2019-11-14T15:45:47-06:00 2018-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2018-01-01 111888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER % CHS SERVICES GOOD 6313763000 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 RUTH HENNESSEY PRESIDENT 5167051919 2019-11-08 true LAURA J PARELLO P01080295 6464713000 167.68.125.77 13049920193185000086 2019-11-14 P 3B584E6C6EC03F54C23492763082C94E75791172 F456C520C4F0493F307ED3F1DC1F0DE42227702A 2018 2020-03-31 21:24:44Z ALAN D GUERCI MD 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 693685598 false 0928 X HTTP://GOODSAMARITAN.CHSLI.ORG/ X 1959 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. 23 22 4237 407 1526762 -996643 2461447 4091606 613796868 657920555 2900766 3927880 16719866 14938799 635878947 680878840 1938293 2009305 0 0 322297548 339227221 0 0 0 300991823 342232163 625227664 683468689 10651283 -2589849 544423186 555892776 272535266 297734936 271887920 258157840 X SEE SCHEDULE O false false 596382146 2009305 647573728 GOOD SAMARITAN HOSPITAL MEDICAL CENTER IS 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. 9085718 0 11196098 GOOD SAMARITAN NURSING HOME IS LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN SAYVILLE, NEW YORK. THE 100 BED FACILITY HAS BEEN PART OF GOOD SAMARITAN HOSPITAL MEDICAL CENTER SINCE 1980. THE RESIDENT POPULATION OF THE NURSING HOME IS MEDICALLY COMPLEX AND REQUIRES FULL-TIME CARE. SKILLED NURSING CARE AT THE FACILITY PROVIDES ONGOING MEDICALLY COMPLEX CARE ALONG WITH GERIATRIC CARE, REHABILITATIVE CARE, AND DEMENTIA DISEASE CARE. 2018 PATIENT DAYS FOR THE NURSING HOME TOTALED 35,311. 605467864 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true false false true 317 0 true 4237 true true true false false false false false false false false false false 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 5167053700 992 NORTH VILLAGE AVE ROCKVILLE CENTRE NY 11570 X SALVATORE SODANO CHAIRMAN 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 0 2639580 401663 DANIEL DEBARBA EVP & CFO 50.0 0.0 X 0 1103919 376508 THOMAS OCKERS CAO THROUGH 12/18/18 50.0 0.0 X 622015 0 48797 RUTH HENNESSEY PRESIDENT EFFECTIVE 12/19/18 50.0 0.0 X 11458 758529 169337 DONALD TEPLITZ CMO 50.0 0.0 X 576177 0 58222 JOHN MCMURRAY COO 50.0 0.0 X 362713 0 54996 NEIL LOBO PHYSICIAN 50.0 0.0 X 955613 0 58186 KOUROSH ADHAMI PHYSICIAN 50.0 0.0 X 955613 0 58186 BABAK DANESH PHYSICIAN 50.0 0.0 X 914750 0 32046 JAMES KOHLROSER PHYSICIAN 50.0 0.0 X 921933 0 60786 PANKAJ SINGHAL PHYSICIAN 50.0 0.0 X 1460085 0 60786 WILLIAM C ARMSTRONG SVP FINANCE 0.0 50.0 X 0 868007 207575 6780357 5370035 1587088 852 true true false PROGRESSIVE EMERGENCY PHYSICIANS LL 1236 RXR PLAZA UNIONDALE NY 11556 PHYSICIAN SERVICES 17460607 MEDICAL SOLUTIONS 9101 WESTERN AVENUE SUITE 101 OMAHA NE 68114 NURSING SERVICES 2813733 MAJESTIC PROP MGT AAF CAPTREE 60 CUTTERMILL RD GREAT NECK NY 11021 RENT 933003 COLUMBIA PARTNERS LLC 161 STILLWELL LA LAUREL HOLLOW NY 11792 RENT 788915 REMI HOLDINGS LLC 11325 N COMMUNITY HOUSE ROAD SUITE CHARLOTTE SC 28277 EQUIP MAINTENANCE 867185 52 794005 3217614 79987 4091606 NET PATIENT SERVICE REVENUE - HOSPITAL 622110 646724457 646724457 NET PATIENT SERVICE REV. - NURSING HOME 623000 11196098 11196098 657920555 3856792 3856792 0 0 2100755 2100755 0 2100755 2100755 12877846 12806758 71088 71088 71088 0 0 0 0 0 0 0 0 0 RESIDENT SHARING PROGRAM-MANAGEMENT FEE 900099 1585698 1585698 COFFEE SHOP & CAFETERIA 722514 1593440 1593440 LAB SERVICES 621500 7198823 1526762 5672061 2460083 849271 1610812 12838044 680878840 658769826 1526762 16490646 2009305 2009305 0 0 0 1734378 634399 1099979 0 0 252322183 236331780 15990403 21051405 19635277 1416128 42316142 39056320 3259822 21803113 20336418 1466695 226300 60968 165332 4473 4473 4500 4500 123521 123521 0 0 34384014 30642261 3741753 1613401 130536 1482865 8577604 4879475 3698129 0 0 8852352 7662324 1190028 268594 239606 28988 0 0 371922 371922 42977539 42977539 24436905 20109393 4327512 16041005 16041005 MEDICAL SUPPLIES EXPENSE 112982963 112982963 CHS SERVICES 48746718 17511286 31235432 EQUIPMENT SERVICE CONTRACTS 7125149 7125149 HOME OFFICE ALLOCATION 8029366 8029366 27465837 26725465 740372 683468689 605467864 78000825 0 X 12326151 9733273 111239403 97176226 0 0 74180502 78712970 0 0 0 0 0 0 7115524 7502341 6068251 7200243 562183330 368413800 175395642 193769530 36876653 37317878 0 0 0 0 0 0 121221060 124480315 544423186 555892776 77260932 85205571 0 0 0 0 4859904 4293297 0 0 0 0 2005370 2308913 0 0 188409060 205927155 272535266 297734936 X 270159761 256412943 1728159 1744897 0 0 271887920 258157840 544423186 555892776 X -2589849 -9280920 -1859311 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 123521 123521 false PART II-B, LINE 1 - OTHER LOBBYING ACTIVITIES AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON THE BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ASSOCIATIONS REPRESENT. 