2015-11-12T19:12:11-06:00 2014-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2014-01-01 112050523 ST FRANCIS HOSPITAL % CHS SERVICES STFR 5165626000 100 PORT WASHINGTON BLVD ROSLYN NY 11576 RUTH HENNESSEY EXECUTIVE VP, CAO 6464713000 2015-11-11 true LAURA PARELLO P01080295 6464713000 2014 2016-02-25 16:41:14Z ALAN D GUERCI MD 100 PORT WASHINGTON BLVD ROSLYN NY 11576 902794881 false 0928 X HTTP://STFRANCISHEARTCENTER.CHSLI.ORG X 1922 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. 23 22 3693 683 0 4830681 1518258 505599925 540068950 31822723 29360258 13289572 10602548 555542901 581550014 15545886 20096761 0 0 268952411 277780789 0 0 0 231235591 235203645 515733888 533081195 39809013 48468819 887855235 947233162 265193398 285403158 622661837 661830004 X ST. FRANCIS HOSPITAL, 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 476100229 20096761 545982642 THE 364 CERTIFIED BED HOSPITAL PROVIDES CARDIOVASCULAR TESTING AND OTHER GENERAL MEDICAL SERVICES NECESSARY TO SUPPORT CARDIOVASCULAR PATIENTS AND ALSO PROVIDES NON-CARDIOVASCULAR SERVICES IN RESPONSE TO THE GENERAL NEEDS OF THE COMMUNITY. DURING 2014, THE HOSPITAL ADMITTED 15,756 PATIENTS, PERFORMED 1,129 OPEN HEART OPERATIONS AND 7,164 CATHETERIZATIONS. FURTHER, THE HOSPITAL PERFORMED 3,069 PTCA'S AND 3,646 CARDIAC ARRYTHMIA PROCEDURES. IN ADDITION, THERE WERE 24,795 EMERGENCY ROOM VISITS AND DURING THE YEAR THE HOSPITAL SERVICED 192,369 OUTPATIENTS. 476100229 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 true false false false false false false false false false true true true false false true 131 0 true 3693 true false false false false false false false false false false X 23 22 false false false false true true true true true false false true true true true true true true true false X CHS SERVICES 5167051933 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X PETER QUICK CHAIRMAN THRU APRIL 2014 2.0 0.0 X X 0 0 0 REV MSGR FRANCIS J CALDWELL SECRETARY THRU APRIL 2014 2.0 0.0 X X 0 0 0 PETER P D'ANGELO TREASURER THRU APR14/TRUSTEE 2.0 0.0 X X 0 0 0 RABBI BARRY DOV SCHWARTZ PHD TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 EUGENE F MURPHY TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 JOSEPH A GRIMALDI TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 SUSAN POWERS SCHOTT TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 THOMAS J FANNING TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 SR BETTY KEEGAN FMM TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 KEVIN J CONWAY TRUSTEE 2.0 0.0 X 0 0 0 SR DOLORES WISNIEWSKI CIJ TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 BRIAN P HEHIR TRUSTEE 2.0 0.0 X 0 0 0 STEPHEN F MCLOUGHLIN TRUSTEE 2.0 0.0 X 0 0 0 JAMES D'ADDARIO TRUSTEE THRU APRIL 2014 2.0 0.0 X 0 0 0 RICHARD J J SULLIVAN JR CHAIRMAN AS OF APRIL 2014 2.0 0.0 X X 0 0 0 BARBARA ELLEN BLACK TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 THOMAS DOWLING JR MD TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 VIRGINIA EWEN TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 SISTER AUDREY HARSEN TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 FRANK L KURRE TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 BRIAN MCGUIRE VICE CHAIR AS OF APRIL 2014 2.0 0.0 X X 0 0 0 REV MSGR ROBERT MORRISEY TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 PATRICIA NAZEMETZ TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 CHRIS PASCUCCI TREASURER AS OF APRIL 2014 2.0 0.0 X X 0 0 0 DANIEL T ROWE TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 JOSEPH TANTILLO SECRETARY