2023-11-13T15:29:28-06:00 2022-12-31 PwC US Tax LLP 2001 MARKET STREET SUITE 1800 PHILADELPHIA PA 19103 990 2022-01-01 111888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER % CHS SERVICES GOOD 6313763000 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 RUTH HENNESSEY PRESIDENT/CAO 5167051919 2023-11-09 true RUTH HENNESSEY 999009999 ERIC M MCNEIL P00460263 2673303000 2023-11-08 3 2022 2023-04-26 12:10:37Z GOOD SAMARITAN UNIVERSITY HOSPITAL PATRICK O'SHAUGHNESSY DO 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 935108929 false 0928 X HTTP://GOODSAMARITAN.CHSLI.ORG/ X 1959 NY WE, AT CH, HUMBLY JOIN TOGETHER TO BRING CHRISTS HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. 23 22 4336 26 1890861 0 2664318 4506105 765394159 827564013 5583208 933971 29191090 25730665 802832775 858734754 272369 268294 0 0 361558677 386883745 0 0 0 414103594 450858861 775934640 838010900 26898135 20723854 1039152790 1037967992 738934573 747374698 300218217 290593294 X SEE SCHEDULE O false false 738936680 268294 818223346 GOOD SAMARITAN UNIVERSITY HOSPITAL IS A 437 BED MEDICAL CENTER LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN WEST ISLIP, NEW YORK. A PREMIER HEALTHCARE FACILITY, PROVIDING QUALITY AND COST EFFECTIVE HEALTH CARE SERVICES EXTENDING ACROSS THE CONTINUUM OF CARE TO ALL DISCIPLINES, BOTH FOR INPATIENTS AND OUTPATIENTS. IN 2022 THE MEDICAL CENTER PROVIDED INPATIENT SERVICES FOR 25,834 DISCHARGED INDIVIDUALS, MANAGED 91,111 EMERGENCY DEPARTMENT VISITS AND 43,859 CLINIC VISITS. THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH COMMUNITY SERVICE AND CHARITABLE ACTIVITIES. 9041389 0 9340667 GOOD SAMARITAN NURSING HOME IS LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN SAYVILLE, NEW YORK. THE 100 BED FACILITY HAS BEEN PART OF GOOD SAMARITAN HOSPITAL MEDICAL CENTER SINCE 1980. THE RESIDENT POPULATION OF THE NURSING HOME IS MEDICALLY COMPLEX AND REQUIRES FULL-TIME CARE. SKILLED NURSING CARE AT THE FACILITY PROVIDES ONGOING MEDICALLY COMPLEX CARE ALONG WITH GERIATRIC CARE, REHABILITATIVE CARE, AND DEMENTIA DISEASE CARE. 2022 PATIENT DAYS FOR THE NURSING HOME TOTALED 24,702. 747978069 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true false false true 308 0 true 4336 true true true false false false false false false false false false true false X 23 22 false false false false true true true true true false false true true true true true true true true true true X CHS SERVICES 5167053700 992 NORTH VILLAGE AVE ROCKVILLE CENTRE NY 11570 X PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 50.0 0.0 X X 0 2439713 836578 PADMALATHA GURRAM PHYSICIAN 50.0 0.0 X 1640402 0 36758 BARAA ALLAF PHYSICIAN 50.0 0.0 X 1417952 0 75560 Leonid Kogan PHYSICIAN 50.0 0.0 X 1445868 0 28299 DANIEL DEBARBA EVP & CFO THRU 8/5/2022 50.0 0.0 X 0 1103144 308072 Sami Almaskeen STAFF PHYSICIAN 50.0 0.0 X 1337261 0 68733 Kourosh Adhami PHYSICIAN 50.0 0.0 X 1246277 0 68116 RUTH HENNESSEY PRESIDENT/CAO 50.0 0.0 X 1037879 0 183426 PATRICK MINICUS EVP & CFO AS OF 12/12/2022 50.0 0.0 X 0 805216 69870 DONALD TEPLITZ CMO 50.0 0.0 X 686059 0 54729 JOHN MCMURRAY COO 50.0 0.0 X 433388 0 62447 JOHN FRANCFORT MD TRUSTEE RESIGNED 5/22 37.5 2.0 X 281765 0 20512 SALVATORE SODANO CHAIRMAN 2.0 0.0 X X 0 0 0 BRIAN MCGUIRE VICE CHAIR 2.0 0.0 X X 0 0 0 JEROME POLLER SECRETARY 2.0 0.0 X X 0 0 0 ROBERT ZUCCARO TREASURER 2.0 0.0 X X 0 0 0 CHRIS PASCUCCI TRUSTEE 2.0 0.0 X 0 0 0 VIRGINIA EWEN TRUSTEE 2.0 0.0 X 0 0 0 FRANK L KURRE TRUSTEE 2.0 0.0 X 0 0 0 REV MSGR ROBERT MORRISEY TRUSTEE 2.0 0.0 X 0 0 0 DANIEL T ROWE TRUSTEE RESIGNED 12/22 2.0 0.0 X 0 0 0 Rev John McCartney TRUSTEE 2.0 0.0 X 0 0 0 KEVIN J CONWAY TRUSTEE 2.0 0.0 X 0 0 0 PETER D'ANGELO TRUSTEE 2.0 0.0 X 0 0 0 REV PETER DUGANDZIC TRUSTEE 2.0 0.0 X 0 0 0 HON ANTHONY MARANO TRUSTEE 2.0 0.0 X 0 0 0 STEPHEN F MCLOUGHLIN TRUSTEE 2.0 0.0 X 0 0 0 WILLIAM WARD TRUSTEE 2.0 0.0 X 0 0 0 PETER QUICK TRUSTEE 2.0 0.0 X 0 0 0 THOMAS CHRISTMAN TRUSTEE 2.0 0.0 X 0 0 0 Debra Del Vecchio TRUSTEE AS OF 2.0 0.0 X 0 0 0 Regina Piscazzi TRUSTEE AS OF 2.0 0.0 X 0 0 0 John Romanelli MD TRUSTEE AS OF 2.0 0.0 X 0 0 0 Andrew Zucaro TRUSTEE AS OF 2.0 0.0 X 0 0 0 9526851 4348073 1813100 1336 false true false EW HOWELL CO LLC 245 NEWTON RD SUITE 600 PLAINVIEW NY 11803 CONTRUCTING SRVCS 29477707 PROGRESSIVE EMERGENCY PHYS LLC 1236 RXR PLAZA UNIONDALE NY 11556 PHYSICIAN SERVICES 21629261 REMI HOLDINGS LLC 11325 N COMMUNITY HOUSE ROAD SUITE CHARLOTTE SC 28277 EQUIP MAINTENANCE 1994257 LONG ISLAND ANESTHESIOLOGISTS PLL 100 Merrick Road Suite 112 E ROCKVILLE CENTRE NY 11570 PHYSICIAN SERVICES 1750000 HENNINGSON DURHAM RICHARDSON PC 1917 SOUTH 67TH STREET OMAHA NE 68106 ARCHITECTURAL SRVCS 1507245 58 4488732 17373 4506105 NET PATIENT SERVICE REVENUE - 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OTHER LOBBYING ACTIVITIES AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON THE BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ASSOCIATIONS REPRESENT. 