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ST CHARLES HOSPITAL CORP: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
ST CHARLES HOSPITAL CORP (EIN 11-1871039)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-15
IRS object ID
201833199349315783
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-15T16:19:42-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PricewaterhouseCoopers LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1300 Madison AvenueAddressLine1Txt
CityNew YorkCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10017ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN111871039EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST CHARLES HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% CHS SERVICES INCInCareOfNm
Business Name ControlSTCHBusinessNameControlTxt
Phone6314746116PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 BELLE TERRE ROADAddressLine1Txt
CityPORT JEFFERSONCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11777ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAMES O'CONNORPersonNm
Person TitleEXEC VP & CAOPersonTitleTxt
Phone5167051937PhoneNum
Signature2018-11-12SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLAURA J PARELLOPreparerPersonNm
PTINP01080295PTIN
Phone6464713000PhoneNum
Preparation2018-11-15PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address155.201.188.32IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id13049920183195000159FederalOriginalSubmissionId
Federal Original Submission Id2018-11-15FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id618ACE5A638F5610B23A87A01F7C418F45FC2D61AtSubmissionCreationDeviceId
At Submission Filing Device Id618ACE5A638F5610B23A87A01F7C418F45FC2D61AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerALAN D GUERCI MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 BELLE TERRE RDAddressLine1Txt
CityPORT JEFFERSONCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11777ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$218,672,666GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresshttp://stcharleshospital.chsli.org/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1907FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionWE, 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 Body23VotingMembersGoverningBodyCnt
Voting Members Independent22VotingMembersIndependentCnt
Total Employee2105TotalEmployeeCnt
Total Volunteers80TotalVolunteersCnt
Total Gross UBI$32,604TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$16,664NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$3,281,707PYContributionsGrantsAmt
CY Contributions Grants$3,124,056CYContributionsGrantsAmt
PY Program Service Revenue$227,864,292PYProgramServiceRevenueAmt
CY Program Service Revenue$210,394,228CYProgramServiceRevenueAmt
PY Investment Income$86,186PYInvestmentIncomeAmt
CY Investment Income$84,518CYInvestmentIncomeAmt
PY Other Revenue$4,696,240PYOtherRevenueAmt
CY Other Revenue$5,069,864CYOtherRevenueAmt
PY Total Revenue$235,928,425PYTotalRevenueAmt
CY Total Revenue$218,672,666CYTotalRevenueAmt
PY Grants And Similar Paid$707,329PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$685,195CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$133,760,943PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$117,206,921CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$99,609,796PYOtherExpensesAmt
CY Other Expenses$103,626,638CYOtherExpensesAmt
PY Total Expenses$234,078,068PYTotalExpensesAmt
CY Total Expenses$221,518,754CYTotalExpensesAmt
PY Revenues Less Expenses$1,850,357PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,846,088CYRevenuesLessExpensesAmt
Total Assets BOY$136,225,216TotalAssetsBOYAmt
Total Assets EOY$129,935,381TotalAssetsEOYAmt
Total Liabilities BOY$149,794,761TotalLiabilitiesBOYAmt
Total Liabilities EOY$146,196,781TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$13,569,545NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$16,261,400NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE OMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$190,328,652ExpenseAmt
Grant$685,195GrantAmt
Revenue$213,913,948RevenueAmt
DescST. CHARLES HOSPITAL IS A 243 BED REHABILITATION AND ACUTE CARE HOSPITAL THAT ALSO OPERATES OUTPATIENT FACILITIES IN BOTH NASSAU AND SUFFOLK COUNTIES. FOUNDED BY THE DAUGHTERS OF WISDOM IN 1907, ST. CHARLES PROVIDES A FULL RANGE OF HEALTHCARE SERVICES. IN 2017 ST. CHARLES HAD 11,031 DISCHARGED AND PROVIDED 22,624 EMERGENCY ROOM VISITS. ST. CHARLES PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH OTHER COMMUNITY SERVICE AND CHARITABLE ACTIVITIES.Desc
Total Program Service Expenses$190,328,652TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document153IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee2105EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members23GoverningBodyVotingMembersCnt
Independent Voting Member22IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCHS SERVICES INCPersonNm
Phone5167053700PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1992 NORTH VILLAGE AVENUEAddressLine1Txt
CityROCKVILLE CENTRECityNm
State AbbreviationNYStateAbbreviationCd
ZIP11570ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
SALVATORE SODANO
CHAIRMAN2.00.0Yes (X)Yes (X)$0$0$0
BRIAN MCGUIRE
VICE CHAIR2.00.0Yes (X)Yes (X)$0$0$0
JEROME POLLER
SECRETARY2.00.0Yes (X)Yes (X)$0$0$0
CHRIS PASCUCCI
TREASURER2.00.0Yes (X)Yes (X)$0$0$0
BARBARA ELLEN BLACK
TRUSTEE2.00.0Yes (X)$0$0$0
VIRGINIA EWEN
TRUSTEE2.00.0Yes (X)$0$0$0
FRANK L KURRE
TRUSTEE2.00.0Yes (X)$0$0$0
REV MSGR ROBERT MORRISEY
TRUSTEE2.00.0Yes (X)$0$0$0
DANIEL T ROWE
TRUSTEE2.00.0Yes (X)$0$0$0
JOHN WAGNER
TRUSTEE2.00.0Yes (X)$0$0$0
REV JAMES VLAUN
TRUSTEE2.00.0Yes (X)$0$0$0
KEVIN J CONWAY
TRUSTEE2.00.0Yes (X)$0$0$0
PETER D'ANGELO
TRUSTEE2.00.0Yes (X)$0$0$0
REV PETER DUGANDZIC
TRUSTEE2.00.0Yes (X)$0$0$0
HON ANTHONY MARANO
TRUSTEE2.00.0Yes (X)$0$0$0
STEPHEN F MCLOUGHLIN
TRUSTEE2.00.0Yes (X)$0$0$0
JOHN FRANCFORT MD
TRUSTEE2.00.0Yes (X)$0$0$0
ALEXANDER HAZELTON
TRUSTEE2.00.0Yes (X)$0$0$0
WILLIAM WARD
TRUSTEE2.00.0Yes (X)$0$0$0
ROBERT ZUCCARO
TRUSTEE2.00.0Yes (X)$0$0$0
PETER QUICK
TRUSTEE2.00.0Yes (X)$0$0$0
THOMAS CHRISTMAN
TRUSTEE2.00.0Yes (X)$0$0$0
ALAN D GUERCI MD
PRESIDENT & CEO50.00.0Yes (X)Yes (X)$0$3,776,985$400,495
DANIEL DEBARBA
EVP & CFO50.00.0Yes (X)$0$1,024,580$369,985
JAMES O'CONNOR
CAO50.00.0Yes (X)$566,397$0$124,179
SUNIL DHUPER
CMO50.00.0$361,130$0$23,557Yes (X)
SATHISH SUBBAIAH MD
PHYSICIAN50.00.0$4,054,986$0$23,449Yes (X)
MORGAN CHEN MD
PHYSICIAN50.00.0$3,840,001$0$54,861Yes (X)
DOUGLAS PETRACO MD
PHYSICIAN50.00.0$2,120,435$0$57,264Yes (X)
STEVEN PUOPOLO MD
PHYSICIAN50.00.0$1,905,812$0$54,980Yes (X)
PHILIP SCHRANK MD
PHYSICIAN50.00.0$1,823,540$0$23,449Yes (X)
WILLIAM C ARMSTRONG
SVP FINANCE0.050.0$0$890,381$227,844Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$14,672,301TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,691,946TotReportableCompRltdOrgAmt
