GOOD SAMARITAN UNIVERSITY HOSPITAL: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: GOOD SAMARITAN UNIVERSITY HOSPITAL (EIN 11-1888924)
Tax period: 2017-01-01 to 2017-12-31
Filed: 2018-11-15
IRS object ID: 201813199349314966
Schema version: 2017v2.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-11-15T15:44:23-06:00	ReturnTs
Tax Period End	2017-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	PricewaterhouseCoopers LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	300 Madison Avenue	AddressLine1Txt
City	New York	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	10017	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2017-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	111888924	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL MEDICAL CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
In Care Of	% CHS SERVICES	InCareOfNm
Business Name Control	GOOD	BusinessNameControlTxt
Phone	6313763000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1000 MONTAUK HIGHWAY	AddressLine1Txt
City	WEST ISLIP	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	11795	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	THOMAS OCKERS	PersonNm
Person Title	EXEC VP & CAO	PersonTitleTxt
Phone	5167051919	PhoneNum
Signature	2018-11-12	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	LAURA J PARELLO	PreparerPersonNm
PTIN	P01080295	PTIN
Phone	6464713000	PhoneNum
Preparation	2018-11-15	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	155.201.188.32	IPv4AddressTxt

Field	Value	IRS element (for citing)
Federal Original Submission Id	13049920183195000173	FederalOriginalSubmissionId
Federal Original Submission Id	2018-11-15	FederalOriginalSubmissionIdDt
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	618ACE5A638F5610B23A87A01F7C418F45FC2D61	AtSubmissionCreationDeviceId
At Submission Filing Device Id	618ACE5A638F5610B23A87A01F7C418F45FC2D61	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	ALAN D GUERCI MD	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1000 MONTAUK HIGHWAY	AddressLine1Txt
City	WEST ISLIP	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	11795	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$666,932,657	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	HTTP://GOODSAMARITAN.CHSLI.ORG/	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1959	FormationYr
Legal Domicile State	NY	LegalDomicileStateCd
Activity Or Mission	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.	ActivityOrMissionDesc
Voting Members Governing Body	23	VotingMembersGoverningBodyCnt
Voting Members Independent	22	VotingMembersIndependentCnt
Total Employee	4190	TotalEmployeeCnt
Total Volunteers	254	TotalVolunteersCnt
Total Gross UBI	$1,581,341	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$817,380	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,797,293	PYContributionsGrantsAmt
CY Contributions Grants	$2,461,447	CYContributionsGrantsAmt
PY Program Service Revenue	$600,980,336	PYProgramServiceRevenueAmt
CY Program Service Revenue	$613,796,868	CYProgramServiceRevenueAmt
PY Investment Income	$2,329,357	PYInvestmentIncomeAmt
CY Investment Income	$2,900,766	CYInvestmentIncomeAmt
PY Other Revenue	$13,149,395	PYOtherRevenueAmt
CY Other Revenue	$16,719,866	CYOtherRevenueAmt
PY Total Revenue	$618,256,381	PYTotalRevenueAmt
CY Total Revenue	$635,878,947	CYTotalRevenueAmt
PY Grants And Similar Paid	$1,988,114	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$1,938,293	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$311,620,667	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$322,297,548	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$270,223,695	PYOtherExpensesAmt
CY Other Expenses	$300,991,823	CYOtherExpensesAmt
PY Total Expenses	$583,832,476	PYTotalExpensesAmt
CY Total Expenses	$625,227,664	CYTotalExpensesAmt
PY Revenues Less Expenses	$34,423,905	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$10,651,283	CYRevenuesLessExpensesAmt
Total Assets BOY	$515,158,689	TotalAssetsBOYAmt
Total Assets EOY	$544,423,186	TotalAssetsEOYAmt
Total Liabilities BOY	$264,083,142	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$272,535,266	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$251,075,547	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$271,887,920	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	SEE SCHEDULE O	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$547,510,602	ExpenseAmt
Grant	$1,938,293	GrantAmt
Revenue	$606,761,540	RevenueAmt
