2019-11-14T15:45:47-06:00 2018-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2018-01-01 770611240 GOOD SAMARITAN HOSPITAL FOUNDATION % CHS SERVICES GOOD 6313763000 1000 MONTAUK HWY WEST ISLIP NY 11795 RUTH HENNESSEY PRESIDENT 5167051919 2019-11-14 true LAURA J PARELLO P01080295 6464713000 167.68.125.77 13049920193185000088 2019-11-14 P 3B584E6C6EC03F54C23492763082C94E75791172 3B584E6C6EC03F54C23492763082C94E75791172 2018 2020-04-17 16:48:07Z RUTH HENNESSEY 1000 MONTAUK HWY WEST ISLIP NY 11795 1670900 false 0928 X HTTP://GOODSAMARITAN.CHSLI.ORG/ X 2000 NY WE, AT CHS, 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. 8 7 0 0 0 1159137 1412018 0 0 13371 27796 -42217 -53688 1130291 1386126 207955 794005 0 0 0 0 0 0 79908 491442 494751 699397 1288756 430894 97370 5171722 5498435 182449 411792 4989273 5086643 X SEE SCHEDULE O false false 1171756 794005 0 TO SOLICIT GRANTS AND CONTRIBUTIONS TO BE USED FOR AN ONGOING DEVELOPMENT PROGRAM WHICH WILL PROVIDE FUNDS EXCLUSIVELY FOR THE USE OF GOOD SAMARITAN HOSPITAL MEDICAL CENTER, A 437 BED MEDICAL CENTER LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN WEST ISLIP, NEW YORK. A PREMIER HEALTHCARE FACILITY, PROVIDING QUALITY AND COST EFFECTIVE HEALTH CARE SERVICES EXTENDING ACROSS THE CONTINUUM OF CARE TO ALL DISCIPLINES, BOTH FOR INPATIENTS AND OUTPATIENTS. IN 2018 THE MEDICAL CENTER PROVIDED INPATIENT SERVICES FOR 26,642 DISCHARGED INDIVIDUALS, MANAGED 88,346 EMERGENCY DEPARTMENT VISITS AND 21,854 CLINIC VISITS. THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH COMMUNITY SERVICE AND CHARITABLE ACTIVITIES. 1171756 true true false false false false false false false false false false false false true true false true false false false false false false true false false true false true false false false false false false false false false false false false false true false false false true 0 2 true 0 false false false false false true true false false false false false false X 8 7 false false true false true true true true true false false true true true true true true false false false X CHS SERVICES 5167053700 992 NORTH VILLAGE AVE ROCKVILLE CENTRE NY 11570 X KELLY DANIELE-CROSMAN CHAIRMAN 2.0 0.0 X X 0 0 0 JOHN VULLO DO SECRETARY 2.0 50.0 X X 0 487542 60416 CHARLES FERRARO TRUSTEE 2.0 0.0 X 0 0 0 THOMAS MCATEER TRUSTEE 2.0 0.0 X 0 0 0 KATHLEEN GIAMO TRUSTEE 2.0 0.0 X 0 0 0 EILEEN LA MENDOLA TRUSTEE 2.0 0.0 X 0 0 0 MICHAEL VIRGILIO TRUSTEE 2.0 0.0 X 0 0 0 SALVATORE CAPITANO TRUSTEE 2.0 0.0 X 0 0 0 SR ELLEN MOORE TRUSTEE - THROUGH 5/2018 2.0 0.0 X 0 6985 0 JACQUELINE DIAZ TRUSTEE - THROUGH 4/2018 2.0 0.0 X 0 0 0 THOMAS OCKERS CAO THROUGH 12/18/18 50.0 0.0 X X 0 622015 48797 RUTH HENNESSEY PRESIDENT EFFECTIVE 12/19/18 50.0 0.0 X 0 769987 169337 DANIEL DEBARBA EVP & CFO 50.0 0.0 X 0 1103919 376508 WILLIAM C ARMSTRONG SVP FINANCE 0.0 50.0 X 0 868007 207575 0 3858455 862633 0 true true false 0 337069 1074949 1412018 0 27796 27796 0 0 0 0 0 0 231086 337069 284774 -53688 -53688 0 0 0 0 0 0 0 1386126 -25892 794005 794005 0 0 0 0 0 0 0 0 0 88353 10099 17454 60800 0 0 0 0 0 0 16095 15128 763 204 36018 17114 18904 0 0 0 1761 1761 0 0 0 0 0 0 PURCHASED SERVICES-SALARIES 261129 261129 PURCHASED SERVICES-BENEFITS 91395 91395 1288756 1171756 37092 79908 2027670 1416841 3124052 3638669 0 341483 0 0 0 0 0 0 0 0 0 0 20000 101442 0 0 0 0 0 0 0 0 0 0 0 0 5171722 5498435 0 11275 0 0 0 0 0 0 0 0 0 0 0 0 0 0 182449 400517 182449 411792 X 1870221 1117465 3119052 3969178 0 0 4989273 5086643 5171722 5498435 97370 X false true X true false X X 1 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 111888924 3 true 794005 0 1 794005 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 0 MEDICAL CENTER 400517 400517 X PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTE CHS AND MOST OF ITS SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CHS ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE ACCOUNTING STANDARDS CODIFICATION 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. GALA 250730 176425 74305 2450 92764 19000 26319 GOLF 228735 119995 108740 1998 91954 14099 2 88690 40649 48041 1007 18580 3989 8375 4239 568155 337069 231086 4448 1007 203298 3989 27375 44657 284774 -53688 NY 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 true GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 501(C)(3) 794005 NONE NONE CAPITAL SUPPORT 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY MAINTAINS THE BOOKS AND RECORDS FOR GOOD SAMARITAN HOSPITAL MEDICAL CENTER AND GOOD SAMARITAN HOSPITAL FOUNDATION AND IS THEREFORE ABLE TO MONITOR THAT GOOD SAMARITAN HOSPITAL MEDICAL CENTER USED THE GRANT FUNDS AS CAPITAL SUPPORT. PART II, LINE 1, COLUMN (H) NAME OF ORGANIZATION OR GOVERNMENT: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (H) PURPOSE OF GRANT OR ASSISTANCE: TO MEET THE OBJECTIVE OF THE GOOD SAMARITAN HOSPITAL FOUNDATION BY DISTRIBUTING