ST FRANCIS HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ST FRANCIS HOSPITAL (EIN 11-2050523)
Tax period
2011-01-01 to 2011-12-31
Filed
2013-01-07
IRS object ID
201300079349301700
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-01-07T14:07:55-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN221478099EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1COHNREZNICK LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14 BECKER FARM ROADAddressLine1
CityROSELANDCity
StateNJState
ZIP Code070681739ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN112050523EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTFRNameControl
Phone5165626000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 PORT WASHINGTON BLVDAddressLine1
CityROSLYNCity
StateNYState
ZIP Code11576ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALAN D GUERCI MDName
TitlePRESIDENT & CHIEF EXECUTIVE OFFICERTitle
Phone5165626798Phone
Date Signed2013-01-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS LANNINGName
PTINP00851654PTIN
Phone9732283500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonALAN D GUERCI MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1100 PORT WASHINGTON BLVDAddressLine1
CityROSLYNCity
StateNYState
ZIP Code11576ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1528033508GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0923GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteHTTP://STFRANCISHEARTCENTER.CHSLI.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionST. FRANCIS HOSPITAL, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS),AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALINGMISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITTS 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees3369TotalNbrEmployees
Total Nbr Volunteers430TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year13428686ContributionsGrantsPriorYear
Contributions Grants Current Year3868546ContributionsGrantsCurrentYear
Program Service Revenue Prior Year457250531ProgramServiceRevenuePriorYear
Program Service Revenue CY477161420ProgramServiceRevenueCY
Investment Income Prior Year12829668InvestmentIncomePriorYear
Investment Income Current Year25434994InvestmentIncomeCurrentYear
Other Revenue Prior Year5090293OtherRevenuePriorYear
Other Revenue Current Year5752912OtherRevenueCurrentYear
Total Revenue Prior Year488599178TotalRevenuePriorYear
Total Revenue Current Year512217872TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year5631475GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY18301830GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year234699100SalariesEtcPriorYear
Salaries Etc Current Year265030849SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year194742696OtherExpensePriorYear
Other Expenses Current Year200168603OtherExpensesCurrentYear
Total Expenses Prior Year435073271TotalExpensesPriorYear
Total Expenses Current Year483501282TotalExpensesCurrentYear
Revenues Less Expenses Prior Year53525907RevenuesLessExpensesPriorYear
Revenues Less Expenses CY28716590RevenuesLessExpensesCY
Total Assets BOY772336562TotalAssetsBOY
Total Assets EOY796680990TotalAssetsEOY
Total Liabilities BOY251696882TotalLiabilitiesBOY
Total Liabilities EOY272784268TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY520639680NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY523896722NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionST. FRANCIS HOSPITAL, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS),AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALINGMISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITTS 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense417863704Expense
Grants21101830Grants
Revenue477161420Revenue
DescriptionTHE 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 2011, THE HOSPITAL ADMITTED 18,009 PATIENTS, PERFORMED 1,477 OPEN HEART OPERATIONS AND 7,769 CATHETERIZATIONS. FURTHER, THE HOSPITAL PERFORMED 3,046 PTCA'S AND 6,556 OTHER NON-SURGICAL PROCEDURES. IN ADDITION, THERE WERE 22,204 EMERGENCY ROOM VISITS AND DURING THE YEAR THE HOSPITAL SERVICES 126,546 OUTPATIENTS.Description
Total Program Service Expense417863704TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096141NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3369NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHS SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5167051933TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1992 NORTH VILLAGE AVENUEAddressLine1
CityROCKVILLE CENTRECity
StateNYState
ZIP Code11570ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
ALAN D GUERCI MD
BOARD MEMBER/PRESIDENT50.00XX22582560596927
C JUSTIN MCCARTHY
TREASURER2.00XX000
CHRISTOPHER S PASCUCCI
BOARD MEMBER2.00X000
DANIEL J DENIHAN
VICE CHAIR2.00XX000
DAVID MILLER DDS
BOARD MEMBER2.00X000
DELORES C KERSHAW
BOARD MEMBER2.00X000
EDWARD J COOK PHD
BOARD MEMBER2.00X000
EUGENE F MURPHY
BOARD MEMBER2.00X000
EUGENE P SOUTHER ESQ
BOARD MEMBER2.00X000
JAMES D'ADDARIO
BOARD MEMBER2.00X000
KEVIN J CONWAY
BOARD MEMBER2.00X000
MATTHEW D SERRA
BOARD MEMBER2.00X000
PETER QUICK
CHAIR2.00XX000
RABBI BARRY DOV SCHWARTZ PHD
BOARD MEMBER2.00X000
REV MSGR F J CALDWELL
SECRETARY2.00XX000
ROBERT P QUINN
BOARD MEMBER2.00X000
SR BETTY KEEGAN FMM
BOARD MEMBER2.00X000
SR DOLORES WISNIEWSKI CIJ
BOARD MEMBER2.00X000
JOSEPH GRIMALDI
BOARD MEMBER2.00X000
SUSAN POWERS SCHOTT
BOARD MEMBER2.00X000
THOMAS E CHRISTMAN
BOARD MEMBER2.00X000
THOMAS J FANNING
BOARD MEMBER2.00X000
RUTH HENNESSEY
EXECUTIVE VP & CAO50.00X5811260132903
WILLIAM ARMSTRONG
SR. VP & CFO50.00X16003070462970
JACK SOTERAKIS MD
VP MEDICAL AFFAIRS50.00686075036491X
RICHARD SHLOFMITZ MD
CHAIRMAN OF CARDIOLOGY50.003234483046116X
ANN CELLA
VP NURSING50.001136603093276X
ANTONIO MADRID
PHYSICIAN50.001046168036688X
GEORGE PETROSSIAN
PHYSICIAN50.001366911044531X
THEOFANI TSIAMTSIOURIS
PHYSICIAN50.001120769045185X
THOMAS PAPPAS
PHYSICIAN50.001249279046169X
FieldValueIRS element (for citing)
Total Reportable Comp From Org14279977TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1541256TotalOtherCompensation
Number Individuals GT100 K501NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PHYSICIANS DIAGNOSTIC IMAGING PC
100 PORT WASHINGTON BLVDROSLYNNY11576MEDICAL CONSULTANTS1801029
NASSAU CHEST PHYSICIANS PC
233 EAST SHORE ROADGREAT NECKNY11020MEDICAL CONSULTANTS1397837
DELLA FEMINA
PO BOX 641052PITTSBURGHPA15264ADVERTISING937274
PROSKAUER ROSE
1585 BROADWAYNEW YORKNY10036LEGAL SERVICE643793
MUNICIPAL ASSET MANANGEMENT
60 EAST 42ND ST SUITE 2134NEW YORKNY10165INVESTMENT SERVICE594452
FieldValueIRS element (for citing)
Number Of Contractors GT100 K25NumberOfContractorsGT100K
Related Organizations3765651RelatedOrganizations
All Other Contributions102895AllOtherContributions
Total Contributions3868546TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code621400BusinessCode
Total Revenue Column477161420TotalRevenueColumn
Related Or Exempt Function Income477161420RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue477161420TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column9416487TotalRevenueColumn
Exclusion$9,416,487ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1788127Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real1788127Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1788127TotalRevenueColumn
Exclusion$1,788,127ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1031834143Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1015815636Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities16018507Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column16018507TotalRevenueColumn
Exclusion$16,018,507ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PURCHASE DISCOUNT/REBA900099165355165355
COMMUNITY HEALTH & EDU9000994066540665
RESEARCH & EDUCATION900099472472

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column3758293TotalRevenueColumn
Exclusion$3,758,293ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3964785TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column512217872TotalRevenueColumn