Desc	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 2017 THE MEDICAL CENTER PROVIDED INPATIENT SERVICES FOR 26,490 DISCHARGED INDIVIDUALS, MANAGED 86,560 EMERGENCY DEPARTMENT VISITS AND 18,284 CLINIC VISITS. THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH COMMUNITY SERVICE AND CHARITABLE ACTIVITIES.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$8,540,536	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$10,763,231	RevenueAmt
Desc	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. 2017 PATIENT DAYS FOR THE NURSING HOME TOTALED 35,512.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$556,051,138	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	Yes (true)	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (true)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	308	IRPDocumentCnt
IRP Document W2 G	1	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	4190	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	23	GoverningBodyVotingMembersCnt
Independent Voting Member	22	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (true)	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (true)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (true)	WrittenPolicyOrProcedureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	CHS SERVICES	PersonNm
Phone	5167053700	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	992 NORTH VILLAGE AVE	AddressLine1Txt
City	ROCKVILLE CENTRE	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	11570	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
SALVATORE SODANO
CHAIRMAN	2.0	0.0	Yes (X)	Yes (X)	$0	$0	$0
BRIAN MCGUIRE
VICE CHAIR	2.0	0.0	Yes (X)	Yes (X)	$0	$0	$0
JEROME POLLER
SECRETARY	2.0	0.0	Yes (X)	Yes (X)	$0	$0	$0
CHRIS PASCUCCI
TREASURER	2.0	0.0	Yes (X)	Yes (X)	$0	$0	$0
BARBARA ELLEN BLACK
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
VIRGINIA EWEN
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
FRANK L KURRE
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
REV MSGR ROBERT MORRISEY
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
DANIEL T ROWE
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
JOHN WAGNER
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
REV JAMES VLAUN
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
KEVIN J CONWAY
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
PETER D'ANGELO
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
REV PETER DUGANDZIC
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
HON ANTHONY MARANO
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
STEPHEN F MCLOUGHLIN
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
JOHN FRANCFORT MD
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
ALEXANDER HAZELTON
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
WILLIAM WARD
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
ROBERT ZUCCARO
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
PETER QUICK
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
THOMAS CHRISTMAN
TRUSTEE	2.0	0.0	Yes (X)		$0	$0	$0
ALAN D GUERCI MD
PRESIDENT & CEO	50.0	0.0	Yes (X)	Yes (X)	$0	$3,776,985	$400,495
DANIEL DEBARBA
EVP & CFO	50.0	0.0		Yes (X)	$0	$1,024,580	$369,985
THOMAS OCKERS
EXECUTIVE VP & CAO	50.0	0.0		Yes (X)	$676,487	$0	$46,690
DONALD TEPLITZ
CMO	50.0	0.0			$576,374	$0	$56,020	Yes (X)
NEIL LOBO
PHYSICIAN	50.0	0.0			$967,428	$0	$58,595		Yes (X)
KOUROSH ADHAMI
PHYSICIAN	50.0	0.0			$970,393	$0	$55,676		Yes (X)
BABAK DANESH
PHYSICIAN	50.0	0.0			$935,073	$0	$26,046		Yes (X)
JAMES KOHLROSER
PHYSICIAN	50.0	0.0			$957,046	$0	$58,545		Yes (X)
PANKAJ SINGHAL
PHYSICIAN	50.0	0.0			$1,444,740	$0	$55,128		Yes (X)
WILLIAM C ARMSTRONG
SVP FINANCE	0.0	50.0			$0	$890,381	$227,844			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$6,527,541	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$5,691,946	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,355,024	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	799	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
PROGRESSIVE EMERGENCY PHYSICIANS LL
1236 RXR PLAZA	UNIONDALE	NY	11556	PHYSICIAN SERVICES	$18,113,699
MEDICAL SOLUTIONS
9101 WESTERN AVENUE SUITE 101	OMAHA	NE	68114	NURSING SERVICES	$2,504,489
MAJESTIC PROP MGT AAF CAPTREE
60 CUTTERMILL RD	GREAT NECK	NY	11021	RENT	$905,641
COLUMBIA PARTNERS LLC
161 STILLWELL LA	LAUREL HOLLOW	NY	11792	RENT	$894,567
STANTEC CONSULTING SVCS
261 FIFTH AVE 23RD FL	NEW YORK	NY	10016	CONSTRUCTION/DESIGN	$762,823

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	47	CntrctRcvdGreaterThan100KCnt
Related Organizations	$207,955	RelatedOrganizationsAmt
Government Grants	$2,096,139	GovernmentGrantsAmt
All Other Contributions	$157,353	AllOtherContributionsAmt
Total Contributions	$2,461,447	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE - HOSPITAL	622110	$603,033,637	$603,033,637
NET PATIENT SERVICE REV. - NURSING HOME	623000	$10,763,231	$10,763,231

