2021-11-15T16:52:14-06:00 2020-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2020-01-01 131740242 DOMINICAN SISTERS FAMILY HEALTH SERVICE INC DOMI 9149411710 299 NORTH HIGHLAND AVENUE OSSINING NY 10562 ANNMARIE COVONE EXECUTIVE VP & CFO 9149411710 2021-11-15 1 ANNMARIE COVONE XXX-XX-XXXX GARRETT M HIGGINS P00543209 9143818900 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ARCHCARE AT HOME SCOTT P LA RUE 299 NORTH HIGHLAND AVENUE OSSINING NY 10562 22884531 0 X WWW.DSFHS.ORG X 1974 NY DSFHS PROVIDES COMPREHENSIVE AND FAMILY FOCUSED CARE TO PERSONS IN NEED AS A CERTIFIED COMMUNITY BASED, NON-PROFIT HOME HEALTH AGENCY. OUR PROGRAMS AND SERVICES PROMOTE HEALTH, INDEPENDENCE AND QUALITY OF LIFE. 19 19 230 19 0 0 7707567 3732097 16661780 19087316 1850 1228 95657 63890 24466854 22884531 1908 0 0 0 15000477 15082531 0 0 0 5673635 6666488 20676020 21749019 3790834 1135512 14564435 10427294 16497413 11224760 -1932978 -797466 DSFHS IS A NON-PROFIT HOME HEALTH AGENCY THAT PROVIDES COMPASSIONATE AND FAMILY FOCUSED HOME CARE. 0 0 11642490 18068342 THE CERTIFIED HOME HEALTH AGENCY PROVIDES CARE AND SUPPORT TO THOSE WHO HAVE HOME HEALTH CARE NEEDS THAT ARE FOR LIMITED DURATION. CARE MAY INVOLVE SKILLED NURSING, CASE MANAGEMENT, MEDICAL SOCIAL WORKER, HOME HEALTH AIDES, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES. ADDITIONAL SPECIALTY SERVICES PROVIDED ARE MATERIAL/CHILD HEALTH, WOUND CARE PAIN MANAGEMENT, HEALTH EDUCATION AND SUPERVISION AND SCREENING FOR NURSING HOME PLACEMENT. PASTORAL CARE COUNSELING IS PROVIDED IN BOTH ENGLISH AND SPANISH TO HELP PATIENTS AND FAMILIES OF ALL FAITHS COPE SPIRITUALLY AND EMOTIONALLY WITH ILLNESS AND HEALING. 274369 1018974 ADJUNCT PROGRAMS PROVIDE NON-MEDICAL SERVICES, WHICH ARE GRANT FUNDED, TO THE MOST VULNERABLE MEMBERS OF SOCIETY IN THE SOUTH BRONX AND SUFFOLK COUNTY. IN THE SOUTH BRONX, THE RYAN WHITE PROGRAM ADDRESSES THE NEEDS OF THE HIV/AIDS POPULATION, OFFERING TESTING AND COUNSELING SERVICES. 11916859 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 23 0 230 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 19 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X ANNMARIE COVONE 6466334700 205 LEXINGTON AVENUE 2ND FLOOR NEW YORK NY 10016 FRANCIS J SERBAROLI ESQ CHAIRMAN 0.10 1.70 X X 0 0 0 THOMAS M O'BRIEN VICE-CHAIR 0.10 1.70 X X 0 0 0 TARA A CORTES SECRETARY 0.10 1.70 X X 0 0 0 THOMAS E ALBERTO BOARD MEMBER 0.10 1.70 X 0 0 0 JOHN CAHILL BOARD MEMBER 0.10 1.70 X 0 0 0 JOHN T DUNLAP BOARD MEMBER 0.10 1.70 X 0 0 0 MSGR CHARLES J FAHEY BOARD MEMBER 0.10 1.70 X 0 0 0 THOMAS J FAHEY JR MD BOARD MEMBER 0.10 1.70 X 0 0 0 ERIC P FELDMANN BOARD MEMBER 0.10 1.70 X 0 0 0 KAREN GRAY BOARD MEMBER 0.10 1.70 X 0 0 0 JEFFREY J HODGMAN BOARD MEMBER 0.10 1.70 X 0 0 0 GEORGE IRISH BOARD MEMBER 0.10 1.70 X 0 0 0 CLARION E JOHNSON MD BOARD MEMBER 0.10 1.70 X 0 0 0 RORY