8673726 8673726 330253888 196962204 133291684 11695101 11191709 503392 319954033 269606670 50347363 84096625 0 84096625 276912790 OTHER RECEIVABLES 2869375 INSURANCE CLAIMS RECEIVABLE 106981892 DUE FROM RELATED PARTIES -21849484 RIGHT OF USE ASSETS 24935690 BOND INDENTURE AGREEMENTS 19574877 132512350 0 THIRD PARTY PAYOR LIABILITY 37148758 SELF INSURANCE RESERVE-MALPRACTICE 114071059 SELF INSURANCE RESERVE-LIABILIES 44251868 OTHER NON-CURRENT LIABILITIES 12094849 OPERATING LEASE LIABILITIES 23489659 TENANT SECURITY DEPOSIT 19009 231075202 X PART X, OTHER LIABILITIES - LINE 2, FIN 48 FOOTNOTE CH AND MOST OF ITS SUBSIDIARIES ARE 501(C)(3) ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THESE ENTITIES ARE ALSO EXEMPT FROM NEW YORK STATE INCOME TAXES. THERE ARE VARIOUS SUBSIDIARIES OF CH THAT ARE FOR-PROFIT ENTITIES. TAXABLE OPERATIONS AND THE POTENTIAL FOR INCOME TAXES FROM THESE ENTITIES AND FROM UNRELATED BUSINESS ACTIVITIES OF THE TAX EXEMPT ENTITIES ARE NOT SIGNIFICANT TO THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. true true X true X 300. true X true true true false true true 12823355 1988811 10834543 0.01290 123391420 83783137 39608283 0.04730 4379775 2992861 1386914 0.00170 140594550 88764809 51829740 0.06190 772346 0 772346 0.00090 11970067 4794808 7175259 0.00860 337226 0 337226 0.00040 13079639 4794808 8284831 0.00990 153674189 93559617 60114571 0.07180 true 28837173 180714281 196614057 -15899776 X true true 1 1 GOOD SAMARITAN HOSPITAL MEDICAL CTR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 HTTP://GOODSAMARITAN.CHSLI.ORG/ 5154001H X X X X HOSPITAL GOOD SAMARITAN HOSPITAL MED CTR 1 false false true X X X X X X X X 22 true true true true X goodsamaritan.chsli.org/ X www.chsli.org true 22 true www.chsli.org false true X 300. 400. X X X true true X X X true X www.chsli.org X www.chsli.org X www.chsli.org X X X X X X true X false X X X X X true X false false PART V, SECTION B, LINE 3E IN 2022, MEMBERS OF THE LONG ISLAND HEALTH COLLABORATIVE REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM HEALTH NEEDS PRIORITIES FOR THE 2022-2024 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. PART V, SECTION B, LINE 5 GOOD SAMARITAN HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ASSOCIATION WITH LONG ISLAND HEALTH COLLABORATIVE (LIHC) MEMBERS. THE LIHC IS A PARTNERSHIP OF LONG ISLAND'S HOSPITALS, COUNTY HEALTH DEPARTMENTS, HEALTH PROVIDERS, COMMUNITY-BASED SOCIAL AND HUMAN SERVICE ORGANIZATIONS, ACADEMIC INSTITUTIONS, HEALTH PLANS, LOCAL GOVERNMENT AND THE BUSINESS SECTOR, ALL ENGAGED IN IMPROVING THE HEALTH OF LONG ISLANDERS. THE LIHC IS THE MAIN WORKING GROUP ASSOCIATED WITH CARRYING OUT THE GOALS OF THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPRESENTS A COLLABORATION BETWEEN CATHOLIC HEALTH, THE LONG ISLAND HEALTH COLLABORATIVE (LIHC), LOCAL COMMUNITY-BASED AGENCIES, PATIENTS LIVING IN OUR COMMUNITY AND THE SUFFOLK COUNTY DEPARTMENT OF HEALTH. CATHOLIC HEALTH RETAINED DATAGEN IN THE SUMMER OF 2022 TO PROVIDE RESEARCH ANALYSIS TO FACILITATE THIS REPORT, WHICH DEFINES THE IDENTIFIED COMMUNITY HEALTH NEEDS AND BARRIERS EXPRESSED BY COMMUNITY MEMBERS AND THE LOCAL COMMUNITY-BASED ORGANIZATIONS THAT SERVE THE REGION. THIS REPORT'S PRIMARY DATA WAS COLLECTED BY THE LONG ISLAND HEALTH COLLABORATIVE FROM JANUARY 2021 THROUGH AUGUST 2022. IT INCLUDES INPUT AND COMMENTS FROM COMMUNITY MEMBERS AND COMMUNITY LEADERS. THE SECONDARY DATA USED IS FROM YEARS 2018-2021. THE RESULTS FROM MULTIPLE ANALYSES WILL ENABLE CATHOLIC HEALTH TO DEPLOY NEW AND EXISTING CHRONIC DISEASE PREVENTION STRATEGIES, ADDRESS RELEVANT SOCIAL DETERMINANTS OF HEALTH RISK FACTORS, AND WORK TO REDUCE THE HEALTH DISPARITIES IDENTIFIED. PRIMARY DATA WAS OBTAINED FROM A COMMUNITY HEALTH NEEDS ASSESSMENT SENT TO INDIVIDUALS AND A SIMILAR SURVEY TO COMMUNITY-BASED ORGANIZATION LEADERS. ADDITIONALLY, WE LOOKED AT RESULTS FROM TWO QUALITATIVE STUDIES TO ROUND OUT OUR PRIMARY DATA. SECONDARY DATA WAS DERIVED FROM PUBLICLY-AVAILABLE DATA SETS CURATED BY DATAGEN INTO ITS PROPRIETARY DATA ANALYTICS PLATFORM, CHNA ADVANTAGE, OFFERING 200 PLUS METRICS TO DETERMINE HEALTH ISSUES WITHIN SUFFOLK COUNTY. AS SUCH, PRIORITIES SELECTED FOR THE 2022-2024 CYCLE REMAIN UNCHANGED FROM THE 2019-2021 CYCLE SELECTION, AND THE SELECTED HEALTH DISPARITIES IN WHICH PARTNERS ARE FOCUSING THEIR EFFORTS RESTS ON THE INEQUITIES EXPERIENCED BY THOSE IN HISTORICALLY UNDERSERVED COMMUNITIES AND COMMUNITIES OF COLOR. THE ENGAGEMENT OF THE BROADER COMMUNITY, FOR ASSESSMENT PROCESSES, IS ACHIEVED THROUGH THE LIHC AND ITS PARTNERS' ONGOING DISTRIBUTION OF THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT (CHAS) SURVEY. THIS SURVEY IS OFFERED ONLINE VIA A SURVEYMONKEY LINK AND IS AVAILABLE TO RESIDENTS