AS OF APRIL 2014 2.0 0.0 X X 0 0 0 JOHN WAGNER TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 REV JAMES VLAUN TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 REV PETER DUGANDZIC TRUSTEE 2.0 0.0 X 0 0 0 HON ANTHONY MARANO TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 JEROME POLLER TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 SALVATORE SODANO TRUSTEE AS OF APRIL 2014 2.0 0.0 X 0 0 0 ALAN D GUERCI MD PRESIDENT & CEO 50.0 0.0 X X 0 1230209 247778 RUTH HENNESSEY EXEC VP & CAO 50.0 0.0 X 619572 0 131386 WILLIAM C ARMSTRONG SVP FINANCE 50.0 0.0 X 157612 510193 135888 JACK SOTERAKIS MD VP MEDICAL AFFAIRS 50.0 0.0 X 515590 0 58477 RICHARD SHLOFMITZ MD CHAIRMAN CARDIOLOGY 50.0 0.0 X 4259897 0 38422 GEORGE PETROSSIAN MD PHYSICIAN 50.0 0.0 X 2219278 0 45488 NEWELL ROBINSON MD CHAIRMAN CT & VASCULAR SURGERY 50.0 0.0 X 1751800 0 21879 EDWARD LUNDY MD PHYSICIAN 50.0 0.0 X 1497875 0 45366 ARIN GUPTA MD PHYSICIAN 50.0 0.0 X 1357983 0 45178 THOMAS PAPPAS MD PHYSICIAN 50.0 0.0 X 1248593 0 47196 13628200 1740402 817058 698 false true false WINTHROP UNIVERSITY HOSPITAL 200 OLD COUNTRY ROAD DIALYSIS CTR MINEOLA NY 11501 HEMODIALYSIS SVCS 1682866 NASSAU CHEST PHYSICIANS PC 233 EAST SHORE ROAD GREAT NECK NY 11023 PHYSICIAN SERVICES 1443750 DELLA FEMINA ROTHSCHILD JEARY 129 WEST 29TH STREET NEW YORK NY 10001 ADVERTISING SERVICES 1238861 PHYSICIANS DIAGNOSTIC IMAGING 100 PORT WASHINGTON BLVD ROSLYN NY 11576 PHYSICIAN SERVICES 1000833 MAQUET MEDICAL SYSTEMS 3615 SOLUTIONS CENTER CHICAGO IL 60677 SOFTWARE MAINTENANCE 667854 22 1461742 56516 1518258 PATIENT REVENUE 621400 540068950 540068950 540068950 7950438 7950438 0 0 1683232 1683232 0 1683232 1683232 342654687 321244867 21409820 21409820 21409820 0 0 0 MANAGEMENT FEES - 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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. 105130 105130 357415781 160231926 197183855 11910312 6942027 4968285 216270644 178954163 37316481 6289515 6289515 245863266 DUE FROM RELATED PARTIES 26309879 INSURANCE CLAIMS RECEIVABLE 29599049 55908928 0 POST RETIREMENT LIABILITIES 16517350 ESTIMATED MALPRACTICE LIABILITIES 25978350 OTHER SELF INSURED LIABILITIES 27397526 THIRD PARTY PAYOR LIABILITIES 25658068 95551294 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 true X true X 300. true X true true true false true true 5220256 2257053 2963203 0.00560 14456734 10878489 3578245 0.00670 415480 295603 119877 0.00020 20092470 13431145 6661325 0.01250 1542509 0 1542509 0.00290 805948 293608 512340 0.00100 0 0 0 0.00000 4286204 0 4286204 0.00800 283749 0 283749 0.00050 6918410 293608 6624802 0.01240 27010880 13724753 13286127 0.02490 true 2732796 201948286 208784150 -6835864 X true true 1 1 ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 HTTP://STFRANCISHEARTCENTER.CHSLI.ORG 2953000H X X X X CARDIOVASCULAR SVCS ST FRANCIS HOSPITAL 1 false false true X X X X X X X X 13 true true true true X STFRANCISHEARTCENTER.CHSLI.ORG/ X WWW.CHSLI.ORG - SEE PART V, SECTION C true 13 true WWW.CHSLI.ORG false false true X 300. 