2013-01-15T13:43:29-06:00 2011-12-31 221478099 COHNREZNICK LLP 4 BECKER FARM ROAD ROSELAND NJ 070681739 990 2011-01-01 113284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER OURL 6315871600 111 BEACH DRIVE WEST ISLIP NY 11795 JOSEPH TOMAINO 6315871600 2013-01-15 1 THOMAS LANNING P00851654 9732283500 2011 2016-02-25 16:41:14Z JOSEPH TOMAINO 111 BEACH DRIVE WEST ISLIP NY 11795 61006481 0 0928 X HTTP://OLC.CHSLI.ORG X 1894 NY OUR LADY OF CONSOLATION GERIATRIC CARE 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, 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. 22 21 843 180 0 0 168082 122472 57398506 60560750 127363 117881 198590 205378 57892541 61006481 0 19924 0 0 40240079 40474408 0 0 0 17602429 18002475 57842508 58496807 50033 2509674 32530110 36302529 29626112 32085971 2903998 4216558 X OUR LADY OF CONSOLATION GERIATRIC CARE 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, 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. 0 0 52690583 19924 60594159 THE FACILITY PROVIDES SKILLED CARE FOR UP TO 450 RESIDENTS ON ADAILY BASIS. THE FACILITY PROVIDED CARE FOR 157,648 DAYS FOR THEYEAR 2011. 52690583 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 65 0 1 843 1 0 0 0 0 0 0 0 0 0 0 X 22 21 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHS SERVICES INC 6314656442 992 NORTH VILLAGE AVE ROCKVILLE CENTRE NY 11570 HON ANGIE CARPENTER 2.00 X X 0 0 0 BERNADETTE CURRY PHD RN 2.00 X X 0 0 0 CHARLES FALKNER 2.00 X X 0 0 0 SISTER DOLORES CASTELLANO CIJ 2.00 X X 0 0 0 DONATO BALSAMO DO 2.00 X 0 12959 71 ROBERT DOYLE 2.00 X 0 0 0 PHILIP FAVA 2.00 X 0 0 0 SR MARGARET KELLIHER DW 2.00 X 0 0 0 WALTER LACE 2.00 X 0 0 0 BROTHER CAMPION LALLY OSF 2.00 X 0 0 0 TIMOTHY J MATTIMORE ESQ 2.00 X 0 0 0 SISTER KATHLEEN MCCARTHY OP 2.00 X 0 0 0 REV MSGR THOMAS MULVANERTY 2.00 X 0 0 0 DIANE SWEENEY 2.00 X 0 0 0 RICHARD ROMER 2.00 X 0 0 0 DANIEL ROWE 2.00 X 0 0 0 J TIMOTHY SHEA ESQ 2.00 X 0 0 0 CHARLES SPENCER 2.00 X 0 0 0 DEBBIE VAN BOURGONDIEN 2.00 X 0 0 0 JEFFREY VOLLMUTH 2.00 X 0 0 0 SR DOLORES WISNIEWSKI 2.00 X 0 0 0 JOSEPH TOMAINO 50.00 X X 418470 0 176579 WILLIAM MEAD 50.00 X 371519 0 44526 JAMES RYAN 50.00 X 188626 0 39583 SISTER MARILYN BREEN 37.50 X 0 0 0 DAVID SISKIND MD 50.00 X 266575 0 44697 THERESA ROSENTHAL 50.00 X 182983 0 38471 JOHN HAIGHT 50.00 X 188094 0 37753 ALICE KOLASA MD 37.50 X 152695 0 13923 THERESA LEONARD 37.50 X 148964 0 14549 NAZILA SHENASSA 37.50 X 135460 0 43982 CHRISTOPHER LOHAN 37.50 X 121017 0 33819 CATHERINE ARGEROPLOS 37.50 X 112493 0 34454 2286896 12959 522407 18 0 1 0 AXIS CONSTRUCTION 125 LASER CT HAUPPAUGE NY 117880000 GENERAL CONTRACTING 1760051 AIDES AT HOME 29 W MARIE ST HICKSVILLE NY 118010000 HOMECARE STAFFING 468413 BESTCARE PO BOX 9010 LEVITTOWN NY 117569010 HOMECARE STAFFING 429563 AFFINITY REHABILITATION 10600 YORK RD SUITE 105 COCKEYSVILLE MD 210300000 REHAB DEPARTMENT STAFFING 251777 JVK OPERATIONS LIMITED 130 NEW HIGHWAY N AMITYVILLE NY 117010000 LAUNDRY 215020 15 122472 122472 PATIENT REVENUE 623000 60560750 60560750 60560750 117881 117881 CAFETERIA/COFFE SHOP 623000 132588 132588 VENDING MACHINES/DISCO 623000 33409 33409 TELEVISION/TELEPHONE R 623000 21685 21685 17696 17696 205378 61006481 60594159 0 289850 19924 19924 1997876 532726 1465150 27024607 25988129 1036478 2147514 2147514 7047229 6989643 57586 2257182 2257182 152918 4424 148494 6987 6987 71904 71904 5480785 5285850 194935 792096 559480 232616 720027 720027 1937365 1937365 32745 18922 13823 7119 7119 86114 86114 1303212 1303212 MEDICAL EXPENSES 1952697 1951719 978 DIETARY FOOD & EXPENSES 1670854 1670854 HOUSEKEEPING AND LAUNDR 784787 784787 BAD DEBT 604796 604796 2398069 1930149 467920 