5039490 5039490 264694349 155551456 109142893 11307566 10603744 703822 270737673 202258600 68479073 10404252 10404252 193769530 OTHER RECEIVABLES 4019141 DUE FROM RELATED PARTIES 18744005 INSURANCE CLAIMS RECEIVABLE 101045054 GOODWILL ISLAND DIGESTIVE 672115 124480315 0 THIRD PARTY PAYOR LIABILITY 24550740 SELF INSURANCE RESERVE-MALPRAC 107666954 SELF INSURANCE RESERVE-LIABILI 45016991 OTHER NON-CURRENT LIABILITIES 7940039 DUE TO RELATED PARTIES 20752431 205927155 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 true X true X 300. true X true true true false true true 9867523 6593112 3274411 0.00480 91001582 67758727 23242855 0.03400 13571306 8762365 4808941 0.00700 114440411 83114204 31326207 0.04580 1249650 0 1249650 0.00180 9446804 4310269 5136535 0.00750 330899 206417 124482 0.00020 209434 0 209434 0.00030 11236787 4516686 6720101 0.00980 125677198 87630890 38046308 0.05560 true 7809241 151246491 177498660 -26252169 X true true 1 1 GOOD SAMARITAN HOSPITAL MEDICAL CTR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 HTTP://GOODSAMARITAN.CHSLI.ORG/ 5154001H X X X X HOSPITAL GOOD SAMARITAN HOSPITAL MED CTR 1 false false true X X X X X X X X 16 true true true true X goodsamaritan.chsli.org/ X www.chsli.org true 16 true www.chsli.org false true X 300. 400. X X X true true X X X true X www.chsli.org X www.chsli.org X www.chsli.org X X X X X X true X false X X X X X true X false false PART V, SECTION B, LINE 3E IN 2016, MEMBERS OF THE LONG ISLAND HEALTH COLLABORATIVE REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM HEALTH NEEDS PRIORITIES FOR THE 2016-2018 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM (PHIP), WITH THE PHIP SERVING AS THE CENTRALIZED DATA RETURN AND ANALYSIS HUB. AS DIRECTED BY THE DATA RESULTS, COMMUNITY PARTNERS SELECTED CHRONIC DISEASE AS THE PRIORITY AREA WITH A FOCUS ON (1) OBESITY AND (2) PREVENTIVE CARE AND MANAGEMENT FOR THE 2016-2018 CYCLE. THE GROUP ALSO AGREED A STRONG EMPHASIS ON MENTAL HEALTH WITH INTEGRATATION THROUGHOUT THE INTERVENTION STRATEGIES. PART V, SECTION B, LINE 5 GOOD SAMARITAN HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ASSOCIATION WITH LONG ISLAND HEALTH COLLABORATIVE (LIHC) MEMBERS. THE LIHC IS A PARTNERSHIP OF LONG ISLAND'S HOSPITALS, COUNTY HEALTH DEPARTMENTS, HEALTH PROVIDERS, COMMUNITY-BASED SOCIAL AND HUMAN SERVICE ORGANIZATIONS, ACADEMIC INSTITUTIONS, HEALTH PLANS, LOCAL GOVERNMENT AND THE BUSINESS SECTOR, ALL ENGAGED IN IMPROVING THE HEALTH OF LONG ISLANDERS. THE LIHC IS THE MAIN WORKING GROUP ASSOCIATED WITH CARRYING OUT THE GOALS OF THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM. IN 2016, MEMBERS OF LIHC REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM PREVENTION AGENDA PRIORITIES FOR THE 2016-2018 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. PRIMARY DATA SOURCES COLLECTED AND ANALYZED INCLUDE THE LONG ISLAND COMMUNITY HEALTH ASSESSMENT SURVEY, QUALITATIVE DATA FROM COMMUNITY-BASED ORGANIZATION SUMMIT EVENTS, AND THE LIHC WELLNESS SURVEY. THE BROAD COMMUNITY WAS ENGAGED IN ASSESSMENT EFFORTS THROUGH THE DISTRIBUTION AND COMPLETION OF THE PREVENTION AGENDA COMMUNITY MEMBER SURVEYS. THIS TOOL WAS DEVELOPED IN COLLABORATION WITH COMMUNITY PARTNERS FROM THE LIHC. DATA FROM THIS SURVEY WERE COLLECTED AUGUST 1, 2015 THROUGH APRIL 30, 2016 THROUGH DISTRIBUTION AND PROMOTION OF THIS SURVEY THROUGHOUT A WIDE RANGE OF SOCIAL SERVICE LOCATIONS, INCLUDING GOOD SAMARITAN HOSPITAL, DOCTOR'S OFFICES, HEALTH DEPARTMENTS, LIBRARIES, SCHOOLS, INSURANCE ENROLLMENT SITES AND COMMUNITY-BASED ORGANIZATIONS. THIS INCLUDES THE MEDICALLY UNDERSERVED COMMUNITIES OF BAY SHORE, WYANDANCH, BRENTWOOD AND CENTRAL ISLIP. GOOD SAMARITAN HOSPITAL PROMOTES THE SURVEY THROUGH SOCIAL MEDIA LINKS, ON ITS WEBSITE, AND BY DISTRIBUTING SURVEYS AT HEALTH FAIRS AND OTHER CONSUMER-ORIENTED EVENTS. PART V, SECTION B, LINE 6A BROOKHAVEN MEMORIAL HOSPITAL (NOW CALLED LONG ISLAND COMMUNITY HOSPITAL), NORTHWELL HEALTH SYSTEM (HUNTINGTON HOSPITAL, SOUTHSIDE HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL, PECONIC BAY MEDICAL CENTER), GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CATHERINE OF SIENA MEDICAL CENTER, STONY BROOK SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY HOSPITAL AND VETERANS AFFAIRS MEDICAL CENTER. PART V, SECTION B, LINE 6B THE HOSPITAL'S CHNA WAS ALSO CONDUCTED WITH NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND MORE THAN 40 COMMUNITY-BASED ORGANIZATIONS, COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). PART V, SECTION B, LINE 11 GOOD SAMARITAN HOSPITAL AND LIHC COMMUNITY PARTNERS SELECTED CHRONIC DISEASE AS THE PRIORITY AREA WITH A FOCUS ON (1) OBESITY AND (2) PREVENTIVE CARE AND MANAGEMENT FOR THE 2016-2018 CYCLE. MENTAL HEALTH WILL BE HIGHLIGHTED WITHIN ALL INTERVENTION STRATEGIES. PRIORITY 1: OBESITY THE HOSPITAL IS IMPROVING COMMUNITY HEALTH BY WORKING