400. X X X true true X X true X X X X X X X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5 ST. FRANCIS HOSPITAL (ST. FRANCIS OR THE HOSPITAL) CONDUCTED A CHNA THAT INCLUDED INPUT FROM THE DEMATTEIS CENTER FOR CARDIAC RESEARCH AND EDUCATION'S OUTPATIENTS, INPATIENTS, EMPLOYEES, PATIENTS SCREENED AT COMMUNITY OUTREACH EVENTS, FAMILY MEMBERS AND GENERAL COMMUNITY MEMBERS WHO ATTENDED THE HOSPITAL'S ANNUAL HEALTH FAIR. INPUT WAS ALSO SOUGHT FROM PEOPLE IN THE MEDICALLY UNDERSERVED "SELECT COMMUNITIES" BY ST. FRANCIS'S OUTREACH STAFF WHEN CONDUCTING HEALTH SCREENINGS AT VARIOUS COMMUNITY AND PARISH SITE LOCATIONS. IN ADDITION, ST. FRANCIS COLLABORATED WITH THE NASSAU COUNTY DEPARTMENT OF HEALTH. IN-PERSON INTERVIEWS WERE CONDUCTED WITH KEY LONG ISLAND LEADERS FROM COMMUNITY-BASED ORGANIZATIONS, WHICH INCLUDED THE AMERICAN HEART ASSOCIATION, THE AMERICAN DIABETES ASSOCIATION, THE AMERICAN CANCER SOCIETY, ISLAND HARVEST FOOD PANTRY AND THE UNITED WAY OF LONG ISLAND. CRITICAL INFORMATION WAS THEN ANALYZED. NEEDS WERE IDENTIFIED THROUGH THIS COUNTY-WIDE EFFORT. ALL OF THESE COMMUNITY-BASED ORGANIZATIONS REACH OUT TO MEDICALLY UNDERSERVED AND MINORITY POPULATIONS, ESPECIALLY ISLAND HARVEST AND THE UNITED WAY OF LONG ISLAND. A STANDARD SURVEY TOOL WAS DEVELOPED AND GIVEN TO LEADERS OF ALL OF THE ABOVE ORGANIZATIONS. PART V, SECTION B, LINE 6A ST. JOSEPH HOSPITAL, MERCY MEDICAL CENTER, LONG BEACH MEMORIAL HOSPITAL, THE NORTH SHORE-LIJ SYSTEM, SOUTH NASSAU COMMUNITIES HOSPITAL AND WINTHROP-UNIVERSITY HOSPITAL. PART V, SECTION B, LINE 6B NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND VARIOUS COMMUNITY-BASED ORGANIZATIONS, NOW COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). PART V, SECTION B, LINE 7B - OTHER WEBSITE NSHC.ORG/LONG-ISLAND-HEALTH-COLLABORATIVE/ PART V, SECTION B, LINE 11 PRIORITY 1: PREVENT CHRONIC DISEASE THE HOSPITAL IS INCREASING ACCESS TO HIGH-QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT FOR CARDIOVASCULAR DISEASE, DIABETES AND CANCER IN BOTH CLINICAL AND COMMUNITY SETTINGS VIA A COMMUNITY-BASED APPROACH, ESPECIALLY IN MEDICALLY UNDERSERVED COMMUNITIES. IT IS EXPANDING OUTREACH AND ACCESS TO CARE BY DELIVERING HEALTH SCREENINGS, EDUCATION AND CLINICAL SERVICES TO AT-RISK POPULATIONS. PRIORITY 2: REDUCE OBESITY IN ADULTS THROUGH COMMUNITY-BASED AWARENESS INITIATIVES AND THE ADDITION OF BARIATRIC SERVICES AT ST. FRANCIS HOSPITAL. THE HOSPITAL IS INCREASING AWARENESS OF ACHIEVING AND MAINTAINING A HEALTHY WEIGHT BY OFFERING BODY MASS INDEX (BMI) SCREENING AND WAIST CIRCUMFERENCE MEASUREMENT AS CARDIOVASCULAR DISEASE RISK FACTOR AND OBESITY INDICATORS TO OUR NO-COST COMMUNITY HEALTH OUTREACH BUS COMMUNITY SCREENING PROGRAM, IN ADDITION TO FREE EXERCISE CLASSES, YOGA, TAI CHI, CHAIR YOGA, BALANCE TRAINING AND CLASSES SUCH AS THE "HEART OF GOOD EATING" AND "CHANGING OUR WEIGHS" WEIGHT-LOSS PROGRAM. PRIORITY 3: PREVENT VACCINE-PREVENTABLE DISEASE THROUGH COMMUNITY-WIDE EFFORTS TO DECREASE THE BURDEN OF INFLUENZA. THE HOSPITAL IS PROVIDING FREE INFLUENZA VACCINES TO HIGH-RISK/MEDICALLY UNDERSERVED POPULATIONS AT OUTREACH SITES ACROSS LONG ISLAND, WITH A SPECIAL FOCUS ON THE NINE UNDERSERVED "SELECT" COMMUNITIES IN NASSAU COUNTY, THROUGH HEALTHY SUNDAYS AND COMMUNITY OUTREACH BUS EFFORTS. THE AREAS OF MENTAL HEALTH, SUBSTANCE ABUSE, AND PRENATAL CARE WERE NOT SELECTED, AS ST. FRANCIS DOES NOT HAVE A BEHAVIORAL HEALTH DEPARTMENT OR OB/GYN SERVICES TO SUPPORT INITIATIVES IN THESE AREAS. PART V, SECTION B, LINE 20E ST. FRANCIS HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN ST. FRANCIS 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 AT LEAST ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. ST. FRANCIS HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS INTERNET WEBSITE. 