2019-11-15T13:39:29-06:00 2018-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2018-01-01 113403968 CATHOLIC HEALTH SYSTEM OF LONG ISLAND % CHS SERVICES INC CATH 5167053700 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 ALAN D GUERCI MD PRESIDENT, CEO 5167051938 2019-11-11 true LAURA J PARELLO P01080295 6464713000 167.68.125.77 13049920193195000139 2019-11-15 P 3B584E6C6EC03F54C23492763082C94E75791172 3B584E6C6EC03F54C23492763082C94E75791172 2018 2020-03-31 21:24:44Z CATHOLIC HEALTH SERVICES OF LI ALAN D GUERCI MD 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 81419479 false 0928 X HTTP://WWW.CHSLI.ORG X 1997 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 23 22 9 0 0 0 12385878 19894960 28077638 28174560 1337414 3189380 0 0 41800930 51258900 34603000 77003000 0 0 12065164 12240267 0 0 0 24091691 15787208 70759855 105030475 -28958925 -53771575 182380456 115935311 226967915 220309144 -44587459 -104373833 X SEE SCHEDULE O false false 23624801 42600 28174560 CATHOLIC HEALTH SERVICES OF LONG ISLAND PROMOTES THE EFFICIENT GOVERNANCE AND MANAGEMENT OF THE SUPPORTED ORGANIZATIONS. IN ADDITION, CHSLI'S COOPERATIVE PLANNING AND EFFICIENT USE OF RESOURCES ASSISTS THE SUPPORTED ORGANIZATIONS TO ACHIEVE THEIR RESPECTIVE AND COLLABORATIVE GOALS. 750000 750000 0 SUPPORTING AND STRENGTHENING THE MINISTRIES OF THE DIOCESE OF ROCKVILLE CENTRE. 76000000 76000000 0 SUPPORTING AND STRENGTHENING THE MINISTRIES OF THE CHSLI HEALTH SYSTEM AND RELATED ORGANIZATIONS. 210400 210400 0 100585201 true true false false false false false false false false true false true true true true false true false false false false false false false false false true false true true false false false false false false false false false false false false false false true true true true false false true 37 0 true 9 true false false false false false false false false false false true false X 23 22 false false false false true true true true true false false true true true true true true true true true true X CHS SERVICES INC 5167053700 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X 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 TREASURER 2.0 0.0 X X 0 0 0 BARBARA ELLEN BLACK 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 JOHN WAGNER TRUSTEE 2.0 0.0 X 0 0 0 REV JAMES VLAUN 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 ALEXANDER HAZELTON TRUSTEE 2.0 0.0 X 0 0 0 WILLIAM WARD TRUSTEE 2.0 0.0 X 0 0 0 ROBERT ZUCCARO TRUSTEE 2.0 0.0 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 ALAN D GUERCI MD PRESIDENT & CEO 50.0 0.0 X X 2639580 0 401663 DANIEL DEBARBA EVP & CFO 50.0 0.0 X 1103919 0 376508 DENNIS VERZI EVP & COO 50.0 0.0 X 1696408 0 260465 ANTHONY PELLICANO SVP CHIEF HR OFFICER 50.0 0.0 X 820321 0 93055 PATRICK O'SHAUGHNESSY EXEC VP MEDICAL AFFAIRS & CMO 50.0 0.0 X 1087633 0 340370 DAVID DECERBO EVP & GENERAL COUNSEL 50.0 0.0 X 938905 0 144569 WILLIAM JAMES SPENCER SVP MISSION &MINISTRY 50.0 0.0 X 326295 0 58089 MARYANN CUDAHY EXECUTIVE ASSISTANT 37.5 0.0 X 233665 0 53436 TERRENCE O'BRIEN FORMER EVP STRATEGIC PLANNING 0.0 0.0 X 512888 0 0 9359614 0 1728155 9 true true false CONIFER VALUE BASED CARE LLC 1596 WHITEHALL ROAD ANNAPOLIS MD 21409 CONSULTING SERVICES 1074966 KPMG LLP 345 PARK AVENUE NEW YORK NY 10154 AUDITING SERVICES 920030 AKERMAN LLP 495 NORTH KELLER ROAD MAITLAND FL 32751 LEGAL SERVICES 580773 PUTNEY TWOMBLY HALL HIRSON 521 FIFTH AVENUE NEW YORK NY 10175 LEGAL SERVICES 455155 RIVKIN RADLER LLP 926 RXR PLAZA UNIONDALE NY 11556 LEGAL SERVICES 386069 12 19722456 172504 19894960 MANAGEMENT SERVICES REVENUE 900099 28174560 28174560 28174560 1693709 1693709 0 0 0 0 0 31656250 30160579 1495671 1495671 1495671 0 0 0 0 0 0 0 0 0 0 51258900 28174560 3189380 77003000 