STRATEGY STUDIO / PUBLIC DATA EXPLORER

NURSING SISTERS HOME CARE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NURSING SISTERS HOME CARE INC (EIN 11-2126736)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201103199349303375
Schema version
2010v3.4
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)
Timestamp2011-11-15T10:33:28-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-01-01TaxPeriodBeginDate

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 Signed2011-11-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS LANNINGName
Phone9732283500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

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 Receipts31344025GrossReceipts
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 Body23NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees581TotalNbrEmployees
Total Nbr Volunteers9TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year19270ContributionsGrantsPriorYear
Contributions Grants Current Year24220ContributionsGrantsCurrentYear
Program Service Revenue Prior Year28214971ProgramServiceRevenuePriorYear
Program Service Revenue CY31260116ProgramServiceRevenueCY
Investment Income Prior Year2918InvestmentIncomePriorYear
Investment Income Current Year5200InvestmentIncomeCurrentYear
Other Revenue Prior Year74964OtherRevenuePriorYear
Other Revenue Current Year54489OtherRevenueCurrentYear
Total Revenue Prior Year28312123TotalRevenuePriorYear
Total Revenue Current Year31344025TotalRevenueCurrentYear
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 Year24276776SalariesEtcPriorYear
Salaries Etc Current Year27630853SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4066892OtherExpensePriorYear
Other Expenses Current Year3641788OtherExpensesCurrentYear
Total Expenses Prior Year28343668TotalExpensesPriorYear
Total Expenses Current Year31272641TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-31545RevenuesLessExpensesPriorYear
Revenues Less Expenses CY71384RevenuesLessExpensesCY
Total Assets BOY3693995TotalAssetsBOY
Total Assets EOY4508383TotalAssetsEOY
Total Liabilities BOY19068238TotalLiabilitiesBOY
Total Liabilities EOY19803244TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-15374243NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-15294861NetAssetsOrFundBalancesEOY
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 HELAING MISSION, PROMOTES EXELLENCE 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
Expense27275328Expense
Revenue31260116Revenue
DescriptionNURSING SISTERS HOME CARE (DBA CATHOLIC HOME CARE)PROVIDES APPROXIMATELY 184,000 VISITS TO 9,868 HOME CARE RECIPIENTS IN 2010. 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 Expense27275328TotalProgramServiceExpense
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 Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
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 With109626NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees581NumberOfEmployees
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 Members23NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
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 CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
BERNADETTE CURRY PHD RN
VICE CHAIRPERSON2.00XX000
BROTHER CAMPION LALLY OSF
TRUSTEE2.00X000
CHARLES FALKNER
TREASURER2.00XX000
CHARLES SPENCER
TRUSTEE2.00X000
CHRISTOPER REDMOND ESQ
TRUSTEE2.00X000
DANIEL ROWE
TRUSTEE2.00X000
DEBBIE VAN BOURGONDIEN
TRUSTEE2.00X000
DONATO BALSAMO DO
TRUSTEE2.00X03360289
HON ANGIE CARPENTER
CHAIRPERSON2.00XX000
JTIMOTHY SHEAESQ
TRUSTEE2.00X000
JEFFREY VOLLMUTH
TRUSTEE2.00X000
MARY BRACKEN
TRUSTEE2.00X000
MARY ELLEN POLIT
EVA & CAO50.00XX0345941146649
PHILIP FAVA
TRUSTEE2.00X000
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
TAMMY RAFLE
TRUSTEE2.00X000
TIMOTHY J MATTIMORE ESQ
TRUSTEE2.00X000
WALTER LACE
TRUSTEE2.00X000
DENNIS J VERZI
EVP CONTINUING CARE50.00X0814872189108XX
WILLIAM MEAD
CFO CONTINUING CARE50.00X0323276106112
CATHERINE CIRESI
DIRECTOR OF BUSINESS OPERA37.50130383024906X
DAISY WILLIAMS
PHYSICAL THERAPIST37.5014365600X
DENISE FASANO
DIRECTOR OF PATIENT SERVIC37.50137348017577X
JANICE REMMERS
DIRECTOR OF PATIENT ACCOUNTS37.50152324030284X
NANCY POL STITH
DIRECTOR OF REHAB37.50119697031465X
FieldValueIRS element (for citing)
Total Reportable Comp From Org683408TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1517691TotalReportableCompFrmRltdOrgs
Total Other Compensation546190TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PERSONAL TOUCH
PO BOX 5248NEW YORKNY10087HOME HEALTH AIDE274660
EXTENDED CARE
445 HAMILTON AVEWHITE PLAINSNY10601HOME HEALTH AIDE218031
ABLE HEALTHCARE SERVICES
1240 BROADCAST PLAZAMERRICKNY11566HOME HEALTH AIDE141778
BEST CARE
PO BOX 9010LEVITTOWNNY11756HOME HEALTH AIDE115613
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions24220AllOtherContributions
Total Contributions24220TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUDescription
Business Code621610BusinessCode
Total Revenue Column31260116TotalRevenueColumn
Related Or Exempt Function Income31260116RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue31260116TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5200TotalRevenueColumn
Exclusion$5,200ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAL EQUIPMENT TO A53200033672$33,672
MED TRANSCRIPT FEES9000991154711547
LIFELINE PROGRAM90009992709270
FieldValueIRS element (for citing)
Total Other Revenue54489TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column31344025TotalRevenueColumn
Related Or Exempt Function Income31280933RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$38,872ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total22166723Total
Program Services20489398ProgramServices
Management And General1677325ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1168085Total
Program Services1065293ProgramServices
Management And General102792ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2706971Total
Program Services2544392ProgramServices
Management And General162579ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1589074Total
Program Services1449235ProgramServices
Management And General139839ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total4302Total
Management And General4302ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total64821Total
Management And General64821ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total26481Total
Management And General26481ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total32673Total
Management And General32673ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total303080Total
Program Services199811ProgramServices
Management And General103269ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total393607Total
Program Services393498ProgramServices
Management And General109ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total638286Total
Program Services612447ProgramServices
Management And General25839ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total17840Total
Program Services11985ProgramServices
Management And General5855ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total28856Total
Management And General28856ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total64552Total
Management And General64552ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total288390Total
Management And General288390ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total86832Total
Management And General86832ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
FINANCE AND TECHNOLOGY636267636267
MED/SURGICAL SUPPLIES391154391154
BAD DEBT EXPENSE242179242179
TELEPHONE1304695504975420

