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 111871039 ST CHARLES HOSPITAL CORP % CHS SERVICES INC STCH 6314746116 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 JAMES O'CONNOR PRESIDENT 5167051937 2023-11-10 true JAMES OCONNOR 999009999 ERIC M MCNEIL P00460263 2673303000 2023-11-09 3 2022 2023-04-26 12:10:37Z ST CHARLES HOSPITAL PATRICK O'SHAUGHNESSY DO 200 BELLE TERRE RD PORT JEFFERSON NY 11777 240099546 false 0928 X http://stcharleshospital.chsli.org/ X 1907 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 1859 37 10405 4037 2352943 1388635 240913457 234305149 116934 129663 4191383 4276099 247574717 240099546 86842 88845 0 0 126570596 136282234 0 0 0 103389849 112301148 230047287 248672227 17527430 -8572681 126136330 123983628 130122854 139670167 -3986524 -15686539 X SEE SCHEDULE O false false 206715859 88845 236650075 ST. CHARLES HOSPITAL IS A 243 BED REHABILITATION AND ACUTE CARE HOSPITAL THAT ALSO OPERATES OUTPATIENT FACILITIES IN. BOTH NASSAU AND SUFFOLK COUNTIES. FOUNDED BY THE DAUGHTERS OF WISDOM IN 1907, ST. CHARLES PROVIDES A FULL RANGE OF HEALTHCARE SERVICES. IN 2022 ST. CHARLES HAD 10,360 DISCHARGED AND PROVIDED 20,185 EMERGENCY ROOM VISITS. ST. CHARLES PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH OTHER COMMUNITY SERVICE AND CHARITABLE ACTIVITIES. 206715859 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 false false false false false false true true true false false true 154 0 true 1859 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 X PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 50.0 0.0 X X 0 2439713 836578 JAMES O'CONNOR PRESIDENT/CAO 50.0 0.0 X 1260286 0 171311 DANIEL DEBARBA EVP & CFO THRU 8/5/2022 50.0 0.0 X 0 1103144 308072 Vlada Frankenburger PHYSICIAN 50.0 0.0 X 1262301 0 42059 Anil Sangwan PHYSICIAN 50.0 0.0 X 1009697 0 41133 Sanjay Sangwan PHYSICIAN 50.0 0.0 X 856938 0 26445 PATRICK MINICUS EVP & CFO AS OF 12/12/2022 50.0 0.0 X 0 805216 69870 Derek Mattimoe PHYSICIAN 50.0 0.0 X 758912 0 71066 Matthew Wagner PHYSICIAN 50.0 0.0 X 685282 0 68277 SUNIL DHUPER MD CMO 50.0 0.0 X 511379 0 38579 RONALD WEINGARTNER COO 50.0 0.0 X 396792 0 39114 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 ROBERT ZUCCARO TREASURER 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 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 6741587 4629838 1733016 379 false true false ORTHOPEDIC ASSOC OF LI PHYS MED 6 TECHNOLOGY DRIVE SUITE 1000 EAST SETAUKET NY 11733 PHYSICIAN SERVICES 2347082 OBGYN HOSPITALIST MEDICAL SERVICE 777 LOWNDES HILL ROAD BUILDING 1 GREENVILLE SC 29607 PHYSICIAN SERVICES 1708476 LI MINIMALLY INVASIVE SURG PC 3003 NEW HYDE PARK RD SUITE 307 NEW HYDE PARK NY 11722 PHYSICIAN SERVICES 982189 ISLAND NEONATOLOGY LLC PO BOX 272 EAST ISLIP NY 11730 PHYSICIAN SERVICES 858496 REMI HOLDINGS LLC 11325 N COMMUNITY HOUSE ROAD SUITE CHARLOTTE SC 28277 EQUIPMENT SERVICES 648143 32 38834 1327443 22358 1388635 NET PATIENT SERVICE REVENUE 622110 234305149 234294744 10405 234305149 129663 129663 0 0 1486132 1486132 0 1486132 1486132 0 0 0 0 0 0 0 0 0 0 REHAB SERVICES 624310 867992 867992 COFFEE SHOP 722514 434636 434636 PHARMACY INCOME 446110 93122 93122 1394217 1394217 2789967 240099546 236650075 10405 2050431 88845 88845 0 0 0 2417461 549958 1867503 0 95974053 87428545 8545508 0 6674445 5968072 706373 22350802 19985363 2365439 8865473 7927219 938254 338922 271465 67457 1400 1400 10000 10000 114124 114124 0 0 14574594 10475498 4099096 60788 800 59988 3896112 2468602 1427510 0 0 4924411 1837575 3086836 125732 109689 16043 0 0 