AT PUBLIC EVENTS, WORKSHOPS, EDUCATIONAL PROGRAMS, INTERVENTIONS, ETC., WHICH ARE OFFERED BY LIHC PARTNERS. IT IS ALSO DISTRIBUTED AMONG PHYSICIAN OFFICES, HOSPITAL WAITING AREAS, LIBRARIES, SCHOOLS, FEDERALLY-QUALIFIED HEALTH CLINICS, AND INSURANCE ENROLLMENT SITES, AMONG OTHER PUBLIC VENUES. THE LIHC AGGRESSIVELY PROMOTES THE SURVEY THROUGH SOCIAL MEDIA AND A LINK TO THE SURVEY IS ALSO AVAILABLE ON THE GOOD SAMARITAN UNIVERSITY HOSPITAL WEBSITE. RESULTS FROM THE CHAS ARE ANALYZED TWICE A YEAR. FINDINGS ARE SHARED WITH ALL LIHC PARTICIPANTS, WITH THE MEDIA AND POSTED ON THE LIHC WEBSITE. SURVEYS WERE DISTRIBUTED BY PAPER AND ELECTRONICALLY, THROUGH SURVEY MONKEY, TO COMMUNITY MEMBERS FROM JANUARY 2021 THROUGH DECEMBER 2021 WITH 1,143 SURVEYS COLLECTED. A CERTIFIED TRANSLATION OF THE SURVEY IS AVAILABLE IN THE FOLLOWING LANGUAGES: SPANISH, POLISH AND HAITIAN CREOLE. LARGE PRINT COPIES ARE ALSO AVAILABLE TO THOSE LIVING WITH VISION IMPAIRMENT. FOR THIS ASSESSMENT CYCLE, THE LIHC ALSO ENGAGED THE COMMUNITY THROUGH FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH LEADERS OF COMMUNITY-BASED ORGANIZATIONS (CBO). THE RESEARCH FIRM EUREKAFACTS, LLC., CONDUCTED THE FOCUS GROUPS AND CBO INTERVIEWS, INTERPRETED THE RESULTS, AND PRODUCED THE REPORT. FOCUS GROUPS WERE HELD IN LOW-INCOME COMMUNITIES, RIVERHEAD, AND WYANDANCH. PART V, SECTION B, LINE 6A LONG ISLAND COMMUNITY HOSPITAL, NORTHWELL HEALTH SYSTEM (HUNTINGTON HOSPITAL, SOUTH SHORE UNIVERSITY HOSPITAL, JOHN T. MATHER MEMORIAL HOSPITAL, PECONIC BAY MEDICAL CENTER), ST. CHARLES HOSPITAL, ST. CATHERINE OF SIENA HOSPITAL, STONY BROOK SOUTHAMPTON HOSPITAL, STONY BROOK UNIVERSITY HOSPITAL AND VETERANS AFFAIRS MEDICAL CENTER. PART V, SECTION B, LINE 6B THE HOSPITAL'S CHNA WAS ALSO CONDUCTED WITH NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND MORE THAN 40 COMMUNITY-BASED ORGANIZATIONS, COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). PART V, SECTION B, LINE 11 COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. THE WORK PLAN FOR ADDRESSING THE IDENTIFIED NEEDS CAN BE FOUND IN THE CHNA APPENDIX E, PUBLICLY AVAILABLE ON THE HOSPITAL'S WEBSITE, HTTPS://GOODSAMARITAN.CHSLI.ORG/ PRIORITY 1: PREVENT CHRONIC DISEASE: GOOD SAMARITAN HOSPITAL OFFERS REGULARLY SCHEDULED PREVENTIVE HEALTH SCREENINGS IN LOCAL COMMUNITIES, PARTICULARLY THOSE IN MEDICALLY-UNDERSERVED COMMUNITIES. THESE INCLUDE BLOOD PRESSURE, BODY MASS INDEX (BMI), PROSTATE CANCER AND ORAL AND HEAD AND NECK CANCER SCREENINGS. THERE WERE 7 EVENTS PROVIDING 183 FREE BLOOD PRESSURE SCREENINGS. ONE OF THESE EVENTS WAS HELD IN COLLABORATION WITH CALVARY BAPTIST CHURCH LENDING TABLES IN BAY SHORE. HOSPITAL STAFF ALSO PROVIDED BLOOD PRESSURE SCREENINGS AT THE SECOND ANNUAL VETERANS DRIVE-THROUGH RESOURCE EVENT, HEALTHY SUNDAYS AND THE BABYLON STREET FAIR. FREE PROSTATE CANCER SCREENING WERE PROVIDED ON SEPTEMBER 20TH, NOVEMBER 5TH, AND NOVEMBER 7TH, SCREENING A TOTAL OF 15 PEOPLE. HEALTHY SUNDAYS' COMMUNITY EVENTS ARE HELD IN COLLABORATION WITH HOUSES OF WORSHIP AND COMMUNITIES. THESE INCLUDE HEALTH SCREENINGS, EDUCATION AND REFERRALS TO CARE ALONG WITH SELECT PARTNERS OFFERING FREE OR DISCOUNTED SERVICES. VOLUNTEERS FROM GOOD SAMARITAN PARTICIPATED IN 10 HEALTHY SUNDAYS IN 2022 ACROSS VARIOUS CHURCHES. THERE WERE 9 LECTURES PROVIDED FROM JANUARY TO DECEMBER ON VARIOUS TOPICS, INCLUDING STROKE, HEART HEALTH, BREAST HEALTH, AND THORACIC AORTIC DISEASE. THERE WAS A 2022 VIRTUAL CANCER SYMPOSIUM ON APRIL 25TH PRESENTED BY THE CANCER INSTITUTE AT GOOD SAMARITAN AND MONDAYS AT RACINE. THE SYMPOSIUM PROVIDED INFORMATION ON TRENDING CANCER-RELATED TOPICS, INCLUDING STRESS RELIEF, NUTRITION, GENETICS, RADIATION THERAPY AND BREAST HEALTH FOR 50 PEOPLE. SMOKING CESSATION PROGRAMS ARE OFFERED TO REDUCE THE RISK OF DISEASES CAUSED OR THE EFFECTS OF SMOKING. THE LEARN TO BE.TOBACCO-FREE SMOKING CESSATION PROGRAM IS BEING OFFERED VIRTUALLY WITH THE SUFFOLK COUNTY DEPARTMENT OF HEALTH. THE HOSPITAL HOSTED 10 TEDDY BEAR CLINICS, TEACHING FIRST AID TO 664 PEOPLE. THE HOSPITAL ALSO HOSTED 16 'STOP THE BLEED' EVENTS, TRAINING 344 PEOPLE IN TOTAL. PRIORITY 2: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS: PROMOTION OF ALL PROGRAMS, EVENTS AND EDUCATION OFFERED BY LIHC MEMBERS WHO SPEAK TO THE PREVENTION OF MENTAL AND SUBSTANCE USE DISORDERS. PARTICIPATION IN LOCAL TASK FORCES ADDRESSING OPIOID USE DISORDERS. GOOD SAMARITAN OFFERS FREE SUPPORT GROUPS TO BRING TOGETHER PEOPLE WHO ARE GOING THROUGH OR WHO HAVE GONE THROUGH SIMILAR EXPERIENCES. THESE ARE OPEN TO ALL COMMUNITY MEMBERS AND INCLUDE CANCER, BARIATRIC/WEIGHT LOSS SURGERY, BRAIN ANEURYSM AND STROKE SUPPORT, ALONG WITH MORE THAN 10 TYPES OF SUPPORT GROUPS FOR NEW PARENTS/SIBLINGS AND BREASTFEEDING. THE BREAST CANCER GROUP MEETS BI-MONTHLY, THE LIFE GOES ON CANCER SUPPORT GROUP AND BREASTFEEDING GROUPS MEET