KELLEHER BOARD MEMBER 0.10 1.70 X 0 0 0 REV MSGR JOSEPH LAMORTE BOARD MEMBER 0.10 1.70 X 0 0 0 KATHRYN ROONEY BOARD MEMBER 0.10 1.70 X 0 0 0 GT SWEENEY BOARD MEMBER 0.10 1.70 X 0 0 0 GENNARO VASILE PDD BOARD MEMBER 0.10 1.70 X 0 0 0 BISHOP GERALD WALSH BOARD MEMBER 0.10 1.70 X 0 0 0 SCOTT P LA RUE PRESIDENT/CEO 0.10 38.70 X 0 1406730 343704 ANNMARIE COVONE EXECUTIVE VICE PRESIDENT/C 0.10 38.70 X 0 873596 195331 TAMI A SIEDLER VP HOME & COMMUNITY SERVICE 37.50 X 370536 0 84837 REGINA E TANCREDI DIRECTOR OF BUSINESS OPERATION 37.50 X 159240 0 59338 ANN CRANE REGIONAL ADMINISTRATOR 37.50 X 133487 0 44238 JACQUELYN D AUGUSTO COMMUNITY HEALTH NURSE 37.50 X 128681 0 25781 STEPHANIE CANALES LAIAISON NURSE 37.50 X 127456 0 10420 ZHANNA KARLIK COMMUNITY HEALTH NURSE 37.50 X 126752 0 11683 1046152 2280326 775332 40 0 1 0 THERADYNAMICS REHAB LLC 225 CROSSWAYS PARK DR WOODBURY NY 11797 REHABILITATION SERVICES 1230847 HOMECARE HOMEBASE LLC PO BOX 678637 DALLAS TX 75267 HOME HEALTH CARE SERVICES 512220 BLACKTREE HEALTHCARE CONSULTING LLC 1030 CONTINENTAL DRIVE KING OF PRUSSIA PA 19406 BILLING SERVICES 401513 GHP STEVENS LLC 4 WEST RED OAK LANE SUITE 200 WHITE PLAINS NY 10604 REAL ESTATE SERVICES 369780 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVE SUITE 300 HARRISON NY 10528 AUDITING & CONSULTING SERVICES 120800 6 2924996 807101 3732097 NET PATIENT SERVICE REVENUE 623000 17955006 17955006 CARE MANAGEMENT & HEALTH HOME 623000 1018974 1018974 RENTAL INCOME FROM RELATED PARTY 532000 113336 113336 19087316 1228 1228 FORGIVENESS OF DEBT 900099 34300 34300 REIMBURSEMENT FROM AFFILIATES 900099 15608 15608 OTHER REVENUE 900099 7316 7316 6666 6666 63890 22884531 19087316 0 65118 381801 381801 11480102 7651811 3828291 29590 29590 2226690 1447571 779119 964348 623558 340790 606123 606123 21061 21061 90000 6250 83750 1742643 1145695 596948 631 631 279115 132530 146585 855837 56078 799759 508118 130080 378038 286129 157572 128557 7763 7763 52016 52016 455936 455936 96700 96700 BAD DEBT EXPENSE 986354 986354 MEDICAL SUPPLIES 287805 287805 REPAIRS & MAINTENANCE 118014 11073 106941 OTHER DIRECT EXPENSE 103970 63998 39972 168273 164854 3419 21749019 11916859 9832160 0 1021882 1871185 524708 1522526 6229102 448709 2222244 2984117 329345 345541 6929705 5676546 1574313 1253159 2662841 2002057 14564435 10427294 6120571 4795627 0 700000 5484 0 10371358 5729133 16497413 11224760 X -1995597 -860085 62619 62619 -1932978 -797466 14564435 10427294 1135512 0 X X 0 1 X 1 0 X 1748613 1616421 3739783 7707567 3732097 18544481 33286016 32749284 16332081 16661780 19087316 118116477 35034629 34365705 20071864 24369347 22819413 136660958 0 0 0 136660958 46213 16940 2854 1850 1228 69085 46213 16940 2854 1850 1228 69085 8580 8580 63180 286118 223066 95657 63890 731911 35152602 34668763 20297784 24466854 22884531 137470534 0.99410 0.99470 0.00050 0.00050 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2016 AMOUNT: $ 37,143. 