2011-11-15T10:10:21-06:00 2010-12-31 JH COHN LLP 4 BECKER FARM ROAD ROSELAND NJ 070681739 990 2010-01-01 061562701 ST CATHERINE OF SIENA MEDICAL CENTER STCA 6318623000 50 ROUTE 25A SMITHTOWN NY 11787 JAMES CALDAS 6318623000 2011-11-14 1 THOMAS LANNING 9732283500 2010 2016-02-24 21:20:13Z JAMES CALDAS 50 ROUTE 25A SMITHTOWN NY 11787 248044052 0 0928 X HTTP://STCATHERINES.CHSLI.ORG X 2000 NY ST CATHERINE OF SIENA MEDICAL CENTER, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, AND COMMITS ITSELF TO THOSE IN NEED, CHSLI AFFIRMS THE SANCTITY OF LIFE, AND ADVOCATES FOR THE POOR AND UNDERSERVED, AND SERVES THE COMMON GOOD. IT CONDUCTS ITS HEALTHCARE PRACTICE, BUSINESS, EDUCATION AND INNOVATION WITH JUSTICE, INTEGRITY AND RESPECT FOR THE DIGNITY OF EACH PERSON. 24 22 2350 212 0 0 452551 453782 226167448 242916127 609656 453872 1919460 2824435 229149115 246648216 0 155389 0 0 140359246 142552535 0 0 0 90290022 96782194 230649268 239490118 -1500153 7158098 159918050 169490228 224541970 226721170 -64623920 -57230942 X ST CATHERINE OF SIENA MEDICAL CENTER, A MEMBER OF CATHOLIC HEALTH SERVICES OF LONG ISLAND (CHS), AS A MINISTRY OF THE CATHOLIC CHURCH, CONTINUES CHRIST'S HEALING MISSION, PROMOTES EXCELLENCE IN CARE, COMMITTED TO THOSE IN NEED, CHSLI 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 186432730 215166233 ST. CATHERINE OF SIENA MEDICAL CENTER IS A 311 BED ACUTE CARE HOSPITAL DEVOTED TO PROVIDING ADVANCED HEALTHCARE IN AN ENVIRONMENT OF COMPASSION. IN 2010, ST. CATHERINE'S HAD 13,982 DISCHARGED AND PROVIDED CARE FOR 33,231 EMERGENCY ROOM VISITS. ST. CATHERINE'S PROVIDES CARE REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY AND ALONG WITH OTHER UNCOMPENSATED CARE REPORTED $9,969,000 IN CHARITY CARE. COMMUNITY SERVICE AND OTHER CHARITABLE ACTIVITIES PROVIDED FOR THE COMMUNITY TOTALED $5,423,000 AND REPORTED $2,063,000 IN BAD DEBTS IN 2010. 24044146 27749894 ST. CATHERINE OF SIENA NURSING HOME IS LOCATED ON THE CAMPUS OF ST. CATHERINE OF SIENA MEDICAL CENTER. CONSISTING OF 240 BEDS, THE NURSING HOME PROVIDED 84,437 DAYS OF CARE IN 2010. THE NURSING HOME PROVIDED $534,000 IN UNCOMPENSATED CARE AS BAD DEBT IN 2010. 210476876 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 135 0 1 2350 1 0 0 0 0 0 1 1 0 0 0 0 X 24 22 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHS SERVICES INC 5167051937 992 NORTH VILLAGE AVENUE ROCKVILLE CENTRE NY 11570 X REV MSGR JOHN ROWAN 2.00 X X 0 0 0 JOSEPH TANTILLO 2.00 X X 0 0 0 SALVATORE SODANO 2.00 X X 0 0 0 THOMAS REILLY 2.00 X X 0 0 0 RAYMOND BORSELLA 2.00 X 0 0 0 ROBERT CARLIN MD 2.00 X 0 0 0 REV MSGR JAMES MCNAMARA 2.00 X 0 0 0 JOHN F VAN BOURGONDIEN 2.00 X 0 0 0 SYLVIA DIAZ 2.00 X 0 0 0 J ROBERT GROSS DC 2.00 X 0 0 0 MICHAEL LAMBERT 2.00 X 0 0 0 WILLIAM A MULLANEY 2.00 X 14592 0 0 GEORGE RICE 2.00 X 0 0 0 HENRY C SCHREIBER 2.00 X 0 0 0 JAMES UMBDENSTOCK 2.00 X 0 0 0 JERRY NINIA MD 2.00 X 0 0 0 JAMES DILTS 2.00 X 0 0 0 HON JEANNE GARANT 2.00 X 0 0 0 SISTER ANN GRAY DW 2.00 X 0 0 0 GARY VEITH MD 2.00 X 0 0 0 JOHN HALLERON III ESQ 2.00 X 0 0 0 JEROME POLLER 2.00 X 0 0 0 RICHARD SCHMIDT 2.00 X 0 0 0 JAMES CALDAS 50.00 X X 0 689240 147153 DENNIS VERZI 50.00 X 0 814872 189108 GARA EDELSTEIN 50.00 X 347808 0 134004 DAVID RIVADENEIRA 40.00 X 612476 0 45185 JUNE J LEE 40.00 X 376437 0 27143 PHILIP BRUNO 50.00 X 316058 0 35107 MICHAEL QUARTARARO 50.00 X 227328 0 37335 WILLIAM ALLISON 50.00 X 0 3444668 617341 FRANK J FOX 50.00 X 0 354725 1811467 SHARON KENNISH 50.00 X 1608359 0 582162 3503058 5303505 3626005 154 1 1 0 JVK OPERATIONS LIMITED 130 