TO REDUCE THE INCIDENCE OF OBESITY AND RELATED CO-MORBIDITIES SUCH AS HEART DISEASE AND DIABETES BY PROVIDING INDIVIDUALS WITH THE TOOLS AND KNOWLEDGE TO POSITIVELY IMPACT FOOD CHOICES AND ACTIVITY LEVELS. THE HEALTHIER FAMILIES PROGRAM, A FREE, 10-WEEK EDUCATIONAL SERIES PROMOTING A HEALTHY LIFESTYLE, WAS OFFERED IN COLLABORATION WITH THE BAY SHORE WELLNESS ALLIANCE. IT IS OFFERED TO CHILDREN IN GRADES 3-5 WHO RESIDE IN THE UNDERSERVED BAY SHORE SCHOOL DISTRICT AND WHO HAVE BEEN DESIGNATED AS AT-RISK FOR FUTURE OBESITY-RELATED HEALTH ISSUES. IN 2018, 15 FAMILIES WERE ENROLLED IN THE HEALTHIER FAMILIES PROGRAM. AT LEAST 75% OF THE STUDENTS DEMONSTRATED RELEVANT IMPROVEMENT IN HEIGHT/WEIGHT/BMI AT THE END OF THE 10 WEEK SESSION. IN A SURVEY OF STUDENTS AND PARENTS, MORE THAN 90% DEMONSTRATED A GREATER KNOWLEDGE AND AWARENESS OF THE IMPORTANCE OF A HEALTHY LIFESTYLE AND THE NEED TO CONTINUE. FREE BARIATRIC EDUCATIONAL SEMINARS ARE HELD MONTHLY, HOSTED BY ONE OF THREE GOOD SAMARITAN BARIATRIC SURGEONS. IN 2018, 368 PEOPLE ATTENDED THE 19 BARIATRIC SEMINARS OFFERED AT THE HOSPITAL. GOOD SAMARITAN OFFERS FREE BARIATRIC SUPPORT GROUPS TWICE A MONTH, FACILITATED BY A REGISTERED NURSE AND SUPPORTED BY A LICENSED SOCIAL WORKER WITH A BACKGROUND IN EATING DISORDERS. THESE GROUPS HELP PATIENTS PREPARE FOR SURGERY AND MAKE THE NECESSARY CHANGES TO BE SUCCESSFUL IN THEIR JOURNEY TOWARD A HEALTHIER LIFESTYLE. IN ADDITION, POST-SURGERY PATIENTS RECEIVE THE SUPPORT NEEDED TO CONTINUE TO MAINTAIN A HEALTHY LIFESTYLE FOLLOWING WEIGHT-LOSS SURGERY. THE AVERAGE NUMBER OF ATTENDEES AT AN EVENING MEETING IS 30-33, OF WHICH 15 NEW PARTICIPANTS ARE PRE-SURGICAL. THE AVERAGE NUMBER OF ATTENDEES AT AN AFTERNOON MEETING IS 10-20, OF WHICH 9 ARE PRE-SURGICAL. FREE COMMUNITY FOOD FOR YOUR SOUL WORKSHOPS ARE OFFERED, HIGHLIGHTING THE IMPORTANCE OF NUTRITION. IN 2018 THE FOOD FOR YOUR SOUL WORKSHOPS FOCUSED ON OBESITY AND DIABETES, AND WERE ACCOMPANIED BY A COOKING DEMONSTRATION AND TASTING; 47 COMMUNITY MEMBERS ATTENDED. IN RECOGNITION OF NATIONAL NUTRITION MONTH, REGISTERED DIETICIANS FROM THE FOOD AND NUTRITION DEPARTMENT HOSTED AN INFORMATION TABLE IN THE EMPLOYEE CAFETERIA. THE HOSPITALS REGISTERED DIETICIANS PLANNED MEATLESS MONDAYS AND HEALTHY THURSDAY MENU OPTIONS FOR THE STAFF TO ENCOURAGE HEALTHY EATING BEHAVIORS. GOOD SAMARITAN HOSPITAL PARTICIPATES IN THE AMERICAN HEART ASSOCIATION HEART WALK, THE LONG ISLAND MARCUM WORKPLACE CHALLENGE - A 3.5-MILE RUN-WALK FOR CHARITY - AND THE AMERICAN CANCER SOCIETY'S MAKING STRIDES AGAINST BREAST CANCER WALK. IN 2018, 193 EMPLOYEES PARTICIPATED IN THE THREE WALKS. THESE EVENTS ENCOURAGE WALKING FOR PHYSICAL ACTIVITY AND GOOD HEALTH FOR EMPLOYEES AND THE COMMUNITY. EDUCATIONAL MATERIALS ARE OFFERED AT EACH EVENT. CHS WAS THE MEDAL OF HONOR TITLE SPONSOR AND THE OFFICIAL RACE MEDICINE PROVIDER FOR THE 2018 CHS SUFFOLK COUNTY MARATHON. THE NET PROCEEDS FROM THE ANNUAL EVENT BENEFITS LOCAL VETERANS' SERVICES ORGANIZATIONS. THERE WERE 32 GOOD SAMARITAN EMPLOYEES WHO WORKED IN THE RACE MEDICINE TENT. PRIORITY 2: PREVENTIVE CARE AND MANAGEMENT THE THERESA PATNODE SANTMANN HEART AND SOUL SYMPOSIUM WAS HELD ON AUGUST 15, 2018, WITH 210 COMMUNITY MEMBERS IN ATTENDANCE. THE SYMPOSIUM IS FREE AND EXPLORES ASPECTS OF WELLNESS AND CHRONIC ILLNESSES AND INCLUDES A NUTRITION COMPONENT FOR EACH EDUCATIONAL WORKSHOP. IN 2018, HEALTH CARE PROFESSIONALS OFFERED FREE, COMMUNITY-BASED BLOOD PRESSURE SCREENINGS AT THE WEST ISLIP LIBRARY ON THE FIRST WEDNESDAY OF EVERY MONTH. STAFF PROVIDED 90 BLOOD PRESSURE SCREENINGS TO COMMUNITY MEMBERS. GOOD SAMARITAN HOSPITAL OFFERED FREE COMMUNITY LECTURES HIGHLIGHTING NUTRITION AND CARDIOLOGY, AND PROVIDED SPEAKERS AND INFORMATION ON THE IMPORTANCE OF NUTRITION, HEART HEALTH AND DIABETES. A TOTAL OF 10 BLOOD PRESSURE SCREENINGS AND 21 COLORECTAL CANCER SCREENING KITS WERE PROVIDED AT THE COMMUNITY LECTURES. GOOD SAMARITAN STAFF VOLUNTEERED AT CHS HEALTHY SUNDAYS COMMUNITY OUTREACH EVENTS HELD AT CHURCHES IN UNDERSERVED COMMUNITIES, OFFERING FREE HEALTH SCREENINGS AND PROVIDING EDUCATIONAL MATERIALS ON PREVENTIVE HEALTH. IN 2018, GOOD SAMARITAN VOLUNTEER STAFF SUPPORTED 5 EVENTS WITH 162 BLOOD PRESSURE AND 37 BMI SCREENINGS, AND 117 FLU VACCINATIONS WERE ADMINISTERED. REFERRALS FOR FREE FOLLOW-UP CARE AT THE BISHOP MCHUGH HEALTH CENTER IN BABYLON OR SOUTH BAY CARDIOVASCULAR WERE PROVIDED TO 24 INDIVIDUALS. GOOD SAMARITAN HOSPITAL POSTS EDUCATIONAL VIDEOS ON YOUTUBE.COM/GSHMC ON VARIOUS TOPICS SUCH AS GENETIC COUNSELING, COLON CANCER PREVENTION AND DIAGNOSIS, AND OTHERS. FOUR FREE GOOD SAM UNIVERSITY COMMUNITY LECTURES WERE OFFERED TO 232 ATTENDEES AT WORKSHOPS HELD IN 2018. GOOD SAMARITAN HOSPITAL HOSTS A FREE POSITIVELY PINK! EVENT AT THE WESTFIELD MALL IN BAY SHORE, LOCATED NEAR MEDICALLY UNDERSERVED COMMUNITIES. COMMUNITY MEMBERS CAN SPEAK WITH BREAST HEALTH EXPERTS, REGISTERED