2023-11-13T15:29:28-06:00 2022-12-31 PwC US Tax LLP 2001 MARKET STREET SUITE 1800 PHILADELPHIA PA 19103 990 2022-01-01 111635088 MERCY MEDICAL CENTER % CHS SERVICES INC MERC 5167052525 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 JOSEPH MANOPELLA PRESIDENT 5167052525 2023-11-09 true JOSEPH MANOPELLA 999009999 ERIC M MCNEIL P00460263 2673303000 2023-11-09 3 2022 2023-04-26 12:10:37Z MERCY HOSPITAL PATRICK O'SHAUGHNESSY DO 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 301895570 false 0928 X HTTP://MERCYMEDICALCENTER.CHSLI.ORG X 1913 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 22 2201 301 44934 24303 5110642 1784816 270727586 294873584 175167 -460173 5396086 5061226 281409481 301259453 112357 138186 0 0 156100955 169827474 0 0 0 140551078 155400721 296764390 325366381 -15354909 -24106928 246923236 235502376 221673042 234669705 25250194 832671 X SEE SCHEDULE O false false 273640270 138186 286842127 MERCY MEDICAL CENTER IS A 375 BED, NOT-FOR-PROFIT ACUTE CARE HOSPITAL SERVING THE HEALTHCARE NEEDS OF NASSAU COUNTY AND ITS SURROUNDING AREA. FOUNDED IN 1913 BY THE NURSING SISTERS OF THE CONGREGATION OF THE INFANT JESUS, MERCY MEDICAL CENTER HAS GROWN FROM A THREE FLOOR WOODEN STRUCTURE TO AN EXTENSIVE INSTITUTION OCCUPYING A 42-ACRE CAMPUS THAT HOUSES SOME OF THE MOST ADVANCED MEDICAL TECHNOLOGIES. IN 2022, THE MEDICAL CENTER HAD 11,384 DISCHARGES AND PROVIDED CARE FOR 33,378 EMERGENCY ROOM VISITS. IN ACCORDANCE WITH ITS MISSION AND PHILOSOPHY, THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY. 7257259 0 8841590 Residential Care Programs: Residential and home-based services for individuals with disabilities. 280897529 true true false true false false false false false true 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 181 0 true 2201 true true true false false false false true true false false false false false false X 23 22 false false false false true true true true true false false true true true true true true true true false X CHS SERVICES INC 5167053700 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 50.0 0.0 X X 0 2439713 836578 PETER SCAMINACI PRESIDENT/CAO THRU 4/1/2022 50.0 0.0 X 0 1010900 648876 DANIEL DEBARBA EVP & CFO THRU 8/5/2022 50.0 0.0 X 0 1103144 308072 RONALD W STEIMEL FORMER CAO 0.0 50.0 X 0 793778 182975 PATRICK MINICUS EVP & CFO AS OF 12/12/2022 50.0 0.0 X 0 805216 69870 FAHIM AHMED CMO 50.0 0.0 X 637661 0 68536 ALEXANDER TELIS MD CLINICAL ATTENDING CRIT CARE 50.0 0.0 X 578105 0 75941 Emmanouil Tsounias MD Pediatric Hospitalist 50.0 0.0 X 418290 0 52909 LIYIN CHEN MD HOSPITALIST 50.0 0.0 X 394199 0 65181 Hassan Frinjari MD PHYSICIAN 50.0 0.0 X 397046 0 60473 Swaena Davarajan MD Dir. Pediatrics & Neonatology 50.0 0.0 X 378878 0 70322 IHAB IBRAHIM COO 50.0 0.0 X 360411 0 62946 Joseph Manopella PRESIDENT AS OF 7/25/2022 50.0 0.0 X 286739 0 28633 JOHN FRANCFORT MD TRUSTEE RESIGNED 5/22 2.0 37.5 X 0 281765 20512 SALVATORE SODANO CHAIR 2.0 0.0 X X 0 0 0 BRIAN MCGUIRE VICE CHAIR 2.0 0.0 X X 0 0 0 JEROME POLLER SECRETARY 2.0 0.0 X X 0 0 0 CHRIS PASCUCCI TRUSTEE 2.0 0.0 X 0 0 0 VIRGINIA EWEN TRUSTEE 2.0 0.0 X 0 0 0 FRANK L KURRE TRUSTEE 2.0 0.0 X 0 0 0 REV MSGR ROBERT MORRISEY TRUSTEE 2.0 0.0 X 0 0 0 DANIEL T ROWE TRUSTEE RESIGEND 12/22 2.0 0.0 X 0 0 0 REV JOHN MCCARTNEY TRUSTEE 2.0 0.0 X 0 0 0 KEVIN J CONWAY TRUSTEE 2.0 0.0 X 0 0 0 PETER D'ANGELO TRUSTEE 2.0 0.0 X 0 