Related Or Exempt Function Income477367912RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$30,981,414ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total18301830Total
Program Services18301830ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total9635654Total
Program Services4003165ProgramServices
Management And General5632489ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total196801853Total
Program Services169249594ProgramServices
Management And General27552259ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total13758502Total
Program Services11832312ProgramServices
Management And General1926190ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total31077252Total
Program Services26726437ProgramServices
Management And General4350815ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total13757588Total
Program Services11831526ProgramServices
Management And General1926062ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1055875Total
Program Services5484ProgramServices
Management And General1050391ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total789653Total
Management And General789653ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total196740Total
Management And General196740ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5721679Total
Program Services3685195ProgramServices
Management And General2036484ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1909974Total
Program Services1909974ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4854407Total
Program Services4174790ProgramServices
Management And General679617ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total117567Total
Program Services101108ProgramServices
Management And General16459ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total9141640Total
Program Services7861810ProgramServices
Management And General1279830ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total527073Total
Program Services453283ProgramServices
Management And General73790ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total6762209Total
Program Services5815500ProgramServices
Management And General946709ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total5651132Total
Program Services3373258ProgramServices
Management And General2277874ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total24552629Total
Program Services21115261ProgramServices
Management And General3437368ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total4416124Total
Program Services4416124ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES9267176192671761
FINANCE & TECHNOLOGY18752010152420203509990
EQUIPMENT SERVICE CONTR57280484926121801927
CHS CORPORATE MANAGEMEN38832953883295

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13436787Total
Program Services10167151ProgramServices
Management And General3269636ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total483501282Total
Program Services417863704ProgramServices
Management And General65637578ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY384924BOY
EOY1489240EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY18568214BOY
EOY24848752EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY58035738BOY
EOY57497683EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY927645BOY
EOY842512EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY7414126BOY
EOY7048150EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4274224BOY
EOY5103803EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis538982519LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec274453142LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY257456945BOY
EOY264529377EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY368671305BOY
EOY370743359EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY18835043BOY
EOY17681927EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY37768398BOY
EOY46896187EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY772336562BOY
EOY796680990EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY51865093BOY
EOY56074215EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY127289261BOY
EOY119719673EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY72542528BOY
EOY96990380EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY251696882BOY
EOY272784268EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY517853804BOY
EOY521130352EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2785876BOY
EOY2766370EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY520639680BOY
EOY523896722EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY772336562BOY
EOY796680990EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses28716590ReconcilationRevenueExpenses
Reconcilation Other Changes-25459548ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$104,918OtherActivitiesAmount
Total Lobbying Expenditures IIB104918TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationAMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON THE BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ORGANIZATIONS REPRESENT.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis105130OtherCostOrOtherBasis
Book Value105130BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis327077247OtherCostOrOtherBasis
Depreciation125962088Depreciation
Book Value201115159BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis9068382OtherCostOrOtherBasis
Depreciation5057533Depreciation
Book Value4010849BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis191150953OtherCostOrOtherBasis
Depreciation143433521Depreciation
Book Value47717432BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11580807OtherCostOrOtherBasis
Book Value11580807BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings264529377TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM RELATED PARTIES/AFFILIATES14313077
ASSETS RESTRICTED UNDER BOND INDENTURE10163429
INSURANCE CLAIMS RECEIVABLE22419681
FieldValueIRS element (for citing)
Total Book Value Other Assets46896187TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
POST RETIREMENT LIABILITES$14,405,906
ESTIMATED MALPRACTICE LIABILITIES$20,331,498
OTHER SELF INSURED LIABILITIES$23,833,939
THIRD PARTY PAYOR & OTHER LIABILITIES$31,747,132
NOTES PAYABLE$6,671,905
FieldValueIRS element (for citing)
Total Of Amounts96990380TotalOfAmounts
Total Revenue512217872TotalRevenue
Total Expenses483501282TotalExpenses
Excess Or Deficit For Year28716590ExcessOrDeficitForYear
Net Unrealized GL On Investments-20922660NetUnrealizedGLOnInvestments
Other-$4,536,888OtherAmount
Total Adjustments-25459548TotalAdjustments
Excess Or Deficit Per FS3257042ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt490909939TotRevenueEtcAuditedFinclStmt
Other Revenues7995607OtherRevenues
Revenue Not Rptd F9907995607RevenueNotRptdF990
Revenue Subtotal482914332RevenueSubtotal
Other Revenues Not Included29303540OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt29303540RevenueNotRptdOnFinStmt
Total Revenue Per Form990512217872TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt473363526TotExpensesEtcAuditedFinclStmt
Other Expenses Included13815206OtherExpensesIncluded
Expenses Not Rptd F99013815206ExpensesNotRptdF990
Expenses Subtotal459548320ExpensesSubtotal
Other Expenses Not Included23952962OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt23952962ExpensesNotRptdOnFinStmt
Total Expenses Per Form990483501282TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:ST. FRANCIS HOSPITAL (HOSPITAL) IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES PERSUANT TO SECTION 501(A) OF THE CODE. THERE ARE NO TRANSACTIONS THAT MANAGEMENT HAS DEEMED TO BE "UNRELATED BUSINESS INCOME" AND THEREFORE NO TAX LIABILITY HAS BEEN RECONGNIZED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT OF BEING SUSTAINED.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN NET ASSETS DEFINED BENEFIT PLAN -956,000. LOSS ON DEBT EXTINGUISHMENT -780,888. WORKING CAPITAL TRANSFER TO ST. FRANCIS CARDIAC PREVENTION SERVICES P.C. -2,800,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -4,536,888.
