2017-11-13T15:40:18-06:00 2016-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2016-01-01 061562701 ST CATHERINE OF SIENA MEDICAL CENTER % CHS SERVICES INC STCA 6318623000 50 ROUTE 25A SMITHTOWN NY 11787 PAUL ROWLAND EXEC VP & CAO 5167051937 2017-11-06 true LAURA J PARELLO P01080295 6464713000 155.201.188.12 13049920173175000063 2017-11-13 P A47FF8DD5715699DF48307C25ACEE32075633D08 061919171EF570F7EF91D6556883685BED3C11EB 2016 2017-02-10 21:41:12Z ALAN D GUERCI MD 50 ROUTE 25A SMITHTOWN NY 11787 354125601 false 0928 X HTTP://STCATHERINES.CHSLI.ORG/ X 2000 NY CHSLI AND ITS MEMBERS, AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUE CHRIST'S HEALING MISSION, BY PROMOTING EXCELLENCE IN CARE AND COMMITTING ITSELF TO THOSE IN NEED. 23 22 2274 255 186594 -26802 49810203 12645433 220724403 240876446 244760 511810 1782993 547358 272562359 254581047 123418 788108 0 0 140819843 145981776 60000 0 0 93308482 100102824 234311743 246872708 38250616 7708339 191338461 203136491 219070882 223128519 -27732421 -19992028 X ST. CATHERINE OF SIENA MEDICAL CENTER, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, AND ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. false false 188787704 788108 205627649 ST. CATHERINE OF SIENA MEDICAL CENTER IS A 306 BED ACUTE CARE HOSPITAL DEVOTED TO PROVIDING ADVANCED HEALTHCARE IN AN ENVIRONMENT OF COMPASSION. IN 2016, THE MEDICAL CENTER HAD 11,219 DISCHARGES AND PROVIDED CARE FOR 28,993 EMERGENCY ROOM VISITS. IN ACCORDANCE WITH ITS MISSION AND PHILOSOPHY, THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH OTHER COMMUNITY SERVICE AND CHARITABLE ACTIVITIES. 30191241 0 35062203 ST. CATHERINE OF SIENA NURSING HOME IS LOCATED ON THE CAMPUS OF ST.CATHERINE OF SIENA MEDICAL CENTER. CONSISTING OF 240 BEDS, THE NURSING HOME PROVIDED 76,178 DAYS OF CARE IN 2016. 218978945 true true false true false false false false false false true false true true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false true true true true false false true 176 0 true 2274 true true true false false false false false false false false false X 23 22 false false false false true true true true true false false true true true true true true true true false X CHS SERVICES INC 5167051919 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X SALVATORE SODANO CHAIRMAN 2.0 0.0 X X 0 0 0 BRIAN MCGUIRE VICE CHAIR 2.0 0.0 X X 0 0 0 JOSEPH TANTILLO SECRETARY 2.0 0.0 X X 0 0 0 CHRIS PASCUCCI TREASURER 2.0 0.0 X X 0 0 0 BARBARA ELLEN BLACK TRUSTEE 2.0 0.0 X 0 0 0 VIRGINIA EWEN TRUSTEE 2.0 0.0 X 0 0 0 FRANK L KURRE TRUSTEE 2.0 0.0 X 0 0 0 REV MSGR ROBERT MORRISEY TRUSTEE 2.0 0.0 X 0 0 0 DANIEL T ROWE TRUSTEE 2.0 0.0 X 0 0 0 JOHN WAGNER TRUSTEE 2.0 0.0 X 0 0 0 REV JAMES VLAUN TRUSTEE 2.0 0.0 X 0 0 0 KEVIN J CONWAY TRUSTEE 2.0 0.0 X 0 0 0 PETER D'ANGELO TRUSTEE 2.0 0.0 X 0 0 0 REV PETER DUGANDZIC TRUSTEE 2.0 0.0 X 0 0 0 BRIAN P HEHIR TRUSTEE 2.0 0.0 X 0 0 0 HON ANTHONY MARANO TRUSTEE 2.0 0.0 X 0 0 0 STEPHEN F MCLOUGHLIN TRUSTEE 2.0 0.0 X 0 0 0 JEROME POLLER TRUSTEE 2.0 0.0 X 0 0 0 JOHN FRANCFORT MD TRUSTEE 2.0 0.0 X 0 0 0 ALEXANDER HAZELTON TRUSTEE 2.0 0.0 X 0 0 0 WILLIAM WARD TRUSTEE 2.0 0.0 X 0 0 0 ROBERT ZUCCARO TRUSTEE 2.0 0.0 X 0 0 0 ALAN D GUERCI MD PRESIDENT & CEO 50.0 0.0 X X 0 2595065 360447 DANIEL DEBARBA EVP & CFO (Effective 6/6/16) 50.0 0.0 X 0 591354 37422 PAUL ROWLAND EXEC VP & CAO 50.0 0.0 X 463819 0 36808 WILLIAM C ARMSTRONG SVP FINANCE 50.0 0.0 X 0 1552126 188843 JASON GOLBIN CMO 50.0 0.0 X 396524 0 41998 BRUCE MAYERSEN MD PHYSICIAN 50.0 0.0 X 785239 0 53155 SCHENLEY QUE MD PHYSICIAN 50.0 0.0 X 598553 0 41149 JUNE LEE MD PHYSICIAN 50.0 0.0 X 459708 0 30058 MICKEL KHLAT PROGRAM DIRECTOR - 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LOBBYING ACTIVITIES AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ASSOCIATIONS REPRESENT. 10126496 10126496 92135348 47294725 44840623 68557811 51153095 17404716 4424008 1062427 3361581 75733416 TRUSTEE HELD ASSETS 45041093 F 45041093 INSURANCE CLAIMS RECEIVABLE 32766243 OTHER ASSETS 116392 32882635 0 RESIDENT FUNDS AND SECURITY DEPOSIT 91621 THIRD PARTY PAYOR LIABILITIES 21704307 RETIREMENT LIABILITY - PENSION 1282000 RETIREMENT LIABILITY - 457B FUNDS 264160 RETIREMENT LIABILITY-POST RETIREMNT 2107000 ESTIMATED MALPRACTICE LIABILITY 33691797 SELF INSURED LIABILITY 24582992 DUE TO RELATED PARTIES 43331734 127055611 X PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTE CHS AND MOST OF ITS SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CHS ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE ACCOUNTING STANDARDS CODIFICATION TOPIC 740, INCOME