2011-11-15T09:28:25-06:00 2010-12-31 JH COHN LLP 4 BECKER FARM ROAD ROSELAND NJ 070681739 990 2010-01-01 113438973 WSNCHS NORTH INC WSNC 5165202250 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 117145713 AARON GLATT MD 5165202250 2011-11-14 1 THOMAS LANNING 9732283500 2010 2016-03-07 17:11:31Z ST JOSEPH HOSPITAL AARON GLATT MD 4295 HEMPSTEAD TURNPIKE BETHPAGE NY 117145713 107305702 0 X WWW.NEWISLANDHOSPITAL.ORG X 1999 NY ST JOSEPH HOSPITAL, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND(CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, ADVOCATES FOR THE POOR AND UNDERSERVED. AND SERVES THE COMMON GOOD. CHS CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION, AND INNOVATION WITH JUSTICE, INTEGRITY, AND RESPECT FOR THE DIGNITY OF EACH PERSON. 19 10 997 32 0 0 86658 229164 98037165 103916568 45526 39486 3686286 3004630 101855635 107189848 0 0 0 0 56137047 58113955 0 0 0 45290381 47013277 101427428 105127232 428207 2062616 57806024 63721679 40472181 52275285 17333843 11446394 X ST JOSEPH HOSPITAL, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED. CHS AFFIRMS THE SANCTITY OF LIFE, ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. CHS CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION, AND INNOVATION WITH JUSTICE, INTEGRITY, AND RESPECT FOR THE DIGNITY OF EACH PERSON. 0 0 91540072 103990921 ST JOSEPH HOSPITAL IS A 203-BED, COMMUNITY HOSPITAL THAT PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL, CRITICAL CARE AND SURGICAL SERVICES. ITS EMERGENCY DEPARTMENT CARES FOR MORE THAN 36,000 PATIENTS A YEAR. OTHER VITAL SERVICES INCLUDE AN AMBULATORY SURGERY UNIT, THE CENTER FOR SLEEP MEDICINE, HYPERBARIC MEDICINE AND WOUND HEALING, A BALANCE CENTER, AN ENDOSCOPY UNIT, A DIABETES EDUCATION CENTER, A FULL SCOPE OF OUTPATIENT RADIOLOGY SERVICES, INCLUDING A NEW CT SCANNER, MRI, AND NUCLEAR CAMERA. 91540072 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 73 0 1 997 1 0 0 0 0 0 1 1 0 0 0 0 X 19 10 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CHS SERVICES INC 5167051926 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X SISTER ELAINE CALLAHAN OP 2.00 X X 0 0 0 JOSEPH TANTILLO 2.00 X X 0 0 0 GARA EDELSTEIN 2.00 X X 0 347808 134004 WILLIAM ARMSTRONG 2.00 X 0 653102 245315 LAWRENCE CHARITON 2.00 X 0 0 0 JOSEPH CONTE 2.00 X 0 581231 200321 MARCY DUNN 2.00 X 0 455697 173333 EDMOND FARRELL 2.00 X 0 198033 44423 JOAN FLAUMENBAUM 2.00 X 0 0 0 RUTH HENNESSEY 2.00 X 0 571993 108072 JACK HOWLETT 2.00 X 0 0 0 EDWARD MURPHY 2.00 X 0 0 0 ALAN PROTZELDDS 2.00 X 9167 0 0 HONCHRISTOPHER G QUINN 2.00 X 0 0 0 THOMAS RYAN 2.00 X 0 0 0 FATHER JOHN TIZIO 2.00 X 0 0 0 DENNIS VERZI 2.00 X 0 814872 189108 JOEL YOHAI MD 2.00 X 0 885524 41611 AARON GLATT MD 50.00 X X 420167 0 28442 DREW PALLAS 50.00 X 268057 0 9215 LAWRENCE REDUTO 50.00 X 213906 0 25879 ROBERT LAMAGNA 50.00 X 163700 0 23061 IHAB IBRAHIM 50.00 X 161931 0 25276 MARGARET MINNICK 50.00 X 163764 0 25136 BERNARD STARK 37.50 X 199988 0 20841 ANNE WILSON-RISK 50.00 X 146495 0 19051 1747175 4508260 1313088 66 0 1 0 CANDESCENT HEALING LLC 32 ELM STREET SUITE 1 RYE NY 11788 HYPERBARIC SERVICES 1413955 SLEEPTECH LLC PO BOX 5833 HICKSVILLE NY 11802 SLEEP LAB SERVICES 943330 SODEXHO OPERATIONS LLC PO BOX 81049 WOBURN MA 01803 MANAGEMENT SERVICES 518100 ISLAND MEDICAL PHYSICIANS PC 88 ARKAY DRIVE HAUPPAUGE NY 11788 MEDICAL SERVICES 240335 ALLIED UROLOGICAL SVCS LLC PO BOX 847324 DALLAS TX 75284 MEDICAL SERVICES 105000 7 198067 31097 229164 NET PATIENT SVC REV 621990 103916568 103916568 103916568 39486 39486 34867 34867 34867 34867 211210 198067 115854 95356 95356 RADIOLOGY SERVICES 900099 2395388 2395388 CAFETERIA REVENUE 900099 186804 186804 PURCHASE DISC/REFUNDS 900099 77180 77180 215035 215035 2874407 107189848 106386309 0 574375 879477 879477 42947807 38174180 4773627 2514760 2190391 324369 8578405 7471911 1106494 3193506 2781589 411917 5554425 3934555 1619870 185804 185804 307461 307461 80343 80343 15383800 14934556 449244 1823901 1823901 432687 85120 347567 2045194 2045194 2942485 2942485 2584225 2584225 PROVISION FOR BAD DEBT 5430505 5430505 EQUIPMENT