2022-11-11T16:24:24-06:00 2021-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue NEW YORK NY 10017 990 2021-01-01 112126736 NURSING SISTERS HOME CARE INC % CHS SERVICES INC NURS 6314656457 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 KIM KRANTZ PRESIDENT 6318287411 2022-11-09 true KIM KRANTZ 999009999 LAURA J PARELLO P01080295 6464713000 2022-11-04 2 2021 2022-09-23 18:48:47Z CATHOLIC HEALTH HOME CARE KIM KRANZ 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 86717260 false 0928 X HTTP://CATHOLICHOMECARE.CHSLI.ORG/ X 1911 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. 8 8 773 0 0 0 2042613 1199393 90524960 85391948 161257 81289 33750 44630 92762580 86717260 433704 12541 0 0 72677150 70312843 0 0 30688 8946672 9932544 82057526 80257928 10705054 6459332 77139229 82721495 35244122 31641622 41895107 51079873 X SEE SCHEDULE O false false 72127288 12541 85431225 NURSING SISTERS HOME CARE (DBA CATHOLIC HEALTH HOME CARE) PROVIDES APPROXIMATELY 409,000 VISITS TO 28,183 HOME CARE RECIPIENTS IN 2021. SERVICES INCLUDE SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH LANGUAGE PATHOLOGY, NUTRITIONAL COUNSELING, MEDICAL SOCIAL WORKERS, WOUND CARE NURSES AND CLOSELY SUPERVISED HOME HEALTH AIDES. 72127288 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 false true false true false false false false false false false false false false false false false true true true false false true 23 0 true 773 true false false false false false true true false false false false false false X 8 8 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 N VILLAGE AVE ROCKVILLE CENTRE NY 11570 X KIM KRANZ PRESIDENT 50.0 0.0 X 457762 0 73019 DANIELLE STEIN VP FINANCE 50.0 0.0 X 264237 0 66570 PAMELA JOACHIM MGR ALLIED HEALTH 20.0 0.0 X 85562 173119 40527 IYABODE ALFRED VP OF OPERATIONS 37.5 0.0 X 248803 0 38249 MICHELLE PAVONE RN 37.5 0.0 X 188118 0 59865 BARBARA ROWE AVP VALUE BASED CARE 37.5 0.0 X 185125 0 32405 MARY FRAWLEY AVP HOMECARE & HOSPICE 37.5 0.0 X 195243 0 20745 THOMAS CHRISTMAN CHAIRPERSON 2.0 0.0 X 0 0 0 JENNIFER HOFFMAN VICE CHAIRPERSON 2.0 0.0 X 0 0 0 MICHAEL LAMBERT SECRETARY 2.0 0.0 X 0 0 0 C JUSTIN MCCARTHY TREASURER 2.0 0.0 X 0 0 0 JOHN O'BRIEN TRUSTEE 2.0 0.0 X 0 0 0 PETER DAGHER TRUSTEE 2.0 0.0 X 0 0 0 DOUGLAS CELIBERTI TRUSTEE 2.0 0.0 X 0 0 0 REV STEPHEN PIETROWSKI TRUSTEE 2.0 0.0 X 0 0 0 SISTER MARY ALICE ASCHENBACH TRUSTEE 2.0 0.0 X 0 0 0 1624850 173119 331380 208 false true false 110 BICOUNTY BLVD LLC 85 SOUTH SERVICE ROAD PLAINVIEW NY 11803 RENT 935298 NETSMART TECHNOLOGIES INC PO BOX 823519 PHILADELPHIA PA 191823519 CODING REVIEW 644574 HOMECARE THERAPIES LLC 20 JERUSALEM AVENUE 3RD FLOOR HICKSVILLE NY 11801 THERAPIST SVS 244620 ABLE HEALTHCARE SERVICES 1240 BROADCAST PLAZA MERRICK NY 11742 HOME HEALTH AIDS SVS 218698 MAXIM HEALTHCARE STAFFING SVCS 12558 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 HOME HEALTH AIDS SVS 130773 5 608028 591365 1199393 PATIENT SERVICE REVENUE 621610 85391948 85391948 85391948 81289 81289 0 0 0 0 0 0 5353 0 0 5353 5353 0 0 0 0 0 0 MED TRANSCRIPT FEES 900099 22637 22637 COMMUNITY PROGRAMS 900099 16640 16640 39277 86717260 85431225 0 86642 12541 12541 0 0 0 861580 861580 0 49623566 46880958 2742608 3433783 3188335 245448 12493001 11599998 893003 3900913 3622075 278838 71900 71900 0 0 7259 7259 0 0 2510000 2328620 181380 3975 3975 613523 204363 409160 0 0 890376 890376 1035444 1016685 18759 0 0 0 0 325463 325463 282750 281192 1558 MEDICAL SUPPLIES 1707609 1707609 CHS SERVICES 1627641 652604 975037 HOME OFFICE 349301 349301 OTHER 507303 302870 173745 30688 80257928 72127288 8099952 30688 0 0 30614191 379430 0 0 12941341 11808192 0 0 0 0 0 0 0 0 301975 406051 6372971 5549015 835005 823956 5523009 5526348 0 0 0 0 0 0 26923708 63777518 77139229 82721495 10695255 10258476 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24548867 21383146 35244122 31641622 X 41618648 50728450 276459 351423 41895107 51079873 77139229 82721495 X 6459332 -70038 2795472 X false true X true true true X 119627 3509257 237368 2042613 1199393 7108258 72689809 83218762 90090399 90524960 85391948 