CHILDREN. THERE WERE 20-30 STUDENTS AT EACH CLINIC. THE HOSPITAL ALSO HOSTED 13 'STOP THE BLEED' EVENTS, TRAINING 277 PEOPLE IN TOTAL. PRIORITY 2: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS: PROMOTION OF ALL PROGRAMS, EVENTS AND EDUCATION OFFERED BY LIHC MEMBERS WHO SPEAK TO THE PREVENTION OF MENTAL AND SUBSTANCE USE DISORDERS. PARTICIPATION IN LOCAL TASK FORCES ADDRESSING OPIOID USE DISORDERS. GOOD SAMARITAN OFFERS FREE SUPPORT GROUPS TO BRING TOGETHER PEOPLE WHO ARE GOING THROUGH OR WHO HAVE GONE THROUGH SIMILAR EXPERIENCES. THESE ARE OPEN TO ALL COMMUNITY MEMBERS AND INCLUDE CANCER AND BARIATRIC/WEIGHT LOSS SURGERY, BRAIN ANEURYSM AND STROKE SUPPORT, ALONG WITH MORE THAN 10 TYPES OF SUPPORT GROUPS FOR NEW PARENTS/SIBLINGS AND BREAST-FEEDING. THE BREAST CANCER AND LIFE GOES ON SUPPORT GROUPS MET MONTHLY, WITH AN AVERAGE OF 15 AND 12 ATTENDEES PER MEETING, RESPECTIVELY. THE STROKE SUPPORT GROUP MEETS MONTHLY; 73 PEOPLE ATTENDED IN 2024. THE HOSPITAL ALSO HOSTS A BREASTFEEDING CAF TO PROMOTE THE HEALTH BENEFITS OF BREAST-FEEDING AND PROVIDE PEER SUPPORT TO NURSING MOTHERS. THE BREASTFEEDING GROUP MET WEEKLY, WITH 8-12 WOMEN ATTENDING EACH WEEK. THE BARIATRIC SURGERY GROUP MET 48 TIMES IN 2023; 100 PEOPLE ATTENDED. CH'S MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE FOR DOWNLOAD ON THE HOSPITAL'S WEBSITE AND DISTRIBUTED AT COMMUNITY EVENTS. THE SHERPA PROGRAM, WHICH IS MADE UP OF PEER RECOVERY COACHES WHO MEET WITH OVERDOSE SURVIVORS AND THEIR FAMILIES IN THE EMERGENCY DEPARTMENT, IS OFFERED AT THE HOSPITAL. IN 2023, THERE WERE 144 PEOPLE REFFERED TO THE PROGRAM. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY OUTREACH ACTIVITIES THAT ADDRESS OTHER NEW YORK STATE PREVENTION AGENDA PRIORITIES. THE HOSPITAL PARTICIPATES IN THE ANNUAL GLOBAL BIG LATCH ON DESIGNED TO PROMOTE AND SUPPORT BREASTFEEDING. IN 2023, THE GLOBAL BIG LATCH ON WAS HELD ON AUGUST 25TH. 31 PEOPLE ATTENDED. FREE, EVIDENCE-BASED FALL PREVENTION PROGRAMS DESIGNED TO IMPROVE BALANCE AND STRENGTH AND HELP REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS ARE ALSO AVAILABLE AT THE HOSPITAL. PATIENTS IDENTIFIED AT RISK FOR FALLS ARE REFERRED TO CH'S ST. CHARLES HOSPITAL. GOOD SAMARITAN ALSO OFFERS FREE FLU VACCINATIONS AT EVENTS IN UNDERSERVED COMMUNITIES, AT HEALTHY SUNDAYS EVENTS, HOSPITAL HEALTH FAIRS AND OTHER COMMUNITY EVENTS. THE CATHOLIC HEALTH MISSION IS THE DRIVING FORCE BEHIND ALL COMMUNITY OUTREACH ACTIVITIES. IN ADDITION TO THE INTERVENTIONS SUMMARIZED ABOVE, GOOD SAMARITAN UNIVERSITY HOSPITAL, ALONG WITH THE CH HOME CARE, PROVIDE ADDITIONAL OUTREACH PROGRAMS THAT EMPHASIZE THE HEALTH CARE MINISTRY OF THE CATHOLIC CHURCH AND SOCIAL DETERMINANTS OF HEALTH. THE HOSPITAL PARTICIPATED IN THE AMERICAN HEART ASSOCIATION LONG ISLAND HEART WALK MOVE MORE CHALLENGE ON SEPTEMBER 10TH, AS WELL AS THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER WALK ON OCTOBER 15TH. THERE ARE PROGRAMS THAT SUPPORT STAFF RESILIENCY SUCH AS CODE LAVENDER, DAILY PRAYER, AND RECHARGE ROOMS. THE HOSPITAL HOSTED 3 BLOOD DRIVES BETWEEN JANUARY AND DECEMBER, COLLECTING 306 PINTS OF BLOOD FOR LONG ISLAND BLOOD SERVICES. GOOD SAMARITAN STAFF ALSO PARTICIPATED IN COLLECTION DRIVES FOR FOOD, CLOTHING AND SCHOOL SUPPLIES SUPPORTING LOCAL COMMUNITY ORGANIZATIONS IN UNDERSERVED AREAS. THE HOSPITAL ALSO HOSTED THE WOUNDED WARRIOR PROJECT SOLDIER RIDE TO SUPPORT SERVICES AND PROGRAMS FOR WOUNDED WARRIORS, THE GOOD SAMARITAN CANCER SURVIVORS DAY CELEBRATION, A BABIESCHILDREN'S MEMORIAL AND COMMUNITY BURIAL OF THE UNBORN, ADOPT-A-FAMILY COLLECTIONS AT CHRISTMAS, AND BOB SWEENEY'S CAMP H.O.P.E., IN COLLABORATION WITH GOOD SHEPHERD HOSPICE. GOOD SAMARITAN ALSO HELD TWO EMS AND EMT EDUCATION EVENTS ON MAY 24TH AND ONE ON NOVEMBER 6TH WITH 100 AND 50 ATTENDEES, REPECTIVELY. THE 5TH ANNUAL ADVANCES IN COMPREHENSIVE STROKE CARE CONFERENCE WAS HELD ON SEPTEMBER 20TH. TWO-HUNDRED