2021-11-12T10:22:54-06:00 2020-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2020-01-01 111635088 MERCY MEDICAL CENTER % CHS SERVICES INC MERC 5167052525 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 PETER SCAMINACI PRESIDENT 5167052525 2021-11-09 true PETER SCAMINACI 999009999 LAURA J PARELLO P01080295 6464713000 2 2020 2022-09-23 18:48:47Z PATRICK O'SHAUGHNESSY DO 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 288665218 false 0928 X HTTP://MERCYMEDICALCENTER.CHSLI.ORG X 1913 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 1987 200 169105 98595 22860155 49691631 227126818 223581684 240970 218805 7198664 5327544 257426607 278819664 1121202 1204793 0 0 137804608 146658092 0 0 0 117579959 130180235 256505769 278043120 920838 776544 227672025 266011768 186522648 224916252 41149377 41095516 X SEE SCHEDULE O false false 237971346 1204793 224626501 MERCY MEDICAL CENTER IS A 375 BED, NOT-FOR-PROFIT ACUTE CARE HOSPITAL SERVING THE HEALTHCARE NEEDS OF NASSAU COUNTY AND ITS SURROUNDING AREA. FOUNDED IN 1913 BY THE NURSING SISTERS OF THE CONGREGATION OF THE INFANT JESUS, MERCY MEDICAL CENTER HAS GROWN FROM A THREE FLOOR WOODEN STRUCTURE TO AN EXTENSIVE INSTITUTION OCCUPYING A 42-ACRE CAMPUS THAT HOUSES SOME OF THE MOST ADVANCED MEDICAL TECHNOLOGIES. IN 2020, THE MEDICAL CENTER HAD 10,421 DISCHARGES AND PROVIDED CARE FOR 26,320 EMERGENCY ROOM VISITS. IN ACCORDANCE WITH ITS MISSION AND PHILOSOPHY, THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY. 237971346 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true false false true 257 0 true 1987 true true true false false false false true true false false false false false 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 D GUERCI MD PRESIDENT & CEO 50.0 0.0 X X 0 1900476 457415 WILLIAM C ARMSTRONG SVP FINANCE 0.0 50.0 X 0 1069806 855547 DANIEL DEBARBA EVP & CFO 50.0 0.0 X 0 1119150 410475 RONALD W STEIMEL FORMER CAO 0.0 50.0 X 0 620416 180436 PETER SCAMINACI PRESIDENT/CAO 50.0 0.0 X 0 521312 219252 ALAN WONG MD CHIEF QUALITY OFFICER 50.0 0.0 X 499491 0 70914 ALEXANDER TELIS MD CLINICAL ATTENDING CRIT CARE 50.0 0.0 X 487049 0 75901 FAHIM AHMED CMO 50.0 0.0 X 481929 0 68346 JONATHAN HANNAM PHYSICIAN 50.0 0.0 X 366252 0 71714 SYED KAMAL MD HOSPITALIST 50.0 0.0 X 373700 0 63213 ALEEM ALI HOSPITALIST 50.0 0.0 X 365904 0 61488 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 2574325 5231160 2534701 381 true true false PROGRESSIVE EMERGENCY PHYS LLC 1236 RXR PLAZA UNIONDALE NY 11556 PHYSICIAN SERVICES 2806992 LI MINIMALLY INVASIVE SURG PC 3003 New Hyde Park Rd NEW HYDE PARK NY 11042 PHYSICIAN SERVICES 2115722 FASTAFF LLC 5700 S QUEBEC STREET SUITE 300 GREENWOOD VILLAGE CO 80111 NURSING SERVICES 916096 REMI HOLDINGS LLC 11325 N COMMUNITY HOUSE RD CHARLOTTE NC 28277 EQUIPMENT SERVICES 717864 EMPIRE STATE RADIOLOGY PC 2330 UTAH AVENUE SUITE 200 EL SEGUNDO CA 90245 RADIOLOGY SERVICES 556112 39 18283971 31009642 398018 49691631 NET PATIENT SERVICE REVENUE - 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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. 180334 27364 152970 203201 1000 6300 17567 180334 223646 750 6300 14895 203201 238882 905 6300 9841 223646 261810 730 16614 7044 238882 1.00000 false false 7712446 7712446 197968587 126602387 71366200 406263 395034 11229 142638090 112801118 29836972 7547055 5767848 1779207 110706054 INSURANCE CLAIMS RECEIVABLE 57350502 DUE FROM RELATED PARTIES 28036000 OTHER RECEIVABLES - CURRENT 1699030 457B FUNDS 152034 87237566 0 ESTIMATED MALPRACTICE LIABILITIES 61161387 AMOUNTS DUE TO RELATED PARTIES 75078344 OTHER SELF INSURANCE LIABILITY 16609347 THIRD PARTY PAYOR LIABILITIES 38554707 191403785 X PART V, LINE 4 - ENDOWMENT FUNDS MERCY MEDICAL CENTER'S MAGOVERN FUND IS RESTRICTED FOR THE PURPOSE OF FUNDING