2023-11-15T11:25:39-06:00 2022-12-31 PwC US Tax LLP 2001 MARKET STREET SUITE 1800 PHILADELPHIA PA 19103 990 2022-01-01 112916033 ST FRANCIS HOSPITAL FOUNDATION INC % CHS SERVICES STFR 5165626000 100 PORT WASHINGTON BLVD ROSLYN NY 11576 CHARLES LUCORE PRESIDENT 5167051933 2023-11-15 true CHARLES LUCORE 999009999 ERIC M MCNEIL P00460263 2673303000 2023-11-09 3 2022 2023-04-26 12:10:37Z CHARLES LUCORE 100 PORT WASHINGTON BLVD ROSLYN NY 11576 53445706 false 0928 X HTTP://STFRANCISHEARTCENTER.CHSLI.ORG X 1988 NY WE, AT CH, 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. 23 21 0 0 0 0 14747898 9675414 0 0 3187989 2831240 -4822 -7928 17931065 12498726 14349629 15530235 0 0 0 0 0 0 210990 1497107 1636677 15846736 17166912 2084329 -4668186 262392526 224366134 9014512 7546172 253378014 216819962 X SEE SCHEDULE O. false false 15530235 15530235 0 THE PRINCIPAL PURPOSE OF THE ST. FRANCIS HOSPITAL FOUNDATION, INC. IS SOLICITING, MAINTAINING, AND INVESTING PUBLIC CONTRIBUTIONS, BEQUESTS, AND GRANTS FOR THE PURPOSEOF ENHANCING QUALITY, DEVELOPMENT, AND EXPANDING THE MEDICAL SERVICES OF ST. FRANCIS HOSPITAL, INCLUDING FUNDING FOR THE PURHASE OF MEDICAL EQUIPMENT, RESEARCH, STAFFING AND CONTINUING EDUCATION AND TRAINING THEREBY CREATING A BETTER FACILITY AND TRAINED PROFESIONAL FOR THE PUBLIC. THE ST. FRANCIS HOSPITAL FOUNDATION IS ALSO INVOLVED IN MAKING GRANTS TO FUND RESEARCH THROUGH THE ST. FRANCIS RESEARCH AND EDUCATIONAL CORPORATION 15530235 true true false false false false false false false true false false false false true true false true false false false false false false true false false true false true false false false false false false false false false false false false false true false false false true 18 0 true 0 false false false false false true true false false false false false false X 23 21 false false false false true true true true true false false true true true true true true false false false X CHS SERVICES 5167053700 992 NORTH VILLAGE AVE 3RD FLOOR ROCKVILLE CENTRE NY 11570 X CHARLES LUCORE PRESIDENT 50.0 0.0 X X 0 1239292 229014 DANIEL DEBARBA EVP & CFO thru 8/5/2022 50.0 0.0 X 0 1103144 308072 RUTH HENNESSEY FORMER CAO 0.0 50.0 X 0 1037879 183426 PATRICK MINICUS EVP & CFO AS OF 12/12/2022 50.0 0.0 X 0 805216 69870 RONALD GULOTTA MD TRUSTEE 50.0 0.0 X 0 637120 67854 MARGARET MAHER SVP&CHIEF DEVELOPMENT OFFICER 50.0 0.0 X 0 473197 23745 HERBERT J MCCOOEY CHAIR 2.0 0.0 X X 0 0 0 THOMAS J FANNING VICE CHAIR 2.0 0.0 X X 0 0 0 BRIAN POISSANT ESQ TRUSTEE 2.0 0.0 X 0 0 0 SR PAT BARRETT SECRETARY resigned 12/22 2.0 0.0 X X 0 0 0 DWIGHT I ARNESEN TRUSTEE 2.0 0.0 X 0 0 0 JAN A BURMAN TRUSTEE 2.0 0.0 X 0 0 0 JOHN BURNS SR TRUSTEE 2.0 0.0 X 0 0 0 DOMINIC CAMERA JR TRUSTEE 2.0 0.0 X 0 0 0 ROBERT B CATELL TRUSTEE 2.0 0.0 X 0 0 0 JEFFREY D FORCHELLI ESQ TRUSTEE 2.0 0.0 X 0 0 0 ROBERT F GARTLAND TRUSTEE 2.0 0.0 X 0 0 0 STEVEN M MARENTIS TRUSTEE 2.0 0.0 X 0 0 0 ROBERT P MORAN TRUSTEE 2.0 0.0 X 0 0 0 ELIZABETH VENUTI TRUSTEE 2.0 0.0 X 0 0 0 TANJA DIXON TRUSTEE 2.0 0.0 X 0 0 0 RICHARD L WINSLOW TRUSTEE 2.0 0.0 X 0 0 0 PAUL L CUNEO TRUSTEE 2.0 0.0 X 0 0 0 Peter Forman TRUSTEE 2.0 0.0 X 0 0 0 Alexander Matina TRUSTEE 2.0 0.0 X 0 0 0 Louise Spadaro MD Trustee as of 2.0 0.0 X 0 0 0 Sr Margaret Culloty Secretary as of 2.0 0.0 X 0 0 0 0 5295848 881981 0 true true false 0 664988 9010426 9675414 0 2577389 2577389 0 0 0 0 0 40879077 40625226 253851 253851 253851 313826 664988 321754 -7928 -7928 0 0 0 0 0 0 0 12498726 2823312 15530235 15530235 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 294609 83619 210990 0 0 0 6755 6755 0 0 0 0 0 0 PURCHSD SERV-SALARIES 1037137 1037137 PURCHSD SERV-BENEFITS 298018 298018 OTHER EXPENSES 158 158 17166912 15530235 1425687 210990 0 0 10390950 1658684 11749139 12069287 0 0 0 0 0 0 0 0 0 0 0 19848 0 0 240252437 210618315 0 0 0 0 0 0 0 0 262392526 224366134 381124 239279 0 0 101462 201462 0 0 0 0 0 0 0 0 0 0 8531926 7105431 9014512 7546172 X 167834304 141435519 85543710 75384443 253378014 216819962 262392526 224366134 X -4668186 -33472866 1583000 X false true X true false X X 1 ST FRANCIS HOSPITAL 112050523 3 true 7944366 0 1 7944366 0 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4738911 4812760 9551671 3133252 1605659 4738911 3126427 6825 3133252 3124527 1900 3126427 3124527 0 3124527 1.00000 false false 0 DUE TO RELATED PARTIES 7105431 7105431 X PART V, LINE 4 - INTENDED USE OF ENDOWMENT FUNDS INCOME FROM THESE ENDOWMENT FUNDS ARE REVIEWED ANNUALLY AND IF APPLICABLE USED TO OFFSET EXPENSES RELATED TO CARE OF PEDIATRIC CARDIAC PATIENTS IN NEED OF FINANCIAL SUPPORT. ANY UNUSED INCOME WILL BECOME TEMPORARILY RESTRICTED TO BE RELEASED INTO OPERATIONS IN THE PERIOD IN WHICH THE RESTRICTION OF THE ENDOWMENT IS MET. 