Field	Value	IRS element (for citing)
Total Program Service Revenue	$613,796,868	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,899,241	TotalRevenueColumnAmt
Exclusion	$2,899,241	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,846,675	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$1,846,675	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,846,675	TotalRevenueColumnAmt
Exclusion	$1,846,675	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$31,055,235	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$31,053,710	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$1,525	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,525	TotalRevenueColumnAmt
Exclusion	$1,525	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$0	FundraisingGrossIncomeAmt
Fundraising Direct Expenses	$0	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gaming Gross Income	$0	GamingGrossIncomeAmt
Gaming Direct Expenses	$0	GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$0	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$0	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
PHYSICIAN SERVICES REVENUE	621110	$3,727,903	$3,727,903
COFFEE SHOP & CAFETERIA	722514	$1,610,534		$1,610,534
LAB SERVICES	621500	$7,256,837		$5,675,496	$1,581,341

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,277,917	TotalRevenueColumnAmt
Exclusion	$2,277,917	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$14,873,191	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$635,878,947	TotalRevenueColumnAmt
Related Or Exempt Func Income	$617,524,771	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$1,581,341	UnrelatedBusinessRevenueAmt
Exclusion	$14,311,388	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$1,938,293	TotalAmt
Program Services	$1,938,293	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,355,571	TotalAmt
Program Services	$632,394	ProgramServicesAmt
Management And General	$723,177	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$241,050,890	TotalAmt
Program Services	$224,416,162	ProgramServicesAmt
Management And General	$16,634,728	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$19,488,061	TotalAmt
Program Services	$18,092,587	ProgramServicesAmt
Management And General	$1,395,474	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$39,746,633	TotalAmt
Program Services	$36,459,274	ProgramServicesAmt
Management And General	$3,287,359	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$20,656,393	TotalAmt
Program Services	$19,177,259	ProgramServicesAmt
Management And General	$1,479,134	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$209,363	TotalAmt
Program Services	$132,491	ProgramServicesAmt
Management And General	$76,872	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$34,980	TotalAmt
Program Services	$14,147	ProgramServicesAmt
Management And General	$20,833	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$107,359	TotalAmt
Management And General	$107,359	ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$32,043,913	TotalAmt
Program Services	$29,119,334	ProgramServicesAmt
Management And General	$2,924,579	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$1,594,450	TotalAmt
Program Services	$172,278	ProgramServicesAmt
Management And General	$1,422,172	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$8,677,324	TotalAmt
Program Services	$5,255,247	ProgramServicesAmt
Management And General	$3,422,077	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$7,851,501	TotalAmt
Program Services	$6,830,010	ProgramServicesAmt
Management And General	$1,021,491	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$207,670	TotalAmt
Program Services	$174,125	ProgramServicesAmt
Management And General	$33,545	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$385,010	TotalAmt
Program Services	$385,010	ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$33,116,566	TotalAmt
Program Services	$33,116,566	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$23,042,405	TotalAmt
Program Services	$19,341,154	ProgramServicesAmt
Management And General	$3,701,251	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$13,745,937	TotalAmt
Program Services	$13,745,312	ProgramServicesAmt
Management And General	$625	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES EXPENSE	$94,789,316	$94,789,316
CHS SERVICES	$44,219,835	$19,794,677	$24,425,158
EQUIPMENT SERVICE CONTRACTS	$7,091,569	$7,091,569
HOME OFFICE ALLOCATION	$7,812,518		$7,812,518

