2016-11-14T11:26:29-06:00 2015-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2015-01-01 113284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER % CHS SERVICES INC OURL 6315871600 111 BEACH DRIVE WEST ISLIP NY 11795 JAMES RYAN CAO 5167057185 2016-11-09 true LAURA J PARELLO P01080295 6464713000 2015 2017-02-10 21:41:12Z OLC NURSING & REHAB CTR JAMES RYAN 111 BEACH DRIVE WEST ISLIP NY 11795 54157586 false 0928 X HTTP://OLC.CHSLI.ORG X 1894 NY CHSLI AND ITS MEMBERS, AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUE CHRIST'S HEALING MISSION, BY PROMOTING EXCELLENCE IN CARE AND COMMITTING ITSELF TO THOSE IN NEED. 15 15 804 130 0 148936 491397 57684325 53372958 81123 100778 197525 192453 58111909 54157586 38720 8012 0 0 42854083 38189906 0 0 0 15856115 14325447 58748918 52523365 -637009 1634221 34383569 35820124 33657357 33490262 726212 2329862 X OUR LADY OF CONSOLATION GERIATRIC CARE CENTER, 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. CHS AFFIRMS THE SANCTITY OF LIFE, AND ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. false false 46392461 8012 53410222 THE FACILITY PROVIDES SKILLED CARE FOR UP TO 450 RESIDENTS ON A DAILY BASIS. THE FACILITY PROVIDED CARE FOR 144,196 DAYS FOR THE YEAR 2015. 46392461 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 false true false true false false false false false false false false true false false false false true true true false false true 59 0 true 804 true false false false false false false false false false false X 15 15 false false false false true true true true true false false true true true true true true true true false X CHS SERVICES INC 5167057185 992 NORTH VILLAGE AVE ROCKVILLE CENTER NY 11570 X THOMAS CHRISTMAN CHAIRPERSON 2.0 0.0 X X 0 0 0 JENNIFER HOFFMAN VICE CHAIRPERSON 2.0 0.0 X X 0 0 0 SISTER DOLORES WISNIEWSKI CIJ SECRETARY 2.0 0.0 X X 0 0 0 C JUSTIN MCCARTHY TREASURER 2.0 0.0 X X 0 0 0 BRIAN P KERLY ESQ TRUSTEE 2.0 0.0 X 0 0 0 DIANE SWEENEY TRUSTEE 2.0 0.0 X 0 0 0 DOUGLAS CELIBERTI TRUSTEE 2.0 0.0 X 0 0 0 JOHN O'BRIEN TRUSTEE 2.0 0.0 X 0 0 0 MICHAEL LAMBERT TRUSTEE 2.0 0.0 X 0 0 0 PETER DAGHER TRUSTEE 2.0 0.0 X 0 0 0 PETER WRIGHT TRUSTEE 2.0 0.0 X 0 0 0 REV STEPHEN PIETROWSKI TRUSTEE 2.0 0.0 X 0 0 0 SISTER AUDREY HARSEN TRUSTEE 2.0 0.0 X 0 0 0 DR DONATO BALSAMO TRUSTEE 2.0 0.0 X 0 0 0 CALVIN SULLIVAN TRUSTEE 2.0 0.0 X 0 0 0 JAMES RYAN CAO AS OF 1/30/2015 50.0 0.0 X 183837 45790 47298 SISTER MARILYN BREEN CAO THRU 1/30/15 37.5 0.0 X 0 0 0 JOHN HAIGHT VP FIN CONTINUING CARE 50.0 0.0 X 199970 0 41493 ROBERT CARLIN DIR MEDICAL SVCS 37.5 0.0 X 163597 0 10898 THERESA ROSENTHAL VP CLINICAL SVCS 50.0 0.0 X 189226 0 42276 DEBORAH JULIANO NCC 37.5 0.0 X 142841 0 17359 AEKYUNG LEE RN 37.5 0.0 X 141167 0 32840 SHENASSA NAZILA PHARMACY CONSULTANT 37.5 0.0 X 166074 0 33456 MARISA SHAPIRO PHYSICIAN 50.0 0.0 X 159080 0 33091 CHRISTOPHER LOHAN DIR OF REHABILITATION SERVICES 37.5 0.0 X 130772 0 39625 KAREN ESTRADA FORMER SVP/CFO 0.0 35.0 X 0 181604 44919 JOSEPH TOMAINO FORMER EVP CONTINUING CARE 0.0 0.0 X 0 314959 7541 1476564 542353 350796 24 true true false CHEM RX PHARMACY SVCS LLC 750 PARK PLACE LONG BEACH NY 11561 PHARMACEUTICALS 972739 AFFINITY REHABILITATION LLP 10600 YORK RD SUITE 105 COKEYSVILLE MD 21030 HOME HEALTH AID SVCS 349675 ENCOMPASS GROUP LLC PO BOX 740209 ATLANTA GA 30374 LINENS 162869 HORIZON HEALTHCARE STAFFING 20 JERUSALEM AVENUE 3RD FLOOR HICKSVILLE NY 11801 REHAB STAFFING SVCS 162820 HEALTHPRO MANAGEMENT SVCS 10600 YORK RD SUITE 105 COKEYSVILLE MD 21030 REHABILITATION 136500 5 224734 136570 130093 213892 491397 PATIENT REVENUE 623000 53372958 53372958 53372958 100778 100778 0 0 0 0 0 0 0 0 0 CAFETERIA & COFFEE SHOP 900099 131311 131311 PURCHASE DISCOUNTS & REBATES 900099 28046 28046 MEDICAL RECORDS PRINTING 900099 9218 9218 23878 23878 192453 54157586 53410222 255967 8012 8012 0 0 0 873596 405997 467599 0 