2021-11-12T10:22:54-06:00 2020-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2020-01-01 113555766 CHS SERVICES INC % CHS SERVICES INC CHSS 5167053700 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 PATRICK O'Shaughnessy PRESIDENT & CEO 5167053700 2021-11-11 true PATRICK OShaughnessy 999009999 LAURA J PARELLO P01080295 6464713000 2 2020 2022-09-23 18:48:47Z PATRICK O'SHAUGHNESSY DO 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 290512526 false 0928 X N/A X 2000 NY WE, AT CHS, 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. 21 20 1354 0 283788 0 5595843 3974328 239097010 268261581 0 0 5554591 18276617 250247444 290512526 5705527 4048770 0 0 144268372 156132841 0 0 0 97829885 114053026 247803784 274234637 2443660 16277889 194147313 280626861 84891223 150024576 109256090 130602285 X SEE SCHEDULE O false false 274234637 4048770 285533641 CHS SERVICES INC. PROVIDES ADMINISTRATIVE SUPPORT TO THE CHS 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. 274234637 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 true false true false false false false false false false false false false false false false true true true false false true 159 0 true 1354 true true true false false false false false false false false false true false X 21 20 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 ALAN GUERCI MD PRESIDENT & CEO 50.0 0.0 X X 0 1900476 457415 WILLIAM ARMSTRONG SR VP FINANCE 50.0 0.0 X 1069806 0 855547 DANIEL DEBARBA EVP & CFO 50.0 0.0 X 0 1119150 410475 JULIE KAPOOR SVP MANAGED CARE 50.0 0.0 X 597434 0 211192 RON STEIMEL SVP BUSINESS DEVELOPMENT 50.0 0.0 X 620416 0 180436 PATRICK MINICUS SVP CORPORATE FINANCE 50.0 0.0 X 675996 0 68239 JIMMY MURRY SVP INFO SVCS & CIO 50.0 0.0 X 652598 0 65928 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 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 JOHN FRANCFORT MD TRUSTEE 2.0 0.0 X 0 0 0 ROBERT COUGHLAN 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 3616250 3019626 2249232 500 false true false ENVISION PHARMACEUTICAL SVC LLC 2181 EAST AURORA RD TWINSBURG OH 44087 EMPLOYEE RX 21596637 BERKELEY RESEARCH GROUP LLC 2200 POWELL STREET SUITE 1200 EMERYVILLE CA 94608 CONSULTING SERVICES 14699639 HUNTER LANE LLC 2181 EAST AURORA RD TWINSBURG OH 44087 EMPLOYEE RX 9305202 HARVEST 245 OLD COUNTRY ROAD 131 JERICHO TPKE JERICHO NY 11753 RENT 4308943 PRESIDIO HOLDINGS INC 121000 SUNSET HILLS ROAD SUITE 300 RESTON VA 20190 SOFTWARE MAINTENANCE 2872449 52 3974328 3974328 ASSESSMENT REVENUE 900099 267850242 267850242 MANAGEMENT SERV REV 900099 283788 283788 PHYSICIAN AFFILIATE SUBSIDY 900099 127551 127551 268261581 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CREDENTIALLING FEE REIMBURSEMENT 900099 147000 147000 EXPENSE REIMBURSEMENT-RELATED PARTY 900099 17683399 17683399 OTHER REVENUE 900099 446218 446218 18276617 290512526 285533641 283788 720769 4048770 4048770 0 0 0 0 0 121237860 121237860 10664188 10664188 15496372 15496372 8734421 8734421 19275529 19275529 50000 50000 -1200 -1200 0 0 0 4081936 4081936 0 0 10857127 10857127 30554359 30554359 0 0 7638674 7638674 254725 254725 0 0 0 0 24250851 24250851 340957 340957 EQUIPMENT SERVICE CONTRACTS 331887 331887 OTHER EXPENSES 16418181 16418181 274234637 274234637 0 0 41416301 33289107 2982708 2315921 0 0 807090 1463218 0 0 0 0 0 0 0 0 5642732 6229962 254425128 183352334 78344720 71072794 0 0 0 0 0 0 0 0 64953762 166255859 194147313 280626861 50057477 79385310 0 0 107556 70031 0 0 0 0 0 0 0 0 0 0 34726190 70569235 84891223 150024576 X 109256090 130602285 0 0 109256090 130602285 194147313 280626861 X 16277889 5068306 X false true X true true true X X 11 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 MARYHAVEN CENTER OF HOPE 112861698 10 false 0 0 MARYHAVEN SCHOOL CORPORATION 112861690 2 false 0 0 11 0 0 false false false false 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 CHSLI AND SUCH OTHER ORGANIZATIONS AS ARE OPERATED, SUPERVISED, OR CONTROLLED BY OR IN CONNECTION WITH CHSLI 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 CHSLI AND THOSE ORGANIZATIONS FOR WHICH CHSLI IS THE SOLE MEMBER AND CERTAIN OTHER PUBLIC CHARITIES CONTROLLED BY SUCH ORGANIZATIONS. PART IV, SECTION C, LINE 1 CHS SERVICES SUPPORTS THOSE ENTITIES FOR WHICH CHSLI IS THE SOLE MEMBER. THE BOARD OF TRUSTEES OF CHS SERVICES OVERLAPS WITH THE BOARD OF TRUSTEES OF CHSLI. 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 CHSLI BEING THE SOLE MEMBER AND CERTAIN OTHER PUBLIC CHARITIES CONTROLLED BY SUCH ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 24304889 15925336 8379553 230120239 167426998 62693241 71072794 DUE FROM RELATED ORGANIZATIONS 166255859 166255859 0 DUE TO RELATED ORGANIZATIONS 66821325 DEFERRED RENT 1974397 SELF INSURED LIABILIIES 1773513 70569235 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. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVEROCKVILLE CTRNY ROCKVILLE CENTRE NY 11570 113403968 501(c)(3) 4048770 NONE NONE WORKING CAP. SUBSIDY 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES INC. MAINTAINS THE BOOKS AND RECORDS FOR CHS SERVICES INC. AND CATHOLIC HEALTH SERVICES OF LONG ISLAND AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH SERVICES OF LONG ISLAND USES THE GRANT AS A WORKING CAPITAL SUBSIDY. X true true X X X X X X true true false false false false false false false ALAN GUERCI MD PRESIDENT & CEO 0 1556421 0 308000 0 36055 0 426935 0 30480 0 2357891 0 0 WILLIAM ARMSTRONG SR VP FINANCE 352643 0 112000 0 605163 0 841513 0 14034 0 1925353 0 0 0 DANIEL DEBARBA EVP & CFO 0 923822 0 164000 0 31328 0 366935 0 43540 0 1529625 0 0 JULIE KAPOOR SVP MANAGED CARE 504629 0 75000 0 17805 0 167935 0 43257 0 808626 0 0 0 RON STEIMEL SVP BUSINESS DEVELOPMENT 538271 0 64000 0 18145 0 139935 0 40501 0 800852 0 0 0 PATRICK MINICUS SVP CORPORATE FINANCE 574190 0 85000 0 16806 0 25935 0 42304 0 744235 0 0 0 JIMMY MURRY SVP INFO SVCS & CIO 566364 0 61000 0 25234 0 25935 0 39993 0 718526 0 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 WILLIAM ARMSTRONG RECEIVED A SEVERANCE PAYMENT OF $495,117. 