TAXES. MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS, USING A THRESHOLD OF MORE LIKELY THAN NOT OF BEING SUSTAINED. true true X true X 300. true X true true false true true 2656559 1058120 1598439 0.00650 22058059 19483744 2574315 0.01040 618206 461792 156415 0.00060 25332824 21003656 4329169 0.01750 550241 0 550241 0.00220 8460 0 8460 0 0 0 0 0 0 193712 0 193712 0.00080 752413 0 752413 0.00300 26085237 21003656 5081582 0.02050 true 3569929 65497610 75636154 -10138544 X true true 1 1 ST CATHERINE OF SIENA HOSPITAL 50 ROUTE 25A SMITHTOWN NY 11787 HTTP://STCATHERINES.CHSLI.ORG/ 5157003H X X X PSYCHIATRIC UNIT ST CATHERINE OF SIENA MEDICAL CENTER 1 false false true X X X X X X X X X 16 true true true true X STCATHERINES.CHSLI.ORG/ X WWW.CHSLI.ORG true 16 true WWW.CHSLI.ORG false true X 300. 400. X X X true true X X X true X WWW.CHSLI.ORG X WWW.CHSLI.ORG X WWW.CHSLI.ORG X X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5 ST. CATHERINE OF SIENA MEDICAL CENTER 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. CATHERINE OF SIENA MEDICAL CENTER, DOCTORS OFFICES, HEALTH DEPARTMENTS, LIBRARIES, SCHOOLS, INSURANCE ENROLLMENT SITES AND COMMUNITY-BASED ORGANIZATIONS. THIS INCLUDES THE MEDICALLY UNDERSERVED COMMUNITIES OF HUNTINGTON STATION, HUNTINGTON CENTRAL ISLIP, BRENTWOOD AND RONKONKOMA. ST. CATHERINE OF SIENA MEDICAL CENTER PROMOTES THE SURVEY THROUGH SOCIAL MEDIA LINKS, ON ITS WEBSITE, AND BY DISTRIBUTING SURVEYS AT HEALTH FAIRS AND OTHER CONSUMER-ORIENTED EVENTS. PART V, SECTION B, LINE 6A BROOKHAVEN MEMORIAL HOSPITAL, HUNTINGTON HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL PECONIC BAY MEDICAL CENTER, GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CATHERINE OF SIENA MEDICAL CENTER, SOUTHAMPTON HOSPITAL, SOUTHSIDE HOSPITAL, STONY BROOK UNIVERSITY HOSPITAL AND VETERANS AFFAIRS MEDICAL CENTER. PART V, SECTION B, LINE 6B THE HOSPITALS CHNA WAS CONDUCTED WITH NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND MORE THAN 40 COMMUNITY-BASED ORGANIZATIONS, COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). PART V, SECTION B, LINE 11 ST. CATHERINE OF SIENA MEDICAL CENTER AND LIHC COMMUNITY PARTNERS SELECTED CHRONIC DISEASE AS THE PRIORITY AREA WITH A FOCUS ON (1) OBESITY AND (2) PREVENTIVE CARE AND MANAGEMENT FOR THE 2016-2018 CYCLE. MENTAL HEALTH WILL BE HIGHLIGHTED WITHIN ALL INTERVENTION STRATEGIES. PRIORITY 1: OBESITY THE HOSPITAL IS WORKING TO INCREASE EDUCATION AND SUPPORT SERVICES TO HELP REDUCE OBESITY IN ADULTS AND CHILDREN IN SUFFOLK COUNTY, ESPECIALLY WITHIN THE HOSPITALS SERVICE AREAS, INCLUDING THE DISADVANTAGED AND UNDERSERVED COMMUNITIES. THROUGH COMMUNITY OUTREACH PROGRAMS, IT IS ADDRESSING THE NEED FOR IMPROVED AWARENESS AND EDUCATION ABOUT HEALTHY LIFESTYLE OPTIONS. PROGRAMS INCLUDE THE BOARD "WALK" TO WELLNESS WALKING PROGRAM AND ORGANIZED COMMUNITY WALKS IN PARTNERSHIP WITH OTHER GROUPS. FREE INFORMATION ON NUTRITION, WELLNESS, CHRONIC DISEASE PREVENTION, AND FREE BLOOD PRESSURE AND BMI SCREENINGS ARE OFFERED. THE HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY WALKING EVENTS TO ENCOURAGE PHYSICAL ACTIVITY, INCLUDING THE AMERICAN CANCER SOCIETYS RELAY FOR LIFE AT COMMACK HIGH SCHOOL IN WHICH 3 EMPLOYEES PARTICIPATED, A KINGS PARK COMMUNITY PARADE IN WHICH 4 EMPLOYEES PARTICIPATED, AND A ST. JAMES COMMUNITY PARADE AT WHICH 10 EMPLOYEES PARTICIPATED. EDUCATIONAL MATERIALS ARE OFFERED TO PARTICIPANTS AT EACH EVENT. ST. CATHERINE OF SIENA MEDICAL CENTER PARTICIPATED IN THE AMERICAN HEART ASSOCIATION HEART WALK, THE LONG ISLAND MARCUM WORKPLACE CHALLENGE-A 3.5 MILE RUN-WALK FOR CHARITY-AND AMERICAN CANCER SOCIETY'S MAKING STRIDES AGAINST BREAST CANCER WALK. THESE EVENTS PROMOTE WALKING FOR PHYSICAL ACTIVITY AND GOOD HEALTH FOR COMMUNITY. ST. CATHERINE OF SIENA IS ACTIVELY PARTICIPATING WITH THE LONG ISLAND HEALTH COLLABORATIVE'S (LIHC) ARE YOU READY FEET? WALKING PROGRAM FOR LONG ISLANDERS. ST. CATHERINE COMMUNTIY OUTREACH STAFF WORKED WITH THE DIETICIAN AT THE LOCAL SHOPRITE OF COMMACK TO EDUCATE AND DISTRIBUTE MATERIALS RELATED TO WEIGHT MANAGEMENT, AND HEALTHY FOOD AND BEVERAGE CHOICES. BMI AND BLOOD PRESSURE SCREENINGS ARE OFFERED AT THE LOCAL SHOPRITE GROCERY STORE THREE TIMES ANNUALLY. THIS STORE IS LOCATED NEAR THE UNDERSERVED COMMUNITIES OF CENTRAL ISLIP AND BRENTWOOD. IN 2016, A TOTAL OF 57 BLOOD PRESSURE SCREENINGS WERE PROVIDED ALONG WITH THE DISTRIBUTION OF EDUCATIONAL MATERIALS. LECTURES ON PHYSICIAN-DRIVEN PROGRAMS ON TOPICS RELATED TO WEIGHT MANAGEMENT AND NUTRITION FOUR TIMES ANNUALLY. IN 2016, THERE WERE A TOTAL OF 410 ATTENDEES AT THE 3 SCHEDULED LECTURES. FOR PATIENTS WHO HAVE