EXPENDITURES RELATING TO THE HOSPITAL'S SCHOOL OF RADIOLOGY. PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTE CH AND MOST OF ITS SUBSIDIARIES ARE 501(C)(3) ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THESE ENTITIES ARE ALSO EXEMPT FROM NEW YORK STATE INCOME TAXES. THERE ARE VARIOUS SUBSIDIARIES OF CH THAT ARE FOR-PROFIT ENTITIES. TAXABLE OPERATIONS AND THE POTENTIAL FOR INCOME TAXES FROM THESE ENTITIES AND FROM UNRELATED BUSINESS ACTIVITIES OF THE TAX EXEMPT ENTITIES ARE NOT SIGNIFICANT TO THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. true true X true X 300. true X true true true false true true 5006183 1230398 3775785 0.01360 54750567 30989304 23761263 0.08550 2456218 1175379 1280839 0.00460 62212968 33395081 28817887 0.10370 1161307 0 1161307 0.00420 1181256 521580 659676 0.00240 77752 0 77752 0.00030 2420315 521580 1898735 0.00690 64633283 33916661 30716622 0.11060 true 5159737 61822278 71139257 -9316979 X true true 1 1 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 http://mercymedicalcenter.chsli.org 2909000H X X X X PSYCHIATRIC UNIT / REHABILITATIVE SERVICES MERCY MEDICAL CENTER 1 false false true X X X X X X X X X 19 true true true true X mercymedicalcenter.chsli.org/ X www.chsli.org true 19 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 2019, 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 2019-2021 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM (PHIP), WITH THE PHIP SERVING AS THE CENTRALIZED DATA RETURN AND ANALYSIS HUB. 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 MERCY MEDICAL CENTER 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. IN 2019, MEMBERS OF THE LIHC REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM PREVENTION AGENDA PRIORITIES FOR THE 2019-2021 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LIHC, WHICH SERVED AS THE CENTRALIZED DATA RETURN AND ANALYSIS HUB. PRIMARY DATA SOURCES INCLUDE THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT SURVEY (CHAS) AND THE RESULTS FROM FOCUS GROUPS AND KEY COMMUNITY-BASED ORGANIZATION LEADER INTERVIEWS. SECONDARY DATA SOURCES COMPRISED PUBLICALLY-AVAILABLE DATA SETS WHICH WERE REVIEWED TO DETERMINE CHANGE IN HEALTH STATUS AND EMERGING ISSUES WITHIN NASSAU COUNTY. SOURCES OF SECONDARY DATA INCLUDED STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM (SPARCS), NEW YORK STATE PREVENTION AGENDA DASHBOARD, PREVENTION QUALITY INDICATORS (PQI), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), EXTENDED BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (EBRFSS), NEW YORK STATE COMMUNITY HEALTH INDICATOR REPORTS (CHIRS) AND NEW YORK STATE VITAL STATISTICS. THE ENGAGEMENT OF THE BROADER COMMUNITY, FOR ASSESSMENT PROCESSES, IS ACHIEVED THROUGH THE LIHC AND ITS PARTNERS' ONGOING DISTRIBUTION OF THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT (CHAS) SURVEY. THIS SURVEY IS OFFERED ONLINE VIA A SURVEYMONKEY LINK AND IS AVAILABLE TO RESIDENTS AT PUBLIC EVENTS, WORKSHOPS, EDUCATIONAL PROGRAMS, INTERVENTIONS, ETC., WHICH ARE OFFERED BY LIHC PARTNERS. IT IS ALSO DISTRIBUTED AMONG PHYSICIAN OFFICES, HOSPITAL WAITING AREAS, LIBRARIES, SCHOOLS, FEDERALLY-QUALIFIED HEALTH CLINICS, INSURANCE ENROLLMENT SITES, AMONG OTHER PUBLIC VENUES. THE LIHC AGGRESSIVELY PROMOTES THE SURVEY THROUGH SOCIAL MEDIA AND A LINK TO THE SURVEY IS ALSO AVAILABLE ON THE MERCY MEDICAL CENTER 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 1, 2018 THROUGH DECEMBER 31, 2018 WITH 1,664 SURVEYS COLLECTED IN NASSAU COUNTY. A CERTIFIED TRANSLATION OF THE SURVEY IS AVAILABLE IN THE FOLLOWING LANGUAGES: SPANISH, POLISH AND HAITIAN CREOLE. LARGE PRINT COPIES ARE ALSO AVAILABLE TO THOSE LIVING WITH VISION IMPAIRMENT. FOR THIS ASSESSMENT CYCLE, THE LIHC ALSO ENGAGED THE COMMUNITY THROUGH FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH LEADERS OF COMMUNITY-BASED ORGANIZATIONS (CBO). THE RESEARCH FIRM EUREKAFACTS, LLC CONDUCTED THE FOCUS GROUPS AND CBO INTERVIEWS, INTERPRETED THE RESULTS, AND PRODUCED THE REPORT. FOCUS GROUPS WERE HELD IN LOW-INCOME COMMUNITIES, ELMONT AND HEMPSTEAD. PART V, SECTION B, LINE 6A ST. JOSEPH HOSPITAL, ST. FRANCIS HOSPITAL, NORTHWELL HEALTH SYSTEM (GLEN COVE HOSPITAL, LONG ISLAND JEWISH VALLEY STREAM, LONG ISLAND JEWISH MEDICAL CENTER, NORTH SHORE UNIVERSITY HOSPITAL, PLAINVIEW HOSPITAL, SOUTH OAKS HOSPITAL, SYOSSET HOSPITAL), NASSAU UNIVERSITY MEDICAL CENTER, MOUNT SINAI SOUTH NASSAU HOSPITAL AND NYU WINTHROP HOSPITAL. PART V, SECTION B, LINE 6B THE HOSPITAL'S CHNA WAS ALSO CONDUCTED WITH NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND MORE THAN 40 COMMUNITY-BASED ORGANIZATIONS, COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). PART V, SECTION B, LINE 11 COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES:(1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. THE WORK PLAN FOR ADDRESSING THE IDENTIFIED NEEDS CAN BE FOUND IN THE CHNA APPENDIX E, PUBLICLY AVAILABLE ON THE HOSPITAL WEBSITE, HTTPS://MERCYMEDICALCENTER.CHSLI.ORG/. PRIORITY 1: PREVENT CHRONIC DESEASE MERCY MEDICAL CENTER OFFERS REGULARLY SCHEDULED PREVENTIVE HEALTH SCREENINGS IN LOCAL COMMUNITIES, PARTICULARLY IN MEDICALLY-UNDERSERVED COMMUNITIE. THESE SCREENINGS INCLUDE BLOOD PRESSURE, BODY MASS INDEX (BMI), MAMMOGRAPHY, AND PSA. IN ADDITION, MERCY MEDICAL CENTER HOSTS REGULARLY SCHEDULED IN-PERSON AND VIRTUAL LECTURES, SYMPOSIUMS AND EDUCATION EVENTS, FOCUSING ON UNDERSERVED COMMUNITIES. HEALTHY SUNDAYS COMMUNITY OUTREACH EVENTS ARE HELD IN COLLABORATION WITH CHURCHES, HOUSES OF WORSHIP AND COMMUNITIES. ONE EVENT WAS HELD IN 2020, SERVING 75 COMMUNITY MEMBERS AND INCLUDED HEALTH SCREENINGS, EDUCATION AND FLU VACCINATIONS FOR 33 COMMUNITY MEMBERS. THIS EVENT WAS HELD IN COLLABORATION WITH THE TZU CHI FOUNDATION AND THEIR FREE FOOD DISTRIBUTION EVENT FOR THOSE IN NEED. MERCY ALSO OFFERS FREE MAMMOGRAPHY SCREENINGS TO UNINSURED COMMUNITY MEMBERS WITH THE ASSISTANCE OF A GRANT FROM PINK AID. EIGHT COMMUNITY MEMBERS WERE SCREENED, AND FIVE WERE REFERRED FOR FREE FOLLOW-UP CARE. HEMPSTEAD SENIOR CENTER HOSTED 2 LECTURES WITH MERCY MEDICAL CENTER EXPERTS PROVIDING EDUCATION ABOUT STROKE AND DIABETES. 65 COMMUNITY MEMBERS PARTICIPATED IN EACH. YOUTH FROM S.T.R.O.N.G. YOUTH, INC., IN UNIONDALE PARTICIPATED IN TEDDY BEAR AND FIRST AID CLINICS TEACHING HEALTH CARE AND FIRST AID. THERE WERE 2 SESSIONS HELD IN FEBRUARY WITH 25 STUDENTS PARTICIPATING IN EACH CLINIC. S.T.R.O.N.G. YOUTH, INC., IS A COMMUNITY DEVELOPMENT ORGANIZATION SPECIALIZING IN YOUTH AND GANG VIOLENCE PREVENTION AND INTERVENTION. IN JANUARY, A PRESENTATION ON VAPING-MYTHS AND FACTS WAS PROVIDED BY A HOSPITAL EMERGENCY DEPARTMENT PHYSICIAN TO MORE THAN 200 STUDENTS AT WESTBURY MIDDLE SCHOOL. MERCY HOSPITAL OFFERED WEEKLY VIRTUAL PRESENTATIONS FOR THE VILLAGE GREEN SENIOR LIVING CENTER IN LEVITTOWN. PRESENTATIONS IN MAY, JUNE AND JULY COVERED MENTAL HEALTH, COLON CANCER AWARENESS, HYPERBARIC MEDICINE, DIABETES AWARENESS AND BALANCE. VIRTUAL PROGRAMMING CONTINUED IN SEPTEMBER. BI-WEEKLY, HEALTHY THURSDAYS VIRTUAL PRESENTATIONS BEGAN IN AUGUST IN COLLABORATION WITH THE FRIEDBERG JEWISH COMMUNITY CENTER (JCC) IN OCEANSIDE. TOPICS INCLUDED MENTAL HEALTH, DIABETES, MOVEMENT FOR HEALTH, SLEEP, FALLS PREVENTION, BREAST HEALTH AWARENESS, BREAST HEALTH SCREENING AND STROKE. MEDITATION AND RELAXATION WAS INTRODUCED AT THE JCC AND PRESENTED EVERY TUESDAY FOR AN HOUR BEGINNING IN SEPTEMBER. PROGRAMMING WILL CONTINUE THROUGH DECEMBER. A MONTHLY DIABETES SUPPORT GROUP BEGAN IN JUNE AND SERVES 26 COMMUNITY MEMBERS. MERCY STAFF PARTICIPATED IN THE "SOCK IT TO SEPSIS" PROGRAM. STAFF DONATED