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$26,062,107	TotalAmt
Program Services	$25,373,933	ProgramServicesAmt
Management And General	$688,174	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$625,227,664	TotalAmt
Program Services	$556,051,138	ProgramServicesAmt
Management And General	$69,176,526	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$34,943,965	BOYAmt
EOY	$12,326,151	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$73,004,492	BOYAmt
EOY	$111,239,403	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$74,073,195	BOYAmt
EOY	$74,180,502	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$6,645,479	BOYAmt
EOY	$7,115,524	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$6,049,496	BOYAmt
EOY	$6,068,251	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$519,596,575	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$344,200,933	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$164,101,445	BOYAmt
EOY	$175,395,642	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$45,331,645	BOYAmt
EOY	$36,876,653	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$111,008,972	BOYAmt
EOY	$121,221,060	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$515,158,689	BOYAmt
EOY	$544,423,186	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$69,005,371	BOYAmt
EOY	$77,260,932	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$5,084,943	BOYAmt
EOY	$4,859,904	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$2,020,993	BOYAmt
EOY	$2,005,370	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$187,971,835	BOYAmt
EOY	$188,409,060	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$264,083,142	BOYAmt
EOY	$272,535,266	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$249,469,573	BOYAmt
EOY	$270,159,761	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,605,974	BOYAmt
EOY	$1,728,159	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$251,075,547	BOYAmt
EOY	$271,887,920	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$515,158,689	BOYAmt
EOY	$544,423,186	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$10,651,283	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$9,810,090	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$351,000	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	Yes (true)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (true)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbyingGrp
Total Direct Lobbying		TotalDirectLobbyingGrp
Total Lobbying Expend		TotalLobbyingExpendGrp
Other Exempt Purpose Expend		OtherExemptPurposeExpendGrp
Total Exempt Purpose Expend		TotalExemptPurposeExpendGrp
Lobbying Nontaxable Amount		LobbyingNontaxableAmountGrp
Grassroots Nontaxable		GrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non Tx		TotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non Tx		TotLbbyExpendMnsLbbyngNonTxGrp
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$107,359	OtherActivitiesAmt
Total Lobbying Expenditures	$107,359	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1 - OTHER LOBBYING ACTIVITIES	FormAndLineReferenceDesc
Explanation	AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON THE BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ASSOCIATIONS REPRESENT.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amounts		ArtPublicExhibitionAmountsGrp
Held Works Art		HeldWorksArtGrp
CY Minus3 Yr Endwmt Fund		CYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt Fund		CYMinus4YrEndwmtFundGrp

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,039,490	OtherCostOrOtherBasisAmt
Book Value	$5,039,490	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$255,056,483	OtherCostOrOtherBasisAmt
Depreciation	$146,884,995	DepreciationAmt
Book Value	$108,171,488	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$11,185,572	OtherCostOrOtherBasisAmt
Depreciation	$10,211,693	DepreciationAmt
Book Value	$973,879	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$241,438,246	OtherCostOrOtherBasisAmt
Depreciation	$187,104,245	DepreciationAmt
Book Value	$54,334,001	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,876,784	OtherCostOrOtherBasisAmt
Book Value	$6,876,784	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$175,395,642	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
OTHER RECEIVABLES	$5,605,885
DUE FROM RELATED PARTIES	$27,904,425
INSURANCE CLAIMS RECEIVABLE	$86,814,597
GOODWILL ISLAND DIGESTIVE	$896,153

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$121,221,060	TotalBookValueOtherAssetsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
THIRD PARTY PAYOR LIABILITY	$21,483,031
SELF INSURANCE RESERVE-MALPRAC	$92,526,585
SELF INSURANCE RESERVE-LIABILI	$44,663,290
OTHER NON-CURRENT LIABILITIES	$10,728,797
DUE TO RELATED PARTIES	$19,007,357

Field	Value	IRS element (for citing)
Total Liability	$188,409,060	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTE	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	300.	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,464,041	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,435,295	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,028,746	NetCommunityBenefitExpnsAmt
Total Expense	0.00640	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$89,250,119	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$73,082,478	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$16,167,641	NetCommunityBenefitExpnsAmt
Total Expense	0.02590	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,634,174	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,227,604	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,406,570	NetCommunityBenefitExpnsAmt
Total Expense	0.00380	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$111,348,334	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$88,745,377	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$22,602,957	NetCommunityBenefitExpnsAmt
Total Expense	0.03610	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,074,311	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,074,311	NetCommunityBenefitExpnsAmt
Total Expense	0.00170	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,989,712	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,705,086	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,284,626	NetCommunityBenefitExpnsAmt
Total Expense	0.00850	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$213,549	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$213,549	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,277,572	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,705,086	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,572,486	NetCommunityBenefitExpnsAmt
Total Expense	0.01050	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$122,625,906	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$93,450,463	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$29,175,443	NetCommunityBenefitExpnsAmt
Total Expense	0.04660	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$7,407,035	BadDebtExpenseAmt
Reimbursed By Medicare	$140,022,516	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$160,611,586	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$20,589,070	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL MEDICAL CTR	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1000 MONTAUK HIGHWAY	AddressLine1Txt
City	WEST ISLIP	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	11795	ZIPCd