0 0 7988279 5830907 2157372 4653418 4653418 MEDICAL SUPPLIES 28163662 28163662 CHS SERVICES 23431690 10434325 12997365 PHYSICIAN PRACTICE SUBSIDY 13188528 13188528 HOME OFFICE 3455579 3455579 7373909 7333388 40521 248672227 206715859 41956368 0 332261 348739 3455954 3403112 0 0 25899380 23039477 0 0 0 0 0 0 4360310 4144236 1925098 2412977 250085647 200825997 52269683 49259650 481506 420657 0 0 0 0 0 0 37412138 40954780 126136330 123983628 31477016 29203871 0 0 0 0 0 0 0 0 0 0 0 0 0 0 98645838 110466296 130122854 139670167 X -5153554 -16840875 1167030 1154336 -3986524 -15686539 126136330 123983628 X -8572681 -64708 -3062626 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 114124 114124 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. 775960 3785 3785 775960 775960 906 906 775960 775960 7201 7201 775960 775960 19391 19391 775960 775960 10430 10430 775960 1.00000 false false 38000 38000 123033353 93496583 29536770 593839 249534 344305 120073776 101535797 18537979 6346679 5544083 802596 49259650 DUE FROM RELATED PARTIES, NET 10499000 OTHER RECEIVABLES, NET 812137 OTHER ASSETS 113680 INSURANCE CLAIMS RECEIVABLE 24413163 RIGHT OF USE ASSETS 5116800 40954780 0 SELF INSURANCE LIABILITIES 17072167 DUE TO RELATED PARTIES 50861651 THIRD PARTY PAYOR LIABILITIES 11189977 ESTIMATED MALPRACTICE 23658374 OTHER LIAB-POST RETIREMENT 117000 OTHER LIAB-457B PLAN 2248776 OPERATING LEASE LIABILITIES 5318351 110466296 X PART V, LINE 4 - ENDOWMENT FUNDS THE ENDOWMENT INVESTMENTS ARE TO BE HELD IN PERPETUITY, THE INCOME OF WHICH IS EXPENDABLE TO SUPPORT HEALTHCARE SERVICES. 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 2692490 2354349 338141 0.00140 43769848 22686937 21082911 0.08480 983095 600584 382511 0.00150 47445433 25641870 21803563 0.08770 1406529 0 1406529 0.00570 2334065 311675 2022390 0.00810 104916 0 104916 0.00040 141438 0 141438 0.00060 3986948 311675 3675273 0.01480 51432381 25953545 25478836 0.10250 true 8389948 58172971 63244711 -5071740 X true true 1 1 ST CHARLES HOSPITAL CORP 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 WWW.STCHARLESHOSPITAL.CHSLI.ORG/ 5149001H X X X X REHABILITATIVE SERVICES ST CHARLES HOSPITAL CORP 1 false false true X X X X X X X X X 22 true true true true X STCHARLESHOSPITAL.CHSLI.ORG/ X WWW.CHSLI.ORG true 22 true WWW.CHSLI.ORG false true X 300. 400. X X X true true X X X true X WWW.CHSLI.ORG X WWW.CHSLI.ORG X WWW.CHSLI.ORG X X X X X X true X false X X X X X true X false false PART V, SECTION B, LINE 3E IN 2022, MEMBERS OF THE LONG ISLAND HEALTH COLLABORATIVE REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM HEALTH NEEDS PRIORITIES FOR THE 2022-2024 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. PART V, SECTION B, LINE 5 ST. CHARLES 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 SUFFOLK COUNTY. SOURCES OF SECONDARY DATA INCLUDED STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM (SPARCS), NEW YORK STATE PREVENTION AGENDA DASHBOARD, PREVENTION QUALITY INDICATORS (PQI), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), EXTENDED BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (EBRFSS), NEW YORK STATE COMMUNITY HEALTH INDICATOR REPORTS (CHIRS) AND NEW YORK STATE VITAL STATISTICS. THE ENGAGEMENT OF THE BROADER COMMUNITY, FOR ASSESSMENT PROCESSES, IS ACHIEVED THROUGH THE LIHC AND ITS PARTNERS' ONGOING DISTRIBUTION OF THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT (CHAS) SURVEY. THIS SURVEY IS OFFERED ONLINE VIA A SURVEYMONKEY LINK AND IS AVAILABLE TO RESIDENTS AT PUBLIC EVENTS, WORKSHOPS, EDUCATIONAL