2013-11-13T13:59:28-06:00 2012-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2012-01-01 113284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER % CHS SERVICES INC OURL 6315871600 111 BEACH DRIVE Suite WEST ISLIP NY 11795 JOSEPH TOMAINO 6315871600 2013-01-11 true 6464713000 2012 2016-02-24 21:20:13Z JOSEPH TOMAINO 111 BEACH DRIVE WEST ISLIP NY 11795 60116674 false 0928 X HTTP://OLC.CHSLI.ORG X 1894 NY CATHOLIC HEALTH SERVICES OF LONG ISLAND AND ITS MEMBERS, AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUE CHRIST'S HEALING MISSION, BY PROMOTING EXCELLENCE IN CARE AND COMMITTING ITSELF TO THOSE IN NEED. 19 18 863 200 0 122472 27979 60560750 59758066 117881 90130 205378 240499 61006481 60116674 19924 22269 0 0 40474408 42570695 0 0 0 18002475 17321255 58496807 59914219 2509674 202455 36302529 34498916 32085971 30004859 4216558 4494057 X OUR LADY OF CONSOLATION GERIATRIC CARE CENTER, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND, AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, AND ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. false false 53183913 22269 59783313 THE FACILITY PROVIDES SKILLED CARE FOR UP TO 2,314 RESIDENTS ON A DAILY BASIS. THE FACILITY PROVIDED CARE FOR 159,967 DAYS FOR THE YEAR 2012. 53183913 true false false true false false false false false false true false false true true true true false false false false false false false false false false true false true false false false false false false false false false false false false false true true true false false true 68 0 true 863 true false false false false false false false false false false X 19 18 false false false false true true true true true false false true true true true true true true true false X CHS SERVICES INC 6314656442 992 NORTH VILLAGE AVE ROCKVILLE CENTER NY 11570 X Hon Angie Carpenter 2.0 X X 0 0 0 Bernadette Curry PHD RN 2.0 X X 0 0 0 Charles Falkner 2.0 X X 0 0 0 Sister Dolores Castellano CIJ 2.0 X X 0 0 0 Donato Balsamo DO 2.0 X 0 6118 0 Robert Doyle 2.0 X 0 0 0 Philip Fava 2.0 X 0 0 0 Sr Margaret Kelliher DW 2.0 X 0 0 0 Walter Lace 2.0 X 0 0 0 Brother Campion Lally OSF 2.0 X 0 0 0 Timothy J Mattimore Esq 2.0 X 0 0 0 Rev Msgr Thomas Mulvanerty 2.0 X 0 0 0 Diane Sweeney 2.0 X 0 0 0 Richard Romer 2.0 X 0 0 0 Daniel Rowe 2.0 X 0 0 0 Charles SpenCer 2.0 X 0 0 0 Debbie Van Bourgondien 2.0 X 0 0 0 Sister Dolores Wisniewski 2.0 X 0 0 0 Joseph Tomaino 50.0 X X 785524 0 189739 Karen Estrada 50.0 X 251671 0 47294 Sister Marilyn Breen 37.5 X 0 0 0 Jeffrey Nichols 37.5 X 238057 0 32661 John Haight 50.0 X 225743 0 40448 Theresa Rosenthal 50.0 X 184538 0 39822 Lori Spina 37.5 X 220700 0 44256 Shenassa Nazila 37.5 X 148322 0 41305 Marisa Shiparo 37.5 X 148766 0 31129 Aekyung Lee 37.5 X 142231 0 31429 Christopher Lohan 37.5 X 137603 0 35073 James Ryan 50.0 X 143110 71685 41036 WILLIAM MEAD 50.0 X 0 367525 121538 2626265 445328 695730 25 true true false CHEM RX 750 PARK PLACE LONG BEACH NY 11561 PHARMACEUTICALS 977356 AIDES AT HOME 29 W MARIE ST HICKSVILLE NY 11801 PROFESSIONAL FEES 426603 AFFINITY REHABILITATION LLP 10600 YORK RD SUITE 105 COKEYSVILLE MD 21030 PROFESSIONAL FEES 412897 BESTCARE INC PO BOX 9010 LEVITTOWN NY 11756 PROFESSIONAL FEES 260568 SOUTH SHORE HOME HEALTH SRV 1225-2 MONTAUK HWY OAKDALE NY 11769 PROFESSIONAL FEES 174719 10 27979 27979 PATIENT REVENUE 623000 59758066 59758066 59758066 90130 90130 0 0 0 0 0 0 0 0 0 CAFETERIA & COFFEE SHOP 900099 143452 143452 TELEVISION & TELEPHONE RENTAL 900099 11482 11482 VENDING MACHINES 900099 4608 4608 80957 20639 60318 240499 60116674 59783313 305382 22269 22269 0 0 0 2204820 495079 1709741 0 0 28271454 27248699 1022755 0 2312706 2312706 0 0 7405458 6898093 507365 0 2376257 2376257 0 0 93465 10 93455 0 4410 0 4410 0 110800 0 110800 0 2348 0 2348 0 0 5746824 5518989 227835 0 0 766639 569598 197041 0 884133 0 884133 0 0 838177 838177 0 0 0 0 44261 27574 16687 0 291540 291540 0 0 108238 22269 85969 0 1424554 0 1424554 0 0 HOUSEKEEPING & LAUNDRY 859133 859133 MEDICAL EXPENSES 2091036 2090610 426 DIETARY FOOD & EXPENSES 1810987 1810987 OTHER 2244710 1801923 442787 59914219 53183913 6730306 0 2241980 230099 3340547 3448629 8795 17185 9395661 10198661 0 0 0 0 0 0 52729 29506 760882 102422 41424760 22861731 18822420 18563029 0 0 0 0 0 0 0 0 1679515 1909385 36302529 34498916 12045670 11728229 0 0 0 0 15207840 15110767 0 0 0 0 0 0 0 0 4832461 3165863 32085971 30004859 X 4197183 4437911 19375 56146 0 0 4216558 4494057 36302529 34498916 X 202455 75044 X X false true X true false X 164546 31811 168082 122472 27979 514890 55321813 57448983 57398506 60560750 59758066 290488118 0 0 0 55486359 57480794 57566588 60683222 59786045 291003008 0 0 0 291003008 203329 194953 127363 117881 90130 733656 0 203329 194953 127363 117881 90130 733656 0 374629 214983 198590 205378 240499 1234079 56064317 57890730 57892541 61006481 60116674 292970743 0.99328 0.98900 0.00250 0.00330 X false false false false false false false false true 2348 2348 false SCHEDULE C, PART II, LINE 1 LOBBYING ACTIVITIES OLC paid dues to LeadingAge NY, a trade associate, who is involved in lobbying activities. The total dues paid for 2012 was $27,958.72 which 6.20% was used for lobbying, amounting to the expense of $1,733.44. OLC also paid dues to CCLC (Continuing Care Leadership Coalition), a trade associate, who is involved in lobbying activities. The total dues paid for 2012 was $3,775.16 which 16.27% was used for lobbying, amounting to the expense of $614.22. 325000 325000 21598373 8848002 12750371 17974931 12812828 5162103 1526456 1200901 325555 18563029 EST RECEIVABLE FROM 3RD PARTY 25611 RESIDENT FUNDS 135301 OTHER ASSETS 43000 DEFERRED FINANCING COSTS 279350 INSURANCE CLAIMS RECEIVABLE 1426123 1909385 0 DUE TO RELATED PARTIES 1575334 PAYABLE DUE 3RD PARTY INSURERS 1455228 RESIDENT FUNDS 135301 3165863 X PART X, OTHER LIABILITIES LINE 2, FIN 48 FOOTNOTE THE CENTER 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 PURSUANT TO SECTION 501(A) OF THE CODE. THERE ARE NO TRANSACTIONS WHICH MANAGEMENT HAS DEEMED TO BE UNRELATED BUSINESS INCOME AND THEREFORE NO TAX LIABILITY HAS BEEN RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAN NOT. true DIOCESE OF ROCKVILLE CENTRE - CATHOLIC MINISTRIES 50 N PARK AVE ROCKVILLE CTR NY 11570 111837437 501(C)(3) 22269 NONE NONE GENERAL SUPPORT 1 SCHEDULE I, PART I, LINE 2 PROCEDURE FOR MONITORING GRANT FUND USE THE DIOCESE OF ROCKVILLE CENTRE PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL, WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI. SCHEDULE I, PART II, LINE 1, COLUMN (H) PURPOSE OF GRANT OR ASSISTANCE TO 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. X X X X X false true false false false false false false false Joseph Tomaino 619528 0 149200 0 16796 0 160810 0 28929 0 975263 0 0 0 Karen Estrada 241134 0 0 0 10537 0 21332 0 25962 0 298965 0 0 0 James Ryan 101614 71539 25000 0 16496 146 9964 6858 16249 7965 