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. GOLF OUTING 406777 254768 152009 123234 51201 34679 GALA 572037 410220 161817 79608 8850 24182 0 978814 664988 313826 202842 51201 8850 58861 321754 -7928 true ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 501(C)(3) 7944366 NONE NONE CAPITAL ACQUISITIONS ST FRANCIS RESEARCH & EDUCATIONAL CORPORATION INC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 501(C)(3) 7585869 NONE NONE MEDICAL RESEARCH 2 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE IN 2015 THE BOARD OF TRUSTEES OF THE ST. FRANCIS HOSPITAL FOUNDATION APPROVED A FIVE YEAR GRANT TO THE ST. FRANCIS RESEARCH AND EDUCATIONAL CORPORATION (R&E) TO SUPPORT THEIR WORK ON MEDICAL RESEARCH. THE AMOUNT OF SUPPORT IS BASED ON A PROJECTED FIVE YEAR BUDGETED RESEARCH NEED OF THE R&E. CHS SERVICES MAINTAINS THE BOOKS AND RECORDS FOR ST. FRANCIS HOSPITAL, ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION AND ST. FRANCIS HOSPITAL FOUNDATION AND IS THEREFORE ABLE TO MONITOR THAT THE HOSPITAL USED FUNDS FOR CAPITAL ACQUISITIONS AND R&E USED FUNDS FOR MEDICAL RESEARCH. false true false false false false false false false DANIEL DEBARBA EVP & CFO thru 8/5/2022 0 626446 0 350000 0 126698 0 274411 0 33661 0 1411216 0 0 PATRICK MINICUS EVP & CFO AS OF 12/12/2022 0 607424 0 180000 0 17792 0 21411 0 48459 0 875086 0 0 CHARLES LUCORE PRESIDENT 0 928253 0 275000 0 36039 0 178978 0 50036 0 1468306 0 0 RUTH HENNESSEY FORMER CAO 0 666635 0 170000 0 201244 0 164167 0 19259 0 1221305 0 176818 RONALD GULOTTA MD TRUSTEE 0 561986 0 71000 0 4134 0 19978 0 47876 0 704974 0 0 MARGARET MAHER SVP&CHIEF DEVELOPMENT OFFICER 0 397391 0 74000 0 1806 0 19978 0 3767 0 496942 0 0 PART I, LINE 3 - METHODS TO ESTABLISH COMPENSATION BY RELATED ORGANIZATION THE FOLLOWING METHODS ARE USED BY A RELATED ORGANIZATION TO ESTABLISH COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, FORM 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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. DANIEL DEBARBA $253,000 PARTICIPATION IN PLAN RUTH HENNESSEY $143,000 PARTICIPATION IN PLAN CHARLES LUCORE $159,000 PARTICIPATION IN PLAN THE DEFERRED COMPENSATION AMOUNT 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 $176,818 VESTED IN PLAN THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2022 FORM W-2, BOX 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. PART II - FORMER OFFICERS & DIRECTORS EFFECTIVE 12/19/2018, RUTH HENNESSEY WAS TRANSFERRED TO GOOD SAMARITAN HOSPITAL MEDICAL CENTER, A RELATED ENTITY, TO SERVE AS A PRESIDENT/CEO. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION ST. FRANCIS HOSPITAL, ROSLYN, NEW YORK (D/B/A ST. FRANCIS HOSPITAL & HEART CENTER) IS THE SOLE CORPORATE MEMBER OF ST. FRANCIS HOSPITAL FOUNDATION. FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY ST. FRANCIS HOSPITAL, ROSLYN, NEW YORK (D/B/A ST. FRANCIS HOSPITAL & HEART CENTER) AS THE SOLE CORPORATE MEMBER OF ST. FRANCIS HOSPITAL FOUNDATION HAS THE POWER TO APPOINT THE GOVERNING BODY OF THE ST. FRANCIS HOSPITAL FOUNDATION. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY THE ST. FRANCIS HOSPITAL FOUNDATION MAY NOT TAKE ANY ACTION REQUIRING CONSENT OR APPROVAL OF THE MEMBER UNTIL THE MEMBER SHALL HAVE EXERCISED ITS RESERVED POWERS. IN ADDITION, CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A CATHOLIC HEALTH) AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF ST. FRANCIS HOSPITAL, ROSLYN, NEW YORK IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF ST.FRANCIS HOSPITAL, ROSLYN, NEW YORK. 