27714295 25174987 2539308 1985454 1776622 208832 5404722 4717533 687189 2211839 1979195 232644 31958 4511 27447 3250 3250 30000 30000 3704 3704 0 0 3854888 3331859 523029 26603 26603 2229808 1841589 388219 0 0 0 679209 679209 29079 22882 6197 0 0 642987 642987 36384 36384 1295886 1233749 62137 995586 995586 MEDICAL SUPPLIES 2323777 2323777 CHS SERVICES 886223 344289 541934 HOME OFFICE 216580 216580 EQUIPMENT SERVICE CONTRACTS 30305 30305 1009220 842988 166232 52523365 46392461 6130904 0 X 1215258 3134457 3723609 312004 0 0 4977044 7594522 0 0 0 0 0 0 62106 51103 520372 631408 43567582 26667886 17490781 16899696 3501023 3571230 0 0 0 0 0 0 2893376 3625704 34383569 35820124 10643226 9297640 0 0 0 0 14925411 14538698 0 0 0 0 0 0 0 0 8088720 9653924 33657357 33490262 X 503627 2017858 222585 312004 0 0 726212 2329862 34383569 35820124 1634221 -30571 X false true X true true true X 122472 27979 67827 148936 491397 858611 60560750 59758066 59372100 57684325 53372958 290748199 0 0 0 60683222 59786045 59439927 57833261 53864355 291606810 0 0 0 291606810 117881 90130 -42811 81123 100778 347101 0 117881 90130 -42811 81123 100778 347101 0 205378 240499 190207 197525 192453 1026062 61006481 60116674 59587323 58111909 54157586 292979973 0.99531 0.99526 0.00119 0.00126 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3704 3704 false PART II-B, LINE 1 - LOBBYING ACTIVITIES OUR LADY OF CONSOLATION GERIATRIC CARE CENTER PAID DUES TO LEADINGAGE NY, A TRADE ASSOCIATION, WHO IS INVOLVED IN LOBBYING ACTIVITIES. THE TOTAL DUES PAID FOR 2015 WAS $29,945 WHICH 10.2% WAS USED FOR LOBBYING, AMOUNTING TO THE EXPENSE OF $3,054. OUR LADY OF CONSOLATION GERIATRIC CARE CENTER ALSO PAID DUES TO CCLC (CONTINUING CARE LEADERSHIP COALITION), A TRADE ASSOCIATION, WHO IS INVOLVED IN LOBBYING ACTIVITIES. THE TOTAL DUES PAID FOR 2015 WAS $13,816 WHICH 4.7% WAS USED FOR LOBBYING, AMOUNTING TO THE EXPENSE OF $650. 325000 325000 32844774 18066441 14778333 8816589 7208547 1608042 1581219 1392898 188321 16899696 RESIDENT FUNDS 132748 OTHER ASSETS 4760 INSURANCE CLAIMS RECEIVABLE 2051196 DUE FROM RELATED PARTIES 1437000 3625704 0 DUE TO RELATED PARTIES 6017695 THIRD PARTY PAYOR LIABILITIES 2482147 RESIDENT FUNDS 132748 GENERAL LIABILITY INSURANCE 1021334 9653924 X PART X, OTHER LIABILITIES, LINE 2, FIN 48 FOOTNOTE CHS AND MOST OF ITS SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CHS ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE CODIFICATION TOPIC 740, INCOME TAXES. MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS, USING A THRESHOLD OF MORE LIKELY THAN NOT OF BEING SUSTAINED. true CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVE ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 8012 NONE NONE OUTPATIENT CENTERS 1 PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR OUR LADY OF CONSOLATION GERIATRIC CARE CENTER AND CATHOLIC HEALTH SERVICES OF LONG ISLAND AND IS THEREFORE ABLE TO MONITOR THAT CATHOLIC HEALTH SERVICES OF LONG ISLAND USES THE GRANT FUNDS FOR OUTPATIENT CENTERS AND GRANTS FOR THE UNDERSERVED COMMUNITIES. PART II, LINE 1, COLUMN (H) NAME OF ORGANIZATION OR GOVERNMENT: CATHOLIC HEALTH SYSTEM OF LONG ISLAND (H) PURPOSE OF GRANT: 1) SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND AS A PASS THROUGH TO PROVIDE GENERAL SUPPORT TO THE CATHOLIC MINISTRIES OF THE DIOCESE OF ROCKVILLE CENTRE IN CONNECTION WITH THE FORMATION OF YOUTH AND ADULTS IN THE FAITH, PROMOTION OF THE DIGNITY OF LIFE, PROMOTION OF QUALITY EDUCATION FOR YOUNG PEOPLE, AND FOSTERING OF VOCATIONS FOR THE PRIESTHOOD; AND 2) PROVIDE SUPPORT TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND TO FUND OUTPATIENT CENTERS THAT PROVIDE CHARITY CARE TO THOSE CENTERS COMMUNITIES. IN ADDITION THE GRANTS PROVIDED TO CATHOLIC HEALTH SYSTEM OF LONG ISLAND ARE USED TO FUND SUPPORT PROVIDED THROUGH THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CAREGIVERS