0 0 REV PETER DUGANDZIC TRUSTEE 2.0 0.0 X 0 0 0 HON ANTHONY MARANO TRUSTEE 2.0 0.0 X 0 0 0 STEPHEN F MCLOUGHLIN TRUSTEE 2.0 0.0 X 0 0 0 WILLIAM WARD TRUSTEE 2.0 0.0 X 0 0 0 ROBERT ZUCCARO TREASURER 2.0 0.0 X X 0 0 0 PETER QUICK TRUSTEE 2.0 0.0 X 0 0 0 THOMAS CHRISTMAN TRUSTEE 2.0 0.0 X 0 0 0 Debra Del Vecchio TRUSTEE AS OF 2.0 0.0 X 0 0 0 Regina Piscazzi TRUSTEE AS OF 2.0 0.0 X 0 0 0 John Romanelli MD TRUSTEE AS OF 2.0 0.0 X 0 0 0 Andrew Zucaro TRUSTEE AS OF 2.0 0.0 X 0 0 0 3451329 6434516 2551824 468 true true false EW HOWELL CO LLC 245 Newtown Rd Suite 600 PLAINVIEW NY 11803 CONSTRUCTION 4285364 LI MINIMALLY INVASIVE SURG PC 3003 New Hyde Park Rd NEW HYDE PARK NY 11042 PHYSICIAN SERVICES 3669661 PROGRESSIVE EMERGENCY PHYS LLC 1236 RXR PLAZA UNIONDALE NY 11556 PHYSICIAN SERVICES 2150784 REMI HOLDINGS LLC 11325 N COMMUNITY HOUSE RD CHARLOTTE NC 28277 EQUIPMENT SERVICES 1019289 EMPIRE STATE RADIOLOGY PC 2330 Utah Avenue Suite 200 EL SEGUNDO CA 90245 PHYSICIAN SERVICES 834168 34 1686456 98360 1784816 NET PATIENT SERVICE REVENUE - HOSPITAL 622110 285987060 285987060 NET PATIENT SERVICE REV-LAB PROCEDURES 621500 44934 44934 BEHAVIORAL HEALTH PROGRAMS 621300 8841590 8841590 294873584 175944 175944 0 0 3757009 3757009 0 3757009 3757009 636117 -636117 -636117 -636117 0 0 0 0 0 0 0 0 0 CAFETERIA & COFFEE SHOP 722514 449150 449150 RADIOLOGY SCHOOL TUITION 900099 280630 280630 PHYSICIAN SERVICES 621110 144996 144996 429441 429441 1304217 301259453 295683717 44934 3745986 138186 138186 0 0 0 1444926 1444926 0 127060346 115775318 11285028 0 8301178 7572188 728990 22590753 20606887 1983866 10430271 9514309 915962 29100 29100 4638 4638 10000 10000 33177 33177 0 0 12638015 9613681 3024334 115709 93219 22490 5083665 3439600 1644065 0 0 5870684 4952106 918578 39915 33551 6364 0 0 18476 18476 0 11468533 9480379 1988154 8643710 8643710 MEDICAL SUPPLIES 42967546 42967546 CHS SERVICES 26633845 11860271 14773574 NURSING AGENCY COSTS 5928725 5928725 OUTSIDE LAB SERVICES 5150508 5150508 30764475 23663943 7100532 325366381 280897529 44468852 0 1389147 1191332 0 0 135422 89267 29885756 34270326 0 0 0 0 0 0 4695493 4469878 2723992 3448817 381375097 269161570 111040798 112213527 4021923 1864076 0 0 0 0 0 0 93030705 77955153 246923236 235502376 34935284 35543794 0 0 0 0 2438954 2206601 0 0 0 0 1041856 1949230 0 0 183256948 194970080 221673042 234669705 X 22628036 -1031405 2622158 1864076 25250194 832671 246923236 235502376 X -24106928 -438457 127862 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 33177 33177 false PART II-B, LINE 1 - LOBBYING ACTIVITIES AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ASSOCIATIONS REPRESENT. 136970 67231 69739 152969 16000 136969 180334 27364 152970 203201 1000 6300 17567 180334 223646 750 6300 14895 203201 1.00000 false false 7712446 7712446 199877035 137731215 62145820 3206862 1373401 1833461 153951405 124083055 29868350 16627349 5973899 10653450 112213527 INSURANCE CLAIMS RECEIVABLE 53595953 DUE FROM RELATED PARTIES 9672000 OTHER RECEIVABLES - CURRENT 5028559 457B FUNDS 623365 RIGHT OF USE ASSET 9035276 77955153 0 ESTIMATED MALPRACTICE LIABILIT 56321866 AMOUNTS DUE TO RELATED PARTIES 98231644 OTHER SELF INSURANCE LIABILITY 17714598 THIRD PARTY PAYOR LIABILITIES 14802450 OPERATING LEASE LIABILITY 7889167 TENANT SECURITY DEPOSIT 10355 194970080 X PART V, LINE 4 - ENDOWMENT FUNDS MERCY HOSPITAL'S MAGOVERN FUND IS RESTRICTED FOR THE PURPOSE OF FUNDING EXPENDITURES RELATING TO THE HOSPITAL'S SCHOOL OF RADIOLOGY. 