NEW SOCKS THAT WERE DISTRIBUTED TO COMMUNITIES IN NEED. SEPSIS EDUCATION WAS ATTACHED TO EACH PAIR OF SOCKS. PRIORITY 2: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, INTERVENTIONS INCLUDE: PROMOTION OF ALL PROGRAMS, EVENTS, AND EDUCATION OFFERED BY LIHC MEMBERS WHO SPEAK TO THE PREVENTION OF MENTAL AND SUBSTANCE USE DISORDERS. THE HOSPITAL PARTICIPATES IN LOCAL TASK FORCES ADDRESSING OPIOID USE DISORDERS. MERCY MEDICAL CENTER'S BEHAVIORAL HEALTH SERVICES HAVE BEEN MEETING THE BEHAVIORAL HEALTH NEEDS OF THE COMMUNITY SINCE 1958 AND ARE STAFFED BY CARING, QUALIFIED HEALTH PROFESSIONALS, INCLUDING PSYCHIATRISTS, PSYCHIATRIC NURSE PRACTITIONERS, LICENSED CLINICAL SOCIAL WORKERS, LICENSED MENTAL HEALTH COUNSELORS, REGISTERED NURSES, LICENSED CREATIVE ARTS THERAPISTS, ACTIVITIES THERAPISTS AND BEHAVIORAL HEALTH AIDES. CARING, SEASONED, CLINICAL STAFF WILL ASSESS EACH SITUATION AND PROVIDE INFORMATION AND REFERRAL ABOUT BEHAVIORAL HEALTH SERVICES AND/OR OTHER COMMUNITY RESOURCES THAT WILL HELP DURING THIS TIME. STAFF IS AVAILABLE 24-HOURS-A-DAY, 7-DAYS-A-WEEK. THE CHS MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE FOR DOWNLOAD ON THE MERCY WEBSITE. IN ADDITION TO THE TWO SELECTED NEW YORK STATE PRIORITY AND FOCUS AREAS, MERCY MEDICAL CENTER ALSO PARTICIPATES IN COMMUNITY OUTREACH ACTIVITIES THAT ADDRESS OTHER NEW YORK STATE PREVENTION AGENDA PRIORITIES. MERCY PROVIDES CLINICAL EDUCATION AND MENTORING FOR NURSING STUDENTS FROM LOCAL COLLEGES. FREE, EVIDENCE-BASED FALL PREVENTION PROGRAMS ARE OFFERED THAT ARE DESIGNED TO IMPROVE BALANCE AND STRENGTH AND HELP REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS. A VIRTUAL FALLS PREVENTION EDUCATION EVENT FACILITATED BY THE DIRECTOR OF THERAPUETIC SERVICES WAS OFFERED IN PARTNERSHIP WITH THE FRIEDBERG JEWISH COMMUNITY CENTER (JCC) IN OCEANSIDE. AS A MEMBER OF CATHOLIC HEALTH SERVICES, MERCY OFFERS OUTREACH SERVICES AS PART OF THE CHS MISSION AND SOCIAL DETERMINANTS OF HEALTH. MERCY STAFF PARTICPATED IN THE AMERICAN HEART ASSOCIATION LONG ISLAND HEART WALK MOVE MORE CHALLENGE AND THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER VIRTUAL WALK. MERCY HOSTED 2 BLOOD DRIVES COLLECTING 117 PINTS OF BLOOD IN SUPPORT OF LONG ISLAND BLOOD SERVICES. MERCY ALSO CONDUCTS COLLECTION DRIVES FOR FOOD, CLOTHING, AND SCHOOL SUPPLIES AND ADOPT-A-FAMILY COLLECTIONS AT CHRISTMAS, BENEFITTING LOCAL COMMUNITY PARTNERS AND CHURCHES. PART V, SECTION B, LINE 20E MERCY MEDICAL CENTER HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH AND ARE CLEARLY VISIBLE TO THE PUBLIC. MERCY MEDICAL CENTER HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 THE METHODOLOGY WAS USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS. PART I, LINE 7A, COLUMN (D) DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE 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 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 2020. PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT AS PART OF ITS TAX EXEMPT PURPOSE, MERCY MEDICAL CENTER PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. MERCY TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF WHETHER THEY HAVE THIRD-PARTY COVERAGE OR THE ABILITY TO PAY. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, MERCY IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM THE HOSPITAL SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY. PART III, LINES 2 AND 4 - TEXT OF FOOTNOTE DISCUSSING BAD DEBT PAGES 20 TO 24 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PATIENT ACCOUNTS RECEIVABLE. THE FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN. PART III, LINE 8 - COSTING METHODOLOGY THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III, SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2020 