3 ST FRANCIS RESEARCH & EDUCATIONAL 101 NORTHERN BLD OLD BROOKVILLE NY 11545 RESEARCH, COMMUNITY ED, CARDIAC REHAB, WOMEN'S HEALTH CENTER ST FRANCIS SOUTHBAY CARDIOVASCULAR CL 540 UNION BLVD WEST ISLIP NY 11795 OUTPATIENT CARDIOVASCULAR SERVICES MCHUGH HEALTH CENTER 750 SOUTH BROADWAY HICKSVILLE NY 11801 PRIMARY CARE FOR UNINSURED AND UNDERINSURED 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 2014. PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT AS PART OF ITS TAX EXEMPT PURPOSE THE HOSPITAL PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. THE HOSPITAL TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF WHETHER THEY HAVE THIRD-PARTY COVERAGE OR THE ABILITY TO PAY. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE HOSPITAL IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. A PATIENT'S PORTION OF A BILL THAT 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 THE 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 THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THIS ALLOWANCE BASED UPON HISTORICAL COLLECTION AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHS FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY CHS POLICY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE. CHS DOES NOT HAVE ANY OFF-BALANCE-SHEET CREDIT EXPOSURE RELATED TO ITS PATIENT ACCOUNTS RECEIVABLE. 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 2014 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. ST. FRANCIS BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY, BUT DOING SO WITH NO RECOURSE TO OBTAIN 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, SO ST. FRANCIS 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 CHS 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 BOARD OF TRUSTEES AND EXECUTIVE LEADERSHIP COUNCIL, COMMUNITY HEALTH AND EDUCATION DEPARTMENT MEETINGS, AT COLLABORATIVE SESSIONS WITH MEMBER HOSPITALS OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), WITH PARTNERS AT COMMUNITY AGENCIES AND ORGANIZATIONS SUCH AS SCHOOLS, NURSING HOMES AND REHABILITATION CENTERS, AND THROUGH PARTICIPANT SURVEYS CONDUCTED AT MULTIPLE OUTREACH SITES IN THE COMMUNITY. THE HEALTHY SUNDAYS PROGRAM, WHICH PROVIDES FREE HEALTH SCREENINGS AND EDUCATION TO THE UNDERSERVED FOLLOWING WORSHIP SERVICES PERIODICALLY THROUGHOUT THE YEAR, WAS THE RESULT OF A JOINT COMMUNITY NEEDS ASSESSMENT BY CHS HOSPITALS. IT HAS ALSO BECOME A PRIMARY SOURCE OF PUBLIC PARTICIPATION. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH AND SPANISH) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT DOUBLES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED VIA CALENDAR LISTINGS IN PARISH BULLETINS AND FLYERS POSTED IN PLACES OF BUSINESS AND WORSHIP IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CHS'S WEBSITE. ADDITIONALLY, COMMUNITY NEEDS SURVEYS ARE COMPLETED BY PARTICIPANTS ATTENDING THE HOSPITAL'S HEALTH SCREENINGS AT LIBRARIES AND SENIOR CENTERS THROUGHOUT THE COUNTY. IN 2014, TO BETTER IDENTIFY AND ADDRESS THE REGION'S PREVALENT HEALTH NEEDS, ST. FRANCIS CONTINUED TO COLLABORATE WITH OTHER HOSPITALS, LOCAL HEALTH DEPARTMENTS, HEALTH CARE PROVIDERS, PUBLIC HEALTH SPECIALISTS FROM ACADEMIC INSTITUTIONS AND COMMUNITY-BASED ORGANIZATIONS IN THE LONG ISLAND HEALTH COLLABORATIVE (LIHC), ONE OF THE FIRST BI-COUNTY INITIATIVES OF ITS KIND IN NEW YORK. 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 NSHC.ORG/LONG-ISLAND-HEALTH-COLLABORATIVE. PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS ARE FULLY VERSED IN THE CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. THE HOSPITAL POSTS 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 AT LEAST ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 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. THE HOSPITAL POSTS ITS CHARITY CARE POLICY SUMMARY ON ITS INTERNET WEBSITE. THE HOSPITAL PROVIDES ALL PATIENTS INTERPRETERS TO ASSIST THEM IN UNDERSTANDING ITS CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, A STATEMENT IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER INFORMATION. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4 - COMMUNITY INFORMATION A NOT-FOR-PROFIT HOSPITAL, ST. FRANCIS HOSPITAL IS A MEMBER OF CHS. ST. FRANCIS HOSPITAL IS LOCATED ON THE NORTH SHORE OF NASSAU COUNTY IN THE TOWN OF NORTH HEMPSTEAD. ST. FRANCIS HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS INCLUDE 97.04% OF HOSPITAL DISCHARGES. THE PRIMARY SERVICE AREA IS NASSAU COUNTY, FROM WHICH THE HOSPITAL OBTAINED 56.02% OF ITS DISCHARGES IN 2014. THE SECONDARY SERVICE AREA PROVIDES ANOTHER 40.83% OF DISCHARGES AND COMPRISES TWO AREAS, WEST AND EAST. THE WEST AREA CONSISTS OF ZIP CODES FROM QUEENS AND PROVIDES 20.03% OF ST. FRANCIS DISCHARGES. THE EAST AREA CONSISTS OF ZIP CODES IN SUFFOLK COUNTY AND PROVIDES 18.63% OF ST. FRANCIS DISCHARGES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH ST. FRANCIS HOSPITAL CONTINUES TO PARTNER WITH OTHER COMMUNITY ORGANIZATIONS TO ADDRESS THE DIVERSE NEEDS OF UNDERINSURED AND UNINSURED INDIVIDUALS ACROSS LONG ISLAND. FOLLOWING ARE SEVERAL PROGRAMS WHICH WERE REPRESENTATIVE OF THESE EFFORTS IN 2014: - ST. FRANCIS HOSPITAL OPERATES THE BISHOP MCHUGH HEALTH CENTER IN HICKSVILLE WITH A FOCUS ON PROVIDING PRIMARY CARE TO THE UNINSURED AND UNDERINSURED. THE CENTER'S MEDICAL STAFF PROVIDES PHYSICAL EXAMINATIONS, LAB WORK, FLU SHOTS, IMMUNIZATIONS AND SPECIALTY REFERRALS AS NEEDED. IN 2014, THERE WERE 1,364 PATIENT VISITS AT THE CENTER, WITH 1,713 REFERRALS FOR SPECIALTY CARE. - THE CHS HEALTHY SUNDAYS PROGRAM OFFERED FREE HEALTH SCREENINGS, FOLLOWING WEEKEND SERVICES AT LOCAL HOUSES OF WORSHIP, TO INDIVIDUALS WHO WOULD OTHERWISE HAVE DIFFICULTY ACCESSING HEALTH CARE. AS PART OF THE COLLABORATION BETWEEN MEMBER HOSPITALS OF CHS, ST. FRANCIS HOSPITAL PROVIDED 738 FLU SHOTS TO MEDICALLY UNDERSERVED AT HEALTHY SUNDAYS EVENTS IN 2014. HEALTHY SUNDAYS CONTINUES TO PROVIDE A VITAL LINK TO PRIMARY CARE REFERRALS FOR THE MEDICALLY UNDERSERVED. - ST. FRANCIS HOSPITAL'S MOBILE HEALTH SCREENING UNIT PROVIDED CARE TO THOUSANDS OF INDIVIDUALS WHO DID NOT HAVE ACCESS TO A TRADITIONAL HEALTH CARE FACILITY. THE SELF-CONTAINED MOBILE UNIT WAS ONSITE AT LOCATIONS IN QUEENS, NASSAU AND SUFFOLK COUNTIES IN 2014. DURING THESE OUTREACH VISITS, ST. FRANCIS HOSPITAL NURSES PROVIDED 4,425 HEALTH SCREENINGS AND/OR FLU SHOTS, INCLUDING THOSE FOR 588 PATIENTS IN 9 COMMUNITIES IDENTIFIED AS PARTICULARLY IN NEED. - CONCERN ABOUT THE SUDDEN DEATH OF SEVERAL STUDENT-ATHLETES IN RECENT YEARS HAS LED TO HIGH DEMAND FOR FREE CARDIAC SCREENINGS AT ST. FRANCIS HOSPITAL THROUGH ITS STUDENT ATHLETE CARDIAC SCREENING PROGRAM. THE HOSPITAL PROVIDED 152 CARDIAC SCREENINGS AT NO COST TO LOCAL HIGH SCHOOL ATHLETES IN 2014. THESE SCREENINGS INCLUDE EKG AS WELL AS ECHOCARDIOGRAM. THE GOAL IS TO DETECT AND ASSESS ANY UNDERLYING CARDIAC ABNORMALITIES WHICH MAY PUT A STRAIN ON AN ATHLETE'S HEART, ESPECIALLY DURING STRENUOUS PHYSICAL ACTIVITY. IN AN EFFORT TO REDUCE OBESITY, ST. FRANCIS HOSPITAL OFFERED 2,449 FREE BODY MASS INDEX (BMI) SCREENINGS ON THE OUTREACH BUS. PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM ST. FRANCIS HOSPITAL (ST. FRANCIS) IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH IS LOCATED ON A SINGLE CAMPUS IN ROSLYN, NEW YORK. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, ST. FRANCIS THROUGH ITS DAILY OPERATIONS, PROVIDES TO THE AREA ACUTE, EMERGENT AND OUTPATIENT CARE. ST. FRANCIS IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND)(CHS) 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. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2014, CHS COMPRISED SIX HOSPITALS (MERCY MEDICAL CENTER, ST. FRANCIS HOSPITAL AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL AND REHABILITATION CENTER AND ST. CATHERINE OF SIENA MEDICAL CENTER IN SUFFOLK COUNTY), AS WELL AS THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING AND REHABILITATION CARE CENTER, GOOD SAMARITAN NURSING HOME AND OUR LADY OF CONSOLATION NURSING AND REHABILITATIVE CARE CENTER, ALL IN SUFFOLK COUNTY), A REGIONAL HOME CARE AND HOSPICE NETWORK, AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH APPROXIMATELY 17,000 EMPLOYEES AND 4,600 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CHS PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: 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, ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTH CARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. MEMBER ORGANIZATIONS OF CHS OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. ALL OF CHS'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. THE CHS SYSTEM PROVIDES AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS, AND PROVIDES FREE HEALTH SCREENINGS THROUGH THE HEALTHY SUNDAYS PROGRAMS, HEALTH FAIRS AND OTHER PROGRAMS THAT HELP THE COMMUNITIES SERVED BY CHS ACCESS CARE. SINCE 1907, CATHOLIC HEALTH CARE ON LONG ISLAND HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF SERVING THE COMMUNITY. TO FURTHER THE MISSION OF BRINGING CARE TO THE COMMUNITY, CHS AND ITS MEMBER HOSPITALS, TOGETHER WITH A NUMBER OF OTHER HEALTH CARE PROVIDERS ON LONG ISLAND, ENTERED INTO A PARTNERSHIP AGREEMENT WHICH OPERATES AS THE LONG ISLAND HEALTH NETWORK (LIHN). LIHN WAS CREATED TO ESTABLISH A COMPREHENSIVE AND EFFICIENT HOSPITAL NETWORK IN NASSAU AND SUFFOLK COUNTIES WORKING TO, AMONG OTHER THINGS, IMPROVE QUALITY OF CARE, FACILITATE CLINICAL INTEGRATION, BENCHMARK BEST PRACTICES AND REDUCE LENGTH OF STAY AND COSTS. MERCY MEDICAL CENTER, A RELATED ORGANIZATION, PROVIDES UNCOMPENSATED CARE THROUGH A BROAD RANGE OF COMMUNITY SERVICE PROGRAMS AND CHARITABLE ACTIVITIES. true ST FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 501(C)(3) 19137930 0 NONE NONE WORKING CAP. SUBSIDY CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 N VILLAGE AVE ROCKVILLE CENTRE NY 11570 113403968 501(C)(3) 708831 NONE NONE OUTPATIENT CENTERS FRANCISCAN MISSIONARIES OF MARY 3305 WALLACE AVE BRONX NY 10467 132988747 501(C)(3) 250000 NONE NONE GENERAL SUPPORT 3 PART I LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR ST. FRANCIS HOSPITAL (SFH), ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC (SFPC), AND CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS) AND IS THEREFORE ABLE TO MONITOR THAT SFPC USES THE GRANT AS A WORKING CAPITAL SUBSIDY AND CHS USES THE GRANT FUNDS FOR OUTPATIENT CENTERS. THE FRANCISCAN MISSIONARIES OF MARY PROVIDES UPDATES TO CONTRIBUTORS LIKE ST. FRANCIS HOSPITAL. 