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 6062752 1277378 4785374 0.01470 65053989 41446067 23607922 0.07260 1112538 603637 508901 0.00160 72229279 43327082 28902197 0.08890 1521063 0 1521063 0.00470 1202281 592552 609729 0.00190 176576 0 176576 0.00050 2899920 592552 2307368 0.00710 75129199 43919634 31209565 0.09600 true 9217129 69442078 76579167 -7137089 X true true 1 1 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 http://mercymedicalcenter.chsli.org 2909000H X X X X PSYCHIATRIC UNIT / REHABILITATIVE SERVICES MERCY MEDICAL CENTER 1 false false true X X X X X X X X X 22 true true true true X mercymedicalcenter.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. COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEWYORK 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 MERCY 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, 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 MERCY 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 2021 THROUGH DECEMBER 2021 WITH 1,143 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, ELMONT AND HEMPSTEAD. PART V, SECTION B, LINE 6A ST. JOSEPH HOSPITAL, ST. FRANCIS HOSPITAL, NORTHWELL HEALTH SYSTEM (GLEN COVE HOSPITAL, LONG ISLAND JEWISH VALLEY STREAM, LONG ISLAND JEWISH MEDICAL CENTER, NORTH SHORE UNIVERSITY HOSPITAL, PLAINVIEW HOSPITAL, SOUTH OAKS HOSPITAL, SYOSSET HOSPITAL), NASSAU UNIVERSITY MEDICAL CENTER, MOUNT SINAI SOUTH NASSAU HOSPITAL AND NYU WINTHROP HOSPITAL. 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 WEBSITE, HTTPS://MERCYMEDICALCENTER.CHSLI.ORG/. PRIORITY 1: PREVENT CHRONIC DESEASE MERCY MEDICAL CENTER OFFERS REGULARLY SCHEDULED PREVENTIVE HEALTH SCREENINGS IN LOCAL COMMUNITIES, PARTICULARLY IN MEDICALLY-UNDERSERVED COMMUNITIES. THESE SCREENINGS INCLUDE BLOOD PRESSURE, BODY MASS INDEX (BMI), MAMMOGRAPHY, AND PSA. IN ADDITION, MERCY HOSPITAL HOSTS REGULARLY SCHEDULED IN-PERSON AND VIRTUAL LECTURES, SYMPOSIUMS AND EDUCATION EVENTS, FOCUSING ON UNDERSERVED COMMUNITIES. IN 2022, 13 FREE COMMUNITY LECTURES WERE CONDUCTED THROUGHOUT THE YEAR, WITH AN ATTENDANCE OF APPROXIMATELY 1,260 INDIVIDUALS. THE LECTURES FOCUSED ON DIABETES, ORTHOPEDIC ISSUES, SEPSIS, SLEEP, BREAST HEALTH, COLON CANCER AND HYPERTENSION. THE HOSPITAL OFFERS FREE SCREENING MAMMOGRAMS THROUGH A GRANT FROM PINK AID. PINK AID'S MISSION IS TO HELP UNDERSERVED LOCAL WOMEN BREAST CANCER TREATMENT WITH SUPPORT AND DIGNITY, TO PROVIDE SCREENING TO WOMEN IN FINANCIAL NEED AND TO EMPOWER BREAST CANCER SURVIVORS TO HEAL BY HELPING AND INSPIRING OTHERS. TO DATE, 27 PEOPLE RECEIVED A FREE SCREENING MAMMOGRAPHY. A PINKTEMBER EVENT WAS HELD ON SEPTEMBER 14TH IN THE GARDEN OF CARING WHERE SURGEONS TALKED ABOUT PREVENTION AND SCREENING. THREE HUNDRED PEOPLE ATTENDED. HEALTHY SUNDAYS COMMUNITY OUTREACH EVENTS ARE HELD IN COLLABORATION WITH CHURCHES, HOUSES OF WORSHIP AND COMMUNITIES. A HEALTHY SUNDAYS EVENT ON OCTOBER 2ND, WAS HELD IN COLLABORATION WITH THE QUEEN OF THE MOST HOLY ROSARY CHURCH. FIFTY COMMUNITY MEMBERS RECEIVED BLOOD PRESSURE SCREENINGS. ADDITIONALLY, VOLUNTEERS FROM MERCY HOSPITAL PARTICIPATED IN OTHER HEALTHY SUNDAYS EVENTS. THE FRIEDBERG JEWISH COMMUNITY CENTER (JCC) IN OCEANSIDE IS AN ACTIVE COMMUNITY PARTNER. A SENIOR HEALTH FAIR WAS HELD ON JUNE 