DIETITIANS AND NURSES ABOUT BREAST HEALTH AND DISEASE PREVENTION. INFORMATION, BLOOD PRESSURE SCREENINGS AND ON-SITE MAMMOGRAPHY APPOINTMENT SCHEDULING ARE OFFERED. IN OCTOBER 2018, THE POSITIVELY PINK! HEALTH FAIR WAS ATTENDED BY 100 PEOPLE AND VOLUNTEER STAFF PROVIDED 11 BLOOD PRESSURE SCREENINGS. THE SEVEN-WEEK STEPPING ON PROGRAM IS AN EVIDENCE-BASED FALL PREVENTION PROGRAM DESIGNED TO IMPROVE BALANCE AND STRENGTH AND HELP REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS. IN 2018, THE PROGRAM WAS OFFERED 4 TIMES WITH MORE 68 TOTAL ATTENDEES. PRIORITY 3: MENTAL HEALTH THE HOSPITAL IS PROVIDING TARGETED POPULATIONS WITH INFORMATION ABOUT THE SIGNS AND SYMPTOMS OF MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES (OFTEN OCCURRING CONCOMITANTLY WITH A CHRONIC DISEASE) AND OFFERING LINKS TO COMMUNITY-BASED CLINICAL PROGRAMS AND SERVICES. WHEN A LACK OF ACCESS TO MENTAL HEALTH RESOURCES IS IDENTIFIED, GOOD SAMARITAN HOSPITAL PROVIDES INFORMATION ON AND REFERS PATIENTS TO THE EXTENSIVE MENTAL HEALTH SERVICES AVAILABLE WITHIN CHS AND ITS PARTNERS. IF NOT AVAILABLE WITHIN CHS, GOOD SAMARITAN HOSPITAL WILL USE LIHC'S DATABASE TO IDENTIFY OR RECOMMEND A SUITABLE OPTION. THE CHS MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE THROUGHOUT THE HOSPITAL AND AT ALL GOOD SAMARITAN HOSPITAL OUTREACH EVENTS. TO COMBAT THE GROWING OPIOID EPIDEMIC, THE HIGH-VOLUME EMERGENCY DEPARTMENT (ED) AT GOOD SAMARITAN IS THE SITE OF AN INNOVATIVE PILOT-THE SHERPA PROGRAM-ROLLED OUT IN 2017. CHS BEGAN COLLABORATING WITH THE DIOCESE OF ROCKVILLE CENTRE, LONG ISLAND COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE AND THE FAMILY & CHILDREN'S ASSOCIATION (FCA) TO BUILD AN ADDICTION TREATMENT INFRASTRUCTURE ON LONG ISLAND. TWO GOALS WERE DETERMINED: TO REVISIT EXISTING ED PROTOCOLS FOR OVERDOSE VICTIMS AND TO CREATE A LIAISON PROGRAM TO CONNECT THESE PATIENTS WITH SUPPORT SERVICES. SINCE ITS INCEPTION, THE PROGRAM HAS PROVIDED SERVICES TO 281 INDIVIDUALS AT RISK OF AN OVERDOSE. A CHS POLICY WAS ESTABLISHED TO PREVENT UNNECESSARY OPIOID PRESCRIPTIONS IN THE EMERGENCY DEPARTMENT(ED), AND THE SHERPA PROGRAM WAS DEVELOPED BY FCA. A FREE SERVICE PROVIDED BY FCA, SHERPA IS STAFFED BY PEER RECOVERY COACHES TRAINED TO MEET WITH OVERDOSE SURVIVORS AND THEIR FAMILIES IN EDs. THE TEAM DIRECTS PEOPLE TO TREATMENT, OFFERING ENCOURAGEMENT AND FOLLOW-UP. SHERPA IS SUPPORTED BY THE NEW YORK STATE (NYS) OFFICE OF ALCOHOLISM & SUBSTANCE ABUSE SERVICES, NYS SENATE AND LONG ISLAND COMMUNITY FOUNDATION. IN AUGUST 2018, GOOD SAMARITANS MISSION AND MINISTRY COMMITTEE SPONSORED "THE RIGHT TOOLS FOR SCHOOL", A SCHOOL SUPPLY COLLECTION. THE HOSPITAL "ADOPTS" 25 STUDENTS SELECTED BY YOUTH ENRICHMENT SERVICES (YES), A LOCAL SERVICE AGENCY THAT WORKS WITH NEEDY CHILDREN AND FAMILIES IN THE TOWN OF ISLIP. THE STUDENT INFORMATION IS NOT DISCLOSED, BUT INFORMATION IS PROVIDED ABOUT THEIR GENDER, AGE, FAVORITE COLOR AND SCHOOL SUPPLIES THEY WILL NEED. PART V, SECTION B, LINE 20E GOOD SAMARITAN HOSPITAL MEDICAL CENTER HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN GOOD SAMARITAN HOSPITAL MEDICAL CENTER, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH AND ARE CLEARLY VISIBLE TO THE PUBLIC. GOOD SAMARITAN HOSPITAL MEDICAL CENTER HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 1 GOOD SAMARITAN NURSING HOME 101 ELM STREET SAYVILLE NY 11782 SKILLED NURSING FACILITY PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS. PART I, LINE 7A, COLUMN (D) DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S "NEED" CALCULATION. THIS CALCULATION CONSIDERS 100% OF A HOSPITAL'S "NEED" BASED ON A "UNITS OF SERVICE" METHODOLOGY FOR UNINSURED PATIENTS. THE CALCULATION ALSO MAKES ADJUSTMENTS BASED ON THE PROPORTION OF MEDICAID ELIGIBLE PATIENTS TREATED AT THE FACILITY. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2018. PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT AS PART OF ITS TAX EXEMPT PURPOSE, GOOD SAMARITAN HOSPITAL MEDICAL CENTER PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. GOOD SAMARITAN HOSPITAL MEDICAL CENTER TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF WHETHER THEY HAVE THIRD-PARTY COVERAGE OR THE ABILITY TO PAY. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, GOOD SAMARITAN HOSPITAL MEDICAL CENTER IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM GOOD SAMARITAN HOSPITAL MEDICAL CENTER SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY. PART III, LINES 2 AND 4 - TEXT OF FOOTNOTE DISCUSSING BAD DEBT PAGES 22 TO 29 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PATIENT ACCOUNTS RECEIVABLE. THE FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN. PART III, LINE 8 - COSTING METHODOLOGY THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2018 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. PART III, LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. GOOD SAMARITAN BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY BUT ALSO DOING SO WITH NO RECOURSE IN OBTAINING PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING-EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED ARE NOT TURNED AWAY. GOOD SAMARITAN WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY. PART III, LINE 9B THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INABILITY TO PAY FOR THOSE SERVICES. IN ADDITION, UPON APPLYING FOR CHARITY CARE, EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY WILL BE ASSESSED. ELIGIBILITY FOR ASSISTANCE: A REASONABLE REVIEW SHALL BE PERFORMED PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (I.E. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE CHS CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET. PART VI, LINE 2 - ASSESSMENT OF COMMUNITY NEEDS AND GOALS COMMUNITY HEALTH NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT MEETINGS, AT COLLABORATIVE SESSIONS WITH MEMBER HOSPITALS OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AND WITH PARTNERS AT COMMUNITY AGENCIES AND ORGANIZATIONS THAT ARE PART OF THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). THE LIHC COMMUNITY HEALTH ASSESSMENT SURVEYS ARE OFFERED YEAR-ROUND AT MULTIPLE OUTREACH SITES IN THE COMMUNITY. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH, SPANISH, POLISH, HAITAIN CREOLE AND LARGE PRINT) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT SERVES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CHS'S WEBSITE. GOOD SAMARITAN HOSPITAL CONTINUES TO COLLABORATE WITH OTHER HOSPITALS, LOCAL HEALTH DEPARTMENTS, HEALTH CARE PROVIDERS, PUBLIC HEALTH SPECIALISTS FROM ACADEMIC INSTITUTIONS AND COMMUNITY-BASED ORGANIZATIONS AT LIHC EVENTS. LIHC'S WEBSITE OFFERS COMPREHENSIVE INFORMATION TO PROMOTE GOOD HEALTH AND PREVENT CHRONIC DISEASE. IN ADDITION TO PROVIDING NUMEROUS RESOURCES SUCH AS HEALTH PROGRAM INVENTORIES, HEALTH INSURANCE INFORMATION AND EDUCATIONAL VIDEOS, LIHC AND ITS MEMBERS HAVE ORGANIZED WALKING PROGRAMS, AND DEVELOPED A UNIVERSAL SCREENING TOOL TO HELP MEASURE THE EFFECTIVENESS OF COMMUNITY HEALTH EFFORTS. MORE INFORMATION CAN BE FOUND AT WWW.LIHEALTHCOLLAB.ORG. ADDITIONALLY, COMMUNITY NEEDS SURVEYS ARE COMPLETED BY PARTICIPANTS ATTENDING THE HOSPITAL'S HEALTH SCREENINGS AT LIBRARIES AND SENIOR CENTERS THROUGHOUT THE COUNTY. PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY 1. SINCE IT IS THE DUTY OF THE MEDICAL CENTER TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF THE MEDICAL CENTER'S CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS HAVE BEEN FULLY VERSED IN THE MEDICAL CENTER'S CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. THE MEDICAL CENTER HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE MEDICAL CENTER INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. THE MEDICAL CENTER PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. THE MEDICAL CENTER HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE MEDICAL CENTER PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING THE MEDICAL CENTER'S CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, INFORMATION IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER DETAILS. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4 - COMMUNITY INFORMATION GOOD SAMARITAN'S PRIMARY SERVICE AREA INCLUDES: AMITYVILLE, BABYLON, NORTH BABYLON, WEST BABYLON, BAY SHORE, BRENTWOOD, COPIAGUE, DEER PARK, LINDENHURST, WEST ISLIP, CENTRAL ISLIP, EAST ISLIP AND WYANDANCH. THE SECONDARY CATCHMENT AREA COMPRISES EAST MASSAPEQUA, FARMINGDALE, ISLIP, ISLIP TERRACE, HOLBROOK, BOHEMIA, PATCHOGUE, SAYVILLE, OAKDALE AND RONKONKOMA. THE SERVICE AREA POPULATION IS COMPRISED OF SEVERAL COMMUNITIES WHERE INDIVIDUALS SPEAK A LANGUAGE OTHER THAN ENGLISH, SUCH AS THE SELECT, UNDERSERVED COMMUNITIES OF BAY SHORE, BRENTWOOD AND CENTRAL ISLIP. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH GOOD SAMARITAN HOSPITAL MEDICAL CENTER (GOOD SAMARITAN) IS A NOT-FOR-PROFIT COMPREHENSIVE HEALTH CARE FACILITY RENDERING INPATIENT, AMBULATORY, AND EMERGENCY MEDICAL CARE TO THE COMMUNITY. IN ADDITION, GOOD SAMARITAN OPERATES A NURSING HOME AND THE BISHOP MCHUGH HEALTH CENTER IN BABYLON, WHICH CARES FOR MEDICALLY UNDESERVED RESIDENTS. IN 2018, THE HEALTH CENTER HAD MORE THAN 200 PATIENT VISITS. GOOD SAMARITAN CONTINUES TO OFFER A CHILD PASSENGER SAFETY PROGRAM TO PROMOTE THE PROPER INSTALLATION OF CHILD SAFETY SEATS AND BOOSTER SEATS. GOOD SAMARITAN SERVES AS A COMMUNITY RESOURCE FOR CHILD PASSENGER SAFETY AND PROVIDES EDUCATION TO PARENTS BY APPOINTMENT ON PROPER TECHNIQUES FOR TRANSPORTING CHILDREN, ALONG WITH FREE CHILD SAFETY SEAT CHECKS. SIXTY-FOURT COMMUNITY MEMBERS TOOK ADVANTAGE OF THIS PROGRAM IN 2018. GOOD SAMARITAN HOSTS BLOOD DRIVES THROUGHOUT THE YEAR. DONORS INCLUDE GOOD SAMARITAN STAFF AND COMMUNITY MEMBERS. VICTIMS OF SEXUAL ASSAULT HAVE SPECIAL