2020-11-11T16:18:25-06:00 2019-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2019-01-01 271459941 ST CATHERINE OF SIENA MEDICAL CENTER FOUNDATION % CHS SERVICES INC STCA 6318623000 50 ROUTE 25A SMITHTOWN NY 11787 JAMES O'CONNOR PRESIDENT 6318623000 2020-11-09 true LAURA J PARELLO P01080295 6464713000 155.201.35.69 13049920203165000078 2020-11-11 P 3B584E6C6EC03F54C23492763082C94E75791172 BB937A9EAF0258E2900CA48AEBB9445B27FAB226 2019 2021-01-29 14:40:06Z JAMES O'CONNOR 50 ROUTE 25A SMITHTOWN NY 11787 400149 false 0928 X N/A X 2002 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. 7 7 0 0 0 0 292861 312254 0 0 0 0 -22993 -32524 269868 279730 0 0 0 0 72588 0 152300 50442 50442 109377 229460 334265 279902 -64397 -172 979527 1376303 649453 1046401 330074 329902 X SEE SCHEDULE O false false 218707 0 0 To solicit grants and contributions to be used for an ongoing DEVELOPMENT program which will provide funds exclusively for the use of St. Catherine of Siena Medical Center. 218707 true true false false false false false false false false true false false false true true false true false false false false false true true false false false false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false true true false false false false false false X 7 7 false false false false true true true true true false false true true true true true true false false false X CHS SERVICES INC 5167053700 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X DANIEL DEBARBA EVP & CFO 50.0 0.0 X 0 1192885 386743 JAMES O'CONNOR EVP & CAO 50.0 0.0 X 0 671852 155756 PAUL ROWLAND EVP & CAO - THROUGH 2/23/18 0.0 0.0 X 0 211500 0 RICHARD SCHMIDT CHAIRMAN 2.0 0.0 X X 0 0 0 GARY CARPENTER TRUSTEE 2.0 0.0 X 0 0 0 BRIAN CLANCY TRUSTEE 2.0 0.0 X 0 0 0 LIZ WELSH TRUSTEE 2.0 0.0 X 0 0 0 LARRY JUST TRUSTEE 2.0 0.0 X 0 0 0 PHIL PANARELLI TRUSTEE 2.0 0.0 X 0 0 0 CATHY CREIGHTON TRUSTEE 2.0 0.0 X 0 0 0 JOHN VIGLIANTI TRUSTEE 2.0 0.0 X 0 0 0 0 2076237 542499 0 true true false 0 291070 21184 312254 0 0 0 0 0 0 0 0 87895 291070 120419 -32524 -32524 0 0 0 0 0 0 0 279730 -32524 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50442 50442 0 0 3453 3453 1000 1000 38858 38858 0 17806 17806 1033 1033 0 0 0 0 10753 10753 0 PURCHASED SERVICES-SALARIES 118969 118969 PURCHASED SERVICES-BENEFITS 36442 36442 OTHER EXPENSES 1146 1146 279902 218707 10753 50442 879249 1272903 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3000 110052 25602 95203 84450 5075 15950 0 0 0 0 0 0 0 0 979527 1376303 36133 5350 0 0 0 0 0 0 0 0 0 0 0 0 0 0 613320 1041051 649453 1046401 X -395122 -660555 725196 990457 330074 329902 979527 1376303 -172 X false true X true false X X 1 ST CATHERINE OF SIENA MEDICAL CENTER 061562701 3 true 0 0 1 0 0 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 110052 25602 84450 84450 0 DUE TO RELATED PARTY 1041051 1041051 X SCHEDULE D, PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTE CHS 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 CHS 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. CHS ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES. MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS, USING A THRESHOLD OF MORE LIKELY THAN NOT OF BEING SUSTAINED. X true BINRON ALLIANCE PARTNERS INC FUNDRAISING CONSULTING false 378965 50442 328523 378965 50442 328523 DINNER DANCE 243285 195000 48285 51881 5945 20049 GOLF OUTING 135680 96070 39610 33114 9430 0 378965 291070 87895 33114 51881 5945 29479 120419 -32524 false true false false false false false false false DANIEL DEBARBA EVP & CFO 0 897154 0 264000 0 31731 0 346480 0 40263 0 1579628 0 0 JAMES O'CONNOR EVP & CAO 0 571056 0 75000 0 25796 0 127872 0 27884 0 827608 0 0 PAUL ROWLAND EVP & CAO - THROUGH 2/23/18 0 0 0 0 0 211500 0 0 0 0 0 211500 0 0 PART I, LINE 3 - METHODS TO ESTABLISH COMPENSATION BY RELATED ORGANIZATION THE FOLLOWING METHODS ARE USED BY A RELATED ORGANIZATION TO ESTABLISH 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 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. Daniel DeBarba $321,000 participation in the plan JAMES O'CONNOR $102,000 PARTICIPATION IN THE PLAN THE DEFERRED COMPENSATION IN COLUMN C FOR THIS INDIVIDUAL INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION ST. CATHERINE OF SIENA MEDICAL CENTER IS THE SOLE CORPORATE MEMBER OF ST. CATHERINE MEDICAL CENTER FOUNDATION. FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY ST CATHERINE OF SIENA MEDICAL CENTER AS THE SOLE CORPORATE MEMBER OF ST CATHERINE OF SIENA MEDICAL CENTER FOUNDATION HAS THE POWER TO APPOINT THE GOVERNING BODY OF ST Catherine of Siena Medical Center foundation. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BOBY ST CATHERINE OF SIENA MEDICAL CENTER FOUNDATION MAY NOT TAKE ANY ACTION REQUIRING THE CONSENT OR APPROVAL OF THE MEMBER UNTIL THE MEMBER SHALL HAVE EXERCISED ITS RESERVED POWERS. IN ADDITION, CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A CATHOLIC HEALTH SERVICES OF LONG ISLAND) AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF ST CATHERINE OF SIENA MEDICAL CENTER IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF ST CATHERINE OF SIENA MEDICAL CENTER. 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 FOUNDATION AND CHS BOARDS 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 OF CHS,A RELATED ORG 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, LN 19-DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS-CERTIFICATE OF INCORPORATION FILED WITH NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT MADE 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. 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 (11-635088); 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). JAMES O'CONNOR, CAO - THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST CHARLES HOSPITAL CORP (11-1871039); ST CHARLES HOSPITAL FOUNDATION (41-2076312); ST CHARLES CORPORATION (11-2983148); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CATHERINE OF SIENA MEDICAL CENTER FDOUNDATION (27-1459941). FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION ST CATHERINE OF SIENA FOUNDATION 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. 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THIS STRUCTURE IS CONSISTENT WITH THE NEW YORK CORPORATE PRACTICE OF MEDICINE.