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total291999Total
Program Services42695ProgramServices
Management And General249304ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total31272641Total
Program Services27275328ProgramServices
Management And General3997313ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY356780BOY
EOY442094EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2565252BOY
EOY3036006EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3308BOY
EOY11518EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY18944BOY
EOY14330EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2560434LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1804395LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY511056BOY
EOY756039EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY12055BOY
EOY15709EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY226600BOY
EOY232687EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3693995BOY
EOY4508383EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3408339BOY
EOY3226902EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY15659899BOY
EOY16576342EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY19068238BOY
EOY19803244EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-15571371BOY
EOY-15502387EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY48262BOY
EOY58660EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY148866BOY
EOY148866EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-15374243BOY
EOY-15294861EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3693995BOY
EOY4508383EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses71384ReconcilationRevenueExpenses
Reconcilation Other Changes7998ReconcilationOtherChanges
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 Years52417CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years26210CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years308608CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15979CurrentTaxYearMinus1Year
Current Tax Year24220CurrentTaxYear
Total427434Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22849750CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22729221CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24552860CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28214971CurrentTaxYearMinus1Year
Current Tax Year31260116CurrentTaxYear
Total129606918Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22902167CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22755431CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24861468CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28230950CurrentTaxYearMinus1Year
Current Tax Year31284336CurrentTaxYear
Total130034352Total

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 Total509130034352PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8128CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22440CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2901CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2918CurrentTaxYearMinus1Year
Current Tax Year5200CurrentTaxYear
Total41587Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8128CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22440CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2901CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2918CurrentTaxYearMinus1Year
Current Tax Year5200CurrentTaxYear
Total41587Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years147257CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years72819CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years85189CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year74964CurrentTaxYearMinus1Year
Current Tax Year54489CurrentTaxYear
Total434718Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years23057552CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22850690CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24949558CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28308832CurrentTaxYearMinus1Year
Current Tax Year31344025CurrentTaxYear
Total130510657Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99640PublicSupportPercentage509
Prior Year Support Percentage0.99610PriorYearSupportPercentage
Investment Income Percentage0.00030InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00030PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