Total Other Compensation$1,360,063TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K280IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ISLAND NEONATOLOGY LLC
PO BOX 272EAST ISLIPNY11730PHYSICIAN SERVICES$556,004
REMI HOLDINGS LLC
11325 N COMMUNITY HOUSE ROAD SUITECHARLOTTENC28277EQUIPMENT SERVICES$395,448
1895 WWA LLC
1895 WALT WHITMAN ROAD SUITE 1EAST ISLIPNY11730RENT$295,449
MCKESSON CORPORATION DBA MACRO HE
PO BOX 742256ATLANTAGA30374SOFTWARE SUBSCR$280,377
VETERANS BUILDINGS LLC
411 HACKENSACK AVE FLOOR 8 SUITEHACKENSACKNJ07601RENT$203,907
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K16CntrctRcvdGreaterThan100KCnt
Federated Campaigns$45FederatedCampaignsAmt
Membership Dues$0MembershipDuesAmt
Fundraising$0FundraisingAmt
Related Organizations$3,031,725RelatedOrganizationsAmt
Government Grants$22,794GovernmentGrantsAmt
All Other Contributions$69,492AllOtherContributionsAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$3,124,056TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNET PATIENT SERVICE REVENUEDesc
Business622110BusinessCd
Total Revenue Column$210,394,228TotalRevenueColumnAmt
Related Or Exempt Func Income$210,361,624RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$32,604UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$210,394,228TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$84,518TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$84,518ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$970,374RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$970,374RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$970,374TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$970,374ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
COFFEE SHOP722514$547,166$0$0$547,166
MEANINGFUL USE900099$342,898$342,898$0$0
PHYSICIAN SERVICES REVENUE621110$616,650$616,650$0$0

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,592,776TotalRevenueColumnAmt
Related Or Exempt Func Income$2,592,776RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,099,490OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$218,672,666TotalRevenueColumnAmt
Related Or Exempt Func Income$213,913,948RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$32,604UnrelatedBusinessRevenueAmt
Exclusion$1,602,058ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$685,195TotalAmt
Program Services$685,195ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,075,263TotalAmt
Program Services$384,687ProgramServicesAmt
Management And General$690,576ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$89,405,340TotalAmt
Program Services$81,295,612ProgramServicesAmt
Management And General$8,109,728ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$8,348,653TotalAmt
Program Services$7,536,648ProgramServicesAmt
Management And General$812,005ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$9,824,316TotalAmt
Program Services$8,588,719ProgramServicesAmt
Management And General$1,235,597ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$8,553,349TotalAmt
Program Services$7,721,435ProgramServicesAmt
Management And General$831,914ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$374,244TotalAmt
Program Services$263,407ProgramServicesAmt
Management And General$110,837ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$6,000TotalAmt
Program Services$0ProgramServicesAmt
Management And General$6,000ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$3,804TotalAmt
Program Services$0ProgramServicesAmt
Management And General$3,804ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$120,268TotalAmt
Program Services$0ProgramServicesAmt
Management And General$120,268ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$7,582,216TotalAmt
Program Services$5,292,802ProgramServicesAmt
Management And General$2,289,414ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$402,447TotalAmt
Program Services$6,262ProgramServicesAmt
Management And General$396,185ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,772,241TotalAmt
Program Services$2,056,091ProgramServicesAmt
Management And General$1,716,150ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,166,745TotalAmt
Program Services$3,363,423ProgramServicesAmt
Management And General$803,322ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$135,203TotalAmt
Program Services$120,006ProgramServicesAmt
Management And General$15,197ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,628,549TotalAmt
Program Services$1,628,549ProgramServicesAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$4,045,336TotalAmt
Program Services$4,045,336ProgramServicesAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$6,881,478TotalAmt
Program Services$5,112,514ProgramServicesAmt
Management And General$1,768,964ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$4,417,845TotalAmt
Program Services$4,417,845ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$25,311,331$25,311,331$0$0
FINANCE & TECHNOLOGY$16,889,267$7,560,353$9,328,914$0
EQUIPMENT SERVICE CONTRACTS$2,079,683$2,079,683$0$0
PHYSICIAN PRACTICE SUBSIDY$21,087,862$21,087,862$0$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$4,722,119TotalAmt
Program Services$1,770,892ProgramServicesAmt
Management And General$2,951,227ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$221,518,754TotalAmt
Program Services$190,328,652ProgramServicesAmt
Management And General$31,190,102ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$4,482,273BOYAmt
EOY$2,738,194EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,652,338BOYAmt
EOY$1,845,299EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$22,438,612BOYAmt
EOY$22,940,178EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,842,905BOYAmt
EOY$3,872,098EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$2,238,759BOYAmt
EOY$2,161,646EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$205,770,926LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$153,151,749LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$54,515,060BOYAmt
EOY$52,619,177EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$251,090BOYAmt
EOY$312,018EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$46,804,179BOYAmt
EOY$43,446,771EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$136,225,216BOYAmt
EOY$129,935,381EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$28,666,670BOYAmt
EOY$31,548,477EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$39,690,027BOYAmt
EOY$37,950,962EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$81,438,064BOYAmt
EOY$76,697,342EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$149,794,761BOYAmt
EOY$146,196,781EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$14,765,569BOYAmt
EOY-$17,466,448EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$420,064BOYAmt
EOY$429,088EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$775,960BOYAmt
EOY$775,960EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$13,569,545BOYAmt