77003000 0 0 0 6478543 6478543 0 2194700 2194700 0 0 2994041 2994041 332695 332695 240288 240288 1302571 1302571 2750406 2750406 1024824 1024824 0 0 0 0 0 241986 241986 0 0 127539 127539 15878 15878 0 0 7303677 7303677 2456798 2456798 10900 10900 17277 17277 OTHER EXPENSES 535352 10124 525228 105030475 100585201 4445274 0 16931408 14514146 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2087149 1837640 2590946 2547945 53901 43001 55041600 24196966 0 0 30453374 32882163 9469424 9469424 68343600 32991971 182380456 115935311 15144707 14553239 0 0 0 0 162946010 158753838 0 0 0 0 25968409 22620235 0 0 22908789 24381832 226967915 220309144 X -44810645 -104559123 223186 185290 0 0 -44587459 -104373833 182380456 115935311 -53771575 -6014799 X false true X true false X X 12 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 111888924 3 true 0 0 MERCY MEDICAL CENTER 111635088 3 true 9000000 0 ST CHARLES HOSPITAL 111871039 3 true 23000000 0 ST FRANCIS HOSPITAL 112050523 3 true 0 0 ST CATHERINE OF SIENA MEDICAL CENTER 061562701 3 true 21000000 0 WSNCHS NORTH INC 113438973 3 true 16000000 0 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 113284066 10 true 2000000 0 CATHOLIC HOME CARE 112126736 10 true 0 0 GOOD SHEPHERD HOSPICE 112958438 10 true 0 0 CHS HOME SUPPORT SERVICES INC 113594561 10 true 0 0 MARYHAVEN CENTER OF HOPE 112861698 10 true 5000000 0 MARYHAVEN SCHOOL CORPORATION 112861690 2 true 0 0 12 76000000 0 false false false false false false false false false false false false false false false true false PART IV, SECTION A, LINE 1 THE SUPPORTED ORGANIZATIONS OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND ("CHSLI")ARE THOSE ENTITIES FOR WHICH CHSLI IS THE SOLE MEMBER AND CERTAIN OTHER PUBLIC CHARITIES CONTROLLED BY SUCH ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 106444 106444 0 146704 146704 0 2332196 2289349 42847 5602 5448 154 43001 TRUSTEE HELD ASSETS 32882163 F 32882163 DUE FROM RELATED ORGANIZATIONS 4891041 INVESTMENT IN SUBSIDIARIES 2250000 EXECUTIVE RETIREMENT ASSETS 21247889 DONOR RESTRICTED FUNDS 185290 457B FUNDS 1499921 EQUITY INVESTMENTS 2917830 32991971 0 DUE TO RELATED ORGS & AFFILIAT 850000 EXECUTIVE RETIREMENT LIABILITY 23531832 24381832 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. true DIOCESE OF ROCKVILLE CENTRE-CATHOLIC MINISTRIES 50 N PARK AVEROCKVILLE CENTRENY ROCKVILLE CENTRE NY 11570 111837437 501(C)(3) 750000 NONE NONE GENERAL SUPPORT MARYHAVEN CENTER OF HOPE 112861698 501(C)(3) 5000000 NONE NONE GENERAL SUPPORT ST CATHERINE OF SIENA MEDICAL CENTER 061562701 501(C)(3) 21000000 NONE NONE GENERAL SUPPORT ST CHARLES HOSPITAL 111871039 501(C)(3) 23000000 NONE NONE GENERAL SUPPORT WSNCHS NORTH INC (ST JOSEPH) 113438973 501(C)(3) 16000000 NONE NONE FLUORIDE & WATER MERCY MEDICAL CENTER 111635088 501(C)(3) 9000000 NONE NONE HEALTHCARE SERVICES OUR LADY OF CONSOLATION 113284066 501(C)(3) 2000000 NONE NONE HEALTHCARE SERVICES CATHOLIC MEDICAL MISSION BOARD INC 135602319 501(C)(3) 15000 NONE NONE CRISIS INTERVENTION HELP DIOCESE KIKWIT ZAIRE 943255354 501(C)(3) 25000 NONE NONE MEDICATION ROTACARE 113135331 501(C)(3) 37500 NONE NONE INSTALLATION OF HANDRAILS LJDR DAVIS FOUND 462216693 501(C)(3) 20000 NONE NONE DENTAL SERVICES UPLIFT HELP INTL 203821339 501(C)(3) 20000 NONE NONE HEALTH CARE FACILITY SOCIETY OF ST VINCENT DE PAUL 111884961 501(C)(3) 20000 NONE NONE GENERAL SUPPORT COPTIC MEDICATION ASSOCIATION OF NA 271881182 501(C)(3) 15000 NONE NONE GENERAL SUPPORT PROVINCE OF ST MARY CAPUCHIN ORDER 056008676 501(C)(3) 15000 NONE NONE SEEDS OF HOPE TANZANIA 463177613 501(C)(3) 10000 NONE NONE ROADS OF SUCCESS 260809074 501(C)(3) 15000 NONE NONE 17 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE THE DIOCESE OF ROCKVILLE CENTRE PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL; WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI. CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR CATHOLIC HEALTH SYSTEM OF LONG ISLAND AND WSNCHS, INC. (ST JOSEPH HOSPITAL), ST. CATHERINE OF SIENA MEDICAL CENTER, ST. CHARLES HOSPITAL, MERCY MEDICAL CENTER, MARYHAVEN CENTER OF HOPE, AND OUR LADY OF CONSOLATION GERIATRIC CARE CENTER AND IS THEREFORE ABLE TO MONITOR THAT THE GRANT FUNDS ARE USED AS GENERAL SUPPORT. 