STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

CHS SERVICES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CHS SERVICES INC (EIN 11-3555766)
Tax period
2011-01-01 to 2011-12-31
Filed
2013-01-10
IRS object ID
201320109349300407
Schema version
2011v1.2
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)
Timestamp2013-01-10T10:25:19-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN221478099EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1JH COHN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14 BECKER FARM ROADAddressLine1
CityROSELANDCity
StateNJState
ZIP Code070681739ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN113555766EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHS SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHSSNameControl
Phone5167053700Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1992 NORTH VILLAGE AVENUEAddressLine1
CityROCKVILLE CENTRECity
StateNYState
ZIP Code11570ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRICHARD JJ SULLIVAN JRName
TitlePRESIDENTTitle
Phone5167053700Phone
Date Signed2013-01-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS LANNINGName
PTINP00851654PTIN
Phone9732283500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRICHARD JJ SULLIVAN JRNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1992 NORTH VILLAGE AVENUEAddressLine1
CityROCKVILLE CENTRECity
StateNYState
ZIP Code11570ZIPCode
FieldValueIRS element (for citing)
Gross Receipts78064404GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2000YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionCHS SERVICES, INC., 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, ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. CHS CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees829TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI325000TotalGrossUBI
Net Unrelated Business Txbl Income-20167NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year251000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year69906839ProgramServiceRevenuePriorYear
Program Service Revenue CY77812915ProgramServiceRevenueCY
Investment Income Prior Year1897InvestmentIncomePriorYear
Investment Income Current Year489InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year69908736TotalRevenuePriorYear
Total Revenue Current Year78064404TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year50857443SalariesEtcPriorYear
Salaries Etc Current Year56553463SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year22526500OtherExpensePriorYear
Other Expenses Current Year26078174OtherExpensesCurrentYear
Total Expenses Prior Year73383943TotalExpensesPriorYear
Total Expenses Current Year82631637TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3475207RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-4567233RevenuesLessExpensesCY
Total Assets BOY81507121TotalAssetsBOY
Total Assets EOY188750967TotalAssetsEOY
Total Liabilities BOY38479793TotalLiabilitiesBOY
Total Liabilities EOY130461020TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY43027328NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY58289947NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCHS SERVICES,INC., 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, COMMITTED TO THOSE IN NEED, AFFIRMS THE SANCTITY OF LIFE, ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. CHS CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense82631637Expense
Revenue77487915Revenue
DescriptionCHS SERVICES INC. PROVIDES ADMINISTRATIVE SUPPORT TO THE CHS ENTITIES INCLUDING, BUT NOT LIMITED TO ACCOUNTING, SUPPLY CHAIN AND INFORMATION TECHNOLOGY. CHS SERVICES PROMOTES EFFICIENT MANAGEMENT, COOPERATIVE PLANNING AND EFFICIENT USE OF RESOURCES BY ALL SUPPORTED ORGANIZATIONS.Description
Total Program Service Expense82631637TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109644NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees829NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHS SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5167053700TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1992 NORTH VILLAGE AVENUEAddressLine1
CityROCKVILLE CENTRECity
StateNYState
ZIP Code11570ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
RICHARD JJ SULLIVAN JR
CHAIRMAN2.00XX000
SISTER ELAINE CALLAHAN
VICE CHAIR2.00XX000
THOMAS CHRISTMAN
TREASURER2.00XX000
EUGENE MURPHY