RENTAL 1611825 1514146 97679 EQUIPMENT SERVICE CONTR 150680 150680 8479942 5476634 3003308 105127232 91540072 13587160 0 1250991 11557970 2093214 5104227 11031081 10873728 1438030 1404620 949537 1215192 33467275 2943353 36862789 30523922 2410212 2419920 1770170 622100 57806024 63721679 14337078 14222295 15329172 24424085 1820027 3171801 8985904 10457104 40472181 52275285 X 17222144 11051610 111699 394784 17333843 11446394 57806024 63721679 2062616 -7950065 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12390 12390 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: AMOUNT REFLECTS PORTION OF TRADE ASSOCIATION DUES WHICH WERE USED FOR LEGISLATIVE LOBBYING ON BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ORGANIZATIONS REPRESENT. 7390000 7390000 17591478 1043829 16547649 8320179 1809712 6510467 165618 89812 75806 30523922 DUE TO CATHOLIC HEALTH SVCS 3004970 EST MALPRACTICE LIABILITY 2304210 EST THIRD PARTY PAYOR LIABILITY 2117475 OTHER LTD 28000 DUE TO RELATED PARTIES 3002449 10457104 107189848 105127232 2062616 9384720 9384720 11447336 106906764 0 106906764 283084 283084 107189848 105127232 0 105127232 0 105127232 PART XI LINE 8 - ADJUSTMENTS DUE TO ACQUISITION ACCOUNTING 9,101,636 INCREASE IN RESTRICTED FUNDS 283,084 TOTAL PART XI LINE 8 9,384,720 PART XII LINE 4B - INCREASE IN RESTRICTED FUNDS 283,084 AS A PART OF THE ACQUISITION, THE ASSETS AND LIABILITIES OF THE HOSPITAL WERE ASSUMED BY CHS AT FAIR VALUE. THE FOLLOWING TABLE SUMMARIZES THE FAIR VALUES OF THE ASSETS AND LIABILITIES ASSUMED BY CHS EFFECTIVE JANUARY 1, 2010: TOTAL ASSETS $52,773 TOTAL LIABILITIES 46,472 NET ASSETS 6,301 THE ASSETS AND LIABILITIES ASSUMED BY CHS WERE TRANSFERRED TO THE HOSPITAL THROUGH AN EQUITY TRANSFER. ALL ASSETS AND LIABILITIES OF THE HOSPITAL WERE DEEMED TO BE AT FAIR VALUE AS OF JANUARY 1, 2010, WITH THE EXCEPTION OF PROPERTY AND EQUIPMENT WHICH WAS REDUCED BY $5,033 BASED UPON A VALUATION STUDY PERFORMED BY A THIRD PARTY. IN ADDITION, THE HOSPITAL HAD AN AGREEMENT WITH ITS FORMER SPONSORS CHS AND WINTHROP-SOUTH NASSAU UNVERSITY SYSTEM (WSN)IN WHICH EACH FORMER SPONSOR WOULD BE DUE $3,000 IN THE EVENT OF A CHANGE IN CONTROL OF THE HOSPITAL. THESE LIABILITIES, AS OF JANUARY 1,2010 TOTALED $6,000, AND WERE WERE REFLECTED IN ACCOUNTS PAYABLE AND ACCRUED EXPENSES AND DUE TO RELATED PARTIES. THE AMOUNT DUE TO WSN WAS PAID BY CHS, WHICH WAS REFLECTED THROUGH AN EQUITY TRANSFER OF $3,000. THE AMOUNT DUE TO CHS WAS REPAID BY THE HOSPITAL DURING 2010. ST JOSEPH HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES 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. GALA 238489 81870 156619 34553 11293 GOLF OUTING 151873 105857 46016 8065 32403 20965 1 18915 10340 8575 5487 3088 409277 198067 211210 8065 72443 35346 115854 95356 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 1521177 864703 656474 0.00660 6173139 6035317 137822 0.00130 146564 172745 -26181 0.00000 7840880 7072765 768115 0.00790 17848 17848 0.00020 106698 60588 46110 0.00040 124546 60588 63958 0.00060 7965426 7133353 832073 0.00850 1 1779366 42264242 47089561 -4825319 X 1 1 1 1 ST JOSEPH HOSPITAL

4295 HEMPSTEAD TURNPIKE BETHPAGE NY 117145713

X X X NA 1 PART I, LINE 7: RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2 ) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART 1, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A,7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS.PART I, LINE 7A, COLUMN D: DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S "NEED" CALCULATION. THIS CALCULATION CONSIDERS 90% OF A HOSPITAL'S "NEED" IS BASED ON BAD DEBTS AND CHARITY CARE WRITE OFFS, AND 10% IS BASED ON A "UNITS OF SERVICE" METHODOLOGY FOR UNINSURED PATIENTS. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBTS AND CHARITY CARE FOR 2010. IT IS IMPORTANT HOWEVER TO BE AWARE THAT THE COSTS OF BAD DEBTS ARE NOT INCLUDED IN LINE 7A, COLUMN C WHILE THE OFFSETTING REVENUE IS INCLUDED IN LINE 7A, COLUMN D. BAD DEBTS AT COST ARE EXCLUDED FROM LINE 7 AND REPORTED IN PART III, LINE 2 IN ACCORDANCE WITH THE INSTRUCTIONS. AS A RESULT, THE NET COST OF "FINANCIAL ASSISTANCE AT COST" ON LINE 7A, COLUMN F IS UNDERSTATED FOR NYS HOSPITALS WHO REPORT IN ACCORDANCE WITH THE INSTRUCTIONS AND IN SOME INSTANCES MAY SHOW A GAIN DUE TO THE MISMATCHING OF REVENUE AND EXPENSE. IT IS IMPORTANT TO CONSIDER THE BAD DEBTS AT COST AMOUNT IN PART III, LINE 2 WHEN EVALUATING THE NET COSTS OF UNCOMPENSATED CARE FOR HOSPITALS IN NYS. PART I, LINE 7,COLUMN (F):THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $5.4 MILLION PART III, LINE 4: -COSTING METHODOLOGY:RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2 ) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED IN PART III, LINE 2. PART III LINE 4 - BAD DEBT AS COMMUNITY BENEFIT:AS PART OF ITS TAX EXEMPT PURPOSE THE HOSPITAL PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. THE HOSPITAL TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF WHETHER THEY HAVE THIRD-PARTY COVERAGE OR THE ABILITY TO PAY. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE HOSPITAL IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. A PATIENTS PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM THE HOSPITAL SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY. PART III, LINE 8: PART III SECTION B LINE 5 - COSTING METHODOLOGY:THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2010 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 III LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT:LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS ACOMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. ST. JOSEPH BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY, BUT DOING SO WITH NO RECOURSE TO OBTAIN PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED ARE NOT TURNED AWAY, SO ST. JOSEPH WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY. PART III, LINE 9B: THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INABILITY TO PAY FOR THOSE SERVICES. IN ADDITION, UPON APPLYING FOR CHARITY CARE, EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY WILL BE ASSESSED. ELIGIBILITY FOR ASSISTANCE: A REASONABLE REVIEW SHALL BE PERFORMED PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (I.E. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE CHS CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET. PART VI, LINE 2: NEEDS ASSESSMENTTHE HOSPITAL WORKED WITH THE NASSAU COUNTY DEPARTMENT OF HEALTH, OTHER HOSPITAL FACILITIES AND OTHER HEALTHCARE PARTNERS IN THE NASSAU COUNTY REGION ON THE PREVENTION AGENDA PRIORITIES. PARTICIPATION OF THE COMMUNITY MEMBERS IN THE HOSPITAL'S SERVICE AREA WAS SOLICITED VIA MULTIPLE VENUES IN AN EFFORT TO ENGAGE COMMUNITY PARTICIPATION IN THE DEVELOPMENT OF THE COMMUNITY SERVICE PLAN.THE PUBLIC INPUT PROCESS WAS ANNOUNCED VIA THE HOSPITAL'S WEBSITE IN JUNE 2009 WHEREBY WE ENCOURAGED OUR COMMUNITY MEMBERS TO PROVIDE COMMENTS ON THEIR HEALTH CARE PRIORITIES AND HOW ST JOSEPH HOSPITAL COULD BEST SERVE THEIR NEEDS. WE ALSO DEDICATED A SECTION OF THE HOSPITALS COMMUNITY NEWSLETTER IN JULY 2009, DISTRIBUTED TO NEARLY 150,000 COMMUNITY RESIDENTS TO ENCOURAGE COMMUNITY MEMBERS TO PROVIDE INPUT ON THEIR HEALTH CARE PRIORITIES. THE HOSPITAL TYPICALLY HOLDS COMMUNITY LECTURES ON A MONTHLY BASIS, ON VARYING TOPICS IN HEALTHCARE, RANGING FROM STROKE PREVENTION TO SLEEP DISORDERS AS WELL AS NUMEROUS OTHER HEALTHCARE TOPICS OF INTEREST TO THE COMMUNITY. AT EACH OF THESE LECTURES, OFFERED FREE OF CHARGE AND NORMALLY WELL ATTENDED BY COMMUNITY MEMBERS, EACH INDIVIDUAL ATTENDEE IS REQUESTED TO COMPLETE A QUESTIONNAIRE NOT ONLY ABOUT HOW USEFUL THE LECTURE MATERIAL WAS FOR THEIR PERSONAL INTEREST AND USE BUT ALSO FOR OUR HOSPITAL TO LEARN OF OTHER HEALTHCARE TOPICS WHICH WOULD BE OF INTEREST TO THE PARTICIPANTS FOR FUTURE LECTURES. THE HOSPITAL ALSO TAKES THE OPPORTUNITY TO DISCUSS WITH HEALTH LECTURE AUDIENCES ANY SPECIAL NEEDS THEY BELIEVE SHOULD BE FULFILLED BY THEIR LOCAL HOSPITAL AND HEALTHCARE RESOURCE, NOT ONLY ON THE SPECIFIC LECTURE TOPIC BUT ALSO ON ANY OTHER SUBJECT MATTER REGARDING HEALTH AND WELLNESS. PART VI, LINE 3: FINANCIAL ASSISTANCE POLICY COMMUNICATIONALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS ARE FULLY VERSED IN THE CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. THE HOSPITAL POSTS MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN AT LEAST ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. THE HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. THE HOSPITAL POSTS ITS CHARITY CARE POLICY SUMMARY ON THEIR INTERNET WEBSITE. THE HOSPITAL PROVIDES ALL PATIENTS INTERPRETERS TO ASSIST THEM IN UNDERSTANDING ITS CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, A STATEMENT IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER INFORMATION. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4: PART VI, LINE 4: COMMUNITY INFORMATIONTHE HOSPITAL PRIMARILY SERVES PATIENTS FROM THE FOLLOWING SURROUNDING COMMUNITIES: MASSAPEQUA, FARMINGDALE, AMITYVILLE, LEVITTOWN, MASSAPEQUA PARK, WANTAGH, SEAFORD, BETHPAGE, BELLMORE, EAST MEADOW, LINDENHURST, COPIAGUE, BABYLON, HICKSVILLE, PLAINVIEW AND WOODBURY. APPROXIMATELY 90% OF HOSPITAL PATIENTS WHO ARE ADMITTED AND/OR PROVIDED CARE IN OUR EMERGENCY DEPARTMENT RESIDE IN THE AFOREMENTIONED SERVICE AREAS. THIS IS BASED ON ANNUAL 2008 DATA RELATIVE TO INPATIENT ADMISSIONS/EMERGENCY DEPARTMENT VISITS TO OUR HOSPITAL. PART VI, LINE 6: PROMOTION OF COMMUNITY HEALTHWSNCHS NORTH,INC (THE HOSPITAL) IS A 501(C)(3)VOLUNTARY, NOT-FOR-PROFIT CORPORATION WITH CERTIFIED BED CAPACITY OF 203. ON JANUARY 26, 2010, THE HOSPITAL BECAME A MEMBER HOSPITAL OF CATHOLIC HEALTH SERVICES (CHS) OF LONG ISLAND AND THE HOSPITAL IS DOING BUSINESS AS (ST. JOSEPH). CHS SUPPORTS ST. JOSEPH'S MISSION TO DELIVER QUALITY HEALTH CARE AND REMAIN A COMMUNITY-BASED HOSPITAL. CHS IS COMMITTED TO CONTINUING AND EXPANDING THE IMPORTANT MEDICAL SERVICES PROVIDED BY ST. JOSEPH TO THE SURROUNDING COMMUNITIES THAT RELY UPON IT FOR QUALITY CARE. WITH THE ADDITION OF ST. JOSEPH, CHS IS NOW COMPRISED OF SIX HOSPITALS, THREE NURSING HOMES, A REGIONAL HOME CARE AND HOSPICE NETWORK AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH DEVELOPMENTAL NEEDS. THE BOARD OF DIRECTORS IS COMPRISED OF NINETEEN MEMBERS, CONSISTING OF VOLUNTARY COMMUNITY MEMBERS, THE MEDICAL STAFF PRESIDENT, A PHYSICIAN REPRESENTATIVE, MEMBERS OF CHS'BOARD AND THE PRESIDENT & CHIEF EXECUTIVE OFFICER OF ST JOSEPH WHO IS DIRECTLY RESPONSIBLE TO THE BOARD OF DIRECTORS. THE BOARD PROVIDES STRATEGIC, VISIONARY GUIDANCE AND DIRECTION FOR THE HOSPITAL'S CURRENT PROGRAMS, FUTURE PROGRAMS, PATIENT QUALITY AND SAFETY, CAPITAL PROJECTS, SPECIAL INITIATIVES AND FOR ALL GOVERNANCE RESPONSIBILITIES. THERE ARE FOUR BOARD COMMITTEES: FINANCE, EXECUTIVE, PIPS (PERFORMANCE IMPROVEMENT PATIENT SATISFACTION) AND CORPORATE COMPLIANCE AND AUDIT. ONE OR MORE BOARD MEMBERS CHAIR, CO-CHAIR AND/OR ATTEND EACH OF THESE COMMITTEES AT THEIR SCHEDULED MEETINGS. THE BOARD IS VERY MUCH ENGAGED AND COMMITTED IN LISTENING TO AND ADDRESSING COMMUNITY NEEDS TO FURTHER ST JOSEPH'S MISSION OF PROVIDING HIGH QUALITY CARE TO OUR PATIENTS AND VERY SUPPORTIVE OF FORMER COMMISSIONER RICHARD DAINES' "PREVENTION AGENDA FOR THE HEALTHIEST STATE" INITIATIVE; AIMED TO IMPROVE THE HEALTH OF ALL NEW YORKERS. ST. JOSEPH HOSPITAL'S COMMUNITY OUTREACH PROGRAMS INCLUDE HEALTH WORKSHOPS, SUPPORT GROUPS, COMMUNITY HEALTH EDUCATION LECTURES, "MEALS ON WHEELS", HEALTH FAIRS AND SCREENINGS, BLOOD DRIVES AND OTHER PATIENT-FOCUSED INITIATIVES. ST. JOSEPH IS SUPPORTIVE OF EDUCATIONAL INSTITUTIONS AND THEIR RESPECTIVE STUDENTS TO PROVIDE CLINICAL EXPERIENCE AND EDUCATION IN THE HOSPITAL ENVIRONMENT. ST JOSEPH HOLDS MULTIPLE AFFILIATION AGREEMENTS WITH EDUCATIONAL FACILITIES (E.G. HOFSTRA UNIVERSITY, LONG ISLAND UNIVERSITY, STATE UNIVERSITY AT FARMINGDALE, WESTERN SUFFOLK BOCES) FOR ONSITE STUDENT TRAINING / MENTORING IN NURSING, RADIOLOGY TECHNOLOGY, HEALTH ADMINISTRATION AND FOR OTHER HEALTH CARE PROFESSIONS AND IS A DESIGNATED SITE FOR TRAINING OF DOCTOR OF PHARMACY CANDIDATES THROUGH ST. JOHN'S UNIVERSITY. ST. JOSEPH HOSPITAL IS ALSO AN ACTIVE MEMBER OF FARMINGDALE, BETHPAGE, MASSAPEQUA AND AMITYVILLE CHAMBERS OF COMMERCE AND PARTICIPATES IN MANY OF THE CHAMBERS' ACTIVITIES, INCLUDING