58496807 52690583 5806224 0 222555 2241980 5141146 3340547 12725 8795 8117257 9395661 39103 52729 799732 760882 40319496 21497076 17001944 18822420 1195648 1679515 32530110 36302529 11534018 12045670 15207840 14923063 3169031 4832461 29626112 32085971 X 2880299 4197183 23699 19375 2903998 4216558 32530110 36302529 X 2509674 -1197114 X X 0 1 1 X 0 X 201938 164546 31811 168082 122472 688849 49890341 55321813 57448983 57398506 60560750 280620393 50092279 55486359 57480794 57566588 60683222 281309242 0 0 0 281309242 298539 203329 194953 127363 117881 942065 298539 203329 194953 127363 117881 942065 1190414 374629 214983 198590 205378 2183994 51581232 56064317 57890730 57892541 61006481 284435301 0.98900 0.00330 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1907 1907 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: OLC PAID DUES TO NYASHA, A TRADE ASSOCIATE, WHO IS INVOLVED IN LOBBYING ACTIVITIES. THE TOTAL DUES PAID FOR 2011 WAS $20,979.72 WHICH 5.50% WAS USED FOR LOBBYING, AMOUNTING TO THE EXPENSE OF $1,153.88. OLC ALSO PAID DUES TO CCLC (CONTINUING CARE LEADERSHIP COALITION), A TRADE ASSOCIATE, WHO IS INVOLVED IN LOBBYING ACTIVITIES. THE TOTAL DUES PAID FOR 2011 WAS $4,532.00 WHICH 16.61% WAS USED FOR LOBBYING, AMOUNTING TO THE EXPENSE OF $752.77. 325000 325000 21404266 8302560 13101706 17071597 12060574 5011023 1518633 1133942 384691 18822420 DUE TO RELATED PARTIES 3306929 RESIDENT FUNDS 147313 PAYABLE DUE 3RD PARTY INSURERS 1378219 4832461 61006481 58496807 2509674 -7458 -1189656 -1197114 1312560 61006481 0 61006481 0 61006481 58390769 0 58390769 106038 106038 58496807 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 112,289. NET INCOME FROM FUNDRAISING EVENTS REPORTED ON FOUNDATION 990 EZ -72,571. LOSS ON DEBT EXTINGUISHMENT -1,185,331. CONTRIBUTIONS REPORTED ON FOUNDATION 990 EZ -44,043. TOTAL TO SCHEDULE D, PART XI, LINE 8: -1,189,656. PART XIII, LINE 4B - OTHER ADJUSTMENTS: PAYMENTS TO AFFILIATES 106,038. PART XIII, LINE 4B IS THE PAYMENTS TO AFFILIATES FROM PART IX LINE 21 OF THE FORM 990. THIS EXPENSE IS TREATED AS A BELOW THE ITEM ON THE AUDITED FINANCIAL STATEMENTS. 0 DIOCESE OF ROCKVILLE CENTRE-CATHOLIC MINISTRIES 50 NORTH PARK AVE ROCKVILLE CENTRE NY 11570 111837437 19924 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. 1 1 THE DIOCESE OF ROCKVILLE CENTRE PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL, WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI. X X X X X 0 1 0 0 0 0 0 0 0 JOSEPH TOMAINO 352299 0 0 0 66171 0 151509 0 25070 0 595049 0 0 0 WILLIAM MEAD 270778 0 90000 0 10741 0 21393 0 23133 0 416045 0 0 0 JAMES RYAN 163415 0 25000 0 211 0 14605 0 24978 0 228209 0 0 0 DAVID SISKIND MD 240913 0 25000 0 662 0 19968 0 24729 0 311272 0 0 0 THERESA ROSENTHAL 161787 0 20000 0 1196 0 13695 0 24776 0 221454 0 0 0 JOHN HAIGHT 152723 0 35000 0 371 0 13608 0 24145 0 225847 0 0 0 ALICE KOLASA MD 152338 0 0 0 357 0 13723 0 200 0 166618 0 0 0 THERESA LEONARD 92719 0 0 0 56245 0 7047 0 7502 0 163513 0 0 0 NAZILA SHENASSA 135350 0 0 0 110 0 12930 0 31052 0 179442 0 0 0 CHRISTOPHER LOHAN 120816 0 0 0 201 0 10701 0 23118 0 154836 0 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J PART I, LINE 4B SERP CONTRIBUTION EXPENSE WAS AS FOLLOWS: JOSEPH TOMAINO: $168,187 SUPPLEMENTAL INFORMATION PART III PART VII, SECTION A, LINE 1A: TRUSTEE DONATO BALSAMO, D.O. RECEIVED COMPENSATION FOR THE PERFORMANCE OF SERVICES AS A PHYSICIAN FOR GOOD SAMARITAN HOSPITAL (RELATED ORGANIZATION. MR. BALSAMO RECEIVED NO COMPENSATION AS A TRUSTEE FOR OUR LADY OF CONSOLATION. JOSEPH TOMAINO, EVP CONTINUING CARE - THE TOTAL HOURS WORK REPORTED REFLECTS TIME WORKED AS OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SHEPHERD HOSPICE (11-2958438); NURSING SISTERS HOME CARE,INC D/B/A CATHOLIC HOME CARE (11-2126736); CHS HOME SUPPORT SERVICES,INC. (11-3594561); OUR LADY OF CONSOLATION GERIATRIC CARE CENTER(11-3284066); MARYHAVEN CENTER OF HOPE (11-2861698). WILLIAM MEAD, CFO CONTINUING CARE - THE TOTAL HOURS WORK REPORTED REFLECTS TIME WORKED AS OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SHEPHERD HOSPICE (11-2958438); NURSING SISTERS HOME CARE,INC D/B/A CATHOLIC HOME CARE (11-2126736); CHS HOME SUPPORT SERVICES,INC. (11-3594561); OUR LADY OF CONSOLATION GERIATRIC CARE CENTER(11-3284066); MARYHAVEN CENTER OF HOPE (11-2861698). SUPPLEMENTAL INFORMATION PART III 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 2011 FORM W-2 BOX, 5 AS TAXABLE WAGES BECAUSE THEY ARE VESTED, BUT ARE NOT DISTRIBUTED UNTIL RETIREMENT. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE INDIVIDUALS INCLUDES BOTH QUALIFIED AND NONQUALIFIED RETIREMENT PLANS. FORM 990, PART VI, SECTION A, LINE 6 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, SECTION A, LINE 7A CATHOLIC HEALTH SYSTEM OF LONG ISLAND, (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND) (CHS)IS THE SOLE MEMBER OF OUR LADY OF CONSOLATION GERIATRIC CARE CENTER, AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF THE ENTITY. FORM 990, PART VI, SECTION A, LINE 7B 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 OUR LADY OF CONSOLATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990, AND APPROPRIATE SCHEDULES, IS COMPLETED BY THE ACCOUNTING AND FINANCE STAFF OF THE ORGANIZATION AND REVIEWED INTERNALLY BY MANAGEMENT. IT IS THEN REVIEWED BY OUTSIDE TAX ADVISORS. THE FINAL DRAFT OF THE FORM 990 IS THEN PRESENTED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES (THE BOARD), WHICH HAS BEEN DELEGATED THE DETAILED REVIEW FUNCTION BY THE BOARD. UPON APPROVAL OF THE COMMITTEE, THE FORM 990 IS THEN SENT TO ALL VOTING MEMBERS OF THE BOARD. ONCE APPROVED BY THE BOARD (OR THE EXECUTIVE COMMITTEE OF THE BOARD, AS APPROPRIATE), THE ORGANIZATION'S BOARD CHAIR AND CHIEF EXECUTIVE OFFICER COMMUNICATES, IN WRITING TO THE CHS COMPLIANCE AND AUDIT COMMITTEE AND CHS BOARD CHAIR. AFTER REVIEW OF ANY APPLICABLE COMMENTS FROM THE BOARD, THE COMPLIANCE AND AUDIT COMMITTEE WILL THEN RECOMMEND THE APPROVAL OF THE FORM 990 TO THE CHS BOARD OF DIRECTORS WHO WILL THEN REVIEW THE RECOMMENDATIONS AND PROVIDE THE FINAL APPROVAL OF THE FORM 990. THE FORM 990 IS THEN SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C 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 ORGANIZATIONS COMPLIANCE AND AUDIT COMMITTEE BY THE ORGANIZATIONS 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 ORGANIZATIONS 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 ORGANIZATIONS BOARD OF TRUSTEES SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. UPON RECEIPT OF THE WRITTEN REQUEST AND ANY SUPPORTING DOCUMENTS, THE CHS COMPLIANCE AND AUDIT COMMITTEE SHALL MAKE THE FINAL DECISION AS TO WHETHER CHS SHALL ENTER INTO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 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. ONCE APPROVED BY THE CORPORATE CEO, THESE RECOMMENDATIONS ARE SENT TO THE EXECUTIVE COMPENSATION COMMITTEE FOR REVIEW. THE EXECUTIVE COMPENSATION COMMITTEE, WITH AN INDEPENDENT COMPENSATION CONSULTANT ENGAGED BY THE BOARD, WILL REVIEW PROPOSED SALARY ADJUSTMENTS AND INCENTIVE AWARDS TO ENSURE REASONABLENESS BY REVIEWING COMPARABLE TOTAL COMPENSATION DATA (INCLUDING INCENTIVES) PAID TO SIMILARLY SITUATED EXECUTIVES AT THE MEDIAN OF THE DEFINED MARKETPLACE WITH POSSIBLE ADJUSTMENT MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASUREABLE AND RELATED TO INDICATORS OF PERFORMANCE. BASED ON THE INFORMATION, THE COMMITTEE WILL THEN MAKE ITS RECOMMENDATION TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS CERTIFICATE OF INCORPORATION FILIED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE; FINANCIAL STATEMENTS ARE AVAILABLE AT DAC BOND. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -7,458. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 112,289. NET INCOME FROM FUNDRAISING EVENTS REPORTED ON FOUNDATION 990 EZ -72,571. LOSS ON DEBT EXTINGUISHMENT -1,185,331. CONTRIBUTIONS REPORTED ON FOUNDATION 990 EZ -44,043. TOTAL TO FORM 990, PART XI, LINE 5: -1,197,114. PROCESS FOR FORM 990 REVIEW THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS COMPLETED BY THE ACCOUNTING AND FINANCE STAFF OF THE ORGANIZATION AND REVIEWED INTERNALLY BY MANAGEMENT. IT IS THEN REVIEWED BY OUTSIDE TAX ADVISORS AND ANY NECESSARY ASJUSTMENTS ARE MADE, AFTER WHICH TIME IT IS CONSIDERED AN INITIAL DRAFT. THE INITIAL DRAFT IS THEN PRESENTED TO THE EXECUTIVE MANAGEMENT OF THE ORGANIZATION BY TAX ADVISORS AND STAFF TO PROVIDE DETAIL AND GIVE LEADERSHIP AN OPPORTUNITY TO GIVE FEEDBACK RELATIVE TO THE INFORMATION INCLUDED IN THE FORM 990. ANY NECESSARY CHANGES ARE MADE AND A COMPLETE FORM 990 FINAL DRAFT IS SENT TO EXECUTIVES FOR FINAL REVIEW. ATTESTATIONS ARE THEN PROVIDED BY EXECUTIVES INDICATING THEIR REVIEW AND SATISFACTION WITH THE COMFORT OF THE FORM 990. THE FINAL DRAFT OF THE FORM 990 IS PRESENTED TO THE ORGANIZATIONS COMPLIANCE AND AUDIT COMMITTEE (THE COMMITTEE) OF THE BOARD OF TRUSTEES (THE BOARD), WHICH HAS BEEN DELEGATED THE DETAILED REVIEW FUNCTION BY THE BOARD. ONCE THE COMMITTEES REVIEW IS COMPLETE, THE COMMITTEE RECOMMENDS THE APPROVAL OF THE FORM 990 TO THE BOARD (OF THE EXECUTIVE COMMITTEE OF THE BOARD, AS APPROPRIATE). THE FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD. UPON APPROVAL BY THE BOARD (OR THE EXECUTIVE COMMITTEE OF THE BOARD, AS APPROPRIATE), THE ORGANIZATIONS BOARD CHAIR AND CHIEF EXECUTIVE OFFICER COMMUNICATE SUCH APPROVAL IN WRITING TO THE CHS COMPLIANCE AND AUDIT COMMITTEE AND CHS BOARD CHAIR, WHOM RECOMMEND APPROVAL TO THE CHS BOARD, AND CERTIFIES THAT THE CHS BOARD APPROVED FORM 990 REVIEW PROCESS HAS BEEN FOLLOWED. THE CHS COMPLIANCE AND AUDIT COMMITTEE REVIEWS THE ORGANIZATIONS CORRESPONDENCE REGARDING THE FORM 990 RECOMMENDED APPROVAL AND REVIEW PROCESS. THE CHS COMPLIANCE AND AUDIT COMMITTEE IS PROVIDED WITH THE ORGANIZATIONS FORM 990 AND REVIEWS THE FORM TO THE EXTENT IT DEEMS APPROPRIATE IN THE LIGHT OF THE ORGANIZATIONAL CERTIFICATIONS AND OTHER FACTORS AS DETERMINED BY THE COMMITTEE. UPON THE CHS COMPLIANCE AND AUDIT COMMITTEES REVIEW OF THE ORGANIZATIONS RECOMMENDED APPROVAL AND SATISFACTION OF THE FORM 990 REVIEW PROCESS, IT SHALL RECOMMEND THE APPROVAL OF THE FORM 990 TO THE CHS BOARD OF DIRECTORS (OR THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, AS APPROPRIATE). THE CHS BOARD OF DIRECTORS (OR THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, AS APPROPRIATE) REVIEWS THE CHS COMPLIANCE AND AUDIT COMMITTEES RECOMMENDATION AND PROVIDES THE FINAL APPROVAL OF THE FORM 990. THE FORM 990 IS THEN SUBMITTED TO THE INTERNAL REVENUE SERVICE. CONTROLLED GROUP ELECTION - CONTINUED EMPLOYER NAME, ADDRESS & TAX YEAR-END ID NO. 11-3403968 CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/11 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/11 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/11 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/11 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/11 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/11 