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NURSING SISTERS HOME CARE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NURSING SISTERS HOME CARE INC (EIN 11-2126736)
Tax period
2011-01-01 to 2011-12-31
Filed
2013-01-15
IRS object ID
201330159349300543
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)
Timestamp2013-01-15T13:42:08-06:00Timestamp
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 Line1COHNREZNICK 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)
EIN112126736EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NURSING SISTERS HOME CARE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNURSNameControl
Phone6314656457Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11150 PORTION RD NO STE 1AddressLine1
CityHOLTSVILLECity
StateNYState
ZIP Code11742ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOSEPH TOMAINOName
TitleCONTINUING CARE - EVPTitle
Phone6314656457Phone
Date Signed2013-01-15DateSigned
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

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1CATHOLIC HOME CAREBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOSEPH TOMAINONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11150 PORTION RD NO STE 1AddressLine1
CityHOLTSVILLECity
StateNYState
ZIP Code11742ZIPCode
FieldValueIRS element (for citing)
Gross Receipts31229765GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteHTTP://CATHOLICHOMECARE.CHSLI.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1968YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionNURSING SISTER HOME CARE, 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, AND ADVOCATES FOR THE POOR.ActivityOrMissionDescription
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members20NbrIndependentVotingMembers
Total Nbr Employees590TotalNbrEmployees
Total Nbr Volunteers3TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year24220ContributionsGrantsPriorYear
Contributions Grants Current Year23593ContributionsGrantsCurrentYear
Program Service Revenue Prior Year31260116ProgramServiceRevenuePriorYear
Program Service Revenue CY31171916ProgramServiceRevenueCY
Investment Income Prior Year5200InvestmentIncomePriorYear
Investment Income Current Year3878InvestmentIncomeCurrentYear
Other Revenue Prior Year54489OtherRevenuePriorYear
Other Revenue Current Year30378OtherRevenueCurrentYear
Total Revenue Prior Year31344025TotalRevenuePriorYear
Total Revenue Current Year31229765TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY12308GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year27630853SalariesEtcPriorYear
Salaries Etc Current Year29432744SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3641788OtherExpensePriorYear
Other Expenses Current Year5039648OtherExpensesCurrentYear
Total Expenses Prior Year31272641TotalExpensesPriorYear
Total Expenses Current Year34484700TotalExpensesCurrentYear
Revenues Less Expenses Prior Year71384RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-3254935RevenuesLessExpensesCY
Total Assets BOY4508383TotalAssetsBOY
Total Assets EOY6009628TotalAssetsEOY
Total Liabilities BOY19803244TotalLiabilitiesBOY
Total Liabilities EOY24556517TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-15294861NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-18546889NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionNURSING SISTERS HOME CARE DBA CATHOLIC HOME CARE, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND,AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED. CHSLI AFFIRMS THE SANCTITY OF LIFE, 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense29634549Expense
Grants12308Grants
Revenue31171916Revenue
DescriptionNURSING SISTERS HOME CARE (DBA CATHOLIC HOME CARE)PROVIDES APPROXIMATELY 189,200 VISITS TO 9,989 HOME CARE RECIPIENTS IN 2011. SERVICES INCLUDE SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH LANGUAGE PATHOLOGY, NUTRITIONAL COUNSELING, MEDICAL SOCIAL WORKERS, WOUND CARE NURSES AND CLOSELY SUPERVISED HOME HEALTH AIDES.Description
Total Program Service Expense29634549TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
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 Organizations1GrantsToOrganizations
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 With109621NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees590NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
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 Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members20NumberIndependentVotingMembers
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 Line1CATHOLIC HOME CAREBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6314656258TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1245 OLD COUNTRY RDAddressLine1
CityMELVILLECity
StateNYState
ZIP Code11747ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
BERNADETTE CURRY PHD RN
VICE CHAIRPERSON2.00XX000
BROTHER CAMPION LALLY OSF
TRUSTEE2.00X000
CHARLES FALKNER
TREASURER2.00XX000
CHARLES SPENCER
FIRST VICE PRESIDENT2.00XX000
DANIEL ROWE
ASST. SECRETARY2.00XX000
DEBBIE VAN BOURGONDIEN
TRUSTEE2.00X000
DIANE SWEENEY
TRUSTEE2.00X000
DONATO BALSAMO DO
TRUSTEE2.00X01295971
HON ANGIE CARPENTER
CHAIRPERSON2.00XX000
JTIMOTHY SHEAESQ
TRUSTEE2.00X000
JEFFREY VOLLMUTH
TRUSTEE2.00X000
JOSEPH TOMAINO
EX OFFICIO, EVP CONTINUING CARE50.00XX0418470176579
PHILIP FAVA
ASST. TREASURER2.00XX000
REVMSGRTHOMAS MULVANERTY
TRUSTEE2.00X000
RICHARD ROMER
TRUSTEE2.00X000
ROBERT DOYLE
TRUSTEE2.00X000
SR KATHLEEN MCCARTHY OP
TRUSTEE2.00X000
SR MARGARET KELLIHER DW
TRUSTEE2.00X000
SR DOLORES CASTELLANO CIJ
SECRETARY2.00XX000
SR DOLORES WISNIEWSKI