AND SERIOUS MEDICAL NEEDS THAT MUST BE ADDRESSED PROMPTLY, WITH EXPERTISE AND SENSITIVITY, WHILE SIMULTANEOUSLY ENSURING THE ACCURATE AND APPROPRIATE COLLECTION OF FORENSIC EVIDENCE. TO THAT END, GOOD SAMARITAN DEVELOPED THE SEXUAL ASSAULT FORENSIC EXAMINER PROGRAM (SAFE). THE SAFE CENTER IS AN EXTENSION OF THE EMERGENCY DEPARTMENT AND CONTINUES TO PROVIDE A PRIVATE AND SUPPORTIVE SETTING TO ALL VICTIMS TO ENSURE THE PROPER EVALUATION, TREATMENT, AND REFERRAL FOR FOLLOW UP. IN ADDITION, APPROPRIATE EVIDENCE COLLECTION AND DOCUMENTATION IS ALSO COMPLETED IN THIS SETTING. HEALTH REFERRAL LINE IN 2018, THERE WERE A TOTAL OF 18,518 RECORDED REQUESTS BY THE COMMUNITY REGARDING PHYSICIAN REFERRALS, SPECIALTY DEPARTMENT AND SERVICES INFORMATION, COMMUNITY LECTURES, HEALTH AND WELLNESS FAIRS, HEALTH SCREENINGS, AND SPECIAL EVENTS. GOOD SAMARITAN HOSPITAL MEDICAL CENTER PARTICIPATES IN THE COMPREHENSIVE CARE FOR JOINT REPLACEMENT (CJR) MODEL. THE CJR MODEL AIMS TO SUPPORT BETTER AND MORE EFFICIENT CARE FOR BENEFICIARIES UNDERGOING THE MOST COMMON INPATIENT SURGERIES FOR MEDICARE BENEFICIARIES: HIP AND KNEE REPLACEMENTS (ALSO CALLED LOWER EXTREMITY JOINT REPLACEMENTS OR LEJR). PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM GOOD SAMARITAN HOSPITAL MEDICAL CENTER (GOOD SAMARITAN) IS AN ACUTE CARE HOSPITAL LOCATED ON A SINGLE CAMPUS IN WEST ISLIP, NY, WITH A SKILLED NURSING FACILITY ON A SEPARATE CAMPUS IN SAYVILLE, NY. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, GOOD SAMARITAN THROUGH ITS DAILY OPERATIONS, PROVIDES THE AREA WITH ACUTE, EMERGENT, AND OUTPATIENT CARE. GOOD SAMARITAN IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND)(CHS), WHICH IS A NEW YORK, NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2018, CHS COMPRISED SIX HOSPITALS (MERCY MEDICAL CENTER, ST. FRANCIS HOSPITAL, AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL, AND ST. CATHERINE OF SIENA MEDICAL CENTER IN SUFFOLK COUNTY), AS WELL AS THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING AND REHABILITATION CARE CENTER, GOOD SAMARITAN NURSING AND REHABILITATION CARE CENTER, AND OUR LADY OF CONSOLATION NURSING AND REHABILITATIVE CARE CENTER, ALL IN SUFFOLK COUNTY), A REGIONAL HOME CARE AND HOSPICE NETWORK, AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 18,400 STAFF AND 4,300 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CHS PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: WE, AT CATHOLIC HEALTH SERVICES, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. MEMBER ORGANIZATIONS OF CHS OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. ALL OF CHS'S MEMBER ORGANIZATIONS HAVE RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY AND THEIR DISTINCTIVE PERSONALITIES, AS WELL AS THE SERVICE SPECIALTIES WHICH THEY ARE KNOWN FOR, THUS EMBEDDING THE ORGANIZATION IN THE COMMUNITY AND SERVING IT EFFECTIVELY. CHS ENTITIES PROVIDE AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS, PROVIDE FREE HEALTH SCREENINGS THROUGH THE SYSTEM'S HEALTHY SUNDAYS PROGRAMS, HEALTH FAIRS, AND OTHER PROGRAMS. SINCE 1907, CATHOLIC HEALTH SERVICES HAS HAD A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF IMPROVING THE COMMUNITY'S HEALTH. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVE ROCKVILLE CNTR ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 2009305 NONE NONE MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS TO UNDERSERVED COMMUNITY AND 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 AND CATHOLIC HEALTH SERVICES OF LONG ISLAND AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH SERVICES OF LONG ISLAND USES THE GRANT FUNDS FOR MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS TO UNDERSERVED COMMUNITIES AND CAPITAL SUPPORT. PART II, LINE 1, COLUMN (H) NAMES OF ORGANIZATION OR GOVERNMENT: CATHOLIC HEALTH SYSTEM OF LONG ISLAND (H) PURPOSE OF GRANT: 1) SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND AS A PASS THROUGH TO PROVIDE GENERAL SUPPORT TO THE CATHOLIC MINISTRIES OF THE DIOCESE OF ROCKVILLE CENTRE IN CONNECTION WITH THE FORMATION OF YOUTH AND ADULTS IN THE FAITH, PROMOTION OF THE DIGNITY OF LIFE, PROMOTION OF QUALITY EDUCATION FOR YOUNG PEOPLE, AND FOSTERING OF VOCATIONS FOR THE PRIESTHOOD; 2) PROVIDE SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND TO FUND OUTPATIENT CENTERS THAT PROVIDE CHARITY CARE TO THOSE CENTERS COMMUNITIES; AND 3) TO FUND SUPPORT PROVIDED THROUGH THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CAREGIVERS FUND. THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CAREGIVERS FUND WAS FORMED WITH THE MISSION TO ASSIST OUR FELLOW CAREGIVERS ON THE FRONT LINES, HERE AND ABROAD, WHO STRUGGLE JUST TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. X X X X X X false true false false false false false false false ALAN D GUERCI MD PRESIDENT & CEO 0 1465503 0 529000 0 645077 0 364815 0 36848 0 3041243 0 609236 DANIEL