UNDERGONE A BARIATRIC SURGICAL PROCEDURE, ST. CATHERINE OF SIENA OFFERS A FREE BARIATRIC SUPPORT GROUP TO ASSIST WITH THE TRANSITION AND ENCOURAGE HEALTHY EATING AND PHYSICAL FITNESS FOR OPTIMAL HEALTH. IN 2016, 24 SESSIONS WERE HELD WITH 160 PARTICIPANTS. THE MEDICAL CENTER CONTINUES TO COORDINATE FREE OR LOW-COST EVENTS FOR THE COMMUNITY, AND PROVIDES FREE BODY MASS INDEX (BMI) SCREENINGS AND INFORMATION ON NUTRITION, HEALTHY EATING, AND WELLNESS INITIATIVES. THE COMMUNITY OUTREACH PROGRAM ENCOMPASSES ALL EVENTS THE HOSPITAL PARTICIPATES IN, SUCH AS LOCAL COMMUNITY FESTIVALS AND HEALTH FAIRS AND HOSPITAL-SPONSORED EVENTS, INCLUDING THE ANNUAL FALL HEALTH FAIR. CHS WAS THE MEDAL OF HONOR TITLE SPONSOR FOR THE SECOND CONSECUTIVE YEAR SERVING AGAIN AS THE OFFICIAL RACE MEDICINE PROVIDER FOR THE 2016 CHS SUFFOLK COUNTY MARATHON AND FREEDOM FEST. THE NET PROCEEDS FROM THE ANNUAL EVENT BENEFITS LOCAL VETERANS SERVICES ORGANIZATIONS. THERE WERE 2 ST. CATHERINE EMPLOYEES WHO PARTICIPATED IN THE MARATHON. PRIORITY 2: PREVENTIVE CARE AND MANAGEMENT THE HOSPITAL IS WORKING TO INCREASE ACCESS TO HIGH-QUALITY DISEASE PREVENTIVE CARE AND MANAGEMENT FOR CARDIOVASCULAR DISEASE AND DIABETES IN CLINICAL AND COMMUNITY SETTINGS. ST. CATHERINES VOLUNTEER STAFF PROVIDED DISEASE EDUCATION, BLOOD PRESSURE AND BMI SCREENINGS, DERMATOLOGY AND CHOLESTEROL SCREENINGS, AND FREE FLU VACCINATIONS AT LOCAL COMMUNITY FESTIVALS AND HEALTH FAIRS AND HOSPITAL-SPONSORED EVENTS, INCLUDING THE ANNUAL FALL HEALTH FAIR. IN 2016, A TOTAL OF 6,868 PEOPLE WERE IN ATTENDANCE AT COMMUNITY EVENTS IN WHICH THE HOSPITAL COORDINATED OR PARTICIPATED, FOR A TOTAL OF 722 BLOOD PRESSURE SCREENINGS WERE PROVIDED, 285 FLU VACCINATIONS WERE ADMINISTERED, AND 191 CHOLESTEROL AND GLUCOSE SCREENINGS WERE COMPLETED. ST. CATHERINE OF SIENA OFFERS A VARIETY OF FREE COMMUNITY SUPPORT GROUPS RELATED TO THE PREVENTION OR MANAGEMENT OF CHRONIC DISEASES, INCLUDING DIABETES, LUPUS, STROKE, AND PARKINSON'S DISEASE. IN 2016, A TOTAL OF 881 PEOPLE WERE IN ATTENDANCE AT SUPPORT GROUPS RELATED TO DIABETES, LUPUS, AND PARKINSONS DISEASE. THE SEVEN-WEEK STEPPING ON PROGRAM IS AN EVIDENCE-BASED FALL PREVENTION PROGRAM DESIGNED TO REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS. IN 2016, THE PROGRAM WAS OFFERED 3 TIMES WITH ALMOST 40 PARTICIPANTS. ADDITIONAL SESSIONS ARE BEING PLANNED AT ST. CATHERINE OF SIENA MEDICAL CENTER FOR 2017. ST. CATHERINES STAFF VOLUNTEERED AT CHS HEALTHY SUNDAYS COMMUNITY OUTREACH EVENTS HELD IN UNDERSERVED COMMUNITIES, OFFERING FREE HEALTH SCREENINGS AND PROVIDING EDUCATIONAL MATERIALS ON PREVENTIVE CARE AND MANAGEMENT. IN 2016, ST. CATHERINE PARTICIPATED IN 5 EVENTS AND SCREENED 222 INDIVIDUALS IN MEDICALLY UNDERSERVED AREAS. A TOTAL OF 143 FLU VACCINATIONS, 97 BLOOD PRESSURE SCREENINGS AND 30 BMI ASSESSMENTS WERE COMPLETED. A REFERAL FOR FREE FOLLOW-UP CARE WAS PROVIDED TO 37 INDIVUDALS; 36 WERE REFERRED TO THE BISHOP MCHUGH HEALTH CENTER IN BABYLON, AND 1 WAS REFERRED TO CHSS SOUTH BAY CARDIOLOGY. ALL ATTENDEES WERE OFFERED A VARIETY OF HEALTH EDUCATION MATERIALS. ST. CATHERINE PARTICIPATED IN THE SUFFOLK COUNTY RETIRED SENIOR VOLUNTEER PROGRAM (RSVP), LEGISLATOR TROTTAS SENIOR FAIR, AND OTHER ORGANIZATIONAL EMPLOYEE WELLNESS PROGRAMS, OFFERING FREE BLOOD PRESSURE AND BMI SCREENINGS TO INCREASE AWARENESS AND EDUCATION ABOUT CHRONIC DISEASE IN UNDERSERVED COMMUNITIES. IN 2016, A TOTAL OF 750 ATTENDEES RECEIVED EDUCATIONAL MATERIALS, AND 45 BLOOD PRESSURE SCREENINGS WERE PROVIDED. ST. CATHERINE OF SIENA OFFERS A FREE EMERGENCY RESPONSE APPRECIATION DINNER FOR LOCAL EMERGENCY RESPONSE PERSONNEL WHO ALSO COLLABORATE WITH ST. CATHERINE OF SIENA AS COMMUNITY BENEFIT ORGANIZATIONS. THE EVENT INCREASES COMMUNICATION AMONG EMERGENCY RESPONDERS AND THE HOSPITALS EMERGENCY DEPARTMENT. IN MARCH 2016, THERE WERE 70 PARTICIPANTS AT THE EVENT WHICH FOCUSED ON "CARDIAC ARRHYTHMIA AND EKG INTERPRETATION"EMS MANAGEMENT OF ACUTE SURGICAL ISSUES". PRIORITY 3: MENTAL HEALTH THE HOSPITAL PROVIDED EDUCATION ABOUT PRESCRIPTION DRUG USE AND SAFE DRUG DISPOSAL AT HORIZONS COUNSELING CENTER AND THE TWO SMITHTOWN HIGH SCHOOLS. IN 2016, THREE OFF-CAMPUS EVENTS WERE COORDINATED BY THE HOSPITAL IN COLLABORATION WITH COMMUNITY PARTNERS. A TOTAL OF 165 ATTENDEES RECEIVED MENTAL HEALTH AND SUBSTANCE USE EDUCATIONAL MATERIALS. THE ST. CATHERINE OF SIENA COMMUNITY OUTREACH COORDINATOR PARTICIPATED IN THE MENTAL HEALTH FIRST AID TRAINING AT ST. FRANCIS HOSPITAL IN NOVEMBER 2016, PRESENTED BY THE MENTAL HEALTH ASSOCIATION OF NASSAU COUNTY. THIS FREE, EIGHT-HOUR TRAINING IS DESIGNED FOR CAREGIVERS OF THOSE WHO