169323 86508 0 0 Jeffrey Nichols 235459 0 0 0 2598 0 20235 0 12426 0 270718 0 0 0 John Haight 168337 0 47000 0 10406 0 15161 0 25287 0 266191 0 0 0 Theresa Rosenthal 155316 0 20000 0 9222 0 14039 0 25783 0 224360 0 0 0 Lori Spina 190482 0 29600 0 618 0 17288 0 26968 0 264956 0 0 0 Shenassa Nazila 144757 0 0 0 3565 0 13314 0 27991 0 189627 0 0 0 Marisa Shiparo 148766 0 0 0 0 0 13377 0 17752 0 179895 0 0 0 Aekyung Lee 140511 0 0 0 1720 0 7413 0 24016 0 173660 0 0 0 Christopher Lohan 122942 0 0 0 14661 0 11024 0 24049 0 172676 0 0 0 WILLIAM MEAD 0 310892 0 45000 0 11633 0 96766 0 24772 0 489063 0 0 SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN JOSEPH TOMAINO $138,735 PARTICIPATION IN PLAN WILLIAM MEAD $76,741 PARTICIPATION IN PLAN SCHEDULE J, PART II COMPENSATION THE 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 2012 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. SCHEDULE J, PART II FORMER OFFICER DURING 2012, WILLIAM MEAD TRANSFERRED FROM HIS ROLE IN CONTINUING CARE DIVISION TO ANOTHER ROLE WITHIN THE CHS SYSTEM AND THEREFORE HAS BEEN LISTED AS A FORMER EMPLOYEE IN PART VII. FORM 990, PART VI, LINE 6 MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF OUR LADY OF CONSOLATION GERATRIC CARE CENTER IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND) (CHS). CHS IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE). FORM 990, PART VI, LINE 7A ELECTION OF THE GOVERNING BODY CHSIS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER, AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER. FORM 990, PART VI, LINE 7B DECISIONS OF THE GOVERNING BODY CHS AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER, IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERING BODY OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER. FORM 990, PART VI, LINE 11A REVIEW PROCESS OF FORM 990 THE FORM 990 AND APPROPRIATE SCHEDULES ARE COMPLETED BY OUTSIDE TAX ADVISORS AND REVIEWED INTERNALLY BY MANAGEMENT. THE FINAL DRAFT OF THE FORM 990 IS THEN PRESENTED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES (THE BOARD), WHICH HAS BEEN DELEGATED THE 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, LINE 12C CONFLICT OF INTEREST POLICY DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY (THE POLICY) BY BOARD AND BOARD COMMITTEE MEMBERS, EMPLOYEES AND OTHERS THAT SATISFY THE CRITERIA TO BE CONSIDERED AN INTERESTED PERSON IS SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE BY THE ORGANIZATION'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURES SHALL BE GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE BOARD OF TRUSTEES FOR REVIEW. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT NO CONFLICT EXISTS, THE MATTER SHALL BE REFERRED FOR REVIEW BY THE CHS COMPLIANCE AND AUDIT COMMITTEE BEFORE THE DETERMINATION BECOMES FINAL. IF A CONFLICT OF INTEREST IS IDENTIFIED AND IF A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS AND WISHES TO GO FORTH WITH IT, THE CHAIR OF THE ORGANIZATION'S BOARD OF TRUSTEES SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANZIATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST MUST RECUSE HIMSELF FROM ANY DECISION MAKING OR VOTING ON THE INTEREST THAT GAVE RISE TO THE CONFLICT. UPON RECEIPT OF THE WRITTEN REQUEST AND ANY SUPPORTING DOCUMENTS, THE CHS COMPLIANCE AND AUDIT COMMITTEE SHALL MAKE THE FINAL DECISION AS TO WHETHER CHS SHALL ENTER INTO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, LINE 15 COMPENSATION