TRUSTEE2.00X000
TIMOTHY J MATTIMORE ESQ
TRUSTEE2.00X000
WALTER LACE
TRUSTEE2.00X000
MARY ELLEN POLIT
EVP & CAO50.00X01012337101104
WILLIAM MEAD
CFO/SVP CONTINUING CARE50.00X0371519100035
KAREN ESTRADA
SVP/CFO50.00X018692240053
CATHERINE CIRESI
DIRECTOR OF BUSINESS OPERA37.50126303031665X
DENISE FASANO
CHIEF CLINICAL OFFICER37.50133835021639X
ELLEN LASORSA
INFUSION SUPERVISOR37.50123780018128X
JANICE REMMERS
DIRECTOR OF PATIENT ACCOUN37.50149885039877X
NANCY POL STITH
DIRECTOR OF REHAB37.50126236036381X
FieldValueIRS element (for citing)
Total Reportable Comp From Org660039TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2002207TotalReportableCompFrmRltdOrgs
Total Other Compensation565532TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
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
UNLIMITED CARE
333 WESTCHESTER AVE WEST BUILDINGWHITE PLAINSNY11742HOME HEALTH AIDE293542
PERSONAL TOUCH
640 MONTAUK HWYSHIRLEYNY11767HOME HEALTH AIDE222726
BEST CARE
PO BOX 9010LEVITTOWNNY11756HOME HEALTH AIDE215484
ABLE HEALTHCARE SERVICES
1240 BROADCAST PLAZAMERRICKNY11566HOME HEALTH AIDE119699
KPMG LLP
DEPT 0511 PO BOX 120511DALLASTX753120511AUDITING SERVICES117600
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions23593AllOtherContributions
Total Contributions23593TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUDescription
Business Code621610BusinessCode
Total Revenue Column31171916TotalRevenueColumn
Related Or Exempt Function Income31171916RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue31171916TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3878TotalRevenueColumn
Exclusion$3,878ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAL EQUIPMENT TO A53200021718$21,718
MED TRANSCRIPT FEES90009986608660
FieldValueIRS element (for citing)
Total Other Revenue30378TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column31229765TotalRevenueColumn
Related Or Exempt Function Income31180576RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$25,596ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total12308Total
Program Services12308ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21681270Total
Program Services19821558ProgramServices
Management And General1859712ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1597138Total
Program Services1460143ProgramServices
Management And General136995ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4500830Total
Program Services4114772ProgramServices
Management And General386058ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1653506Total
Program Services1511676ProgramServices
Management And General141830ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total59838Total
Management And General59838ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1195739Total
Program Services1077861ProgramServices
Management And General117878ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total59512Total
Management And General59512ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total309277Total
Program Services203194ProgramServices
Management And General106083ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total373405Total
Program Services275005ProgramServices
Management And General98400ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total700731Total
Program Services672692ProgramServices
Management And General28039ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total18850Total
Program Services2975ProgramServices
Management And General15875ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total14496Total
Management And General14496ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total57443Total
Management And General57443ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total331575Total
Management And General331575ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total11418Total
Management And General11418ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
FINANCE AND TECHNOLOGY670190670190
BAD DEBT EXPENSE469286469286
MED/SURGICAL SUPPLIES440643440643
TELEPHONE915627160519957

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total235683Total
Program Services21765ProgramServices
Management And General213918ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total34484700Total
Program Services29634549ProgramServices
Management And General4850151ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY442094BOY
EOY685812EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3036006BOY
EOY4096009EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY11518BOY
EOY11865EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY14330BOY
EOY53915EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3046341LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2135970LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY756039BOY
EOY910371EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY15709BOY
EOY16953EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY232687BOY
EOY234703EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4508383BOY
EOY6009628EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3226902BOY
EOY3525884EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY16576342BOY
EOY21030633EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY19803244BOY
EOY24556517EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-15502387BOY
EOY-18766454EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY58660BOY
EOY70699EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY148866BOY
EOY148866EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-15294861BOY
EOY-18546889EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4508383BOY
