2013-11-13T13:59:29-06:00 2012-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2012-01-01 112050523 ST FRANCIS HOSPITAL % CHS SERVICES STFR 5165626000 100 PORT WASHINGTON BLVD Suite ROSLYN NY 11576 RUTH HENNESSY 5165626000 2013-11-06 true 6464713000 2012 2016-02-25 16:41:14Z ALAN D GUERCI MD 100 PORT WASHINGTON BLVD ROSLYN NY 11576 930614598 false 0928 X HTTP://STFRANCISHEARTCENTER.CHSLI.ORG X 1964 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. 22 21 3360 571 0 3868546 12438012 477161420 473484461 25434994 31393681 5752912 5406807 512217872 522722961 18301830 8403807 0 0 265030849 266123955 0 0 0 200168603 207797314 483501282 482325076 28716590 40397885 796680990 834508131 272784268 271866850 523896722 562641281 X ST. FRANCIS HOSPITAL, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS),AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, AND ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. false false 424935046 8403807 473607276 THE 364 CERTIFIED BED HOSPITAL PROVIDES CARDIOVASCULAR TESTING AND OTHER GENERAL MEDICAL SERVICES NECESSARY TO SUPPORT CARDIOVASCULAR PATIENTS AND ALSO PROVIDES NON-CARDIOVASCULAR SERVICES IN RESPONSE TO THE GENERAL NEEDS OF THE COMMUNITY. DURING 2012, THE HOSPITAL ADMITTED 15,677 PATIENTS, PERFORMED 1,337 OPEN HEART OPERATIONS AND 6,150 CATHETERIZATIONS. FURTHER, THE HOSPITAL PERFORMED 1,847 PTCA'S AND 6,244 OTHER NON-SURGICAL PROCEDURES. IN ADDITION, THERE WERE 22,756 EMERGENCY ROOM VISITS AND DURING THE YEAR THE HOSPITAL SERVICED 180,500 OUTPATIENTS. 424935046 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true true false false false false false true false false false false false false false false false true true true false false true 113 0 true 3360 true false false false false false false false false false false X 22 21 false false false false true true true true true false false true true true true true true true true false X CHS SERVICES 5167051933 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X PETER QUICK 2.0 X X 0 0 0 DANIEL J DENIHAN 2.0 X X 0 0 0 C JUSTIN MCCARTHY 2.0 X X 0 0 0 REV MSGR FRANCIS J CALDWELL 2.0 X X 0 0 0 KEVIN J CONWAY 2.0 X 0 0 0 JAMES D'ADDARIO 2.0 X 0 0 0 PETER D'ANGELO 2.0 X 0 0 0 THOMAS J FANNING 2.0 X 0 0 0 JOSEPH GRIMALDI 2.0 X 0 0 0 BRIAN P HEHIR 2.0 X 0 0 0 SR BETTY KEEGAN 2.0 X 0 0 0 STEPHEN MCLOUGHLIN 2.0 X 0 0 0 EUGENE F MURPHY 2.0 X 0 0 0 CHRISTOPHER S PASCUCCI 2.0 X 0 0 0 ROBERT P QUINN 2.0 X 0 0 0 SUSAN POWERS SCHOTT 2.0 X 0 0 0 MATTHEW SERRA 2.0 X 0 0 0 RABBI BARRY DOV SCHWARTZ PHD 2.0 X 0 0 0 EUGENE P SOUTHER ESQ 2.0 X 0 0 0 CHARLES TRUNZ 2.0 X 0 0 0 SR DOLORES WISNIEWSKI CIJ 2.0 X 0 0 0 ALAN D GUERCI MD 50.0 X X 1101603 0 322203 WILLIAM C ARMSTRONG 50.0 X 907416 0 212310 RUTH HENNESSY 50.0 X 1301844 0 185681 JACK SOTERAKIS MD 50.0 X 524548 0 86359 RICHARD SHLOFMITZ MD 50.0 X 3236125 0 47719 GEORGE PETROSSIAN MD 50.0 X 1540034 0 46134 THOMAS PAPPAS MD 50.0 X 1226534 0 47798 THEOFANI TSIAMTSIOURIS MD 50.0 X 1128648 0 46787 GEORGE DENOTO 50.0 X 1049515 0 46920 ANTONIO MADRID 50.0 X 979503 0 37934 12995770 0 1079845 520 false true false MAQUET MEDICAL SYSTEMS 45 BARBOUR POND DR WAYNE NJ 07470 MEDICAL SUPPLIES 559855 PHYSICIANS DIAGNOSTIC IMAGING 100 PORT WASHINGTON BLVD ROSLYN NY 11576 PHYSICIAN SERVICES 1688401 DELLA FEMINA ROTHSCHILD JEARY PO BOX 641052 PITTSBURGH