LIVE WITH CHRONIC DISEASE AS WELL AS HOSPITAL STAFF WHO WORK WITH CAREGIVERS OR RUN HOSPITAL SUPPORT GROUPS. THE FREE CHS MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE THROUGHOUT THE HOSPITAL AND AT ALL COMMUNITY OUTREACH EVENTS. PART V, SECTION B, LINE 20E ST. CATHERINE OF SIENA MEDICAL CENTER HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES 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. ST. CATHERINE OF SIENA MEDICAL CENTER HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 1 ST CATHERINE OF SIENA NURSING HOME 25 ROUTE 25A SMITHTOWN NY 11787 SKILLED NURSING FACILITY PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS. PART I, LINE 7A COLUMN (D) DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S "NEED" CALCULATION. THIS CALCULATION CONSIDERS 100% OF A HOSPITAL'S "NEED" BASED ON A "UNITS OF SERVICE" METHODOLOGY FOR UNINSURED PATIENTS. THE CALCULATION ALSO MAKES ADJUSTMENTS BASED ON THE PROPORTION OF MEDICAID ELIGIBLE PATIENTS TREATED AT THE FACILITY. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2016. PART I, LINE 7 REFLECTS HOSPITAL INFORMATION ONLY. PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT AS 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 DEBT THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE 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, THE MEDICAL CENTER FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY CHS POLICY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE. CHS DOES NOT HAVE ANY OFF-BALANCE-SHEET CREDIT EXPOSURE RELATED TO ITS PATIENT ACCOUNTS RECEIVABLE. PART III, LINE 8 - COSTING METHODOLOGY THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2016 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. PART III, LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. ST. CATHERINE BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY, BUT ALSO DOING SO WITH NO RECOURSE IN OBTAINING PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING-EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED ARE NOT TURNED AWAY, SO ST. CATHERINE WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY. PART III, LINE 9B THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INANBILITY 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 MEDICAL CENTER'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 GOALS COMMUNITY 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. CATHERINE 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 POLICY 1. SINCE IT IS THE DUTY OF THE MEDICAL CENTER 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 ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE MEDICAL CENTER REPRESENTATIVES. 2. THE MEDICAL CENTER HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE MEDICAL CENTER INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. THE MEDICAL CENTER PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. THE MEDICAL CENTER POSTS ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE MEDICAL CENTER 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 PROVIDED AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4 - COMMUNITY INFORMATION ST. CATHERINE OF SIENA MEDICAL CENTER IS LOCATED ON 110 ACRES ON THE NORTH SHORE OF LONG ISLAND IN SMITHTOWN, NEW YORK. THIS 558-BED, NOT-FOR-PROFIT COMMUNITY HOSPITAL, INCLUDES 240 NURSING/REHAB BEDS AND A MEDICAL OFFICE BUILDING. ST. CATHERINES SERVICE AREA CONSISTS OF 21 COMMUNITIES LOCATED IN WESTERN SUFFOLK COUNTY. APPROXIMATELY 648,000 PEOPLE RESIDE IN THE SERVICE AREA. ST. CATHERINES PRIMARY CATCHMENT AREA HAS A POPULATION OF APPROXIMATELY 248,000 AND INCLUDES SMITHTOWN, ST. JAMES, HAUPPAUGE, KINGS PARK, COMMACK, NESCONSET, NORTHPORT, AND EAST NORTHPORT. THE SECONDARY SERVICE AREA COMPRISES LAKE GROVE, CENTERPORT, GREENLAWN, HUNTINGTON STATION, HUNTINGTON, AND COLD SPRING HARBOR. IN ADDITION, ST. CATHERINE SEES PATIENTS FROM CENTRAL ISLIP, BRENTWOOD, AND RONKONKOMA. THESE ARE PRIMARILY UNDERSERVED COMMUNITIES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH ST. CATHERINE OF SIENA MEDICAL CENTER OFFERS A WIDE AND COMPREHENSIVE ARRAY OF COMMUNITY SERVICE PROGRAMS THAT ADDRESS CRITICAL HEALTH ISSUES TO A DIVERSE GROUP OF PATIENTS. THE FOLLOWING ARE COMMUNITY SERVICE PROGRAMS OFFERED BY ST. CATHERINE OF SIENA MEDICAL CENTER: ST. CATHERINE'S COMMUNITY OUTREACH INCLUDES FREE COMMUNITY LECTURES, BLOOD PRESSURE, BODY MASS INDEX (BMI) AND OTHER SCREENINGS, SMOKING CESSATION ASSISTANCE, FOOD AND CLOTHING DRIVES, AND FALL PREVENTION PROGRAMS FOR SENIORS IN PARTNERSHIP WITH ASSISTED LIVING FACILITIES, CHAMBERS OF COMMERCE, LIBRARIES, AND OTHER LOCAL ORGANIZATIONS. ST. CATHERINE