Field	Value	IRS element (for citing)
Website Address	HTTP://GOODSAMARITAN.CHSLI.ORG/	WebsiteAddressTxt
State License	5154001H	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Teaching Hospital	Yes (X)	TeachingHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	HOSPITAL	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL MED CTR	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	16	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (true)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	goodsamaritan.chsli.org/	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	www.chsli.org	OtherWebsiteURLTxt
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	www.chsli.org	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	300.	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	www.chsli.org	FAPAvailableOnWebsiteURLTxt
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Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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, HUNTINGTON HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL PECONIC BAY MEDICAL CENTER (NOW PART OF NORTHWELL HEALTH), GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CATHERINE OF SIENA MEDICAL CENTER, SOUTHAMPTON HOSPITAL, SOUTHSIDE HOSPITAL, STONY BROOK UNIVERSITY HOSPITAL AND VETERANS AFFAIRS MEDICAL CENTER.
PART V, SECTION B, LINE 6B	THE HOSPITALS 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 2017, 16 FAMILIES WERE ENROLLED IN THE HEALTHIER FAMILIES PROGRAM. AT LEAST 50% 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 80% DEMONSTRATED A GREATER KNOWLEDGE AND AWARENESS OF THE IMPORTANCE OF A HEALTHY LIFESTYLE AND THE NEED TO CONTINUE, AND 80% OF THE STUDENT PARTICIPANTS ACHIEVED A SET GOAL OF 500 MINUTES OF EXERCISE BY THE CONCLUSION OF THE 10 WEEK SESSION. FREE BARIATRIC EDUCATIONAL SEMINARS ARE HELD MONTHLY, HOSTED BY ONE OF THREE GOOD SAMARITAN BARIATRIC SURGEONS. IN 2017, 569 PEOPLE ATTENDED THE 24 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 THOUGHT WORKSHOPS ARE OFFERED, HIGHLIGHTING THE IMPORTANCE OF NUTRITION. IN 2017, THE FOOD FOR THOUGHT WORKSHOPS FOCUSED ON WEIGHT MANAGEMENT, HOW TO NAVIGATE A MENU AND OFFERED A COOKING DEMONSTRATION; 140 COMMUNITY MEMBERS ATTENDED. IN RECOGNITION OF NATIONAL NUTRITION MONTH, REGISTERED DIETICIANS FROM THE FOOD AND NUTRITION DEPARTMENT HOSTED LUNCH AND LEARN NUTRITION LECTURES IN THE HOSPITALS EMPLOYEE CAFETERIA ON MARCH 15 AND 26, 2017. IN ADDITION, INFORMATIONAL TABLES WERE AVAILABLE ON MARCH 7 AND 28. 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. 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 FOR THE SECOND CONSECUTIVE YEAR SERVING AGAIN AS THE OFFICIAL RACE MEDICINE PROVIDER FOR THE 2017 CHS SUFFOLK COUNTY MARATHON. THE NET PROCEEDS FROM THE ANNUAL EVENT BENEFITS LOCAL VETERANS' SERVICES ORGANIZATIONS. THERE WERE 25 GOOD SAMARITAN EMPLOYEES WHO WORKED IN THE RACE MEDICINE TENT AND 14 PARTICIPATED IN THE MARATHON. PRIORITY 2: PREVENTIVE CARE AND MANAGEMENT IN FEBRUARY 2017, GOOD SAMARITAN HOSPITAL HOSTED A FREE "OPEN YOUR HEART TO HEALTH" EVENT AT WESTFIELD SOUTH SHORE MALL IN BAY SHORE IN PROXIMITY TO MEDICALLY UNDERSERVED COMMUNITIES. MORE THAN 500 COMMUNITY MEMBERS HAD THE OPPORTUNITY TO TALK TO CARDIOLOGISTS, REGISTERED DIETITIANS, CARDIOLOGY TECHNOLOGISTS, AND NURSES OFFERING INFORMATION ON CARDIAC HEALTH AND PREVENTION IN ADDITION TO BLOOD PRESSURE SCREENINGS. A TOTAL OF 35 BLOOD PRESSURE SCREENINGS AND 16 INFLUENZA VACCINATIONS WERE PROVIDED, AND 10 INDIVIDUALS RECEIVED A FREE COLORECTAL CANCER SCREENING KIT. IN 2017, HEALTH CARE PROFESSIONALS PARTICIPATED IN FREE, COMMUNITY-BASED BLOOD PRESSURE SCREENINGS AT THE WEST ISLIP LIBRARY. STAFF PROVIDED 93 BLOOD PRESSURE SCREENINGS, OFFERED ON THE FIRST WEDNESDAY OF EVERY MONTH. 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. FREE BMI AND BLOOD PRESSURE SCREENINGS WERE OFFERED. A TOTAL OF 42 BLOOD PRESSURE SCREENINGS AND 17 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 2017, 7 EVENTS WERE HELD WITH 447 SCREENINGS, INCLUDING 221 BLOOD PRESSURE, 101 BMI, AND 125 FLU VACCINATIONS. REFERRALS FOR FREE FOLLOW-UP CARE AT THE BISHOP MCHUGH HEALTH CENTER IN BABYLON 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. IN 2017, GOOD SAMARITAN HOSPITAL OFFERED 8 CARDIAC AND PULMONARY SUPPORT GROUPS ATTENDED BY 80 COMMUNITY MEMBERS. FOUR FREE GOOD SAM UNIVERSITY COMMUNITY LECTURES WERE OFFERED TO 240 ATTENDEES AT WORKSHOPS HELD IN 2017. 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 2017, THE PROGRAM WAS OFFERED 5 TIMES WITH MORE 63 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 & CHILDRENS 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. A CHS POLICY WAS ESTABLISHED TO PREVENT UNNECESSARY OPIOID PRESCRIPTIONS IN THE ED, AND THE SHERPA PROGRAM WAS DEVELOPED BY FCA. A FREE SERVICE PROVIDED BY FCA, SHERPA IS MADE UP OF 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.
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.