PA 15264 ADVERTISING SERVICES 1626613 NASSAU CHEST PHYSICIANS PC 233 EAST SHORE ROAD GREAT NECK NY 11023 PHYSICIAN SERVICES 1277125 WINTHROP UNIVERSITY HOSPITAL 200 OLD COUNTRY ROAD DIALYSIS CTR MINEOLA NY 11501 HEMODIALYSIS SVCS 1236579 19 12372780 65232 12438012 PATIENT REVENUE 621400 473484461 473484461 473484461 7705996 7705996 0 0 1742724 1742724 0 1742724 1742724 431579322 407891637 23687685 23687685 23687685 0 0 0 PURCHASE DISCOUNT/REBATE 900099 99621 99621 COMMUNITY HEATLH & EDU 900099 23194 23194 OTHER REVENUE 900099 3541268 3541268 3664083 522722961 473607276 36677673 8403807 8403807 0 0 0 7071536 3760673 3310863 0 198652017 177254659 21397358 14702852 13119167 1583685 31801483 28376057 3425426 13896067 12399283 1496784 4282483 85650 4196833 729764 729764 210000 210000 86172 86172 0 0 6076178 3888754 2187424 1723146 1723146 4422091 3945775 476316 0 285429 254685 30744 0 9213934 8221476 992458 481513 429648 51865 0 0 6140542 5479127 661415 6634239 4497668 2136571 26609197 23743047 2866150 8409034 8409034 MEDICAL SUPPLIES EXPENSE 86807864 86807864 0 CHS SERVICES 25908599 21504137 4404462 EQUIPMENT SERVICE CONTRACTS 5845388 5215765 629623 CHS CORP MANAGEMENT 4585321 0 4585321 9346420 7329452 2016968 482325076 424935046 57390030 0 1489240 1678282 24848752 24785910 0 0 57497683 67345607 842512 753686 0 0 0 0 7048150 6892963 5103803 4214535 558351754 299857564 264529377 258494191 370743359 400296033 0 0 0 0 17681927 16528811 46896187 53518113 796680990 834508131 56074215 56516012 0 0 0 0 119719673 119575590 0 0 0 0 0 0 0 0 96990380 95775248 272784268 271866850 X 521130352 559810256 2766370 2831025 0 0 523896722 562641281 796680990 834508131 X 40397885 -810326 -843000 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 86172 86172 false PART II-B LINE 1 - LOBBYING ACTIVITIES AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON THE BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ORGANIZATIONS REPRESENT. 105130 105130 344915607 137138953 207776654 11666989 5860543 5806446 200555367 156858067 43697300 1108661 1108661 258494191 DUE FROM RELATED PARTIES 23929479 RESTRICT UNDER BOND INDENTURE 10138051 INSURANCE CLAIMS RECEIVABLE 19450583 53518113 0 POST RETIREMENT LIABILITIES 17124676 ESTIMATED MALPRACTICE LIABILITIES 18239531 OTHER SELF INSURED LIABILITIES 24075122 THIRD PARTY PAYOR & OTHER LIABILITIES 34333214 NOTES PAYABLE 2002705 95775248 X PART X, OTHER LIABILITIES LINE 2, FIN 48 FOOTNOTE 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 RECOGNIZED 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. true true X true X 300. true X true true true false true true 4988234 1433469 3554765 0.00740 13099513 8434270 4665243 0.00970 257440 280472 -23033 0.00000 18345187 10148211 8196975 0.01710 1602215 21906 1580309 0.00330 795869 268109 527760 0.00110 9890950 9890950 0.02050 280164 280164 0.00060 12569198 290015 12279183 0.02550 30914385 10438226 20476158 0.04260 true 618765 0 175678752 210148362 -34469610 X true true 1 1 ST FRANCIS HOSPITAL

100 PORT WASHINGTON BLVD ROSLYN NY 11576

HTTP://STFRANCISHEARTCENTER.CHSLI.ORG X X X X CARDIOVASCULAR SVCS ST FRANCIS HOSPITAL 1 true true 300. true 400. true X true true X X X X true false true X false false 2 ST FRANCIS RESEARCH & EDUCATIONAL

101 NORTHERN BLD OLD BROOKVILLE NY 11545

