2013-11-13T13:59:29-06:00 2012-12-31 PricewaterhouseCoopers LLP 300 Madison Avenue New York NY 10017 990 2012-01-01 111635088 MERCY MEDICAL CENTER % CHS SERVICES INC MERC 5167052525 1000 NORTH VILLAGE AVENUE Suite ROCKVILLE CENTRE NY 11570 AARON GLATT 5167052525 2013-11-05 true 6464713000 2012 2016-02-24 21:20:13Z ALAN D GUERCI MD 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 206983252 false 0928 X HTTP://MERCYMEDICALCENTER.CHSLI.ORG X 1913 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 1705 847 0 7474013 3240816 195083274 196351902 222396 748070 3832880 6264964 206612563 206605752 233812 337026 0 0 108767971 119263685 0 0 0 84999514 77836258 194001297 197436969 12611266 9168783 191170091 193602315 153892344 146940031 37277747 46662284 X MERCY MEDICAL CENTER, 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 178279338 337026 199660178 MERCY MEDICAL CENTER IS A 375 BED, NOT-FOR-PROFIT ACUTE CARE HOSPITAL SERVING THE HEALTHCARE NEEDS OF NASSAU COUNTY AND ITS SURROUNDING AREA. FOUNDED IN 1913 BY THE NURSING SISTERS OF THE CONGREGATION OF THE INFANT JESUS, MERCY MEDICAL CENTER HAS GROWN FROM A THREE FLOOR WOODEN STRUCTURE TO AN EXTENSIVE INSTITUTION OCCUPYING A 42-ACRE CAMPUS THAT HOUSES SOME OF THE MOST ADVANCED MEDICAL TECHNOLOGIES. ACCORDING TO INTERNAL DATA, OVER 49% OF MMC'S TOTAL INPATIENT DISCHARGES IN 2012 CAME FROM HEMPSTEAD, UNIONDALE, FREEPORT, AND ROOSEVELT. THESE FOUR COMMUNITIES HAVE BEEN REFERRED TO AS "COMMUNITIES AT RISK", MANY OF THE RESIDENTS LIVING IN POVERTY AND HAVING POOR HEALTH OUTCOMES. OF THE 32,021 ED TREATED & RELEASED VISITS MMC HAD IN 2012, 14,578 OR NEARLY 45% CAME FROM THESE SAME FOUR ZIP CODES. 178279338 true true false true false false false false false true true false false true true true false true false false false false false false true false true true true false true false false false false false false false false false false false false false true true true false false true 119 0 true 1705 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 INC 5167051926 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 0 1101603 322203 WILLIAM C ARMSTRONG 50.0 X 0 907416 212310 AARON GLATT 50.0 X 629375 0 234887 JOHN REILLY 50.0 X 438046 0 45771 RONALD W STEIMEL 50.0 X 405782 0 44732 ALAN WONG MD 38.0 X 450567 0 41594 ALEXANDER TELIS MD 38.0 X 370673 0 41156 CHINWE OFFOR MD 38.0 X 279814 0 40147 SWAENA DEVARAJAN MD 38.0 X 330720 0 46027 NANCY SIMMONS 50.0 X 0 1003005 118123 STEPHEN TRAPANI 37.5 X 0 390350 119570 2904977 3402374 1266520 169 true true false VIRTUAL RADIOLOGIC PROF OF NY 11995 SINGLETREE LN SUITE 500 MINNEAPOLIS MN 55344 RADIOLOGY SERVICES 500000 TGC LLC PO BOX 130 HIGHLAND MD 20777 CONSULTING FEE 488921 MADONNA PHYSICIANS SERVICES PC 375 N BROADWAY LLS JERICHO NY 11753 PROFESSIONAL FEES 400000 DAWSON HOLDING CO PO BOX 6 HICKSVILLE NY 11802 RENT 342529 LI THORACIC SURGERY PC 444 MERRICK RD SUITE 380 LYNBROOK NY 11563 PROFESSIONAL FEES 235497 17 135506 2500000 321084 284226 3240816 NET PATIENT SERVICE REVENUE - HOSPITAL 621300 196351902 196351902 196351902 