AND FIFTY HEALTH CARE PROFESSIONALS ATTENDED. THE CATHOLIC HEALTH MISSION IS THE DRIVING FORCE BEHIND ALL COMMUNITY OUTREACH ACTIVITIES. IN ADDITION TO THE INTERVENTIONS SUMMARIZED ABOVE, GOOD SAMARITAN UNIVERSITY HOSPITAL, ALONG WITH THE CATHOLIC HEALTH SKILLED NURSING FACILITIES, CATHOLIC HEALTH HOME CARE, GOOD SHEPHERD HOSPICE, AND CATHOLIC HEALTH PHYSICIAN PARTNERS PROVIDE ADDITIONAL OUTREACH PROGRAMS THAT EMPHASIZE THE HEALTH CARE MINISTRY OF THE CATHOLIC CHURCH AND SOCIAL DETERMINANTS OF HEALTH. CH OFFERS A VIRTUAL EDUCATION SERIES STREAMING ON YOUTUBE, PROVIDING SHORT VIDEOS ON TOPICS SUCH AS, KEEPING YOUR CHILD SAFE AT EVERY AGE AND CHILD AND ADOLESCENT MENTAL HEALTH. THIS HAS REACHED MORE THAN 30,000 TOTAL VIEWS. THERE ARE 16 SHOWS THAT AIRED ON THE CATHOLIC FAITH NETWORK (CFN) AND ARE POSTED TO CATHOLIC HEALTH'S YOUTUBE CHANNEL WITH A CATHOLIC HEALTH CARDIOLOGIST, DAVID D'AGATE, DO. THE "STRONGER TOGETHER" SERIES WITH DR. D'AGATE DISCUSSES TOPICS SUCH AS CARDIAC HEALTH, SLEEP, FERTILITY, AND ACCESS TO CARE. THIS SHOW AIRS ON CFN EVERY FOUR TO FIVE WEEKS AND IS PROMOTED VIA CATHOLIC HEALTH'S INTERNAL AND EXTERNAL COMMUNICATIONS, INCLUDING A SUBSTANTIAL SOCIAL MEDIA CAMPAIGN. IN TOTAL, THESE VIDEOS HAVE MORE THAN 278,000 VIEWS. ADDITIONALLY, A NEW CATHOLIC HEALTH SEGMENT ON CFN LIVE WILL AIR EIGHT TIMES PER YEAR. THERE ARE ALSO QUARTERLY SHOWS ON CFN WITH CATHOLIC HEALTH PRESIDENT AND CEO, PATRICK O'SHAUGHNESSY, DO. THE SHOWS WITH DR. O'SHAUGHNESSY AND MONSIGNOR JIM VLAUN BRING THE LATEST IN RESEARCH AND INFORMATION ON MEDICAL PROCEDURES AND ADVANCEMENTS. THE "ON-CALL WITH DR. JASON GOLBIN" SHOW IS DESIGNED FOR PHYSICIANS AND ADVANCED PRACTICE PROVIDERS. IN EACH MONTHLY EPISODE, CATHOLIC HEALTH'S CHIEF MEDICAL OFFICER, JASON GOLBIN, DO, SPEAKS WITH OUR PHYSICIAN LEADERS ABOUT THE SYSTEM'S EMERGING TECHNOLOGIES AND NEWEST CLINICAL RESOURCES WHILE GETTING A GLIMPSE INTO THEIR PERSONAL STORIES AND THE HUMAN SIDE OF COMPASSIONATE CARE. THESE VIDEOS HAVE MORE THAN 2,000 VIEWS IN TOTAL. THE COMMUNITY OUTREACH SCREENING BUSES TRAVEL ACROSS LONG ISLAND TO UNDERSERVED COMMUNITY-BASED ORGANIZATIONS OFFERING FREE HEALTH SCREENINGS, INCLUDING BLOOD PRESSURE, CHOLESTEROL, BODY MASS INDEX AND GLUCOSE. FROM JANUARY TO DECEMBER, THE MOBILE BUS TEAMS SCREENED 6,497 PEOPLE. HEALTHY SUNDAYS, A VOLUNTEER-STAFFED PROGRAM, PROVIDES FREE BP AND BMI SCREENINGS, FLU VACCINATIONS, HEALTH EDUCATION AND REFERRALS TO FOLLOW-UP CARE. FROM JANUARY TO DECEMBER, THE HEALTHY SUNDAYS TEAMS SCREENED 1,462 PEOPLE. THE COMMUNITY OUTREACH TEAMS PROVIDED FREE SCREENINGS AT THE BETHPAGE AIR SHOW AND AT THE CATHOLIC HEALTH AMPHITHEATER AT BALD HILL. FREE CPR TRAINING AND EDUCATION WAS ALSO PROVIDED TO WESTBURY MUSIC FAIR. A NEW "WELLNESS WEDNESDAY" PROGRAM AT ADVENTURELAND WILL PROVIDE EDUCATION ON STRANGER SAFETY AND FREE HEALTH RESOURCES IN 2024. IN 2023, CATHOLIC HEALTH (CH) CORPORATE TEAMS COLLECTED 745 TOYS FOR THE GERALD RYAN OUTREACH CENTER IN WYANDANCH AND GAVE 250 TOILETRY BAGS TO UNDERSERVED PARISHES. CH ALSO DISTRIB PART V, SECTION B, LINE 20E GOOD SAMARITAN UNIVERSITY HOSPITAL HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN GOOD SAMARITAN UNIVERSITY HOSPITAL, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH AND ARE CLEARLY VISIBLE TO THE PUBLIC. GOOD SAMARITAN UNIVERSITY HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 1 GOOD SAMARITAN NURSING HOME 101 ELM STREET SAYVILLE NY 11782 SKILLED NURSING FACILITY PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS. PART I, LINE 7A, COLUMN (D) DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S "NEED" CALCULATION. THIS CALCULATION CONSIDERS 100% OF A HOSPITAL'S "NEED" BASED ON A "UNITS OF SERVICE" METHODOLOGY FOR UNINSURED PATIENTS. THE CALCULATION ALSO MAKES ADJUSTMENTS BASED ON THE PROPORTION OF MEDICAID ELIGIBLE PATIENTS TREATED AT THE FACILITY. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2022. PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2020 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM GOOD SAMARITAN UNIVERSITY HOSPITAL SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY. PART III, LINES 2 AND 4 - TEXT OF FOOTNOTE DISCUSSING BAD DEBT PAGES 19 TO 24 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PATIENT ACCOUNTS RECEIVABLE. THE FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN. PART III, LINE 8 - COSTING METHODOLOGY THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2019 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. PART III, LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. GOOD SAMARITAN BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY BUT ALSO DOING SO WITH NO RECOURSE IN OBTAINING PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING-EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED ARE NOT TURNED AWAY. GOOD SAMARITAN WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY. PART III, LINE 9B THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INABILITY TO PAY FOR THOSE SERVICES. IN ADDITION, UPON APPLYING FOR CHARITY CARE, EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY WILL BE ASSESSED. ELIGIBILITY FOR ASSISTANCE: A REASONABLE REVIEW SHALL BE PERFORMED PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (I.E. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE CH CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET. PART VI, LINE 2 - ASSESSMENT OF COMMUNITY NEEDS AND GOALS COMMUNITY HEALTH NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT MEETINGS, AT COLLABORATIVE SESSIONS WITH MEMBER HOSPITALS OF CATHOLIC HEALTH (CH), AND WITH PARTNERS AT COMMUNITY AGENCIES AND ORGANIZATIONS THAT ARE PART OF THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). THE LIHC COMMUNITY HEALTH ASSESSMENT SURVEYS ARE OFFERED YEAR-ROUND AT MULTIPLE OUTREACH SITES IN THE COMMUNITY. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH, SPANISH, POLISH, HAITAIN CREOLE AND LARGE PRINT) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT SERVES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CH'S WEBSITE. GOOD SAMARITAN UNIVERSITY HOSPITAL CONTINUES TO COLLABORATE WITH OTHER HOSPITALS, LOCAL HEALTH DEPARTMENTS, HEALTH CARE PROVIDERS, PUBLIC HEALTH SPECIALISTS FROM ACADEMIC INSTITUTIONS AND COMMUNITY-BASED ORGANIZATIONS AT LIHC EVENTS. LIHC'S WEBSITE OFFERS COMPREHENSIVE INFORMATION TO PROMOTE GOOD HEALTH AND PREVENT CHRONIC DISEASE. IN ADDITION TO PROVIDING NUMEROUS RESOURCES SUCH AS HEALTH PROGRAM INVENTORIES, HEALTH INSURANCE INFORMATION AND EDUCATIONAL VIDEOS, LIHC AND ITS MEMBERS HAVE ORGANIZED WALKING PROGRAMS, AND DEVELOPED A UNIVERSAL SCREENING TOOL TO HELP MEASURE THE EFFECTIVENESS OF COMMUNITY HEALTH EFFORTS. MORE INFORMATION CAN BE FOUND AT WWW.LIHEALTHCOLLAB.ORG. ADDITIONALLY, COMMUNITY NEEDS SURVEYS ARE COMPLETED BY PARTICIPANTS ATTENDING THE HOSPITAL'S HEALTH SCREENINGS AT LIBRARIES AND SENIOR CENTERS THROUGHOUT THE COUNTY; THE SURVEYS ARE ALSO AVAILABLE THROUGH A LINK ON THE HOSPITAL'S WEBSITE. PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY 1. SINCE IT IS THE DUTY OF THE HOSPITAL TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF THE CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS HAVE BEEN FULLY VERSED IN THE HOSPITAL'S CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. THE HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. THE HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. THE HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE HOSPITAL PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING THE HOSPITAL'S CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, INFORMATION IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER DETAILS. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4 - COMMUNITY INFORMATION FOUNDED IN 1959, GOOD SAMARITAN UNIVERSITY HOSPITAL IS A 537-BED (INCLUDING 100 NURSING HOME BEDS), NOT-FOR-PROFIT, ACUTE CARE COMMUNITY HOSPITAL. GOOD SAMARITAN HOSPITAL IS LOCATED IN WEST ISLIP, ON THE SOUTH SHORE OF LONG ISLAND, NEW YORK. GOOD SAMARITAN'S PRIMARY SERVICE AREA INCLUDES: AMITYVILLE, BABYLON, NORTH BABYLON, WEST BABYLON, BAY SHORE, BRENTWOOD, COPIAGUE, DEER PARK, LINDENHURST, WEST ISLIP, CENTRAL ISLIP, EAST ISLIP, AND WYANDANCH. THE SECONDARY CATCHMENT AREA COMPRISES EAST MASSAPEQUA, FARMINGDALE, ISLIP, ISLIP TERRACE, HOLBROOK, BOHEMIA, PATCHOGUE, SAYVILLE, OAKDALE AND RONKONKOMA. THE SERVICE AREA POPULATION IS COMPRISED OF SEVERAL COMMUNITIES WHERE INDIVIDUALS SPEAK A LANGUAGE OTHER THAN ENGLISH, SUCH AS THE SELECT, UNDERSERVED COMMUNITIES OF BAY SHORE, BRENTWOOD, AND CENTRAL ISLIP. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH GOOD SAMARITAN UNIVERSITY HOSPITAL (GOOD SAMARITAN) IS A NOT-FOR-PROFIT COMPREHENSIVE HEALTH CARE FACILITY RENDERING INPATIENT, AMBULATORY, AND EMERGENCY MEDICAL CARE TO THE COMMUNITY. IN ADDITION, GOOD SAMARITAN OPERATES A NURSING HOME AND THE BISHOP MCHUGH HEALTH CENTER IN BABYLON, WHICH CARES FOR MEDICALLY-UNDESERVED RESIDENTS. GOOD SAMARITAN HOSTS BLOOD DRIVES THROUGHOUT THE YEAR. DONORS INCLUDE GOOD SAMARITAN STAFF AND COMMUNITY MEMBERS. PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM GOOD SAMARITAN UNIVERSITY HOSPITAL (GOOD SAMARITAN) IS AN ACUTE CARE HOSPITAL LOCATED ON A SINGLE CAMPUS IN WEST ISLIP, NY, WITH A SKILLED NURSING FACILITY ON A SEPARATE CAMPUS IN SAYVILLE, NY. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, GOOD SAMARITAN THROUGH ITS DAILY OPERATIONS, PROVIDES THE AREA WITH ACUTE, EMERGENT, AND OUTPATIENT CARE. GOOD SAMARITAN IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH (CH)), WHICH IS A NEW YORK, NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CH IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2023, CH COMPRISED SIX HOSPITALS (MERCY HOSPITAL, ST. FRANCIS HOSPITAL, AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN UNIVERSITY HOSPITAL, ST. CHARLES HOSPITAL, AND ST. CATHERINE OF SIENA HOSPITAL IN SUFFOLK COUNTY), AS WELL AS THREE SKILLED NURSING FACILITIES (ST. CATHERINE OF SIENA NURSING & REHABILITATION, GOOD SAMARITAN NURSING & REHABILITATION, AND OUR LADY OF CONSOLATION NURSING & REHABILITATION, ALL IN SUFFOLK COUNTY), AND GOOD SHEPHERD HOSPICE. WITH MORE THAN 17,000 STAFF AND 4,600 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CH PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: WE, AT CATHOLIC HEALTH, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. MEMBER ORGANIZATIONS OF CH OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. ALL OF CH'S MEMBER ORGANIZATIONS HAVE RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY AND THEIR DISTINCTIVE PERSONALITIES, AS WELL AS THE SERVICE SPECIALTIES WHICH THEY ARE KNOWN FOR, THUS EMBEDDING THE ORGANIZATION IN THE COMMUNITY AND SERVING IT EFFECTIVELY. CH ENTITIES PROVIDE AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS, PROVIDE FREE HEALTH SCREENINGS THROUGH THE SYSTEM'S HEALTHY SUNDAYS PROGRAMS, HEALTH FAIRS, AND OTHER PROGRAMS. SINCE 1907, CATHOLIC HEALTH HAS HAD A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF IMPROVING THE COMMUNITY'S HEALTH. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVE ROCKVILLE CNTR ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 360636 NONE NONE OUTPATIENT CENTERS 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR GOOD SAMARITAN HOSPITAL AND CATHOLIC HEALTH AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH SERVICES OF LONG ISLAND USES THE GRANT FUNDS FOR MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS TO UNDERSERVED COMMUNITIES AND CAPITAL SUPPORT. PART II, LINE 1, COLUMN (H) NAMES OF ORGANIZATION OR GOVERNMENT: CATHOLIC HEALTH SYSTEM OF LONG ISLAND (H) PURPOSE OF GRANT: 1) SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND AS A PASS THROUGH TO PROVIDE GENERAL SUPPORT TO THE CATHOLIC MINISTRIES OF THE DIOCESE OF ROCKVILLE CENTRE IN CONNECTION WITH THE FORMATION OF YOUTH AND ADULTS IN THE FAITH, PROMOTION OF THE DIGNITY OF LIFE, PROMOTION OF QUALITY EDUCATION FOR YOUNG PEOPLE, AND FOSTERING OF VOCATIONS FOR THE PRIESTHOOD; 2) PROVIDE SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND TO FUND OUTPATIENT CENTERS THAT PROVIDE CHARITY CARE TO THOSE CENTERS' COMMUNITIES; AND 3) TO FUND SUPPORT PROVIDED THROUGH THE CATHOLIC HEALTH CAREGIVERS FUND. THE CATHOLIC HEALTH CAREGIVERS FUND WAS FORMED WITH THE MISSION TO ASSIST OUR FELLOW CAREGIVERS ON THE FRONT LINES, HERE AND ABROAD, WHO STRUGGLE JUST TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. X X X X X X false true false false false false false false false PATRICK MINICUS EVP & CFO 0 921345 0 270000 0 28815 0 655803 0 52702 0 1928665 0 0 PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 0 1748018 0 1400000 0 29656 0 1414803 0 56089 0 4648566 0 0 RUTH HENNESSEY PRESIDENT/CAO 695448 0 150000 0 248614 0 273450 0 20000 0 1387512 0 224144 0 DONALD TEPLITZ CMO 624944 0 66000 0 4608 0 21450 0 34805 0 751807 0 0 0 JOHN MCMURRAY COO 392701 0 46000 0 965 0 21450 0 43668 0 504784 0 0 0 BARAA ALLAF PHYSICIAN 709687 0 743494 0 1280 0 21450 0 56831 0 1532742 0 0 0 PADMALATHA GURRAM PHYSICIAN 660076 0 654160 0 3096 0 21450 0 9403 0 1348185 0 0 0 SAMI ALMASKEEN STAFF PHYSICIAN 758818 0 523342 0 666 0 21450 0 49841 0 1354117 0 0 0 LEONID KOGAN PHYSICIAN 607075 0 472008 0 1012 0 21450 0 8579 0 1110124 0 0 0 JOHN VUOLLO PHYSICIAN 1025493 0 6236 0 3096 0 21167 0 50504 0 1106496 0 0 0 PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. RUTH HENNESSEY $252,000 PARTICIPATION IN THE PLAN. PATRICK O'SHAUGHNESSY $1,392,000 PARTICIPATION IN THE PLAN. PATRICK MINICUS $633,000 PARTICIPATION IN THE PLAN. THE DEFERRED COMPENSATION IN COLUMN C FOR THESE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. THE FOLLOWING INDIVIDUALS VESTED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). THESE AMOUNTS INCLUDE A TAX GROSS UP. RUTH HENNESSY $224,144 VESTED IN PLAN. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2023 FORM W-2, BOX 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. PART II - FORMER OFFICERS & DIRECTORS EFFECTIVE 12/19/18, RUTH HENNESSEY WAS TRANSFERRED FROM ST. FRANCIS HOSPITAL, A RELATED ENTITY, TO SERVE AS THE PRESIDENT/CAO. SOUTHWEST SUFFOLK MEDICAL PC SEE PART V 15583332 SEE PART V false SAMARITAN MEDICAL SERVICES PC SEE PART V 81516230 SEE PART V false CARDIAC EKG INTERPRETATION PC SEE PART V 203841 SEE PART V false SCHEDULE L, PART IV, LINE (1) COLUMN (B) RELATIONSHIP Entity more than 35% owned by Donald Teplitz, Key Employee. SCHEDULE L, PART IV, LINE (1) COLUMN (D) DESCRIPTION OF TRANSACTION Subsidy for PC operating losses. SCHEDULE L, PART IV, LINE (2) COLUMN (B) RELATIONSHIP Entity more than 35% owned by Donald Teplitz, Key Employee. SCHEDULE L, PART IV, LINE (2) COLUMN (D) DESCRIPTION OF TRANSACTION Subsidy for PC operating losses. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF GOOD SAMARITAN UNIVERSITY HOSPITAL IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A/ CATHOLIC HEALTH)(CH). CH IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN NTEGRATED NETWORK OF HEALTHCARE PROVIDERS. CH IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE). FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CH IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF GOOD SAMARITAN UNIVERSITY HOSPITAL, AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF GOOD SAMARITAN UNIVERSITY HOSPITAL, CH IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF GOOD SAMARITAN UNIVERSITY HOSPITAL. THE GOVERNING BODY OF GOOD SAMARITAN UNIVERSITY HOSPITAL IS THE SAME AS THAT OF CH. FORM 990, PART VI, LINE 11B - REVIEW PROCESS FOR FORM 990 THE FORM 990 AND RELATED SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD, AND