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. THE CAREGIVERS COMMITTEE, COMPRISED OF STAFF WHO ARE DONATING THEIR SERVICES, MANAGE THE CAREGIVERS FUND. THROUGHOUT THE YEAR, ORGANIZATIONS SUBMIT GRANT APPLICATIONS TO REQUEST FUNDS THAT ARE USED TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. THE CAREGIVERS COMMITTEE REVIEWS THESE APPLICATIONS, AND CHOOSES RECIPIENTS BASED ON THE FOLLOWING CRITERIA: I) CLEAR AND IDENTIFIED NEED, II) ABILITY TO USE THE FUNDS RESPONSIBLY, III) CARE FOR THE CAREGIVERS ON THE FRONT LINE, IV) ABILITY OF THE RECIPIENTS TO USE THE FUNDS FOR THE RECOMMENDED PURPOSES, AND V) CONFIRMATION OF THE LEGAL STATUS OF THE RECIPIENT. FOLLOWING SELECTION, THE COMMITTEE DIRECTS THE GIFTS TO BE MADE TO RECIPIENTS WITH COVER LETTERS INDICATING THE INTENDED PURPOSES. RECIPIENTS ARE ASKED TO PROVIDE FOLLOW-UPS ON THE USE OF THE FUNDS TO THE COMMITTEE WITHIN SIX MONTHS OF THE USE OF FUNDS. PART II, LINE 1 COLUMN (H) NAME OF ORGANIZATION OR GOVERNMENT: DIOCESE OF ROCKVILLE CENTRE - CATHOLIC MINISTRIES APPEAL (H) PURPOSE OF GRANT OR ASSISTANCE: TO PROVIDE GENERAL SUPPORT OF 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. X true true X X X X X X true true false false false false false false false ALAN D GUERCI MD PRESIDENT & CEO 1465503 0 529000 0 645077 0 364815 0 36848 0 3041243 0 609236 0 DANIEL DEBARBA EVP & CFO 870966 0 200000 0 32953 0 339815 0 36693 0 1480427 0 0 0 DENNIS VERZI EVP & COO 926140 0 200000 0 570268 0 248815 0 11650 0 1956873 0 199000 0 TERRENCE O'BRIEN FORMER EVP STRATEGIC PLANNING 12279 0 0 0 500609 0 0 0 0 0 512888 0 0 0 ANTHONY PELLICANO SVP CHIEF HR OFFICER 556690 0 123000 0 140631 0 91815 0 1240 0 913376 0 95164 0 PATRICK O'SHAUGHNESSY EXEC VP MEDICAL AFFAIRS & CMO 782843 0 262000 0 42790 0 306815 0 33555 0 1428003 0 0 0 DAVID DECERBO EVP & GENERAL COUNSEL 657940 0 74000 0 206965 0 118815 0 25754 0 1083474 0 180899 0 WILLIAM JAMES SPENCER SVP MISSION &MINISTRY 265736 0 40000 0 20559 0 23658 0 34431 0 384384 0 0 0 MARYANN CUDAHY EXECUTIVE ASSISTANT 207955 0 25000 0 710 0 18647 0 34789 0 287101 0 0 0 PART I, LINE 4A, SEVERANCE PAYMENT DURING 2018, TERENCE O'BRIEN RECEIVED $319,259 OF SEVERANCE PAYMENTS AND $120,000 IN INCENTIVE PAYMENTS AS PART OF THE SEVERANCE AGREEMENT. PART I, LINE 4B - SUPPLEMENTAL NON-QUALIFIED 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 $341,000 PARTICIPATION IN PLAN DANIEL DEBARBA $316,000 PARTICIPATION IN PLAN DENNIS VERZI $225,000 PARTICIPATION IN PLAN DAVID DECERBO $95,000 PARTICIPATION IN PLAN ANTHONY PELLICANO $68,000 PARTICIPATION IN PLAN PATRICK O'SHAUGHNESSY $283,000 PARTICIPATION IN PLAN THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THESE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. THE FOLLOWING INDIVIDUALS VESTED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). THESE AMOUNTS INCLUDE A TAX GROSS UP. ALAN GUERCI $609,236 VESTED IN PLAN DENNIS VERZI $527,853 VESTED IN PLAN DAVID DECERBO $180,899 VESTED IN PLAN ANTHONY PELLICANO $116,791 VESTED IN PLAN THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2018 FORM W-2, BOX 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. A SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORP 273722095 86476RAUB 2011-12-14 