EOY6009628EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-3254935ReconcilationRevenueExpenses
Reconcilation Other Changes2908ReconcilationOtherChanges
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)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years26210CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years308608CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15979CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24220CurrentTaxYearMinus1Year
Current Tax Year23593CurrentTaxYear
Total398610Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22729221CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years24552860CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years28214971CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year31260116CurrentTaxYearMinus1Year
Current Tax Year31171916CurrentTaxYear
Total137929084Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22755431CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years24861468CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years28230950CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year31284336CurrentTaxYearMinus1Year
Current Tax Year31195509CurrentTaxYear
Total138327694Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509138327694PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22440CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2901CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2918CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5200CurrentTaxYearMinus1Year
Current Tax Year3878CurrentTaxYear
Total37337Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22440CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2901CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2918CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5200CurrentTaxYearMinus1Year
Current Tax Year3878CurrentTaxYear
Total37337Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years72819CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years85189CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years74964CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year54489CurrentTaxYearMinus1Year
Current Tax Year30378CurrentTaxYear
Total317839Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22850690CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years24949558CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years28308832CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year31344025CurrentTaxYearMinus1Year
Current Tax Year31229765CurrentTaxYear
Total138682870Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99740PublicSupportPercentage509
Prior Year Support Percentage0.99640PriorYearSupportPercentage
Investment Income Percentage0.00030InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00030PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance148866BeginningOfYearBalance
Investment Earnings Or Losses2907InvestmentEarningsOrLosses
Other Expenditures2907OtherExpenditures
End Of Year Balance148866EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance148866BeginningOfYearBalance
Investment Earnings Or Losses16739InvestmentEarningsOrLosses
Other Expenditures16739OtherExpenditures
End Of Year Balance148866EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance148866BeginningOfYearBalance
Investment Earnings Or Losses5008InvestmentEarningsOrLosses
Other Expenditures5008OtherExpenditures
End Of Year Balance148866EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance148866BeginningOfYearBalance
Investment Earnings Or Losses6InvestmentEarningsOrLosses
Other Expenditures6OtherExpenditures
End Of Year Balance148866EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis279538OtherCostOrOtherBasis
Depreciation140504Depreciation
Book Value139034BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2380100OtherCostOrOtherBasis
Depreciation1748540Depreciation
Book Value631560BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis386703OtherCostOrOtherBasis
Depreciation246926Depreciation
Book Value139777BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings910371TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO RELATED PARTIES$20,720,133
PENSION LIABILITY$176,082
DUE TO THRID PARTY$134,418
FieldValueIRS element (for citing)
Total Of Amounts21030633TotalOfAmounts
Total Revenue31229765TotalRevenue
Total Expenses34484700TotalExpenses
Excess Or Deficit For Year-3254935ExcessOrDeficitForYear
Net Unrealized GL On Investments2908NetUnrealizedGLOnInvestments
Total Adjustments2908TotalAdjustments
Excess Or Deficit Per FS-3252027ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt31223375TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments2907NetUnrealizedGainsInvestments
Other Revenues2741OtherRevenues
Revenue Not Rptd F9905648RevenueNotRptdF990
Revenue Subtotal31217727RevenueSubtotal
Other Revenues Not Included12039OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt12039RevenueNotRptdOnFinStmt
Total Revenue Per Form99031229766TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt34414949TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal34414949ExpensesSubtotal
Other Expenses Not Included69751OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt69751ExpensesNotRptdOnFinStmt
Total Expenses Per Form99034484700TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 2D - OTHER ADJUSTMENTS:CHS HOME CARE FOUNDATION ADJUSTMENT $2,741
PART XII, LINE 4B - OTHER ADJUSTMENTS:TEMP. RESTRICTED CONTRIB. RECEIVED AND REPORTED AS A CHANGE IN NET ASSETS $12,039
PAYMENT TO AFFILIATES REPORTED AS AN ADJUSTMENT TO EQUITY ON THE AUDITED FINANCIAL STATEMENTS.