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Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 2017.
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	THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THIS ALLOWANCE BASED UPON HISTORICAL WRITE OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE MEDICAL CENTER FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY CHS POLICY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE. THE HOSPITAL DOES NOT HAVE ANY OFF-BALANCE-SHEET CREDIT EXPOSURE RELATED TO ITS PATIENT ACCOUNTS RECEIVABLE.
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 2017 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, AND HAITAIN CREOLE) 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 SAMARITANS 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 2017, 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. SEVENTY TWO COMMUNITY MEMBERS TOOK ADVANCES OF THIS PROGRAM IN 2017. 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, PROVIDING 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 2017, THERE WERE A TOTAL OF 23,920 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, 2017, 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 HOME, 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 4,600 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 CHRISTS 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 SYSTEMS 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. TO FURTHER THE MISSION OF BRINGING CARE TO THE COMMUNITY, CHS AND ITS MEMBER HOSPITALS, TOGETHER WITH A NUMBER OF OTHER HEALTH CARE PROVIDERS ON LONG ISLAND, ENTERED INTO A COLLABORATIVE AGREEMENT, WHICH OPERATES AS THE LONG ISLAND HEALTH NETWORK (LIHN). LIHN WAS CREATED TO ESTABLISH A COMPREHENSIVE AND EFFICIENT HOSPITAL NETWORK IN NASSAU AND SUFFOLK COUNTIES WORKING TO, AMONG OTHER THINGS, IMPROVE QUALITY OF CARE, FACILITATE CLINICAL INTEGRATION, BENCHMARK BEST PRACTICES AND REDUCE LENGTH OF STAY AND COSTS.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CATHOLIC HEALTH SERVICES OF LONG ISLAND	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	992 N VILLAGE AVE ROCKVILLE CNTR	AddressLine1Txt
City	ROCKVILLE CENTRE	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	11570	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	113403968	RecipientEIN
IRC Section	501(C)(3)	IRCSectionDesc
Cash Grant	$1,938,293	CashGrantAmt
Valuation Method Used	NONE	ValuationMethodUsedDesc
Non Cash Assistance	NONE	NonCashAssistanceDesc
Purpose Of Grant	OUTPATIENT CENTERS	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Form990 Of Other Organizations	Yes (X)	Form990OfOtherOrganizationsInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ALAN D GUERCI MD
PRESIDENT & CEO	$0	$1,422,720	$0	$750,000	$0	$1,604,265	$0	$365,382	$0	$35,113	$0	$4,177,480	$0	$1,568,553
DANIEL DEBARBA
EVP & CFO	$0	$845,561	$0	$150,000	$0	$29,019	$0	$335,382	$0	$34,603	$0	$1,394,565	$0	$0
THOMAS OCKERS
EXECUTIVE VP & CAO	$519,269	$0	$150,000	$0	$7,218	$0	$24,111	$0	$22,579	$0	$723,177	$0	$0	$0
DONALD TEPLITZ
CMO	$523,892	$0	$50,000	$0	$2,482	$0	$24,111	$0	$31,909	$0	$632,394	$0	$0	$0
NEIL LOBO
PHYSICIAN	$741,430	$0	$224,756	$0	$1,242	$0	$24,111	$0	$34,484	$0	$1,026,023	$0	$0	$0
KOUROSH ADHAMI
PHYSICIAN	$744,395	$0	$224,756	$0	$1,242	$0	$24,111	$0	$31,565	$0	$1,026,069	$0	$0	$0
BABAK DANESH
PHYSICIAN	$749,471	$0	$184,756	$0	$846	$0	$24,111	$0	$1,935	$0	$961,119	$0	$0	$0
JAMES KOHLROSER
PHYSICIAN	$741,480	$0	$214,756	$0	$810	$0	$24,111	$0	$34,434	$0	$1,015,591	$0	$0	$0
PANKAJ SINGHAL
PHYSICIAN	$1,443,930	$0	$0	$0	$810	$0	$24,111	$0	$31,017	$0	$1,499,868	$0	$0	$0
WILLIAM C ARMSTRONG
SVP FINANCE	$0	$698,726	$0	$170,000	$0	$21,655	$0	$195,382	$0	$32,462	$0	$1,118,225	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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 $342,000 PARTICIPATION IN THE PLAN WILLIAM ARMSTRONG $172,000 PARTICIPATION IN THE PLAN DANIEL DEBARBA $312,000 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 $1,568,553, VESTED IN PLAN. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2017 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.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc
SOUTHWEST SUFFOLK MEDICAL PC
SEE PART V	$3,034,817	SEE PART V
SAMARITAN MEDICAL SERVICES PC
SEE PART V	$15,305,706	SEE PART V
CARDIAC EKG INTERPRETATION PC
SEE PART V	$789,279	SEE PART V