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

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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
Depreciation111672Depreciation
Book Value167866BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2026230OtherCostOrOtherBasis
Depreciation1489996Depreciation
Book Value536234BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis254666OtherCostOrOtherBasis
Depreciation202727Depreciation
Book Value51939BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings756039TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM THIRD PARTY9854
1150 CORP SECURITY DEPOSIT15306
RESTRICTED CASH207527
FieldValueIRS element (for citing)
Total Book Value Other Assets232687TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO RELATED PARTIES$16,400,260
PENSION LIABILITY$176,082
FieldValueIRS element (for citing)
Total Of Amounts16576342TotalOfAmounts
Total Revenue31344025TotalRevenue
Total Expenses31272641TotalExpenses
Excess Or Deficit For Year71384ExcessOrDeficitForYear
Net Unrealized GL On Investments7998NetUnrealizedGLOnInvestments
Total Adjustments7998TotalAdjustments
Excess Or Deficit Per FS79382ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt31341624TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments7998NetUnrealizedGainsInvestments
Revenue Not Rptd F9907998RevenueNotRptdF990
Revenue Subtotal31333626RevenueSubtotal
Other Revenues Not Included10399OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt10399RevenueNotRptdOnFinStmt
Total Revenue Per Form99031344025TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt31208089TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal31208089ExpensesSubtotal
Other Expenses Not Included64552OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt64552ExpensesNotRptdOnFinStmt
Total Expenses Per Form99031272641TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 4B - OTHER ADJUSTMENTS:UNRESTRICTED CONTRIBUTIONS RECEIVED AND REPORTED AS A CHANGE IN NET ASSETS
PAYMENT TO AFFILIATES REPORTED AS AN ADJUSTMENT TO EQUITY ON THE AUDITED FINANCIAL STATEMENTS.

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 (7 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
MARY ELLEN POLIT
0264703080000012380117672028977049259000
DENNIS J VERZI
051517802810000186940180416086920100398000
WILLIAM MEAD
0242545070000010731084747021365042938800
CATHERINE CIRESI
1145290150000854071710177350155289000
DENISE FASANO
121969015000037909190083870154925000
JANICE REMMERS
1320970200000227067690235150182608000
NANCY POL STITH
1093890100000308082840231810151162000

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BSERP CONTRIBUTION EXPENSE WAS AS FOLLOWS: MARY ELLEN POLIT: $134,860 WILLIAM MEAD: $86,462 DENNIS VERZI: $172,632
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 IIIDENNIS J. VERZI, 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 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