SECRETARY2.00XX000
JAMES HARDEN
FORMER PRESIDENT & CEO50.00XX027831591600268
LIONEL BARRAU MD
TRUSTEE2.00X000
REV MSGR ROBERT MORISSEY
TRUSTEE2.00X000
THOMAS DOWLING MD
TRUSTEE2.00X000
REV JAMES VLAUN
TRUSTEE2.00X000
SR AUDREY HARSEN
TRUSTEE2.00X000
SISTER MARGARET JOHN KELLY
TRUSTEE2.00X000
BARBARA ELLEN BLACK
TRUSTEE2.00X000
PATRICIA NAZEMETZ
TRUSTEE2.00X000
JOSEPH TANTILLO
TRUSTEE2.00X000
JOHN WAGNER
TRUSTEE2.00X000
RICHARD SARLI
VP-FINANCE50.00X4351330128161
COLLEEN BLYE
CFO50.00X0903665364508
CATHY O'BRIEN
VP-SUPPLY CHAIN50.00721293092501X
MARCY DUNN
VP AND CIO50.0013177990250394X
DEBORAH WALSH
VP- PATIENT FIN SVCS50.00553926029423X
ALAN KATZ
VP MEDICAL INFORMATICS50.00429669047368X
PEGEEN MCGOWAN
VP CORP COMPLIANCE INTERNATIONA50.00326244081124X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3784064TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3686824TotalReportableCompFrmRltdOrgs
Total Other Compensation2593747TotalOtherCompensation
Number Individuals GT100 K119NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MILLER AND MILONE
100 QUENTIN ROOSEVELT BLVDGARDEN CITYNY11530MEDICAID SERVICES919865
STRATA DECISION TECHNOLOGIES
2001 S 1ST STCHAMPAIGNIL61820COMPUTER SERVICES503211
RUBIN & ROTHMAN LLC
1787 VETS MEM HWYISLANDIANY11722COLLECTION SERVICES288841
TRITECH HEALTHCARE MANAGEMENT
125 NEWTOWN RDPLAINVIEWNY11803COLLECTION SERVICES248663
JH COHN LLP
1212 AVENUE OF AMERICASNEW YORKNY10036TAX SERVICES214850
FieldValueIRS element (for citing)
Number Of Contractors GT100 K11NumberOfContractorsGT100K
Government Grants250000GovernmentGrants
All Other Contributions1000AllOtherContributions
Total Contributions251000TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
ASSESSMENT REVENUE9000997748791577487915
MANAGEMENT SERV REV900099325000325000
FieldValueIRS element (for citing)
Total Program Service Revenue77812915TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column489TotalRevenueColumn
Exclusion$489ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column78064404TotalRevenueColumn
Related Or Exempt Function Income77487915RelatedOrExemptFunctionIncome
Unrelated Business Revenue325000UnrelatedBusinessRevenue
Exclusion$489ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total435133Total
Program Services435133ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total42580101Total
Program Services42580101ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4415835Total
Program Services4415835ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6148476Total
Program Services6148476ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2973918Total
Program Services2973918ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1635694Total
Program Services1635694ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total36226Total
Program Services36226ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total257211Total
Program Services257211ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7920439Total
Program Services7920439ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4833354Total
Program Services4833354ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total80776Total
Program Services80776ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total96856Total
Program Services96856ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total82698Total
Program Services82698ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4817238Total
Program Services4817238ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total24151Total
Program Services24151ProgramServices

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionCOLLECTION SERVICESDescription
Total854364Total
Program Services854364ProgramServices

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total5439167Total
Program Services5439167ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total82631637Total
Program Services82631637ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY2995721EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY318268BOY
EOY781285EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY85229BOY
EOY444017EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2282533BOY
EOY2849483EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis78731786LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec19697650LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY36369305BOY