NEW HIGHWAY NORTH AMITYVILLE NY 11701 LAUNDRY SERVICES 670496 ISLAND NEONATOLOGY LLC PO BOX 272 EAST ISLIP NY 11730 MEDICAL SERVICES 412500 LAB CORP OF AMERICA HOLDGIN PO BOX 12140 BURLINGTON NY 27216 MEDICAL SERVICES 408367 HORIZON HEALTHCARE STAFFING 20 JERUSALEM AVE HICKSVILLE NY 11801 STAFFING SERVICES 312755 JZANUS CONSULTING INC 170 JERICHO TPKE FLORAL PARK NY 11001 CONSULTING SERVICES 225714 21 1357 223270 124710 104445 453782 NET PATIENT REV-HOSP 621990 215166233 215166233 NET PATIENT REV-NH 623000 27749894 27749894 242916127 453872 453872 1674581 1296804 377777 377777 377777 103710 223270 99032 4678 4678 CONTRACTED SVCS-SWSM 2197547 2197547 TELEPHONE 900099 91042 91042 CAFETERIA 722210 34313 34313 119078 119078 2441980 246648216 245491451 0 702983 155389 155389 3488465 1336721 2151744 102420000 99011550 3408450 7349125 6963296 385829 21180861 20068866 1111995 8114084 7688095 425989 4126266 1260397 2865869 862858 862858 150896 150896 37669 37669 8339554 7903701 435853 855496 758397 97099 39322075 38688396 633679 2936938 2490810 446128 20695 18346 2349 38432 34070 4362 5409730 4795726 614004 2840806 1447030 1393776 6918827 6133540 785287 4788371 4004267 784104 CHS SERVICES ALLOCATION 9165691 9165691 EQUIP RENTAL/MAINT 2830495 2509234 321261 SERVICE/MAINT CONTRACTS 2642959 2342983 299976 PROVISION FOR BAD DEBTS 2592438 2592438 HOME OFFICE ALLOCATION 2102721 2102721 799277 273624 525653 239490118 210476876 29013242 0 23901270 25188382 475918 365715 22734996 28048406 2863179 2841429 1340516 788787 135851628 50890849 83853836 84960779 22508304 25304676 2240031 1992054 159918050 169490228 23392180 25711959 78322642 76890260 31566667 28766667 91260481 95352284 224541970 226721170 X -65018619 -57609932 394699 378990 -64623920 -57230942 159918050 169490228 X 7158098 234880 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 37669 37669 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 THE BEHALF OF THE HEALTHCARE INDUSTRY THOSE TRADE ORGANIZATIONS REPRESENT. 10126496 10126496 81979424 27501933 54477491 42953040 23034574 19918466 792668 354342 438326 84960779 RESIDENT FUNDS AND SECURITY DEPOSITS 365715 THIRD PARTY PAYOR LIABILITY 38248856 RETIREMENT LIABILITY-PENSION 579138 RETIREMENT LIABILITY-457B FUNDS 103474 RETIREMENT LIABILITY-POST RETIREMENT 1470000 ESTIMATED MALPRACTICE LIABILITY 5496397 SELF INSURED LIABILITY 23631006 DUE TO RELATED PARTIES 25457698 95352284 246648216 239490118 7158098 170469 94411 -30000 234880 7392978 251345533 94411 3705586 3799997 247545536 -897320 -897320 246648216 238251238 4730315 4730315 233520923 5969195 5969195 239490118 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL AND STATE TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED "UNRELATED BUSINESS INCOME" AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES USING A THRESHOLD OF MORE LIKELY THAT NOT. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. PART XI, LINE 8 - OTHER ADJUSTMENTS: POSTRETIREMENT BENEFIT PLAN CHANGES OTHER THAN PERIODIC BENEFIT COST -30,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: SIENA VILLAGE-SEPARAT ENTITY 3,626,528. NARR-OPERATIONS 79,058. PART XII, LINE 4B - OTHER ADJUSTMENTS: MEDICAL OFFICE BUILDING RENTAL EXPENSES -1,296,804. RESTRICTED CONTRIBUTIONS 278,854. GRANT INCOME FOR PURCHASE OF PPE 120,630. PART XIII, LINE 2D - OTHER ADJUSTMENTS: MEDICAL OFFICE BUILDING EXPENSES 1,296,804. SIENA VILLAGE EXPENSES 3,433,511. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHS TRANSFER-SCS 2,166,776. CHS TRANSFER-SCSNH 24,876. CHSLI TRANSFER-SCS 793,539. CHSLI TRANSFER-SCSNH 11,004. OTHER, NONOPERATING LOSSSES-SCS 2,973,000. DINNER DANCE 220215 158195 62020 32820 4750 19570 GOLF OUTING 106765 65075 41690 19130 12070 10692 326980 223270 103710 19130 44890 4750 30262 99032 4678 1 1 1 X 300.000000000000 1 X 1 1 1 0 0 4132472 760654 3371618 0.01420 468202 406767 61435 0.00030 4600674 1167421 3433053 0.01450 652143 575 651568 0.00280 23179 0 23179 0.00010 22909714 18862046 4047668 0.01710 0 0 1563 0 1563 0.00000 23586599 18862621 4723978 0.02000 28187273 20030042 8157031 0.03450 2850 2850 0.00000 9161 4320 4841 0.00000 825 825 0.00000 12836 4320 8516 1 705143 0 76077434 86566503 -10489069 X 1 1 1 NA 1 1 ST CATHERINE OF SIENA HOSPITAL

50 ROUTE 25A SMITHTOWN NY 11787

X X X PSYCHIATRIC UNIT NA 1 0 0 0 0 0 0 0 0 0 0 0 1 ST CATHERINE OF SIENA NURSING HOME

52 ROUTE 25A SMITHTOWN NY 11787

SKILLED NURSING FACILITY 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 OTEHR LINES INCLUDE COSTS THAT WERE DERIVED 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 1, LINE 7A COLUMN DDIRECT 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 HOSPITALS "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 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 $ 2592438. PART II: FOOD DRIVES ST. CATHERINE CONDUCTS SEVERAL FOOD DRIVES THROUGHOUT THE YEAR INCLUDING THANKSGIVING AND CHRISTMAS TO ASSIST LOCAL FOOD PANTRIES. ALL NON-PERISHABLE ITEMS AND PERSONAL CARE ITEMS ARE DONATED TO THE LOCAL CONSORTIUM OF FOOD PANTRIES CONSISTING OF LOCAL PARISHES. IN ADDITION, FOOD DRIVES ARE HELD BEFORE EACH OF THE FIVE HEALTHY SUNDAYS (OUTREACH TO PROVIDE SERVICES TO UNDERSERVED COMMUNITIES ORGANIZED THROUGH PARISHES) AND THE ITEMS COLLECTED ARE DONATED TO THE PARISHS FOOD PANTRY WHERE HEALTHY SUNDAYS ARE HELD. KINGS PARK DAY REPRESENTATIVES FROM SEVERAL DEPARTMENTS ATTEND THIS EVENT TO ANSWER HEALTH RELATED QUESTIONS AND EDUCATE ATTENDEES ON HEALTH RELATED TOPICS SUCH AS BREAST HEALTH, DIGESTIVE TRACT HEALTH AND HEALTHY LIFE STYLE/NUTRITION. EDUCATIONAL MATERIAL IS ALSO PROVIDED.THANKSGIVING MEALS FOR HOMEBOUND RESIDENTS OF SIENA VILLAGE - ST. CATHERINE DONATES A TRADITIONAL THANKSGIVING MEAL TO ALL HOMEBOUND RESIDENTS OF SIENA VILLAGE. THE MEALS ARE PREPARED BY THE HOSPITAL STAFF AND DELIVERED TO SIENA VILLAGE WHERE THEY ARE DISTRIBUTED TO INDIVIDUAL RESIDENT APARTMENTS BY A LOCAL YOUTH GROUP PART III, LINE 4: COSTING METHODOLOGYBAD DEBT AT COST WAS CALCULATED BY APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 TO BAD DEBT EXPENSE, WHICH IS REPORTED AT CHARGES.PART III LINE 4-TEXT OF FOOTNOTE DISCUSSING BAD DEBT:THE ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THIS ALLOWANCE BASED UPON HISTORICAL COLLECTION AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTABLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE MEDICAL CENTER FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN BALANCES WITH COLLECTION AGENCIES, SUBJECT TO CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE.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: 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.ST. CATHERINE INCURRED A LOSS OF APPROXIMATELY $10.5 MILLION TO DELIVER CARE TO MEDICARE PATIENTS. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. ST. CATHERINE BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY, BUT ALSO 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. CATHERINE WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY.LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. 