748070 748070 0 0 2408801 188688 2220113 0 2220113 2220113 0 330978 135506 188812 142166 142166 0 0 CAFETERIA & COFFEE SHOP 561000 594409 594409 RADIOLOGY SCHOOL TUITION 561499 274230 274230 OTHER 624100 3034046 3034046 3902685 206605752 199660178 3704758 337026 337026 0 0 0 1067421 438046 629375 0 93111861 87188156 5923705 5820426 5415435 404991 12781939 11809303 972636 6482038 6031012 451026 772038 13052 758986 272764 4000 268764 171648 171648 48378 48378 0 0 3942739 3942739 943830 12519 931311 4055997 3151252 904745 0 0 0 3295960 3295960 134494 112421 22073 0 0 742038 742038 2771583 0 2771583 8309221 8309221 5730583 5730583 MEDICAL SUPPLIES 21186984 21186984 CHS SERVICES 15445720 13128862 2316858 EQUIPMENT SERVICE CONTRACTS 2833665 2833665 EQUIPMENT RENTAL 1261342 1215775 45567 5917274 3381289 2535985 197436969 178279338 19157631 0 9080955 12523797 248723 244315 208359 143691 21631565 21195195 0 0 0 0 0 0 2345469 2402349 1930067 1843104 275016029 172026684 105179093 102989345 13628313 17278906 0 0 0 0 0 0 36917547 34981613 191170091 193602315 19389394 18613294 0 0 0 0 37958030 37596106 0 0 0 0 9122541 4201499 0 0 87422379 86529132 153892344 146940031 X 35029684 44343043 2248063 2319241 0 0 37277747 46662284 191170091 193602315 X 9168783 31594 184160 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 48378 48378 false PART II-B, LINE 1 LOBBYING ACTIVITIES AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ORGANIZATIONS REPRESENT. 321872 1106 3500 17520 301958 329471 18230 2750 23079 321872 341486 2030 2000 12045 329471 350792 1860 2000 9166 341486 360363 7910 2000 15481 350792 1.00000 false false 0 8529460 8529460 0 165839376 85109989 80729387 0 397287 319093 78194 0 95305339 82181379 13123960 0 4944567 4416223 528344 102989345 ASSETS LIMITED AS TO USE 4471546 OTHER RECEIVABLES - CURRENT 1382968 457B FUNDS 251573 INSURANCE CLAIMS RECEIVABLE 28875526 34981613 0 ESTIMATED THIRD PARTY PAYOR LIAB 13348255 AMOUNTS DUE TO RELATED PARTIES 26284104 ESTIMATED MALPRACTICE LIABILITY 30739711 OTHER SELF INSURANCE LIABILITY 16157062 86529132 X SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS MERCY MEDICAL CENTER'S MAGOVERN FUND IS RESTRICTED FOR THE PURPOSE OF FUNDING EXPENDITURES RELATING TO THE HOSPITAL'S RADIOLOGY TRAINING PROGRAM. PART X, OTHER LIABILITIES LINE 2, FIN 48 FOOTNOTE MERCY MEDICAL 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 OF BEING SUSTAINED. BALL 263475 80637 182838 7556 66264 17216 GOLF 83845 27015 56830 100 5090 26355 7607 1 119164 27854 91310 8950 38491 11183 466484 135506 330978 9050 12646 131110 36006 188812 142166 true true true X 300. true X true true false true true 0 4270284 4609724 -339440 0.00000 28433480 22039206 6394274 0.03240 0 464078 338871 125207 0.00060 0 33167842 26987801 6180041 0.03300 652446 11540 640906 0.00330 572843 121456 451387 0.00230 19342012 18078256 1263756 0.00580 64410 0 64410 0.00030 0 0 0 0.00000 20631711 18211252 2420459 0.01170 0 53799553 45199053 8600500 0.04470 84065 84065 0.00040 2468 2468 15386 15386 0.00010 1055 1055 9579 9579 112553 112553 0.00050 true 1265571 0 61278964 57817996 3460968 X true true 1 1 MERCY MEDICAL CENTER