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. PART III, LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. MERCY MEDICAL CENTER BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY BUT ALSO DOING SO WITH NO RECOURSE IN OBTAINING PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING-EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED, ARE NOT TURNED AWAY. MERCY MEDICAL CENTER WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY. PART III, LINE 9B THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INABILITY TO PAY FOR THOSE SERVICES. IN ADDITION, UPON APPLYING FOR CHARITY CARE, EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY WILL BE ASSESSED. ELIGIBILITY FOR ASSISTANCE: A REASONABLE REVIEW SHALL BE PERFORMED PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (I.E. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE CHS CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET. PART VI, LINE 2 - ASSESSMENT OF COMMUNITY NEEDS AND GOALS NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S BOARD OF TRUSTEES AND EXECUTIVE LEADERSHIP COUNCIL, COMMUNITY HEALTH AND EDUCATION DEPARTMENT MEETINGS, AT COLLABORATIVE SESSIONS WITH MEMBER HOSPITALS OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AND WITH PARTNERS AT COMMUNITY AGENCIES AND ORGANIZATIONS THAT ARE PART OF THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). THE LIHC COMMUNITY HEALTH ASSESSMENT SURVEYS ARE OFFERED YEAR-ROUND AT MULTIPLE OUTREACH SITES IN THE COMMUNITY. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH, SPANISH, POLISH, HAITAIN CREOLE AND LARGE PRINT) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT DOUBLES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CHS'S WEBSITE. MERCY MEDICAL CENTER CONTINUES TO COLLABORATE WITH OTHER HOSPITALS, LOCAL HEALTH DEPARTMENTS, HEALTH CARE PROVIDERS, PUBLIC HEALTH SPECIALISTS FROM ACADEMIC INSTITUTIONS AND COMMUNITY-BASED ORGANIZATIONS AT LIHC EVENTS. LIHC'S WEBSITE OFFERS COMPREHENSIVE INFORMATION TO PROMOTE GOOD HEALTH AND PREVENT CHRONIC DISEASE. IN ADDITION TO PROVIDING NUMEROUS RESOURCES SUCH AS HEALTH PROGRAM INVENTORIES, HEALTH INSURANCE INFORMATION AND EDUCATIONAL VIDEOS, LIHC AND ITS MEMBERS HAVE ORGANIZED WALKING PROGRAMS, AND DEVELOPED A UNIVERSAL SCREENING TOOL TO HELP MEASURE THE EFFECTIVENESS OF COMMUNITY HEALTH EFFORTS. MORE INFORMATION CAN BE FOUND AT WWW.LIHEALTHCOLLAB.ORG. PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY 1. SINCE IT IS THE DUTY OF MERCY MEDICAL CENTER TO ENSURE THAT EVERY PATIENT IS AWARE OF THE EXISTENCE OF THE HOSPITAL'S CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENT HAVE BEEN FULLY VERSED IN MERCY MEDICAL CENTER'S CHARITY CARE POLICY. ALL HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. MERCY MEDICAL CENTER HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN MERCY MEDICAL CENTER INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. MERCY MEDICAL CENTER PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. MERCY MEDICAL CENTER HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. MERCY MEDICAL CENTER PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING MERCY MEDICAL CENTER'S CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, A STATEMENT IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER INFORMATION. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4 - COMMUNITY INFORMATION MERCY MEDICAL CENTER IS LOCATED ON THE SOUTH SHORE OF NASSAU COUNTY IN ROCKVILLE CENTRE. A NOT-FOR-PROFIT HOSPITAL WITH 375 BEDS, MERCY IS A MEMBER OF CATHOLIC HEALTH SERVICES SERVING THE HEALTH CARE NEEDS OF NASSAU COUNTY AND THE SURROUNDING AREA. THE POPULATION IN THE HOSPITAL'S PRIMARY SERVICE AREA IS ETHNICALLY DIVERSE WITH A POPULATION OF MORE THAN 500,000 RESIDENTS. MERCY'S SERVICE AREA CONSISTS OF SOME OF THE POOREST POPULATIONS IN NASSAU COUNTY, INCLUDING FOUR (HEMPSTEAD, ROOSEVELT, FREEPORT, AND UNIONDALE) OF THE EIGHT HIGHEST POVERTY ZIP CODES IN THE COUNTY. MERCY MEDICAL CENTER'S DISCHARGE DATA INDICATES THAT MERCY CONTINUES TO SERVE ECONOMICALLY CHALLENGED COMMUNITIES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH MERCY PARTICIPATED IN OR HOSTED COMMUNITY EVENTS, BOTH IN-PERSON AND VIRTUALLY, AT WHICH HEALTH EDUCATION WAS PROVIDED, EMPHASIZING WELLNESS, NUTRITION, DIABETES PREVENTION, AND PREVENTIVE CARE SCREENINGS. IN 2020, EMS EDUCATION LECTURES WERE HELD VIRTUALLY WITH A GREAT COMMUNITY RESPONSE. IN JUNE, 65 LOCAL EMS PROFESSIONALS ATTENDED A VIRTUAL PRESENTATION ON KAWASAKI DISEASE, AND IN JULY, THERE WERE 87 PARTICIPANTS IN A VIRTUAL PRESENTATION ON STROKE PREVENTION. THE SEPTEMBER LECTURE COVERED TRAUMA AND MERCY'S NEW CARDIAC CATHETERIZATION LAB AND HAD 57 PARTICIPANTS. DUE TO THE REMARKABLE RESPONSE, VIRTUAL EMS LECTURES WILL CONTINUE TO BE SCHEDULED ON A REGULAR BASIS. FREE COMMUNITY LECTURES WERE CONDUCTED THROUGHOUT THE YEAR, AND MOST WERE HELD VIRTUALLY AND AVAILABLE TO COMMUNITIES ACROSS LONG ISLAND. MERCY, IN CONJUNCTION WITH OTHER CHS HOSPITALS, PARTICIPATED IN THE HEALTHY SUNDAYS PROGRAM, A COMMUNITY OUTREACH PROGRAM HELD IN PARISHES AND OTHER COMMUNITY CENTERS. EVENTS OFFER SCREENINGS AND HEALTH EDUCATION. THE HOSPITAL OFFERS SMOKING CESSATION INFORMATION, REFERRALS TO SMOKING CESSATION PROGRAMS AND THE NY-QUIT LINE CARDS AT ALL COMMUNITY OUTREACH EVENTS. MERCY OFFERS SMOKING CESSATION PROGRAMS TO EMPLOYEES THROUGH ITS EMPLOYEE ASSISTANCE PROGRAM AND TO PHYSICIANS THROUGH THE CENTER FOR TOBACCO CONTROL. PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, MERCY MEDICAL CENTER THROUGH ITS DAILY OPERATIONS, PROVIDES ACUTE, EMERGENT, AND OUTPATIENT CARE. MERCY IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND)(CHS), 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. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2020, CHS COMPRISED SIX HOSPITALS (MERCY MEDICAL CENTER, ST. FRANCIS HOSPITAL AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL CORP, AND ST. CATHERINE OF SIENA MEDICAL CENTER IN SUFFOLK COUNTY), AS WELL AS THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING AND REHABILITATION CARE CENTER, GOOD SAMARITAN NURSING & REHABILITATION CARE CENTER, AND OUR LADY OF CONSOLATION NURSING AND REHABILITATIVE CARE CENTER, ALL IN SUFFOLK COUNTY), A REGIONAL HOME CARE AND HOSPICE NETWORK, AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 17,000 EMPLOYEES AND 4,600 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CHS PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: 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. MEMBER ORGANIZATIONS OF CHS OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. ALL OF CHS'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. CHS ENTITIES PROVIDE AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS AS WELL AS FREE HEALTH SCREENINGS THROUGH ITS HEALTHY SUNDAYS PROGRAMS. SINCE 1907, CATHOLIC HEALTH SERVICES HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE IMPROVING THE COMMUNITY'S HEALTH. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVEROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 1204793 NONE NONE OUTPATIENT CENTERS 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR MERCY MEDICAL CENTER 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 UNDESERVED COMMUNITIES AND CAPITAL SUPPORT. PART II, LINE 1, COLUMN (H) NAME OF ORGANIZATION OR GOVERNMENT: CATHOLIC HEALTH SYSTEM OF LONG ISLAND (H) PURPOSE OF GRANT: 1) SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND AS A PASS THROUGH TO PROVIDE GENERAL SUPPORT TO THE CATHOLIC MINISTRIES OF THE DIOCESE OF ROCKVILLE CENTRE IN CONNECTION WITH THE FORMATION OF YOUTH AND