HEALTH FAIRS, STREET FAIRS AND COMMUNITY FESTIVAL DAYS. AT THESE FESTIVALS THE HOSPITAL PROVIDES FREE EDUCATIONAL HEALTH CARE MATERIAL AND TYPICALLY OFFERS FREE BLOOD PRESSURE SCREENINGS TO COMMUNITY RESIDENTS. ST JOSEPH ALSO HOLDS HEALTH FAIRS ON ITS PREMISES, WHERE IT INVITES ALL ITS COMMUNITY MEMBERS TO LEARN ABOUT HOSPITAL SERVICES AND SPECIAL PROGRAMS. ST JOSEPH HELD A FAIR TO PROVIDE CAROTID ARTERY ULTRASOUND, ABDOMINAL AORTIC SCREENING, LIPID PROFILE AND GLUCOSE SCREENING TESTS, BLOOD PRESSURES, DIETITIAN CONSULTATIONS AND DIABETES EDUCATOR CONSULTATIONS, AMONG OTHER FREE HEALTH SERVICES FOR COMMUNITY MEMBERS IN ATTENDANCE. ALSO, IN COLLABORATION WITH THE BETHPAGE LIBRARY, ST. JOSEPH SPONSORS SEASONAL FLU VACCINE CLINIC TO SENIORS IN THE NASSAU COUNTY AREA. IN LINE WITH THE FORMER NYSDOH COMMISSIONER RICHARD DAINES' "PREVENTION AGENDA FOR THE HEALTHIEST STATE", PRIORITIES WERE CHOSEN BY TAKING INTO CONSIDERATION THE 2-3 PRIORITIES (OF THE PUBLISHED LIST OF 10 PRIORITIES) THAT WOULD PROVIDE THE GREATEST HEALTH CARE BENEFIT TO THE HEALTH OF THE LARGEST NUMBER OF NEW YORKERS IN OUR STATE, DIRECTLY OR INDIRECTLY, AND SPECIFICALLY IN NASSAU COUNTY THROUGH COLLABORATION WITH OUR LOCAL HEALTH DEPARTMENT, OTHER HOSPITAL PROVIDERS IN THE COUNTY AND, WITH OTHER HEALTHCARE PARTNERS. COLLABORATION, FOCUS, ATTENTION AND ACTION BY THIS GROUP ON THE PRIORITIES SELECTED SHOULD ALLOW US TO ACHIEVE THE DESIRED OUTCOME; A HEALTHIER COUNTY WHICH WILL CONTRIBUTE TO THE GOAL OF A HEALTHIER NEW YORK STATE. THE CRITERIA USED INCLUDED: THE BENEFITS THAT THE PRIORITY HEALTH FOCUS WOULD YIELD TO BETTER THE QUALITY OF LIFE FOR COMMUNITY RESIDENTS, A REDUCED NEED FOR EXPENSIVE HEALTHCARE RESOURCES FOR HEALTH CONDITIONS THAT MIGHT HAVE OTHERWISE BEEN MITIGATED BEFORE THEIR MANIFESTATION TO A LEVEL REQUIRING THE USE OF EXTENSIVE AND EXPENSIVE HEALTH RESOURCES AND, ULTIMATELY PRIORITIES THAT WOULD, OVER THE COURSE OF TIME, FREE-UP SUFFICIENT GOVERNMENTAL AND OTHER HEALTH PAYER SPENDING TO HELP SUPPORT THE FUNDING OF HEALTH INSURANCE FOR THE UNINSURED / UNDER-INSURED AND TO BE ABLE TO REDUCE AND EVENTUALLY ELIMINATE ANY BARRIERS TO HIGH QUALITY HEALTH CARE FOR EVERYONE IN OUR COMMUNITIES IN NEED OF CARE. DATA USED TO HELP SELECT THESE PRIORITIES WAS DERIVED FROM THE NEW YORK STATE DEPARTMENT OF HEALTH PREVENTION AGENDA WEBSITE AND ASSOCIATED LINKS / DATA TOOLS, THE NASSAU COUNTY COMMUNITY HEALTH ASSESSMENT AND A COMPARISON OF ACTUAL MOST RECENT AVAILABLE PREVENTION AGENDA INDICATOR RATES FOR NASSAU COUNTY VERSUS PREVENTION AGENDA OBJECTIVES FOR 2013 AS TARGETED BY THE NYSDOH. IN SUMMARY, THE GROUP DEVELOPED A PRIORITY-SETTING PLAN TO HELP DETERMINE WHICH OF THE TEN PREVENTION AGENDA PRIORITIES WOULD BE REASONABLY PRACTICAL TO ADDRESS AND BEST MEET THE NEEDS OF OUR CATCHMENT AREAS. THE GROUP FOCUSED ON CONSIDERATION OF THE FOLLOWING CRITERIA FOR SELECTION OF THE PREVENTION AGENDA PRIORITY CHOICES: - COUNTY INDICATORS OFFERING THE GREATEST OPPORTUNITY FOR IMPACT - COMMUNITY NEED - ALIGNMENT AND SYNERGY WITH EXISTING HOSPITAL STRATEGY AND MISSION - AVAILABILITY OF OUTCOME MEASURES - AVAILABILITY OF BENCHMARKS ON PERFORMANCE QUALITY INDICATORS - POTENTIAL FOR GRANT / FUNDING - EXISTING GROUPS, PROGRAMS AND RESOURCES PURSUANT TO A SERIES OF MEETINGS HELD IN COLLABORATION WITH THE NASSAU COUNTY DEPARTMENT OF HEALTH (NCDOH), OTHER HOSPITAL FACILITIES IN THE COUNTY AND OTHER HEALTH CARE PARTNERS, IT WAS DECIDED BY THE GROUP THAT THE PREVENTION PRIORITIES THE COUNTY WOULD BE FOCUSED ON WERE THE FOLLOWING PUBLIC HEALTH PREVENTION AGENDA SELECTIONS: TOBACCO USE: PREVENTION AND CESSATION AND UNINTENTIONAL INJURY AND PREVENTION OF FALLS AMONG THOSE AGED 65+ YEARS OF AGE. WORK GROUPS, NAMED THE "THOUGHT LEADERS", WERE ESTABLISHED; ONE FOR EACH OF THESE PRIORITIES. THE THOUGHT LEADERS WORKGROUPS WERE COMPRISED OF A REPRESENTATIVE FROM EACH HOSPITAL, INCLUDING ST. JOSEPH HOSPITAL, AND THE NCDOH TO ASSESS THE CURRENT STATUS, PROGRAMMING, RESOURCES AND POTENTIAL PARTNERS FOR EACH PRIORITY AND TO FORMULATE A STRATEGIC PLAN TO ADDRESS EACH PRIORITY OVER THE NEXT THREE