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF ORGANIZATION MISSION:FORM 990, PART III, LINE 1NURSING 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.
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 AND OFFERING A COMPREHENSIVE RANGE OF SERVICES TO PATIENTS, MANAGED CARE PLANS AND EMPLOYEES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE).
FORM 990, PART VI, SECTION A, LINE 7ATHE 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 AND OFFERING A COMPREHENSIVE RANGE OF SERVICES TO PATIENTS, MANAGED CARE PLANS AND EMPLOYEES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE).
FORM 990, PART VI, SECTION A, LINE 7BTHE 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 AND OFFERING A COMPREHENSIVE RANGE OF SERVICES TO PATIENTS, MANAGED CARE PLANS AND EMPLOYEES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE).
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS COMPLETED BY THE ACCOUNTING AND FINANCE STAFF OF THE ORGANIZATION AND REVIEWED INTERNALLY BY MANAGEMENT. IT IS THEN REVIEWED BY OUTSIDE TAX ADVISORS AND ANY NECESSARY ASJUSTMENTS ARE MADE, AFTER WHICH TIME IT IS CONSIDERED A FINAL DRAFT. THE FINAL DRAFT OF THE FORM 990 IS 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. ONCE THE COMMITTEE'S REVIEW IS COMPLETE, THE COMMITTEE RECOMMENDS THE APPROVAL OF THE FORM 990 TO THE BOARD (OF THE EXECUTIVE COMMITTEE OF THE BOARD, AS APPROPRIATE). THE FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD. UPON APPROVAL 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, SUCH APPROVAL, RECOMMENDS APPROVAL TO THE CHS BOARD, AND CERTIFIES THAT THE CHS BOARD APPROVED FORM 990 REVIEW PROCESS HAS BEEN FOLLOWED. THE CHS COMPLIANCE AND AUDIT COMMITTEE REVIEWS THE ORGANIZATION'S CORRESPONDENCE REGARDING THE FORM 990 RECOMMENDED APPROVAL AND REVIEW PROCESS. THE CHS COMPLIANCE AND AUDIT COMMITTEE IS PROVIDED WITH THE ORGANIZATION'S FORM 990 AND REVIEWS THE FORM TO THE EXTENT IT DEEMS APPROPRIATE IN THE LIGHT OF THE ORGANIZATIONAL CERTIFICATIONS AND OTHER FACTORS AS DETERMINED BY THE COMMITTEE. UPON THE CHS COMPLIANCE AND AUDIT COMMITTEE'S REVIEW OF THE ORGANIZATION'S RECOMMENDED APPROVAL AND SATISFACTION OF THE FORM 990 REVIEW PROCESS, IT SHALL RECOMMEND THE APPROVAL OF THE FORM 990 TO THE CHS BOARD OF DIRECTORS (OR THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, AS APPROPRIATE). THE CHS BOARD OF DIRECTORS (OR THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, AS APPROPRIATE) REVIEWS THE CHS COMPLIANCE AND AUDIT COMMITTEE'S RECOMMENDATION AND PROVIDES 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 EXECUTIVE COMPENSATION POLICY (THE "POLICY")APPLIES TO THOSE WHO ARE DEFINED AS "DISQUALIFIED PERSONS". THE POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CHS OR AN OPERATING ENTITY, AND IS EITHER A)A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHEIF EXECUTIVE OFFICER, AND CHIEF OPERATING OFFICERS OR PERSON HOLDING EQUIVALENT POSITIONS; C)THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS; D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITES OF CHS OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CHS OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CHS OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CHS OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CHS OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. THE CHIEF EXECUTIVE OFFICER SUBMITS FOR APROVAL 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, AND THE COMMITTEE MAKES RECOMMENDATION TO THE BOARD OF TRUSTEES WITH RESPECT TO THE PROPOSED EXECUTIVE COMPENSATION. THE BOARD HAS RETAINED AN INDEPENDENT COMPENSATION CONSULTANT TO APPLY ITS STANDARD METHODOLOGY FOR DETERMINATION OF APPROPRIATE EXECUTIVE COMPENSATION AND BENEFIT LEVELS FOR "DISQUALIFIED PERSONS." IT IS POLICY TO TARGET THE TOTAL COMPENSATION (BASE SALARY, INCENTIVE COMPENSATION AND BENEFITS) OF "DISQUALIFIED PERSONS" AT THE MEDIAN OF THE DEINED MARKETPLACE FOR SIMILARLY SITUATED EXECUTIVES IN CONSULTATION WITH AN INDEPENDENT COMPENSATION CONSULTANT IN A MANNER THAT COMPLIES WITH THE INTERMEDIATE SANCTION REGULATIONS AND OTHER FEDERAL AND STATE LAWS AND REGULATIONS. THE BOARD REVIEWS BASE SALARIES FOR "DISQUALIFIED PERSONS" BASED UPON THE MEDIAN AMOUNTS (50TH PERCENTILE) PAID TO SIMILARLY SITUATED EXECUTIVES WITHIN THE RELEVANT MARKETPLACE, WITH POSSIBLE ADJUSTMENTS MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. INCENTIVE COMPENSATION IS BASED ON A PERCENTAGE OF THE BASE SALARY AND AWARDED ONLY IF A "DISQUALIFIED PERSON" MEETS OBJECTIVE PERFORMANCE CRITERIA. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASURABLE AND RELATED TO INDICATORS OF PERFORMANCE, WHICH SHALL INCLUDE BOTH THE PERFORMANCE OF THE OPERATING ENTITY THAT EMPLOYS THE "DISQUALIFIED PERSON" AND THE PERFORMANCE OF THE CHS SYSTEM AS A WHOLE. USING SUCH CRITERIA, THE CHS CEO SHALL RECOMMEND TO THE CHS EXECUTIVE COMPENSATION COMMITTEE INCENTIVE COMPENSATION FOR SYSTEM-LEVEL EXECUTIVES WHO ARE "DISQUALIFIED PERSONS," AND THE CEO OF EACH OPERATING ENTITY SHALL RECOMMEND TO THE OPERATING ENTITY ECC INCENTIVE COMPENSATION FOR OPERATING ENTITY EXECUTIVES WHO ARE "DISQUALIFIED PERSONS," IF APPROVED BY THE CHS CEO. EXECUTIVES PARTICIPATE IN THE DIOCESAN PENSION PLAN AND OTHER BENEFIT PLANS AS APPROVED BY THE CHS CORPORATE BOARD OR CHS OPERATING ENTITY BOARD, AS THE CASE MAY BE.
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; FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND.
HOURS FOR TRUSTEESREFLECTED 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.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 7,998.
ELECTION TO ALLOCATE BUSINESS ASSET EXPENSECONTROLLED 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 NONE
CONTROLLED GROUP ELECTION - CONTINUEDEMPLOYER 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 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 26-3169427 CATHOLIC HOME CARE 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: 12/31/10
TAX BRACKET ALLOCATIONTHE 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 NONE
TAX BRACKET ALLOCATION - CONTINUEDEMPLOYER 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 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 26-3169427 CATHOLIC HOME CARE 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: 12/31/10

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 (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CATHOLIC HEALTH SERVICES OF LONG ISLAND
N-640587COST
CHS SERVICES INC
N-253644COST
OUR LADY OF CONSOLATION
N-133067COST
CHS HOME SUPPORT SERVICES
N-298357COST
GOOD SHEPHERD HOSPICE
N320681COST