EOY59034136EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY42451786BOY
EOY122646325EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY81507121BOY
EOY188750967EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY14316392BOY
EOY20077715EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY74681EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
EOY88848520EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY12674232BOY
EOY9857736EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY11489169BOY
EOY11602368EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY38479793BOY
EOY130461020EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY43027328BOY
EOY58289947EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY43027328BOY
EOY58289947EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY81507121BOY
EOY188750967EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-4567233ReconcilationRevenueExpenses
Reconcilation Other Changes19829852ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (57 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
GOOD SAMARITAN HOSPITAL MEDICAL CENTER
1118889243011$0
MERCY MEDICAL CENTER
1116350883011$0
ST CHARLES HOSPITAL AND REHABILITATION CENTER
1118710393011$0
ST FRANCIS HOSPITAL
1120505233011$0
CHS AMBULANCE SERVICES INC
1410819619011$0
ST CATHERINE OF SIENA HOSPITAL
0615627013011$0
OUR LADY OF CONSOLATION NURSING HOME
1132840663011$0
MARYHAVEN CENTER OF HOPE
1128616989011$0
MARYHAVEN TRANSPORTATION SERVICES
1134347769011$0
RIVERHEAD HOSTEL HOLDINGS CORP
1124997909011$0
MARYHAVEN SCHOOL CORPORATION
1128616909011$0
RIVERHEAD HOSTEL HOLDINGS CORP
1124997909011$0
SIENA MEDICAL REALTY LLC
0615689349011$0
SIENA RETIREMENT REALTY LLC
0615691029011$0
SIENA VILLAGE
0615691299011$0
ST FRANCIS HOSPITAL RESEARCH CORP
1130908679011$0
SUFFOLK HEARING & SPEECH
1121104889011$0
ST CHARLES HOSPITAL CORPORATION
1129831487011$0
THE SAMARITAN CORP
1127166409011$0
WISDOM GARDENS HOUSING CORP
1135597139011$0
GOOD SHEPHERD HOSPICE
1129584389011$0
GOOD SAMARITAN NURSING HOME
1118889243011$0
ST CATHERINE OF SIENA NURSING HOME
0615627013011$0
THE CENTER OF HOPE FOUNDATION
1136383679011$0
GOOD SAMARITAN HOSPITAL FOUNDATION
7706112409011$0
ST CHARLES HOSPITAL FOUNDATION
4120763129011$0
ST FRANCIS HOSP FOUNDATION
1129160339011$0
CATHOLIC HOME CARE
1121267369011$0
CHS HOME SUPPORT SERVICES
1135945619011$0
CATHOLIC HEALTH SYSTEM OF LI
1134039689011$0
SAMARITAN MANAGEMENT SERVICES INC
1128381859011$0
SOUTH SHORE PRACTICE MANAGEMENT SERVICES
1133079779011$0
GOOD SAMARITAN SELF INSURANCE
1125373969011$0
RVC INSURANCE
2080670393011$0
ADVANCED REHABILITATION MEDICINE PLLC
1136407093011$0
CARDIAC EKG INTRPRETATION PC
1129245183011$0
LONG ISLAND REGIONAL ARTHRITIS AND OSTEOPOROSIS CARE
2089641403011$0
RADIOLOGY CONSULTANTS
4216461349011$0
SAMARITAN MEDICAL EMERGENCY SERVICES
2082434129011$0
SAMARITAN MEDICAL SERVICES
2080884539011$0
SAMARITAN PEDIATRIC SERVICES
2081802633011$0
SOUTHWEST SUFFOLK MEDICAL
0616031953011$0
ST FRANCIS CARDIAC PREVENTION
1132248853011$0
ST FRANCIS CARDIOVASCULAR
1136139973011$0
FAIRVIEW MANAGEMENT
1127983839011$0
GOOD SHEPHERD HOSPICE FOUNDATION
2631694273011$0
HEALTHCARE TEMP SERVICES
1128011369011$0
MERCY MEDICAL CENTER FOUNDATION
5508136039011$0
RVC SUPPORT
2715310849011$0
SAMARITAN AT HOME SERVICES
1128299469011$0
SAMARITAN HOME CARE AMERICA
1133192599011$0
ST CATHERINE OF SIENA
2714599413011$0
WSNCHSNORTHLLC
1134389733011$0
ST FRANCIS MERCY CORP
1116350889011$0
OUR LADY OF CONSOLATION
4505175669011$0
ST CHARLES HOSPITAL FOUNDATION
4120763129011$0
MERCY INTERNAL MEDICINE
5106396499011$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs57TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis7544252InvestmentCostOrOtherBasis
Depreciation2036655Depreciation
Book Value5507597BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis71187534InvestmentCostOrOtherBasis
Depreciation17660995Depreciation
Book Value53526539BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings59034136TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM RELATED ORGANIZATIONS45309993
TRUSTEE HELD FUNDS RESTRICTED AS TO USE77336332
FieldValueIRS element (for citing)
Total Book Value Other Assets122646325TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DUE TO RELATED ORGANIZATIONS$8,578,311
DEFERRED RENT$2,118,105
SELF INSURED LIABILIIES$876,659
DUE TO AFFILIATES$29,293