YEARS. ST. JOSEPH HOSPITAL HAS UNDERTAKEN THESE INITIATIVES FROM THE STANDPOINT OF PROVIDING EDUCATION FOR HOSPITALIZED PATIENTS DURING THEIR STAY AND UPON DISCHARGE, PUBLICIZING RELEVANT INFORMATION TO THE COMMUNITY AT LARGE AND IN PHYSICIAN AND EMPLOYEE NEWSLETTERS. THESE INITIATIVES WOULD BE CLASSIFIED AS "NEW" FROM THE STANDPOINT THAT THE STATE HEALTH DEPARTMENT, LOCAL HEALTH DEPARTMENT, AS WELL AS HOSPITAL PROVIDERS, INCLUDING HEALTH PRACTITIONERS AND OTHER COMMUNITY PARTNERS WOULD ALL BE WORKING COLLABORATIVELY TOWARD COMMON GOALS AND OBJECTIVES. WITH THIS MAGNITUDE AND BROAD SCALE LEVEL OF SUPPORT AND CHANNELED EFFORT, IT IS MORE LIKELY THAT WE CAN REALIZE GREATER AND MORE SIGNIFICANT IMPACT AND IMPROVEMENT IN AFFECTING POSITIVE CHANGE IN PREVENTATIVE CARE. WE BELIEVE THAT THE FIRST STEP NEEDS TO BE FOCUSED ON RAISING LEVEL OF AWARENESS AND WORKING ON DEVELOPING NEW AND STRENGTHENING EXISTING RELATIONSHIPS WITH OUR COMMUNITY PARTNERS. OTHER IMPORTANT SERVICES PROVIDED BY ST. JOSEPH HOSPITAL TO PROMOTE COMMUNITY HEALTH & WELLNESS ARE:- HYPERBARIC AND WOUND HEALING OUTPATIENT CENTER- THE CENTER FOR SLEEP MEDICINE: - OUTPATIENT BALANCE/VESTIBULAR TESTING AND PHYSICAL THERAPY- MRI SERVICE- SPEECH SWALLOWING AND VOICE DISORDERS PART VI, LINE 7: AFFILIATED HEALTHCARE SYSTEM:ST. JOSEPH IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH IS LOCATED ON A SINGLE CAMPUSIN BETHPAGE, NEW YORK.ALONG WITH THE AFOREMNETIONED COMMUNITY PROGRAMS, ST. JOSEPH THROUGH ITSDAILY OPERATIONS, PROVIDES TO THE AREA ACUTE, EMERGENT AND OUTPATIENTCARE. ST. JOSEPH IS NEWLY A MEMBER OF CATHOLIC HEALTH SYSTEMS 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, 2010 CHS WAS COMPRISED OF SIX HOSPITALS (MERCY MEDICALCENTER, AND ST. FRANCIS HOSPITAL IN NASSAU COUNTY; GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL AND ST. CATHERINE OF SIENA MEDICAL CENTER IN SUFFOLK COUNTY), THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING HOME; GOOD SAMARITAN NURSING HOME AND OUR LADY OF CONSOLATION RESIDENCE, ALL IN SUFFOLK COUNTY); A REGIONALHOME CARE AND HOSPICE NETWORK AND A COMMUNITY BASED AGENCY FOR PERSONSWITH SPECIAL NEEDS. WITH MORE THAN 17,000 STAFF AND 3,800 MEDICAL STAFFWORKING THROUGHOUT THE SYSTEM, CHS PROVIDES THE REGION'S FINEST HEALTH ANDHUMAN SERVICES.MEMBER ORGANIZATIONS OF CHS OFFER VIRTUALLY EVERY MEDICAL SPECIALTY ANDCLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THESCOPE, QUALITY AND ACCESSIBILITY OF CARE. EACH OF CHS MEMBER ORGANIZATIONS HAS RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY,THEIR DISTINCTIVE PERSONALITIES, AS WELL AS THE SERVICE SPECIALTIES WHICHTHEY ARE KNOWN FOR, THUS EMBEDDING THE ORGANIZATION IN THE COMMUNITY AND SERVING IT EFFECTIVELY. THE CHS SYSTEM PROVIDES AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS, PROVIDES FREE HEALTH SCREENINGS THROUGH THE HEALTHY SUNDAY PROGRAMS, HEALTH FAIRS AND OTHER PROGRAMS WHICH HELP THE COMMUNITIES SERVED BY CHS ACCESS CARE SINCE 1907, CATHOLIC HEALTHCARE ON LONG ISLAND HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY BASED HOSPTIAL AND HUMAN SERVICE ORGANIZATIONS.WITH THE PRIMARY OBJECTIVE OF SERVING THE COMMUNITY. TO FURTHER THE MISSION OF BRINGING CARE TO THE COMMUNITY, CHS AND ITSMEMBER HOSPITALS, TOGETHER WITH A NUMBER OF OTHER HEALTHCARE PROVIDERS ONLONG ISLAND ENTERED INTO A PARTNERSHIP AGREEMENT WHICH OPERATES AS THELONG ISLAND HEALTH NETWORK ( LIHN). LIHN WAS CREATED TO ESTABLISH ACOMPREHENSIVE AND EFFICIENT HOSPITAL NETWORK IN NASSAU AND SUFFOLKCOUNTIES BY WORKING TO, AMONG OTHER THINGS, IMPROVE QUALITY OF CARE,FACILITATE CLINICAL INTEGRATION, BENCHMARK BEST PRACTICES AND REDUCELENGTH OF STAY COSTS. REPORTS FILED WITH STATES PART VI, LINE 7 NY X X X X 0 0 0 0 0 0 0 0 0 GARA EDELSTEIN 0 261040 0 75000 0 11768 0 123641 0 10363 0 481812 0 0 WILLIAM ARMSTRONG 0 481076 0 160000 0 12026 0 220926 0 24389 0 898417 0 0 JOSEPH CONTE 0 452102 0 113000 0 16129 0 174081 0 26240 0 781552 0 0 MARCY DUNN 0 342770 0 100000 0 12927 0 149509 0 23824 0 629030 0 0 EDMOND FARRELL 0 197395 0 0 0 638 0 15629 0 28794 0 242456 0 0 RUTH HENNESSEY 0 419094 0 