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/11 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/11 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/11 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/11 26-3169427 CATHOLIC HOME CARE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/11 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/11 27-1531084 OUR LADY OF CONSOLATION FOUNDATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/11 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/11 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/11 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/11 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/11 STATEMENT OF TAX BRAKET ALLOCATION THE AMOUNTS IN EACH TAXABLE INCOME BRACKET IN THE TAX TABLE IN SECTION 11(B) HAVE BEEN ALLOCATED TO THE CORPORATIONS LISTED BELOW PURSUANT TO REGULATION 1.1561-3(A). THE ORIGINAL COPY OF THIS STATEMENT IS FILED WITH THE INTERNAL REVENUE SERVICE CENTER IN OGDEN, UTAH. AUTHORIZATION CONSENT FOR ALLOCATION ON BEHALF OF MEMBER COMPANIES ____________________________________________ EMPLOYER ID NO. $50,000 $25,000 $9,925,000 BRACKET BRACKET BRACKET 11-3403968 NONE NONE NONE 14-1801961 NONE NONE NONE 11-3594561 NONE NONE NONE 11-3555766 NONE NONE NONE 11-1888924 NONE NONE NONE 77-0611240 NONE NONE NONE 11-2537396 NONE NONE NONE 11-2958438 NONE NONE NONE 11-3434776 NONE NONE NONE 11-2861698 NONE NONE NONE 11-2861690 NONE NONE NONE 11-3638367 NONE NONE NONE 11-1635088 NONE NONE NONE 11-2126736 NONE NONE NONE 11-3284066 NONE NONE NONE 20-8067039 NONE NONE NONE 11-2499790 NONE NONE NONE 06-1569129 NONE NONE NONE 06-1562701 NONE NONE NONE 11-1871039 NONE NONE NONE 41-2076312 NONE NONE NONE 11-3613997 NONE NONE NONE 11-2050523 NONE NONE NONE 11-2916033 NONE NONE NONE 11-3090867 NONE NONE NONE 11-2110488 NONE NONE NONE 11-2983148 NONE NONE NONE 11-2716640 NONE NONE NONE 11-3559713 NONE NONE NONE 11-1635088 NONE NONE NONE 55-0813603 NONE NONE NONE 27-1459941 NONE NONE NONE IN PROCESS NONE NONE NONE 26-3169427 NONE NONE NONE 45-0517566 NONE NONE NONE 27-1531084 NONE NONE NONE 11-2798383 NONE NONE NONE 11-2801136 NONE NONE NONE 11-2838185 $50,000 $25,000 $9,925,000 11-3319259 NONE NONE NONE 06-1568934 NONE NONE NONE 11-3307977 NONE NONE NONE 11-2126736 NONE NONE NONE STATEMENT OF TAX BRAKET ALLOCATION - CONTINUED EMPLOYER NAME, ADDRESS & TAX YEAR-END ID NO. 11-3403968 CATHOLIC HEALTH SERVICES OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 14-1801961 CHS AMBULANCE SERVICES 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-3594561 CHS HOME SUPPORT SERVICES, INC. 15 POWER DRIVE HAUPPAUGUE, NY 11788 TAX YEAR END: 12/31/10 11-3555761 CHS SERVICES, INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-1888924 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 77-0611240 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 11-2537396 GOOD SAMARITAN HOSPITAL SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 11-2958438 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/10 11-3434776 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAX YEAR END: 12/31/10 11-2861698 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-2861690 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-3638367 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON, NY 11776 TAXABLE YEAR: 12/31/10 11-1635088 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2126736 CATHOLIC HOME CARE 1150 PORTION BLVD. SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 11-3284066 OUR LADY OF CONSOLATION GERIATRIC CARE CENTER 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 20-8067039 RVC INSURANCE COMPANY, INC. 