FUND. THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CAREGIVERS FUND WAS FORMED WITH THE MISSION TO ASSIST OUR FELLOW CAREGIVERS ON THE FRONT LINES, HERE AND ABROAD, WHO STRUGGLE JUST TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. X X X X X X true false false false false false false false false JAMES RYAN CAO AS OF 1/30/2015 183353 20737 0 25000 484 53 15350 1655 26949 3344 226136 50789 0 0 ROBERT CARLIN DIR MEDICAL SVCS 131972 0 31200 0 425 0 10785 0 113 0 174495 0 0 0 JOHN HAIGHT VP FIN CONTINUING CARE 178438 0 21000 0 532 0 14383 0 27110 0 241463 0 0 0 THERESA ROSENTHAL VP CLINICAL SVCS 157485 0 18000 0 13741 0 13243 0 29033 0 231502 0 0 0 DEBORAH JULIANO NCC 141325 0 0 0 1516 0 8088 0 9271 0 160200 0 0 0 AEKYUNG LEE RN 140851 0 0 0 316 0 7190 0 25650 0 174007 0 0 0 SHENASSA NAZILA PHARMACY CONSULTANT 113322 0 0 0 52752 0 9584 0 23872 0 199530 0 0 0 MARISA SHAPIRO PHYSICIAN 157385 0 0 0 1695 0 13161 0 19930 0 192171 0 0 0 CHRISTOPHER LOHAN DIR OF REHABILITATION SERVICES 125134 0 0 0 5638 0 10612 0 29013 0 170397 0 0 0 KAREN ESTRADA FORMER SVP/CFO 0 174812 0 0 0 6792 0 12819 0 32100 0 226523 0 0 JOSEPH TOMAINO FORMER EVP CONTINUING CARE 0 0 0 0 0 314959 0 0 0 7541 0 322500 0 316239 PART I, LINE 4A - SEVERANCE PAYMENT JOSEPH TOMAINO, FORMER EVP OF CONTINUING CARE RECEIVED PAYMENT OF SEVERANCE OF $316,239. MEDICAL BENEFITS WERE ALSO PROVIDED DURING 2015. PART II - FORMER OFFICERS AND KEY EMPLOYEES EFFECTIVE 12/25/13, KAREN ESTRADA WAS TRANSFERRED TO MARYHAVEN CENTER OF HOPE AS THE VP OF FINANCE, A RELATED ENTITY. X ENERGY EFFICIENT LIGHTING EQUIPMENT 1 213892 FMV false true false SCHEDULE M, PART I, COLUMN (B) THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS IN COLUMN B. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF OUR LADY OF CONSOLATION GERATRIC CARE CENTER IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND) (CHS). CHS IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE). FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER, AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY CHS AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER, IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERING BODY OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER. FORM 990, PART VI, LINE 11B - REVIEW PROCESS OF FORM 990 THE FORM 990 AND APPROPRIATE SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PRESENTED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES (THE BOARD), WHICH HAS BEEN DELEGATED THE REVIEW FUNCTION BY THE BOARD. UPON APPROVAL OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO ALL VOTING MEMBERS OF THE BOARD. ONCE APPROVED BY THE BOARD (OR THE EXECUTIVE COMMITTEE OF THE BOARD, AS APPROPRIATE), THE ORGANIZATION'S BOARD CHAIR AND CHIEF EXECUTIVE OFFICER COMMUNICATES, IN WRITING TO THE CHS COMPLIANCE AND AUDIT COMMITTEE AND CHS BOARD CHAIR. AFTER REVIEW OF ANY APPLICABLE COMMENTS FROM THE BOARD, THE COMPLIANCE AND AUDIT COMMITTEE WILL THEN RECOMMEND THE APPROVAL OF THE FORM 990 TO THE CHS BOARD OF DIRECTORS WHO WILL THEN REVIEW THE RECOMMENDATIONS AND PROVIDE THE FINAL APPROVAL OF THE FORM 990. THE FORM 990 IS THEN SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12C - CONFLICT OF INTEREST POLICY DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE BY THE ORGANIZATION'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURES SHALL BE GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE BOARD OF TRUSTEES FOR REVIEW. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT NO CONFLICT EXISTS, THE MATTER SHALL BE REFERRED FOR REVIEW BY THE CHS COMPLIANCE AND AUDIT COMMITTEE BEFORE THE DETERMINATION BECOMES FINAL. IF A CONFLICT OF INTEREST IS IDENTIFIED AND IF A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS AND WISHES TO GO FORWARD WITH IT, THE CHAIR OF THE ORGANIZATION'S BOARD OF TRUSTEES SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANZIATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIMSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. 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, 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 POLICY. 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, CHIEF EXECUTIVE OFFICER, AND CHIEF OPERATING OFFICERS OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS; D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CHS OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CHS OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CHS OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CHS OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CHS OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CORPORATE CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE DONE BY AN INDEPENDENT CONSULTANT ANNUALLY. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE BOARD OF TRUSTEES. FORM 990, PART VI, LINE 19 - DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE; CHS CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND. FORM 990, PART VII, SECTION A - LINE 1A HOURS FOR TRUSTEES ARE THE ESTIMATED WEEKLY HOURS (2.0) TRUSTEES CONTRIBUTE TO THIS AND ALL OTHER RELATED ORGANIZATIONS, NOT NECESSARILY EQUALLY BUT IN THE PROPORTION NECESSARY, FOR WHICH THEY RECEIVE NO COMPENSATION. SITER MARILYN BREEN, CAO - THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR THE FOLLOWING RELATED ENTITIES: OLGCC (11-3284066) AND OUR LADY OF CONSOLATION FOUNDATION (45-0517566) JAMES RYAN, CAO - THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR THE FOLLOWING RELATED ENTITIES: OLGCC (11-3284066) AND OUR LADY OF CONSOLATION FOUNDATION (45-0517566) JOHN HAIGHT, VP FIN CONTINUING CARE- THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR THE FOLLOWING RELATED ENTITIES: OLGCC (11-3284066) AND OUR LADY OF CONSOLATION FOUNDATION (45-0517566) FORM 990, PART X, LINE 20 - TAX-EXEMPT BOND LIABILITIES THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 ARE ISSUED ON BEHALF OF THE CATHOLIC HEALTH SERVICES OF LONG ISLAND OBLIGATED GROUP PROJECT WHICH INCLUDES THE FILING ENTITY AND RELATED ENTITIES. TWO BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 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 SERVICES OF LONG ISLAND. CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 11A- I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 11A- II CHSLI false CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 11A- I GOOD SAMARTN false MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113434776 TRANSPORTATIO NY 501(C)(3) 11A- I MARYHAVENCTR true MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 9 CHSLI true MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR true THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113638367 SUPPORT ORG NY 501(C)(3) 11A- I MARYHAVENCTR false MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 CHSLI false CATHOLIC HOME CARE 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 112126736 HOME CARE NY 501(C)(3) 9 CHSLI true RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR true SIENA VILLAGE INC 2000 BISHOPS ROAD SMITHTOWN NY 11787 061569129 SR HOUSING NY 501(C)(3) 9 STCATHERINE false ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) 3 CHSLI false ST CHARLES HOSPITAL 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI false CHS HOME SUPPORT SERVICES INC 15 POWER DRIVE HAUPPAUGE NY 11788 113594561 RESP THERAPY NY 501(C)(3) 9 CATHHOMECARE true ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI false ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 11A- I ST FRANCIS false ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 11A- I ST FRANCIS false WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI false THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 112983148 SUPPORT ORG NY 501(C)(3) 11A- I CHSLI false THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 11A- I CHSLI false WISDOM GARDENS HOUSING DEVELOPMENT FUND 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113559713 SR HOUSING NY 501(C)(3) 9 MARYHAVENCTR true GOOD SHEPHERD HOSPICE 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 9 CHSLI true ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 11A- I ST CHARLES false GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) 11A- I GOOD SAMARTN false MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 550813603 SUPPORT ORG NY 501(C)(3) 11A- I MERCY MEDCTR false ST CATHERINE OF SIENA MEDICAL CTR FDN 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) 11A- I STCATHERINE false CHS HOME CARE AND HOSPICE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 452907761 SUPPORT ORG NY 501(C)(3) 11A- I CATHHOMECARE true GOOD SHEPHERD HOSPICE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 11A- I GOODSHEPHERD false OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 11A- I OURLADYOFC true RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 11A- I CHSLI false ST FRANCIS CARDIOVASCULAR PHYSICIANS P 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 11A- I ST FRANCIS false RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INS NY 501(C)(3) 11A- II CHSLI false SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 HEALTHCARESVC NY 501(C)(4) GOOD SAMARTN false ST JOSEPH HOSPITAL FOUNDATION 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 472353387 SUPPORT ORG NY 501(C)(3) 11A- I WSNCHS NORTH false BIPO HOLDINGS LLC 1600 STEWART AVE WESTBURY NY WESTBURY NY 11590 464763720 PHYSICIAN ASSN NY NA N/A IDHC LLC 2500 YORK RD JAMISONPA 18929 JAMISON PA 18929 452411095 HEALTH SERVICES PA NA N/A BEACON HEALTH PTNRS 1600 STEWART AVE WESTBURY NY WESTBURY NY 11590 454229842 HEALTHCARE NY NA N/A RADIOLOGY CONSULTING OF LONG ISLANDPLLC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 421646134 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN PEDIATRIC SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208180263 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208088453 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SOUTHWEST SUFFOLK MEDICAL PC 580 UNION BOULEVARD WEST ISLIP NY 11795 061603195 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false CARDIAC EKG INTERPRETATION PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112924518 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208964140 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112838185 HEALTHCARE SVC NY CHSLI C-CORP false FAIRVIEW HILL MANAGEMENT CO INC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 112798383 HOLDING CO NY CHSLI C-CORP false ADVANCED REHABILIATION MEDICINE PLLC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113640709 HEALTHCARE SVC NY STCHARLES HOSP C-CORP false ST FRANCIS CARDIAC PREVENTION SERVICES 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113224885 HEALTHCARE SVC NY STFRANCIS HOSP C-CORP false SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113307977 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false SAMARITAN HOME CARE AMERICA 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113319259 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false HEALTH CARE TEMP SERVICES INC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 112801136 EMPLOYMENT AGENCY NY FAIRVIEW HILL C-CORP false MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 510639649 HEALTHCARE SVC NY MERCY MED CTR C-CORP false LONG ISLAND EMERGENCY CARE PC 1000 N VILLAGE AVE ROCKVILLE NY 11571 113633515 PHYSICIAN SVC NY MERCY MED CTR S-CORP false false true true true true false false false true false false true true false true true true true true CATHOLIC HOME CARE OPQ 85599 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.