2017 AMOUNT: $ 72,224. 2018 AMOUNT: $ 9,156. 2019 AMOUNT: $ 5,501. 2020 AMOUNT: $ 7,316. MEDICAL RECORD - 2016 AMOUNT: $ 12,978. 2017 AMOUNT: $ 7,966. 2018 AMOUNT: $ 8,112. 2019 AMOUNT: $ 8,391. 2020 AMOUNT: $ 6,666. FLU IMMUNIZATIONS - 2016 AMOUNT: $ 13,059. 2017 AMOUNT: $ 130. FORGIVENESS OF DEBT - 2017 AMOUNT: $ 205,798. 2018 AMOUNT: $ 205,798. 2019 AMOUNT: $ 81,765. 2020 AMOUNT: $ 34,300. REIMBURSEMENT FORM AFFILIATES - 2020 AMOUNT: $ 15,608. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 74819 74819 0 647330 604800 42530 2875199 2664114 211085 3332357 2332813 999544 1253159 DEPOSITS 110742 INSURANCE RECOVERY RECEIVABLE 753315 DUE FROM RELATED PARTY 1138000 2002057 DUE TO THIRD PARTY PAYORS 664799 PROFESSIONAL LIABILITIES 1138000 DUE TO RELATED PARTY 1969419 DEFERRED RENT 372115 PAYCHECK PROTECTION PROGRAM LOAN 1584800 5729133 X 38190278 16525681 16525681 21664597 1219934 1219934 22884531 37412745 16883660 16883660 20529085 1219934 1219934 21749019 PART X, LINE 2: THE AGENCY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE AGENCY HAS NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE AGENCY IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE ATTRIBUTED TO RELATED PARTY: 16,525,681. PART XI, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS FROM CONSOLIDATED ENTITY 217,972. RECLASS OF BAD DEBT EXPENSES TO PART IX, LINE 24 986,354. RECLASS OF REIMBURSEMENT FORM AFFILIATES TO PART VIII, LINE 11 15,608. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES ATTRIBUTED TO RELATED PARTY: 16,883,660. PART XII, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS FROM CONSOLIDATED ENTITY 217,972. RECLASS OF BAD DEBT EXPENSES TO PART IX, LINE 24 986,354. RECLASS OF REIMBURSEMENT FORM AFFILIATES TO PART VIII, LINE 11 15,608. X X X 0 1 0 0 0 0 0 1 0 SCOTT P LA RUE PRESIDENT/CEO 0 991770 0 273779 0 141181 0 321656 0 22048 0 1750434 0 283210 ANNMARIE COVONE EXECUTIVE VICE PRESIDENT/C 0 671748 0 127877 0 73971 0 161663 0 33668 0 1068927 0 127877 TAMI A SIEDLER VP HOME & COMMUNITY SERVICE 302296 0 55000 0 13240 0 82650 0 2187 0 455373 0 0 0 REGINA E TANCREDI DIRECTOR OF BUSINESS OPERATION 158840 0 400 0 0 0 25670 0 33668 0 218578 0 0 0 ANN CRANE REGIONAL ADMINISTRATOR 133087 0 400 0 0 0 22836 0 21402 0 177725 0 0 0 JACQUELYN D AUGUSTO COMMUNITY HEALTH NURSE 124948 0 3733 0 0 0 3733 0 22048 0 154462 0 0 0 PART I, LINE 4B SCOTT P. LA RUE AND ANNMARIE COVONE ALSO PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE DISTRIBUTED $134,281 TO SCOTT AND $60,731 TO ANNMARIE IN THEIR 2020 W-2S. PART I, LINE 7 THE FOLLOWING EMPLOYEES RECEIVED TAXABLE BOARD DISCRETIONARY BONUS IN THEIR 2020 W-2'S FOR THE ORGANIZATION: - TAMI A SIEDLER $55,000 - REGINA E TANCREDI $400 - ANN CRANE $400 - JACQUELYN D AUGUSTO $3,733 - STEPHANIE