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. ALAN GUERCI $401,000 PARTICIPATION IN THE PLAN WILLIAM ARMSTRONG $179,000 PARTICIPATION IN THE PLAN DANIEL DEBARBA $341,000 PARTICIPATION IN THE PLAN RONALD STEIMEL $114,000 PARTICIPATION IN THE PLAN JULIE KAPOOR $142,000 PARTICIPATION IN THE PLAN THE DEFERRED COMPENSATION IN COLUMN C FOR THESE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. 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 SERVICES OF LONG ISLAND) (CHS). CHS IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE (DIOCESE). FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CHS 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 CHS 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 CHS, 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 CHS COMPLIANCE AND COMMITTEE BY CHS' 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 CHS COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE CHS 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 CHS AND WISHES TO GO FORWARD WITH IT, THE CHAIR OF THE BOARD OF DIRECTORS SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CHS 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 CHS, CERTIFIES THAT CHS 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 CHS 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 CHS OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CHS OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CHS OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CHS OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CHS 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 CHS CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CHS 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 CHS 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; CHS 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. ALAN D. GUERCI, PRESIDENT & CEO - THE TOTAL HOURS WORKED REPORTED 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 SYSTEM OF LONG ISLAND (11-3403968); 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); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396) AND ST. JOSEPH HOSPITAL FOUNDATION (47-2353387). DANIEL DEBARBA, EVP & CFO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR HIGHEST PAID EMPLOYEE FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL CORP (11-1871039); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941); CATHOLIC HEALTH SYSTEM OF LONG ISLAND (11-3403968) AND RVC INSURANCE COMPANY INC. (20-8067039). FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION CHS SERVICES,INC. IS A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND. WE, AT CATHOLIC HEALTH SERVICES, 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 : $5,068,306 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 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113434776 TRANSPORTATIO NY 501(C)(3) 12A- I MARYHAVENCTR false MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 10 CHSLI false MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR false 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 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 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR 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 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113559713 SR HOUSING NY 501(C)(3) 10 MARYHAVENCTR false GOOD SHEPHERD HOSPICE 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 10 CHSLI false ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 12A- I ST CHARLES false GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) 12A- I GOOD SAMARTN false MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 550813603 SUPPORT ORG NY 501(C)(3) 12A- I MERCY MEDCTR false ST CATHERINE OF SIENA MEDICAL CTR FDN 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) 12A- I STCATHERINE false CHS HOME CARE AND HOSPICE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 452907761 SUPPORT ORG NY 501(C)(3) 12A- I CATHHOMECARE false GOOD SHEPHERD HOSPICE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 12A- I GOODSHEPHERD false OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 12A- I OURLADYOFC false RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 12A- I CHSLI false CHS PHYSICIAN PARTNERS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 12A- I ST FRANCIS false RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INS NY 501(C)(3) 12B- II CHSLI false SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 HEALTHCARESVC NY 501(C)(4) GOOD SAMARTN false ST JOSEPH HOSPITAL FOUNDATION 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 472353387 support org NY 501(C)(3) 12A- I WSNCHS NORTH false BIPO HOLDINGS LLC 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 464763720 PHYSICIAN ASSN NY NA N/A IDHC LLC 2500 YORK RDJAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVICES PA NA N/A BEACON HEALTH PTNRS 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 454229842 HEALTHCARE NY NA N/A WISDOM GARDENS LP 51 TERRYVILLE RD PORT JEFFERSON NY 11776 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 RADIOLOGY CONSULTING OF LONG ISLAND 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 true false false false false false true true true true true true true true true GOOD SAMARITAN HOSPITAL MEDICAL CENTER LMQS 7491068 COST MERCY MEDICAL CENTER LMQS 18066992 COST ST FRANCIS HOSPITAL LMQS 36104535 COST ST CHARLES HOSPITAL CORP LMQS 5404673 COST ST CATHERINE OF SIENA MEDICAL CENTER LMQS 16623960 COST WSNCHS NORTH INC - ST JOSEPH HOSPITAL LMQS 1202417 COST MERCY MEDICAL CENTER K 1424196 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.