FUNDS IN SUPPORT OF HOSPITAL INITIATIVES. false true false false false false false false false JOHN VULLO DO SECRETARY 0 486325 0 0 0 1217 0 24558 0 35858 0 547958 0 0 THOMAS OCKERS CAO THROUGH 12/18/18 0 534569 0 80000 0 7446 0 24558 0 24239 0 670812 0 0 RUTH HENNESSEY PRESIDENT EFFECTIVE 12/19/18 0 602247 0 100000 0 67740 0 146405 0 22932 0 939324 0 0 DANIEL DEBARBA EVP & CFO 0 870966 0 200000 0 32953 0 339815 0 36693 0 1480427 0 0 WILLIAM C ARMSTRONG SVP FINANCE 0 721425 0 125000 0 21582 0 183815 0 23760 0 1075582 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. WILLIAM ARMSTRONG $160,000 PARTICIPATION IN THE PLAN DANIEL DEBARBA $316,000 PARTICIPATION IN THE PLAN THE DEFERRED COMPENSATION IN COLUMN C FOR THESE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. PART II - FORMER OFFICERS & DIRECTORS WILLIAM ARMSTRONG WAS REPORTED AS AN OFFICER IN 2015 AS THE TOP FINANCIAL OFFICIAL IN HIS ROLE AS INTERIM CFO. EFFECTIVE 2016, DANIEL DEBARBA IS THE TOP FINANCIAL OFFICER AS CFO, AND WILLIAM ARMSTRONG HAS RESUMED HIS ROLE AS SVP OF FINANCE. FORM 990, PART VI, LINE 4 - CHANGES IN GOVERNING DOCUMENTS THE ORGANIZATION'S BYLAWS WERE PREVIOUSLY AMENDED AND THE SIGNIFICANT CHANGES WERE NOT PREVIOUSLY REPORTED ON FORM 990. THE FOLLOWING SIGNIFICANT CHANGES TO THE BY-LAWS HAVE BEEN MADE: - ORGANIZATIONS GOALS AND OBJECTIVES HAVE EXPANDED - COMPOSITION OF TRUSTEES CHANGED TO A LIMIT OF NOT FEWER THAN THREE AND NO MORE THAN 40 VOTING MEMBERS - COMPOSITION OF OFFICERS CHANGED TO A CHAIRPERSON, VICE CHAIRPERSON, A PRESIDENT AND OTHER OFFICERS AS ELECTED BY THE BOARD OF TRUSTEES - PROVISIONS REGARDING THE APPROVAL PROCESS TO AMEND THE BY-LAWS FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION GOOD SAMARITAN HOSPITAL MEDICAL CENTER IS THE SOLE CORPORATE MEMBER OF GOOD SAMARITAN HOSPITAL FOUNDATION. FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY GOOD SAMARITAN HOSPITAL MEDICAL CENTER AS THE SOLE CORPORATE MEMBER OF GOOD SAMARITAN HOSPITAL FOUNDATION HAS THE POWER TO APPOINT THE GOVERNING BODY OF GOOD SAMARITAN HOSPITAL FOUNDATION. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY GOOD SAMARITAN HOSPITAL 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 GOOD SAMARITAN HOSPITAL MEDICAL CENTER IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF GOOD SAMARITAN HOSPITAL 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, LINE 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. THOMAS OCKERS, EXEC VP & CAO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396). 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 (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). DONALD TEPLITZ, CHIEF MEDICAL OFFICER - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR KEY EMPLOYEE FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240) AND SAMARITAN EMERGENCY MEDICAL SERVICES, P.C. (20-8243412). RUTH HENNESSEY, PRESIDENT - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); AND ST FRANCIS HOSPITAL FOUNDATION (11-2916033). FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION GOOD SAMARITAN HOSPITAL FOUNDATION 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. CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 12A-I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 12B-II CHSLI false CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 12A-I GOOD SAMARTN false MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113434776 TRANSPORTATIO NY 501(C)(3) 12A-I MARYHAVENCTR 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 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 false ST CHARLES HOSPITAL 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI false CHS HOME SUPPORT SERVICES INC 15 POWER DRIVE HAUPPAUGE NY 11788 113594561 RESP THERAPY NY 501(C)(3) 10 CATHHOMECARE false ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI false ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 12A-I ST FRANCIS false ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 12A-I ST FRANCIS false WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI false THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 112983148 SUPPORT ORG NY 501(C)(3) 12A-I CHSLI false THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 12A-I CHSLI false WISDOM GARDENS HOUSING DEVELOPMENT FUND 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 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 IDHC LLC 2500 YORK RD JAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVICES PA NA BEACON HEALTH PTNRS 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 454229842 HEALTHCARE NY NA WISDOM GARDENS LP 51 TERRYVILLE RD PORT JEFFERSON NY 11776 113567947 SR HOUSING NY NA 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 false true true false true false false false false false false false true true true true true false false 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.