150000 0 2899 0 85109 0 22963 0 680065 0 0 DENNIS VERZI 0 515178 0 281000 0 18694 0 180416 0 8692 0 1003980 0 0 JOEL YOHAI MD 0 537911 0 186000 0 161613 0 24395 0 17216 0 927135 0 0 AARON GLATT MD 351575 0 53040 0 15552 0 8600 0 19842 0 448609 0 0 0 DREW PALLAS 248000 0 20000 0 57 0 8600 0 615 0 277272 0 0 0 LAWRENCE REDUTO 213747 0 0 0 159 0 8388 0 17491 0 239785 0 0 0 ROBERT LAMAGNA 163683 0 0 0 17 0 6400 0 16661 0 186761 0 0 0 IHAB IBRAHIM 151905 0 10000 0 26 0 6200 0 19076 0 187207 0 0 0 MARGARET MINNICK 153448 0 10000 0 316 0 6338 0 18798 0 188900 0 0 0 BERNARD STARK 199823 0 0 0 165 0 0 0 20841 0 220829 0 0 0 ANNE WILSON-RISK 146438 0 0 0 57 0 0 0 19051 0 165546 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 IN DECEMBER, 2009 THE PROPOSED SPONSORSHIP OF THE HOSPITAL BY CATHOLIC HEALTH SYSTEMS OF LONG ISLAND,INC. (D/B/A CATHOLIC HEALTH SERVICES OF LONG ISLAND)(CHS) WAS MEMORIALIZED IN A MEMORANDUM OF UNDERSTANDING DETAILING NEXT STEPS TO BE COMPLETED FOR THE HOSPITAL TO BECOME A FULLY SPONSORED MEMBER OF CHS. THESE INCLUDED, AMONG OTHER THINGS, AMENDMENT OF THE BY-LAWS AND OPERATING CERTIFICATE TO DESIGNATE CHS AS THE CORPORATE MEMBER OF THE HOSPITAL; SUBMISSION OF A CERTIFICATE OF NEED (CON) FOR APPROVAL OF CHS TO BECOME THE LICENSED CO-OPERATOR OF THE HOSPITAL; AND THE HOSPITAL ENTERING INTO AN ADMINISTRATIVE SERVICES AGREEMENT WITH CHS. ON JANUARY 21, 2010 CHS ACCEPTED DESIGNATION AS THE SOLE CORPORATE MEMBER OF THE HOSPITAL AND A SLATE OF DIRECTORS AND OFFICERS WAS APPOINTED BY CHS. FOR FINANCIAL REPORTING PURPOSES, THE ACQUISITION OF THE HOSPITAL IS PRESENTED TO HAVE OCCURED AS OF JANUARY 1, 2010, SINCE THE ACTIVITY OF THE HOSPITAL WAS DEEMED TO BE IMMATERIAL FROM JANUARY 1, 2010 THROUGH JANUARY 21, 2010. ON APRIL 22, 2010 THE NEW YORK STATE DEPARTMENT OF HEALTH (DOH) APPROVED THE CHANGE IN ASSUMED NAME FROM NEW ISLAND HOSPITAL TO ST. JOSEPH HOSPITAL AND SHORTLY THEREAFTER DOH ISSUED A NEW OPERATING CERTIFICATE BEARING THE ST. JOSEPH HOSPITAL NAME. THE CON FOR CHS TO BE THE ESTABLISHED CO-OPERATOR OF SJH HAS BEEN SUBMITTED AND IS CURRENTLY PENDING APPROVAL FROM THE DOH. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ST JOSEPH HOSPITAL IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND) (CHS). CHS IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER (DIOCESE). FORM 990, PART VI, SECTION A, LINE 7A CHS IS THE SOLE MEMBER OF ST JOSEPH HOSPITAL AND AS SUCH, HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF ST JOSEPH HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B CHS AS THE SOLE MEMBER OF ST JOSEPH HOSPITAL IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE NY ST JOSEPH'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 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 ADJUSTMENTS ARE MADE, AFTER WHICH TIME IT IS CONSIDERED AN INITIAL DRAFT. THE INITIAL DRAFT IS THEN PRESENTED TO 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 IS SENT TO EXECUTIVES FOR FINAL REVIEW. ATTESTATIONS ARE THEN PROVIDED BY EXECUTIVES INDICATING THEIR REVIEW AND SATISFACTION WITH THE CONTENT OF THE FORM 990. THE 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. ONCE THE COMMITTEE'S REVIEW IS COMPLETE, THE COMMITTEE RECOMMENDS THE APPROVAL OF THE FORM 990 TO THE BOARD (OR THE EXECUTIVE COMMITTEE OF THE ONCE THE COMMITTEE'S REVIEW IS COMPLETE, THE COMMITTEE RECOMMENDS THE APPROVAL OF THE FORM 990 TO THE BOARD (OR 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 ORGANIZATION'S BOARD CHAIR AND CHIEF EXECUTIVE OFFICER COMMUNICATES, IN WRITING TO THE CHS COMPLIANCE AND AUDIT COMMITTEE AND CHS BOARD CHAIR, SUCH 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 ORGANIZATION'S CORRESPONDENCE REGARDING THE FORM 990 RECOMMENDS APPROVAL AND REVIEW PROCESS. THE CHS COMPLIANCE AND AUDIT COMMITTEE IS PROVIDED WITH THE ORGANIZATION'S 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 COMMITTEE'S REVIEW OF THE ORGANIZATION'S RECOMMENDED APPROVAL AND SATISFACTION OF THE FORM 990 REVIEW PROCESS, IT RECOMMENDS 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 COMMITEE OF THE BOARD OF DIRECTORS, AS APPROPRIATE) REVIEWS THE CHS COMPLIANCE AND AUDIT COMMITTEE'S RECOMMENDATION AND PROVIDES 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 SUBMIITTED 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 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 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 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 EXECUTIVE COMPENSATION POLICY (THE "POLICY") APPLIES TO THOSE WHO ARE DEFINED AS "DISQUALIFIED PERSONS". 