PUBLISHES A COMMUNITY NEWSLETTER, THE SIENA VOICE, WHICH IS MAILED TO MORE THAN 107,000 LOCAL HOUSEHOLDS. THE VOICE IS A PRIMARY METHOD OF EDUCATING THE COMMUNITY ABOUT HEALTH-RELATED ISSUES ADVISING ABOUT FREE SUPPORT GROUPS AND OTHER NO-CHARGE SERVICES AND KEEPING THEM INFORMED OF UPCOMING EVENTS AND HOSPITAL SERVICES. THE HOSPITALS MATERNITY DEPARTMENT OFFERS THE "YOU AND YOUR BABY" EDUCATIONAL SERIES WHICH INCLUDES A VARIETY OF SUPPORT GROUPS AND WORKSHOPS FOR NEW MOTHERS AND FAMILY MEMBERS. SOME GROUPS ARE THE BREAST-FEEDING, CHILDBIRTH EDUCATION, EARLY PREGNANCY, FAMILY AND FRIENDS CPR, INFANT ONLY, GRANDPARENTS CLASSES, INFANT CARE CLASSES, PRENATAL BREAST-FEEDING CLASSES, LACTATION SUPPORT GROUP, SIBLING CLASSES, MOTHER'S CIRCLE OF HOPE AND A POSTPARTUM SUPPORT GROUP. ST. CATHERINE'S IS DEDICATED TO EDUCATING THE COMMUNITY AND PROUDLY OFFERS MEDICAL COMMUNITY EDUCATION THROUGH FREE LECTURES AND PRESENTATIONS ON A VARIETY OF HEALTH AND WELLNESS TOPICS. OTHER SUPPORT GROUPS OFFERED INCLUDE BARIATRIC, DIABETES, STROKE, PARKINSON'S DISEASE, LUPUS, CAREGIVERS OF A CHRONICALLY ILL OR DISABLED PARTNER, AND CAREGIVERS OF PEOPLE WITH DEMENTIA. THROUGH A COMBINATION OF LECTURES AND PRESENTATIONS, ST. CATHERINE'S HOPES TO IMPROVE THE QUALITY OF LIFE AND PROMOTE WELLNESS AND HEALTHY LIVING. ST. CATHERINE, IN COLLABORATION WITH SMITHTOWN AND COMMACK HIGH SCHOOLS, CONDUCTS A 16-WEEK HEALTH CARE CAREER EXPLORATION AND INTERNSHIP PROGRAM (HCEIP) THAT INCLUDES A SEMINAR AND HANDS-ON WORKSHOP FOR STUDENTS INTERESTED IN CAREERS IN HEALTH CARE. PROFESSIONALS FROM VARIOUS CLINICAL DEPARTMENTS LECTURE/TEACH AND PROVIDE SKILL-BASED TRAINING ALONG WITH INFORMATION REGARDING COLLEGE CHOICES AND DEGREE REQUIREMENTS TO HELP STUDENTS MAKE CAREER CHOICES. UPON COMPLETION OF THE PROGRAM AND 30 HOURS OF VOLUNTEER SERVICE IN EITHER THE HOSPITAL OR NURSING AND REHABILITATION CARE CENTER, STUDENTS ARE ELIGIBLE TO RECEIVE HALF A HEALTH CREDIT. ST. CATHERINE OF SIENA MEDICAL CENTER PARTICIPATES IN THE COMPREHENSIVE CARE FOR JOINT REPLACEMENT (CJR) MODEL. THE CJR MODEL AIMS TO SUPPORT BETTER AND MORE EFFICIENT CARE FOR BENEFICIARIES UNDERGOING THE MOST COMMON INPATIENT SURGERIES FOR MEDICARE BENEFICIARIES: HIP AND KNEE REPLACEMENTS (ALSO CALLED LOWER EXTREMITY JOINT REPLACEMENTS OR LEJR). PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM ST. CATHERINE OF SIENA MEDICAL CENTER (ST. CATHERINE OR THE HOSPITAL OR THE MEDICAL CENTER) AND ST. CATHERINE OF SIENA NURSING AND REHABILITATION CARE CENTER ARE LOCATED ON A SINGLE CAMPUS IN SMITHTOWN, NEW YORK. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, ST. CATHERINE, THROUGH ITS DAILY OPERATION, PROVIDES TO THE AREA ACUTE, EMERGENT AND OUTPATIENT CARE, AS WELL AS LONG-TERM CARE AND HOUSING. ST. CATHERINE 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, 2016, CHS COMPRISED SIX HOSPITALS (MERCY MEDICAL CENTER, ST. FRANCIS HOSPITAL AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL AND ST. CATHERINE OF SIENA MEDICAL CENTER IN SUFFOLK COUNTY), AS WELL AS THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING AND REHABILITATION CARE CENTER, GOOD SAMARITAN NURSING HOME AND OUR LADY OF CONSOLATION NURSING AND REHABILITATIVE CARE CENTER, ALL IN SUFFOLK COUNTY), A REGIONAL HOME CARE AND HOSPICE NETWORK, AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 17,500 STAFF AND 4,300 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CHS PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTH CARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. 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 SERVICES HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF IMPROVING THE COMMUNITY'S HEALTH. TO FURTHER THE MISSION OF BRINGING CARE TO THE COMMUNITY, CHS AND ITS MEMBER HOSPITALS, TOGETHER WITH A NUMBER OF OTHER HEALTH CARE PROVIDERS ON LONG ISLAND, ENTERED INTO A 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 BY WORKING TO, AMONG OTHER THINGS, IMPROVE QUALITY OF CARE, FACILITATE CLINICAL INTEGRATION, BENCHMARK BEST PRACTICES, AND REDUCE LENGTH OF STAY AND COSTS. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVE ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 788108 NONE NONE OUTPATIENT CENTERS 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR ST CATHERINE OF SIENA MEDICAL CENTER 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. X X X X X X false true false false false false false false false ALAN D GUERCI MD PRESIDENT & CEO 0 1382345 0 410000 0 802720 0 327174 0 33273 0 2955512 0 767223 DANIEL DEBARBA EVP & CFO (Effective 6/6/16) 0 460115 0 115000 0 16239 0 21174 0 16248 0 628776 0 0 PAUL ROWLAND EXEC VP & CAO 384411 0 56000 0 23408 0 34617 0 2191 0 500627 0 0 0 JASON GOLBIN CMO 365706 0 30000 0 818 0 20617 0 21381 0 438522 0 0 0 BRUCE MAYERSEN MD PHYSICIAN 677058 0 106706 0 1475 0 20617 0 32538 0 838394 0 0 0 SCHENLEY QUE MD PHYSICIAN 597143 0 0 0 1410 0 20617 0 20532 0 639702 0 0 0 JUNE LEE MD PHYSICIAN 349847 0 109500 0 361 0 20617 0 9441 0 489766 0 0 0 MICKEL KHLAT PROGRAM DIRECTOR - HOSPITALIST 298305 0 40793 0 109235 0 20617 0 29709 0 498659 0 0 0 NARINDER DAWAR HOSPITALIST 396290 0 28500 0 14271 0 15171 0 10058 0 464290 0 0 0 WILLIAM C ARMSTRONG SVP FINANCE 0 665953 0 200000 0 686173 0 158174 0 30669 0 1740969 0 664661 PATRICK O'SHAUGHNESSY FORMER CMO 0 715731 0 175000 0 17846 0 285174 0 30010 0 1223761 0 0 DENNIS VERZI FORMER CAO 0 873389 0 200000 0 666455 0 225174 0 10467 0 1975485 0 190000 PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN The following individuals participated in the supplemental non-qualified retirement plan. The amounts below are included on Schedule J, Part II, Column C. Alan Guerci $306,000 participation in the plan William Armstrong $137,000 participation in the plan Dennis Verzi $204,000 participation in the plan Patrick O'Shaughnessy $264,000 participation in the plan Paul Rowland $14,000 Participation in 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 $767,223, vested in plan. William Armstrong $664,661, vested in plan. Dennis Verzi $632,427 vested in plan. The amounts outlined herein were included in each individual's 2016 Form W-2, Box 5 as taxable wages because they are vested, but are not distributed until retirement. Part II - Former officers and directors Effective 7/1/2013, Dennis Verzi was transferred to Catholic Health Services of Long Island, a related entity, to serve as the COO. Effective 6/1/2013, Patrick O'Shaughnessy was transferred to Catholic Health Services of Long Island, a related entity, to serve as the CMO. PART II - REPORTING OF TOP FINANCIAL OFFICIAL WILLIAM ARMSTRONG WAS REPORTED AS AN OFFICER IN 2015 AS THE TOP FINANCIAL OFFICIAL IN HIS ROLE AS INTERIM CFO. EFFECTIVE 6/6/16, DANIEL DEBARBA BECAME THE TOP FINANCIAL OFFICER AS CFO, AND WILLIAM ARMSTRONG RESUMED HIS ROLE AS SVP OF FINANCE. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF ST. CATHERINE OF SIENA MEDICAL CENTER 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. FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF ST CATHERINE OF SIENA MEDICAL CENTER, AND HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF ST. CATHERINE. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF ST. CATHERINE OF SIENA MEDICAL CENTER, CHS IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERING BODY OF ST. CATHERINE OF SIENA MEDICAL CENTER. THE GOVERNING BODY OF ST. CATHERINE MEDICAL CENTER IS THE SAME AS THAT OF CHS. FORM 990, PART VI, LINE 11B - REVIEW PROCESS FOR FORM 990 THE FORM 990 AND RELATED SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD, AND PRESENTED TO THE COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF CHS, WHICH HAS BEEN DELEGATED THE FORM 990 REVIEW FUNCTION BY THE BOARD. UPON REVIEW AND RECOMMENDATION OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO THE BOARD FOR APPROVAL. UPON BOARD APPROVAL, THE FORM 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST POLICY DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE CHS COMPLIANCE AND AUDIT COMMITTEE BY CHS' COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURE IS GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE CHS COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE CHS BOARD OF DIRECTORS. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED AND A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS AND WISHES TO GO FORWARD WITH IT, THE CHAIR OF THE BOARD OF DIRECTORS SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. THE PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIM/HERSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. FORM 990, PART VI, LINE 15 - COMPENSATION POLICY THE CHIEF ADMINISTRATIVE OFFICER SUBMITS FOR APPROVAL TO THE SYSTEM CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE CHS EXECUTIVE COMPENSATION POLICY (COMPENSATION POLICY). THE COMPENSATION POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CHS OR AN OPERATING ENTITY, AND IS EITHER A) A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF OPERATING OFFICERS (COO) OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS (CFO); D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CHS OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CHS OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CHS OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CHS OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CHS OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CHS CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CHS BOARD OF DIRECTORS FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE PERFORMED ANNUALLY BY AN INDEPENDENT CONSULTANT. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION PROVIDED, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE CHS BOARD OF DIRECTORS. FORM 990, PART VI, LINE 19 - DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE; CHS CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND. FORM 990, PART VII, SECTION A - LINE 1A HOURS FOR TRUSTEES ARE THE ESTIMATED WEEKLY HOURS (2.0) TRUSTEES CONTRIBUTE TO THIS AND ALL OTHER RELATED ORGANIZATIONS, NOT NECESSARILY EQUALLY BUT IN THE PROPORTION NECESSARY, FOR WHICH THEY RECEIVE NO COMPENSATION. ALAN GUERCI, M.D. PRESIDENT AND CEO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); CATHOLIC HEALTH SYSTEMS OF LONG ISLAND (11-3403968); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); RVC INSURANCE COMPANY (20-8067039); 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); SIENNA VILLAGE (06-1569129) AND ST. CHARLES HOSPITAL (11-1871039). PAUL ROWLAND, EXECUTIVE VP AND CAO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); SIENA VILLAGE (06-1569129). WILLIAM ARMSTRONG, SR VP FINANCE - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR HIGHEST PAID EMPLOYEE FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL (11-1871039); SIENA VILLAGE, INC. (06-1569129); AND GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396). DANIEL DEBARBA, EVP & CFO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL (11-1871039); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); SIENA VILLAGE, INC. (06-1569129); 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) 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 LIABILITIES THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 ARE ISSUED ON BEHALF OF THE CATHOLIC HEALTH SERVICES OF LONG ISLAND OBLIGATED GROUP PROJECT WHICH INCLUDES THE FILING ENTITY AND RELATED ENTITIES. THREE BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 SUFFOLK BONDS), NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BOND) AND SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2014c SUFFOLK BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH SERVICES OF LONG ISLAND. FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS CHANGES IN POST RETIREMENT BENEFITS: $154,000 SCHEDULE B, PART I, LINE 2 ST. CATHERINE OF SIENA MEDICAL CENTER IS THE SOLE MEMBER OF SIENA VILLAGE. EFFECTIVE DECEMBER 15, 2015, SIENA VILLAGE SOLD SUBSTANTIALLY ALL OF ITS ASSETS AND CEASED OPERATIONS. SIENA VILLAGE TRANSFERRED $42,728,649 OF THE PROCEEDS OF THE SALE TO ST. CATHERINE OF SIENA MEDICAL CENTER IN 2015. IN 2016, SIENA VILLAGE TRANSFERRED ITS REMAINING ASSETS OF $5,038,124 TO ST. CATHERINE OF SIENA MEDICAL CENTER. BOTH THE PROCEEDS OF THE SALE AND THE REMAINING ASSETS TRANSFERRED ARE RESTRICTED FOR THE PAYMENT OF ST. CATHERINE OF SIENA MEDICAL CENTER BOND PRINCIPAL PAYMENTS AS PAYMENTS BECOME DUE. SIENA RETIREMENT REALTY CCRC 50 ROUTE 25A SMITHTOWN NY 11787 061569102 RETIRE COMMUN NY 0 3477302 STCATHERINE SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN NY 11787 061568934 MED BUILDING NY 1360975 7225857 STCATHERINE CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 12A- I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 12B- II CHSLI true CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) 3 CHSLI true GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 12A- I GOOD SAMARTN true MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113434776 TRANSPORTATIO NY 501(C)(3) 12A- I MARYHAVENCTR false MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 10 CHSLI false MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR false THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113638367 SUPPORT ORG NY 501(C)(3) 12A- I MARYHAVENCTR false MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 CHSLI true CATHOLIC HOME CARE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112126736 HOME CARE NY 501(C)(3) 10 CHSLI false OUR LADY OF CONSOLATION GERIATRIC CARE 111 BEACH DRIVE WEST ISLIP NY 11795 113284066 LT NURSE CARE NY 501(C)(3) 10 CHSLI false RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR false SIENA VILLAGE INC 2000 BISHOPS ROAD SMITHTOWN NY 11787 061569129 SR HOUSING NY 501(C)(3) 10 STCATHERINE true ST CHARLES HOSPITAL 