PRESENTED TO THE COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF CH, WHICH HAS BEEN DELEGATED THE FORM 990 REVIEW FUNCTION BY THE BOARD. UPON REVIEW AND RECOMMENDATION OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO THE BOARD FOR APPROVAL. UPON BOARD APPROVAL, THE FORM 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE CH COMPLIANCE AND AUDIT COMMITTEE BY CH'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURE IS GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE CH COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE CH BOARD OF DIRECTORS. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED AND A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CH AND WISHES TO GO FORWARD WITH IT, THE CHAIR OF THE BOARD OF DIRECTORS SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CH COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CH, CERTIFIES THAT CH CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. THE PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIM/HERSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. FORM 990, PART VI, LINE 15 - COMPENSATION POLICY THE CHIEF ADMINISTRATIVE OFFICER SUBMITS FOR APPROVAL TO THE SYSTEM CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE CH EXECUTIVE COMPENSATION POLICY (COMPENSATION POLICY). THE COMPENSATION POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CH OR AN OPERATING ENTITY, AND IS EITHER A) A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF OPERATING OFFICERS (COO) OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS (CFO); D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CH OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CH OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CH OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CH OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CH OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CH CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CH BOARD OF DIRECTORS FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE PERFORMED ANNUALLY BY AN INDEPENDENT CONSULTANT. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION PROVIDED, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE CH BOARD OF DIRECTORS. FORM 990, PART VI, LINE 19 - DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS-CERTIFICATE OF INCORPORATION FILED WITH NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT MADE PUBLICLY AVAILABLE; CH CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND. FORM 990, PART VII, SECTION A - LINE 1A HOURS FOR TRUSTEES ARE THE ESTIMATED WEEKLY HOURS (2.0) TRUSTEES CONTRIBUTE TO THIS AND ALL OTHER RELATED ORGANIZATIONS, NOT NECESSARILY EQUALLY BUT IN THE PROPORTION NECESSARY, FOR WHICH THEY RECEIVE NO COMPENSATION. DONALD TEPLITZ, CHIEF MEDICAL OFFICER - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR KEY EMPLOYEE FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240) AND SAMARITAN EMERGENCY MEDICAL SERVICES, P.C. (20-8243412). RUTH HENNESSEY, PRESIDENT/CAO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); AND ST FRANCIS HOSPITAL FOUNDATION (11-2916033). PATRICK O'SHAUGHNESSY, PRESIDENT & CEO - THE TOTAL HOURS WORKED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); RVC INSURANCE COMPANY, INC. (20-8067039); CATHOLIC HEALTH SYSTEMS OF LONG ISLAND (11-3403968); ST. FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11- 1888924); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL CORP (11-1871039); ST. JOSEPH HOSPITAL FOUNDATION (47-2353387); RVC II INSURANCE COMPANY, INC. (92-1136144) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). PATRICK MINICUS, EVP & CFO - THE TOTAL HOURS WORKED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); RVC INSURANCE COMPANY, INC. (20-8067039); CATHOLIC HEALTH SYSTEMS OF LONG ISLAND (11-3403968); ST. FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11- 