RESEARCH, COMMUNITY ED, CARDIAC REHAB, WOMEN'S HEALTH CENTER ST FRANCIS SOUTHBAY CARDIOVASCULAR CL

540 UNION BLVD WEST ISLIP NY 11795

OUTPATIENT CARDIOVASCULAR SERVICES PART I, LINE 4 THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DOES NOT SPECIFICALLY ADDRESS FREE OR DISCOUNTED CARE FOR THE MEDICALLY INDIGENT. WHEN ESTABLISHED, THE POLICY'S FACTOR IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE WAS SPECIFICALLY SET HIGHER THAN FEDERALLY REQUIRED GUIDELINES IN ORDER TO CAPTURE POTENTIALLY MEDICALLY INDIGENT PATIENTS WHO MAY PRESENT THEMSELVES AT THE HOSPITAL FOR CARE. THE POLICY OF THE HOSPITAL IS CURRENTLY BEING REVISED TO SPECIFICALLY DISCUSS CARE TO THE MEDICALLY INDIGENT. 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 2012. PART III, LINE 2 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. PART III, LINE 4 TEXT OF FOOTNOTE DISCUSSING BAD DEBT: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THIS ALLOWANCE BASED UPON HISTORICAL COLLECTION AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO 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. THE HOSPITAL DOES NOT HAVE ANY OFF-BALANCE-SHEET CREDIT EXPOSURE RELATED TO ITS PATIENT ACCOUNTS RECEIVABLE. 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 2012 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 $34.5 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 PERIODICALLY THROUGHOUT THE YEAR, WAS THE RESULT OF A JOINT COMMUNITY NEEDS ASSESSMENT BY CHS HOSPITALS. IT HAS ALSO BECOME A PRIMARY SOURCE OF PUBLIC PARTICIPATION. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH AND SPANISH) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT DOUBLES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED VIA CALENDAR LISTINGS IN PARISH BULLETINS AND FLYERS POSTED IN PLACES OF BUSINESS AND WORSHIP IN THE COMMUNITY SURROUNDING THE OUTREACH SITE. 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 POSTS 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 HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS INCLUDE 85% OF HOSPITAL DISCHARGES. THE PRIMARY SERVICE AREA IS NASSAU COUNTY, FROM WHICH THE HOSPITAL OBTAINED 56.3% OF ITS DISCHARGES IN 2012 (UP FROM 55.3% IN 2011). THE SECONDARY SERVICE AREA PROVIDES ANOTHER 29.2% OF DISCHARGES (DOWN FROM 29.8%) AND COMPRISES TWO AREAS, WEST AND EAST. THE WEST AREA CONSISTS OF 30 ZIP CODES IN QUEENS, AND ONE IN BROOKLYN, AND PROVIDED 15.6% OF ST. FRANCIS DISCHARGES (SAME AS 2011). THE EAST AREA CONSISTS OF 26 ZIP CODES IN SUFFOLK COUNTY AND PROVIDED 13.6% OF ST. FRANCIS DISCHARGES (DOWN FROM 14.2%). 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 2012: - 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 CENTER'S MEDICAL STAFF PROVIDES PHYSICAL EXAMINATIONS, LAB WORK, X-RAYS, FLU SHOTS, IMMUNIZATIONS AND SPECIALTY REFERRALS AS NEEDED. - 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 784 BLOOD PRESSURE/DIABETES SCREENINGS AND/OR FLU SHOTS AT HEALTHY SUNDAYS EVENTS IN 2012. THIS PROGRAM CONTINUES TO PROVIDE A VITAL LINK TO PRIMARY CARE REFERRALS FOR THE MEDICALLY UNDERSERVED. - ST. FRANCIS HOSPITAL'S MOBILE HEALTH SCREENING UNIT PROVIDED CARE TO THOUSANDS OF INDIVIDUALS WHO DID NOT HAVE ACCESS TO A TRADITIONAL HEALTH CARE FACILITY. THE SELF-CONTAINED MOBILE UNIT 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 4,845 HEALTH SCREENINGS AND/OR