FieldValueIRS element (for citing)
Total Of Amounts11602368TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
ExplanationCHS SERVICES, INC. IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CHS SERVICES, INC. ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE INCOME TAX TOPIC OF THE CODIFICATION. MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CONSOLIDATED FINANCIAL STATEMENTS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JAMES HARDEN
071416405030960156589901570820029448043834270928786
RICHARD SARLI
33580308760001173001073400208210563294000
COLLEEN BLYE
0726623011000006704203396420248660126817300
CATHY O'BRIEN
2512400665000403553073557018944081379403919230
MARCY DUNN
3939300110000081386902244970258970156819307981800
DEBORAH WALSH
250274055000024865201953109892058334902362210
ALAN KATZ
42672000029490195310278370477037000
PEGEEN MCGOWAN
2483610671000107830535120276120407368000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINES 4A-BPART I LINE 4A JAMES HARDEN FORMER PRESIDENT AND CEO RECEIVED PAYMENT OF SEVERANCE OF $451,152. PART I, LINE 4B SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN: MARCY DUNN $798,180 PAYMENT FROM PLAN, $204,966 PARTICIPATION IN PLAN CATHY O'BRIEN $391,923 PAYMENT FROM PLAN, $54,026 PARTICIPATION IN PLAN DEBORAH WALSH $236,221 PAYMENT FROM PLAN, JAMES HARDEN $928,786 PAYMENT FROM PLAN, PEGEEN MCGOWAN $33,981 PARTICIPATION IN PLAN RICHARD SARLI $ 87,909 PARTICIPATION IN PLAN COLEEN BLYE $317,758 PARTICIPATION IN THE PLAN
PART IIITHE AMOUNTS REFLECTED IN COLUMN B(III) AND COLUMN C FOR THE INDIVIDUALS INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP"). THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2011 FORM W-2 BOX, 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NONQUALIFIED RETIREMENT PLANS.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF CHS SERVICES, INC. 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 PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE.
FORM 990, PART VI, SECTION A, LINE 7ACHS IS THE SOLE MEMBER OF CHS SERVICES, INC. AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7BCHS, AS THE SOLE MEMBER OF CHS SERVICES, INC., IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE CHS SERVICES' GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990, AND APPROPRIATE SCHEDULES, IS COMPLETED BY THE ACCOUNTING AND FINANCE STAFF OF THE ORGANIZATION AND REVIEWED INTERNALLY BY MANAGEMENT. IT IS THEN REVIEWED BY OUTSIDE TAX ADVISORS. THE FINAL DRAFT OF THE FORM 990 IS THEN PRESENTED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES (THE BOARD), WHICH HAS BEEN DELEGATED THE DETAILED REVIEW FUNCTION BY THE BOARD. UPON APPROVAL OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO ALL VOTING MEMBERS OF THE BOARD. ONCE APPROVED BY THE BOARD (OR THE EXECUTIVE COMMITTEE OF THE BOARD, AS APPROPRIATE), THE ORGANIZATION'S BOARD CHAIR AND CHIEF EXECUTIVE OFFICER COMMUNICATES, IN WRITING TO THE CHS COMPLIANCE AND AUDIT COMMITTEE AND CHS BOARD CHAIR. AFTER REVIEW OF ANY APPLICABLE COMMENTS FROM THE BOARD, THE COMPLIANCE AND AUDIT COMMITTEE WILL THEN RECOMMEND THE APPROVAL OF THE FORM 990 TO THE CHS BOARD OF DIRECTORS WHO WILL THEN REVIEW THE RECOMMENDATIONS AND PROVIDE THE FINAL APPROVAL OF THE FORM 990. THE FORM 990 IS THEN SUBMITTED TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT 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 ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE BY THE ORGANIZATION'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURES SHALL BE GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE BOARD OF TRUSTEES FOR REVIEW. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT NO CONFLICT EXISTS, THE MATTER SHALL BE REFERRED FOR REVIEW BY THE CHS COMPLIANCE AND AUDIT COMMITTEE BEFORE THE DETERMINATION BECOMES FINAL. IF A CONFLICT OF INTEREST IS IDENTIFIED AND IF 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 FORTH WITH IT, THE CHAIR OF THE ORGANIZATION'S BOARD OF TRUSTEES SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF 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 ORGANZIATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT,UPON RECEIPT OF THE WRITTEN REQUEST AND ANY SUPPORTING DOCUMENTS, THE CHS COMPLIANCE AND AUDIT COMMITTEE SHALL MAKE THE FINAL DECISION AS TO WHETHER CHS SHALL ENTER INTO THE TRANSACTION OR ARRANGEMENT.