421915878 0 0 0 72809436 86728019 90327767 92567573 86591341 429024136 65206 0 58607 123813 0 65206 0 58607 123813 428900323 14938 71418 161806 161257 81289 490708 0 14938 71418 161806 161257 81289 490708 0 21642 35162 52460 33750 39277 182291 72846016 86834599 90542033 92762580 86711907 429697135 0.99815 0.99573 0.00114 0.00103 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7259 7259 false PART II-B, LINE 1 - OTHER LOBBYING ACTIVITIES CATHOLIC HEALTH HOME CARE PAID DUES TO HOMECARE ASSOCIATION NYS AND HEATHCARE ASSOCIATION NYS, TRADE ASSOCIATES, WHO ARE INVOLVED IN LOBBYING ACTIVITIES. THE TOTAL DUES PAID FOR 2021 FOR HOMECARE ASSOCIATION NYS WAS $43,250 WHICH 12.21% WAS USED FOR LOBBYING, AMOUNTING TO THE EXPENSE OF $5,281. THE TOTAL DUES PAID FOR 2021 FOR HEALTHCARE ASSOCIATION NYS WAS $13,997 WHICH 14.13% WAS USED FOR LOBBYING, AMOUNTING TO THE EXPENSE OF $1,978. 148866 17 17 148866 148866 17 17 148866 148866 17 17 148866 148866 16 16 148866 148866 14 14 148866 1.00000 false false 204999 196174 8825 6167972 5352841 815131 823956 DUE FROM RELATED PARTY 58676807 RESTRICTED CASH 351423 INSURANCE CLAIMS RECEIVABLE 1336435 OTHER ASSETS 126745 RIGHT OF USE ASSET 3286108 63777518 0 DUE TO RELATED PARTIES 2201673 PENSION LIABILITY 126745 THIRD PARTY PAYOR LIABILITY 13837238 GENERAL LIABILITY INSURANCE 1336435 OPERATING LEASE LIABILITY 3881055 21383146 X PART V, ENDOWMENT FUNDS - LINE 4, ORGANIZATION'S INTENDED USE THE ENDOWMENT IS PERMANENTLY RESTRICTED, WITH THE INCOME TO PROVIDE CHARITY CARE TO THE HOME CARE POPULATION. 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 CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVEROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 12541 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 CATHOLIC HEALTH HOME CARE AND CATHOLIC HEALTH AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH USES THE GRANT FUNDS FOR MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS FOR THE 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; AND 2) PROVIDE SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND TO FUND OUTPATIENT CENTERS THAT PROVIDE CHARITY CARE TO THOSE CENTERS' COMMUNITIES. IN ADDITION THE GRANTS PROVIDED TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND ARE USED TO FUND SUPPORT PROVIDED THROUGH THE CATHOLIC HEALTH CAREGIVERS FUND. THE CATHOLIC HEALTH CAREGIVERS FUND WAS FORMED WITH THE MISSION TO ASSIST OUR FELLOW CAREGIVERS ON THE FRONT LINES, HERE AND ABROAD, WHO STRUGGLE JUST TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. X true true X X X X X X false true false false false false false false false KIM KRANZ PRESIDENT 366066 0 74000 0 17696 0 27724 0 45295 0 530781 0 0 0 DANIELLE STEIN VP FINANCE 239044 0 24000 0 1193 0 23626 0 42944 0 330807 0 0 0 BARBARA ROWE AVP VALUE BASED CARE 183533 0 500 0 1092 0 17770 0 14635 0 217530 0 0 0 MARY FRAWLEY AVP HOMECARE & HOSPICE 192781 0 500 0 1962 0 18501 0 2244 0 215988 0 0 0 PAMELA JOACHIM MGR ALLIED HEALTH 85562 168903 0 500 0 3716 8300 15914 5338 10975 99200 200008 0 0 IYABODE ALFRED VP OF OPERATIONS 247800 0 0 0 1003 0 23900 0 14349 0 287052 0 0 0 MICHELLE PAVONE RN 182319 0 5740 0 59 0 17998 0 41867 0 247983 0 0 0 FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF NURSING SISTERS HOME CARE, INC. (D/B/A CATHOLIC HEALTH HOME CARE) 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 CATHOLIC HEALTH HOME CARE, AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF CATHOLIC HEALTH HOME CARE. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY CH AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF CATHOLIC HEALTH HOME CARE IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF CATHOLIC HEALTH HOME CARE. FORM 990, PART VI, LINE 11B - REVIEW PROCESS OF FORM 990 THE FORM 990 AND APPROPRIATE SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PRESENTED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES (THE BOARD), WHICH HAS BEEN DELEGATED THE REVIEW FUNCTION BY THE BOARD. UPON APPROVAL OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO ALL VOTING MEMBERS OF THE BOARD. ONCE APPROVED