EOY-$16,261,400EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$136,225,216BOYAmt
EOY$129,935,381EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,846,088ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$58,233NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$96,000OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$120,268OtherActivitiesAmt
Total Lobbying Expenditures$120,268TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1 - LOBBYING ACTIVITIESFormAndLineReferenceDesc
ExplanationAMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ASSOCIATIONS REPRESENT.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$775,960BeginningYearBalanceAmt
Investment Earnings Or Losses$1,198InvestmentEarningsOrLossesAmt
Other Expenditures$1,198OtherExpendituresAmt
End Year Balance$775,960EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$775,960BeginningYearBalanceAmt
Investment Earnings Or Losses$479InvestmentEarningsOrLossesAmt
Other Expenditures$479OtherExpendituresAmt
End Year Balance$775,960EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$775,960BeginningYearBalanceAmt
Investment Earnings Or Losses$477InvestmentEarningsOrLossesAmt
Other Expenditures$477OtherExpendituresAmt
End Year Balance$775,960EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$775,960BeginningYearBalanceAmt
Investment Earnings Or Losses$477InvestmentEarningsOrLossesAmt
Other Expenditures$477OtherExpendituresAmt
End Year Balance$775,960EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$775,960BeginningYearBalanceAmt
Investment Earnings Or Losses$1,319InvestmentEarningsOrLossesAmt
Other Expenditures$1,319OtherExpendituresAmt
End Year Balance$775,960EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$38,000OtherCostOrOtherBasisAmt
Book Value$38,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$100,009,616OtherCostOrOtherBasisAmt
Depreciation$68,370,735DepreciationAmt
Book Value$31,638,881BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,000OtherCostOrOtherBasisAmt
Depreciation$175DepreciationAmt
Book Value$6,825BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$98,357,900OtherCostOrOtherBasisAmt
Depreciation$80,351,457DepreciationAmt
Book Value$18,006,443BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,358,410OtherCostOrOtherBasisAmt
Depreciation$4,429,382DepreciationAmt
Book Value$2,929,028BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$52,619,177TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
DUE FROM RELATED PARTIES, NET$14,619,000
OTHER RECEIVABLES, NET$1,005,593
OTHER ASSETS$112,436
INSURANCE CLAIMS RECEIVABLE$27,709,742
FieldValueIRS element (for citing)
Total Book Value Other Assets$43,446,771TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDescAmtAmt
SELF INSURANCE LIABILITIES$17,390,469
DUE TO RELATED PARTIES$23,084,458
THIRD PARTY PAYOR LIABILITIES$8,448,942
ESTIMATED MALPRACTICE$26,137,222
OTHER LIAB-POST RETIREMENT$996,000
OTHER LIAB-457B PLAN$640,251
FieldValueIRS element (for citing)
Total Liability$76,697,342TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4 - ENDOWMENT FUNDSTHE ENDOWMENT INVESTMENTS ARE TO BE HELD IN PERPETUITY, THE INCOME OF WHICH IS EXPENDABLE TO SUPPORT HEALTHCARE SERVICES.
PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTECHS 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.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other300.FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,066,690TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,832,907DirectOffsettingRevenueAmt
Net Community Benefit Expns$233,783NetCommunityBenefitExpnsAmt
Total Expense0.00110TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$31,507,452TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$16,871,126DirectOffsettingRevenueAmt
Net Community Benefit Expns$14,636,326NetCommunityBenefitExpnsAmt
Total Expense0.06610TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,465,784TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$780,616DirectOffsettingRevenueAmt
Net Community Benefit Expns$685,168NetCommunityBenefitExpnsAmt
Total Expense0.00310TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$36,039,926TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,484,649DirectOffsettingRevenueAmt
Net Community Benefit Expns$15,555,277NetCommunityBenefitExpnsAmt
Total Expense0.07030TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$358,029TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$358,029NetCommunityBenefitExpnsAmt
Total Expense0.00160TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,098,832TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$428,363DirectOffsettingRevenueAmt
Net Community Benefit Expns$670,469NetCommunityBenefitExpnsAmt
Total Expense0.00300TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$79,083TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$79,083NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,535,944TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$428,363DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,107,581NetCommunityBenefitExpnsAmt
Total Expense0.00500TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$37,575,870TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,913,012DirectOffsettingRevenueAmt
Net Community Benefit Expns$16,662,858NetCommunityBenefitExpnsAmt
Total Expense0.07530TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$3,019,369BadDebtExpenseAmt
Reimbursed By Medicare$54,391,365ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$51,801,991CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$2,589,374MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST CHARLES HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 BELLE TERRE ROADAddressLine1Txt
CityPORT JEFFERSONCityNm
State AbbreviationNYStateAbbreviationCd
ZIP11777ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.STCHARLESHOSPITAL.CHSLI.ORG/WebsiteAddressTxt
State License5149001HStateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Teaching HospitalYes (X)TeachingHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherREHABILITATIVE SERVICESOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ST CHARLES HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSTCHARLESHOSPITAL.CHSLI.ORG/OwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLWWW.CHSLI.ORGOtherWebsiteURLTxt
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLWWW.CHSLI.ORGStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care300.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.CHSLI.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.CHSLI.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.CHSLI.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Prospective Medicare MedicaidYes (X)ProspectiveMedicareMedicaidInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, SECTION B, LINE 3EIN 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 THAT A STRONG EMPHASIS ON MENTAL WITH INTEGRATION THROUGHOUT INTERVENTION STRATEGIES BE PERFORMED.