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI true CHS HOME SUPPORT SERVICES INC 15 POWER DRIVE HAUPPAUGE NY 11788 113594561 RESP THERAPY NY 501(C)(3) 10 CATHHOMECARE false ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI true ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 12A- I ST FRANCIS false ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 12A- I ST FRANCIS true WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI true THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 112983148 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 12A- I CHSLI false WISDOM GARDENS HOUSING DEVELOPMENT FUND 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113559713 SR HOUSING NY 501(C)(3) 10 MARYHAVENCTR false GOOD SHEPHERD HOSPICE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 10 CHSLI false ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 12A- I ST CHARLES false GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) 12A- I GOOD SAMARTN false MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 550813603 SUPPORT ORG NY 501(C)(3) 12A- I MERCY MEDCTR false ST CATHERINE OF SIENA MEDICAL CTR FDN 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) 12A- I STCATHERINE true CATHOLIC HOME CARE FOUNDATION 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 452907761 SUPPORT ORG NY 501(C)(3) 12A- I CATHHOMECARE false GOOD SHEPHERD HOSPICE FOUNDATION 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 12A- I GOODSHEPHERD false OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 12A- I OURLADYOFC false RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 12A- I CHSLI false ST FRANCIS CARDIOVASCULAR PHYSICIANS P 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 12A- I ST FRANCIS false RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INS NY 501(C)(3) 12B- II CHSLI false SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 HEALTHCARESVC NY 501(C)(4) GOOD SAMARTN false ST JOSEPH HOSPITAL FOUNDATION 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 472353387 SUPPORT ORG NY 501(C)(3) 12A- I WSNCHS NORTH false BIPO HOLDINGS LLC 1600 STEWART AVE WESTBURY NY WESTBURY NY 11590 464763720 PHYSICIAN ASSN NY NA IDHC LLC 2500 YORK RD JAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVICES PA NA BEACON HEALTH PTNRS 1600 STEWART AVE WESTBURY NY WESTBURY NY 11590 454229842 HEALTHCARE NY NA WISDOM GARDENS LP 51 TERRYVILLE RD PORT JEFFERSON NY 11776 113567947 SR HOUSING NY NA N/A RADIOLOGY CONSULTING OF LONG ISLANDPLLC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 421646134 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN PEDIATRIC SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208180263 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208088453 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SOUTHWEST SUFFOLK MEDICAL PC 580 UNION BOULEVARD WEST ISLIP NY 11795 061603195 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false CARDIAC EKG INTERPRETATION PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112924518 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208964140 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112838185 HEALTHCARE SVC NY CHSLI C-CORP false ADVANCED REHABILIATION MEDICINE PLLC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113640709 HEALTHCARE SVC NY STCHARLES HOSP C-CORP false ST FRANCIS CARDIAC PREVENTION SERVICES 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113224885 HEALTHCARE SVC NY STFRANCIS HOSP C-CORP false SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113307977 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false SAMARITAN HOME CARE AMERICA 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113319259 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 510639649 HEALTHCARE SVC NY MERCY MED CTR C-CORP false LONG ISLAND EMERGENCY CARE PC 1000 N VILLAGE AVE ROCKVILLE NY 11571 113633515 PHYSICIAN SVC NY MERCY MED CTR S-CORP false false true true true true false false false true false true true true false true true true true true SIENA VILLAGE C 5038124 COST CHS SERVICES INC LMPR 669233 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER LM 606805 COST SIENA VILLAGE LQ 556082 COST ST FRANCIS HOSPITAL LM 325374 COST MERCY MEDICAL CENTER LM 284582 COST ST JOSEPH HOSPITAL LM 100382 COST ST CHARLES HOSPITAL LM 80668 COST SCHEDULE R, PART IV FOR ALL PROFESSIONAL CORPORATIONS REPORTED ON SCHEDULE R, PART IV, THE PHYSICIAN IS THE SOLE SHAREHOLDER OF THE ENTITY AND THE DIRECT CONTROLLING ENTITY REPORTED IN COLUMN (D) IS THE BENEFICIAL OWNER. THIS STRUCTURE IS CONSISTENT WITH THE NEW YORK CORPORATE PRACTICE OF MEDICINE.