ADULTS IN THE FAITH, PROMOTION OF THE DIGNITY OF LIFE, PROMOTION OF QUALITY EDUCATION FOR YOUNG PEOPLE, AND FOSTERING OF VOCATIONS FOR THE PRIESTHOOD; 2) PROVIDE SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND TO FUND OUTPATIENT CENTERS THAT PROVIDE CHARITY CARE TO THOSE CENTERS' COMMUNITIES; AND 3) TO FUND SUPPORT PROVIDED THROUGH THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CAREGIVERS FUND. THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CAREGIVERS FUND WAS FORMED WITH THE MISSION TO ASSIST OUR FELLOW CAREGIVERS ON THE FRONT LINES, HERE AND ABROAD, WHO STRUGGLE JUST TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. X true true X X X X X X true true false false false false false false false ALAN D GUERCI MD PRESIDENT & CEO 0 1556421 0 308000 0 36055 0 426935 0 30480 0 2357891 0 0 WILLIAM C ARMSTRONG SVP FINANCE 0 352643 0 112000 0 605163 0 841513 0 14034 0 1925353 0 0 DANIEL DEBARBA EVP & CFO 0 923822 0 164000 0 31328 0 366935 0 43540 0 1529625 0 0 RONALD W STEIMEL FORMER CAO 0 538271 0 64000 0 18145 0 139935 0 40501 0 800852 0 0 PETER SCAMINACI PRESIDENT/CAO 0 474188 0 30000 0 17124 0 204534 0 14718 0 740564 0 0 ALAN WONG MD CHIEF QUALITY OFFICER 418155 0 80667 0 669 0 28443 0 42471 0 570405 0 0 0 ALEXANDER TELIS MD CLINICAL ATTENDING CRIT CARE 259982 0 226675 0 392 0 28443 0 47458 0 562950 0 0 0 FAHIM AHMED CMO 470163 0 11000 0 766 0 28443 0 39903 0 550275 0 0 0 JONATHAN HANNAM PHYSICIAN 225094 0 140313 0 845 0 24286 0 47428 0 437966 0 0 0 SYED KAMAL MD HOSPITALIST 205204 0 168298 0 198 0 21454 0 41759 0 436913 0 0 0 ALEEM ALI HOSPITALIST 209836 0 155864 0 204 0 21890 0 39598 0 427392 0 0 0 PART I, LINE 4A - SEVERANCE WILLIAM ARMSTRONG RECEIVED A SEVERANCE PAYMENT OF $495,117. THE AMOUNT IS INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). PART I, LINES 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. ALAN D. GUERCI, MD $401,000 PARTICIPATION IN PLAN WILLIAM ARMSTRONG $179,000 PARTICIPATION IN PLAN DANIEL DEBARBA $341,000 PARTICIPATION IN PLAN RONALD STEIMEL $114,000 PARTICIPATION IN PLAN PETER SCAMINACI $178,000 PARTICIPATION IN PLAN THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THESE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. PART II - REPORTING OF TOP FINANCIAL OFFICIAL WILLIAM ARMSTRONG WAS REPORTED AS AN OFFICER IN 2015 AS THE TOP FINANCIAL OFFICIAL IN HIS ROLE AS INTERIM CFO. EFFECTIVE 2016, DANIEL DEBARBA BECAME THE TOP FINANCIAL OFFICER AS CFO, AND WILLIAM ARMSTRONG HAS RESUMED HIS ROLE AS SVP OF FINANCE. PART II - OFFICER EFFECTIVE 11/01/2018 PETER SCAMINACI WAS TRANSFERRED FROM ST. JOSEPH HOSPITAL, A RELATED ENTITY, TO SERVE AS THE PRESIDENT/CAO. EFFECTIVE 11/01/2018, RON STEIMEL WAS TRANSFERRED TO CHS SERVICES, A RELATED ENTITY, TO SERVE AS THE SENIOR VICE PRESIDENT FOR BUSINESS DEVELOPMENT. MERCY INTERNAL MEDICINE PC SEE PART V 531000 PURCHASED SALARIES/CONTRACT MG false SCHEDULE L, PART IV, LINE (1) COLUMN (B) - RELATIONSHIP FAHIM AHMED, A KEY EMPLOYEE OF MERCY MEDICAL CENTER, IS THE SOLE SHAREHOLDER OF MERCY INTERNAL MEDICINE, PC FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF MERCY MEDICAL CENTER 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 CENTER (DIOCESE). FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF MERCY MEDICAL CENTER AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF MERCY MEDICAL CENTER. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF MERCY MEDICAL CENTER, CHS IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF MERCY MEDICAL CENTER. THE GOVERNING BODY OF MERCY MEDICAL CENTER IS THE SAME AS THAT OF CHS. 