PART V, SECTION B, LINE 5ST. CHARLES 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 ST. CHARLES HOSPITAL, DOCTOR'S OFFICES, HEALTH DEPARTMENTS, LIBRARIES, SCHOOLS, INSURANCE ENROLLMENT SITES AND COMMUNITY-BASED ORGANIZATIONS. THIS INCLUDES THE UNDERSERVED COMMUNITIES OF CORAM, FARMINGVILLE, PATCHOGUE, PORT JEFFERSON STATION AND SOUND BEACH. ST. CHARLES 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 6ABROOKHAVEN 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 6BTHE HOSPITAL'S CHNA WAS 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 11ST. CHARLES 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 ST. CHARLES HOSPITAL IS WORKING TO PREVENT OBESITY IN CHILDREN THROUGH A FOCUS ON NUTRITION AND EXERCISE. ST. CHARLES HOSPITAL HELD THINKHEALTHY! HEALTHY NUTRITION/EXERCISE PROGRAMS FOR CHILDREN IN 2017. IN FEBRUARY 2017, ST. CHARLES HOSPITALS EXECUTIVE CHEF AND DIRECTOR, NUTRITIONAL SERVICES DEPARTMENT, PROVIDED EDUCATION AND TRAINING TO 15 CHEFS EMPLOYED BY THE SACHEM SCHOOL DISTRICT. EDUCATION CONSISTED OF NUTRITIONAL CONTENT IN HEALTHY FOODS AND TRAINING CONSISTED OF COOKING HEALTHY RECIPES WITH THESE FOODS. IN MARCH 2017, A REGISTERED DIETITIAN FROM ST. CHARLES PRESENTED TWO SEMINARS (ONE HOUR EACH) TO A TOTAL OF 500 STUDENTS AND TEACHERS AT CLINTON AVENUE ELEMENTARY SCHOOL (COMSEWOGUE SCHOOL DISTRICT). THE EAT THE RAINBOW EDUCATION CONSISTED OF INFORMING CHILDREN OF HEALTHY FOOD CHOICES THAT MATCHED THE COLOR OF THE RAINBOW. IN JUNE 2017, ST. CHARLES HOSPITALS EXECUTIVE CHEF AND THE DIRECTOR OF THE NUTRITIONAL SERVICES DEPARTMENT, PROVIDED AN EATING THE RAINBOW PRESENTATION TO 100 STUDENTS AND 20 ADULTS AT THE WENONAH ELEMENTARY SCHOOL IN THE SACHEM SCHOOL DISTRICT. EDUCATION CONSISTED OF NUTRITIONAL CONTENT IN HEALTHY FOODS AND INFORMING CHILDREN OF HEALTHY FOOD CHOICES THAT MATCHED THE COLOR OF THE RAINBOW. ST. CHARLES HOSPITAL PARTNERED WITH THE PORT JEFFERSON CHAMBER OF COMMERCE, JOHN T. MATHER MEMORIAL HOSPITAL AND STONY BROOK UNIVERSITY MEDICAL CENTER TO OFFER A HEALTH FAIR FOR RESIDENTS OF THE THREE VILLAGE COMMUNITY. THE HOSPITAL PROVIDED A HEALTHY FOOD COURT WHERE THE EXECUTIVE CHEF DEMONSTRATED COOKING A HEALTHY BREAKFAST, LUNCH AND SNACKS. RECIPES FOR THE HEALTHY FOOD WERE DISTRIBUTED. A TOTAL OF 400 ADULTS AND CHILDREN ATTENDED. ST. CHARLES'S BARIATRIC SURGERY SUPPORT GROUP PROVIDES INFORMATION AND ENCOURAGEMENT FOR THOSE WHO SHARE THE WEIGHT-LOSS SURGERY EXPERIENCE. FREE MONTHLY EDUCATION SESSIONS ARE OFFERED TO THE COMMUNITY. THE OVEREATERS ANONYMOUS SUPPORT GROUP PROVIDES FELLOWSHIP FOR INDIVIDUALS WHO, THROUGH SHARED EXPERIENCE, STRENGTH, AND HOPE, ARE RECOVERING FROM COMPULSIVE OVEREATING. ST. CHARLES HOSPITAL ACTIVELY PROMOTES THE LONG ISLAND HEALTH COLLABORATIVE'S (LIHC) WALKING PROGRAM, BY DISTRIBUTING PROMOTIONAL MATERIALS AT COMMUNITY EVENTS AND THROUGH SOCIAL MEDIA. ST. CHARLES HOSPITAL ALSO SHARES PROGRAM INFORMATION WITH CHS-AFFILIATED PHYSICIANS AND MID-LEVEL PRACTITIONERS TO ENCOURAGE MORE PEOPLE TO WALK AND CHOOSE A HEALTHIER LIFESTYLE. THIRTY ST. CHARLES HOSPITAL EMPLOYEES PARTICIPATED IN 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 TO PARTICIPANTS AT EACH EVENT. PRIORITY 2: PREVENTIVE CARE AND MANAGEMENT ST. CHARLES IS WORKING TO INCREASE ACCESS TO HIGH-QUALITY DISEASE PREVENTIVE CARE AND MANAGEMENT FOR CARDIOVASCULAR DISEASE, DIABETES, AND ORTHOPEDIC CARE THROUGH ITS SPEAKERS TO GO PROGRAM. THE PROGRAM PROVIDES FREE EDUCATION TO THE COMMUNITY ON VARIOUS HEALTH AND WELLNESS PROGRAMS AND PROMOTES HEALTHIER LIFESTYLES. ST. CHARLES PROMOTED "SPEAKERS TO GO" LECTURES AND SEMINARS ON SOCIAL MEDIA, INCLUDING FACEBOOK, TWITTER, AND INSTAGRAM. IN ADDITION, AN ONLINE REGISTRATION FORM WAS DEVELOPED AND WAS AVAILABLE THROUGH SOCIAL MEDIA POSTS. IN 2017, ST. CHARLES PROVIDED NEARLY 40 FREE COMMUNITY LECTURES ON A VARIETY OF TOPICS HELD AT THE HOSPITAL AND AT ST. CHARLES'S OUTPATIENT REHABILITATION SITES AS WELL AS LOCAL SCHOOLS, SENIOR CITIZEN CENTERS, COMMUNITY/SCHOOL HEALTH FAIRS, AND LIBRARIES. ATTENDANCE RANGED FROM 15 PEOPLE TO 500 PEOPLE. TOPICS INCLUDED SLEEP BETTER, LIVE BETTER, STRIKING OUT STROKES, SMOKING CESSATION, BLOOD PRESSURE SCREENINGS, TAI CHI FOR ARTHRITIS, FALLS PREVENTION, MINIMIZING STRESS/MAXIMIZING LIFE, HEALTHY EATING FOR A HEALTHY HEART, BONE HEALTHY DIET, GET SHARP-STAY SHARP, ACL INJURY PREVENTION, ORAL CANCER SCREENINGS, AND SING A SONG OF HEALTH: BENEFITS OF MUSIC THERAPY. THERE IS A GREAT NEED FOR ORAL HYGIENE AND DENTAL SERVICES FOR VETERANS. ST. CHARLES HOSPITAL HELD A CLINIC FOR VETERANS IN NOVEMBER 2017, PROVIDING FREE SERVICES FOR ONE DAY. DENTAL SERVICES WERE DELIVERED TO 26 VETERANS, WITH MORE THAN 100 PROCEDURES PERFORMED. IN 2017, ST. CHARLES HOSPITAL OFFERED FREE MONTHLY SUPPORT GROUPS. A GROUP FOR WEIGHT-LOSS SURGERY PATIENTS HAD AN AVERAGE OF 15 PARTICIPANTS, A BI-WEEKLY SUPPORT GROUP FOR OVEREATERS ANONYMOUS HAD AN AVERAGE OF 20 PARTICIPANTS, AND A BI-WEEKLY STROKE SUPPORT GROUP HAD AN AVERAGE OF 12 PARTICIPANTS. ST. CHARLES STAFF VOLUNTEER AT CHS HEALTHY SUNDAYS COMMUNITY OUTREACH EVENTS HELD IN UNDERSERVED CHURCHES, OFFERING FREE HEALTH SCREENINGS AND PROVIDING EDUCATIONAL MATERIALS ON PREVENTIVE HEALTH. FOUR HEALTHY SUNDAYS EVENTS WERE HELD IN 2017: JANUARY 2017: ST. JOHN THE