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 INANBILITY 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 MEDICAL CENTERS 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: ASSESMENT OF COMMUNITY NEEDS AND GOALSST. CATHERINES PROVIDES HIGH QUALITY CARE WITH COMPASSION AND RESPECT FOR EACH PATIENT REGARDLESS OF AGE, RELIGION, RACE, GENDER OR ABILITY TO PAY. THE STANDARD OF CARE IS EQUAL FOR ALL PATIENTS. ST. CATHERINES IS CONTINUOUSLY EVALUATING THE SERVICE AREA NEEDS BY REVIEWING PATIENT SURVEYS, COMMUNITY FEEDBACK, DEMOGRAPHIC DATA, COMMUNITY HEALTH INDICATORS AND PATIENT CARE TRENDS TO DEVELOP AND REFINE ITS SCOPE OF SERVICES AND DELIVERY OF CARE.ST. CATHERINES IS PROUD OF THE FACT THAT ITS YEAR-END, 2008 PATIENT SATISFACTION SCORES WERE AMONG THE BEST SCORES THAT ST. CATHERINES HAS EVER HAD. MEASURING PATIENT SATISFACTION AND USING PATIENT FEEDBACK IS AT THE HEART OF ST. CATHERINE OF SIENA MEDICAL CENTERS STRATEGIC PLAN FOR IMPROVING PROGRAMS AND SERVICES.ST. CATHERINES SOLICITED COMMENTS ABOUT THE QUALITY OF SERVICE FROM 50% OF OUR INPATIENTS UTILIZING THE PRESS GANEY PATIENT SATISFACTION SURVEY. THESE RESULTS ARE REVIEWED ON A MONTHLY BASIS AND QUALITY IMPROVEMENTS ARE IMPLEMENTED WHEN A NEED IS IDENTIFIED. PATIENT PRIORITIES ARE CAREFULLY REVIEWED; OPPORTUNITIES TO IMPROVE QUALITY OF CARE AND SERVICES ARE THEN IDENTIFIED AND IMPLEMENTED.THE HEALTHY SUNDAYS PROGRAM, WHICH PROVIDES FREE MEDICAL SCREENINGS AND EDUCATION TO THE UNDERSERVED FOLLOWING WORSHIP SERVICES ON A BIMONTHLY BASIS, WAS THE RESULT OF A JOINT COMMUNITY NEEDS ASSESSMENT BY CHS HOSPITALS. THESE EVENTS ARE PROMOTED VIA CALENDAR LISTINGS IN PARISH BULLETINS AND FLYERS POSTED IN PLACES OF BUSINESS AND WORSHIP IN THE COMMUNITY SURROUNDING THE OUTREACH SITE. PART VI, LINE 3: COMMUNICATION OF FINANCIAL ASSISTANCE POLICY:1. SINCE IT IS THE DUTY OF THE MEDICAL CENTER TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF ITS CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS ARE FULLY VERSED IN THE CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE MEDICAL CENTER REPRESENTATIVES.2. THE MEDICAL CENTER HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE MEDICAL CENTER INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS. 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.3. THE MEDICAL CENTER 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.4. THE MEDICAL CENTER POSTS ITS CHARITY CARE POLICY SUMMARY ON THEIR INTERNET WEBSITE.5. THE MEDICAL CENTER PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING ITS CHARITY CARE PROGRAM IN THE PRIMARY LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6. 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 PROVIDED AT OR BELOW A SIXTH GRADE READING LEVEL. PART VI, LINE 4: COMMUNITY INFORMATIONST. CATHERINES SERVICE AREA CONSISTS OF 21 COMMUNITIES LOCATED IN WESTERN SUFFOLK COUNTY. ST. CATHERINES PRIMARY CATCHMENT AREA HAS A POPULATION OF APPROXIMATELY 248,000 AND INCLUDES: SMITHTOWN, ST. JAMES, HAUPPAUGE, KINGS PARK, COMMACK, NESCONSET, NORTHPORT AND EAST NORTHPORT. THESE COMMUNITIES REPRESENT APPROXIMATELY 53% OF TOTAL ADMISSIONS.OUR SECONDARY SERVICE AREA HAS A POPULATION OF MORE THAN 245,000 AND ACCOUNTS FOR 3.5%OF THE MEDICAL CENTERS TOTAL ADMISSIONS. THE SECONDARY SERVICE AREA COMPRISES, LAKE GROVE, CENTERPORT, GREENLAWN, HUNTINGTON STATION, HUNTINGTON AND COLD SPRING HARBOR.ALTHOUGH THE OVERALL SERVICE AREA POPULATION IS PROJECTED TO HAVE A SMALL INCREASE FROM 2004 TO 2009, THERE WILL BE SIGNIFICANT INCREASES IN THE 45-64 AND 65+ AGE GROUPS. THE PROJECTED 2006 AVERAGE INCOME LEVELS FOR