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2499790 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 06-1569129 SIENA VILLAGE 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 06-1562701 ST. CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 11-1871039 ST. CHARLES HOSPITAL AND REHABILITATION CENTER 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 41-2076312 ST. CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 11-3613997 ST. FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2050523 ST. FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD. ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2916033 ST. FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-3090867 ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION 100 PORT WASHINGTON BOULEVARD ROSLYN, NY 11576 TAX YEAR END: 12/31/10 11-2110488 SUFFOLK HEARING & SPEECH 369 EAST MAIN STREET EAST ISLIP, NY 11730 TAX YEAR END: 12/31/10 11-2983148 THE ST. CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAX YEAR END: 12/31/10 11-2716640 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 11-3559713 WISDOM GARDENS HOUSING DEVELOPMENT CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION, NY 11776 TAX YEAR END: 12/31/10 11-1635088 ST. FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 27-1459941 ST. CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN, NY 11787 TAX YEAR END: 12/31/10 IN PROCESS CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAX YEAR END: 12/31/10 26-3169427 CATHOLIC HOME CARE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE, NY 11747 TAX YEAR END: 12/31/10 45-0517566 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP, NY 11795 TAX YEAR END: 12/31/10 27-1531084 OUR LADY OF CONSOLATION FOUNDATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE, NY 11570 TAX YEAR END: 12/31/10 11-2798383 FAIRVIEW HILL MANAGEMENT CORP 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/10 11-2801136 HEALTHCARE TEMP SERVICES 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777 TAXABLE YEAR: 12/31/10 11-2838185 SAMARITAN MANAGEMENT SERVICES 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 11-3319259 SAMARITAN HOME CARE AMERICA, INC. 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 06-1568934 SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN, NY 11787 TAXABLE YEAR: 12/31/10 11-3307977 SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP, NY 11795 TAXABLE YEAR: 12/31/10 11-2126736 NURSING SISTERS HOME CARE, INC 1150 PORTION ROAD, SUITE 1 HOLTSVILLE, NY 11742 TAXABLE YEAR: 12/31/10 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113403968 SUPPORT ORG NY 501(C)(3) LINE 11A, I N/A 0 CHS SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 113555766 SUPPORT ORG NY 501(C)(3) LINE 11A, I CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 CHS AMBULANCE SERVICES INC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 141801961 DORMANT NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 111888924 HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112537396 SELF INSURANCE NY 501(C)(3) LINE 11A, I GOOD SAMARITAN HOSPITAL 0 MARYHAVEN TRANSPORTATION SERVICES 51 TERRYVILLE ROAD PORT JEFFERSON STATION NY 11776 113434776 TRANSPORTATION SERVICES NY 501(C)(3) LINE 9 MARYHAVEN CENTER OF HOPE 0 MARYHAVEN CENTER OF HOPE 51 TERRYVILLE ROAD PORT JEFFERSON STATION NY 11776 112861698 PROGRAMS/HOUSING FOR THE DEVELOPMENTALLY DISABLED NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 MARYHAVEN SCHOOL CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION NY 11776 112861690 SCHOOL FOR DEVELOPMENTALLY DISABLED NY 501(C)(3) LINE 9 MARYHAVEN CENTER OF HOPE 0 THE CENTER OF HOPE FOUNDATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION NY 11776 113638367 SUPPORT ORG NY 501(C)(3) LINE 11A, I MARYHAVEN CENTER OF HOPE 0 MERCY MEDICAL CENTER 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 111635088 HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 CATHOLIC HOME CARE 1150 PORTION ROAD SUITE 1 HOLTSVILLE NY 11742 112126736 HOME CARE NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 RIVERHEAD HOSTEL HOLDING CORPORATION 51 TERRYVILLE ROAD PORT JEFFERSON STATION NY 11776 112499790 RENTING NY 501(C)(3) LINE 9 MARYHAVEN CENTER OF HOPE 0 SIENA VILLAGE INC 50 ROUTE 25A SMITHTOWN NY 11787 061569129 SENIOR HOUSING NY 501(C)(3) LINE 9 ST CATHERINE OF SIENA MEDICAL CENTER 0 ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 061562701 HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 ST CHARLES HOSPITAL 200 BELLE TERRE ROAD PORT JEFFERSON STATION NY 11777 111871039 HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 CHS HOME SUPPORT SERVICES INC 15 POWER DRIVE HAUPPAUGE NY 11788 113594561 RESPIRATORY THERAPY SVC/MED. EQUIP. NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 ST FRANCIS HOSPITAL 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112050523 HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 ST FRANCIS HOSPITAL FOUNDATION 100 PORT WASHINGTON BLVD ROSLYN NY 11576 112916033 SUPPORT ORG NY 501(C)(3) LINE 11A, I ST FRANCIS HOSPITAL 0 ST FRANCIS HOSPITAL RESEARCH & EDUCATIONAL CORP 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113090867 RESEARCH ORGANIZATION NY 501(C)(3) LINE 9 ST FRANCIS HOSPITAL 0 WSNCHS NORTH INC 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 11714 113438973 HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 SUFFOLK HEARING & SPEECH CENTER INC 369 EAST MAIN STREET EAST ISLIP NY 11730 112110488 DIAGNOSTIC TESTING NY 501(C)(3) LINE 3 GOOD SAMARITAN HOSPITAL 0 THE ST CHARLES CORPORATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 112983148 SUPPORT ORG NY 501(C)(3) LINE 11A, I CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 THE SAMARITAN CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 112716640 SUPPORT ORG NY 501(C)(3) LINE 11A, I CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 WISDOM GARDENS HOUSING DEVELOPMENT FUND INC 51 TERRYVILLE ROAD PORT JEFFERSON STATION NY 11776 113559713 SENIOR HOUSING NY 501(C)(3) LINE 9 MARYHAVEN CENTER OF HOPE 0 GOOD SHEPHERD HOSPICE 245 OLD COUNTRY ROAD MELVILLE NY 11747 112958438 HOSPICE SERVICES NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 ST CHARLES HOSPITAL FOUNDATION 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 412076312 SUPPORT ORG NY 501(C)(3) LINE 11A, I ST CHARLES HOSPITAL 0 GOOD SAMARITAN HOSPITAL FOUNDATION 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 770611240 SUPPORT ORG NY 501(C)(3) LINE 11A, I GOOD SAMARITAN HOSPITAL 0 ST FRANCIS-MERCY CORPORATION 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 111635088 SUPPORT ORG NY 501(C)(3) LINE 11A, I CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 550813603 SUPPORT ORG NY 501(C)(3) LINE 11A, I MERCY MEDICAL CENTER 0 ST CATHERINE OF SIENA MEDICAL CENTER FOUNDATION 50 ROUTE 25A SMITHTOWN NY 11787 271459941 SUPPORT ORG NY 501(C)(3) LINE 11A, I ST CATHERINE OF SIENA MEDICAL CENTER 0 CATHOLIC HOME CARE FOUNDATION 1150 PORTION ROAD SUITE 1 HOLTSVILLE NY 11742 SUPPORT ORG NY 501(C)(3) LINE 11A, I CATHOLIC HOME CARE 0 GOOD SHEPHERD HOSPICE FOUNDATION 245 OLD COUNTRY ROAD MELVILLE NY 11747 263169427 SUPPORT ORG NY 501(C)(3) LINE 11A, I GOOD SHEPHERD HOSPICE 0 OUR LADY OF CONSOLATION FOUNDATION 111 BEACH DRIVE WEST ISLIP NY 11795 450517566 SUPPORT ORG NY 501(C)(3) LINE 11A, I OUR