1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570

http://mercymedicalcenter.chsli.org X X X X PSYCHIATRIC UNIT / REHABILITATIVE SERVICES MERCY MEDICAL CENTER 1 true true 300. true 400. true X true true X X X X true false true X false false PART I, LINE 4 THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DOES NOT SPECIFICALLY ADDRESS FREE OR DISCONTINUED 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 THE METHODOLOGY WAS 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 APPOINTED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2012. PART II MERCY MEDICAL CENTERS (MMC'S) COMMUNITY BUILDING ACTIVITIES PROMOTE THE COMMUNITY'S HEALTH IN MANY WAYS. FOR EXAMPLE, ASSISTING PATIENTS TO ENROLL IN PUBLIC PROGRAMS EXPANDS THEIR ACCESS TO CARE. DISASTER READINESS DRILLS BEYOND MINIMUM MANDATES ENSURES AVAILABILITY OF HOSPITAL SERVICES DURING TIMES OF HIGHEST NEED. COLLECTION AND DISPOSAL OF SYRINGES FOR THE COMMUNITY ELIMINATES A HEALTH HAZARD. ADVOCACY FOR BEHAVIORAL HEALTH CLIENTS PROMOTES THE INTERESTS OF A VULNERABLE POPULATION. DEFENSIVE DRIVING CLASSES PREVENT INJURY FROM CAR ACCIDENTS. PART III, LINE 2 COSTING METHODOLOGY BAD DEBT AT COST WAS CALCULATED BY APPLYING THE COST TO CHARGE RATIO FROM WORKSHEET 2 TO BAD DEBT EXPENSE, WHICH IS REPORTED AT CHARGES. 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 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 MEDICAL CENTER 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 MEDICAL CENTER DOES NOT HAVE ANY OFF-BALANCE-SHEET CREDIT EXPOSURE RELATED TO ITS PATIENT ACCOUNTS RECEIVABLE PART III, LINE 4 BAD DEBT AS COMMUNITY BENEFIT AS PART OF ITS TAX EXEMPT PURPOSE MERCY MEDICAL CENTER PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. MERCY 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, MERCY IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM THE HOSPITAL SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY. PART III, 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 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 METHODOLOGY PART VI, LINE 2 NEEDS ASSESSMENT MERCY MEDICAL CENTER WORKS WITH MANY OUTSIDE PARTICIPANTS IN THE COMMUNITY IN ONGOING IDENTIFICATION OF COMMUNITY HEALTH NEEDS, INCLUDING NEIGHBORING SCHOOLS, PARISHES, BUSINESSES, COMMUNITY CENTERS, AND LOCAL CHAPTERS OF ORGANIZATIONS. MERCY STRIVES TO REACH INDIVIDUALS OF ALL AGES AND BACKGROUNDS TO PROVIDE QUALITY CARE AND HEALTH EDUCATION. OVER THE YEAR, MERCY HAS WORKED WITH MANY ORGANIZATIONS TO DEVELOP HEALTH CARE PROGRAMS FOR RESIDENTS IN THE AREA: AMERICAN CANCER ASSOCIATION, AMERICAN HEART ASSOCIATION, CATHOLIC CHARITIES; DOWNSTATE NEW YOK HEALTHY START PROGRAM; ECONOMIC OPPORTUNITY CENTER; NASSAU COUNTY DEPARTMENT OF DRUG & ALCOHOL; NASSAU COUNTY DEPARTMENT OF MENTAL HEALTH; NASSAU COUNTY DEPARTMENT OF HEALTH, ROCKVILLE CENTRE CHAMBER OF COMMERCE, ROCKVILLE CENTRE LIONS CLUB AND DIOCESE OF ROCKVILLE CENTRE. THE HEALTHY SUNDAYS PROGRAM, WHICH PROVIDES FREE