FLU SHOTS TO PATIENTS WITHOUT ADEQUATE HEALTH COVERAGE. - 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 349 CARDIAC SCREENINGS AT NO COST TO LOCAL HIGH SCHOOL ATHLETES IN 2012. THESE SCREENINGS INCLUDE EKG AS WELL AS ECHOCARDIOGRAM. THE GOAL IS TO DETECT AND ASSESS ANY UNDERLYING CARDIAC ABNORMALITIES WHICH MAY PUT A STRAIN ON AN ATHLETE'S HEART, ESPECIALLY DURING STRENUOUS PHYSICAL ACTIVITY. - ST. FRANCIS HOSPITAL PROVIDED 987 FREE BLOOD PRESSURE SCREENINGS AT THE HOSPITAL AND COMMUNITY SITES INCLUDING THE PORT WASHINGTON PUBLIC LIBRARY, WESTBURY PUBLIC LIBRARY, ST. BRIGID'S SENIOR CENTER IN WESTBURY, GREAT NECK SENIOR CENTER, EAST WILLISTON PUBLIC LIBRARY, AND ATRIA ON ROSLYN HARBOR. - 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 IN 2011, THIS DECREASE WAS NOT ONLY SUSTAINED IN 2012, BUT AN ADDITIONAL 10% ON TOP THIS WAS NOTED IN 2012. BALANCE TRAINING AND A NEW CHAIR YOGA WORKSHOP HAS BEEN ADDED TO ITS COMMUNITY HEALTH AND EDUCATION PROGRAMMING FOR THE COMMUNITY AS PART OF OUR CAMPAIGN TO DECREASE FALLS IN SENIORS. 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, 2012, CHS COMPRISED SIX HOSPITALS (MERCY MEDICAL CENTER, ST. FRANCIS HOSPITAL AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL AND REHABILITATION CENTER AND ST. CATHERINE OF SIENA MEDICAL CENTER IN SUFFOLK COUNTY), AS WELL AS THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING AND REHABILITATION CARE CENTER, GOOD SAMARITAN NURSING HOME AND OUR LADY OF CONSOLATION NURSING AND REHABILITATIVE CARE CENTER, ALL IN SUFFOLK COUNTY), A REGIONAL HOME CARE AND HOSPICE NETWORK, AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 17,000 STAFF AND 4,600 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 $2.5 MILLION DOLLARS IN 2012. PART VI, LINE 7 - LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT NY true DIOCESE OF ROCKVILLE CENTRE- CATHOLIC MINISTRIES 111837437 501(C)(3) 461425 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 THE DIOCESE OF ROCKVILLE CENTRE PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL, WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI. MERCY MEDICAL CENTER - 1000 N VILLAGE AVE 111635088 501(C)(3) 2500000 WORKING CAP. SUBSIDY ST FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 501(C)(3) 5442382 WORKING CAP. SUBSIDY 3 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. CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR ST FRANCIS HOSPITAL AND MERCY MEDICAL CENTER AND IS THEREFORE ABLE TO MONITOR THAT MERCY MEDICAL CENTER USES THE GRANT FUNDS AS A WORKING CAPITAL SUBSIDY. CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR ST FRANCIS HOSPITAL AND ST. FRANCIS CARDIOVASCULAR PHYSICIANS P.C. AND IS THEREFORE ABLE TO MONITOR THAT ST. FRANCIS CARDIOVASCULAR PHYSICIANS P.C. USES THE GRANT FUNDS AS A WORKING CAPITAL SUBSIDY. PART II, LINE 1, COLUMN (H) NAME OF ORGANIZATION OR GOVERNMENT: MERCY MEDICAL CENTER (H) PURPOSE OF GRANT OR ASSISTANCE: WORKING CAPITAL SUBSIDY TO OFFSET LOSSES INCURRED FOR PROVIDING UNCOMPENSATED CARE THROUGH A BROAD RANGE OF COMMUNITY SERVICE PROGRAMS AND CHARITABLE ACTIVITIES. NAME OF ORGANIZATION OR GOVERNMENT: DIOCESE OF ROCKVILLE CENTRE-CATHOLIC MINISTRY (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 ALAN D GUERCI MD 803701 0 261600 0 36302 0 289984 0 32219 0 1423806 0 0 0 WILLIAM C