EVANGELIST CHURCH, RIVERHEAD - 46 INDIVIDUALS WERE PROVIDED BLOOD PRESSURE AND BMI SCREENINGS, AND 35 FREE FLU VACCINATIONS WERE ADMINISTERED. FOUR WERE REFERRED TO THE BISHOP MCHUGH HEALTH CENTER IN BABYLON FOR FREE FOLLOW-UP CARE. APRIL 2017: CHURCH OF ST. ROSALIE, HAMPTON BAYS, 30 INDIVIDUALS WERE PROVIDED BLOOD PRESSURE AND BMI SCREENINGS ALONG WITH HEALTH EDUCATION MATERIALS. ONE INDIVIDUAL WAS REFERRED TO THE BISHOP MCHUGH HEALTH CENTER IN BABYLON FOR FREE FOLLOW-UP CARE. JULY 2017: ST. FRANCES CABRINI CHURCH, CORAM. ST. CHARLES PARTNERED WITH LONG ISLAND DIGESTIVE DISEASE CONSULTANTS WHOSE CLINICAL STAFF OFFERED FREE SCREENINGS FOR INDIVIDUALS WITH GASTROINTESTINAL ISSUES. FREE HEALTH EDUCATION MATERIALS WERE OFFERRED TO ALL ATTENDEES. NOVEMBER 2017: CHURCH OF ST. ROSALIE, HAMPTON BAYS, 75 INDIVIDUALS ATTENDED, ALL RECEIVED A FLU SHOT AND WERE PROVIDED WITH HEALTH EDUCATION MATERIALS. ST. CHARLES HOSPITAL OFFERED THREE FREE, EVIDENCE-BASED,SEVEN-WEEK STEPPING ON PROGRAMS AT THE ROSE CARACAPPA SENIOR CENTER IN MT. SINAI. A TOTAL OF 45 INDIVIDUALS COMPLETED THE PROGRAM IN 2017. THIS PROGRAM EMPOWERS OLDER ADULTS TO LEARN HEALTH BEHAVIORS THAT REDUCE THE RISK OF FALLS, IMPROVE SELF-MANAGEMENT, AND INCREASE QUALITY OF LIFE. PRIORITY 3: MENTAL HEALTH ST. CHARLES HOSPITAL HAS COMPLETED THE NECESSARY WORK TO OPEN AN ADDITIONAL 10 BEDS FOR MEDICALLY SUPERVISED DETOXIFICATION. AS OF YEAR END 2017, THE HOSPITAL HAS NOT YET RECEIVED A CERTIFICATE OF OCCUPANCY FROM THE NEW YORK STATE DEPARTMENT OF HEALTH. ST. CHARLES HOSPITAL IS A DESIGNATED DISTRIBUTOR OF INTRANASAL NARCAN. THIS MEDICATION IS PROVIDED AS PREVENTION FOR POTENTIAL OVERDOSE INCIDENTS ONLY FOR INDIVIDUALS WHO PRESENT AT THE EMERGENCY DEPARTMENT SEEKING DETOXIFICATION. THE FREE CHS MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE THROUGHOUT THE HOSPITAL AND AT ALL COMMUNITY OUTREACH EVENTS. IN MAY 2017, ST. CHARLES HOSPITAL HOSTED A MULTIDISCIPLINARY SYMPOSIUM ON SUBSTANCE ABUSE. THE PROGRAM WAS FILLED TO CAPACITY AT 125 ATTENDEES. EXPERT CLINICIANS AND PROFESSIONALS PROVIDED CURRENT, EVIDENCE-BASED RESOURCES AND MATERIAL ON ALL ASPECTS OF ADDICTION, RECOVERY AND RELAPSE FOR PATIENTS ACROSS THE LIFESPAN: BIRTH TO GERIATRICS. TO FURTHER THE CONTINUUM OF CARE FOR PATIENTS POST-DISCHARGE FROM BOTH THE DETOXIFICATION PROGRAM AND THE REHABILITATION PROGRAM. ST. CHARLES OFFERS NUMEROUS SUPPORT GROUPS POST-DISCHARGE, INCLUDING MONTHLY AL-ANON FAMILY SUPPORT GROUP - STEP MEETING, WEEKLY AL-ANON FAMILY SUPPORT GROUP BEGINNERS MEETING, WEEKLY ALCOHOLICS ANONYMOUS - BACK TO BASICS, WEEKLY ALCOHOLICS ANONYMOUS - LIVING SOBER AND WEEKLY NARCOTICS ANONYMOUS.
PAER V, SECTION B, LINE 20EST. CHARLES HOSPITAL HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN ST. CHARLES HOSPITAL 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. ST. CHARLES HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE.

Supplemental Information Detail SupplementalInformationDetail (11 entries)

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PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEETRATIO 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 THEIR SERVICES AS TRACKED BY HOSPITAL PERSONNNEL 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, LINES 2,3 - BAD DEBT AS COMMUNITY BENEFITAS PART OF ITS TAX EXEMPT PURPOSE THE HOSPITAL PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. THE HOSPITAL 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, THE HOSPITAL 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 THE HOSPITAL 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 DEBTTHE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THIS ALLOWANCE BASED UPON HISTORICAL COLLECTION AND 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, CHS 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. CHS DOES NOT HAVE ANY OFF-BALANCE-SHEET CREDIT EXPOSURE RELATED TO ITS PATIENT ACCOUNTS RECEIVABLE.
PART III LINE 8 - COSTING METHODOLOGYTHE 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 9BTHE 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 HOSPITAL'S 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 GOALSCOMMUNITY HEALTH NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S BOARD OF TRUSTEES AND EXECUTIVE LEADERSHIP COUNCIL, 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. ST. CHARLES 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.
PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY1. SINCE IT IS THE DUTY OF THE HOSPITAL TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF ITS CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS ARE FULLY VERSED IN THE CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. THE HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL 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 HOSPITAL 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 HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE HOSPITAL PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING ITS CHARITY CARE PROGRAM IN THE PRIMARY LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6.ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, A STATEMENT IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER INFORMATION. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL.