PROGRAMS, INTERVENTIONS, ETC., WHICH ARE OFFERED BY LIHC PARTNERS. IT IS ALSO DISTRIBUTED AMONG PHYSICIAN OFFICES, HOSPITAL WAITING AREAS, LIBRARIES, SCHOOLS, FEDERALLY-QUALIFIED HEALTH CLINICS, AND INSURANCE ENROLLMENT SITES, AMONG OTHER PUBLIC VENUES. THE LIHC AGGRESSIVELY PROMOTES THE SURVEY THROUGH SOCIAL MEDIA AND A LINK TO THE SURVEY IS ALSO AVAILABLE ON THE ST. CHARLES HOSPITAL'S 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, RIVERHEAD, AND WYANDANCH. PART V, SECTION B, LINE 6A LONG ISLAND COMMUNITY HOSPITAL, NORTHWELL HEALTH SYSTEM (HUNTINGTON HOSPITAL, SOUTH SHORE UNIVERSITY HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL, PECONIC BAY MEDICAL CENTER), GOOD SAMARITAN UNIVERSITY HOSPITAL, ST. CATHERINE OF SIENA HOSPITAL, STONY BROOK SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY HOSPITAL AND VETERANS AFFAIRS MEDICAL CENTER. PART V, SECTION B, LINE 6B THE HOSPITAL'S CHNA WAS 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://STCHARLESHOSPITAL.CHSLI.ORG/. PRIORITY 1: PREVENT CHRONIC DISEASE: ST. CHARLES CENTER OFFERS REGULARLY SCHEDULED PREVENTIVE HEALTH SCREENINGS IN LOCAL COMMUNITIES, PARTICULARLY THOSE IN MEDICALLY-UNDERSERVED COMMUNITIES, INCLUDING BLOOD PRESSURE, BODY MASS INDEX (BMI), ORAL, HEAD AND NECK CANCER, AND COLON CANCER. ST. CHARLES HOSPITAL PROVIDED FREE BLOOD PRESSURE SCREENING EVENTS MONTHLY AT THE PORT JEFFERSON LIBRARY WITH A TOTAL OF 77 INDIVIDUALS SCREENED. HEALTHY SUNDAYS' COMMUNITY OUTREACH EVENTS ARE HELD IN COLLABORATION WITH CHURCHES, HOUSES OF WORSHIP, AND COMMUNITY ORGANIZATIONS. HEALTHY SUNDAYS INCLUDES HEALTH SCREENINGS, EDUCATION AND REFERRALS TO CARE, ALONG WITH SELECT PARTNERS OFFERING FREE OR DISCOUNTED SERVICES. HEALTHY SUNDAYS HELD EVENTS IN OCTOBER, NOVEMBER AND DECEMBER, AND PROVIDED FREE SCREENINGS AND HEALTH EDUCATION TO 141 COMMUNITY MEMBERS. ST. CHARLES HOSTED 20 EDUCATION EVENTS AND LECTURES FROM JANUARY THROUGH DECEMBER ON A VARIETY OF TOPICS, INCLUDING SUBSTANCE ABUSE AND PREVENTION, STROKE, COLON CANCER AND DIGESTIVE HEALTH, FALLS PREVENTION, SMOKING CESSATION, AND NUTRITION. MORE THAN 700 COMMUNITY MEMBERS PARTICIPATED IN THESE EDUCATIONAL EVENTS. THE HOSPITAL HOSTED A DIABETES PREVENTION PROGRAM IN COLLABORATION WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH. THERE WERE 18 REGISTRANTS. AS PART OF A CATHOLIC HEALTH SYSTEM-WIDE INITIATIVE, FREE PROSTATE CANCER SCREENINGS FOR THE COMMUNITY WERE OFFERED ON SEPTEMBER 9TH IN CONJUNCTION WITH PROSTATE CANCER AWARENESS MONTH. TWELVE PEOPLE ATTENDED. THE HOSPITAL HOSTED A COMMUNITY DRIVE-THRU FLU VACCINATION EVENT. TWENTY EIGHT PEOPLE PARTICIPATED. PRIORITY 2: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS: PROMOTION OF ALL PROGRAMS, EVENTS, AND EDUCATION OFFERED BY LIHC MEMBERS THAT SPEAK TO THE PREVENTION OF MENTAL AND SUBSTANCE USE DISORDERS. PARTICIPATION IN LOCAL TASK FORCES ADDRESSING OPIOID USE DISORDERS. ST. CHARLES HOSPITAL OFFERS FREE SUPPORT GROUPS OPEN TO ALL COMMUNITY MEMBERS, INCLUDING MONTHLY BARIATRIC SUPPORT GROUP, BRAIN INJURY SUPPORT GROUP, EPILEPSY SUPPORT GROUP, PARKINSON'S DISEASE SUPPORT GROUP, MONTHLY AND SPINAL CORD INJURY SUPPORT GROUP; BI-MONTHLY MUSCULAR DYSTROPHY SUPPORT GROUP (MDA); WEEKLY SPEECH COMMUNICATION SUPPORT GROUP, AND WEEKLY BREASTFEEDING SUPPORT GROUP; AND BI-WEEKLY STROKE SUPPORT GROUP. IN 2022 ST. CHARLES CONTINUED TO OFFER VIRTUAL SUPPORT GROUPS FOR STROKE, PARKINSON'S DISEASE, LACTATION, MOTHER CIRCLE OF HOPE (POSTPARTUM DEPRESSION), AND BARIATRICS. ONE HUNDRED AND TWENTY PERSONS WERE ENROLLED IN THE STROKE