HOUSEHOLDS IN THE SERVICE AREA ARE LARGELY COMPARABLE TO THE AVERAGE OF $99,889 FOR SUFFOLK COUNTY AS A WHOLE. THE POPULATION IS PROJECTED TO BECOME MORE RACIALLY AND ETHNICALLY DIVERSE. PART VI, LINE 6: PROMOTION OF COMMUNITY HEALTHST. CATHERINE OF SIENA MEDICAL CENTER OFFERS A WIDE AND COMPREHENSIVE ARRAY OF COMMUNITY SERVICE PROGRAMS THAT ADDRESS CRITICAL HEALTH ISSUES TO A DIVERSITY OF PATIENTS, INCLUDING:ANNUAL COMMUNITY HEALTH FAIR: ST. CATHERINES ANNUAL COMMUNITY HEALTH FAIR IS A PIVOTAL EDUCATION PORTAL FOR THE COMMUNITY. THE HEALTH FAIR IS THE PRIMARY PLACE WHERE COMMUNITY MEMBERS CAN RECEIVE FREE HEALTH CARE EDUCATION AND SCREENINGS AND DISCOVER THE VAST SCOPE OF SERVICES PROVIDED BY THE MEDICAL CENTER.AUXILIARY VOLUNTEER DEPARTMENT: THE AUXILIARY AND VOLUNTEERS OF ST. CATHERINE OF SIENA MEDICAL CENTER ARE A GROUP OF DEDICATED AND GENEROUS INDIVIDUALS, WHO OFFER THEIR TIME, TALENT AND SERVICES TO PATIENTS AND STAFF ON A DAILY BASIS. THE AUXILIARY ALSO DONATES FUNDS TO SUPPORT THE MISSION OF THE MEDICAL CENTER, RAISED THROUGH FUNDRAISING ACTIVITIES THAT INCLUDE: FASHION SHOWS, MANAGING THE HOSPITAL GIFT SHOP, PLANTS SALES AND SPECIAL EVENTS.COMMUNITY BLOOD DRIVES: ST. CATHERINE HOSTS THREE BLOOD DRIVES ANNUALLY IN COLLABORATION WITH LONG ISLAND BLOOD SERVICES, A DIVISION OF NEW YORK BLOOD CENTER.COMMUNITY NEWSLETTER: ST. CATHERINES PUBLISHES A QUARTERLY NEWSLETTER, THE VOICE. WHICH IS MAILED THROUGHOUT THE PRIMARY CATCHMENT AREA. THE VOICE IS A PRIMARY COMPONENT OF EDUCATING THE COMMUNITY ABOUT HEALTH-RELATED ISSUES AND KEEPING THEM INFORMED OF UPCOMING EVENTS AND HOSPITAL SERVICES.EMERGENCY RESPONSE APPRECIATION DINNERS: EMERGENCY RESPONSE PERSONNEL ARE AT THE FOREFRONT OF THE MEDICAL PROCESS. THEY PROVIDE IMMEDIATE MEDICAL SERVICE AND WORK COLLABORATIVELY TO OFFER TIMELY CARE. ST. CATHERINES RECOGNIZES THIS FACT AND HAS IMPLEMENTED A QUARTERLY EMERGENCY RESPONSE APPRECIATION DINNER FOR LOCAL EMERGENCY RESPONSE PERSONNEL. THE APPRECIATION DINNERS WERE IMPLEMENTED IN 2008, AND HAVE BECOME A HIGHLIGHT FOR ST. CATHERINES AND LOCAL EMERGENCY RESPONSE TEAMS. EACH DINNER ACTS AS A REMINDER OF HOW GRATEFUL THE HOSPITAL IS FOR PROMPTNESS AND EFFICIENCY IN THE FIELD. THE DINNERS OFFER A FORUM FOR SPECIAL EDUCATIONAL PROGRAMS AND AN OPPORTUNITY FOR EMERGENCY RESPONSE PERSONNEL TO GAIN EDUCATION CREDITS.FACE TO FACE: ST. CATHERINES IS NOW A PARTNER OF FACE TO FACE. FACE TO FACE IS A HUMANITARIAN PROGRAM CONDUCTED UNDER THE AUSPICES OF THE EDUCATIONAL AND RESEARCH FOUNDATION FOR THE AMERICAN ACADEMY OF FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY (AAFPRS FOUNDATION). THE FOUNDATION OFFERS PRO-BONO CONSULTATIONS AND SURGERIES TO VICTIMS OF DOMESTIC VIOLENCE TO ENHANCE THEIR SELF-ESTEEM AND ASSIST IN THE TREMENDOUS EFFORT TO REBUILD THEIR LIVES. ST. CATHERINES HAS SUCCESSFULLY PERFORMED ONE SURGERY UNDER THIS PROGRAM IN 2008.HEALTHY SUNDAY SERIES: THE HEALTHY SUNDAY PROGRAM MANIFESTS THE COMMITMENT OF CATHOLIC HEALTH SERVICES OF LONG ISLAND BY PROACTIVELY HELPING UNDERSERVED COMMUNITIES BY PROVIDING EDUCATIONAL SEMINARS AND PREVENTIVE SCREENINGS THAT MAY BE OTHERWISE UNAVAILABLE. THE PROGRAM REACHES OUT INTO COMMUNITIES OF NEED THROUGH LOCAL PARISHES TO HELP BRIDGE THE GAP BETWEEN THE INDIVIDUAL AND THE HEALTH PROVIDER TO PROVIDE QUALITY, ACCESSIBLE SERVICES ULTIMATELY BUILDING A LINK FOR THE COORDINATION OF CARE. HEALTHY SUNDAYS PROVIDES A SAFE AVENUE TO IMPROVE ACCESS TO VITAL PRIMARY CARE SERVICES.MATERNITY EDUCATION: YOU AND YOUR BABY EDUCATION SERIESTHE MATERNITY DEPARTMENT OFFERS A