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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).
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 - CHANGES IN NET ASSETS	POST RETIREMENT BENEFIT PLAN CHANGE: $351,000
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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (35 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
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	Yes (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	Yes (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	Yes (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	Yes (true)
ST CHARLES HOSPITAL
200 BELLE TERRE ROAD	PORT JEFFERSN ST	NY	11777	111871039	HOSPITAL	NY	501(C)(3)	3	CHSLI	Yes (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	Yes (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	Yes (true)
WSNCHS NORTH INC
4295 HEMPSTEAD TURNPIKE	BETHPAGE	NY	11714	113438973	HOSPITAL	NY	501(C)(3)	3	CHSLI	Yes (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	Yes (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	Yes (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
ST FRANCIS CARDIOVASCULAR PHYSICIANS P
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	Yes (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

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	UBI Code VUBICodeVAmt	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
BIPO HOLDINGS LLC
992 N VILLAGE AVE ROCKVILLE CENTRE	ROCKVILLE CENTRE	NY	11570	464763720	PHYSICIAN ASSN	NY	NA	N/A
IDHC LLC
2500 YORK RDJAMISONPA 18929	JAMISON	PA	18929	452411095	HEALTH SERVICES	PA	GSH	RELATED	$1,646,390	$1,794,110	false	$0	false	0.51000
BEACON HEALTH PTNRS
992 N VILLAGE AVE ROCKVILLE CENTRE	ROCKVILLE CENTRE	NY	11570	454229842	HEALTHCARE	NY	NA	N/A
WISDOM GARDENS LP
51 TERRYVILLE RD	PORT JEFFERSON	NY	11776	113567947	SR HOUSING	NY	NA	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (13 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
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

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (true)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	Yes (true)	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (true)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	Yes (true)	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	false	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (true)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (true)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
CHS SERVICES
LMPR	$1,956,995	COST
ST FRANCIS HOSPITAL
LM	$654,393	COST
ST CATHERINE OF SIENA MEDICAL CENTER
LM	$100,281	COST
WSNCHS NORTH
LM	$195,784	COST
GOOD SAMARITAN HOSPITAL FOUNDATION
C	$207,955	COST
SAMARITAN EMERGENCY MEDICAL SERVICES
LMQ	$322,280	COST
IDHC LLC
S	$1,456,569	COST

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE R, PART IV	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt