2015-11-12T19:12:11-06:00 2014-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2014-01-01 450517566 OUR LADY OF CONSOLATION FOUNDATION % CHS SERVICES INC OURL 6314656442 245 OLD COUNTRY ROAD MELVILLE NY 11747 JAMES RYAN ADMINISTRATOR 6464713000 2015-11-11 true LAURA PARELLO P01080295 6464713000 2014 2016-02-25 16:41:14Z SISTER MARILYN BREEN 245 OLD COUNTRY ROAD MELVILLE NY 11747 90610 false 0928 X N/A X 2002 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 14 0 0 0 135804 67960 0 0 0 0 32639 -5868 168443 62092 0 16769 0 0 0 0 0 0 0 0 0 0 16769 168443 45323 524879 570202 0 0 524879 570202 X OUR LADY OF CONSOLATION FOUNDATION, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, 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 16769 16769 0 SUPPORTED THE FUNDRAISING ACTIVITIES OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER. 16769 true true false false false false false false false false false false false false false true false true false false false false false false true false false true false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false true true false false false false X 15 14 false false false false true true true true true false false true true true true true true false false false X CHS SERVICES INC 6314656442 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X HON ANGIE CARPENTER CHAIRPERSON 2.0 0.0 X X 0 0 0 LOUIS C CALIBERTI TRUSTEE 2.0 0.0 X X 0 0 0 SISTER AUDREY HARSEN TRUSTEE 2.0 0.0 X X 0 0 0 BROTHER CAMPION LALLY OSF SECRETARY 2.0 0.0 X X 0 0 0 WILLIAM LAVERTY VICE CHAIRPERSON 2.0 0.0 X X 0 0 0 DOMINICK LETTIERI TRUSTEE 2.0 0.0 X X 0 0 0 TIMOTHY J MATTIMORE ESQ TRUSTEE 2.0 0.0 X 0 0 0 STEPHEN SIMAS TRUSTEE 2.0 0.0 X 0 0 0 CHARLES SPENCER TREASURER 2.0 0.0 X 0 0 0 WALTER LACE TRUSTEE 2.0 0.0 X 0 0 0 JUSTIN MCCARTHY TRUSTEE 2.0 0.0 X 0 0 0 PETER WRIGHT TRUSTEE 2.0 0.0 X 0 0 0 JOSEPH TOMAINO EVP CONTINUING CARE THRU JAN14 50.0 0.0 X X 0 1078251 497133 SISTER MARILYN BREEN CAO 37.5 0.0 X X 0 0 0 JOHN HAIGHT VP FINANCE CONTINUING CARE 2.0 0.0 X 0 167109 38337 SISTER KATHLEEN MCCARTHY OP TRUSTEE 2.0 0.0 X 0 0 0 KAREN ESTRADA FORMER SVP/CFO 0.0 50.0 X 0 220986 47019 0 1466346 582489 0 true true false NONE 0 51192 16768 67960 0 0 0 0 0 0 0 0 22650 51192 28518 -5868 -5868 0 0 0 62092 -5868 16769 16769 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16769 16769 0 0 0 0 524879 570202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 524879 570202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 524879 570202 0 0 524879 570202 524879 570202 45323 X false true X true false X X 1 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 113284066 09 true 16769 0 1 16769 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 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. CHRISTMAS FEST 25915 22015 3900 1750 10127 LIFE BALL 24927 20927 4000 2000 791 1 23000 8250 14750 11750 2100 73842 51192 22650 15500 13018 28518 -5868 true OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP NY 11795 113284066 501(C)(3) 16769 NONE NONE GENERAL SUPPORT 1 SCHEDULE I, 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 OUR LADY OF CONSOLATION FOUNDATION AND IS THEREFORE ABLE TO MONITOR THAT OUR LADY OF CONSOLATION GERIATRIC CARE CENTER USES THE GRANT FUNDS FOR GENERAL SUPPORT. true true false false false false false false false JOSEPH TOMAINO EVP CONTINUING CARE THRU JAN14 0 25040 0 0 0 1053211 0 478239 0 18894 0 1575384 0 296092 JOHN HAIGHT VP FINANCE CONTINUING CARE 0 166669 0 0 0 440 0 12693 0 25644 0 205446 0 0 KAREN ESTRADA FORMER SVP/CFO 0 208451 0 0 0 12535 0 15552 0 31467 0 268005 0 0 PART I, LINE 3 - METHODS TO ESTABLISH COMPENSATION BY RELATED ORGANIZATION THE FOLLOWING METHODS ARE USED BY A RELATED ORGANIZATION TO ESTABLISH COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, FORM 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A - SEVERANCE PAYMENT JOSEPH TOMAINO, EVP CONTINUING CARE RECEIVED PAYMENT OF SEVERANCE OF $654,172 AND IS ENTITLED TO ADDITIONAL SEVERANCE OF $341,239. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE FOLLOWING INDIVIDUAL PARTICIPATED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNT BELOW IS INCLUDED ON SCHEDULE J, PART II, COLUMN C. JOSEPH TOMAINO $137,000 PARTICIPATION IN PLAN THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE BELOW INDIVIDUAL INCLUDES BOTH QUALIFIED AND NON-QUALIFIED RETIREMENT PLANS. THE FOLLOWING INDIVIDUAL VESTED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNT BELOW IS INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). JOSEPH TOMAINO $398,798 VESTED IN PLAN THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN THE INDIVIDUAL'S 2014 FORM W-2, BOX 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. PART II - FORMER OFFICERS AND KEY EMPLOYEES KAREN ESTRADA, FORMER SVP/CFO, BECAME A HIGHEST COMPENSATED EMPLOYEE OF MARYHAVEN CENTER OF HOPE DURING 2014. FORM 990, PART VI, LINE 6 - MEMBERS OF THE ORGANIZATION OUR LADY OF CONSOLATION GERIATRIC CARE CENTER IS THE SOLE CORPORATE MEMBER OF OUR LADY OF CONSOLATION FOUNDATION. FORM 990, PART VI, LINE 7A - ELECTION OF THE GOVERNING BODY OUR LADY OF CONSOLATION GERIATRIC CARE CENTER AS THE SOLE CORPORATE MEMBER OF OUR LADY OF CONSOLATION FOUNDATION HAS THE POWER TO APPOINT THE GOVERNING BODY OF OUR LADY OF CONSOLATION FOUNDATION. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY OUR LADY OF CONSOLATION FOUNDATION MAY NOT TAKE ANY ACTION REQUIRING THE CONSENT OR APPROVAL OF THE MEMBER UNTIL THE MEMBER SHALL HAVE EXERCISED ITS RESERVED POWERS. IN ADDITION, CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A CATHOLIC HEALTH SERVICES OF LONG ISLAND) 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 GOVERNING 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 WHETHER CHS SHALL ENTER INTO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, LINE 15 - COMPENSATION POLICY (OF CHS, A RELATED ORG) 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. JOSEPH TOMAINO, EVP CONTINUING CARE - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CENTER OF HOPE FOUNDATION (11-3638367); RIVERHEAD HOSTEL HOLDING CORP (11-2499790); OLGCC (11-3284066); MARYHAVEN TRANSPORTATION SERVICES (11-3434776); MARYHAVEN SCHOOL (11-2861690); MARYHAVEN CENTER OF HOPE (11-2861698); GOOD SHEPHERD HOSPICE (11-2958438); GOOD SHEPHERD HOSPICE FOUNDATION INC. (26-3169427); CHS HOME SUPPORT SERVICES (11-3594561); CATHOLIC HOME CARE (11-2126736); AND OUR LADY OF CONSOLATION FOUNDATION (45-0517566) SITER MARILYN BREEN, CAO - THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR THE FOLLOWING RELATED ENTITIES: OLCGCC (11-3284066) AND OUR LADY OF CONSOLATION FOUNDATION (45-0517566) 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 false MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 9 CHSLI false MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR false 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 1150 PORTION ROAD SUITE 1 HOLTSVILLE NY 11742 112126736 HOME CARE NY 501(C)(3) 9 CHSLI false OUR LADY OF CONSOLATION GERIATRIC CARE 111 BEACH DRIVE WEST ISLIP NY 11795 113284066 LT NURSE CARE NY 501(C)(3) 9 CHSLI false RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR false 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 false 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 false GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE NY 11747 112958438 HOSPICE SVC NY 501(C)(3) 9 CHSLI false 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 1150 PORTION ROAD SUITE 1 HOLTSVILLE NY 11742 452907761 SUPPORT ORG NY 501(C)(3) 11A- I CATHHOMECARE false GOOD SHEPHERD HOSPICE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE NY 11747 263169427 SUPPORT ORG NY 501(C)(3) 11A- I GOODSHEPHERD false 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 CENTER NY 11570 472353387 SUPPORT ORG NY 501(C)(3) 11A- I WSNCHS NORTH false 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 false false false false false false false false false false false false false false false false false 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.