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 FOUNDATION AND CH BOARDS FOR APPROVAL. UPON BOARD APPROVAL, THE FORM 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST POLICY 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 RGANIZATION 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 (OF CH, A RELATED ORG) 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 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 THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT 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. DANIEL DEBARBA, EVP & CFO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR HIGHEST PAID EMPLOYEE FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL CORP (11-1871039); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); ST.CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941); CATHOLIC HEALTH SYSTEM OF LONG ISLAND (11-3403968); RVC INSURANCE COMPANY INC. (20-8067039) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). CHARLES LUCORE, PRESIDENT - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL THE FOLLOWING RELATED ENTITIES: ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867) AND ST FRANCIS HOSPITAL FOUNDATION (11-2916033) MARGARET MAHER, SVP&CHIEF DEVELOPMENT OFFICER - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS A KEY EMPLOYEE FOR ALL THE FOLLOWING RELATED ENTITIES: ST FRANCIS HOSPITAL FOUNDATION (11-2916033); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941); ST JOSEPH HOSPITAL FOUNDATION (47-2353387); GOOD SHEPHERD HOSPICE FOUNDATION INC. (26-3169427); OUR LADY OF CONSOLATION FOUNDATION (45-0517566) 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); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS Board Designated Endowment : $1,583,000 FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION ST. FRANCIS HOSPITAL FOUNDATION 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. 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 false CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL 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 false MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 CHSLI false 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 false ST CHARLES HOSPITAL CORP 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI false ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI false ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 12A- I ST FRANCIS false WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI false 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 11776 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 false 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 false 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 false 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 10570 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 ASSN NY NA N/A IDHC LLC 2500 YORK RDJAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVICES PA NA N/A BEACON HEALTH PTNRS 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 454229842 HEALTHCARE NY NA N/A WISDOM GARDENS LP 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113567947 SR HOUSING NY NA N/A CHS PHYSICIAN PARTNERS ACO LLC 992 N Village Ave Rockville Centre ROCKVILLE CENTRE NY 11570 999999999 HEALTHCARE NY NA N/A LONG ISLAND HEALTHCARE NETWORK 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 113465837 CONTRACTING NY NA N/A RADIOLOGY CONSULTING OF LONG ISLANDPLLC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 421646134 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN PEDIATRIC SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208180263 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208088453 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SOUTHWEST SUFFOLK MEDICAL PC 580 UNION BOULEVARD WEST ISLIP NY 11795 061603195 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false CARDIAC EKG INTERPRETATION PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112924518 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208964140 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112838185 HEALTHCARE SVC NY CHSLI C-CORP false ADVANCED REHABILIATION MEDICINE PLLC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113640709 HEALTHCARE SVC NY STCHARLES HOSP C-CORP false ST FRANCIS CARDIAC PREVENTION SERVICES 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113224885 HEALTHCARE SVC NY STFRANCIS HOSP C-CORP false SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113307977 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false SAMARITAN HOME CARE AMERICA 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113319259 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 510639649 HEALTHCARE SVC 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 false true false false false false false false false true true true true true true false false 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.