MEDICAL SCREENINGS AND EDUCATION TO THE UNDERSERVED FOLLOWING WORSHIP SERVICES ON A BIMONTHLY BASIS SERVES AS A PRIMARY SOURCE OF PUBLIC PARTICIPATION AS COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH AND SPANISH) ARE OFTEN DISTRIBUTED AT THESE SCREENING SITES. THUS 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. IN SELECTING THE PREVENTION AGENDA PRIORITIES, MERCY MET IN THE PAST WITH OTHER HEALTHCARE PROVIDERS TO SELECT 2 PRIORITIES TO WORK ON TOGETHER FOR A JOINT COUNTY WIDE EFFORT. THESE OTHER PROVIDERS INCLUDED THE NASSAU COUNTY DEPARTMENT OF HEALTH, AND MANY NASSAU COUNTY HOSPITALS (LONG BEACH MEDICAL CENTER, NORTH SHORE LONG ISLAND JEWISH HEALTH CENTER, SOUTH NASSAU COMMUNITIES HOSPITAL, ST. FRANCIS HOSPITAL AND WINTHROP UNIVERSITY HOSPITAL). THE PRIORITIES SELECTED WERE PREVENTION OF INTENTIONAL INJURY FROM FALL RELATED HOSPITALIZATIONS AGE 65+ (FALLS PREVENTION) AND TOBACCO USE IN ADOLESCENT AND ADULTS (SMOKING CESSATION). MERCY CONTINUED TO WORK WITH SOME OF THE ORIGINAL HOSPITAL PARTNERS AND THE CENTER FOR TOBACCO CONTROL AND THE TOBACCO ACTION COALITION OF LONG ISLAND ON THE SMOKING CESSATION INITIATIVE, AND THE TOWN OF HEMPSTEAD DEPARTMENT OF SENIOR ENRICHMENT AND THE NASSAU COUNTY DEPARTMENT OF SENIOR AFFAIRS ON THE FALLS INITIATIVE. MERCY ADDED ANOTHER PREVENTION AGENDA PRIORITY UNDER CHRONIC DISEASES - DIABETES. IN WORKING WITH THE AMERICAN DIABETES ASSOCIATION, AMERICAN ASSOCIATION OF DIABETES EDUCATORS, HOSPITAL MEDICAL STAFF AND CHS HOSPITALS, MERCY HOPES TO REDUCE INPATIENT HOSPITALIZATIONS BY PROMOTING DIABETES AWARENESS AND EDUCATION THROUGH COMMUNITY LECTURES, SUPPORT GROUPS AND SELF MANAGEMENT CLASSES. COMMUNITY HEALTH NEEDS ARE DISCUSSED AND ASSESSED ON A CONTINUAL BASIS AMONG THE MISSION AND MINISTRY COMMITTEE AND THE PLANNING COMMITTEE OF THE BOARD, AS WELL AS THE BOARD OF TRUSTEES, MERCY SENIOR LEADERSHIP, AND VARIOUS COMMITTEES WITHIN THE HOSPITAL SUCH AS THE COMMUNITY OUTREACH COMMITTEE AND THE CANCER COMMITTEE, BOTH OF WHICH HAVE MULTI DISCIPLINARY REPRESENTATION OF HOSPITAL STAFF. MERCY SOLICITED INPUT FROM ITS AUXILIARY ORGANIZATIONS AT THE HOSPITAL - THE FRIENDS OF MERCY MEDICAL CENTER AND THE COUNCIL OF LEAGUES, REPRESENTING OVER 2000 VOICES. COMMUNITY HEALTH NEEDS WAS ALSO ASSESSED BY THE ADMINISTRATIVE STAFF AND BOARD OF TRUSTEES OF OUR PARENT CORPORATION, CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS). MERCY DISTRIBUTED A COMMUNITY NEEDS SURVEY AT MANY OF ITS OUTREACH PROGRAMS. THROUGH PATIENT SATISFACTION SURVEYS, INPATIENTS AND EMERGENCY DEPARTMENT PATIENTS HAVE THE OPPORTUNITY TO MAKE COMMENTS ABOUT THEIR ONGOING AND FUTURE HEALTH CARE NEEDS. THROUGH A JOINT COMMUNITY NEEDS ASSESSMENT BY MERCY ADMINISTRATION, THE PASTORAL CARE DEPARTMENT, CHS OUTREACH COORDINATOR AND THE PARISH COMMUNITY, MERCY IS ABLE TO IDENTIFY THOSE POPULATIONS AT GREATEST RISK AND PROVIDE APPROPRIATE SERVICES (HEALTHY SUNDAYS WAS A RESULT OF THIS ASSESSMENT). PART VI, LINE 3 COMMUNICATION OF FINANCIAL ASSISTANCE POLICY ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS ARE FULLY VERSED IN THE CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. THE HOSPITAL POSTS MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN AT LEAST ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. THE HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. THE HOSPITAL POSTS ITS CHARITY CARE POLICY SUMMARY ON ITS INTERNET WEBSITE. THE HOSPITAL PROVIDES ALL PATIENTS INTERPRETERS TO ASSIST THEM IN UNDERSTANDING ITS CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, A STATEMENT IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER INFORMATION. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL PART VI, LINE 4 COMMUNITY INFORMATION LOCATED IN SOUTH CENTRAL NASSAU COUNTY, MERCY'S PRIMARY SERVICE AREA (COMPRISING 61% OF ALL INPATIENT DISCHARGES AND 75% OF EMERGENCY DEPARTMENT (ED) TREAT AND RELEASE CASES) HAS A POPULATION OF ABOUT 435,000. THE POPULATION IS ETHNICALLY QUITE DIVERSE, MORE THAN HALF OF IT AFRICAN-AMERICAN, HISPANIC OR ASIAN. NEARLY A THIRD OF RESIDENTS SPEAK A LANGUAGE OTHER THAN ENGLISH IN THE HOME, AND MORE THAN A QUARTER ARE FOREIGN BORN. MERCY'S PRIMARY SERVICE AREA ALSO COMPRISES SOME OF THE POOREST POPULATIONS IN NASSAU COUNTY, INCLUDING FOUR OF THE EIGHT HIGHEST POVERTY ZIP CODES IN THE COUNTY. THESE ZIP CODES ALONE ACCOUNTED FOR 30% OF MERCY'S TOTAL DISCHARGES AND 48% OF THE HOSPITAL'S ED DISCHARGES IN 2012. FULLY 45% OF ALL INDIVIDUALS IN THE COUNTY BELOW THE POVERTY LINE LEVEL LIVE IN MERCY'S PRIMARY SERVICE AREA. WHILE A THIRD OF THE RESIDENTS IN THIS SERVICE AREA HAVE A BACHELOR'S DEGREE, NEARLY A QUARTER FROM THESE HIGH-POVERTY ZIP CODES DOES NOT HAVE A HIGH SCHOOL DIPLOMA. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH OVER THE YEAR, MERCY PROVIDED MANY OPPORTUNITIES TO EDUCATE THE COMMUNITY ON GOOD HEALTHY LIFESTYLE ISSUES. MONTHLY FREE PROGRAMS WERE GIVEN ON BREASTFEEDING, CHILDBIRTH PREPARATION, AND INFANT AND CHILD CPR. A PARTNERSHIP WAS FORMED WITH CATHOLIC CHARITIES TO OFFER WOMEN, INFANT AND CHILD SERVICES TO OUR PATIENTS IN THE OUTPATIENT OB/GYN/PEDI CLINIC. BECAUSE OF HURRICANE SANDY, MERCY OFFERED MANY PROGRAMS TO THE VICTIMS OF THIS DISASTER, INCLUDING FREE FLU AND TETANUS SHOTS. THEY WERE GIVEN OUT IN LONG BEACH AND ISLAND PARK AND OTHER PLACES IN NEED. MERCY PARTICIPATED IN DOZENS OF COMMUNITY HEALTH FAIRS ALL AROUND LONG ISLAND, IN TOWNS INCLUDING GARDEN CITY, ROCKVILLE CENTRE, LYNBROOK, BELLMORE, FREEPORT, AND UNIONDALE. AT EACH FAIR EDUCATIONAL MATERIAL WAS DISTRIBUTED, EMPHASIZING WELLNESS - NUTRITION AND EXERCISE, UNDERSTANDING RISK FACTORS AND DISEASE PREVENTION WAYS TO STAY HEALTHY. EDUCATIONAL MATERIALS WERE DISTRIBUTED AT VARIOUS EVENTS FOR MOST OF THE NATIONAL HEALTH AWARENESS DAYS - BREAST CANCER, PROSTATE CANCER, SKIN CANCER, DIABETES, AND HEART. AT MANY OF THESE EVENTS, FREE SCREENINGS WERE GIVEN TO THOSE WHO ATTENDED. A PATIENT NAVIGATION PROGRAM BEGAN IN 2012, PROVIDING AN RN NAVIGATOR TO HELP THOSE PATIENTS DIAGNOSED WITH CANCER TO NAVIGATE THE SYSTEM AND GET THE HEALTH CARE THEY NEEDED AND DESERVED. SPEAKER BUREAUS WERE