2013-01-15T14:19:02-06:00
2011-12-31
221478099
COHNREZNICK LLP
4 BECKER FARM ROAD
ROSELAND
NJ
070681739
990
2011-01-01
113638367
CENTER OF HOPE FOUNDATION INC
CENT
6314744120
51 TERRYVILLE RD
PORT JEFFERSON STATION
NY
117763097
LEWIS GROSSMAN
CEO
6314744110
2013-01-15
1
THOMAS LANNING
P00851654
9732283500
2011
2016-02-25 16:41:14Z
LEWIS GROSSMAN
51 TERRYVILLE RD
PORT JEFFERSON STATION
NY
117763097
3750
0
X
HTTP://GOODSAMARITAN.CHSLI.
X
1998
NY
CENTER OF HOPE FOUNDATION, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND, AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, COMMITTED TO THOSE IN NEED, 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.
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CENTER OF HOPE FOUNDATION, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND, AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, COMMITTED TO THOSE IN NEED, 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
413
250
DAY PROGRAMS FOR THE DEVELOPMENTALLY DISABLED: THE ORGANIZATION RAISES MONEY THROUGH FUNDRAISING EVENTS TO SUPPORT THE WORK OF MARYAVEN CENTER OF HOPE AND ITS SUBSIDIARIES IN THEIR WORK WITH THE MENTALLY RETARDED, DEVELOPMENTALLY DISABLED, AND MENTALLY ILL. (2500 INDIVIDUALS)
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SUSAN DICKINSON
6314744120
51 TERRYVILLE RD
PORT JEFFERSON STATION
NY
117761368
GARY BENCIVENGA
CHAIRPERSON
2.00
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DANIEL ROWE
VICE CHAIRPERSON
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CHARLES FALKNER
TREASURER
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JAMES MCPEAK
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ROBERT DOYLE
BOARD MEMBER
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MICHELE FRANCIS
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LEWIS GROSSMAN
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72430
SUSAN DICKINSON
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KAREN ESTRADA
AVP
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0
186928
40053
JOSEPH TOMAINO
EVP
37.50
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418470
176579
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DIRECTOR OF RESIDENTIAL
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EVA TARANTINO
DIRECTOR OF HUMAN RESOURCE
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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 CENTER OF HOPE FOUNDATION IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND, DBA CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS). CHS IS A NY NON-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
CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF CENER OF HOPE FOUNDATION AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF CENTER OF HOPE FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7B
CHS AS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF CENTER OF HOPE FOUNDATION IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY THE FOUNDATION'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 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 COMPIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE BOARD OF TRUSTEES FOR REVIEW. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT NO CONFLICT EXISTS, THE MATTER SHALL BE REFERRED FOR REVIEW BY THE CHS COMPLIANCE AND AUDIT COMMITTEE BEFORE THE DETERMINATION BECOMES FINAL. IF A CONFLICT OF INTEREST IS IDENTIFIED AND 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 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 SIMILIAR 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
CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE; FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
ELECTION TO ALLOCATE BUSINESS ASSET EXPENSE
CONTROLLED GROUP ELECTION STATEMENT
THE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS, AS DEFINED IN SECTION 179(D)(7), HEREBY CONSENT TO THE APPORTIONMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2010 ELECTION TO ALLOCATE $40,000 ALTERNATIVE MINIMUM TAX EXEMPTION THE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS(WITHIN THE MEANING OF SECTION 1563(A)), HEREBY CONSENT UNDER REGULATION 1.58-1(C)(3) TO THE APPORTIONMENT PLAN LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2010. ELECTION TO ALLOCATE $150,000 ALTERNATIVE MINIMUM TAX PHASE-OUT THE UNDERSIGNED CORPORATIONS, COMPONENT MEMBERS OF A CONTROLLED GROUP OF CORPORATIONS (WITHIN THE MEANING OF SECTION 1563(A)), HEREBY CONSENT UNDER REGULATION 1.58-1(C(3) TO THE APPOINTMENT PLAN LISTE EMPLOYER ID NO. $128,00 $40,000 $150,000 11-3403968 NONE NONE NONE 14-1801961 NONE NONE NONE 11-3594561 NONE NONE NONE 11-3555766 NONE NONE NONE 11-1888924 NONE NONE NONE 77-0611240 NONE NONE NONE 11-2537396 NONE NONE NONE 11-2958438 NONE NONE NONE 11-3434776 NONE NONE NONE 11-2861698 NONE NONE NONE 11-2861690 NONE NONE NONE 11-3638367 NONE NONE NONE 11-1635088 NONE NONE NONE 11-2126736 NONE NONE NONE 11-3284066 NONE NONE NONE 20-8067039 NONE NONE NONE 11-2499790 NONE NONE NONE 06-1569129 NONE NONE NONE 06-1562701 NONE NONE NONE 11-1871039 NONE NONE NONE 41-2076312 NONE NONE NONE 11-3613997 NONE NONE NONE 11-2050523 NONE NONE NONE 11-2916033 NONE NONE NONE 11-3090867 NONE NONE NONE 11-2110488 NONE NONE NONE 11-2983148 NONE NONE NONE 11-2716640 NONE NONE NONE 11-3559713 NONE NONE NONE 11-1635088 NONE NONE NONE 55-0813603 NONE NONE NONE 27-1459941 NONE NONE NONE IN PROCESS NONE NONE NONE 26-3169427 NONE NONE NONE 45-0517566 NONE NONE NONE 27-1531084 NONE NONE NONE 11-2798383 NONE NONE NONE 11-2801136 NONE NONE NONE 11-2838185 $128,000 $40,000 $150,000 11-3319259 NONE NONE NONE 06-1568934 NONE NONE NONE 11-3307977 NONE NONE NONE 11-2126736 NONE NONE NONE
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: 12/31/10 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 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 ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE 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
STATEMENT OF TAX BRACKET 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 BRACKET 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 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 ROCKVILLE CENTRE, NY 11795 TAX YEAR END: 12/31/10 55-0813603 MERCY MEDICAL CENTER FOUNDATION 1000 NORTH VILLAGE 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
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
OUR LADY OF CONSOLATION GERIATRIC CARE CENTER
111 BEACH DRIVE
WEST ISLIP
NY
11795
113284066
LT NURSING CARE
NY
501(C)(3)
LINE 3
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0