SCHEDULE D PART XIV MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIIONS THAT REQUIRE RECOGNITION IN THE COMBINED FINANCIAL STATEMENTS.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1DIOCESE OF ROCKVILLE CENTRE-CATHOLIC MINISTRIESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line150 NORTH PARK AVEAddressLine1
CityROCKVILLE CENTRECity
StateNYState
ZIP Code11570ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient111837437EINOfRecipient
Amount Of Cash Grant12308AmountOfCashGrant
Purpose Of GrantTO PROVIDE GENERAL SUPPORT OF 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.PurposeOfGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPART II, LINE 1 COLUMN HIdentifier
ExplanationTHE DIOCESE OF ROCKVILLE CENTRE PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL, WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
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
JOSEPH TOMAINO
0352299000661710151509025070059504900
MARY ELLEN POLIT
025021301138000648324073452027652011134410430359
WILLIAM MEAD
0270778090000010741076902023133047155400
KAREN ESTRADA
0186516000406016085023968022697500
CATHERINE CIRESI
1253700009330127330189320157968000
DENISE FASANO
133405000430013201084380155474000
JANICE REMMERS
1496050002800149830248940189762000
NANCY POL STITH
1258810003550117340246470162617000

Form990 Schedule J Part III Form990ScheduleJPartIII (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BSERP CONTRIBUTION EXPENSE WAS AS FOLLOWS: MARY ELLEN POLIT: $53,898 WILLIAM MEAD: $55,509 JOSEPH TOMAINO: $131,127
PART IIIPART VII, SECTION A, LINE 1A TRUSTEE DONATO BALSAMO, D.O. RECEIVED COMPENSATION FOR THE PERFORMANCE OF SERVICES AS A PHYSICIAN FOR GOOD SAMARITAN HOSPITAL (RELATED ORGANIZATION). MR.BALSAMO RECEIVED NO COMPENSATION AS A TRUSTEE FOR NURSING SISTERS HOME CARE, D/B/A CATHOLIC HOME CARE.SUPPLEMENTAL INFORMATION
PART IIIJOSEPH TOMAINO, EVP CONTINUING CARE - THE TOTAL HOURS WORK REPORTED REFLECTS TIME WORKED AS OFFICERS FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SHEPHERD HOSPICE (11-2958438); NURSING SISTERS HOME CARE, INC D/B/A CATHOLIC HOME CARE (11-2126736); CHS HOME SUPPORT SERVICES, INC. (11-3594561); OUR LADY OF CONSOLATION GERIATRIC CARE CENTER (11-3284066); MARYHAVEN CENTER OF HOPE (11-2861698).SUPPLEMENTAL INFORMATION
PART IIIWILLIAM MEAD, CFO/SVP CONTINUING CARE - THE TOTAL HOURS WORK REPORTED REFLECTS TIME WORKED AS OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SHEPHERD HOSPICE (11-2958438); NURSING SISTERS HOME CARE, INC. D/B/A CATHOLIC HOME CARE (11-2126736); CHS HOME SUPPORT SERVICES, INC. (11-3594561); OUR LADY OF CONSOLATION GERIATRIC CARE CENTER (11-3284066); MARYHAVEN CENTER OF HOPE (11-2861698).SUPPLEMENTAL INFORMATION
PART IIIMARY ELLEN POLIT, EVP, CAO CATHOLIC HOME CARE - THE TOTAL HOURS WORK REPORTED REFLECTS TIME WORKED AS OFFICERS FOR THE FOLLOWING RELATED ENTITIES: NURSING SISTERS HOME CARE, INC D/B/A CATHOLIC HOME CARE (11-2126736); CHS HOME SUPPORT SERVICES, INC. (11-3594561); GOOD SHEPERD HOSPICE (11-2958438); AND AS AN ADMINISTRATOR FOR THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924)AND OUR LADY OF CONSULATION GERIATIRC CARE CENTER (11-3284066).SUPPLEMENTAL INFORMATION
PART IIIKAREN ESTRADA, SVP CONTINUING CARE - THE TOTAL HOURS WORK REPORTED REFLECTS TIME WORKED AS OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SHEPHERD HOSPICE (11-2958438); NURSING SISTERS HOME CARE, INC. D/B/A CATHOLIC HOME CARE (11-2126736); CHS HOME SUPPORT SERVICES, INC. (11-3594561); OUR LADY OF CONSOLATION GERIATRIC CARE CENTER (11-3284066); MARYHAVEN CENTER OF HOPE (11-2861698).SUPPLEMENTAL INFORMATION