PART XII, LINE 2D - OTHER ADJUSTMENTS:ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC REVENUE 5,804,749. ST. FRANCIS CARDIAC PREVENTION SERVICES PC REVENUE 2,037,409. NET ASSETS RELEASED FROM RESTRICTION 153,449.
PART XII, LINE 4B - OTHER ADJUSTMENTS:TEMPORARY RESTRICTED NET ASSET INVESTMENT INCOME 192,966. TRANSFER FROM ST. FRANCIS RESEARCH & EDUCATIONAL CORP 1,302,376. TRANSFER FROM ST. FRANCIS HOSPITAL FOUNDATION 2,463,275. TEMPORARY RESTRICTED NET ASSET DONATIONS 102,895. INVESTMENT INCOME 25,242,028.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:ST. FRANCIS CARADIAC PREVENTION SERVICES PC EXPENSES 3,084,294. ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC EXPENSES 10,730,912.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:TRANSFER TO CATHOLIC HEALTH SERVICES OF LONG ISLAND 334,192. TRANSFER TO CHS SERVICES INC 5,695,770. TRANSFER TO MERCY MEDICAL CENTER 6,423,000. TRANSFER TO ST FRANCIS CARDIOVASCULAR PHYSICIANS PC 11,500,000.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage300.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4259867TotalCommunityBenefitExpense
Direct Offsetting Revenue1387567DirectOffsettingRevenue
Net Community Benefit Expense2872300NetCommunityBenefitExpense
Percent Of Total Expense0.00590PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense13647587TotalCommunityBenefitExpense
Direct Offsetting Revenue9980923DirectOffsettingRevenue
Net Community Benefit Expense3666664NetCommunityBenefitExpense
Percent Of Total Expense0.00760PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense261524TotalCommunityBenefitExpense
Direct Offsetting Revenue256381DirectOffsettingRevenue
Net Community Benefit Expense5143NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense18168978TotalCommunityBenefitExpense
Direct Offsetting Revenue11624871DirectOffsettingRevenue
Net Community Benefit Expense6544107NetCommunityBenefitExpense
Percent Of Total Expense0.01350PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1585999TotalCommunityBenefitExpense
Direct Offsetting Revenue27856DirectOffsettingRevenue
Net Community Benefit Expense1558143NetCommunityBenefitExpense
Percent Of Total Expense0.00320PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense1382532TotalCommunityBenefitExpense
Direct Offsetting Revenue235594DirectOffsettingRevenue
Net Community Benefit Expense1146938NetCommunityBenefitExpense
Percent Of Total Expense0.00240PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense8134292TotalCommunityBenefitExpense
Direct Offsetting Revenue5923663DirectOffsettingRevenue
Net Community Benefit Expense2210629NetCommunityBenefitExpense
Percent Of Total Expense0.00460PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense733229TotalCommunityBenefitExpense
Direct Offsetting Revenue334209DirectOffsettingRevenue
Net Community Benefit Expense399020NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense498057TotalCommunityBenefitExpense
Net Community Benefit Expense498057NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense12334109TotalCommunityBenefitExpense
Direct Offsetting Revenue6521322DirectOffsettingRevenue
Net Community Benefit Expense5812787NetCommunityBenefitExpense
Percent Of Total Expense0.01200PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense30503087TotalCommunityBenefitExpense
Direct Offsetting Revenue18146193DirectOffsettingRevenue
Net Community Benefit Expense12356894NetCommunityBenefitExpense
Percent Of Total Expense0.02550PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$657,569BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare186790072AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare227092951CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-40302879MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1100 PORT WASHINGTON BLVDAddressLine1
CityROSLYNCity
StateNYState
ZIP Code11576ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours
OtherCARDIOVASCULAR SVCSOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent300.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
ST FRANCIS RESEARCH & EDUCATIONAL CORP
101 NORTHERN BLVDOLD BROOKVILLENY11545RESEARCH, COMMUNITY ED,CARDIAC REHAB, WOMEN'S HEALTH CTR
ST FRANCIS SOUTHBAY CARDIOVASCULAR CLIN
540 UNION BLVDWEST ISLIPNY11795OUTPATIENT CARDIOVASCULAR SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 7: 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 1, 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 90% OF A HOSPITAL'S "NEED" IS BASED ON BAD DEBTS AND CHARITY CARE WRITE OFFS, AND 10% IS BASED ON A "UNITS OF SERVICE" METHODOLOGY FOR UNINSURED PATIENTS. THE HOSPITAL HAS APPORTIONED THE ICP REVENUES BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBTS AND CHARITY CARE FOR 2011. PART I, LINE 7, COLUMN F:THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN A, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2.6 MILLION.