CANALES $8,233 - ZHANNA KARLIK $300 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT AGREEMENT FOR CERTAIN ADMINISTRATIVE AND CONSULTING SERVICES WITH CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. CATHOLIC HEALTH CARE SYSTEM SHALL PROVIDE HUMAN RESOURCES, IT SERVICES, FINANCE SERVICES, LEGAL SERVICES, COMPLIANCE, AND SUPPLY CHAIN MANAGEMENT TO THE ORGANIZATION. ANNMARIE COVONE AND SCOTT LA RUE (OFFICERS OF THE FILING ORGANIZATION) WERE PAID BY CATHOLIC HEALTH CARE SYSTEM. THEIR 2020 COMPENSATION IS REPORTED IN PART VII, SECTION A AND SCHEDULE J, PART II. CATHOLIC HEALTH CARE SYSTEM WAS PAID $450,000 FOR SERVICES IN 2020. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBER OF THE CORPORATION SHALL BE CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE ORGANIZATION SHALL NOMINATE AND APPOINT TWO DIRECTORS TO SERVE ON THE DSFHS BOARD. OTHER THAN THE MEMBER'S TWO APPOINTMENTS TO THE DSFHS BOARD OF DIRECTORS, DSFHS SHALL HAVE THE SOLE RIGHT TO NOMINATE DIRECTORS TO SERVE ON THE DSFHS BOARD, SUBJECT TO ARCHCARE'S FINAL APPROVAL. ARCHCARE SHALL ALSO HAVE THE RIGHT TO REMOVE ANY DIRECTOR FROM THE CORPORATION'S BOARD AT ANY TIME FOR THE FOLLOWING REASONS: 1. FAILURE TO TAKE APPROPRIATE ACTION(S) TO MEET WITH THE APPROVED BUDGET AND/OR OVERALL CHCS HEALTH SYSTEM STRATEGY; OR 2. INTERFERING WITH THE PROMPT INTEGRATION OF THE CORPORATION INTO THE MEMBER'S HEALTH CARE SYSTEM, INCLUDING FAILING TO TAKE ADVANTAGE OF SYNERGIES AMONG THE CHCS INSTITUTIONS; OR 3. FAILURE TO RECUSE ONESELF FROM DISCUSSION/VOTING RELATED TO A MATTER WHICH CREATES A POTENTIAL CONFLICT OF INTEREST OR THE APPEARANCE OF IMPROPRIETY. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED TO THE MEMBER OF THE CORPORATION: A) APPROVAL, UPON RECOMMENDATION FROM THE CORPORATION'S BOARD, OF ANY AMENDMENT TO THE BYLAWS AND CERTIFICATE OF INCORPORATION OF THE CORPORATION; B) APPROVAL, UPON RECOMMENDATION OF THE CORPORATION'S BOARD, OF THE OPERATING AND CAPITAL BUDGETS OF CORPORATION; C) APPROVAL, UPON RECOMMENDATION OF THE CORPORATION'S BOARD, OF THE BUSINESS AND STRATEGIC PLAN FOR THE CORPORATION OR ANY AMENDMENT THERETO; D) APPROVAL, UPON RECOMMENDATION OF THE CORPORATION'S BOARD, OF THE FORMATION OR PURCHASE OF AN ENTITY THAT IS A RELATED ENTITY OF THE CORPORATION; E) NOMINATE AND APPOINT TWO DIRECTORS TO SERVE ON THE DSFHS BOARD. OTHER THAN THE MEMBER'S TWO APPOINTMENTS TO THE DSFHS BOARD OF DIRECTORS, DSFHS SHALL HAVE THE SOLE RIGHT TO NOMINATE DIRECTORS TO SERVE ON THE DSFHS BOARD, SUBJECT TO ARCHCARE'S FINAL APPROVAL. ARCHCARE SHALL ALSO HAVE THE RIGHT TO REMOVE ANY DIRECTOR FROM THE CORPORATION'S BOARD AT ANY TIME FOR THE FOLLOWING REASONS: (I) FAILURE TO TAKE APPROPRIATE ACTION(S) TO MEET WITH THE APPROVED BUDGET AND/OR OVERALL CHCS HEALTH SYSTEM STRATEGY; OR (II) INTERFERING WITH THE PROMPT INTEGRATION OF THE CORPORATION INTO