DEBARBA EVP & CFO 0 870966 0 200000 0 32953 0 339815 0 36693 0 1480427 0 0 THOMAS OCKERS CAO THROUGH 12/18/18 534569 0 80000 0 7446 0 24558 0 24239 0 670812 0 0 0 RUTH HENNESSEY PRESIDENT EFFECTIVE 12/19/18 11458 590789 0 100000 0 67740 0 146405 0 22932 11458 927866 0 0 DONALD TEPLITZ CMO 539619 0 34000 0 2558 0 24558 0 33664 0 634399 0 0 0 NEIL LOBO PHYSICIAN 743853 0 209438 0 2322 0 24558 0 33628 0 1013799 0 0 0 KOUROSH ADHAMI PHYSICIAN 743853 0 209438 0 2322 0 24558 0 33628 0 1013799 0 0 0 BABAK DANESH PHYSICIAN 743857 0 169438 0 1455 0 24558 0 7488 0 946796 0 0 0 JAMES KOHLROSER PHYSICIAN 741253 0 179438 0 1242 0 24558 0 36228 0 982719 0 0 0 PANKAJ SINGHAL PHYSICIAN 1459275 0 0 0 810 0 24558 0 36228 0 1520871 0 0 0 WILLIAM C ARMSTRONG SVP FINANCE 0 721425 0 125000 0 21582 0 183815 0 23760 0 1075582 0 0 JOHN MCMURRAY COO 342182 0 20000 0 531 0 24558 0 30438 0 417709 0 0 0 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. ALAN GUERCI $341,000 PARTICIPATION IN THE PLAN 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. 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. 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. 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. EFFECTIVE 12/19/18, RUTH HENNESSEY WAS TRANSFERRED FROM ST. FRANCIS HOSPITAL, A RELATED ENTITY, TO SERVE AS THE PRESIDENT/CAO. SOUTHWEST SUFFOLK MEDICAL PC SEE PART V 32845900 SEE PART V SAMARITAN MEDICAL SERVICES PC SEE PART V 34947612 SEE PART V CARDIAC EKG INTERPRETATION PC SEE PART V 699145 SEE PART V SCHEDULE L, PART IV, LINE (1) COLUMN (B) RELATIONSHIP Entity more than 35% owned by Donald Teplitz, Key Employee. SCHEDULE L, PART IV, LINE (1) COLUMN (D) DESCRIPTION OF TRANSACTION Subsidy for PC operating losses. SCHEDULE L, PART IV, LINE (2) COLUMN (B) RELATIONSHIP Entity more than 35% owned by Donald Teplitz, Key Employee. SCHEDULE L, PART IV, LINE (2) COLUMN (D) DESCRIPTION OF TRANSACTION Subsidy for PC operating losses. SCHEDULE L, PART IV, LINE (3) COLUMN (B) RELATIONSHIP Entity more than 35% owned by Donald Teplitz, Key Employee. SCHEDULE L, PART IV, LINE (3) COLUMN (D) DESCRIPTION OF TRANSACTION Subsidy for PC operating losses. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF GOOD SAMARITAN HOSPITAL IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND)(CHS). CHS IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE). FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF GOOD SAMARITAN HOSPITAL MEDICAL CENTER, AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF GOOD SAMARITAN HOSPITAL MEDICAL CENTER, CHS IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF GOOD SAMARITAN HOSPITAL. THE GOVERNING BODY OF GOOD SAMARITAN HOSPITAL IS THE SAME AS THAT OF CHS. FORM 990, PART VI, LINE 11B - REVIEW PROCESS FOR FORM 990 THE FORM 990 AND RELATED SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD, AND PRESENTED TO THE COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF CHS, WHICH HAS BEEN DELEGATED THE FORM 990 REVIEW FUNCTION BY THE BOARD. UPON REVIEW AND RECOMMENDATION OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO THE BOARD FOR APPROVAL. UPON BOARD APPROVAL, THE FORM 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE CHS COMPLIANCE AND AUDIT COMMITTEE BY CHS' COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURE IS GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE CHS COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE CHS BOARD OF DIRECTORS. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED AND A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS AND WISHES TO GO FORWARD WITH IT, THE CHAIR OF THE BOARD OF DIRECTORS SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. THE PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIM/HERSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. FORM 990, PART VI, LINE 15 - COMPENSATION POLICY THE CHIEF ADMINISTRATIVE OFFICER SUBMITS FOR APPROVAL TO THE SYSTEM CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE CHS EXECUTIVE COMPENSATION POLICY (COMPENSATION POLICY). THE COMPENSATION POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CHS OR AN OPERATING ENTITY, AND IS EITHER A) A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF OPERATING OFFICERS (COO) OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS (CFO); D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CHS OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CHS OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CHS OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CHS OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CHS OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CHS CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CHS BOARD OF DIRECTORS FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE PERFORMED ANNUALLY BY AN INDEPENDENT CONSULTANT. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION PROVIDED, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE CHS BOARD OF DIRECTORS. FORM 990, PART VI, LINE 19 - DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS-CERTIFICATE OF INCORPORATION FILED WITH 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. 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 SYSTEMS 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). 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 X, LINE 20 - TAX EXEMPT BOND LIABILITIES THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 ARE ISSUED ON BEHALF OF THE CATHOLIC HEALTH SERVICES OF LONG ISLAND OBLIGATED GROUP PROJECT WHICH INCLUDES THE FILING ENTITY AND RELATED ENTITIES. THREE BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 SUFFOLK BONDS), SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2014C SUFFOLK BONDS) AND NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH SERVICES OF LONG ISLAND. FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS POST RETIREMENT BENEFIT PLAN CHANGE $ 2,877,000 FORGIVENESS OF PRIOR YEAR RELATED PARTY RECEIVABLES (75,121,840) RELATED PARTY EMPLOYEE BENEFIT SERVICES (13,776,983) NONOPERATING FOR PC FORGIVENESS 84,162,512 ----------- TOTAL: $( 1,859,311) FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION GOOD SAMARITAN HOSPITAL MEDICAL CENTER IS A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND. WE, AT CATHOLIC HEALTH SERVICES, HUMBLY JOIN TOGETHER TO BRING CHRISTS HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. I-CARE VALUES INTEGRITY: WE ARE WHO WE SAY WE ARE AND ACT IN ACCORDANCE WITH THE SPLENDOR OF TRUTH OF OUR CATHOLIC MORAL TEACHING AND OUR CATHOLIC VALUES. COMPASSION: WE HAVE COMPASSION FOR OUR PATIENTS, SEE THE SUFFERING CHRIST IN THEM, STRIVE TO ALLEVIATE SUFFERING AND SERVE THE SPIRITUAL, PHYSICAL AND EMOTIONAL NEEDS OF OUR PATIENTS. ACCOUNTABILITY: WE TAKE RESPONSIBILITY FOR OUR ACTIONS AND THEIR CONSEQUENCES. RESPECT: WE HONOR THE SANCTITY OF LIFE AT EVERY STAGE OF LIFE AND THE DIGNITY OF EVERY PERSON, AND INCORPORATE ALL THE PRINCIPLES OF CATHOLIC SOCIAL TEACHING IN OUR RELATIONSHIPS AND ADVOCACY. EXCELLENCE: WE SEEK THE GLORY OF GOD IN THE COMPASSIONATE SERVICE OF OUR PATIENTS, AND WE STRIVE TO DO THE BEST THAT CAN BE DONE, WHATEVER OUR ROLE. CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 12A- I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 12B- II CHSLI true CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 12A- I GOOD SAMARTN true MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113434776 TRANSPORTATIO NY 501(C)(3) 12A- I MARYHAVENCTR false MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 10 CHSLI false MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR false THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113638367 SUPPORT ORG NY 501(C)(3) 12A- I MARYHAVENCTR false 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 false OUR LADY OF CONSOLATION GERIATRIC CARE 111 BEACH DRIVE WEST ISLIP NY 11795 113284066 LT NURSE CARE NY 501(C)(3) 10 CHSLI false RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR false ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) 3 CHSLI true ST CHARLES HOSPITAL 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 false ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI true ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 12A- I ST FRANCIS false ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 12A- I ST FRANCIS true WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI true THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 112983148 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false WISDOM GARDENS HOUSING DEVELOPMENT FUND 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113559713 SR HOUSING NY 501(C)(3) 10 MARYHAVENCTR false GOOD SHEPHERD HOSPICE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 10 CHSLI false ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 12A- I ST CHARLES false GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) 12A- I GOOD SAMARTN true 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 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 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 true 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 RDJAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVICES PA GSH RELATED 1550143 1730762 false 0 false 0.51000 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 true true false false false true true false true true true true true true true true CHS SERVICES LMPR 4932091 COST MERCY MEDICAL CENTER LM 248339 COST ST FRANCIS HOSPITAL LM 94647 COST ST CHARLES HOSPITAL LM 1413465 COST ST CATHERINE OF SIENA MEDICAL CENTER LM 2860377 COST ST JOSEPH HOSPITAL LM 841465 COST GOOD SAMARITAN HOSPITAL FOUNDATION C 794005 COST SAMARITAN EMERGENCY MEDICAL SERVICES LMQ 512143 COST IDHC LLC S 1250005 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.