192616434 CAPITAL EXPEN, REFUNDING 1999,2000 true false false B NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORP 274291221 63165BAKO 2011-12-14 65530479 CAPITAL EXPEN, REFUNDING 1999,2000 false false false C SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORP 273722095 86476RCU6 2014-09-24 91553113 CAPITAL EXPENDITURES false false false D NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORP 274291221 63166LCZ2 2014-05-21 85724031 REFUND 2004 BONDS false false false A 0 15000000 192616434 0 0 0 3077681 0 0 11128918 178409835 0 false false true true B 0 0 65530479 0 0 0 1093112 0 0 26766090 37671277 0 false false true true C 0 0 91553113 0 0 0 1209113 0 0 89992076 0 351924 false false false true D 0 0 85724031 0 0 0 1359656 0 0 0 84364375 0 true false true true A false true true true false 0 false false false true B false true true true false 0 false false false true C false true true true false 0 true D false true true true false 0 false false false true A false true false false false false 0 false 0 false true B false true false false false false 0 false 0 false true C false true false false false 0 false 0 false true D false true false false false false 0 false 0 false true A true B true C true D true FORM 990 SCHEDULE K THE TAX-EXEMPT BOND ISSUANCES REFLECTED IN SCHEDULE K, PART I ARE ISSUED ON BEHALF OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND'S RELATED OPERATING ENTITIES. PLEASE NOTE THAT SCHEDULE K, PARTS II, III AND IV HAVE BEEN COMPLETED BASED ON THE TOTAL AMOUNT OF THE TAX-EXEMPT BOND ISSUANCES FOR THE GROUP, NOT BY EACH INDIVIDUAL ENTITY, AS THE OFFERING WAS ON BEHALF OF THE GROUP AS A WHOLE. SCHEDULE K, PART III ALL THE BONDS LISTED ON SCHEDULE K REPORT PRIVATE BUSINESS USE OF 0% FOR TAX YEAR ENDED 12/31/2018. CATHOLIC HEALTH SYSTEM OF LONG ISLAND'S BOND COUNSEL HAS A PROCESS IN PLACE TO MONITOR PRIVATE BUSINESS USE. FOR CERTAIN PROJECTS, IN ADDITION TO USING BOND PROCEEDS, CATHOLIC HEALTH SERVICES OF LONG ISLAND HAS USED EQUITY AND SUCH EQUITY HAS BEEN ALLOCATED TO POTENTIAL PRIVATE BUSINESS USE OF SUCH PROJECTS. SCHEDULE K, PART I, LINE C SUPPLEMENTAL INFORMATION SECOND ISSUER FOR LINE C IS: NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORP, EIN #27-4291221, CUSIP# 63166LDJ7 SCHEDULE K, PART I, LINE D SUPPLEMENTAL INFORMATION THIS BOND FULLY REFUNDED THE 2004 BONDS, WHICH WERE REPORTED ON THE ST. FRANCIS HOSPITAL FORM 990, SCHEDULE K. FORM 990, PART III, LINE 4D - OTHER PROGRAM SERVICES 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. THE CAREGIVERS COMMITTEE, COMPRISED OF STAFF WHO ARE DONATING THEIR SERVICES, MANAGE THE CAREGIVERS FUND. THROUGHOUT THE YEAR, ORGANIZATIONS SUBMIT GRANT APPLICATIONS TO REQUEST FUNDS THAT ARE USED TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. THE CAREGIVERS COMMITTEE REVIEWS THESE APPLICATIONS, AND CHOOSES RECIPIENTS BASED ON THE FOLLOWING CRITERIA: I) CLEAR AND IDENTIFIED NEED, II) ABILITY TO USE THE FUNDS RESPONSIBLY, III) CARE FOR THE CAREGIVERS ON THE FRONT LINE, IV) ABILITY OF THE RECIPIENTS TO USE THE FUNDS FOR THE RECOMMENDED PURPOSES, AND V) CONFIRMATION OF THE LEGAL STATUS OF THE RECIPIENT. FOLLOWING SELECTION, THE COMMITTEE DIRECTS THE GIFTS TO BE MADE TO RECIPIENTS WITH COVER LETTERS INDICATING THE INTENDED PURPOSES. RECIPIENTS ARE ASKED TO PROVIDE FOLLOW-UPS ON THE USE OF THE FUNDS TO THE COMMITTEE WITHIN SIX MONTHS OF THE USE OF FUNDS. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHSLI) IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS. CHSLI IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE,AS THE SPONSOR OF CATHOLIC HEALTH SERVICES OF LONG ISLAND HAS THE ABILITY TO NOMINATE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS OUTLINED IN THE BY-LAWS OF CATHOLIC HEALTH SERVICES OF LONG ISLAND, CERTAIN BOARD DECISIONS ALSO REQUIRE THE APPROVAL OF THE ORGANIZATION'S MEMBERS. FORM 990, PART VI, LINE 11B - REVIEW PROCESS OF FORM 990 THE FORM 990 AND RELATED SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD, AND PRESENTED TO THE COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF CHS, WHICH HAS BEEN DELEGATED THE FORM 990 REVIEW FUNCTION BY THE BOARD. UPON REVIEW AND RECOMMENDATION OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO THE BOARD FOR APPROVAL. UPON BOARD APPROVAL, THE FORM 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST POLICY DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE CHS COMPLIANCE AND 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 EXECUTIVE OFFICER SUBMITS FOR APPROVAL TO THE SYSTEM CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE CHS EXECUTIVE COMPENSATION POLICY (COMPENSATION POLICY). THE COMPENSATION POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CHS OR AN OPERATING ENTITY, AND IS EITHER A) A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF OPERATING OFFICERS (COO) OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS (CFO); D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CHS OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CHS OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CHS OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CHS OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CHS OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CHS CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CHS BOARD OF DIRECTORS FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE PERFORMED ANNUALLY BY AN INDEPENDENT CONSULTANT. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION PROVIDED, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE CHS BOARD OF DIRECTORS. FORM 990, PART VI, LINE 19 - DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE; CHS CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND. FORM 990, PART VII, SECTION A - LINE 1A HOURS FOR TRUSTEES ARE THE ESTIMATED WEEKLY HOURS (2.0) TRUSTEES CONTRIBUTE TO THIS AND ALL OTHER RELATED ORGANIZATIONS, NOT NECESSARILY EQUALLY BUT IN THE PROPORTION NECESSARY, FOR WHICH THEY RECEIVE NO COMPENSATION. ALAN D. GUERCI, PRESIDENT & CEO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); RVC INSURANCE COMPANY, INC. (20-8067039); CATHOLIC HEALTH SYSTEM OF LONG ISLAND (11-3403968); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL (11-1871039) AND ST. JOSEPH HOSPITAL FOUNDATION (47-2353387). DANIEL DEBARBA, EVP & CFO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR HIGHEST PAID EMPLOYEE FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL (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). FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHSLI) IS THE PARENT 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. CHS ACCOUNTABLE CARE ORGANIZATION LLC 992 N VILLAGE AVE ROCKVILLE CENTRE NY 11570 ACCNTBLE CARE NY 0 0 CHSLI CHS PHYSICIAN HOSPITAL ORGANIZATION LLC 992 N VILLAGE AVE ROCKVILLE CENTRE NY 11570 PHYSICIAN ORG NY 0 625738 CHSLI 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 true 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 true MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 10 CHSLI true MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR true THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113638367 SUPPORT ORG NY 501(C)(3) 12A-I MARYHAVENCTR true MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 CHSLI true CATHOLIC HOME CARE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112126736 HOME CARE NY 501(C)(3) 10 CHSLI true OUR LADY OF CONSOLATION GERIATRIC CARE 111 BEACH DRIVE WEST ISLIP NY 11795 