FORM 990, PART VI, SECTION B, LINE 15THE CHIEF EXECUTIVE OFFICER SUBMITS FOR APPROVAL TO THE CORPORATE CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE POLICY. ONCE APPROVED BY THE CORPORATE CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE 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. 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, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING 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.COM
PART VII, SECTION A, LINE 1AREFLECTED IN PART VII, SECTION A, LINE 1A 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. JAMES HARDEN, FORMER PRESIDENT AND CEO- THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES; CHS SERVICES, INC.(11-3555766); RVC INSURANCE COMPANY, INC. (20-8067039) AND CATHOLIC HEALTH SYSTEMS OF LONG ISLAND (11-3403968) MR. HARDEN RESIGNED FROM HIS POSITION EFFECTIVE JULY 31, 2011. COLEEN BLYE, CFO- THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766), RVC INSURANCE COMPANY, INC., (20-8067039) AND CATHOLIC HEALTH SYSTEMS OF LONG ISLAND (11-3403968)TRUSTEE HOURS
FORM 990, PART XI, LINE 5:EQUITY TRANSFER FROM RELATED PARTIES 19,829,852. TOTAL TO FORM 990, PART XI, LINE 5: 19,829,852.CHANGES IN NET ASSETS OR FUND BALANCES:
PART XII, LINE 2CTHERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR TO THE ORGANIZATION'S PROCESSES FOR AUDIT, REVIEW OR COMPILATION OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT.
CONTROLLED GROUP ELECTION STATEMENTTHE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS, AS DEFINED IN SECTION 179(D)(7), HEREBY CONSENT TO THE APPORTIONMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2011. ELECTION TO ALLOCATE $40,000 ALTERNATIVE MINIMUM TAX EXEMPTION THE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS(WITHIN THE MEANING OF SECTION 1563(A)), HEREBY CONSENT UNDER REGULATION 1.58-1(C)(3) TO THE APPORTIONMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2011. ELECTION TO ALLOCATE $150,000 ALTERNATIVE MINIMUM TAX PHASE-OUT THE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS (WITHIN THE MEANING OF SECTION 1563(A)), HEREBY CONSENT UNDER REGULATION 1.58-1(C(3) TO THE APPOINTMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2011. EMPLOYER ID NO. $128,000 $40,000 $150,000 11-3403968 NONE NONE NONE 14-1801961 NONE NONE NONE 11-3594561 NONE NONE NONE 11-3555766 NONE NONE NONE 11-1888924 NONE NONE NONE 77-0611240 NONE NONE NONE 11-2537396 NONE NONE NONE 11-2958438 NONE NONE NONE 11-3434776 NONE NONE NONE 11-2861698 NONE NONE NONE 11-2861690 NONE NONE NONE 11-3638367 NONE NONE NONE 11-1635088 NONE NONE NONE 11-2126736 NONE NONE NONE 11-3284066 NONE NONE NONE 20-8067039 NONE NONE NONE 11-2499790 NONE NONE NONE 06-1569129 NONE NONE NONE 06-1562701 NONE NONE NONE 11-1871039 NONE NONE NONE 41-2076312 NONE NONE NONE 11-3613997 NONE NONE NONE 11-2050523 NONE NONE NONE 11-2916033 NONE NONE NONE 11-3090867 NONE NONE NONE 11-2110488 NONE NONE NONE 11-2983148 NONE NONE NONE 11-2716640 NONE NONE NONE 11-3559713 NONE NONE NONE 11-1635088 NONE NONE NONE 55-0813603 NONE NONE NONE 27-1459941 NONE NONE NONE IN PROCESS NONE NONE NONE 26-3169427 NONE NONE NONE 45-0517566 NONE NONE NONE 27-1531084 NONE NONE NONE 11-2798383 NONE NONE NONE 11-2801136 NONE NONE NONE 11-2838185 $128,000 $40,000 $150,000 11-3319259 NONE NONE NONE 06-1568934 NONE NONE NONE 11-3307977 NONE NONE NONE 11-2126736 NONE NONE NONEELECTION TO ALLOCATE BUSINESS ASSET EXPENSE
EMPLOYER NAME, ADDRESS & TAX YEAR-END ID NO. 11-3403968 CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/11 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/11 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/11 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/11 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 26-3169427 CATHOLIC HOME CARE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 27-1531084 RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/11 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/11CONTROLLED GROUP ELECTION - CONTINUED