THE MEMBER'S HEALTH CARE SYSTEM, INCLUDING FAILING TO TAKE ADVANTAGE OF SYNERGIES AMONG THE CHCS INSTITUTIONS; OR (III)FAILURE TO RECUSE ONESELF FROM DISCUSSION/VOTING RELATED TO A MATTER WHICH CREATES A POTENTIAL CONFLICT OF INTEREST OR THE APPEARANCE OF IMPROPRIETY. F) APPROVAL OF ANY REAL ESTATE TRANSACTION INVOLVING THE SALE, PLEDGE OR TRANSFER OF REAL PROPERTY WITH A VALUE ABOVE $30,000 AND BELOW $400,000 OR ANY CAPITAL PROJECT INVOLVING THE SALE, PLEDGE OR TRANSFER OF FIXED ASSETS WITH A VALUE ABOVE $30,000 AND BELOW $400,000; G) APPROVAL OF ANY PROGRAM OR SERVICE CHANGES BY THE CORPORATION THAT RESULT IN: (A) CLOSURE OR ESTABLISHMENT OF A LICENSED SERVICE OR PROGRAM; OR (B) CHANGE IN LOCATION OF A LICENSED SERVICE OR LICENSED PROGRAM OUTSIDE THE SERVICE AREA OF THE CORPORATION; AND H) APPROVAL OF ANY MERGER, PURCHASE, JOINT OPERATING AGREEMENT OR OTHER AFFILIATION (EACH AN "AFFILIATION") BY THE CORPORATION WITH A THIRD PARTY, OR WITHDRAWAL FROM, DISPOSITION OF AN INTEREST IN, OR DISSOLUTION OF ANY SUCH AFFILIATION. FORM 990, PART VI, SECTION B, LINE 11B DOMINICAN SISTERS FAMILY HEALTH SERVICE, INC. HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD MEMBERS OF THE ORGANIZATION FOR ANY COMMENTS. ANY COMMENTS ARE THEN GROUPED, SUMMARIZED AND PROVIDED TO THE OUTSIDE ACCOUNTANTS. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED FOR FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATIONS CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. AN INTERESTED PERSON WITH A POTENTIAL CONFLICT OF INTEREST IN A PARTICULAR MATTER SHALL PROMPTLY AND FULLY DISCLOSE THE POTENTIAL CONFLICT TO HIS SUPERVISOR. THE INTERESTED PERSON SHALL THEREAFTER REFRAIN FROM PARTICIPATING IN DELIBERATIONS AND DISCUSSION, AS WELL AS ANY DECISIONS, RELATING TO THE MATTER. THE PRESIDENT SHALL BE RESPONSIBLE FOR DETERMINING THE PROPER WAY FOR THE ORGANIZATION TO HANDLE DECISIONS WHICH INVOLVE UNRESOLVED CONFLICTS OF INTEREST. THE POLICY SHALL BE OVERSEEN AND ADMINISTERED BY THE BOARD OF DIRECTORS WITH ONLY INDEPENDENT DIRECTORS PARTICIPATING OR BY A COMMITTEE OF THE BOARD COMPRISED OF AT LEAST THREE MEMBERS AND OF WHICH ALL COMMITTEE MEMBERS SHALL BE DIRECTORS WHO ARE INDEPENDENT DIRECTORS. THIS PROCESS IS CONDUCTED ANNUALLY, AND IS GIVEN OVERSIGHT BY THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15B THE EXECUTIVE COMMITTEE DETERMINES ADMINISTRATIVE COMPENSATION BASED UPON AN INDEPENDENT STUDY OF CERTIFIES HOME HEALTHCARE COMPANIES OF COMPARABLE SIZE IN THE NEW YORK METROPOLITAN AREA. IN 2020, AN EXECUTIVE SESSION OF THE BOARD WAS HELD TO DISCUSS AND APPROVE THE OTHER OFFICERS AND KEY EMPLOYEES COMPENSATION. THE BOARD'S APPROVAL WAS DOCUMENTED IN THE BOARD MINUTES WHEN THE BUDGET FOR THE ORGANIZATION WAS APPROVED. FORM 990, PART VI, SECTION C, LINE 19 THE CORPORATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE BY POSTING IT ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST AT 299 NORTH HIGHLAND AVENUE, OSSINING, NY 10562 OR BY CALLING THE ORGANIZATION DIRECTLY AT (914)-941-1710. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE OVERSIGHT PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. BENEFICE ADVANTAGE INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 134201050 DORMANT/PROVIDE ADMIN., BENFITS COORDINATING AND OTHER SERVICES TO ARCHCARE NY 501(C)(3) LINE 1 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 CALVARY FUND INC 1740 EASTCHESTER ROAD BRONX NY 10461 133259649 SUPPORT CALVARY HOSPITAL NY 501(C)(3) LINE 12A, I CALVARY HOLDING COMPANY INC 0 CALVARY HOLDING COMPANY 1740 EASTCHESTER ROAD BRONX NY 10461 061531426 SUPPORT THE CALVARY HOSPITAL AND ITS AFFILIATED ORGANIZATIONS NY 501(C)(3) LINE 12A, I CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 CALVARY HOSPITAL INC 1740 EASTCHESTER ROAD BRONX NY 10461 131740274 OPERATE A TAX EXEMPT HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 CARMEL RICHMOND NURSING HOME INC 88 OLD TOWN ROAD STATEN ISLAND NY 103044229 132720248 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 KATERI RESIDENCE 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 133086309 DORMANT/OPERATE SKILLED NURSING & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 133896624 MGT SVCS FOR HEALTH-RELATED FACILITIES IN THE ARCHDIOCESE NY 501(C)(3) LINE 10 PROVIDENCE HEALTH SERVICES 0 CATHOLIC HEALTH CARE FOUNDATION OF THE ARCHDIOCESE OF NY 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 134054158 PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) LINE 7 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 CATHOLIC MANAGED LONG TERM CARE INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 208180809 OPERATE A MANAGED LONG-TERM CARE PLAN NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 CATHOLIC RESOURCES INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 261306110 SUPPORT CATHOLIC MANAGED LONG TERM CARE, INC. NY 501(C)(3) LINE 1 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 EMPIRE STATE HOME CARE SERVICES INC 15 METROTECH CENTER 11 FL BROOKLYN NY 11201 113618585 HOME HEALTH CARE SERVICES NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 FERNCLIFF NURSING HOME COMPANY INC 21 FERNCLIFF DRIVE RHINEBECK NY 12572 141514053 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 MARY MANNING WALSH NURSING HOME COMPANY INC 1339 YORK AVENUE NEW YORK NY 100214707 136220617 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 OUR LADY OF MERCY FUND OF NEW YORK NY 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 133452084 DORMANT/PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) LINE 7 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 OUR LADY OF MERCY HEALTHCARE SYSTEM INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 