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; 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 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 true true X X X X X X false true false false false false false false false ALAN D GUERCI MD PRESIDENT & CEO 0 1199882 0 0 0 30327 0 216396 0 31382 0 1477987 0 0 RUTH HENNESSEY EXEC VP & CAO 519835 0 0 0 99737 0 103628 0 27758 0 750958 0 77258 0 JACK SOTERAKIS MD VP MEDICAL AFFAIRS 399286 0 0 0 116304 0 39628 0 18849 0 574067 0 33319 0 RICHARD SHLOFMITZ MD CHAIRMAN CARDIOLOGY 3415642 0 840000 0 4255 0 17628 0 20794 0 4298319 0 0 0 GEORGE PETROSSIAN MD PHYSICIAN 1325552 0 890630 0 3096 0 17628 0 27860 0 2264766 0 0 0 NEWELL ROBINSON MD CHAIRMAN CT & VASCULAR SURGERY 1497048 0 250000 0 4752 0 17628 0 4251 0 1773679 0 0 0 EDWARD LUNDY MD PHYSICIAN 1495553 0 0 0 2322 0 17628 0 27738 0 1543241 0 0 0 ARIN GUPTA MD PHYSICIAN 1355661 0 0 0 2322 0 17628 0 27550 0 1403161 0 0 0 THOMAS PAPPAS MD PHYSICIAN 795497 0 450000 0 3096 0 17628 0 29568 0 1295789 0 0 0 WILLIAM C ARMSTRONG SVP FINANCE 89172 493519 0 0 68440 16674 2938 105163 4535 23252 165085 638608 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. ALAN D. GUERCI, MD $197,000 PARTICIPATION IN PLAN RUTH HENNESSEY $86,000 PARTICIPATION IN PLAN JACK SOTERAKIS $22,000 PARTICIPATION IN PLAN WILLIAM ARMSTRONG $89,000 PARTICIPATION IN PLAN THE DEFERRED COMPENSATION AMOUNT 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 HENNESSEY $77,258 VESTED IN PLAN JACK SOTERAKIS $101,249 VESTED IN PLAN THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2014 FORM W-2, BOX 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. RICHARD SHLOFMITZ KEY EMPLOYEE PERSONAL/FAMILY X 1000000 847980 false true true 847980 ST FRANCIS CARDIAC PREVENTION SVCS SEE PART V 2350904 SUBSIDIZE LOSS CONTROLLED PC false PART II - LOANS TO AND FROM INTERESTED PERSONS (A) NAME OF PERSON: RICHARD SHLOFMITZ, MD ALTHOUGH ON DECEMBER 17, 2013, THE CORPORATE MEMBERS OF CATHOLIC HEALTH SERVICES OF LONG ISLAND ADOPTED A RESOLUTION RESTRUCTURING THE GOVERNANCE OF CHS SO THAT A SINGLE MIRROR BOARD GOVERNS CHS AND THE SIX ACUTE CARE OPERATING ENTITIES, THE REFERENCED CHANGE WAS EFFECTUATED BY ENACTMENT OF A RESOLUTION AND DID NOT ENTAIL A CHANGE TO THE ORGANIZING DOCUMENT OR BYLAWS. FORM 990, PART VI - LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF ST. FRANCIS HOSPITAL 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 ST. FRANCIS HOSPITAL AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF ST. FRANCIS HOSPITAL. FORM 990, PART VI, LINE 7B - DECISIONS OF THE GOVERNING BODY AS THE SOLE MEMBER OF ST. FRANCIS HOSPITAL, CHS IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERING BODY OF ST. FRANCIS HOSPITAL. THE GOVERNING BODY OF ST. FRANCIS HOSPITAL IS THE SAME AS THAT OF CHS. 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 CHS, 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 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 CHS COMPLIANCE AND AUDIT COMMITTEE BY CHS' 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 CHS COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE CHS 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 CHS AND WISHES TO GO FORWARD WITH IT, THE CHAIR OF THE BOARD OF DIRECTORS SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. 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 CHS 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 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 (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 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 CHS CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE CHS 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 CHS BOARD OF DIRECTORS. 