CONDUCTED THROUGHOUT THE YEAR AT VARIOUS PLACES THROUGHOUT THE ISLAND - FAIRS, LIBRARIES, SENIOR CENTERS, CHURCHES, ETC. TOPICS INCLUDED: - LIVING WITH DIABETES DURING THE HOLIDAYS - EMOTIONAL FIRST AID AFTER DISASTER STRIKES - PROSTATE CANCER AWARENESS - EXERCISE YOUR WAY TO BETTER HEALTH - HEALTHY EATING FOR DIABETES IN SPANISH - GET YOUR PLATE IN SHAPE - HEALTHY HEART - STRESS MANAGEMENT FREE SUPPORT GROUPS WERE AGAIN OFFERED IN 2012, OPEN TO EVERYONE. THEY WERE AVAILABLE FOR BREAST CANCER AND BREAST HEALTH, DIABETES, OSTOMY CARE, STROKE, SUBSTANCE AND ALCOHOL ABUSE AND BREAST FEEDING. MERCY, IN CONJUNCTION WITH OTHER CATHOLIC HEALTH SERVICES OF LONG ISLAND HOSPITALS, PARTICIPATED IN THE HEALTHY SUNDAYS PROGRAM, A COMMUNITY OUTREACH PROGRAM HELD IN PARISHES DESIGNED TO PROMOTE EDUCATION ON MANY IMPORTANT HEALTH SUBJECTS SUCH AS CANCER AWARENESS, DIABETES, BLOOD PRESSURE, HEALTHY EATING, FITNESS, CHOLESTEROL, AND SMOKING CESSATION. MERCY FREQUENTED PARISHES IN WESTBURY, LONG BEACH, UNIONDALE, ROOSEVELT, HICKSVILLE AND ROCKVILLE CENTRE. IN 2012 MERCY CONTINUED ITS COMMUNITY OUTREACH PROGRAMS FOR FALL PREVENTION AND SMOKING CESSATION. MERCY CONDUCTED PROGRAMS AT SENIOR CENTERS, COMMUNITY HEALTH FAIRS AND LIBRARIES, AS WELL AS WITHIN THE HOSPITAL FOR MANY OF ITS INPATIENTS AND OUTPATIENTS WITH FALL HISTORY OR WHO SMOKE. THROUGH MERCY'S NEW RISK ASSESSMENT FORM, HOSPITAL EMPLOYEES EDUCATED INPATIENTS ON RISK FACTORS AND WAYS TO AVOID FUTURE FALLS. NURSING CONTINUED TO REVIEW POTENTIAL CHANGES IN INPATIENT PROCEDURES TO REDUCE INPATIENT FALLS, SUCH AS RISK ADMISSION ASSESSMENTS, DEVELOPING A FALL PLAN OF CARE, PATIENT AND FAMILY EDUCATION, USING SPECIALTY BEDS WITH EXIT ALARMS, INITIATING SAFETY WATCHES AND OFFERING FREQUENT TOILETING IN ORDER TO AVOID A POTENTIAL FALL, WITH THE GOAL OF ENCOURAGING PATIENTS TO FOLLOW THESE PROCEDURES AT HOME. MERCY IS A SMOKE FREE CAMPUS (EXCEPT FOR THE PSYCHIATRIC INPATIENT UNIT WHICH HAS A CLEARLY DEFINED POLICY WHEN ITS PATIENTS MAY TO SMOKE). ALL PATIENTS ARE SCREENED UPON ADMISSION AND THOSE IDENTIFIED AS SMOKERS ARE ENTERED INTO A DATA BASE, SO NURSING STAFF CAN EDUCATE PATIENTS MOST IN NEED. MERCY ADDED SMOKING CESSATION DRUGS TO ITS FORMULARY. MERCY USES PHARMACY MEDICATION RECORDS TO TRACK THE NUMBER OF PATIENTS WITH PRESCRIPTIONS WRITTEN FOR A SMOKING CESSATION MEDICATION. MERCY EMPLOYEES OFFER SMOKING CESSATION INFORMATION, REFERRALS TO SMOKING CESSATION PROGRAMS AND NY-QUIT LINE CARDS AT ALL COMMUNITY OUTREACH EVENTS. MERCY OFFERS SMOKING CESSATION PROGRAMS TO EMPLOYEES THROUGH ITS EMPLOYEE ASSISTANCE PROGRAM AND TO PHYSICIANS THROUGH THE CENTER FOR TOBACCO CONTROL. PART VI, LINE 6 AFFILIATED HEALTHCARE SYSTEM MERCY MEDICAL CENTER IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH IS LOCATED ON A SINGLE CAMPUS IN ROCKVILLE CENTRE, NEW YORK. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, MERCY, THROUGH ITS DAILY OPERATION, PROVIDES TO THE AREA ACUTE, PSYCHIATRIC, REHABILITATIVE, EMERGENT AND OUTPATIENT CARE. MERCY 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. OUR MISSION STATES: CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTH CARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. MEMBER ORGANIZATIONS OF CHS OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. EACH OF CHS' MEMBER ORGANIZATIONS HAVE RETAINED THEIR INDIVIDUAL LINKS TO HISTORY, A DISTINCTIVE PERSONALITY, 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, FREE HEALTH SCREENINGS THROUGH THE HEALTHY SUNDAYS PROGRAM, 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 HOSPITALS AND HUMAN SERVICE ORGANIZATIONS, WITH THE PRIMARY OBJECTIVE OF SERVING THE COMMUNITY. TO FURTHER THE MISSION OF BRINGING CARE TO THE COMMUNITY, CHS AND ITS MEMBER HOSPITALS, TOGETHER WITH A NUMBER OF OTHER 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. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI NY, true DIOCESE OF ROCKVILLE CENTRE - CATHOLIC MINISTRIES 50 N PARK AVE ROCKVILLE CTR NY 11570 111837437 501(C)(3) 184231 0 NONE NONE GENERAL SUPPORT ST FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 501(C)(3) 152795 0 NONE NONE WORKING CAPITAL SUBSIDY 2 0 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. CHS SERVICES, A RELATED ENTITY MAINTAINS THE BOOKS AND RECORDS FOR MERCY MEDICAL CENTER AND IS THEREFORE ABLE TO MONITOR THAT MERCY MEDICAL CENTER USED THE GRANT FUNDS FOR WORKING CAPITAL SUBSIDY. 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 ALAN D GUERCI MD 0 803701 0 261600 0 36302 0 289984 0 32219 0 1423806 0 0 WILLIAM C ARMSTRONG 0 589761 0 98000 0 219655 0 184585 0 27725 0 1119726 0 204388 AARON GLATT 511676 0 100000 0 17699 0 207624 0 27263 0 864262 0 0 0 RONALD W STEIMEL 345242 0 50000 0 10540 0 17425 0 27307 0 450514 0 0 0 JOHN REILLY 395697 0 40000 0 2349 0 17425 0 28346 0 483817 0 0 0 ALAN WONG MD 430327 0 20000 0 240 0 17425 0 24169 0 492161 0 0 0 ALEXANDER TELIS MD 365487 0 5000 0 186 0 15436 0 25720 0 411829 0 0 0 CHINWE OFFOR MD 279018 0 0 796 0 14441 0 25706 0 319961 0 0 0 SWAENA DEVARAJAN MD 304872 0 0 25848 0 17425 0 28602 0 376747 0 0 0 NANCY SIMMONS 0 527231 0 110600 0 365174 0 100078 0 18045 0 1121128 0 17414 STEPHEN TRAPANI 0 338462 0 50000 0 1888 0 92236 0 27334 0 509920 0 0 SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ALAN D GUERCI, MD $270,034 PARTICIPATION IN PLAN WILLIAM C ARMSTRONG $164,635 PARTICIPATION IN PLAN; $204,388 PAYMENT FROM PLAN AARON GLATT $190,199 PARTICIPATION IN PLAN NANCY SIMMONS $79,478 PARTICIPATION IN PLAN; $345,227 PAYMENT FROM 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. FORM 990, PART VI, LINE 6 MEMBERS OF THE ORGANIZATION THE SOLE MEMBER OF MERCY MEDICAL 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 CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF MERCY MEDICAL CENTER AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF MERCY MEDICAL CENTER. FORM 990, PART VI, LINE 7B DECISIONS OF THE GOVERNING BODY CHS AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF MERCY MEDICAL CENTER IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE GOVERING BODY OF MERCY MEDICAL CENTER. 