LADY OF CONSOLATION 0 RVC SUPPORT 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 271531084 REAL ESTATE NY 501(C)(3) LINE 11A, I CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 ST FRANCIS CARDIOVASCULAR PHYSICIANS PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113613997 HEALTHCARE SERVICES NY 501(C)(3) LINE 3 ST FRANCIS HOSPITAL 0 RVC INSURANCE COMPANYINC 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 208067039 CAPTIVE INSURANCE COMPANY NY 501(C)(3) LINE 11A, I CATHOLIC HEALTH SYSTEM OF LONG ISLAND 0 RADIOLOGY CONSULTING OF LONG ISLAND PLLC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 421646134 HEALTHCARE SERVICES NY GOOD SAMARITAN HOSPITAL C SAMARITAN EMERGENCY MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208243412 DIAGNOSTIC TESTING NY GOOD SAMARITAN HOSPITAL C SAMARITAN PEDIATRIC SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208180263 HEALTHCARE SERVICES NY GOOD SAMARITAN HOSPITAL C SAMARITAN MEDICAL SERVICES PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208088453 DIAGNOSTIC TESTING NY GOOD SAMARITAN HOSPITAL C SOUTHWEST SUFFOLK MEDICAL PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 061603195 HEALTHCARE SERVICES NY GOOD SAMARITAN HOSPITAL C CARDIAC EKG INTERPRETATION PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112924518 HEALTHCARE SERVICES NY GOOD SAMARITAN HOSPITAL C LI REGIONAL ARTHRITIS & OSTEOPOROSIS CARE PC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 208964140 HEALTHCARE SERVICES NY GOOD SAMARITAN HOSPITAL C SAMARITAN MANAGEMENT SERVICES INC 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 112838185 HEALTHCARE SERVICES NY CATHOLIC HEALTH SYSTEM OF LONG ISLAND C FAIRVIEW HILL MANAGEMENT CO INC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 112798383 SERVICES NY ST CHARLES CORPORATION C ADVANCED REHABILIATION MEDICINE PLLC 200 BELLE TERRE ROAD PORT JEFFERSON NY 11777 113640709 HEALTHCARE SERVICES NY ST CHARLES HOSPITAL C ST FRANCIS CARDIAC PREVENTION SERVICES PC 100 PORT WASHINGTON BLVD ROSLYN NY 11576 113224885 HEALTHCARE SERVICES NY ST FRANCIS HOSPITAL C SOUTH SHORE PRACTICE MANAGEMENT 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 113307977 HEALTHCARE SERVICES NY GOOD SAMARITAN HOSPITAL C MERCY INTERNAL MEDICINE PC 992 N VILLAGE AVENUE ROCKVILLE CENTRE NY 11710 510639649 HEALTHCARE SERVICES NY MERCY MEDICAL CENTER C 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 CATHOLIC HEALTH SERVICES OF LONG ISLAND N 36126 NET CHS SERVICES INC L -786078 NET ST CATHERINE'S OF SIENA MEDICAL CENTER N -65262 NET MARYHAVEN N 65440 NET GOOD SHEPHARD HOSPICE N 61492 NET CATHOLIC HOME CARE N 83083 NET ST FRANCIS HOSPITAL O 108437 NET GOOD SAMARITAN HOSPITAL MEDICAL CENTER N 175717 NET MERCY MEDICAL CENTER L 7084 NET ST CHARLES HOSPITAL L -112 NET ST JOSEPH'S HOSPITAL L -1454 NET ROCKVILLE CENTRE INSURANCE COMPANY L -7500 NET CHS HOME SUPPORT SERVICE L 5950 NET TRANSACTIONS WITH RELATED PARTIES SCHEDULE R PART V OUR LADY OF CONSOLATION GERIATRIC CARE CENTER HAS DISCLOSED IN SCHEDULE R THE PREDOMINANT TRANSACTION TYPE WITH EACH FACILITY WITH WHICH IT HAS CONDUCTED TRANSACTIONS. HOWEVER, THERE ARE ADDITIONAL TRANSACTION TYPES TO DESCRIBE THE ACTIVITES OUR LADY OF CONSOLATION GERIATRIC CARE CENTER HAS ENGAGED IN WITH ITS RELATED PARTY ORGANIZATIONS. THE FOLLOWING IS A LIST OF ADDITIONAL TRANSACTION TYPES BY FACILITY. NAME OF ORGANIZATION ADDITIONAL TRANSACTION TYPE(S) CATHOLIC HEALTH SERVICES OF LONG ISLAND L, O CHS SERVICES, INC O ST. CATHERINE'S OF SIENA MEDICAL CENTER L, O, P MARYHAVEN O, P GOOD SHEPHARD HOSPICE O, P CATHOLIC HOME CARE O, P GOOD SAMARITAN HOSPITAL MEDICAL CENTER E, L CHS HOME SUPPORT SERVICE O