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 ACTIVITES 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. THE CHIEF EXECUTIVE OFFICER SUBMITS FOR APROVAL 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, AND THE COMMITTEE MAKES RECOMMENDATION TO THE BOARD.OF TRUSTEES WITH RESPECT TO THE PROPOSED EXECUTIVE COMPENSATION. THE BOARD HAS RETAINED AN INDEPENDENT COMPENSATION CONSULTANT TO APPLY ITS STANDARD METHODOLOGY FOR DETERMINATION OF APPROPRIATE EXECUTIVE COMPENSATION AND BENEFIT LEVELS FOR "DISQUALIFIED PERSONS". IT IS POLICY TO TARGET THE TOTAL COMPENSATION (BASE SALARY, INCENTIVE COMPENSATION AND BENEFITS) OF "DISQUALIFIED PERSONS" AT THE MEDIAN OF THE DEINED MARKETPLACE FOR SIMILARLY SITUATED EXECUTIVES IN CONSULTATION WITH AN INDEPENDENT COMPENSATION CONSULTANT IN A MANNER THAT COMPLIES WITH THE INTERMEDIATE SANCTION REGULATIONS AND OTHER FEDERAL AND STATE LAWS AND REGULATIONS. THE BOARD REVIEWS BASE SALARIES FOR "DISQUALIFIED PERSONS" BASED UPON THE MEDIAN AMOUNTS (50TH PERCENTILE) PAID TO SIMILARLY SITUATED EXECUTIVES WITHIN THE RELEVANT MARKETPLACE, WITH POSSIBLE ADJUSTMENTS MADE FOR SPECIAL SKILL, EXPERIENCE, COMPETENCE AND PERFORMANCE, INCLUDING CONTRIBUTION TO THE SYSTEM AS A WHOLE. INCENTIVE COMPENSATION IS BASED ON A PERCENTAGE OF THE BASE SALARY AND AWARDED ONLY IF A "DISQUALIFIED PERSON" MEETS OBJECTIVE PERFORMANCE CRITERIA. THE COMPENSATION COMMITTEE SETS STANDARDS TO ENSURE THAT THE CRITERIA USED TO DETERMINE INCENTIVE COMPENSATION ARE SPECIFIC, OBJECTIVE, MEASURABLE AND RELATED TO INDICATORS OF PERFORMANCE, WHICH SHALL INCLUDE BOTH THE PERFORMANCE OF THE OPERATING ENTITY THAT EMPLOYS THE "DISQUALIFIED PERSON" AND THE PERFORMANCE OF THE CHS SYSTEM AS A WHOLE. USING SUCH CRITERIA, THE CHS CEO SHALL RECOMMEND TO THE CHS EXECUTIVE COMPENSATION COMMITTEE INCENTIVE COMPENSATION FOR SYSTEM-LEVEL EXECUTIVES WHO ARE "DISQUALIFIED PERSONS", AND THE CEO OF EACH OPERATING ENTITY SHALL RECOMMEND TO THE OPERATING ENTITY ECC INCENTIVE COMPENSATION FOR OPERATING ENTITY EXECUTIVES WHO ARE "DISQUALIFIED PERSONS", IF APPROVED BY THE CHS CEO. EXECUTIVES PARTICIPATE IN THE DIOCESAN PENSION PLAN AND OTHER BENEFIT PLANS AS APPROVED BY THE CHS CORPORATE BOARD OR CHS OPERATING ENTITY BOARD, AS THE CASE MAY BE. 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 UPON REQUEST. FORM 990, PART VII, SECTION A LINE 1A REFLECTED IN PART REFLECTED IN PART VII, SECTION A, LINE 1A 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. 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 LISTED BELOW WITH RESPECT TO THE TAXABLE YEAR OF EACH CORPORATION WHICH INCLUDES DECEMBER 31, 2010. 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 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 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 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 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 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 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 1 1 1 0 0 CATHOLIC HEALTH SYSTEM OF LONG ISLAND L -61708 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER O -186479 COST CHS SERVICES INC O -2707335 COST SCHEDULE R PART V, TRANSACTIONS WITH RELATED PARTIES ST JOSEPH HOSPITAL 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 ACTIVITIES ST JOSEPH HAS ENGAGED IN WITH ITS RELATED PARTY ORGANIZATIONS. THE FOLLOWING IS A LIST OF ADDITIONAL TRANSACTION TYPES BY FACILITY. NAME OF ORGANIZATION EIN ADDT'L TXN TYPE CATHOLIC HEALTH SYSTEM OF LONG ISLAND 11-3405968 L GOOD SAMARITAN HOSPITAL MEDICAL CENTER 11-1888924 O CATHOLIC HEALTH SERVICES INC 11-3555766 O