PART III, LINE 4: COSTING METHODOLOGY: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 DETERMINE THE AMOUNT REPORTED IN PART III, LINE 2.TEXT OF FOOTNOTE DISCUSSING BAD DEBT:THE ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THIS ALLOWANCE BASED UPON HISTORICAL 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 UNCOLLECTABLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTIONS AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE.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 PATIENTS 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, LINE 8: COSTING METHODOLOGY:THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2011 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 METHODOLGY. PART III LINE 8- MEDICARE SHORTFALL AS COMMUNITY BENEFIT:LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. ST FRANICS INCURRED A LOSS OF APPROXIMATELY $40.3 MILLION TO DELIVER CARE TO MEDICARE PATIENTS. 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: NEEDS ASSESSMENT: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 MEDICAL SCREENINGS AND EDUCATION TO THE UNDERSERVED FOLLOWING WORSHIP SERVICES ON A BIMONTHLY BASIS, 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. ADDITIONALLY, COMMUNITY NEEDS SURVEYS ARE COMPLETED BY PARTICIPANTS ATTENDING THE HOSPITAL'S HEALTH SCREENINGS AT LIBRARIES AND SENIOR CENTERS THROUGHOUT THE COUNTY.
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 POST ITS CHARITY CARE POLICY SUMMARY ON THEIR 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 HOSPITALS PRIMARY AND SECONDARY SERVICE AREAS INCLUDE 85% OF HOSPITAL DISCHARGES. THE PRIMARY SERVICE AREA IS NASSAU COUNTY, FROM WHICH THE HOSPITAL OBTAINED 55.3% OF ITS DISCHARGES IN 2011 (UP FROM 53.6% IN 2010). THE SECONDARY SERVICE AREA PROVIDES ANOTHER 29.8% OF DISCHARGES (DOWN FROM 31.6%) AND COMPRISES TWO AREAS, WEST AND EAST. THE WEST AREA CONSISTS OF 29 ZIP CODES IN QUEENS AND PROVIDED 15.6% OF ST. FRANCIS DISCHARGES (DOWN FROM 16.5%). THE EAST AREA CONSISTS OF 28 ZIP CODES IN SUFFOLK COUNTY AND PROVIDED 14.2% OF ST. FRANCIS DISCHARGES (DOWN FROM 15.0%).
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 2011:O ON NOVEMBER 14, 2011, ST. FRANCIS HOSPITAL OPENED THE NEW BISHOP MCHUGH HEALTH CENTER IN HICKSVILLE WITH A FOCUS ON PROVIDING PRIMARY CARE TO THE UNINSURED AND UNDERINSURED. THE CENTERS MEDICAL STAFF PROVIDES PHYSICAL EXAMINATIONS, LAB WORK, X-RAYS, FLU SHOTS, IMMUNIZATIONS AND SPECIALTY REFERRALS AS NEEDED. O 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 CONDUCTED 731 BLOOD PRESSURE/DIABETES SCREENINGS AND/OR FLU SHOTS AT HEALTHY SUNDAYS EVENTS IN 2011. THIS PROGRAM CONTINUES TO PROVIDE A VITAL LINK TO PRIMARY CARE REFERRALS FOR THE MEDICALLY UNDERSERVED. O ST. FRANCIS HOSPITALS 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 HAS BEEN ONSITE AT 196 LOCATIONS IN QUEENS, NASSAU AND SUFFOLK COUNTIES DURING THE PAST YEAR. DURING THESE OUTREACH VISITS, ST. FRANCIS HOSPITAL PHYSICIANS AND NURSES PROVIDED 5,369 HEALTH SCREENINGS AND/OR FLU SHOTS TO PATIENTS WITHOUT ADEQUATE HEALTH COVERAGE.O 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 315 CARDIAC SCREENINGS AT NO COST TO LOCAL HIGH SCHOOL ATHLETES IN 2011. 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 ATHLETES HEART, ESPECIALLY DURING STRENUOUS PHYSICAL ACTIVITY. O ST. FRANCIS HOSPITAL PARTICIPATED IN THE ANNUAL DAILY NEWS PROSTATE SCREENING PROGRAM DURING THE WEEK OF FATHERS DAY AND ALSO HELD A SECOND EVENT IN SEPTEMBER AT THE HOSPITAL. IN 2011, A TOTAL OF 413 MEN WERE SCREENED THROUGH THESE PROGRAMS.O ST. FRANCIS HOSPITAL PROVIDED 1,103 FREE BLOOD PRESSURE SCREENINGS AT THE HOSPITAL AND COMMUNITY SITES INCLUDING THE PORT WASHINGTON PUBLIC LIBRARY, WESTBURY PUBLIC LIBRARY, ST. BRIGIDS SENIOR CENTER IN WESTBURY, GREAT NECK SENIOR CENTER, EAST WILLISTON PUBLIC LIBRARY, AND ATRIA ON ROSLYN HARBOR. O IN A JOINT EFFORT TO PREVENT UNINTENTIONAL INJURY AMONG SENIORS, ST. FRANCIS HOSPITAL PARTNERED WITH THE NASSAU COUNTY DEPARTMENT OF HEALTH AND OTHER NASSAU COUNTY HOSPITALS ON A FALLS PREVENTION TASK FORCE. AS A RESULT, ST. FRANCIS HOSPITAL ACHIEVED A 40% REDUCTION IN FALLS AMONG ITS OUTPATIENT POPULATION PARTICIPATING IN ITS CARDIAC AND PULMONARY REHABILITATION CLASSES. THREE DIFFERENT BALANCE TRAINING WORKSHOPS HAVE BEEN ADDED TO ITS COMMUNITY HEALTH AND EDUCATION PROGRAMMING.
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 AFOREMNETIONED 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, 2011 CHS WAS COMPRISED OF SIX HOSPITALS (MERCY MEDICAL CENTER AND ST. FRANCIS HOSPITAL IN NASSAU COUNTY; GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL AND ST. CATHERINE OF SIENA MEDICAL CENTER IN SUFFOLK COUNTY AND AS PASSIVE PARENT TO ST. JOSEPH HOSPITAL IN NASSAU COUNTY), THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING HOME; GOOD SAMARITAN NURSING HOME AND OUR LADY OF CONSOLATION RESIDENCE, ALL IN SUFFOLK COUNTY), A REGIONAL HOME CARE AND HOSPICE NETWORK AND A COMMUNITY BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 17,000 STAFF AND 3,800 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CHS PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES.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. EACH OF CHS' MEMBER ORGANIZATIONS HAS RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY, 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, PROVIDES FREE HEALTH SCREENINGS THROUGH THE HEALTHY SUNDAY PROGRAMS, HEALTH FAIRS AND OTHER PROGRAMS WHICH 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 HOSPTIALS 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 HEALTHCARE 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. TO SUPPORT WORKING CAPITAL NEEDS AND LOSSES INCURRED FROM PROVIDING THESE SERVICES, ST. FRANCIS HAS TRANSFERRED TO MERCY MEDICAL CENTER $6.4 MILLION DOLLARS IN 2011.
NYREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
MERCY MEDICAL CENTER
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY115701116350886423000WORKING CAPITAL SUBSIDY TO OFFSET LOSSES INCURRED FOR PROVIDING UNCOMPENSATED CARE THROUGH A BROAD RANGE OF COMMUNITY SERVICE PROGRAMS AND CHARITABLE ACTIVITIES.
DIOCESE OF ROCKVILLE CENTRE-CATHOLIC MINISTRY
50 NORTH PARK AVENUEROCKVILLE CENTRENY11570111837437378830TO PROVIDE GENERAL SUPPORT OF 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
ST FRANCIS CARDIOVASCULAR PHYSICIANS PC
100 PORT WASHINGTON BLVDROSLYNNY1157611361399711500000WORKING CAPITAL SUBSIDY TO OFFSET LOSSES
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
ExplanationPART I LINE 2-PROCEDURE FOR MONITORING GRANT FUND USE: MERCY MEDICAL CENTER IS A RELATED ORGANIZATION WHICH REPORTS TO ST. FRANCIS HOSPITAL REGULARLY THE NEED FOR FUNDS WHICH ST FRANCIS HOSPITAL THEN PROVIDES VIA WIRE TRANSFER. THE DIOCESE OF ROCKVILLE CENTRE PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL, WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI. ST. FRANCIS CARDIOVASCULAR PHYSICIANS P.C IS A RELATED ORGANIZATION WHICH REPORTS TO ST. FRANCIS HOSPITAL REGULARY THE NEED FOR WORKING CAPITAL FUNDS WHICH ST. FRANCIS HOSPITAL PAYS ON THEIR BEHALF.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ALAN D GUERCI MD
760965034530001151991056709802982902855183000
RUTH HENNESSEY
42590701523000291901079050249980714029000
WILLIAM ARMSTRONG
4879070160000095240004363360266340206327707766310
JACK SOTERAKIS MD
3792520850000221823019353017138072256601604650
RICHARD SHLOFMITZ MD
284238203878680423301935302676303280599000
ANN CELLA
312054016000006645490831280101480122987903024760
ANTONIO MADRID
7974480248000072001935301733501082856000
GEORGE PETROSSIAN
91241904528310166101935302517801411442000
THEOFANI TSIAMTSIOURIS
7960490324000072001935302583201165954000
THOMAS PAPPAS
79618304500000309601935302681601295448000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BPART I, LINE 4B: PARTICIPATION IN THE PLAN AS FOLLOWS: ALAN GUERCI M.D. $547,745, WILLIAM ARMSTRONG - $416,983, RUTH HENNESSEY - $88,552, ANN CELLA $63,775. SERP DISTRIBUTION RELATED TO PRIOR YEARS PARTICIPATION AS FOLLOWS: WILLIAM ARMSTRONG $776,631; JACK SOTERAKIS $160,465; AND ANN CELLA $302,476.
PART IIITHE AMOUNTS REFLECTED IN COLUMN B(III) AND COLUMN C FOR THE INDIVIDUALS INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP"). THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2011 FORM W-2 BOX, 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NONQUALIFIED RETIREMENT PLANS.SUPPLEMENTAL INFORMATION

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1DORMITORY AUTHORITY OF THE STATE OF NYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN146000293IssuerEIN
CUSIP Number64983TH30CUSIPNumber
Date Issued2004-11-09DateIssued
Issue Price100477098IssuePrice
Description Of PurposeHOSPITAL CONSTRUCTIONDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds99387011TotalProceeds
Amount In Reserve Fund6701811AmountInReserveFund
Issuance Costs From Proceeds2511451IssuanceCostsFromProceeds
Capital Expenditures96875560CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonRICHARD SHLOFMITZ MDNamePerson
Loan From OrganizationXLoanFromOrganization
Original Principal$1,000,000OriginalPrincipalAmount
Balance Due842512BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due842512TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6THE 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 PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE).
FORM 990, PART VI, SECTION A, LINE 7ACHS 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, SECTION A, LINE 7BCHS AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF ST. FRANCIS HOSPITAL IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERING BODY OF ST. FRANCIS.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990, AND APPROPRIATE SCHEDULES, IS COMPLETED BY THE ACCOUNTING AND FINANCE STAFF OF THE ORGANIZATION AND REVIEWED INTERNALLY BY MANAGEMENT. IT IS THEN REVIEWED BY OUTSIDE TAX ADVISORS. 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 DETAILED 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, SECTION B, LINE 12CDISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE BY THE ORGANIZATION'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURE SHALL BE GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE BOARD OF TRUSTEES FOR REVIEW. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT NO CONFLICT EXISTS, THE MATTER SHALL BE REFFERED FOR REVIEW BY THE CHS COMPLIANCE AND AUDIT COMMITTEE BEFORE THE DETERMINATION BECOMES FINAL. IF A CONFLICT OF INTEREST IS IDENTIFIED AND A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS AND WISHES TO GO FORTH WITH IT, THE CHAIR OF THE ORGANIZATION'S BOARD OF TRUSTEES SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. UPON RECEIPT OF THE WRITTEN REQUEST AND ANY SUPPORTING DOCUMENTS, THE CHS COMPLIANCE AND AUDIT COMMITTEE SHALL MAKE THE FINAL DECISION AS TO WHETHER CHS SHALL ENTER INTO THE TRANSACTION OR ARRANGEMENT.