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. ALAN D. GUERCI, PRESIDENT & CEO - THE TOTAL HOURS WORKED REPORTED 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); ST FRANCIS HOSPITAL FOUNDATION (11-2916033); 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); SIENA VILLAGE (06-1569129); ST. CATHERINE OF SIENA MEDICAL CENTER (06-1562701); ST.CHARLES HOSPITAL (11-1871039). RUTH HENNESSEY, EXECUTIVE VP AND CAO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. FRANCIS HOSPITAL (11-2050523); ST. FRANCIS HOSPITAL FOUNDATION (11-2916033); ST. FRANCIS RESEARCH AND EDUCATIONAL CORPORATION INC. (11-3090867). JACK SOTERAKIS, MD, VP MEDICAL AFFAIRS - THE TOTAL HOURS WORKED REPORTED (50.0) RELFECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. FRANCIS HOSPITAL (11-2050523); ST. FRANCIS CARDIOVASCULAR PHYSICIANS P.C. (11-3613997). WILLIAM C. ARMSTRONG, SVP FINANCE - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER OR HIGHEST PAID EMPLOYEE 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 (11-1871039); ST. CHARLES HOSPITAL FOUNDATION (41-2076312); SIENA VILLAGE, INC. (06-1569129); GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE (11-2537396) AND GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240). 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. FOUR BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 SUFFOLK BONDS), NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BONDS), NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORPORATION (SERIES 2014 NASSAU BONDS) AND NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORPORATION (SERIES 2014B NASSAU BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH SERVICES OF LONG ISLAND. FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS LOSS ON DEBT EXTINGUISHMENT ($1,761,344) CHANGE IN POST RETIREMENT BENEFIT PLAN : ($ 832,000) 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 true 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 true GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 11A- I GOOD SAMARTN true 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 true CATHOLIC HOME CARE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 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 true ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) 3 CHSLI true ST CHARLES HOSPITAL 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI true CHS HOME SUPPORT SERVICES INC 15 POWER DRIVE HAUPPAUGE NY 11788 113594561 RESP THERAPY NY 501(C)(3) 9 CATHHOMECARE false ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 11A- I ST FRANCIS true ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 11A- I ST FRANCIS true WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI true 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 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 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 true 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 false 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 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 true 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 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 true true true true true false false false false true true true true true true true true true true ST FRANCIS FOUNDATION C 408393 COST ST FRANCIS RESEARCH & EDUCATIONAL CORP C 1053349 COST MERCY MEDICAL CENTER LMS 956402 COST ST FRANCIS RESEARCH & EDUCATIONAL CORP KLMNO 512276 COST ST FRANCIS FOUNDATION LMNOQ 613115 COST CHS SERVICES A 715692 COST CHS SERVICES JLMPS 2048253 COST GOOD SAMARITAN HOSPITAL LMS 548869 COST ST CHARLES HOSPITAL LMS 24937 COST ST CATHERINE OF SIENA MEDICAL CENTER LMS 411548 COST WSNCHS NORTH LMS 75188 COST ST FRANCIS CARDIOVASULAR PHYSICIANS PC B 19137930 COST ST FRANCIS CARDIOVASULAR PHYSICIANS PC LNOQ 5106606 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.