VARIETY OF FEE AND NON-FEE SUPPORT GROUPS AND WORKSHOPS FOR NEW MOTHERS AND FAMILY MEMBERS AS FOLLOWS: BREAST-FEEDING SUPPORT GROUPS, CHILDBIRTH EDUCATION, EARLY PREGNANCY CLASSES, FAMILY AND FRIENDS CPR: INFANT ONLY, GRANDPARENTS CLASSES, INFANT CARE CLASSES, PRENATAL BREAST-FEEDING CLASSES AND SIBLING CLASSES.MEDICAL COMMUNITY EDUCATION: ST. CATHERINES IS DEDICATED TO EDUCATING THE COMMUNITY AND PROUDLY OFFERS FREE LECTURES AND PRESENTATIONS ON A VARIETY OF HEALTH AND WELLNESS TOPICS TO HELP EDUCATE AND RAISE AWARENESS. WITH THE COMBINATION OF LECTURES AND PRESENTATIONS OFFERED, ST. CATHERINES HOPES TO IMPROVE THE QUALITY OF LIFE, PROMOTE WELLNESS AND HEALTHY LIVING FOR ALL THOSE WHO LIVE AND WORK IN THE COMMUNITY.PASTORAL CARE: PASTORAL CARE SERVICE IS AVAILABLE FOR PATIENTS FOR ALL DENOMINATIONS DURING THEIR HOSPITAL STAY. WE PROVIDE SPIRITUAL RESOURCES, COUNSEL AND PRAYER, AND ASSIST PATIENTS WITH INTEGRATING THEIR SPIRITUAL BELIEFS INTO THEIR HEALING PROCESS. PASTORAL CARE IS OFTEN CALLED UPON FOR ETHICAL ADVICE WITH ADVANCE DIRECTIVES IN COLLABORATION WITH THE PATIENT ADVOCATE.OTHER SUPPORT GROUPS OFFERED TO THE COMMUNITY:BARIATRIC SUPPORT GROUPSCARDIAC DEVICE SUPPORT GROUPSDIABETES CLUB (GLAD)GREEN SEMINARPARKINSONS DISEASE SUPPORT GROUPSBEREAVEMENT SUPPORT GROUPS PART VI, LINE 7: ST. CATHERINE OF SIENA MEDICAL CENTER (ST. CATHERINE OR THE HOSPITAL OR THE MEDICAL CENTER) AND ST. CATHERINE OF SIENA NURSING HOME, ARE LOCATED ON A SINGLE CAMPUS IN SMITHTOWN, NEW YORK.ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS ST. CATHERINE, THROUGH ITS DAILY OPERATION, PROVIDES TO THE AREA ACUTE, EMERGENT AND OUTPATIENT CARE AS WELL AS LONG TERM CARE AND HOUSING. ST. CATHERINE IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A CATHOLIC HEALTH SERVICES OF LONG ISLAND) (CHS) WHICH IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE.AS OF DECEMBER 31, 2010 CHS WAS COMPRISED OF SIX HOSPITALS (MERCY MEDICAL CENTER AND ST. FRANCIS HOSPITAL IN NASSAU COUNTY; GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. CHARLES HOSPITAL AND ST. CATHERINE IN SUFFOLK COUNTY; AND AS PASSIVE PARENT TO ST.JOSEPH HOSPITAL IN NASSAU COUNTY) THREE NURSING HOMES (ST. CATHERINE; GOOD SAMARITAN NURSING HOME AND OUR LADY OF CONSOLATION RESIDENCE, ALL IN SUFFOLK COUNTY) A REGIONAL HOME CARE AND HOSPICE NETWORK AND A COMMUNITY BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 17,000 STAFF AND 3,800 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CHS PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES.MEMBER ORGANIZATIONS OF CHS OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICES, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. EACH OF CHS' MEMBER ORGANIZATIONS HAVE RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY, THEIR DISTINCTIVE PERSONALITIES, AS WELL AS THE SERVICE SPECIALTIES WHICH THEY ARE KNOWN FOR, THUS EMBEDDING THE ORGANIZATION IN THE COMMUNITY AND SERVING IT EFFECTIVELY.THE CHS SYSTEM PROVIDES AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS, FREE HEALTH SCREENINGS THROUGH THE HEALTHY SUNDAYS PROGRAM, HEALTH FAIRS AND OTHER PROGRAMS WHICH HELP THE COMMUNITIES SERVED BY CHS ACCESS CARE. SINCE 1907 CATHOLIC HEALTH CARE ON LONG ISLAND HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF SERVING THE COMMUNITY.TO FURTHER THE MISSION OF BRINGING CARE TO THE COMMUNITY, CHS AND ITS MEMBER HOSPITALS, TOGETHER WITH A NUMBER OF OTHER HEALTHCARE PROVIDERS ON LONG ISLAND ENTERED INTO A PARTNERSHIP AGREEMENT WHICH OPERATES AS THE LONG ISLAND HEALTH NETWORK (LIHN). LIHN