THE AMOUNTS IN EACH TAXABLE INCOME BRACKET IN THE TAX TABLE IN SECTION 11(B) HAVE BEEN ALLOCATED TO THE CORPORATIONS LISTED BELOW PURSUANT TO REGULATION 1.1561-3(A). THE ORIGINAL COPY OF THIS STATEMENT IS FILED WITH THE INTERNAL REVENUE SERVICE CENTER IN OGDEN, UTAH. AUTHORIZATION CONSENT FOR ALLOCATION ON BEHALF OF MEMBER COMPANIES ____________________________________________ EMPLOYER ID NO. $50,000 $25,000 $9,925,000 BRACKET BRACKET BRACKET 11-3403968 NONE NONE NONE 14-1801961 NONE NONE NONE 11-3594561 NONE NONE NONE 11-3555766 NONE NONE NONE 11-1888924 NONE NONE NONE 77-0611240 NONE NONE NONE 11-2537396 NONE NONE NONE 11-2958438 NONE NONE NONE 11-3434776 NONE NONE NONE 11-2861698 NONE NONE NONE 11-2861690 NONE NONE NONE 11-3638367 NONE NONE NONE 11-1635088 NONE NONE NONE 11-2126736 NONE NONE NONE 11-3284066 NONE NONE NONE 20-8067039 NONE NONE NONE 11-2499790 NONE NONE NONE 06-1569129 NONE NONE NONE 06-1562701 NONE NONE NONE 11-1871039 NONE NONE NONE 41-2076312 NONE NONE NONE 11-3613997 NONE NONE NONE 11-2050523 NONE NONE NONE 11-2916033 NONE NONE NONE 11-3090867 NONE NONE NONE 11-2110488 NONE NONE NONE 11-2983148 NONE NONE NONE 11-2716640 NONE NONE NONE 11-3559713 NONE NONE NONE 11-1635088 NONE NONE NONE 55-0813603 NONE NONE NONE 27-1459941 NONE NONE NONE IN PROCESS NONE NONE NONE 26-3169427 NONE NONE NONE 45-0517566 NONE NONE NONE 27-1531084 NONE NONE NONE 11-2798383 NONE NONE NONE 11-2801136 NONE NONE NONE 11-2838185 $50,000 $25,000 $9,925,000 11-3319259 NONE NONE NONE 06-1568934 NONE NONE NONE 11-3307977 NONE NONE NONE 11-2126736 NONE NONE NONESTATEMENT OF TAX BRACKET ALLOCATION
EMPLOYER NAME, ADDRESS & TAX YEAR-END ID NO. 11-3403968 CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/11 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/11 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/11 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/11 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 26-3169427 CATHOLIC HOME CARE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 27-1531084 OUR LADY OF CONSOLATION FOUNDATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/11 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/11STATEMENT OF TAX BRACKET ALLOCATION - CONTINUED

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (36 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CATHOLIC HEALTH SYSTEM OF LONG ISLAND
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570113403968SUPPORT ORGNY501(C)(3)LINE 11A, IN/A0
CHS AMBULANCE SERVICES INC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570141801961DORMANTNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
GOOD SAMARITAN HOSPITAL MEDICAL CENTER
1000 MONTAUK HIGHWAYWEST ISLIPNY11795111888924HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112537396SELF INSURANCENY501(C)(3)LINE 11A, I0GOOD SAMARITAN HOSPITAL
MARYHAVEN TRANSPORTATION SERVICES
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113434776TRANSPORTATION SERVICESNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
MARYHAVEN CENTER OF HOPE
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112861698PROGRAMS/HOUSING FOR THE DEVELOPMENTALLY DISABLEDNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
MARYHAVEN SCHOOL CORPORATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112861690SCHOOL FOR DEVELOPMENTALLY DISABLEDNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
THE CENTER OF HOPE FOUNDATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113638367SUPPORT ORGNY501(C)(3)LINE 11A, I0MARYHAVEN CENTER OF HOPE
MERCY MEDICAL CENTER