FORM 990, PART VI, SECTION B, LINE 15THE CHIEF EXECUTIVE OFFICER SUBMITS FOR APPROVAL TO THE CORPORATE CEO RECOMMENDATIONS FOR BASE SALARY ADJUSTMENTS AND INCENTIVE AWARDS FOR "DISQUALIFIED PERSONS" AS DEFINED IN THE POLICY. ONCE APPROVED BY THE CORPORATE CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE FOR REVIEW. 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. 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, SECTION C, LINE 19GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILIED 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 GUERCI, M.D. PRESIDENT AND CEO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS 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); MERCY MEDICAL CENTER (11-1635088) WILLIAM ARMSTRONG, SENIOR VICE PRESIDENT AND CFO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS 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); MERCY MEDICAL CENTER (11-1635088)COMPENSATION OF OFFICERS
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -20,922,660. CHANGE IN NET ASSETS DEFINED BENEFIT PLAN -956,000. LOSS ON DEBT EXTINGUISHMENT -780,888. WORKING CAPITAL TRANSFER TO ST. FRANCIS CARDIAC PREVENTION SERVICES P.C. -2,800,000. TOTAL TO FORM 990, PART XI, LINE 5: -25,459,548.CHANGES IN NET ASSETS OR FUND BALANCES:
CONTROLLED GROUP ELECTION STATEMENTTHE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS, AS DEFINED IN SECTION 179(D)(7), HEREBY CONSENT TO THE APPORTIONMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2011 ELECTION TO ALLOCATE $40,000 ALTERNATIVE MINIMUM TAX EXEMPTION THE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS(WITHIN THE MEANING OF SECTION 1563(A)), HEREBY CONSENT UNDER REGULATION 1.58-1(C)(3) TO THE APPORTIONMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2011. ELECTION TO ALLOCATE $150,000 ALTERNATIVE MINIMUM TAX PHASE-OUT THE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS (WITHIN THE MEANING OF SECTION 1563(A)), HEREBY CONSENT UNDER REGULATION 1.58-1(C(3) TO THE APPOINTMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2011. EMPLOYER ID NO. $128,00 $40,000 $150,000 11-3403968 NONE NONE NONE 14-1801961 NONE NONE NONE 11-3594561 NONE NONE NONE 11-3555766 NONE NONE NONE 11-1888924 NONE NONE NONE 77-0611240 NONE NONE NONE 11-2537396 NONE NONE NONE 11-2958438 NONE NONE NONE 11-3434776 NONE NONE NONE 11-2861698 NONE NONE NONE 11-2861690 NONE NONE NONE 11-3638367 NONE NONE NONE 11-1635088 NONE NONE NONE 11-2126736 NONE NONE NONE 11-3284066 NONE NONE NONE 20-8067039 NONE NONE NONE 11-2499790 NONE NONE NONE 06-1569129 NONE NONE NONE 06-1562701 NONE NONE NONE 11-1871039 NONE NONE NONE 41-2076312 NONE NONE NONE 11-3613997 NONE NONE NONE 11-2050523 NONE NONE NONE 11-2916033 NONE NONE NONE 11-3090867 NONE NONE NONE 11-2110488 NONE NONE NONE 11-2983148 NONE NONE NONE 11-2716640 NONE NONE NONE 11-3559713 NONE NONE NONE 11-1635088 NONE NONE NONE 55-0813603 NONE NONE NONE 27-1459941 NONE NONE NONE IN PROCESS NONE NONE NONE 26-3169427 NONE NONE NONE 45-0517566 NONE NONE NONE 27-1531084 NONE NONE NONE 11-2798383 NONE NONE NONE 11-2801136 NONE NONE NONE 11-2838185 $128,000 $40,000 $150,000 11-3319259 NONE NONE NONE 06-1568934 NONE NONE NONE 11-3307977 NONE NONE NONE 11-2126736 NONE NONE NONEELECTION TO ALLOCATE BUSINESS ASSET EXPENSE
EMPLOYER NAME, ADDRESS & TAX YEAR-END ID NO. 11-3403968 CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/11 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/11 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/11 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/11 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 26-3169427 CATHOLIC HOME CARE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 27-1531084 OUR LADY OF CONSOLATION FOUNDATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/11 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/11CONTROLLED GROUP ELECTION - CONTINUED
THE AMOUNTS IN EACH TAXABLE INCOME BRACKET IN THE TAX TABLE IN SECTION 11(B) HAVE BEEN ALLOCATED TO THE CORPORATIONS LISTED BELOW PURSUANT TO REGULATION 1.1561-3(A). THE ORIGINAL COPY OF THIS STATEMENT IS FILED WITH THE INTERNAL REVENUE SERVICE CENTER IN OGDEN, UTAH. AUTHORIZATION CONSENT FOR ALLOCATION ON BEHALF OF MEMBER COMPANIES ____________________________________________ EMPLOYER ID NO. $50,000 $25,000 $9,925,000 BRACKET BRACKET BRACKET 11-3403968 NONE NONE NONE 14-1801961 NONE NONE NONE 11-3594561 NONE NONE NONE 11-3555766 NONE NONE NONE 11-1888924 NONE NONE NONE 77-0611240 NONE NONE NONE 11-2537396 NONE NONE NONE 11-2958438 NONE NONE NONE 11-3434776 NONE NONE NONE 11-2861698 NONE NONE NONE 11-2861690 NONE NONE NONE 11-3638367 NONE NONE NONE 11-1635088 NONE NONE NONE 11-2126736 NONE NONE NONE 11-3284066 NONE NONE NONE 20-8067039 NONE NONE NONE 11-2499790 NONE NONE NONE 06-1569129 NONE NONE NONE 06-1562701 NONE NONE NONE 11-1871039 NONE NONE NONE 41-2076312 NONE NONE NONE 11-3613997 NONE NONE NONE 11-2050523 NONE NONE NONE 11-2916033 NONE NONE NONE 11-3090867 NONE NONE NONE 11-2110488 NONE NONE NONE 11-2983148 NONE NONE NONE 11-2716640 NONE NONE NONE 11-3559713 NONE NONE NONE 11-1635088 NONE NONE NONE 55-0813603 NONE NONE NONE 27-1459941 NONE NONE NONE IN PROCESS NONE NONE NONE 26-3169427 NONE NONE NONE 45-0517566 NONE NONE NONE 27-1531084 NONE NONE NONE 11-2798383 NONE NONE NONE 11-2801136 NONE NONE NONE 11-2838185 $50,000 $25,000 $9,925,000 11-3319259 NONE NONE NONE 06-1568934 NONE NONE NONE 11-3307977 NONE NONE NONE 11-2126736 NONE NONE NONESTATEMENT OF TAX BRACKET ALLOCATION