WAS CREATED TO ESTABLISH A COMPREHENSIVE AND EFFICIENT HOSPITAL NETWORK IN NASSAU AND SUFFOLK COUNTIES BY WORKING TO, AMONG OTHER THINGS, IMPROVE QUALITY OF CARE, FACILITATE CLINICAL INTEGRATION, BENCHMARK BEST PRACTICES, AND REDUCE LENGTH OF STAY AND COSTS. REPORTS FILED WITH STATES PART VI, LINE 7 NY 0 DIOCESE OF ROCKVILLE CENTRE-CATHOLIC MINISTRIES APPEAL 50 NORTH PARK AVENUE ROCKVILLE CENTRE NY 11570 111837437 155389 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 OTHER INFORMATION: PART IV: PART 1 LINE 2:-THE DIOCESE OF ROCKVILLE CENTER PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL, WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI. X X X X X 1 1 0 0 0 0 0 0 0 JAMES CALDAS 0 633260 0 0 0 55980 0 129759 0 17394 0 836393 0 0 DENNIS VERZI 0 515178 0 281000 0 18694 0 180416 0 8692 0 1003980 0 0 GARA EDELSTEIN 261040 0 75000 0 11768 0 123641 0 10363 0 481812 0 0 0 DAVID RIVADENEIRA 482278 0 129250 0 948 0 19061 0 26124 0 657661 0 0 0 JUNE J LEE 298480 0 75000 0 2957 0 19061 0 8082 0 403580 0 0 0 PHILIP BRUNO 160546 0 60000 0 95512 0 12657 0 22450 0 351165 0 0 0 MICHAEL QUARTARARO 185818 0 40000 0 1510 0 14635 0 22700 0 264663 0 0 0 WILLIAM ALLISON 0 200875 0 216300 0 3027493 0 609298 0 8043 0 4062009 0 2195719 FRANK J FOX 0 343712 0 0 0 11013 0 1782426 0 29041 0 2166192 0 0 SHARON KENNISH 240662 0 90400 0 1277297 0 580961 0 1201 0 2190521 0 0 0 PART I, LINES 4A-B PART I, LINES 4A-B: SEVERENCE PAYMENT WILLIAM ALLISON, FORMER PRESIDENT & CEO RECEIVED PAYMENT OF SEVERENCE. SHARON KENNISH, FORMER EXECUTIVE DIRECTOR RECEIVED PAYMENT OF SEVERENCE. PART I, LINE 4B SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WILLIAM ALLISON $117,865 PARTICIPATION IN PLAN; $2,195,719 PAYMENT FROM PLAN FRANK J FOX $846,421 PARTICIPATION IN PLAN JAMES CALDAS $132,354 PARTICIPATION IN PLAN DENNIS VERZI $172,632 PARTICIPATION IN PLAN GARA EDELSTEIN $133,590 PARTICIPATION IN PLAN SHARON KENNISH $1,159,442 PAYMENT FROM PLAN FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ST. CATHERINE OF SIENA MEDICAL CENTER IS CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH SERVICES OF LONG ISLAND) (CHS). CHS IS A NEW YORK NOT-FOR-PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CHS IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTER. FORM 990, PART VI, SECTION A, LINE 7A CHS IS THE SOLE MEMBER AND ESTABLISHED CO-OPERATOR OF ST CATHERINE OF SIENA MEDICAL CENTER, AND HAS THE RIGHT TO APPOINT THE GOVERNING BODY OF ST. CATHERINE. FORM 990, PART VI, SECTION A, LINE 7B CHS AS THE SOLE MEMBER AND CO-OPERATOR OF ST. CATHERINE IS REQUIRED TO APPROVE CERTAIN DECISIONS MADE BY ST. CATHERINE'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 FINAL DRAFT OF THE FORM 990 IS THEN 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 COMMITTEE'S 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 ORGANIZATION'S BOARD CHAIR AND CHIEF EXECUTIVE OFFICER COMMUNICATES, IN WRITING TO THE CHS COMPLIANCE AND AUDIT COMMITTEE AND CHS BOARD CHAIR, SUCH APPROVAL, RECOMMENDS 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 RECOMMENDED 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 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 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 SUBMITTED UPON HIRE OR APPOINTMENT AND ANNUALLY THEREAFTER. SUCH INDIVIDUALS HAVE A CONTINUING OBLIGATION TO UPDATE THE INFORMATION PROVIDED DURING THE COURSE OF THE YEAR. A SUMMARY OF DISCLOSURES IS PROVIDED TO THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE BY THE ORGANIZATION'S COMPLIANCE OFFICER. ALL