BY THE BOARD (OR THE EXECUTIVE COMMITTEE OF THE BOARD, AS APPROPRIATE), THE ORGANIZATION'S BOARD CHAIR AND CHIEF EXECUTIVE OFFICER COMMUNICATES, IN WRITING TO THE CH COMPLIANCE AND AUDIT COMMITTEE AND CH BOARD CHAIR. AFTER REVIEW OF ANY APPLICABLE COMMENTS FROM THE BOARD, THE COMPLIANCE AND AUDIT COMMITTEE WILL THEN RECOMMEND THE APPROVAL OF THE FORM 990 TO THE CH BOARD OF DIRECTORS WHO WILL THEN REVIEW THE RECOMMENDATIONS AND PROVIDE THE FINAL APPROVAL OF THE FORM 990. THE FORM 990 IS THEN 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 ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE BY THE ORGANIZATION'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURE SHALL BE GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE BOARD OF TRUSTEES FOR REVIEW. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT NO CONFLICT EXISTS, THE MATTER SHALL BE REFERRED FOR REVIEW BY THE CH COMPLIANCE AND AUDIT COMMITTEE BEFORE THE DETERMINATION BECOMES FINAL. 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 ORGANIZATION'S BOARD OF TRUSTEES 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. PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIMSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. UPON RECEIPT OF THE WRITTEN REQUEST AND ANY SUPPORTING DOCUMENTS, THE CH COMPLIANCE AND AUDIT COMMITTEE SHALL MAKE THE FINAL DECISION AS TO WHETHER CH SHALL ENTER INTO THE TRANSACTION OR ARRANGEMENT. 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 POLICY. THE 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, AND CHIEF OPERATING OFFICERS OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS; 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 CORPORATE CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE 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 DONE BY AN INDEPENDENT CONSULTANT ANNUALLY. 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, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE BOARD OF TRUSTEES. 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. DANIELLE STEIN, VP FINANCE - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SHEPHERD HOSPICE (11-2958438); GOOD SHEPHERD HOSPICE FOUNDATION (26-3169427); AND CATHOLIC HEALTH HOME CARE (11-2126736). KIM KRANZ, PRESIDENT - THE TOTAL HOURS WORKED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLWING RELATED ENTITIES: GOOD SHEPHERD HOSPICE (11-2958438); GOOD SHEPHERD HOSPICE FOUNDATION (26-3169427); AND CATHOLIC HEALTH HOME CARE (11-2126736). FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION CATHOLIC HEALTH HOME CARE 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: $2,795,472 FORM 990, PART VIII, LINE 1E - CARES ACT FUNDING ON MARCH 11, 2020, THE WORLD HEALTH ORGANIZATION DESIGNATED THE CORONAVIRUS DISEASE 2019 (COVID-19) OUTBREAK AS A GLOBAL PANDEMIC. FEDERAL, STATE AND LOCAL GOVERNMENT POLICIES RESULTED IN A SUBSTANTIAL PORTION OF THE POPULATION REMAINING AT HOME AND FORCED THE CLOSURE OF CERTAIN BUSINESSES, WHICH HAD AN IMPACT ON PATIENT VOLUMES AND FINANCIAL OPERATIONS FOR MOST SERVICES BEGINNING IN MARCH 2021. IN RESPONSE TO COVID-19, THE CORONAVIRUS AID, RELIEF AND ECONOMIC SECURITY ACT (THE CARES ACT) WAS SIGNED INTO LAW ON MARCH 27, 2020. THE CARES ACT AUTHORIZED FUNDING TO HOSPITALS AND OTHER HEALTHCARE PROVIDERS TO BE DISTRIBUTED THROUGH THE PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND (RELIEF FUND). PAYMENTS FROM THE RELIEF FUND ARE TO BE USED TO PREVENT, PREPARE FOR, AND RESPOND TO CORONAVIRUS, AND SHALL REIMBURSE THE RECIPIENT FOR HEALTH CARE RELATED EXPENSES AND/OR LOST REVENUES ATTRIBUTABLE TO CORONAVIRUS AND ARE NOT REQUIRED TO BE REPAID EXCEPT WHERE RELIEF FUNDS RECEIVED EXCEED THE ACTUAL AMOUNTS OF ELIGIBLE HEALTH CARE RELATED EXPENSES AND/OR LOST REVENUES AS DEFINED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS), PROVIDED THE RECIPIENTS ATTEST TO AND COMPLY WITH THE TERMS AND CONDITIONS. HHS DISTRIBUTIONS FROM THE RELIEF FUND INCLUDE GENERAL DISTRIBUTIONS AND TARGETED DISTRIBUTIONS, TO SUPPORT PROVIDERS IN HIGH IMPACT AREAS AND RURAL PROVIDERS, FOR SERVICE PERIODS THROUGH DECEMBER 