EMPLOYER NAME, ADDRESS & TAX YEAR-END ID NO. 11-3403968 CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/11 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/11 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/11 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/11 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 26-3169427 CATHOLIC HOME CARE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 27-1531084 OUR LADY OF CONSOLATION FOUNDATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/11 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/11STATEMENT OF TAX BRACKET ALLOCATION - CONTINUED

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (36 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CATHOLIC HEALTH SYSTEM OF LONG ISLAND
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570113403968SUPPORT ORGNY501(C)(3)LINE 11A, IN/A0
CHS SERVICES INC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570113555766SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
CHS AMBULANCE SERVICES INC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570141801961DORMANTNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
GOOD SAMARITAN HOSPITAL MEDICAL CENTER
1000 MONTAUK HIGHWAYWEST ISLIPNY11795111888924HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112537396SELF INSURANCENY501(C)(3)LINE 11A, I0GOOD SAMARITAN HOSPITAL
MARYHAVEN TRANSPORTATION SERVICES
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113434776TRANSPORTATION SERVICESNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
MARYHAVEN CENTER OF HOPE
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112861698PROGRAMS/HOUSING FOR THE DEVELOPMENTALLY DISABLEDNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
MARYHAVEN SCHOOL CORPORATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112861690SCHOOL FOR DEVELOPMENTALLY DISABLEDNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
THE CENTER OF HOPE FOUNDATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113638367SUPPORT ORGNY501(C)(3)LINE 11A, I0MARYHAVEN CENTER OF HOPE
MERCY MEDICAL CENTER
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570111635088HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
CATHOLIC HOME CARE
1150 PORTION ROAD SUITE 1HOLTSVILLENY11742112126736HOME CARENY501(C)(3)LINE 90CATHOLIC HEALTH SYSTEM OF LONG ISLAND
OUR LADY OF CONSOLATION GERIATRIC CARE CENTER
111 BEACH DRIVEWEST ISLIPNY11795113284066LT NURSING CARENY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
RIVERHEAD HOSTEL HOLDING CORPORATION
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776112499790RENTINGNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
SIENA VILLAGE INC
50 ROUTE 25ASMITHTOWNNY11787061569129SENIOR HOUSINGNY501(C)(3)LINE 90ST CATHERINE OF SIENA MEDICAL CENTER
ST CATHERINE OF SIENA MEDICAL CENTER
50 ROUTE 25ASMITHTOWNNY11787061562701HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST CHARLES HOSPITAL
200 BELLE TERRE ROADPORT JEFFERSON STATIONNY11777111871039HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
CHS HOME SUPPORT SERVICES INC
15 POWER DRIVEHAUPPAUGENY11788113594561RESPIRATORY THERAPY SVC/MED. EQUIP.NY501(C)(3)LINE 90CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST FRANCIS HOSPITAL FOUNDATION
100 PORT WASHINGTON BLVDROSLYNNY11576112916033SUPPORT ORGNY501(C)(3)LINE 11A, I0ST FRANCIS HOSPITAL
ST FRANCIS HOSPITAL RESEARCH & EDUCATIONAL CORP
100 PORT WASHINGTON BLVDROSLYNNY11576113090867RESEARCH ORGANIZATIONNY501(C)(3)LINE 90ST FRANCIS HOSPITAL
WSNCHS NORTH INC
4295 HEMPSTEAD TURNPIKEBETHPAGENY11714113438973HOSPITALNY501(C)(3)LINE 30CATHOLIC HEALTH SYSTEM OF LONG ISLAND
SUFFOLK HEARING & SPEECH CENTER INC
369 EAST MAIN STREETEAST ISLIPNY11730112110488DIAGNOSTIC TESTINGNY501(C)(3)LINE 30GOOD SAMARITAN HOSPITAL
THE ST CHARLES CORPORATION
200 BELLE TERRE ROADPORT JEFFERSONNY11777112983148SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
THE SAMARITAN CORPORATION
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570112716640SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
WISDOM GARDENS HOUSING DEVELOPMENT FUND INC
51 TERRYVILLE ROADPORT JEFFERSON STATIONNY11776113559713SENIOR HOUSINGNY501(C)(3)LINE 90MARYHAVEN CENTER OF HOPE
GOOD SHEPHERD HOSPICE
245 OLD COUNTRY ROADMELVILLENY11747112958438HOSPICE SERVICESNY501(C)(3)LINE 90GOOD SHEPHERD HOSPICE
ST CHARLES HOSPITAL FOUNDATION
200 BELLE TERRE ROADPORT JEFFERSONNY11777412076312SUPPORT ORGNY501(C)(3)LINE 11A, I0ST CHARLES HOSPITAL
GOOD SAMARITAN HOSPITAL FOUNDATION
1000 MONTAUK HIGHWAYWEST ISLIPNY11795770611240SUPPORT ORGNY501(C)(3)LINE 11A, I0GOOD SAMARITAN HOSPITAL
ST FRANCIS-MERCY CORPORATION
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570111635088SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