23RD. FIVE HUNDRED AND FIFTY PEOPLE ATTENDED. THERE WERE ALSO DISCUSSIONS ON SLEEP, WOUND CARE, HYPERTENSION, AS WELL AS A FLU VACCINATION DAY, WHICH PROVIDED VACCINES TO 50 PEOPLE. SUPPORT GROUPS BRING TOGETHER PEOPLE WHO ARE GOING THROUGH OR HAVE GONE THROUGH SIMILAR EXPERIENCES. MERCY HOSPITAL OFFERS FREE SUPPORT GROUPS OPEN TO ALL COMMUNITY MEMBERS AND THEIR FAMILIES. THE BEHAVIORAL HEALTH FAMILY SUPPORT GROUP MEETS VIRTUALLY ON A WEEKLY BASIS. A MONTHLY CANCER CAREGIVERS SUPPORT GROUP BEGAN WITH FIVE PARTICIPANTS. THE SHERPA PROGRAM HAS BEEN INITIATED AT MERCY, AND A LUNCH AND LEARN EDUCATION FOR STAFF WAS HELD ON AUGUST 31ST. TWENTY-TWO STAFF MEMBERS PARTICIPATED. IN 2022, 63 PEOPLE WERE REFERRED TO THE SHERPA PROGRAM. THE FRIEDBERG JCC IN OCEANSIDE HOSTED A FLU POD FOR THEIR MEMBERS ON OCTOBER 27 SUPPORTED BY MERCY, AND DISTRIBUTED 50 VACCINATIONS. PRIORITY 2: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, INTERVENTIONS INCLUDE: PROMOTION OF ALL PROGRAMS, EVENTS, AND EDUCATION OFFERED BY LIHC MEMBERS WHO SPEAK TO THE PREVENTION OF MENTAL AND SUBSTANCE USE DISORDERS. THE HOSPITAL PARTICIPATES IN LOCAL TASK FORCES ADDRESSING OPIOID USE DISORDERS. MERCY HOSPITAL'S BEHAVIORAL HEALTH SERVICES HAS BEEN MEETING THE BEHAVIORAL HEALTH NEEDS OF THE COMMUNITY SINCE 1958 AND ARE STAFFED BY CARING, QUALIFIED HEALTH PROFESSIONALS, INCLUDING PSYCHIATRISTS, PSYCHIATRIC NURSE PRACTITIONERS, LICENSED CLINICAL SOCIAL WORKERS, LICENSED MENTAL HEALTH COUNSELORS, REGISTERED NURSES, LICENSED CREATIVE ARTS THERAPISTS, ACTIVITIES THERAPISTS AND BEHAVIORAL HEALTH AIDES. CARING, SEASONED, CLINICAL STAFF WILL ASSESS EACH SITUATION AND PROVIDE INFORMATION AND REFERRAL ABOUT BEHAVIORAL HEALTH SERVICES AND/OR OTHER COMMUNITY RESOURCES THAT WILL HELP DURING THIS TIME. STAFF IS AVAILABLE 24-HOURS-A-DAY, 7-DAYS-A-WEEK. THE CH MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE FOR DOWNLOAD ON THE MERCY WEBSITE. IN ADDITION TO THE TWO SELECTED NEW YORK STATE PRIORITY AND FOCUS AREAS, MERCY HOSPITAL ALSO PARTICIPATES IN COMMUNITY OUTREACH ACTIVITIES THAT ADDRESS OTHER NEWYORK STATE PREVENTION AGENDA PRIORITIES. MERCY PROVIDES CLINICAL EDUCATION AND MENTORING FOR NURSING STUDENTS FROM LOCAL COLLEGES. FREE, EVIDENCE-BASED FALL PREVENTION PROGRAMS ARE OFFERED THAT ARE DESIGNED TO IMPROVE BALANCE AND STRENGTH AND HELP REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS. A JOINT/SPINE ENDEAVOR CLASS WAS HELD MONTHLY, WITH AN AVERAGE OF 10 PEOPLE ATTENDING. AS A MEMBER OF CATHOLIC HEALTH SERVICES, MERCY OFFERS OUTREACH SERVICES AS PART OF THE CH MISSION AND SOCIAL DETERMINANTS OF HEALTH. MERCY STAFF PARTICPATED IN THE AMERICAN HEART ASSOCIATION LONG ISLAND HEART WALK MOVE MORE CHALLENGE ON SEPTEMBER 19TH AND THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER WALK ON OCTOBER 16TH. MERCY HOSTED FIVE BLOOD DRIVES COLLECTING 263 PINTS OF BLOOD IN SUPPORT OF LONG ISLAND BLOOD SERVICES. MERCY ALSO CONDUCTS COLLECTION DRIVES FOR FOOD, CLOTHING, AND SCHOOL SUPPLIES AND ADOPT-A-FAMILY COLLECTIONS AT CHRISTMAS, BENEFITTING LOCAL COMMUNITY PARTNERS AND CHURCHES. PART V, SECTION B, LINE 20E MERCY HOSPITAL HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES 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. MERCY HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 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 THE METHODOLOGY WAS 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 NEWYORK 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 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 AS PART OF ITS TAX EXEMPT PURPOSE, MERCY HOSPITAL PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. MERCY TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF WHETHER THEY HAVE THIRD-PARTY COVERAGE OR THE ABILITY TO PAY. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, MERCY IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. A PATIENT'S PORTION OF A BILL THAT 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 THE 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 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. 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. MERCY HOSPITAL 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. MERCY HOSPITAL 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 NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S BOARD OF TRUSTEES AND EXECUTIVE LEADERSHIP COUNCIL, 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 DOUBLES 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. MERCY 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. PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY 1. SINCE IT IS THE DUTY OF MERCY HOSPITAL TO ENSURE THAT EVERY PATIENT IS AWARE OF THE EXISTENCE OF THE HOSPITAL'S CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENT HAVE BEEN FULLY VERSED IN MERCY HOSPITAL'S CHARITY CARE POLICY. ALL HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. MERCY HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN MERCY 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. MERCY 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. MERCY HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. MERCY HOSPITAL PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING MERCY 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, A STATEMENT IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER INFORMATION. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4 - COMMUNITY INFORMATION MERCY HOSPITAL IS LOCATED ON THE SOUTH SHORE OF NASSAU COUNTY IN ROCKVILLE CENTRE. A NOT-FOR-PROFIT HOSPITAL WITH 375 BEDS, MERCY IS A MEMBER OF CATHOLIC HEALTH SERVICES SERVING THE HEALTH CARE NEEDS OF NASSAU COUNTY AND THE SURROUNDING AREA. THE POPULATION IN THE HOSPITAL'S PRIMARY SERVICE AREA IS ETHNICALLY DIVERSE WITH A POPULATION OF MORE THAN 500,000 RESIDENTS. MERCY'S SERVICE AREA CONSISTS OF SOME OF THE POOREST POPULATIONS IN NASSAU COUNTY, INCLUDING FOUR (HEMPSTEAD, ROOSEVELT, FREEPORT, AND UNIONDALE) OF THE EIGHT HIGHEST POVERTY ZIP CODES IN THE COUNTY. MERCY HOSPITAL'S DISCHARGE DATA INDICATES THAT MERCY CONTINUES TO SERVE ECONOMICALLY CHALLENGED COMMUNITIES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH MERCY PARTICIPATED IN OR HOSTED COMMUNITY EVENTS, BOTH IN-PERSON AND VIRTUALLY, AT WHICH HEALTH EDUCATION WAS PROVIDED, EMPHASIZING WELLNESS, NUTRITION, DIABETES PREVENTION, AND PREVENTIVE CARE SCREENINGS. MERCY, IN CONJUNCTION WITH OTHER CH HOSPITALS, PARTICIPATED IN THE HEALTHY SUNDAYS PROGRAM, A COMMUNITY OUTREACH PROGRAM HELD IN PARISHES AND OTHER COMMUNITY CENTERS. EVENTS OFFER SCREENINGS AND HEALTH EDUCATION. THE HOSPITAL OFFERS SMOKING CESSATION INFORMATION, REFERRALS TO SMOKING CESSATION PROGRAMS AND THE NY-QUIT LINE CARDS AT ALL COMMUNITY OUTREACH EVENTS. MERCY OFFERS SMOKING CESSATION PROGRAMS TO EMPLOYEES THROUGH ITS EMPLOYEE ASSISTANCE PROGRAM AND TO PHYSICIANS THROUGH THE CENTER FOR TOBACCO CONTROL. PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, MERCY HOSPITAL THROUGH ITS DAILY OPERATIONS, PROVIDES ACUTE, EMERGENT, AND OUTPATIENT CARE. MERCY IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH (CH)), 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, 2022, CH COMPRISED SIX HOSPITALS (MERCY HOSPITAL, ST. FRANCIS HOSPITAL AND HEART CENTER, 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 NURSING HOMES (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 16,000 EMPLOYEES 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 AS WELL AS FREE HEALTH SCREENINGS THROUGH ITS HEALTHY SUNDAYS PROGRAMS. SINCE 1907, CATHOLIC HEALTH HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE IMPROVING THE COMMUNITY'S HEALTH. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVEROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 138186 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 MERCY HOSPITAL AND CATHOLIC HEALTH AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH USES THE GRANT FUNDS FOR MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS TO UNDESERVED COMMUNITIES AND CAPITAL SUPPORT. PART II, LINE 1, COLUMN (H) NAME 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 SERVICES OF LONG ISLAND CAREGIVERS FUND. THE CATHOLIC HEALTH SERVICES OF LONG ISLAND 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 true true X X X X X X true true false false false false false false false PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 0 1656290 0 753000 0 30423 0 785411 0 51167 0 3276291 0 0 PETER SCAMINACI PRESIDENT/CAO THRU 4/1/2022 0 303097 0 138000 0 569803 0 215241 0 433635 0 1659776 0 0 DANIEL DEBARBA EVP & CFO THRU 8/5/2022 0 626446 0 350000 0 126698 0 274411 0 33661 0 1411216 0 0 RONALD W STEIMEL FORMER CAO 0 569737 0 146000 0 78041 0 137411 0 45564 0 976753 0 59261 PATRICK MINICUS EVP & CFO AS OF 12/12/2022 0 607424 0 180000 0 17792 0 21411 0 48459 0 875086 0 0 FAHIM AHMED CMO 555750 0 81000 0 911 0 23394 0 45142 0 706197 0 0 0 ALEXANDER TELIS MD CLINICAL ATTENDING CRIT CARE 301356 0 276250 0 499 0 23394 0 52547 0 654046 0 0 0 Emmanouil Tsounias MD Pediatric Hospitalist 309275 0 108331 0 684 0 23394 0 29515 0 471199 0 0 0 LIYIN CHEN MD HOSPITALIST 223241 0 169510 0 1448 0 18008 0 47173 0 459380 0 0 0 Hassan Frinjari MD PHYSICIAN 303239 0 88120 0 5687 0 23394 0 37079 0 457519 0 0 0 Swaena Davarajan MD Dir. Pediatrics & Neonatology 374738 0 0 0 4140 0 23394 0 46928 0 449200 0 0 0 IHAB IBRAHIM COO 304196 0 55500 0 715 0 23394 0 39552 0 423357 0 0 0 Joseph Manopella PRESIDENT AS OF 7/25/2022 215153 0 65000 0 6586 0 16726 0 11907 0 315372 0 0 0 JOHN FRANCFORT MD TRUSTEE RESIGNED 5/22 0 281765 0 0 0 0 0 19554 0 958 0 302277 0 0 PART I, LINES 4A - SEVERANCE PAYMENT Peter Scaminaci received a severance payment of $157,514. The amount is included on Schedule J, Part II, Column B (III). PART I, LINES 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 RONALD STEIMEL $116,000 PARTICIPATION IN PLAN PETER SCAMINACI $192,000 PARTICIPATION IN PLAN PATRICK O'SHAUGHNESSY $764,000 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. RON STEIMEL $59,261 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 11/01/2018 PETER SCAMINACI WAS