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570111635088HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
CATHOLIC HOME CARE
1150 PORTION ROAD SUITE 1HOLTSVILLENY11742112126736HOME CARENY501(C)(3)LINE 90CATHOLIC HEALTH SYSTEM OF LONG ISLAND
OUR LADY OF CONSOLATION GERIATRIC CARE CENTER
111 BEACH DRIVEWEST ISLIPNY11795113284066LT NURSING CARENY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
RIVERHEAD HOSTEL HOLDING CORPORATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112499790RENTINGNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
SIENA VILLAGE INC
50 ROUTE 25ASMITHTOWNNY11787061569129SENIOR HOUSINGNY501(C)(3)LINE 90ST CATHERINE OF SIENA MEDICAL CENTER
ST CATHERINE OF SIENA MEDICAL CENTER
50 ROUTE 25ASMITHTOWNNY11787061562701HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST CHARLES HOSPITAL
200 BELLE TERRE ROADPORT JEFFERSON STATIONNY11777111871039HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
CHS HOME SUPPORT SERVICES INC
15 POWER DRIVEHAUPPAUGENY11788113594561RESPIRATORY THERAPY SVC/MED. EQUIP.NY501(C)(3)LINE 90CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST FRANCIS HOSPITAL
100 PORT WASHINGTON BLVDROSLYNNY11576112050523HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST FRANCIS HOSPITAL FOUNDATION
100 PORT WASHINGTON BLVDROSLYNNY11576112916033SUPPORT ORGNY501(C)(3)LINE 11A, I0ST FRANCIS HOSPITAL
ST FRANCIS HOSPITAL RESEARCH & EDUCATIONAL CORP
100 PORT WASHINGTON BLVDROSLYNNY11576113090867RESEARCH ORGANIZATIONNY501(C)(3)LINE 90ST FRANCIS HOSPITAL
WSNCHS NORTH INC
4295 HEMPSTEAD TURNPIKEBETHPAGENY11714113438973HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
SUFFOLK HEARING & SPEECH CENTER INC
369 EAST MAIN STREETEAST ISLIPNY11730112110488DIAGNOSTIC TESTINGNY501(C)(3)LINE 30GOOD SAMARITAN HOSPITAL
THE ST CHARLES CORPORATION
200 BELLE TERRE ROADPORT JEFFERSONNY11777112983148SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
THE SAMARITAN CORPORATION
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570112716640SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
WISDOM GARDENS HOUSING DEVELOPMENT FUND INC
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113559713SENIOR HOUSINGNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
GOOD SHEPHERD HOSPICE
245 OLD COUNTRY ROADMELVILLENY11747112958438HOSPICE SERVICESNY501(C)(3)LINE 90CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST CHARLES HOSPITAL FOUNDATION
200 BELLE TERRE ROADPORT JEFFERSONNY11777412076312SUPPORT ORGNY501(C)(3)LINE 11A, I0ST CHARLES HOSPITAL
GOOD SAMARITAN HOSPITAL FOUNDATION
1000 MONTAUK HIGHWAYWEST ISLIPNY11795770611240SUPPORT ORGNY501(C)(3)LINE 11A, I0GOOD SAMARITAN HOSPITAL
ST FRANCIS-MERCY CORPORATION
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570111635088SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
MERCY MEDICAL CENTER FOUNDATION
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570550813603SUPPORT ORGNY501(C)(3)LINE 11A, I0MERCY MEDICAL CENTER
ST CATHERINE OF SIENA MEDICAL CENTER FOUNDATION
50 ROUTE 25ASMITHTOWNNY11787271459941SUPPORT ORGNY501(C)(3)LINE 11A, I0ST CATHERINE OF SIENA MEDICAL CENTER
CATHOLIC HOME CARE FOUNDATION
1150 PORTION ROAD SUITE 1HOLTSVILLENY11742SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HOME CARE
GOOD SHEPHERD HOSPICE FOUNDATION
245 OLD COUNTRY ROADMELVILLENY11747263169427SUPPORT ORGNY501(C)(3)LINE 11A, I0GOOD SHEPHERD HOSPICE
OUR LADY OF CONSOLATION FOUNDATION
111 BEACH DRIVEWEST ISLIPNY11795450517566SUPPORT ORGNY501(C)(3)LINE 11A, I0OUR LADY OF CONSOLATION
RVC SUPPORT
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570271531084REAL ESTATENY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST FRANCIS CARDIOVASCULAR PHYSICIANS PC
100 PORT WASHINGTON BLVDROSLYNNY11576113613997HEALTHCARE SERVICESNY501(C)(3)LINE 30ST FRANCIS HOSPITAL