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 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 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, 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. ALAN GUERCI, M.D. PRESIDENT AND CEO - THE TOTAL HOURS WORKED REPORTED 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); ST. JOSEPH HOSPITAL (11-3438973). WILLIAM ARMSTRONG, SENIOR VICE PRESIDENT AND CFO - THE TOTAL HOURS WORKED REPORTED 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). AARON GLATT, EVP/CAO - THE TOTAL HOURS WORKED REPORTED REFLECTS TIME WORKED AS AN OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: MERCY MEDICAL CENTER (11-1635088); ST. JOSEPH HOSPITAL (11-3438973). 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 OTHER CHANGES IN NET ASSETS CHANGE IN NET ASSETS - DEFINED BENEFIT PLAN (104,000) MIMS/LIEPC NET ASSETS ASSUMED 288,160 TOTAL 184,160 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 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 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) 3 CHSLI true 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 11795 208243412 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN PEDIATRIC SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208180263 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208088453 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SOUTHWEST SUFFOLK MEDICAL PC 580 UNION BOULEVARD WEST ISLIP NY 11795 061603195 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false CARDIAC EKG INTERPRETATION PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112924518 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208964140 HEALTHCARE SVC NY GOOD SAMARITAN C-CORP false SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112838185 HEALTHCARE SVC NY CHSLI C-CORP false FAIRVIEW HILL MANAGEMENT CO INC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 112798383 HOLDING CO NY CHSLI C-CORP false ADVANCED REHABILIATION MEDICINE PLLC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113640709 HEALTHCARE SVC NY STCHARLES HOSP C-CORP false ST FRANCIS CARDIAC PREVENTION SERVICES 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113224885 HEALTHCARE SVC NY STFRANCIS HOSP C-CORP false SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113307977 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false SAMARITAN HOME CARE AMERICA 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113319259 HEALTHCARE SVC NY SAMARITAN MGMT C-CORP false HEALTH CARE TEMP SERVICES INC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 112801136 EMPLOYMENT AGENCY NY FAIRVIEW HILL C-CORP false MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 510639649 HEALTHCARE SVC NY MERCY MED CTR C-CORP false LONG ISLAND EMERGENCY CARE PC 1000 N VILLAGE AVE ROCKVILLE CENTRE NY 115719024 113633515 PHYSICIAN SVC NY MERCY MED CTR S-CORP false false false true false true false false false false true false false true false true true true true true ST FRANCIS HOSPITAL M 1260000 COST ST FRANCIS HOSPITAL C, P 2500000 COST