SUPPORT GROUP AND 211 ATTENDED THE PARKINSON'S SUPPORT GROUP. THE VIRTUAL LACTATION CLASS HAD 94 PARTICIPANTS, THERE WERE 19 PEOPLE IN THE BREASTFEEDING SUPPORT GROUP, 94 IN THE VIRTUAL CHILDBIRTH CLASS, AND 30 IN THE NEWBORN PARENTING SUPPORT GROUP. THE FRIENDS AND FAMILY CPR CLASSES HAD 13 PARTICIPANTS. THE BARIATRIC SUPPORT GROUP MET 11 TIMES AND HAD A TOTAL OF 641 ATTENDEES. ST. CHARLES HOSPITAL DISTRIBUTES CH'S MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE TO CHS PARTNERS WITHIN THE HOSPITAL,IS AVAILABLE FOR DOWNLOAD ON THE HOSPITAL WEBSITE AND IS DISTRIBUTED AT COMMUNITY EVENTS. TO FURTHER THE CONTINUUM OF CARE FOR PATIENTS POST-DISCHARGE FROM BOTH THE DETOXIFICATION PROGRAM AND THE REHABILITATION PROGRAM, ST. CHARLES OFFERS NUMEROUS SUPPORT GROUPS POST-DISCHARGE, INCLUDING MONTHLY AL-ANON FAMILY SUPPORT GROUP MEETING-STEP MEETING; WEEKLY: AL-ANON FAMILY SUPPORT GROUP-BEGINNERS' MEETING, ALCOHOLICS ANONYMOUS BACK-TO-BASICS, ALCOHOLICS ANONYMOUS-LIVING SOBER, AND WEEKLY NARCOTICS ANONYMOUS. DUE TO COVID-19 GUIDELINES, THESE SUPPORT GROUPS DID NOT RESUME IN 2022. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY OUTREACH ACTIVITIES THAT ADDRESS OTHER NEW YORK STATE PREVENTION AGENDA PRIORITIES. ST. CHARLES, IN COLLABORATION WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH, OFFERED FREE LECTURES FOR SENIORS ON FALLS PREVENTION. THESE ARE HELD AT LIBRARIES, FIRE DEPARTMENTS, SENIOR GROUPS, AND TOWN SENIOR CENTERS. IN 2022, 59 COMMUNITY MEMBERS ATTENDED THESE LECTURES. ST. CHARLES HOSTS A BREASTFEEDING SUPPORT GROUP TO PROMOTE THE HEALTH BENEFITS OF BREASTFEEDING AND PROVIDE PEER SUPPORT TO NURSING MOTHERS. THERE HAVE BEEN 19 PARTICIPANTS IN THE CLASS. THE VIRTUAL CHILDBIRTH CLASS HAD 94 PARTICIPANTS. IN 2022 THE HOSPITAL HELD 6 CPR CLASSES WITH A TOTAL OF 25 ATTENDEES. ST. CHARLES OFFERS FREE, EVIDENCE-BASED FALL PREVENTION PROGRAMS DESIGNED TO IMPROVE BALANCE AND STRENGTH AND HELP REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS. A 7-WEEK EVIDENCED-BASED FALLS PREVENTION PROGRAM WAS HELD ON CAMPUS IN APRIL AND OCTOBER 2022. SIXTEEN PEOPLE ATTENDED. ADDITIONALLY, A FALLS PREVENTION LECTURE WAS HELD ON MARCH 1ST. THIRTY-FIVE PEOPLE ATTENDED. AS A MEMBER OF CATHOLIC HEALTH, ST. CHARLES HOSPITAL STAFF PARTICPATED IN THE AMERICAN HEART ASSOCIATION WALK MOVE MORE CHALLENGE ON SEPTEMBER 19TH AND IN THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER WALK ON OCTOBER 16TH. ST. CHARLES HOSTED 3 BLOOD DRIVES COLLECTING 189 PINTS OF BLOOD IN SUPPORT OF LONG ISLAND BLOOD SERVICES. THE HOSPITAL CONDUCTS COLLECTION DRIVES FOR FOOD, CLOTHING, AND SCHOOL SUPPLIES, SUPPORTING LOCAL CHURCHES AND COMMUNITY CENTERS IN UNDERSERVED AREAS. PART V, SECTION B, LINE 20E ST. CHARLES HOSPITAL HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN ST. CHARLES HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS, SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH AND ARE CLEARLY VISIBLE TO THE PUBLIC. ST. CHARLES 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 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THEIR SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS. PART I, LINE 7A, COLUMN (D) DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S "NEED" CALCULATION. THIS CALCULATION CONSIDERS 100% OF A HOSPITAL'S "NEED" BASED ON A "UNITS OF SERVICE" METHODOLOGY FOR UNINSURED PATIENTS. THE CALCULATION ALSO MAKES ADJUSTMENTS BASED ON THE PROPORTION OF MEDICAID ELIGIBLE PATIENTS TREATED AT THE FACILITY. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2022. PART III, LINES 2,3 - BAD DEBT AS COMMUNITY BENEFIT AS PART OF ITS TAX EXEMPT PURPOSE THE HOSPITAL PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. THE HOSPITAL 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, THE HOSPITAL 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. 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 HOSPITAL'S CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET. PART VI, LINE 2 - ASSESSMENT OF COMMUNITY NEEDS AND GOALS COMMUNITY HEALTH NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S 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 SERVES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CH'S WEBSITE. ST. CHARLES 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 THE HOSPITAL TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF ITS CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS ARE FULLY VERSED IN THE CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. THE HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. THE HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. THE HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE HOSPITAL PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING ITS CHARITY CARE PROGRAM IN THE PRIMARY 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 ST. CHARLES HOSPITAL IS LOCATED ON THE NORTH SHORE OF SUFFOLK COUNTY IN THE TOWN OF BROOKHAVEN. A NOT-FOR-PROFIT HOSPITAL WITH 243 BEDS, ST. CHARLES IS A MEMBER OF CATHOLIC HEALTH SERVICES. THE POPULATION IN THE HOSPITAL'S PRIMARY CATCHMENT AREA IS MORE THAN 386,000 RESIDENTS, REPRESENTING 81% OF THE HOSPITAL'S ADMISSIONS. THE HOSPITAL'S SECONDARY CATCHMENT AREA HAS MORE THAN 200,000 RESIDENTS AND ACCOUNTS FOR ANOTHER 16% OF PATIENT ADMISSIONS. THIS SERVICE AREA INCLUDES ECONOMICALLY CHALLENGED COMMUNITIES, SUCH AS PORT JEFFERSON STATION, FARMINGVILLE, AND CORAM. ST. CHARLES HOSPITAL'S PRIMARY SERVICE AREA IS SHARED WITH AN ACUTE CARE HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL IN PORT JEFFERSON, AND A TERTIARY CARE HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH ST. CHARLES HAS PARTNERED WITH ORGANIZATIONS IN THE COMMUNITY TO FACILITATE OPTIMAL ACCESS TO HEALTH CARE AND THE PREVENTION OF FUTURE ILLNESS OR INJURY. THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY TAKING AN ACTIVE ROLE IN PROMOTING THE HEALTH OF THE COMMUNITY. THE HOSPITAL HAS IDENTIFIED AREAS OF NEED IN THE SURROUNDING COMMUNITIES AND HAS RESPONDED BY ESTABLISHING SERVICES THAT MEET THOSE NEEDS. ST. CHARLES HOSPITAL'S SPECIALTY CARE CENTER PROVIDES COMPREHENSIVE CARE FOR PATIENTS WITH SPECIALIZED DIAGNOSES. ST. CHARLES PARTICIPATES IN CATHOLIC HEALTH SERVICES HEALTHY SUNDAYS AT LOCAL PARISHES PROVIDING PARISHIONERS WITH FREE HEALTH CARE SERVICES SUCH AS CHOLESTEROL AND BLOOD PRESSURE SCREENING. THE HOSPITAL'S PEDIATRIC PULMONARY SPECIALTY CENTER IS AN EXTENSION OF ITS OUTPATIENT SPECIALTY CARE CENTER. THE MOVEMENTS DISORDERS CENTER AT ST. CHARLES HOSPITAL OFFERS TECHNOLOGICALLY ADVANCED, COMPREHENSIVE SERVICES FOR THOSE EXPERIENCING UNEXPLAINED DIFFICULTY WITH MOVEMENT. THE CENTER SPECIALIZES IN THE EVALUATION AND TREATMENT OF PARKINSON'S DISEASE. PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM ST. CHARLES HOSPITAL (ST. CHARLES OR HOSPITAL) OPERATES A 243-BED ACUTE CARE AND PHYSICAL REHABILITATION MEDICAL HOSPITAL LOCATED IN PORT JEFFERSON, NEW YORK, WITH OUTPATIENT FACILITIES IN NASSAU AND SUFFOLK COUNTIES. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, ST. CHARLES, THROUGH ITS DAILY OPERATION, PROVIDES ACUTE, EMERGENT AND OUTPATIENT CARE. ST. CHARLES IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A CATHOLIC HEALTH) (CH) WHICH IS A NEW YORK, NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CH IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2022, CH COMPRISED SIX HOSPITALS (MERCY HOSPITAL, ST. FRANCIS HOSPITAL & HEART CENTER AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN UNIVERSITY HOSPITAL, ST. CHARLES HOSPITAL AND ST. CATHERINE OF SIENA HOSPITAL IN SUFFOLK COUNTY), AS WELL AS THREE 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 STAFF AND 4,600 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CH PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: WE, AT CATHOLIC HEALTH, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. MEMBER ORGANIZATIONS OF CH OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICES, 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 PROGRAM, HEALTH FAIRS, AND OTHER PROGRAMS. SINCE 1907, CATHOLIC HEALTH CARE ON LONG ISLAND HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF IMPROVING THE COMMUNITY'S HEALTH. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 88845 NONE NONE MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS TO UNDERSERVED COMMUNITY AND CAPITAL SUPPORT 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR ST. CHARLES HOSPITAL AND CATHOLIC HEALTH SERVICES OF LONG ISLAND AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH SERVICES OF LONG ISLAND USES THE GRANT FUNDS FOR MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS TO UNDERSERVED COMMUNITIES AND CAPITAL SUPPORT. PART II, LINE 1, COLUMN (H) 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 X X X X X false 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 JAMES O'CONNOR PRESIDENT/CAO 687282 0 185000 0 388004 0 134875 0 36436 0 1431597 0 338060 0 DANIEL DEBARBA EVP & CFO THRU 8/5/2022 0 626446 0 350000 0 126698 0 274411 0 33661 0 1411216 0 0 Vlada Frankenburger PHYSICIAN 998208 0 263373 0 720 0 22875 0 19184 0 1304360 0 0 0 Anil Sangwan PHYSICIAN 519139 0 488457 0 2101 0 22875 0 18258 0 1050830 0 0 0 Sanjay Sangwan PHYSICIAN 522000 0 333206 0 1732 0 22875 0 3570 0 883383 0 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 Derek Mattimoe PHYSICIAN 533626 0 222732 0 2554 0 22875 0 48191 0 829978 0 0 0 Matthew Wagner PHYSICIAN 599257 0 84990 0 1035 0 22875 0 45402 0 753559 0 0 0 SUNIL DHUPER MD CMO 458627 0 48000 0 4752 0 22875 0 15704 0 549958 0 0 0 RONALD WEINGARTNER COO 352040 0 30000 0 14752 0 22875 0 16239 0 435906 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, 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 THE PLAN PATRICK O'SHAUGHNESSY $764,000 PARTICIPATION IN THE PLAN JAMES O'CONNOR $112,000 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. JAMES O'CONNOR $338,060 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 2/23/18, JAMES O'CONNOR SERVES AS PRESIDENT/CAO OF BOTH ST. CATHERINE OF SIENA HOSPITAL AND ST. CHARLES HOSPITAL, A RELATED ENTITY. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF ST. CHARLES 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 ST. CHARLES HOSPITAL AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY ST. CHARLES HOSPITAL. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF ST. CHARLES HOSPITAL, CH IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF ST. CHARLES HOSPITAL. THE GOVERNING BODY OF ST. CHARLES HOSPITAL IS THE SAME AS THAT OF CH. FORM 990, PART VI, LINE 11B - REVIEW PROCESS FOR FORM 990 THE FORM 990 AND RELATED SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD, AND PRESENTED TO THE COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF CH, WHICH HAS BEEN DELEGATED THE FORM 990 REVIEW FUNCTION BY THE BOARD. UPON REVIEW AND RECOMMENDATION OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO THE BOARD FOR APPROVAL. UPON BOARD APPROVAL, THE FORM 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST 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 ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. THE PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIM/HERSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. FORM 990, PART VI, LINE 15 - COMPENSATION POLICY THE CHIEF ADMINISTRATIVE OFFICER SUBMITS FOR APPROVAL TO THE SYSTEM CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE CH EXECUTIVE COMPENSATION POLICY (COMPENSATION POLICY). THE COMPENSATION POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CH OR AN OPERATING ENTITY, AND IS EITHER A) A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF OPERATING OFFICERS (COO) OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS (CFO); D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CH OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CH OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CH OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CH OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CH OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CH CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CH BOARD OF DIRECTORS FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE PERFORMED ANNUALLY BY AN INDEPENDENT CONSULTANT. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION PROVIDED, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE CH BOARD OF DIRECTORS. FORM 990, PART VI, LINE 19 - DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH 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. JAMES O'CONNOR, PRESIDENT/CAO - THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. CHARLES HOSPITAL CORP (11-1871039); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); ST. CHARLES CORPORATION (11-2983148); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941). 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 XI, LINE 9 - CHANGE IN NET ASSETS RELATED PARTY EMPLOYEE BENEFIT SERVICES ($3,734,857) CHANGE IN POST RETIREMENT BENEFIT ($ 28,000) OTHER CHANGES IN NET ASSETS $ 700,230 ----------- TOTAL: ($3,062,626) FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION ST CHARLES 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. 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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 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 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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 RD JAMISONPA 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 N/A WISDOM GARDENS LP 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113567947 SR HOUSING NY MCH-WISDOM LLC RELATED false 0 false CHS PHYSICIAN PARTNERS ACO LLC 992 N Village Ave Rockville Centr 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 true true true false false false false true false true true true true true true true true CHS SERVICES LMPR 5043283 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER LM 76257 COST MERCY MEDICAL CENTER LM 100440 COST ST CATHERINE OF SIENA MEDICAL CENTER LM 57066 COST WSNCHS NORTH INC (ST JOSEPH HOSPITAL) LM 52712 COST ST CHARLES HOSPITAL FOUNDATION LMNOQ 173973 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.