PART VI, LINE 4 - COMMUNITY INFORMATIONST. CHARLES HOSPITAL IS LOCATED ON THE NORTH SHORE OF SUFFOLK COUNTY IN THE TOWN OF BROOKHAVEN. A NOT-FOR-PROFIT HOSPITAL WITH 243 BEDS, ST. CHARLES IS A MEMBER OF CATHOLIC HEALTH SERVICES. THE POPULATION IN THE PRIMARY CATCHMENT AREA REPRESENTS 81% OF THE HOSPITAL'S ADMISSIONS. THE HOSPITAL'S SECONDARY CATCHMENT AREA HAS MORE THAN 200,000 RESIDENTS AND ACCOUNTS FOR ANOTHER 16% OF PATIENT ADMISSIONS. THIS SERVICE AREA (WHICH HAS NOT CHANGED SINCE 2008) COMPRISES SOME ECONOMICALLY CHALLENGED COMMUNITIES. ST. CHARLES HOSPITAL'S PRIMARY SERVICE AREA IS SHARED WITH AN ACUTE CARE HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL IN PORT JEFFERSON, AND A TERTIARY CARE HOSPITAL, STONY BROOK UNIVERSITY MEDICAL CENTER.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHST. CHARLES HAS PARTNERED WITH ORGANIZATIONS IN THE COMMUNITY TO FACILITATE OPTIMAL ACCESS TO HEALTH CARE AND THE PREVENTION OF FUTURE ILLNESS OR INJURY. THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY TAKING AN ACTIVE ROLE IN PROMOTING THE HEALTH OF THE COMMUNITY. THE HOSPITAL HAS IDENTIFIED AREAS OF NEED IN THE SURROUNDING COMMUNITIES AND HAS RESPONDED BY ESTABLISHING SERVICES THAT MEET THOSE NEEDS. ST. CHARLES HOSPITAL'S SPECIALTY CARE CENTER PROVIDES COMPREHENSIVE CARE FOR PATIENTS WITH SPECIALIZED DIAGNOSES. ST. CHARLES PARTICIPATES IN CATHOLIC HEALTH SERVICES HEALTHY SUNDAYS AT LOCAL PARISHES PROVIDING PARISHIONERS WITH FREE HEALTH CARE SERVICES SUCH AS CHOLESTEROL AND BLOOD PRESSURE SCREENING. THE HOSPITAL'S PEDIATRIC PULMONARY SPECIALTY CENTER IS AN EXTENSION OF ITS OUTPATIENT SPECIALTY CARE CENTER. THE MOVEMENTS DISORDERS CENTER AT ST. CHARLES HOSPITAL OFFERS TECHNOLOGICALLY ADVANCED, COMPREHENSIVE SERVICES FOR THOSE EXPERIENCING UNEXPLAINED DIFFICULTY WITH MOVEMENT. THE CENTER SPECIALIZES IN THE EVALUATION AND TREATMENT OF PARKINSON'S DISEASE. THE HOSPITAL PROVIDES COMMUNITY HEALTH PROGRAMS, SCREENINGS, AND SUPPORT GROUPS, INCLUDING BUT NOT LIMITED TO: AN AL-ANON FAMILY SUPPORT GROUP WHICH PROVIDES SUPPORT FOR FAMILY MEMBERS OF ALCOHOLICS. ALCOHOLICS ANONYMOUS SUPPORT GROUPS PROVIDE A PLACE FOR RECOVERING ALCOHOLICS TO HOLD WEEKLY MEETINGS. THE BRAIN INJURY SUPPORT GROUP IS OFFERED TO INDIVIDUALS WHOSE LIVES HAVE BEEN AFFECTED BY A BRAIN INJURY. INDIVIDUALS AND THEIR CAREGIVERS MEET TO DISCUSS RESOURCES, PROVIDE INFORMATION AND SHARE EXPERIENCES. AN EPILEPSY SUPPORT GROUP OFFERS SUPPORT TO INDIVIDUALS DIAGNOSED WITH EPILEPSY AND THEIR FAMILIES. THE HOSPITAL PROVIDES FAMILY EDUCATION CLASSES INCLUDING A BREASTFEEDING CLASS AND A BREASTFEEDING MOTHERS GROUP, NEW MOTHER'S SUPPORT GROUP, NEWBORN PARENTING 101, SIBLING CLASS AND LAMAZE CLASS. NARCOTICS ANONYMOUS PROVIDES ASSISTANCE AND INFORMATION FOR INDIVIDUALS RECOVERING FROM NARCOTICS ADDICTION. THE PARKINSON'S DISEASE SUPPORT GROUP PROVIDES SUPPORT INFORMATION AND AN OPPORTUNITY TO SHARE EXPERIENCES FOR INDIVIDUALS AFFECTED BY PARKINSON'S DISEASE. A SPINAL CORD INJURY SUPPORT GROUP HELPS THOSE WHO HAVE SUFFERED A SPINAL CORD INJURY (SUPPORT GROUPS HELD IN PORT JEFFERSON AND ALBERTSON ON A MONTHLY BASIS). ST. CHARLES HOSPITAL 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 SYSTEMST. CHARLES HOSPITAL (ST. CHARLES OR HOSPITAL) OPERATES A 243-BED ACUTE CARE AND PHYSICAL REHABILITATION MEDICAL HOSPITAL LOCATED IN PORT JEFFERSON, NEW YORK, WITH OUTPATIENT FACILITIES IN NASSAU AND SUFFOLK COUNTIES. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, ST. CHARLES, THROUGH ITS DAILY OPERATION, PROVIDES ACUTE, EMERGENT AND OUTPATIENT CARE. ST. CHARLES 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 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 SERVICES, 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 AS WELL AS FREE HEALTH SCREENINGS THROUGH ITS HEALTHY SUNDAYS PROGRAM, HEALTH FAIRS, AND OTHER PROGRAMS. SINCE 1907, CATHOLIC HEALTH CARE ON LONG ISLAND HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND 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 PARTNERSHIP 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

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1CATHOLIC HEALTH SERVICES OF LONG ISLANDBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1992 N VILLAGE AVE ROCKVILLE CENTREAddressLine1Txt
CityROCKVILLE CENTRECityNm
State AbbreviationNYStateAbbreviationCd
ZIP11570ZIPCd
FieldValueIRS element (for citing)
Recipient EIN113403968RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$685,195CashGrantAmt
Valuation Method UsedNONEValuationMethodUsedDesc
Non Cash AssistanceNONENonCashAssistanceDesc
Purpose Of GrantOUTPATIENT CENTERSPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USECHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR ST CHARLES 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)NAME 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

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp 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
JAMES O'CONNOR
CAO$434,329$0$107,000$0$25,068$0$99,977$0$24,202$0$690,576$0$0$0
SUNIL DHUPER
CMO$318,096$0$40,000$0$3,034$0$22,977$0$580$0$384,687$0$0$0
SATHISH SUBBAIAH MD
PHYSICIAN$3,750,001$0$304,445$0$540$0$22,977$0$472$0$4,078,435$0$0$0
MORGAN CHEN MD
PHYSICIAN$3,743,740$0$95,721$0$540$0$22,977$0$31,884$0$3,894,862$0$0$0
DOUGLAS PETRACO MD
PHYSICIAN$1,791,337$0$327,856$0$1,242$0$22,977$0$34,287$0$2,177,699$0$0$0
STEVEN PUOPOLO MD
PHYSICIAN$1,693,739$0$210,993$0$1,080$0$22,977$0$32,003$0$1,960,792$0$0$0
PHILIP SCHRANK MD
PHYSICIAN$1,649,999$0$172,731$0$810$0$22,977$0$472$0$1,846,989$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$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4B, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANTHE 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 JAMES O'CONNOR $77,000 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, REPORTING OF TOP FINANCIAL OFFICIALWILLIAM 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 O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATIONTHE SOLE MEMBER OF ST. CHARLES 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 BODYCHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF ST CHARLES HOSPITAL AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY ST CHARLES HOSPITAL.
FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODYAS THE SOLE MEMBER OF ST. CHARLES HOSPITAL, CHS IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF ST. CHARLES HOSPITAL. THE GOVERNING BODY OF ST. CHARLES HOSPITAL IS THE SAME AS THAT OF CHS.
FORM 990, PART VI, LINE 11B - REVIEW PROCESS FOR FORM 990THE 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 POLICYDISCLOSURE 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 POLICYTHE 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 INSPECTIONGOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE; CHS CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND.
FORM 990, PART VII, SECTION A - LINE 1AHOURS FOR TRUSTEES ARE THE ESTIMATED WEEKLY HOURS (2.0) TRUSTEES CONTRIBUTE TO THIS AND ALL OTHER RELATED ORGANIZATIONS, NOT NECESSARILY EQUALLY BUT IN THE PROPORTION NECESSARY, FOR WHICH THEY RECEIVE NO COMPENSATION. ALAN D. GUERCI, PRESIDENT & CEO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); RVC INSURANCE COMPANY, INC.(20-8067039); CATHOLIC HEALTH SYSTEM OF LONG ISLAND (11-3403968); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC.(11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST.CHARLES HOSPITAL (11-1871039) AND ST. JOSEPH HOSPITAL FOUNDATION (47-2353387). JAMES O'CONNOR EXECUTIVE DIRECTOR - THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST CHARLES HOSPITAL & REHAB (11-1871039); ST CHARLES FOUNDATION (41-2076312); ST CHARLES CORPORATION (11-2983148). 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).
FORM 990, PART X, LINE 20 - TAX-EXEMPT BOND LIABILITIESTHE 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 - CHANGE IN NET ASSETSCHANGE IN POST RETIREMENT BENEFIT: $96,000 --------- TOTAL: $96,000
FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSIONST CHARLES HOSPITAL 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/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
CATHOLIC HEALTH SYSTEM OF LONG ISLAND
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570113403968SUPPORT ORGNY501(C)(3)12A-INAfalse
CHS SERVICES INC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570113555766SUPPORT ORGNY501(C)(3)12B-IICHSLIYes (true)
CHS AMBULANCE SERVICES INC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570141801961DORMANTNY501(C)(3)3CHSLIfalse
GOOD SAMARITAN HOSPITAL MEDICAL CENTER
1000 MONTAUK HIGHWAYWEST ISLIPNY11795111888924HOSPITALNY501(C)(3)3CHSLIYes (true)
GOOD SAMARITAN SELF INSURANCE AGAINST
MALPRACTICE 1000 MONTAUK HIGHWAYWEST ISLIPNY11795112537396SELF INSURANCNY501(C)(3)12A-IGOOD SAMARTNYes (true)
MARYHAVEN TRANSPORTATION SERVICES
51 TERRYVILLE ROADPORT JEFFERSN STNY11776113434776TRANSPORTATIONY501(C)(3)12A-IMARYHAVENCTRfalse
MARYHAVEN CENTER OF HOPE
51 TERRYVILLE ROADPORT JEFFERSN STNY11776112861698Prgm-disabledNY501(C)(3)10CHSLIfalse
MARYHAVEN SCHOOL CORPORATION
51 TERRYVILLE ROADPORT JEFFERSN STNY11776112861690Schl-disabledNY501(C)(3)2MARYHAVENCTRfalse
THE CENTER OF HOPE FOUNDATION
51 TERRYVILLE ROADPORT JEFFERSN STNY11776113638367SUPPORT ORGNY501(C)(3)12A-IMARYHAVENCTRfalse
MERCY MEDICAL CENTER
1000 NORTH VILLAGE AVENUEROCKVILLE CTRNY11570111635088HOSPITALNY501(C)(3)3CHSLIYes (true)
CATHOLIC HOME CARE
110 Bi-County Blvd Suite 114FARMINGDALENY11735112126736HOME CARENY501(C)(3)10CHSLIfalse
OUR LADY OF CONSOLATION GERIATRIC CARE
111 BEACH DRIVEWEST ISLIPNY11795113284066LT NURSE CARENY501(C)(3)10CHSLIfalse
RIVERHEAD HOSTEL HOLDING CORPORATION
51 TERRYVILLE ROADPORT JEFFERSN STNY11776112499790RENTINGNY501(C)(2)MARYHAVENCTRfalse
ST CATHERINE OF SIENA MEDICAL CENTER
50 ROUTE 25ASMITHTOWNNY11787061562701HOSPITALNY501(C)(3)3CHSLIYes (true)
CHS HOME SUPPORT SERVICES INC
15 POWER DRIVEHAUPPAGENY11788113594561RESP THERAPYNY501(C)(3)10CATHHOMECAREfalse
ST FRANCIS HOSPITAL
100 PORT WASHINGTON BLVDROSLYNNY11576112050523HOSPITALNY501(C)(3)3CHSLIYes (true)
ST FRANCIS HOSPITAL FOUNDATION
100 PORT WASHINGTON BLVDROSLYNNY11576112916033SUPPORT ORGNY501(C)(3)12A-IST FRANCISfalse
ST FRANCIS HOSPITAL RESEARCH & EDUCATIO
100 PORT WASHINGTON BLVDROSLYNNY11576113090867RESEARCH ORGNY501(C)(3)12A-IST FRANCISYes (true)
WSNCHS NORTH INC
4295 HEMPSTEAD TURNPIKEBETHPAGENY11714113438973HOSPITALNY501(C)(3)3CHSLIYes (true)
THE ST CHARLES CORPORATION
200 BELLE TERRE ROADPORT JEFFERSN STNY11777112983148SUPPORT ORGNY501(C)(3)12A-ICHSLIfalse
THE SAMARITAN CORPORATION