POLICY THE CHIEF 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. THE POLICY DEFINES A "DISQUALIFIED PERSON" AS A PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF CHS OR AN OPERATING ENTITY, AND IS EITHER A) A VOTING MEMBER OF THE BOARD OF DIRECTORS OR BOARD OF TRUSTEES; B) THE ENTITY'S PRESIDENT, CHIEF EXECUTIVE OFFICER, AND CHIEF OPERATING OFFICERS OR PERSONS HOLDING EQUIVALENT POSITIONS; C) THE ENTITY'S TREASURERS AND CHIEF FINANCIAL OFFICERS; D) THE PERSON'S COMPENSATION IS PRIMARILY BASED ON REVENUES DERIVED FROM ACTIVITIES OF CHS OR AN OPERATING ENTITY, OR OF A PARTICULAR DEPARTMENT OR FUNCTION OF CHS OR AN OPERATING ENTITY, THAT THE PERSON CONTROLS; E) THE PERSON HAS OR SHARES AUTHORITY TO CONTROL OR DETERMINE A SUBSTANTIAL PORTION OF CHS OR AN OPERATING ENTITY'S CAPITAL EXPENDITURES, OPERATING BUDGET, OR COMPENSATION FOR OTHER EMPLOYEES; F) THE PERSON MANAGES A DEPARTMENT OR ACTIVITY OF CHS OR AN OPERATING ENTITY THAT REPRESENTS A SUBSTANTIAL PORTION OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF CHS OR AN OPERATING ENTITY, COMPARED TO THE ORGANIZATION AS A WHOLE; OR G) FAMILY MEMBERS OF ANY OF THOSE DESCRIBED IN THE PRECEDING D, E, OR F. ONCE APPROVED BY THE CORPORATE CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. REVIEWS ARE DONE BY AN INDEPENDENT CONSULTANT ANNUALLY. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE BOARD OF TRUSTEES. FORM 990, PART VI, LINE 19 DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE; CHS CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND. FORM 990, PART VII SECTION A, LINE 1A - COMPENSATION OF OFFICERS HOURS FOR TRUSTEES ARE THE ESTIMATED WEEKLY HOURS (2.0) TRUSTEES CONTRIBUTE TO THIS AND ALL OTHER RELATED ORGANIZATIONS, NOT NECESSARILY EQUALLY BUT IN THE PROPORTION NECESSARY, FOR WHICH THEY RECEIVE NO COMPENSATION. JOSEPH TOMAINO, EVP CONTINUING CARE - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CENTER OF HOPE FOUNDATION (11-3638367), RIVERHEAD HOSTEL HOLDING CORP (11-2499790), OLGCC (11-3284066), MARYHAVEN TRANSPORTATION SERVICES (11-3434776), MARYHAVEN SCHOOL (11-2861690), MARYHAVEN CENTER OF HOPE (11-2861698), GOOD SHEPHERD HOSPICE (11-2958438), CHS HOME SUPPORT SERVICES (11-3594561), CATHOLIC HOME CARE (11-2126736) KAREN ESTRADA, SVP/CFO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: CENTER OF HOPE FOUNDATION (11-3638367), RIVERHEAD HOSTEL HOLDING CORP (11-2499790), OLGCC (11-3284066), MARYHAVEN TRANSPORTATION SERVICES (11-3434776), MARYHAVEN SCHOOL (11-2861690), GOOD SHEPHERD HOSPICE (11-2958438), CHS HOME SUPPORT SERVICES (11-3594561), CATHOLIC HOME CARE (11-2126736) FORM 990, PART X, LINE 20 TAX-EXEMPT BOND LIABILITIES THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 ARE ISSUED ON BEHALF OF THE CATHOLIC HEALTH SERVICES OF LONG ISLAND OBLIGATED GROUP PROJECT WHICH INCLUDES THE FILING ENTITY AND RELATED ENTITIES. TWO BONDS WERE ISSUED TO THE OBLIGATED GROUP, SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORPORATION (SERIES 2011 SUFFOLK BONDS) AND NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE AND FINANCING CORPORATION (SERIES 2011 NASSAU BONDS). THE BONDS ARE REPORTED ON SCHEDULE K OF THE PARENT ORGANIZATION, CATHOLIC HEALTH SERVICES OF LONG ISLAND. FORM 990, PART XI, LINE 9 RECONCILIATION OF NET ASSETS ALLOCABLE PORTION TO FOUNDATION 75,044 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 11A- I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 11A- II CHSLI false CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) 3 CHSLI false GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANC NY 501(C)(3) 11A- I GOOD SAMARTN false MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113434776 TRANSPORTATIO NY 501(C)(3) 9 MARYHAVENCTR true MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 9 CHSLI true MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR true THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113638367 SUPPORT ORG NY 501(C)(3) 9 MARYHAVENCTR true MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 CHSLI false CATHOLIC HOME CARE 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 112126736 HOME CARE NY 501(C)(3) 9 CHSLI true RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR true SIENA VILLAGE INC 2000 BISHOPS ROAD SMITHTOWN NY 11787 061569129 SR HOUSING NY 501(C)(3) 9 STCATHERINE false ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) 3 CHSLI false ST CHARLES HOSPITAL 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 111871039 HOSPITAL NY 501(C)(3) 3 CHSLI false CHS HOME SUPPORT SERVICES INC 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 113594561 RESP THERAPY NY 501(C)(3) 9 CATHHOMECARE true ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI false ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 11A- I ST FRANCIS false ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 11A- I ST FRANCIS false WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI false SUFFOLK HEARING & SPEECH CENTER INC 369 EAST MAIN STREET EAST ISLIP NY 11730 112110488 DIAGN TESTING NY 501(C)(3) 9 GOOD SAMARTN false THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSN ST NY 11777 112983148 SUPPORT ORG NY 501(C)(3) 11A- I CHSLI false THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) 11A- I CHSLI false WISDOM GARDENS HOUSING DEVELOPMENT FUND 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113559713 SR HOUSING NY 501(C)(3) 9 MARYHAVENCTR true GOOD SHEPHERD HOSPICE 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 9 CHSLI true ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 11A- II ST CHARLES false GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) 11A- I GOOD SAMARTN false ST FRANCIS-MERCY CORPORATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 111635088 SUPPORT ORG NY 501(C)(3) 11A- I CHSLI false MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 550813603 SUPPORT ORG NY 501(C)(3) 11A- I MERCY MEDCTR false ST CATHERINE OF SIENA MEDICAL CTR FDN 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) 11A- I STCATHERINE false CATHOLIC HOME CARE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 452907761 SUPPORT ORG NY 501(C)(3) 11A- I CATHHOMECARE true GOOD SHEPHERD HOSPICE FOUNDATION 110 Bi-County Blvd Suite 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 11A- I GOODSHEPHERD true OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 11A- II OURLADYOFC true RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 11A- I CHSLI false ST FRANCIS CARDIOVASCULAR PHYSICIANS P 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 11A- I ST FRANCIS false RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INS NY 501(C)(3) 11A- II CHSLI false RADIOLOGY CONSULTING OF LONG ISLANDPLLC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 421646134 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 HEALTHCARE SVC NY GOOD 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HOSPICE O,P,Q 143347 COST