113284066 LT NURSE CARE NY 501(C)(3) 10 CHSLI true RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR true ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) 3 CHSLI true ST CHARLES HOSPITAL 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI true CHS HOME SUPPORT SERVICES INC 15 POWER DRIVE HAUPPAUGE NY 11788 113594561 RESP THERAPY NY 501(C)(3) 10 CATHHOMECARE 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-1 ST FRANCIS true ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 12A-1 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 true THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 12A-1 CHSLI true WISDOM GARDENS HOUSING DEVELOPMENT FUND 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113559713 SR HOUSING NY 501(C)(3) 10 MARYHAVENCTR true GOOD SHEPHERD HOSPICE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 10 CHSLI true ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 12A-I ST CHARLES true GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) 12A-I GOOD SAMARTN true 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 true 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 true GOOD SHEPHERD HOSPICE FOUNDATION 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 12A-I GOODSHEPHERD true OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 12A-I OURLADYOFC true RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 12A-I CHSLI true CHS PHYSICIAN PARTNERS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 12A-I ST FRANCIS true RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INS NY 501(C)(3) 12B-II CHSLI true SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 HEALTHCARESVC NY 501(C)(4) GOOD SAMARTN true ST JOSEPH HOSPITAL FOUNDATION 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 472353387 SUPPORT ORG NY 501(C)(3) 12A-I WSNCHS NORTH true BIPO HOLDINGS LLC 992 N VILLAGE AVE ROCKVILLE CENTRE ROCKVILLE CENTRE NY 11570 464763720 PHYSICIAN ASSN NY CHSLI RELATED 1054083 4746507 false 0 true 0.95450 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 CHSLI RELATED 0 0 false 0 false 0.95450 WISDOM GARDENS LP 51 TERRYVILLE RD PORT JEFFERSON NY 11776 113567947 SR HOUSING 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 CENTRE NY 115719024 113633515 PHYSICIAN SVC NY MERCY MED CTR S-CORP false true true true true true false false false true true true true true true true true true true true CHS SERVICES C 12220280 COST CHS SERVICES LMNOP 4522375 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER C 2009305 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER LQS 1742112 COST MERCY MEDICAL CENTER C 744490 COST MERCY MEDICAL CENTER B 9000000 COST MERCY MEDICAL CENTER LQS 11404574 COST ST FRANCIS HOSPITAL C 2094548 COST ST FRANCIS HOSPITAL LQS 4805988 COST ST CHARLES HOSPITAL C 708030 COST ST CHARLES HOSPITAL B 23000000 COST ST CHARLES HOSPITAL DLQS 6543751 COST ST CATHERINE OF SIENA MEDICAL CENTER C 797211 COST ST CATHERINE OF SIENA MEDICAL CENTER DLQS 8027165 COST ST CATHERINE OF SIENA MEDICAL CENTER A 213963 COST ST CATHERINE OF SIENA MEDICAL CENTER B 21000000 COST WSNCHS NORTH INC (ST JOSEPH HOSPITAL) C 376528 COST WSNCHS NORTH INC (ST JOSEPH HOSPITAL) B 16000000 COST WSNCHS NORTH INC (ST JOSEPH HOSPITAL) LQS 274886 COST OUR LADY OF CONSOLATION GERIATRIC CARE CENTER C 172053 COST OUR LADY OF CONSOLATION GERIATRIC CARE CENTER LQS 1519078 COST OUR LADY OF CONSOLATION GERIATRIC CARE CENTER B 2000000 COST MARYHAVEN CENTER OF HOPE C 262689 COST MARYHAVEN CENTER OF HOPE DLQS 287246 COST MARYHAVEN CENTER OF HOPE B 5000000 COST MARYHAVEN CENTER OF HOPE A 80398 COST CATHOLIC HOME CARE LQS 3881335 COST CATHOLIC HOME CARE C 189165 COST GOOD SHEPHERD HOSPICE C 118157 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.