DISCLOSURES ARE INVESTIGATED AND INFORMATION RELATED TO THE DISCLOSURE SHALL BE GATHERED AND SUMMARIZED AND INCLUDED WITH THE SUMMARY OF DISCLOSURES. UPON REVIEW OF THE SUMMARY OF DISCLOSURES, THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE SHALL REPORT ITS FINDINGS TO THE BOARD OF TRUSTEES FOR REVIEW. THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS BASED ON THE CRITERIA CONTAINED IN THE POLICY. IF THE BOARD OR BOARD COMMITTEE DETERMINES THAT NO CONFLICT EXISTS, THE MATTER SHALL BE REFFERED FOR REVIEW BY THE CHS COMPLIANCE AND AUDIT COMMITTEE BEFORE THE DETERMINATION BECOMES FINAL. IF A CONFLICT OF INTEREST IS IDENTIFIED AND A MAJORITY OF THE BOARD OR BOARD COMMITTEE AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS AND WISHES TO GO FORTH WITH IT, THE CHAIR OF THE ORGANIZATION'S BOARD OF TRUSTEES SHALL PROVIDE A WRITTEN REQUEST TO THE CHAIR OF THE CHS COMPLIANCE AND AUDIT COMMITTEE, DELINEATING THE TRANSACTION AND CONFLICT AND PROVIDING REASONS WHY THE BOARD AGREES THAT THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF CHS, CERTIFIES THAT CHS CANNOT SECURE SIMILAR SERVICES FROM AN ORGANIZATION WITHOUT A CONFLICT, AND WISHES TO GO FORWARD WITH IT. 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 COMPENTSATION AND BENEFITS) OF "DISQUALIFIED PERSONS" AT THE MEDIAN OF THE DEFINED 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 AT DAC BOND. FORM 990, PART VII, SECTION A , LINE 1A 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. JAMES CALDAS, INTERIM PRESIDENT AND CEO-THE TOTAL HOURS REPORTED REFLECTS TIME WORKED AS OFFICER FOR ALL OF THE FOLLOWING RELATED ENTITIES: GOOD SAMARITAN HOSPITAL (11-1888924); GOOD SAMARITAN HOSPITAL FOUNDATION (77-0611240); ST CATHERINE OF SIENA MED CENTER (06-1562701); ST CHARLES HOSPITAL & REHAB (11-1871039); ST CHARLES FOUNDATION (41-2076312); ST CHARLES CORPORATION (11-2983148); SIENA VILLAGE (06-1569129); THE SAMARITAN CORPORATION (11-2716640); SUFFOLK HEARING AND SPEECH INC (11-2110488). CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 170,469. DONATED SERVICES AND USE OF FACILITIES: 94,411. POSTRETIREMENT BENEFIT PLAN CHANGES OTHER THAN PERIODIC BENEFIT COST -30,000. TOTAL TO FORM 990, PART XI, LINE 5: 234,880. 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 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 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 SIENA RETIREMENT REALTY CCRC 50 ROUTE 25A SMITHTOWN NY 11787 RETIREMENT COMMUNITY NY 0 3532418 N/A SIENA MEDICAL REALTY 50 ROUTE 25A SMITHTOWN NY 11787 MEDICAL OFFICE BUILDING NY 1601368 8442881 N/A 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 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 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 CATHOLIC HEALTH SERVICES OF LONG ISLAND O 170068 COST SIENA VILLAGE INC O 405097 COST GOOD SAMARITAN HOSPITAL MEDICAL CENTER P -1058048 COST ST FRANCIS HOSPITAL P -81202 COST OUR LADY OF CONSOLATION GERIATRIC CARE P -100002 COST RVC INSURANCE COMPANY INC O 170796 COST TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R PART V LINE 2 ST.CATHERINE 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.CATHERINE HAS ENGAGED IN WITH ITS RELATED PARTY ORGANIZATIONS. THE FOLLOWING IS A LIST OF ADDITIONAL TRANSACTION TYPES BY FACILITY. NAME OF ORGANIZATION EIN ADDNL TRANS TYPES CATHOLIC HEALTH SERVICES OF LONG ISLAND 11-3405968 P GOOD SAMARITAN HOSPITAL MEDICAL CENTER 11-1888924 N,O ST. FRANCIS HOSPITAL 11-2050523 O OUR LADY OF CONSOLATION GERIATRIC CARE 11-3284066 O SIENA VILLAGE 06-1569129 N,P