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 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 AUDIT 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 ADMINISTRATIVE 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 GUERCI, M.D. PRESIDENT AND CEO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); CATHOLIC HEALTH SYSTEM OF LONG ISLAND (11-3403968); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); RVC INSURANCE COMPANY INC. (20-8067039); 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) AND ST. JOSEPH HOSPITAL FOUNDATION (47-2353387). 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 FDOUNDATION (27-1459941); CATHOLIC HEALTH SYSTEM OF LONG ISLAND (11-3403968) AND RVC INSURANCE COMPANY INC. (20-8067039) PETER SCAMINACI, PRESIDENT/CAO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: MERCY MEDICAL CENTER (11-1635088) AND WSNCHS NORTH, INC. (11-3438973). FORM 990, PART X, LINE 20 - TAX-EXEMPT BOND LIABILITIES A PORTION OF THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 ARE ISSUED ON BEHALF OF THE CATHOLIC HEALTH SERVICES OF LONG ISLAND OBLIGATED GROUP PROJECT WHICH INCLUDES THE FILING ENTITY AND RELATED ENTITIES. THREE BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 SUFFOLK BONDS), NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BONDS) AND NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORPORATION (SERIES 2014B BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH SERVICES OF LONG ISLAND. FORM 990, PART XI, LINE 9 - CHANGES IN NET ASSETS CHANGE IN POST RETIREMENT BENEFIT: ($153,000) RELATED PARTY EMPLOYEE BENEFIT SERVICES: ($397,059) LOSS ON DEBT EXTINGUISHMENT: ($400,721) TOTAL TO FORM 990, PART XI, LINE 9: ($950,780) FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION MERCY MEDICAL CENTER IS A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND. WE, AT CATHOLIC HEALTH SERVICES, HUMBLY JOIN TOGETHER TO BRING CHRISTS 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 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 2020. 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, 2020. ADDITIONALLY, FUNDS ARE AVAILABLE TO REIMBURSE PROVIDERS FOR COVID-19 RELATED TREATMENT OF UNINSURED PATIENTS. FUNDING RECEIVED DURING 2020 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 true CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) 3 CHSLI true GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 12A-I GOOD SAMARTN true 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 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 true ST CATHERINE OF SIENA MEDICAL CTR FDN 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) 12A-I STCATHERINE false CHS HOME CARE AND HOSPICE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 452907761 SUPPORT ORG NY 501(C)(3) 12A-I CATHHOMECARE false GOOD SHEPHERD HOSPICE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 12A-I GOODSHEPHERD false OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 12A-I OURLADYOFC false RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 12A-I CHSLI false CHS PHYSICIAN PARTNERS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 12A-I ST FRANCIS false RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INS NY 501(C)(3) 12B-II CHSLI false SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 HEALTHCARESVC NY 501(C)(4) GOOD SAMARTN false ST JOSEPH HOSPITAL FOUNDATION 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 472353387 SUPPORT ORG NY 501(C)(3) 12A-I WSNCHS NORTH false 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 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 true true true true true false false false true true false true true false true true true true true CHS SERVICES INC LMPR 18066990 COST CHS SERVICES INC A 1424196 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER LM 2486797 COST ST FRANCIS HOSPITAL LM 684362 COST ST CHARLES HOSPITAL CORP LM 611117 COST WSNCHS NORTH INC LM 288220 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.