WEEKLY, AND THE BRAIN ANEURYSM AND STROKE GROUP MEET MONTHLY. SUPPORT GROUPS FOR EXPECTANT COUPLES AND NEW PARENTS CONTINUE TO MEET: FIRST-TIME-AROUND PREPARED CHILD BIRTH COURSES HAD A TOTAL OF 152 PARTICIPANTS, BREASTFEEDING YOUR BABY CLASSES HAD 80, CARING FOR YOUR BABY FOR HAD 78, CESAREAN SECTION CLASSES HAD 96, NEW MOTHER'S SUPPORT GROUP HAD 86 ATTENDEES, MOTHER'S CIRCLE OF HOPE WITH 93 ATTENDEES. THE BREAST CANCER SUPPORT GROUP MEETS BI-MONTHLY WITH AN AVERAGE OF 9 PEOPLE PARTICIPATING. THE LIFE GOES ON CANCER SUPPORT GROUP MEETS WEEKLY WITH AN AVERAGE OF 10 PARTICIPANTS. IN 2022, THERE WERE 93 TOTAL PARTICIPANTS IN THE MONTHLY MEETINGS OF THE BRAIN ANEURYSM AND STROKE GROUP. BARIATRIC SUPPORT GROUPS MEET EVERY OTHER MONDAY NIGHT AND EVERY OTHER TUESDAY AFTERNOON WITH AN AVERAGE OF 24 PEOPLE IN ATTENDANCE. CH'S MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDE IS AVAILABLE FOR DOWNLOAD ON THE HOSPITAL'S WEBSITE AND DISTRIBUTED AT COMMUNITY EVENTS. THE SHERPA PROGRAM, WHICH IS MADE UP OF PEER RECOVERY COACHES WHO MEET WITH OVERDOSE SURVIVORS AND THEIR FAMILIES IN THE EMERGENCY DEPARTMENT, IS OFFERED AT THE HOSPITAL. IN 2022, THERE WERE 196 PEOPLE REFFERED TO THE PROGRAM. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY OUTREACH ACTIVITIES THAT ADDRESS OTHER NEW YORK STATE PREVENTION AGENDA PRIORITIES. THE HOSPITAL PARTICIPATES IN THE ANNUAL GLOBAL BIG LATCH ON DESIGNED TO PROMOTE AND SUPPORT BREASTFEEDING. IN 2022, THE GLOBAL BIG LATCH ON WAS HELD IN APRIL. THE HOSPITAL ALSO HOSTS A BREASTFEEDING CAF TO PROMOTE THE HEALTH BENEFITS OF BREASTFEEDING AND PROVIDE PEER SUPPORT TO NURSING MOTHERS. FREE, EVIDENCE-BASED FALL PREVENTION PROGRAMS DESIGNED TO IMPROVE BALANCE AND STRENGTH AND HELP REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS ARE ALSO AVAILABLE AT THE HOSPITAL. PATIENTS IDENTIFIED AT RISK FOR FALLS ARE REFERRED TO CH'S ST. CHARLES HOSPITAL. GOOD SAMARITAN ALSO OFFERS FREE FLU VACCINATIONS AT EVENTS IN UNDERSERVED COMMUNITIES, AT HEALTHY SUNDAYS EVENTS, HOSPITAL HEALTH FAIRS AND OTHER COMMUNITY EVENTS. THE CATHOLIC HEALTH MISSION IS THE DRIVING FORCE BEHIND ALL COMMUNITY OUTREACH ACTIVITIES. IN ADDITION TO THE INTERVENTIONS SUMMARIZED ABOVE, GOOD SAMARITAN UNIVERSITY HOSPITAL, ALONG WITH THE CH HOME CARE, PROVIDE ADDITIONAL OUTREACH PROGRAMS THAT EMPHASIZE THE HEALTH CARE MINISTRY OF THE CATHOLIC CHURCH AND SOCIAL DETERMINANTS OF HEALTH. THE HOSPITAL PARTICIPATED IN THE AMERICAN HEART ASSOCIATION LONG ISLAND HEART WALK MOVE MORE CHALLENGE ON SEPTEMBER 19TH, AS WELL AS THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER WALK ON OCTOBER 16TH. THERE ARE PROGRAMS THAT SUPPORT STAFF RESILIENCY SUCH AS CODE LAVENDER, DAILY PRAYER, AND RECHARGE ROOMS. THE HOSPITAL HOSTED 5 BLOOD DRIVES BETWEEN JANUARY AND DECEMBER, COLLECTING 566 PINTS OF BLOOD IN SUPPORT OF LONG ISLAND BLOOD SERVICES. GOOD SAMARITAN STAFF ALSO PARTICIPATED IN COLLECTION DRIVES FOR FOOD, CLOTHING AND SCHOOL SUPPLIES SUPPORTING LOCAL COMMUNITY ORGANIZATIONS IN UNDERSERVED AREAS. THE HOSPITAL ALSO HOSTED THE WOUNDED WARRIOR PROJECT SOLDIER RIDE TO SUPPORT SERVICES AND PROGRAMS FOR WOUNDED WARRIORS, THE GOOD SAMARITAN CANCER SURVIVORS DAY CELEBRATION, A BABIESCHILDREN'S MEMORIAL AND COMMUNITY BURIAL OF THE UNBORN, ADOPT-A-FAMILY COLLECTIONS AT CHRISTMAS, AND BOB SWEENEY'S CAMP H.O.P.E., IN COLLABORATION WITH GOOD SHEPHERD HOSPICE. GOOD SAMARITAN ALSO HELD EMS AND EMT EDUCATION EVENT. THE EMS/CME CONFERENCE WAS HELD ON MAY 18TH, WITH 47 ATTENDEES. PART V, SECTION B, LINE 20E GOOD SAMARITAN UNIVERSITY HOSPITAL HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN GOOD SAMARITAN UNIVERSITY HOSPITAL, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH AND ARE CLEARLY VISIBLE TO THE PUBLIC. GOOD SAMARITAN UNIVERSITY HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 1 GOOD SAMARITAN NURSING HOME 101 ELM STREET SAYVILLE NY 11782 SKILLED NURSING FACILITY PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS. PART I, LINE 7A, COLUMN (D) DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S "NEED" CALCULATION. THIS CALCULATION CONSIDERS 100% OF A HOSPITAL'S "NEED" BASED ON A "UNITS OF SERVICE" METHODOLOGY FOR UNINSURED PATIENTS. THE CALCULATION ALSO MAKES ADJUSTMENTS BASED ON THE PROPORTION OF MEDICAID ELIGIBLE PATIENTS TREATED AT THE FACILITY. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2022. PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2020 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM GOOD SAMARITAN UNIVERSITY HOSPITAL SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY. PART III, LINES 2 AND 4 - TEXT OF FOOTNOTE DISCUSSING BAD DEBT PAGES 19 TO 24 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PATIENT ACCOUNTS RECEIVABLE. THE FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN. PART III, LINE 8 - COSTING METHODOLOGY THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2019 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES. PART III, LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. GOOD SAMARITAN BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY BUT ALSO DOING SO WITH NO RECOURSE IN OBTAINING PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING-EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED ARE NOT TURNED AWAY. GOOD SAMARITAN WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY. PART III, LINE 9B THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INABILITY TO PAY FOR THOSE SERVICES. IN ADDITION, UPON APPLYING FOR CHARITY CARE, EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY WILL BE ASSESSED. ELIGIBILITY FOR ASSISTANCE: A REASONABLE REVIEW SHALL BE PERFORMED PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (I.E. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE CH CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET. PART VI, LINE 2 - ASSESSMENT OF COMMUNITY NEEDS AND GOALS COMMUNITY HEALTH NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT MEETINGS, AT COLLABORATIVE SESSIONS WITH MEMBER HOSPITALS OF CATHOLIC HEALTH (CH), AND WITH PARTNERS AT COMMUNITY AGENCIES AND ORGANIZATIONS THAT ARE PART OF THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). THE LIHC COMMUNITY HEALTH ASSESSMENT SURVEYS ARE OFFERED YEAR-ROUND AT MULTIPLE OUTREACH SITES IN THE COMMUNITY. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH, SPANISH, POLISH, HAITAIN CREOLE AND LARGE PRINT) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT SERVES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CH'S WEBSITE. GOOD SAMARITAN UNIVERSITY HOSPITAL CONTINUES TO COLLABORATE WITH OTHER HOSPITALS, LOCAL HEALTH DEPARTMENTS, HEALTH CARE PROVIDERS, PUBLIC HEALTH SPECIALISTS FROM ACADEMIC INSTITUTIONS AND COMMUNITY-BASED ORGANIZATIONS AT LIHC EVENTS. LIHC'S WEBSITE OFFERS COMPREHENSIVE INFORMATION TO PROMOTE GOOD HEALTH AND PREVENT CHRONIC DISEASE. IN ADDITION TO PROVIDING NUMEROUS RESOURCES SUCH AS HEALTH PROGRAM INVENTORIES, HEALTH INSURANCE INFORMATION AND EDUCATIONAL VIDEOS, LIHC AND ITS MEMBERS HAVE ORGANIZED WALKING PROGRAMS, AND DEVELOPED A UNIVERSAL SCREENING TOOL TO HELP MEASURE THE EFFECTIVENESS OF COMMUNITY HEALTH EFFORTS. MORE INFORMATION CAN BE FOUND AT WWW.LIHEALTHCOLLAB.ORG. ADDITIONALLY, COMMUNITY NEEDS SURVEYS ARE COMPLETED BY PARTICIPANTS ATTENDING THE HOSPITAL'S HEALTH SCREENINGS AT LIBRARIES AND SENIOR CENTERS THROUGHOUT THE COUNTY; THE SURVEYS ARE ALSO AVAILABLE THROUGH A LINK ON THE HOSPITAL'S WEBSITE. PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY 1. SINCE IT IS THE DUTY OF THE HOSPITAL TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF THE CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS HAVE BEEN FULLY VERSED IN THE HOSPITAL'S CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. THE HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. THE HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. THE HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE HOSPITAL PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING THE HOSPITAL'S CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, INFORMATION IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER DETAILS. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4 - COMMUNITY INFORMATION FOUNDED IN 1959, GOOD SAMARITAN UNIVERSITY HOSPITAL IS A 537-BED (INCLUDING 100 NURSING HOME BEDS), NOT-FOR-PROFIT, ACUTE CARE COMMUNITY HOSPITAL. GOOD SAMARITAN HOSPITAL IS LOCATED IN WEST ISLIP, ON THE SOUTH SHORE OF LONG ISLAND, NEW YORK. GOOD SAMARITAN'S PRIMARY SERVICE AREA INCLUDES: AMITYVILLE, BABYLON, NORTH BABYLON, WEST BABYLON, BAY SHORE, BRENTWOOD, COPIAGUE, DEER PARK, LINDENHURST, WEST ISLIP, CENTRAL ISLIP, EAST ISLIP, AND WYANDANCH. THE SECONDARY CATCHMENT AREA COMPRISES EAST MASSAPEQUA, FARMINGDALE, ISLIP, ISLIP TERRACE, HOLBROOK, BOHEMIA, PATCHOGUE, SAYVILLE, OAKDALE AND RONKONKOMA. THE SERVICE AREA POPULATION IS COMPRISED OF SEVERAL COMMUNITIES WHERE INDIVIDUALS SPEAK A LANGUAGE OTHER THAN ENGLISH, SUCH AS THE SELECT, UNDERSERVED COMMUNITIES OF BAY SHORE, BRENTWOOD, AND CENTRAL ISLIP. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH GOOD SAMARITAN UNIVERSITY HOSPITAL (GOOD SAMARITAN) IS A NOT-FOR-PROFIT COMPREHENSIVE HEALTH CARE FACILITY RENDERING INPATIENT, AMBULATORY, AND EMERGENCY MEDICAL CARE TO THE COMMUNITY. IN ADDITION, GOOD SAMARITAN OPERATES A NURSING HOME AND THE BISHOP MCHUGH HEALTH CENTER IN BABYLON, WHICH CARES FOR MEDICALLY-UNDESERVED RESIDENTS. GOOD SAMARITAN HOSTS BLOOD DRIVES THROUGHOUT THE YEAR. DONORS INCLUDE GOOD SAMARITAN STAFF AND COMMUNITY MEMBERS. PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM GOOD SAMARITAN UNIVERSITY HOSPITAL (GOOD SAMARITAN) IS AN ACUTE CARE HOSPITAL LOCATED ON A SINGLE CAMPUS IN WEST ISLIP, NY, WITH A SKILLED NURSING FACILITY ON A SEPARATE CAMPUS IN SAYVILLE, NY. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, GOOD SAMARITAN THROUGH ITS DAILY OPERATIONS, PROVIDES THE AREA WITH ACUTE, EMERGENT, AND OUTPATIENT CARE. GOOD SAMARITAN IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH (CH)), WHICH IS A NEW YORK, NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CH IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2022, CH COMPRISED SIX HOSPITALS (MERCY HOSPITAL, ST. FRANCIS HOSPITAL, AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN UNIVERSITY HOSPITAL, ST. CHARLES HOSPITAL, AND ST. CATHERINE OF SIENA HOSPITAL IN SUFFOLK COUNTY), AS WELL AS THREE SKILLED NURSING FACILITIES (ST. CATHERINE OF SIENA NURSING & REHABILITATION, GOOD SAMARITAN NURSING & REHABILITATION, AND OUR LADY OF CONSOLATION NURSING & REHABILITATION, ALL IN SUFFOLK COUNTY), AND GOOD SHEPHERD HOSPICE. WITH MORE THAN 16,000 STAFF AND 4,600 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CH PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: WE, AT CATHOLIC HEALTH, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. MEMBER ORGANIZATIONS OF CH OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. ALL OF CH'S MEMBER ORGANIZATIONS HAVE RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY AND THEIR DISTINCTIVE PERSONALITIES, AS WELL AS THE SERVICE SPECIALTIES WHICH THEY ARE KNOWN FOR, THUS EMBEDDING THE ORGANIZATION IN THE COMMUNITY AND SERVING IT EFFECTIVELY. CH ENTITIES PROVIDE AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS, PROVIDE FREE HEALTH SCREENINGS THROUGH THE SYSTEM'S HEALTHY SUNDAYS PROGRAMS, HEALTH FAIRS, AND OTHER PROGRAMS. SINCE 1907, CATHOLIC HEALTH HAS HAD A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF IMPROVING THE COMMUNITY'S HEALTH. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVE ROCKVILLE CNTR ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 268294 NONE NONE OUTPATIENT CENTERS, MISSION SPONSORSHIP, GRANTS TO UNDERSERVED COMMUNITY AND CAPITAL SUPPORT 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR GOOD SAMARITAN HOSPITAL AND CATHOLIC HEALTH AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH USES THE GRANT FUNDS FOR MISSION SPONSORSHIP, OUTPATIENT CENTERS, GRANTS TO UNDERSERVED COMMUNITIES AND CAPITAL SUPPORT. PART II, LINE 1, COLUMN (H) NAMES OF ORGANIZATION OR GOVERNMENT: CATHOLIC HEALTH SYSTEM OF LONG ISLAND (H) PURPOSE OF GRANT: 1) SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND AS A PASS THROUGH TO PROVIDE GENERAL SUPPORT TO THE CATHOLIC MINISTRIES OF THE DIOCESE OF ROCKVILLE CENTRE IN CONNECTION WITH THE FORMATION OF YOUTH AND ADULTS IN THE FAITH, PROMOTION OF THE DIGNITY OF LIFE, PROMOTION OF QUALITY EDUCATION FOR YOUNG PEOPLE, AND FOSTERING OF VOCATIONS FOR THE PRIESTHOOD; 2) PROVIDE SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND TO FUND OUTPATIENT CENTERS THAT PROVIDE CHARITY CARE TO THOSE CENTERS' COMMUNITIES; AND 3) TO FUND SUPPORT PROVIDED THROUGH THE CATHOLIC HEALTH CAREGIVERS FUND. THE CATHOLIC HEALTH CAREGIVERS FUND WAS FORMED WITH THE MISSION TO ASSIST OUR FELLOW CAREGIVERS ON THE FRONT LINES, HERE AND ABROAD, WHO STRUGGLE JUST TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. X X X X X X false true false false false false false false false PATRICK O'SHAUGHNESSY DO PRESIDENT & CEO 0 1656290 0 753000 0 30423 0 785411 0 51167 0 3276291 0 0 PADMALATHA GURRAM PHYSICIAN 580956 0 1057114 0 2332 0 21167 0 15591 0 1677160 0 0 0 BARAA ALLAF PHYSICIAN 710165 0 706648 0 1139 0 21167 0 54393 0 1493512 0 0 0 Leonid Kogan PHYSICIAN 602010 0 843035 0 823 0 21167 0 7132 0 1474167 0 0 0 DANIEL DEBARBA EVP & CFO THRU 8/5/2022 0 626446 0 350000 0 126698 0 274411 0 33661 0 1411216 0 0 Sami Almaskeen STAFF PHYSICIAN 591666 0 737621 0 7974 0 21167 0 47566 0 1405994 0 0 0 Kourosh Adhami PHYSICIAN 987258 0 256697 0 2322 0 21167 0 46949 0 1314393 0 0 0 RUTH HENNESSEY PRESIDENT/CAO 666635 0 170000 0 201244 0 164167 0 19259 0 1221305 0 176818 0 PATRICK MINICUS EVP & CFO AS OF 12/12/2022 0 607424 0 180000 0 17792 0 21411 0 48459 0 875086 0 0 DONALD TEPLITZ CMO 606600 0 75000 0 4459 0 21167 0 33562 0 740788 0 0 0 JOHN MCMURRAY COO 381456 0 51000 0 932 0 21167 0 41280 0 495835 0 0 0 JOHN FRANCFORT MD TRUSTEE RESIGNED 5/22 281765 0 0 0 0 0 19554 0 958 0 302277 0 0 0 PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. DANIEL DEBARBA $253,000 PARTICIPATION IN THE PLAN. RUTH HENNESSEY $143,000 PARTICIPATION IN THE PLAN. PATRICK O'SHAUGHNESSY $764,000 PARTICIPATION IN THE PLAN. THE DEFERRED COMPENSATION IN COLUMN C FOR THESE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. THE FOLLOWING INDIVIDUALS VESTED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). THESE AMOUNTS INCLUDE A TAX GROSS UP. RUTH HENNESSY $176,818 VESTED IN PLAN. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2022 FORM W-2, BOX 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. PART II - FORMER OFFICERS & DIRECTORS EFFECTIVE 12/19/18, RUTH HENNESSEY WAS TRANSFERRED FROM ST. FRANCIS HOSPITAL, A RELATED ENTITY, TO SERVE AS THE PRESIDENT/CAO. SOUTHWEST SUFFOLK MEDICAL PC SEE PART V 9363082 SEE PART V false SAMARITAN MEDICAL SERVICES PC SEE PART V 68906723 SEE PART V false GREAT SOUTH BAY SURGICAL ASSOCIATES SEE PART V 360000 SEE PART V false SCHEDULE L, PART IV, LINE (1) COLUMN (B) RELATIONSHIP Entity more than 35% owned by Donald Teplitz, Key Employee. SCHEDULE L, PART IV, LINE (1) COLUMN (D) DESCRIPTION OF TRANSACTION Subsidy for PC operating losses. SCHEDULE L, PART IV, LINE (2) COLUMN (B) RELATIONSHIP Entity more than 35% owned by Donald Teplitz, Key Employee. SCHEDULE L, PART IV, LINE (2) COLUMN (D) DESCRIPTION OF TRANSACTION Subsidy for PC operating losses. SCHEDULE L, PART IV, LINE (3) COLUMN (A), (B) AND (D) SCHEDULE L, PART IV, LINE (3) COLUMN (A) NAME OF INTERESTED PERSON: Great South Bay Surgical Associates and Vascular Lab, LLP SCHEDULE L, PART IV, LINE (3) COLUMN (B) RELATIONSHIP: Entity more than 35% owned by John Francfort, Trustee. SCHEDULE L, PART IV, LINE (3) COLUMN (D) DESCRIPTION OF TRANSACTION: PHYSICIAN PRACTICE PURCHASE FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF GOOD SAMARITAN UNIVERSITY HOSPITAL IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A/ CATHOLIC HEALTH)(CH). CH IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN NTEGRATED NETWORK OF HEALTHCARE PROVIDERS. CH IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE). FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CH IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF GOOD SAMARITAN UNIVERSITY HOSPITAL, AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF GOOD SAMARITAN UNIVERSITY HOSPITAL, CH IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERNING BODY OF GOOD SAMARITAN UNIVERSITY HOSPITAL. THE GOVERNING BODY OF GOOD SAMARITAN UNIVERSITY HOSPITAL IS THE SAME AS THAT OF CH. FORM 990, PART VI, LINE 11B - REVIEW PROCESS FOR FORM 990 THE FORM 990 AND RELATED SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD, AND PRESENTED TO THE COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF DIRECTORS OF CH, WHICH HAS BEEN DELEGATED THE FORM 990 REVIEW FUNCTION BY THE BOARD. UPON REVIEW AND RECOMMENDATION OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO THE BOARD FOR APPROVAL. UPON BOARD APPROVAL, THE FORM 990 IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE CH COMPLIANCE AND AUDIT COMMITTEE BY CH'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURE IS GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE CH COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE CH BOARD OF DIRECTORS. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF A CONFLICT OF INTEREST IS IDENTIFIED AND A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CH AND WISHES TO GO FORWARD WITH IT, THE CHAIR OF THE BOARD OF DIRECTORS SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CH 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 CH, CERTIFIES THAT CH CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. THE PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIM/HERSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. FORM 990, PART VI, LINE 15 - COMPENSATION POLICY THE CHIEF ADMINISTRATIVE OFFICER SUBMITS FOR APPROVAL TO THE SYSTEM CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE CH EXECUTIVE COMPENSATION POLICY (COMPENSATION POLICY). THE COMPENSATION POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CH OR AN OPERATING ENTITY, AND IS EITHER A) A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF OPERATING OFFICERS (COO) OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS (CFO); D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CH OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CH OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CH OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CH OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CH OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CH CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CH BOARD OF DIRECTORS FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE PERFORMED ANNUALLY BY AN INDEPENDENT CONSULTANT. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION PROVIDED, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE CH BOARD OF DIRECTORS. FORM 990, PART VI, LINE 19 - DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS-CERTIFICATE OF INCORPORATION FILED WITH NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT MADE PUBLICLY AVAILABLE; CH CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND. FORM 990, PART VII, SECTION A - LINE 1A HOURS FOR TRUSTEES ARE THE ESTIMATED WEEKLY HOURS (2.0) TRUSTEES CONTRIBUTE TO THIS AND ALL OTHER RELATED ORGANIZATIONS, NOT NECESSARILY EQUALLY BUT IN THE PROPORTION NECESSARY, FOR WHICH THEY RECEIVE NO COMPENSATION. DANIEL DEBARBA, EVP & CFO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL CORP (11-1871039); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941); CATHOLIC HEALTH SYSTEM OF LONG ISLAND (11-3403968); RVC INSURANCE COMPANY INC. (20-8067039) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). DONALD TEPLITZ, CHIEF MEDICAL OFFICER - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR KEY EMPLOYEE FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240) AND SAMARITAN EMERGENCY MEDICAL SERVICES, P.C. (20-8243412). RUTH HENNESSEY, PRESIDENT/CAO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); AND ST FRANCIS HOSPITAL FOUNDATION (11-2916033). PATRICK O'SHAUGHNESSY, PRESIDENT & CEO - THE TOTAL HOURS WORKED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); RVC INSURANCE COMPANY, INC. (20-8067039); CATHOLIC HEALTH SYSTEMS OF LONG ISLAND (11-3403968); ST. FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11- 1888924); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL CORP (11-1871039); ST. JOSEPH HOSPITAL FOUNDATION (47-2353387); RVC II INSURANCE COMPANY, INC. (92-1136144) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). PATRICK MINICUS, EVP & CFO - THE TOTAL HOURS WORKED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CHS SERVICES, INC. (11-3555766); RVC INSURANCE COMPANY, INC. (20-8067039); CATHOLIC HEALTH SYSTEMS OF LONG ISLAND (11-3403968); ST. FRANCIS HOSPITAL (11-2050523); ST FRANCIS HOSPITAL RESEARCH & EDUCATION CORPORATION, INC. (11-3090867); MERCY MEDICAL CENTER (11-1635088); WSNCHS NORTH, INC. (11-3438973); GOOD SAMARITAN HOSPITAL MEDICAL CENTER (11- 1888924); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST. CHARLES HOSPITAL CORP (11-1871039); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240) AND ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941). FOUNDATION (77-0611240); ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION (27-1459941) AND MERCY MEDICAL CENTER FOUNDATION (51-0813603). FORM 990, PART X, LINE 20 - TAX EXEMPT BOND LIABILITIES THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 ARE ISSUED ON BEHALF OF THE CATHOLIC HEALTH OBLIGATED GROUP PROJECT WHICH INCLUDES THE FILING ENTITY AND RELATED ENTITIES. THREE BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 SUFFOLK BONDS), SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2014C SUFFOLK BONDS) AND NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH. FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS RELATED PARTY EMPLOYEE BENEFIT SERVICES $(3,810,863) POST RETIREMENT BENEFIT PLAN CHANGE (196,000) POST RETIREMENT ADJUSTMENT NON OPERATING GAIN 256,000 ROUNDING (1,296) ----------- TOTAL: $(3,752,159) FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION GOOD SAMARITAN UNIVERSITY HOSPITAL IS A MEMBER OF CATHOLIC HEALTH. WE, AT CATHOLIC HEALTH, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. I-CARE VALUES INTEGRITY: WE ARE WHO WE SAY WE ARE AND ACT IN ACCORDANCE WITH THE SPLENDOR OF TRUTH OF OUR CATHOLIC MORAL TEACHING AND OUR CATHOLIC VALUES. COMPASSION: WE HAVE COMPASSION FOR OUR PATIENTS, SEE THE SUFFERING CHRIST IN THEM, STRIVE TO ALLEVIATE SUFFERING AND SERVE THE SPIRITUAL, PHYSICAL AND EMOTIONAL NEEDS OF OUR PATIENTS. ACCOUNTABILITY: WE TAKE RESPONSIBILITY FOR OUR ACTIONS AND THEIR CONSEQUENCES. RESPECT: WE HONOR THE SANCTITY OF LIFE AT EVERY STAGE OF LIFE AND THE DIGNITY OF EVERY PERSON, AND INCORPORATE ALL THE PRINCIPLES OF CATHOLIC SOCIAL TEACHING IN OUR RELATIONSHIPS AND ADVOCACY. EXCELLENCE: WE SEEK THE GLORY OF GOD IN THE COMPASSIONATE SERVICE OF OUR PATIENTS, AND WE STRIVE TO DO THE BEST THAT CAN BE DONE, WHATEVER OUR ROLE. 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HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 510639649 HEALTHCARE SVC NY MERCY MED CTR C-CORP false LONG ISLAND EMERGENCY CARE PC 1000 N VILLAGE AVE ROCKVILLE NY 11571 113633515 PHYSICIAN SVC NY MERCY MED CTR S-CORP false MY CHS RX INC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 842359236 PHARMACY NY CHSLI C-CORP false false true true true true false false false true true false true true true true true true true true CHS SERVICES LMPR 3918365 COST GOOD SAMARITAN HOSPITAL FOUNDATION LOPQ 671867 COST MERCY MEDICAL CENTER LM 188174 COST ST FRANCIS HOSPITAL LM 116960 COST ST CHARLES HOSPITAL CORP LM 76257 COST ST CATHERINE OF SIENA MEDICAL CENTER LM 1324216 COST WSNCHS NORTH INC (ST JOSEPH HOSPITAL) LM 112613 COST IDHC LLC S 1709526 COST SCHEDULE R, PART IV FOR ALL PROFESSIONAL CORPORATIONS REPORTED ON SCHEDULE R, PART IV, THE PHYSICIAN IS THE SOLE SHAREHOLDER OF THE ENTITY AND THE DIRECT CONTROLLING ENTITY REPORTED IN COLUMN (D) IS THE BENEFICIAL OWNER. THIS STRUCTURE IS CONSISTENT WITH THE NEW YORK CORPORATE PRACTICE OF MEDICINE.