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570112716640SUPPORT ORGNY501(C)(3)12A-ICHSLIfalse
WISDOM GARDENS HOUSING DEVELOPMENT FUND
51 TERRYVILLE ROADPORT JEFFERSN STNY11776113559713SR HOUSINGNY501(C)(3)10MARYHAVENCTRfalse
GOOD SHEPHERD HOSPICE
110 Bi-County Blvd Suite 114FARMINGDALENY11735112958438HOSPICE SVCNY501(C)(3)10CHSLIfalse
ST CHARLES HOSPITAL FOUNDATION
200 BELLE TERRE ROADPORT JEFFERSONNY11777412076312SUPPORT ORGNY501(C)(3)12A-1ST CHARLESYes (true)
GOOD SAMARITAN HOSPITAL FOUNDATION
1000 MONTAUK HIGHWAYWEST ISLIPNY11795770611240SUPPORT ORGNY501(C)(3)12A-1GOOD SAMARTNfalse
MERCY MEDICAL CENTER FOUNDATION
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570550813603SUPPORT ORGNY501(C)(3)12A-IMERCY MEDCTRfalse
ST CATHERINE OF SIENA MEDICAL CTR FDN
50 ROUTE 25ASMITHTOWNNY11787271459941SUPPORT ORGNY501(C)(3)12A-ISTCATHERINEYes (true)
CHS HOME CARE AND HOSPICE FOUNDATION
110 Bi-County Blvd Suite 114FARMINGDALENY11735452907761SUPPORT ORGNY501(C)(3)12A-ICATHHOMECAREfalse
GOOD SHEPHERD HOSPICE FOUNDATION
110 Bi-County Blvd Suite 114FARMINGDALENY11735263169427SUPPORT ORGNY501(C)(3)12A-IGOODSHEPHERDfalse
OUR LADY OF CONSOLATION FOUNDATION
111 BEACH DRIVEWEST ISLIPNY11795450517566SUPPORT ORGNY501(C)(3)12A-IOURLADYOFCfalse
RVC SUPPORT
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570271531084REAL ESTATENY501(C)(3)12A-ICHSLIfalse
ST FRANCIS CARDIOVASCULAR PHYSICIANS P
100 PORT WASHINGTON BLVDROSLYNNY11576113613997HEALTHCARESVCNY501(C)(3)12A-IST FRANCISfalse
RVC INSURANCE COMPANYINC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570208067039CAPTIVE INSNY501(C)(3)12B-IICHSLIfalse
SAMARITAN EMERGENCY MEDICAL SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208243412HEALTHCARESVCNY501(C)(4)GOOD SAMARTNfalse
ST JOSEPH HOSPITAL FOUNDATION
992 N VILLAGE AVENUEROCKVILLE CENTRENY11570472353387SUPPORT ORGNY501(C)(3)12A-IWSNCHS NORTHfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
BIPO HOLDINGS LLC
992 N VILLAGE AVE ROCKVILLE CENTREROCKVILLE CENTRENY11570464763720PHYSICIAN ASSNNYNAN/A
IDHC LLC
2500 YORK RD JAMISONPA 18929JAMISONPA18929452411095HEALTH SERVICESPANAN/A
BEACON HEALTH PTNRS
992 N VILLAGE AVE ROCKVILLE CENTREROCKVILLE CENTRENY11570454229842HEALTHCARENYNAN/A
WISDOM GARDENS LP
51 TERRYVILLE RDPORT JEFFERSONNY11776113567947SR HOUSINGNYNAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
RADIOLOGY CONSULTING OF LONG ISLANDPLLC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795421646134HEALTHCARE SVCNYGOOD SAMARITANC-CORPfalse
SAMARITAN PEDIATRIC SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208180263HEALTHCARE SVCNYGOOD SAMARITANC-CORPfalse
SAMARITAN MEDICAL SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208088453HEALTHCARE SVCNYGOOD SAMARITANC-CORPfalse
SOUTHWEST SUFFOLK MEDICAL PC
580 UNION BOULEVARDWEST ISLIPNY11795061603195HEALTHCARE SVCNYGOOD SAMARITANC-CORPfalse
CARDIAC EKG INTERPRETATION PC
992 N VILLAGE AVENUEROCKVILLE CENTRENY11570112924518HEALTHCARE SVCNYGOOD SAMARITANC-CORPfalse
LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208964140HEALTHCARE SVCNYGOOD SAMARITANC-CORPfalse
SAMARITAN MANAGEMENT SERVICES
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112838185HEALTHCARE SVCNYCHSLIC-CORPfalse
ADVANCED REHABILIATION MEDICINE PLLC
200 BELLE TERRE ROADPORT JEFFERSONNY11777113640709HEALTHCARE SVCNYSTCHARLES HOSPC-CORPfalse
ST FRANCIS CARDIAC PREVENTION SERVICES
100 PORT WASHINGTON BLVDROSLYNNY11576113224885HEALTHCARE SVCNYSTFRANCIS HOSPC-CORPfalse
SOUTH SHORE PRACTICE MANAGEMENT
1000 MONTAUK HIGHWAYWEST ISLIPNY11795113307977HEALTHCARE SVCNYSAMARITAN MGMTC-CORPfalse
SAMARITAN HOME CARE AMERICA
1000 MONTAUK HIGHWAYWEST ISLIPNY11795113319259HEALTHCARE SVCNYSAMARITAN MGMTC-CORPfalse
MERCY INTERNAL MEDICINE PC
992 N VILLAGE AVENUEROCKVILLE CENTRENY11570510639649HEALTHCARE SVCNYMERCY MED CTRC-CORPfalse
LONG ISLAND EMERGENCY CARE PC
1000 N VILLAGE AVEROCKVILLENY11571113633515PHYSICIAN SVCNYMERCY MED CTRS-CORPfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
CHS SERVICES
LMPR$129,050COST
ST FRANCIS HOSPITAL
LM$102,496COST
ST CATHERINE OF SIENA MEDICAL CENTER
LM$574,708COST
ST JOSEPH HOSPITAL
LM$102,489COST
MERCY MEDICAL CENTER
LM$172,080COST

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE R, PART IVFormAndLineReferenceDesc
ExplanationFOR 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