2023-11-14T15:20:49-06:00 2022-12-31 PwC US Tax LLP 2001 MARKET STREET SUITE 1800 PHILADELPHIA PA 19103 990 2022-01-01 113555766 CHS SERVICES INC % CHS SERVICES INC CHSS 5167053700 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 Patrick O'Shaughnessy PRESIDENT, CEO 5167053700 2023-11-13 true Patrick OShaughnessy 999009999 ERIC M MCNEIL P00460263 2673303000 2023-11-09 3 2022 2023-04-26 12:10:37Z PATRICK O'SHAUGHNESSY DO 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 268592723 false 0928 X N/A X 2000 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 1576 0 0 0 22652 13740 226883329 245435752 9 0 20316027 23143231 247222017 268592723 0 0 0 0 165573002 179454422 0 0 0 102048484 109900076 267621486 289354498 -20399469 -20761775 406825660 395086318 290615618 292236702 116210042 102849616 X SEE SCHEDULE O false false 289354498 0 266225486 CHS SERVICES INC. PROVIDES ADMINISTRATIVE SUPPORT TO THE CH ENTITIES INCLUDING, BUT NOT LIMITED TO ACCOUNTING, REVENUE CYCLE, SUPPLY CHAIN AND INFORMATION TECHNOLOGY. CHS SERVICES PROMOTES EFFICIENT MANAGEMENT, COOPERATIVE PLANNING AND EFFICIENT USE OF RESOURCES BY ALL SUPPORTED ORGANIZATIONS. 289354498 true true false false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true 172 0 true 1576 true true true false false false false false false false false false true 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 PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 50.0 0.0 X X 0 2439713 836578 JULIE KAPOOR SVP MANAGED CARE 50.0 0.0 X 1361542 0 223381 DANIEL DEBARBA EVP & CFO (THRU 8/5/22) 50.0 0.0 X 0 1103144 308072 GEORGE BEAUREGARD SVP CHS PHY. PTR. THRU 11/4/22 50.0 0.0 X 732659 0 638453 ANVI THAKORE CMO CHS MEDICAL GROUP 50.0 0.0 X 673057 323767 67784 RON STEIMEL SVP BUSINESS DEVELOPMENT 50.0 0.0 X 793778 0 182975 PATRICK MINICUS EVP & CFO as of 12/12/22 50.0 0.0 X 805216 0 69870 CATHY O'BRIEN SVP SUPPLY CHAIN 50.0 0.0 X 731328 0 106424 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 RESIGNED 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 5097580 4148389 2454049 562 false true false PRESIDIO HOLDINGS INC 121000 SUNSET HILLS ROAD STE 300 RESTON VA 20190 SOFTWARE MAINTENANCE 6016254 HARVEST 245 OLD COUNTRY ROAD 131 JERICHO TURNPIKE JERICHO NY 11753 RENT 3070042 TRITECH HEALTHCARE MGMT 265 SPAGNOLI ROAD MELVILLE NY 11747 Collection 2964820 AMERICAN MEDICAL RESPONSE OF NEW YO PO BOX 843047 DALLAS TX 752843047 AMBULANCE SERVICE 2333278 OPTUM360 LLC PO BOX 843047 DALLAS TX 752843047 PHARMACY 2230688 56 13740 13740 ASSESSMENT REVENUE 900099 245308663 245308663 PHYSICIAN AFFILIATE SUBSIDY 900099 127089 127089 245435752 0 0 0 107406 107406 0 107406 107406 0 0 0 0 0 0 0 0 0 0 EXPENSE REIMBURSEMENT-RELATED PARTY 900099 20916823 20916823 OTHER REVENUE 900099 2111407 2111407 RENTAL INCOME 7595 7595 23035825 268592723 266225486 2480586 0 0 0 0 875086 875086 0 135805480 135805480 9813027 9813027 22469549 22469549 10491280 10491280 3845744 3845744 0 0 0 0 0 5249640 5249640 14056867 14056867 3339856 3339856 0 0 33030786 33030786 0 6754065 6754065 341842 341842 0 0 0 0 20787774 20787774 463856 463856 EQUIPMENT SERVICE CONTRACTS 356999 356999 OTHER EXPENSES 21672647 21672647 289354498 289354498 0 0 143549753 84402851 2688418 2606252 0 0 1360527 847062 0 0 0 0 0 0 0 0 13221770 16215966 293913120 224695144 74171129 69217976 0 0 0 0 0 0 0 0 171834063 221796211 406825660 395086318 64508168 68894089 0 0 170645 246177 0 0 0 0 0 0 0 0 0 0 225936805 223096436 290615618 292236702 X 116210042 102849616 0 0 116210042 102849616 406825660 395086318 X -20761775 7401349 X false true X true true true X X 9 MERCY MEDICAL CENTER 111635088 3 false 0 0 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 111888924 3 false 0 0 ST FRANCIS HOSPITAL 112050523 3 false 0 0 ST CATHERINE OF SIENA MEDICAL CENTER 061562701 3 false 0 0 ST CHARLES HOSPITAL CORP 111871039 3 false 0 0 WSNCHS NORTH INC 113438973 3 false 0 0 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 113284066 10 false 0 0 CATHOLIC HOME CARE 112126736 10 false 0 0 GOOD SHEPHERD HOSPICE 112958438 10 false 0 0 9 0 0 false false false false true false false false false false false false false false false false false PART IV, SECTION A, LINE 1 CHS SERVICES IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR THE CHARITABLE PURPOSE OF SUPPORTING AND ASSISTING CH AND SUCH OTHER ORGANIZATIONS AS ARE OPERATED, SUPERVISED, OR CONTROLLED BY OR IN CONNECTION WITH CH AND ARE DESCRIBED IN EITHER SECTION 509(a)(1) OR 509(A)(2) OF THE INTERNAL REVENUE CODE. THE BYLAWS DESIGNATE THE SUPPORTED ORGANIZATIONS AS CH AND THOSE ORGANIZATIONS FOR WHICH CH IS THE SOLE MEMBER AND CERTAIN OTHER PUBLIC CHARITIES CONTROLLED BY SUCH ORGANIZATIONS. PART IV, SECTION A, LINE 5A EFFECTIVE JANUARY 1, 2022, THE SOLE MEMBER OF MARYHAVEN CENTER OF HOPE AND MARYHAVEN SCHOOL CORPORATION WAS NO LONGER CATHOLIC HEALTH. AS A RESULT, THERE WERE NO LONGER A SUPPORTED ORGANIZATION OF THE COMPANY. PART IV, SECTION C, LINE 1 CHS SERVICES SUPPORTS THOSE ENTITIES FOR WHICH CH IS THE SOLE MEMBER. THE BOARD OF TRUSTEES OF CHS SERVICES OVERLAPS WITH THE BOARD OF TRUSTEES OF CH. THEREFORE, ALTHOUGH THE BOARD OF CHS SERVICES DOES NOT OVERLAP WITH ALL OF THE ENTITIES WHICH IT SUPPORTS, CONTROL IS VESTED WITH THE BOARD OF TRUSTEES OF CHS SERVICES BY CH BEING THE SOLE MEMBER AND CERTAIN OTHER PUBLIC CHARITIES CONTROLLED BY SUCH ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32067033 20118930 11948103 261846087 204576214 57269873 69217976 DUE FROM RELATED ORGANIZATIONS 178048495 RIGHT OF USE ASSETS 43747716 221796211 0 DUE TO RELATED ORGANIZATIONS 173039842 SELF INSURED LIABILIIES 2275977 OPERATING LEASE LIABILITIES 47780617 223096436 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. X true true X X X X X X true true false false false false false false false DANIEL DEBARBA EVP & CFO (THRU 8/5/22) 0 626446 0 350000 0 126698 0 274411 0 33661 0 1411216 0 0 PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 0 1656290 0 753000 0 30423 0 785411 0 51167 0 3276291 0 0 RON STEIMEL SVP BUSINESS DEVELOPMENT 569737 0 146000 0 78041 0 137411 0 45564 0 976753 0 59261 0 PATRICK MINICUS EVP & CFO as of 12/12/22 607424 0 180000 0 17792 0 21411 0 48459 0 875086 0 0 0 CATHY O'BRIEN SVP SUPPLY CHAIN 466765 0 140000 0 124563 0 89411 0 17013 0 837752 0 39000 0 JOHN FRANCFORT MD TRUSTEE RESIGNED 5/22 0 281765 0 0 0 0 0 19554 0 958 0 302277 0 0 JULIE KAPOOR SVP MANAGED CARE 591132 0 185000 0 585410 0 172411 0 50970 0 1584923 0 407000 0 GEORGE BEAUREGARD SVP CHS PHY. PTR. THRU 11/4/22 491930 0 152000 0 88729 0 571765 0 66688 0 1371112 0 0 0 ANVI THAKORE CMO CHS MEDICAL GROUP 655229 237435 0 86000 17828 332 21411 0 32081 14292 726549 338059 0 0 PART I, LINE 3 - METHODS TO ESTABLISH COMPENSATION BY RELATED ORGANIZATION THE FOLLOWING METHODS ARE USED BY A RELATED ORGANIZATION TO 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 4 - SEVERANCE George Beauregard received a severance payment of $43,982. THE AMOUNT IS INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SUPPLEMENTAL NON-RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. DANIEL DEBARBA $253,000 PARTICIPATION IN THE PLAN CATHY O'BRIEN $68,000PARTICIPATION IN THE PLAN RONALD STEIMEL $116,000 PARTICIPATION IN THE PLAN PATRICK O'SHAUGHNESSY $764,000 PARTICIPATION IN THE PLAN JULIE KAPOOR $151,000 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. RONALD STEIMEL $59,261 VESTED IN PLAN JULIE KAPOOR $565,464 VESTED IN PLAN CATHY O'BRIEN $102,104 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. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF CHS SERVICES, INC. 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 CENTRE (DIOCESE). FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CH IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF CHS SERVICES, INC. AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF CHS SERVICES, INC. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY CH AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF CHS SERVICES, INC., IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF CHS SERVICES, INC. FORM 990, PART VI, LINE 11B - REVIEW PROCESS OF 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 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 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 EXECUTIVE 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 CHS 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 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 CONTRIBUTED 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). 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 III, LINE 1 - ORGANIZATION'S MISSION CHS SERVICES,INC. 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 RELATED PARTY EMPLOYEE BENEFIT SERVICES: $7,401,349 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 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 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 11776 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 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 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 N/A IDHC LLC 2500 YORK RDJAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVIC 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 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 false false false true false false false false false true true true true true true true true true GOOD SAMARITAN HOSPITAL MEDICAL CENTER LMQS 3787093 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER OP 131271 COST MERCY MEDICAL CENTER LMQS 16037132 COST ST FRANCIS HOSPITAL LMQS 12484647 COST ST CHARLES HOSPITAL CORP LMQS 5043283 COST ST CATHERINE OF SIENA MEDICAL CENTER LMQS 9142595 COST WSNCHS NORTH INC - ST JOSEPH HOSPITAL LMQS 10603309 COST MERCY MEDICAL CENTER K 1465426 COST ST FRANCIS RESEARCH & EDUCATIONAL CORP INC QS 203950 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.