ARMSTRONG 589761 0 98000 0 219655 0 184585 0 27725 0 1119726 0 204388 0 RUTH HENNESSY 504222 0 72000 0 725622 0 160337 0 25344 0 1487525 0 665460 0 JACK SOTERAKIS MD 406630 0 50000 0 67918 0 62856 0 23503 0 610907 0 19353 0 RICHARD SHLOFMITZ MD 2927162 0 304704 0 4259 0 19950 0 27769 0 3283844 0 0 0 GEORGE PETROSSIAN MD 927754 0 610624 0 1656 0 19950 0 26184 0 1586168 0 0 0 THOMAS PAPPAS MD 795938 0 427500 0 3096 0 19950 0 27848 0 1274332 0 0 0 THEOFANI TSIAMTSIOURIS MD 795768 0 331800 0 1080 0 19950 0 26837 0 1175435 0 0 0 GEORGE DENOTO 795575 0 251926 0 2014 0 19950 0 26970 0 1096435 0 0 0 ANTONIO MADRID 797283 0 181500 0 720 0 19950 0 17984 0 1017437 0 0 0 PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PARTICIPATION IN THE PLAN AS FOLLOWS: ALAN D GUERCI, MD $270,034 PARTICIPATION IN PLAN WILLIAM ARMSTRONG $164,635 PARTICIPATION IN PLAN; $204,388 PAYMENT FROM PLAN RUTH HENNESSY $140,387 PARTICIPATION IN PLAN; $721,378 PAYMENT FROM PLAN JACK SOTERAKIS, MD $42,906 PARTICIPATION IN PLAN; $52,256 PAYMENT FROM PLAN 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. A DORMITORY AUTHORITY OF THE STATE OF NY 146000293 64983TH30 2004-11-09 100447098 HOSPITAL CONSTRUCTION false false false A 0 0 99387011 6745930 0 0 1882067 0 0 90129454 629384 0 2008 false false true true A false false false false 0 true A false false false 0 false 0 false true A true SCHEDULE K, PART I AND PART II BOND ISSUE PRICE DIFFERENCE THE TOTAL PROCEEDS OF THE BOND ISSUE REPORTED ON PART II, LINE 3 ARE NOT IDENTICAL TO THE ISSUE PRICE LISTED IN PART I, COLUMN (E) DUE TO A PREMIUM ON THE BOND. RICHARD SHLOFMITZ KEY EMPLOYEE PERSONAL/FAMILY X 1000000 753686 false true true 753686 SCHEDULE L PART II - LOANS TO AND FROM INTERESTED PERSONS (A) NAME OF PERSON: RICHARD SHLOFMITZ, MD FORM 990, PART VI LINE 6 - MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF ST. FRANCIS HOSPITAL IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND) (CHS). CHS IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF 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 CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF ST. FRANCIS HOSPITAL AND AS SUCH HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF ST. FRANCIS HOSPITAL. FORM 990, PART VI LINE 7B - DECISIONS OF THE GOVERNING BODY CHS 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 LINE 11A - REVIEW PROCESS FOR 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 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. 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, MEASURABLE 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. ALAN GUERCI, M.D. PRESIDENT AND CEO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. FRANCIS HOSPITAL (11-2050523); ST. FRANCIS HOSPITAL FOUNDATION (11-2916033); ST. FRANCIS RESEARCH AND EDUCATIONAL CORPORATION INC. (11-3090867); ST. FRANCIS CARDIOVASCULAR PHYSICIANS P.C. (11-3613997); MERCY MEDICAL CENTER (11-1635088). WILLIAM ARMSTRONG, SENIOR VICE PRESIDENT AND CFO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. FRANCIS HOSPITAL (11-2050523); ST. FRANCIS HOSPITAL FOUNDATION (11-2916033); ST. FRANCIS RESEARCH AND EDUCATIONAL CORPORATION INC. (11-3090867); MERCY MEDICAL CENTER (11-1635088); ST. JOSEPH HOSPITAL (11-3438973). RUTH HENNESSY, EXECUTIVE VP AND CAO - THE TOTAL HOURS WORKED REPORTED (50.0) REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. FRANCIS HOSPITAL (11-2050523); ST. FRANCIS HOSPITAL FOUNDATION (11-2916033); ST. FRANCIS RESEARCH AND EDUCATIONAL CORPORATION INC. (11-3090867). JACK SOTERAKIS, MD, VP MEDICAL AFFAIRS - THE TOTAL HOURS WORKED REPORTED (50.0) RELFECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: ST. FRANCIS HOSPITAL (11-2050523); ST. FRANCIS CARDIOVASCULAR PHYSICIANS P.C. (11-3613997). FORM 990, PART X LINE 20 - TAX EXEMPT BOND LIABILITIES THE TAX-EXEMPT BOND ISSUANCES REFLECTED ON PART X, LINE 20 CONSIST MAINLY OF TAX-EXEMPT BOND LIABILITIES REPORTED ON SCHEDULE K. A PORTION OF THE 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 - OTHER CHANGES IN NET ASSETS CHANGE IN NET ASSETS DEFINED BENEFIT PLAN: -843,000 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) 11A- I NA false CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) 11A- II CHSLI 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 false MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861698 Prgm-disabled NY 501(C)(3) 9 CHSLI false MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112861690 Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR false THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 113638367 SUPPORT ORG NY 501(C)(3) 9 MARYHAVENCTR false MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CTR NY 11570 111635088 HOSPITAL NY 501(C)(3) 3 CHSLI true CATHOLIC HOME CARE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112126736 HOME CARE NY 501(C)(3) 9 CHSLI false OUR LADY OF CONSOLATION GERIATRIC CARE 111 BEACH DRIVE WEST ISLIP NY 11795 113284066 LT NURSE CARE NY 501(C)(3) 9 CHSLI false RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSN ST NY 11776 112499790 RENTING NY 501(C)(2) MARYHAVENCTR false SIENA VILLAGE INC 2000 BISHOPS ROAD SMITHTOWN NY 11787 061569129 SR HOUSING NY 501(C)(3) 9 STCATHERINE 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 false ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) 11A- I ST FRANCIS true ST FRANCIS HOSPITAL RESEARCH & EDUCATIO 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORG NY 501(C)(3) 11A- I ST FRANCIS true WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) 3 CHSLI 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 false GOOD SHEPHERD HOSPICE 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 112958438 HOSPICE SVC NY 501(C)(3) 9 CHSLI false ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) 11A- 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 true ST CATHERINE OF SIENA MEDICAL CTR FDN 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) 11A- I STCATHERINE false CATHOLIC HOME CARE FOUNDATION 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 452907761 SUPPORT ORG NY 501(C)(3) 11A- I CATHHOMECARE false GOOD SHEPHERD HOSPICE FOUNDATION 110 BI-COUNTY BLVD SUITE 114 FARMINGDALE NY 11735 263169427 SUPPORT ORG NY 501(C)(3) 11A- I GOODSHEPHERD false OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) 11A- II OURLADYOFC false RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) 11A- I CHSLI false ST FRANCIS CARDIOVASCULAR PHYSICIANS P 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARESVC NY 501(C)(3) 11A- I ST FRANCIS 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 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