RVC INSURANCE COMPANYINC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570208067039CAPTIVE INSURANCE COMPANYNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND

Form990 Schedule R Part IV Form990ScheduleRPartIV (13 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
RADIOLOGY CONSULTING OF LONG ISLAND PLLC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795421646134HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
SAMARITAN EMERGENCY MEDICAL SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208243412DIAGNOSTIC TESTINGNYGOOD SAMARITAN HOSPITALC
SAMARITAN PEDIATRIC SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208180263HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
SAMARITAN MEDICAL SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208088453DIAGNOSTIC TESTINGNYGOOD SAMARITAN HOSPITALC
SOUTHWEST SUFFOLK MEDICAL PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795061603195HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
CARDIAC EKG INTERPRETATION PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112924518HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
LI REGIONAL ARTHRITIS & OSTEOPOROSIS CARE PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208964140HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
SAMARITAN MANAGEMENT SERVICES INC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112838185HEALTHCARE SERVICESNYCATHOLIC HEALTH SYSTEM OF LONG ISLANDC
FAIRVIEW HILL MANAGEMENT CO INC
200 BELLE TERRE ROADPORT JEFFERSONNY11777112798383SERVICESNYST CHARLES CORPORATIONC
ADVANCED REHABILIATION MEDICINE PLLC
200 BELLE TERRE ROADPORT JEFFERSONNY11777113640709HEALTHCARE SERVICESNYST CHARLES HOSPITALC
ST FRANCIS CARDIAC PREVENTION SERVICES PC
100 PORT WASHINGTON BLVDROSLYNNY11576113224885HEALTHCARE SERVICESNYST FRANCIS HOSPITALC
SOUTH SHORE PRACTICE MANAGEMENT
1000 MONTAUK HIGHWAYWEST ISLIPNY11795113307977HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
MERCY INTERNAL MEDICINE PC
992 N VILLAGE AVENUEROCKVILLE CENTRENY11710510639649HEALTHCARE SERVICESNYMERCY MEDICAL CENTERC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (11 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CATHOLIC HEALTH SERVICES OF LONG ISLAND 11-3405968
P642214COST
GOOD SAMARITAN HOSPITAL MEDICAL CENTER 11-1888924
P-1196863COST
MERCY MEDICAL CENTER 11-1635088
K-1263957COST
ST FRANCIS HOSPITAL 11-2050523
K-237341COST
ST JOSEPH HOSPITAL 11-3438973
K1313185COST
OUR LADY OF CONSOLATION GERIATRIC CARE 11-3284066
K786078COST
ST CATHERINES OF SIENA MEDICAL CENTER 06-1562701
K-542061COST
GOOD SHEPHERD HOSPICE 11-2958438
K447940COST
CATHOLIC HOME CARE 11-2126736
K3857020COST
MARYHAVEN CENTER OF HOPE 11-2861698
K-494974COST
ST CHARLES HOSPITAL AND REHABILITATION 11-1871059
P-436814COST

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierTRANSACTIONS WITH RELATED ORGANIZATIONSIdentifier
Return ReferenceSCHEDULE R PART V LINE 2ReturnReference
ExplanationCHS SERVICES, INC. HAS DISCLOSED IN SCHEDULE R THE PREDOMINANT TRANSACTION TYPE WITH EACH FACILITY WITH WHICH IT HAS CONDUCTED TRANSACATIONS. HOWEVER, THERE ARE ADDITIONAL TRANSACTION TYPES TO DESCRIBE THE ACTIVITIES CHS SERVICES, INC. HAS ENGAGED IN WITH ITS RELATED PARTY ORGANIZATIONS. THE FOLLOWING IS A LIST OF ADDITIONAL TRANSACTION TYPES BY FACILITY. CATHOLIC HEALTH SERVICES OF LONG ISLAND P,I GOOD SAMARITAN HOSPITAL MEDICAL CENTER C,K,L MERCY MEDICAL CENTER C,P,I,L ST. FRANCIS HOSPITAL C,P,I,L ST.CATHERINE OF SIENA MEDICAL CENTER C,P,L ST. JOSEPH HOSPITAL P MARYHAVEN CENTER OF HOPE C,I,L OUR LADY OF CONSOLATION GERIATRIC CARE C,L RVC INSURANCE COMPANY INC, K SIENA VILLAGE K SIENA MEDICAL REALTY K GOOD SHEPHERD HOSPICE C,L CATHOLIC HOME CARE C,I,L CHS HOME SUPPORT C,L ST. CHARLES HOSPITAL AND REHABILITATION CENTER C,K,LExplanation