TRANSFERRED FROM ST. JOSEPH HOSPITAL, A RELATED ENTITY, TO SERVE AS THE PRESIDENT/CAO. EFFECTIVE 11/01/2018, RON STEIMEL WAS TRANSFERRED TO CHS SERVICES, A RELATED ENTITY, TO SERVE AS THE SENIOR VICE PRESIDENT FOR BUSINESS DEVELOPMENT. MERCY INTERNAL MEDICINE PC SEE PART V 542859 PURCHASED SALARIES/CONTRACT MG false SCHEDULE L, PART IV, LINE (1) COLUMN (B) - RELATIONSHIP FAHIM AHMED, A KEY EMPLOYEE OF MERCY HOSPITAL, IS THE SOLE SHAREHOLDER OF MERCY INTERNAL MEDICINE, PC FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF MERCY MEDICAL CENTER (D/B/A MERCY 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 INTEGRATED 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 MERCY HOSPITAL AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF MERCY HOSPITAL. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF MERCY HISPITAL, CH IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF MERCY HOSPITAL. THE GOVERNING BODY OF MERCY 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 SUMBITTED 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 COMMITTE 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 EUIVALENT 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 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 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). PETER SCAMINACI, PRESIDENT/CAO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: MERCY MEDICAL CENTER (11-1635088) AND WSNCHS NORTH, INC. (11-3438973). 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); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). FORM 990, PART IX, LINE 25E - OTHER EXPENSES TOTAL PROGRAM MANAGEMENT HOME OFFICE ALLOCATION EXPENSES: 5,374,683 5,374,683 ALL OTHER EXPENSES : 25,389,792 23,663,943 1,725,849 TOTAL LINE 25E : 30,764,475 23,663,943 7,100,532 FORM 990, PART X, LINE 20 - TAX-EXEMPT BOND LIABILITIES A PORTION OF 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), NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BONDS) AND NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORPORATION (SERIES 2014B BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH SERVICES OF LONG ISLAND. FORM 990, PART XI, LINE 9 - CHANGES IN NET ASSETS CHANGE IN POST RETIREMENT BENEFIT: $102,000 RELATED PARTY EMPLOYEE BENEFIT SERVICES: $ 25,862 TOTAL TO FORM 990, PART XI, LINE 9: $127,862 FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION MERCY 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. 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 HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) 3 CHSLI true 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 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 ST CHARLES 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 true 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 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 ASSN NY NA IDHC LLC 2500 YORK RDJAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVICES PA NA 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 true true true true true false false true true false true true false true true true true true CHS SERVICES INC LMPR 16037132 COST CHS SERVICES INC A 1465426 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER LM 187946 COST ST CHARLES HOSPITAL CORP LM 100440 COST ST CATHERINE OF SIENA MEDICAL CENTER LM 298114 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.