31, 2021. ADDITIONALLY, FUNDS ARE AVAILABLE TO REIMBURSE PROVIDERS FOR COVID-19 RELATED TREATMENT OF UNINSURED PATIENTS. FUNDING RECEIVED DURING 2021 IS REPORTED AS GOVERNMENT GRANTS ON PART VIII, LINE 1E, AS WELL AS ON SCHEDULE B. CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 12A- I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 12B- II CHSLI false CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 12A- I GOOD SAMARTN false MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113434776 TRANSPORTATIO NY 501(C)(3) 12A- I MARYHAVENCTR true MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 10 CHSLI true MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR true THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113638367 SUPPORT ORG NY 501(C)(3) 12A- I MARYHAVENCTR false MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 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 true RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR true ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) 3 CHSLI false ST CHARLES HOSPITAL CORP 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI false ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI false ST FRANCIS HOSPITAL 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 false WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI false THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 112983148 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false WISDOM GARDENS HOUSING DEVELOPMENT FUND 200 BELLE TERRE ROAD PORT JEFFERSON NY 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 true 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 true 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 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 N/A BEACON HEALTH PTNRS 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 454229842 HEALTHCARE NY NA N/A WISDOM GARDENS LP 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113567947 SR HOUSING NY NA N/A CHS PHYSICIAN PARTNERS ACO LLC 992 N Village Ave Rockville Centre Rockville Centre NY 11570 999999999 HEALTHCARE NY NA N/A LONG ISLAND HEALTHCARE NETWORK 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 113465837 CONTRACTING NY NA N/A RADIOLOGY CONSULTING OF LONG ISLANDPLLC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 421646134 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN PEDIATRIC SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208180263 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208088453 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SOUTHWEST SUFFOLK MEDICAL PC 580 UNION BOULEVARD WEST ISLIP NY 11795 061603195 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false CARDIAC EKG INTERPRETATION PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112924518 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208964140 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112838185 HEALTHCARE SVC NY CHSLI C-CORP false ADVANCED REHABILIATION MEDICINE PLLC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113640709 HEALTHCARE SVC NY STCHARLES HOSP C-CORP false ST FRANCIS CARDIAC PREVENTION SERVICES 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113224885 HEALTHCARE SVC NY STFRANCIS HOSP C-CORP false SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113307977 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false SAMARITAN HOME CARE AMERICA 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113319259 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 510639649 HEALTHCARE SVC NY MERCY MED CTR C-CORP false LONG ISLAND EMERGENCY CARE PC 1000 N VILLAGE AVE ROCKVILLE NY 11571 113633515 PHYSICIAN SVC NY MERCY MED CTR S-CORP false MY CHS RX INC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 842359236 PHARMACY NY CHSLI C-CORP false false true false false false false false false false false true false false true true true true true false MARYHAVEN CENTER OF HOPE OPQ 189331 COST GOOD SHEPHERD HOSPICE NOPQ 1390600 COST OUR LADY OF CONSOLATION GERIATRIC CARE CENTER OQ 51788 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.