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 (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF NURSING SISTERS HOME CARE D/B/A CATHOLIC HOME CARE 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 CENTER (DIOCESE).
FORM 990, PART VI, SECTION A, LINE 7ACHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATER OF CATHOLIC HOME CARE AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7BCHS, AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATER OF CATHOLIC HOME CARE, IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY CATHOLIC HOME CARE'S 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 12CDISCLOSURE 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 DISCLOSURE 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 REFFERED 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 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. 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.
REFLECTED 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.HOURS FOR TRUSTEES
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 2,908.CHANGES IN NET ASSETS OR FUND BALANCES:
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, 2010 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, 2010. 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, 2010. EMPLOYER ID NO. $128,00 $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: 12/31/10 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/10 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/10 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/10 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/10 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/10 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 45-2907761 CHS HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 26-3169427 GOOD SHEPHERD HOSPICE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/10 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 27-1531084 OUR LADY OF CONSOLATION FOUNDATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/10 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/10 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/10 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/10CONTROLLED 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 NONETAX 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: 12/31/10 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/10 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/10 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/10 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/10 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/10 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 45-2907761 CHS HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 26-3169427 GOOD SHEPARD HOSPICE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/10 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 27-1531084 OUR LADY OF CONSOLATION FOUNDATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/10 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/10 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/10 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/10TAX 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 SERVICES OF LONG ISLAND
992 N VILLAGE AVEROCKVILLE CENTRENY11570113403968SUPPORT ORGNY501(C)(3)LINE 11A, IN/A0
CATHOLIC HOME CARE FOUNDATION
1150 PORTION RD SUITE 1HOLTSVILLENY11742SUPPORT ORGNY501(C)(3)LINE 90CATHOLIC HOME CARE