133395946 DORMANT/PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) LINE 12A, I OUR LADY OF MERCY HEALTHCARE SYSTEM INC 0 PROVIDENCE HEALTH SERVICES 1011 1ST AVENUE NEW YORK NY 10022 133354940 SPONSOR OF CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE NY 501(C)(3) LINE 3 N/A 0 ST TERESA'S NURSING HOME INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 237012219 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 ST THERESA'S RESIDENCE 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 133110063 INTERMEDIATE CARE FACILITY FOR DEVELOPMENTALLY DISABLED NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 ST VINCENT DE PAUL RESIDENCE 900 INTERVALE AVENUE BRONX NY 10459 133598842 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 TERENCE CARDINAL COOKE HEALTH CARE CENTER 1249 FIFTH AVENUE NEW YORK NY 10029 133007801 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 VISITING NURSE REGIONAL HEALTH CARE SYSTEM INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 113574017 DORMANT/SUPPORT AND MANAGEMENT SERVICES FOR ITS AFFILIATES NY 501(C)(3) LINE 10 CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 VISITING NURSE ASSOCIATION OF BROOKLYN INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 111977434 DORMANT/HOME HEALTH CARE NY 501(C)(3) LINE 10 VISITING NURSE REGIONAL HEALTH CARE SYSTEM INC 0 BROOKLYN VISITING NURSE FOUNDATION 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 113312248 DORMANT/RAISE FUNDS FOR AFFILIATED ORGANIZATIONS NY 501(C)(3) LINE 12B, II VISITING NURSE REGIONAL HEALTH CARE SYSTEM INC 0 ARCHCARE COMMUNITY SERVICES INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 813563801 PROVIDE COMMUNITY AND PASTORAL SERVICES AND SUPPORTIVE HOUSING NY 501(C)(3) LINE 12B, II CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 FAMILY HOME HEALTH CARE INC 65 SOUTH BROADWAY TARRYTOWN NY 10591 133831377 HOME CARE NY 501(C)(3) LINE 10 DOMINICAN SISTERS FAMILY HEALTH SERVICE INC 1 ULSTER HOME HEALTH SERVICES INC PO BOX 1850 KINGSTON NY 12402 141513989 HOME CARE NY 501(C)(3) LINE 10 UMC INC 0 UMC INC PO BOX 1850 KINGSTON NY 12402 141701702 MANAGEMENT SERVICES NY 501(C)(3) LINE 12B, II CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 0 ULSTER HOME CARE INC PO BOX 1850 KINGSTON NY 12402 141702962 HOME CARE NY 501(C)(3) LINE 10 UMC INC 0 ST AGNES HOSPITAL 305 NORTH STREET WHITE PLAINS NY 10605 131740121 DORMANT/OPERATE A HOSPITAL NY CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE C 0 1 0 0 1 0 0 0 0 0 1 0 1 1 0 1 1 1 1 0 FAMILY HOME HEALTH CARE INC M 217972 COST FAMILY HOME HEALTH CARE INC A 53916 COST SCHEDULE R, PART V, LINE 1A: DOMINICAN SISTERS FAMILY HEALTH SERVICE, INC. RECEIVED RENTAL INCOME, WHICH ARE SPECIFIED PAYMENTS, FROM ITS CONTROLLED SUBSIDIARY. THESE PAYMENTS WERE MADE AT ARM'S LENGTH AND MEETS THE FAIR MARKET VALUE STANDARD.