1888924); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL CORP (11-1871039); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240) AND ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941). FOUNDATION (77-0611240); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). FORM 990, PART X, LINE 20 - TAX EXEMPT BOND LIABILITIES THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 ARE ISSUED ON BEHALF OF THE CATHOLIC HEALTH OBLIGATED GROUP PROJECT WHICH INCLUDES THE FILING ENTITY AND RELATED ENTITIES. THREE BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 SUFFOLK BONDS), SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2014C SUFFOLK BONDS) AND NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH. FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION GOOD SAMARITAN UNIVERSITY HOSPITAL IS A MEMBER OF CATHOLIC HEALTH. WE, AT CATHOLIC HEALTH, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. I-CARE VALUES INTEGRITY: WE ARE WHO WE SAY WE ARE AND ACT IN ACCORDANCE WITH THE SPLENDOR OF TRUTH OF OUR CATHOLIC MORAL TEACHING AND OUR CATHOLIC VALUES. COMPASSION: WE HAVE COMPASSION FOR OUR PATIENTS, SEE THE SUFFERING CHRIST IN THEM, STRIVE TO ALLEVIATE SUFFERING AND SERVE THE SPIRITUAL, PHYSICAL AND EMOTIONAL NEEDS OF OUR PATIENTS. ACCOUNTABILITY: WE TAKE RESPONSIBILITY FOR OUR ACTIONS AND THEIR CONSEQUENCES. RESPECT: WE HONOR THE SANCTITY OF LIFE AT EVERY STAGE OF LIFE AND THE DIGNITY OF EVERY PERSON, AND INCORPORATE ALL THE PRINCIPLES OF CATHOLIC SOCIAL TEACHING IN OUR RELATIONSHIPS AND ADVOCACY. EXCELLENCE: WE SEEK THE GLORY OF GOD IN THE COMPASSIONATE SERVICE OF OUR PATIENTS, AND WE STRIVE TO DO THE BEST THAT CAN BE DONE, WHATEVER OUR ROLE. FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS POST RETIREMENT BENEFIT PLAN CHANGE $(395,000) POST RETIREMENT ADJUSTMENT NON OPERATING GAIN $261,000 RELATED PARTY TRANSFERS $1,884,450 ROUNDING $5,162 ----------- TOTAL: $ 1,755,612 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 12A- I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 12B- II CHSLI true CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 12A- I GOOD SAMARTN true MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 CHSLI true CATHOLIC HOME CARE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112126736 HOME CARE NY 501(C)(3) 10 CHSLI false OUR LADY OF CONSOLATION GERIATRIC CARE 111 BEACH DRIVE WEST ISLIP NY 11795 113284066 LT NURSE CARE NY 501(C)(3) 10 CHSLI false ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) 3 CHSLI true ST CHARLES HOSPITAL CORP 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI true ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI true ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 12A- I ST FRANCIS false ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 12A- I ST FRANCIS true WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI true THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 112983148 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false WISDOM GARDENS HOUSING DEVELOPMENT FUND 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113559713 SR HOUSING NY 501(C)(3) 10 MARYHAVENCTR false GOOD SHEPHERD HOSPICE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 10 CHSLI false ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 12A- I ST CHARLES false GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) 12A- I GOOD SAMARTN true MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 550813603 SUPPORT ORG NY 501(C)(3) 12A- I MERCY MEDCTR false ST CATHERINE OF SIENA MEDICAL CTR FDN 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) 12A- I STCATHERINE true CHS HOME CARE AND HOSPICE FOUNDATION 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 452907761 SUPPORT ORG NY 501(C)(3) 12A- I CATHHOMECARE false GOOD SHEPHERD HOSPICE FOUNDATION 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 12A- I GOODSHEPHERD false OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 12A- I OURLADYOFC false RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 12A- I CHSLI false CHS PHYSICIAN PARTNERS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 12A- I ST FRANCIS false RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INS NY 501(C)(3) 12B- II CHSLI false SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 HEALTHCARESVC NY 501(C)(4) GOOD SAMARTN true ST JOSEPH HOSPITAL FOUNDATION 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 472353387 SUPPORT ORG NY 501(C)(3) 12A- I WSNCHS NORTH false RVC II INSURANCE COMPANY INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 921136144 CAPTIVE INS NY 501(C)(3) 12B-II CHSLI false BIPO HOLDINGS LLC 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 464763720 PHYSICIAN ASS NY NA IDHC LLC 2500 YORK RDJAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVIC PA GSH RELATED 1771563 2104972 false 0 false 0.51000 BEACON HEALTH PTNRS 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 454229842 HEALTHCARE NY NA WISDOM GARDENS LP 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113567947 SR HOUSING NY NA CHS PHYSICIAN PARTNERS ACO LLC 992 N Village Ave Rockville Centre ROCKVILLE CENTRE NY 11570 999999999 HEALTHCARE NY NA LONG ISLAND HEALTHCARE NETWORK 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 113465837 CONTRACTING NY NA RADIOLOGY CONSULTING OF LONG ISLANDPLLC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 421646134 HEALTHCARE SV NY GOOD SAMARITAN C-CORP false SAMARITAN PEDIATRIC SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208180263 HEALTHCARE SV NY GOOD SAMARITAN C-CORP false SAMARITAN MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208088453 HEALTHCARE SV NY GOOD SAMARITAN C-CORP false SOUTHWEST SUFFOLK MEDICAL PC 580 UNION BOULEVARD WEST ISLIP NY 11795 061603195 HEALTHCARE SV NY GOOD SAMARITAN C-CORP false CARDIAC EKG INTERPRETATION PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112924518 HEALTHCARE SV NY GOOD SAMARITAN C-CORP false LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208964140 HEALTHCARE SV NY GOOD SAMARITAN C-CORP false SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112838185 HEALTHCARE SV NY CHSLI C-CORP false ADVANCED REHABILIATION MEDICINE PLLC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113640709 HEALTHCARE SV NY STCHARLES HOSP C-CORP false ST FRANCIS CARDIAC PREVENTION SERVICES 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113224885 HEALTHCARE SV NY STFRANCIS HOSP C-CORP false SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113307977 HEALTHCARE SV NY SAMARITAN MGMT C-CORP false SAMARITAN HOME CARE AMERICA 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113319259 HEALTHCARE SV NY SAMARITAN MGMT C-CORP false MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 510639649 HEALTHCARE SV NY MERCY MED CTR C-CORP false LONG ISLAND EMERGENCY CARE PC 1000 N VILLAGE AVE ROCKVILLE NY 11571 113633515 PHYSICIAN SVC NY MERCY MED CTR S-CORP false MY CHS RX INC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 842359236 PHARMACY NY CHSLI C-CORP false false true true true true false false true true false true true true true true true true true CHS SERVICES LMPR 31846733 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER LOPQ 392800 COST MERCY MEDICAL CENTER LM 1262508 COST ST FRANCIS HOSPITAL LM 579040 COST ST CHARLES HOSPITAL CORP LM 1116171 COST ST CATHERINE OF SIENA MEDICAL CENTER LM 4340496 COST WSNCHS NORTH INC (ST JOSEPH HOSPITAL) LM 448381 COST GOOD SAMARITAN HOSPITAL FOUNDATION LOPQ 108549 COST SCHEDULE R, PART IV FOR ALL PROFESSIONAL CORPORATIONS REPORTED ON SCHEDULE R, PART IV, THE PHYSICIAN IS THE SOLE SHAREHOLDER OF THE ENTITY AND THE DIRECT CONTROLLING ENTITY REPORTED IN COLUMN (D) IS THE BENEFICIAL OWNER. THIS STRUCTURE IS CONSISTENT WITH THE NEW YORK CORPORATE PRACTICE OF MEDICINE.