CHS AMBULANCE SERVICES
992 N VILLAGE AVEROCKVILLE CENTRENY11570141801961DORMANTNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
CHS HOME SUPPORT SERVICES INC
15 POWER DRHAUPPAUGENY11788113594561RESPITROY THERAPY SVC/MED. EQUIPMENTNY501(C)(3)LINE 90CATHOLIC HEALTH SYSTEM OF LONG ISLAND
CHS SERVICES INC
992 N VILLAGE AVEROCKVILLE CENTRENY11570113555766SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
GOOD SAMARITAN HOSPITAL FOUNDATION
1000 MONTAUK HIGHWAYWEST ISLIPNY11795770611240SUPPORT ORGNY501(C)(3)LINE 11A, I0GOOD SAMARITAN HOSPITAL
GOOD SAMARITAN HOSPITAL MEDICAL CENTER
1000 MONTAUK HIGHWAYWEST ISLIPNY11795111888924HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
GOOD SAMARITAN HOSPITAL SELF INSURANCE
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112537396SELF INSURANCENY501(C)(3)LINE 11A, I0GOOD SAMARITAN HOSPITAL
GOOD SHEPHERD HOSPICE
245 OLD COUNTRY ROADMELVILLENY11747112958438HOSPICE SERVICENY501(C)(3)LINE 90CATHOLIC HEALTH SYSTEM OF LONG ISLAND
GOOD SHEPHERD HOSPICE FOUNDATION
245 OLD COUNTRY ROADMELVILLENY11747263169427SUPPORT ORGNY501(C)(3)LINE 11A, I0GOOD SHEPARD HOSPICE
MARYHAVEN CENTER OF HOPE
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112861698PROGRAM/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
MARYHAVEN TRANSPORTATION SERVICES
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113434776TRANSPORTATION SERVICESNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
MERCY MEDICAL CENTER
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570111635088HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
MERCY MEDICAL CENTER FOUNDATION
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570550813603SUPPORT ORGNY501(C)(3)LINE 11A, I0MERCY MEDICAL CENTER
OUR LADY OF CONSOLATION FOUNDATION
111 BEACH DRIVEWEST ISLIPNY11795450517566SUPPORT ORGNY501(C)(3)LINE 11A, I0OUR LADY OF CONSOLATION
OUR LADY OF CONSOLATION GERIATRIC CARE
111 BEACH DRIVEWEST ISLIPNY11795113284066LT NURSING CARENY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
RIVERHEAD HOSTEL HOLDINGS CORPORATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112499790RENTINGNY501(C)(2)LINE 90MARYHAVEN CENTER OF HOPE
RVC INSURANCE COMPANY
992 N VILLAGE AVEROCKVILLE CENTRENY11570208067039CAPTIVE INSURANCE COMPANYNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
RVC SUPPORT
992 N VILLAGE AVEROCKVILLE CENTRENY11570271531084REAL ESTATENY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
SIENA VILLAGE INC
50 ROUTE 25ASMITHTOWNNY11787061569129SENIOR HOUSINGNY501(C)(3)LINE 90STCATHERINE OF SIENA MEDICAL CENTER
ST CATHERINE OF SIENA MEDICAL CENTER
50 ROUTE 25ASMITHTOWNNY11787061562701HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST CATHERINE OF SIENA MEDICAL CENTER FOUNDATION
50 ROUTE 25ASMITHTOWNNY11787271459941SUPPORT ORGNY501(C)(3)LINE 11A, I0STCATHERINE OF SIENA MEDICAL CENTER
ST CHARLES HOSPITAL
200 BELLE TERRE ROADPORT JEFFERSONNY11777111871039HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST CHARLES HOSPITAL FOUNDATION
200 BELLE TERRE ROADPORT JEFFERSONNY11777412076312SUPPORT ORGNY501(C)(3)LINE 11A, I0STCHARLES HOSPITAL
ST FRANCIS CARDIOVASCULAR PHYSICIANS PC
61-34 188TH ST SUITE 214FRESH MEADOWSNY11365113613997HEALTH CARE SERVICESNY501(C)(3)LINE 30STFRANCIS HOSPITAL
ST FRANCIS HOSPITAL
100 PORT WASHINGTON BOULEVARDROSLYNNY11576112050523HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST FRANCIS HOSPITAL FOUNDATION
100 PORT WASHINGTON BOULEVARDROSLYNNY11576112916033SUPPORT ORGNY501(C)(3)LINE 11A, I0STFRANCIS HOSPITAL