MERCY MEDICAL CENTER FOUNDATION
1000 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570550813603SUPPORT ORGNY501(C)(3)LINE 11A, I0MERCY MEDICAL CENTER
ST CATHERINE OF SIENA MEDICAL CENTER FOUNDATION
50 ROUTE 25ASMITHTOWNNY11787271459941SUPPORT ORGNY501(C)(3)LINE 11A, I0ST CATHERINE OF SIENA MEDICAL CENTER
CATHOLIC HOME CARE FOUNDATION
1150 PORTION ROAD SUITE 1HOLTSVILLENY11742SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HOME CARE
GOOD SHEPHERD HOSPICE FOUNDATION
245 OLD COUNTRY ROADMELVILLENY11747263169427SUPPORT ORGNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
OUR LADY OF CONSOLATION FOUNDATION
111 BEACH DRIVEWEST ISLIPNY11795450517566SUPPORT ORGNY501(C)(3)LINE 11A, I0OUR LADY OF CONSOLATION
RVC SUPPORT
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570271531084REAL ESTATENY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND
ST FRANCIS CARDIOVASCULAR PHYSICIANS PC
100 PORT WASHINGTON BLVDROSLYNNY11576113613997HEALTHCARE SERVICESNY501(C)(3)LINE 11A, I0ST FRANCIS HOSPITAL
RVC INSURANCE COMPANYINC
992 NORTH VILLAGE AVENUEROCKVILLE CENTRENY11570208067039CAPTIVE INSURANCE COMPANYNY501(C)(3)LINE 11A, I0CATHOLIC HEALTH SYSTEM OF LONG ISLAND

Form990 Schedule R Part IV Form990ScheduleRPartIV (13 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
RADIOLOGY CONSULTING OF LONG ISLAND PLLC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795421646134HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
SAMARITAN EMERGENCY MEDICAL SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208243412DIAGNOSTIC TESTINGNYGOOD SAMARITAN HOSPITALC
SAMARITAN PEDIATRIC SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208180263HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
SAMARITAN MEDICAL SERVICES PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208088453DIAGNOSTIC TESTINGNYGOOD SAMARITAN HOSPITALC
SOUTHWEST SUFFOLK MEDICAL PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795061603195HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
CARDIAC EKG INTERPRETATION PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112924518HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
LI REGIONAL ARTHRITIS & OSTEOPOROSIS CARE PC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795208964140HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
SAMARITAN MANAGEMENT SERVICES INC
1000 MONTAUK HIGHWAYWEST ISLIPNY11795112838185HEALTHCARE SERVICESNYCATHOLIC HEALTH SYSTEM OF LONG ISLANDC
FAIRVIEW HILL MANAGEMENT CO INC
200 BELLE TERRE ROADPORT JEFFERSONNY11777112798383SERVICESNYST CHARLES CORPORATIONC
ADVANCED REHABILIATION MEDICINE PLLC
200 BELLE TERRE ROADPORT JEFFERSONNY11777113640709HEALTHCARE SERVICESNYST CHARLES HOSPITALC
ST FRANCIS CARDIAC PREVENTION SERVICES PC
100 PORT WASHINGTON BLVDROSLYNNY11576113224885HEALTHCARE SERVICESNYST FRANCIS HOSPITALC
SOUTH SHORE PRACTICE MANAGEMENT
1000 MONTAUK HIGHWAYWEST ISLIPNY11795113307977HEALTHCARE SERVICESNYGOOD SAMARITAN HOSPITALC
MERCY INTERNAL MEDICINE PC
992 N VILLAGE AVENUEROCKVILLE CENTRENY11710510639649HEALTHCARE SERVICESNYMERCY MEDICAL CENTERC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (18 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
ST FRANCIS PHO
P2
CATHOLIC HEALTH SERVICES OF LONG ISLAND 11-3405968
P-442757COST
GOOD SAMARITAN HOSPITAL MEDICAL CENTER 11-1888924
P121295COST
MERCY MEDICAL CENTER 11-1635088
B11908COST
ST CATHERINES OF SIENA MEDICAL CENTER 06-1562701
P-88664COST
CHS SERVICES INC 11-3555766
O237341COST
MARYHAVEN CENTER OF HOPE 11-2861698
O25970COST
RVC INSURANCE COMPANY 20-8067039
P-241673COST
OUR LADY OF CONSOLATION GERIATRIC CARE 11-3284066
P-108437COST
CATHOLIC HOME CARE
P47722
ST FRANCIS HOSPITAL FOUNDATION 11-2916053
O2012414COST
ST FRANCIS RESEARCH & EDUCATIONAL CORP 11-3090867
P-1071381COST
ST FRANCIS CARDIAC PREVENTION SERVICES PC
P-1540769COST
ST FRANCIS CARDIOVASCULAR PHYSICIAN'S PC
D-6585033COST
ST CHARLES HOSPITAL AND REHABILITATION 11-1871059
P-8217
ST JOSEPH HOSPITAL
P2998
GOOD SHEPHERD HOSPICE 11-2958438
O-1175
CHS HOME SUPPORT SERVICE INC 11-3594561
P10

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierTRANSACTIONS WITH RELATED ORGANIZATIONSIdentifier
Return ReferenceSCHEDULE R PART V LINE 2ReturnReference
ExplanationST. FRANCIS HOSPITAL HAS DISCLOSED IN SCHEDULE R THE PREDOMINANT TRANSACTION TYPE WITH EACH FACILITY WITH WHICH IT HAS CONDUCTED TRANSACTIONS. HOWEVER, THERE ARE ADDITIONAL TRANSACTION TYPES TO DESCRIBE THE ACTIVITIES ST. FRANCIS HOSPITAL HAS ENGAGED IN WITH ITS RELATED PARTY ORGANIZATIONS. THE FOLLOWING IS A LIST OF ADDITIONAL TRANSACTION TYPES BY FACILITY. CATHOLIC HEALTH SERVICE OF LONG ISLAND O,Q GOOD SAMARTIAN HOSPITAL MEDICAL CENTER O MERCY MEDICAL CENTER O,N,P ST. CATHERINES OF SIENA MEDICAL CENTER O CHS SERVICE INC. A,P MARYHAVEN CENTER OF HOPE P OUR LADY OF CONSOLATION GERIATRIC CARE O ST. FRANCIS HOSPITAL FOUNDATION N ST. FRANCIS RESEARCH AND EDUCATIONAL CORP J,N ST. FRANCIS CARDICA PREVENTION SERVICES PC D,I,N ST. FRANCIS CARDIOVASCULAR PHYSICIAN'S PC I,N,P ST. JOSEPH HOSPITAL OExplanation

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