ST FRANCIS HOSPITAL RESEARCH & EDUCATIONAL CORP
100 PORT WASHINGTON BOULEVARDROSLYNNY11576113090867RESEARCH ORGANIZATIONNY501(C)(3)LINE 90STFRANCIS HOSPITAL
ST FRANCIS-MERCY CORPORATION
992 N VILLAGE AVEROCKVILLE CENTRENY11570111635088SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
SUFFOLK HEARING & SPEECH CENTER INC
369 E MAIN STEAST ISLIPNY11730112110488DIAGNOSTIC TESTINGNY501(C)(3)LINE 30GOOD SAMARITAN HOSPITAL
THE CENTER OF HOPE FOUNDATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113638367SUPPORT ORGNY501(C)(3)LINE 11A, I0MARYHAVEN CENTER OF HOPE
THE SAMARITAN CORPORATION
992 N VILLAGE AVEROCKVILLE CENTRENY11570112716640SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
THE ST CHARLES CORPORATION
200 BELLE TERRE ROADPORT JEFFERSONNY11777112983148SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
WISDOM GARDENS HOUSING DEVELOPMENT
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113559713SENIOR HOUSINGNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
WSNCHS NORTH INC
4295 HEMPSTEAD TURNPIKEBETHPAGENY11714113438973HOSPTIALNY501(C)(3)LINE 30CATHOLIC 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
ADVANCE REHABILITATION MEDICINE PLLC
200 BELLE TERRE ROADPORT JEFFERSONNY11777113640709HEALTHCARE SERVICESNYST CHARLES HOSPITALC
CARDIAC EKG INTERPRETATION PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112924518HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
FAIRVIEW HILL MANAGEMENT CO INC
200 BELLE TERRE ROADPORT JEFFERSONNY11777112798383SERVICESNYST CHARLES CORPORATIONC
LI REGIONAL ARTHRITIS & OSTEOPOROSIS CARE PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208964140HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
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 MANAGEMENT SERVICES INC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112838185HEALTHCARE SERVICESNYCATHOLIC HEALTH SYSTEM OF LONG ISLANDC
SAMARITAN MEDICAL SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208088453DIAGNOSTIC TESTINGNYGOOD SAMARITAN HOSPITALC
SAMARITAN PEDIATRIC SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208180263HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
SOUTHWEST SUFFOLK MEDICAL PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795061603195HEALTHCARE SERVICESNYGOOD SAMARITAN 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 NORTH 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 Org1LoansOrGuaranteesFromOtherOrg
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 Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CATHOLIC HEALTH SERVICES OF LONG ISLAND
N-63728COST
CHS SERVICES INC
N-3857020COST
OUR LADY OF CONSOLATION
N-83083COST
CHS HOME SUPPORT SERVICES
N-332801COST
GOOD SHEPHERD HOSPICE
N78670COST
ST FRANCIS HOSPITAL
P57421COST

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierTRANSACTIONS WITH RELATED PARTIESIdentifier
Return ReferenceSCHEDULE R PART VReturnReference
ExplanationNURSING SISTERS HOME CARE HAS DISCLOSED IN SCHEDULE R THE PREDOMINANT TRANSACTION TYPE WITH EACH FACILITY WITH WHICH IT HAS CONDUCTED TRANSACTIONS. HOWEVER, THERE ARE ADDITIONAL TRANSACTION TYPES TO DESCRIBE THE ACTIVITIES NURSING SISTERS HOME CARE HAS ENGAGED IN WITH ITS RELATED PARTY ORGANIZATIONS. THE FOLLOWING IS A LIST OF ADDITIONAL TRANSACTION TYPES BY FACILITY. NAME OF ORGANIZATION EIN ADDITIONAL TRANS. CATHOLIC HEALTH SERVICES OF LONG ISLAND 11-3405968 O CHS SERVICES INC. 11-3555766 O OUR LADY OF CONSOLATION 11-3284066 O,P CHS HOME SUPPORT SERVICES, INC. 11-3594561 O,M,P GOOD SHEPHERD HOSPICE 11-2958438 O,PExplanation