Good Samaritan Hospital Medical Center

“The sole member of good samaritan university hospital is catholic health system of long island, (d/b/a/ catholic health)(ch). Ch is a new york not-for-profit corporation organized to serve as the coordinating body of an ntegrated network of healthcare providers. Ch is sponsored by the roman catholic diocese of rockville center (diocese).”

“Ch is the sole member and established co-operator of good samaritan university hospital, and as such has the right to appoint the governing body.”

“As the sole member of good samaritan university hospital, ch is required to approve certain decisions made by the governing body of good samaritan university hospital. The governing body of good samaritan university hospital is the same as that of ch.”

“The form 990 and related schedules are completed by outside tax advisors and reviewed internally by management. The final draft of the form 990 is then provided to all voting members of the board, and presented to the compliance and audit committee (the committee) of the board of directors of ch, which has been delegated the form 990 review function by the board. Upon review and recommendation of the committee, the form 990 is then sent to the board for approval. Upon board approval, the form 990 is submitted to the internal revenue service.”

“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 ch compliance and audit committee by ch's compliance officer. All disclosures are investigated and information related to the disclosure is gathered and summarized and included with the summary of disclosures. Upon review of the summary of disclosures, the ch compliance and audit committee shall report its findings to the ch board of directors. The board shall determine whether a conflict of interest exists based on the criteria contained in the policy. 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 ch and wishes to go forward with it, the chair of the board of directors shall provide a written request to the chair of the ch 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 ch, certifies that ch cannot secure similar services from an organization without a conflict, and wishes to go forward with it. The person determined to have a conflict of interest must recuse him/herself from any decision making or voting on the interest that gave rise to the conflict.”

“The chief administrative officer submits for approval to the system ceo recommendations for base salary adjustments and incentive awards for "disqualified persons" as defined in the ch executive compensation policy (compensation policy). The compensation policy defines a "disqualified person" as a person in a position to exercise substantial influence over the affairs of ch 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 (ceo), and chief operating officers (coo) or persons holding equivalent positions; c) the entity's treasurers and chief financial officers (cfo); d) the person's compensation is primarily based on revenues derived from activities of ch or an operating entity, or of a particular department or function of ch or an operating entity, that the person controls; e) the person has or shares authority to control or determine a substantial portion of ch or an operating entity's capital expenditures, operating budget, or compensation for other employees; f) the person manages a department or activity of ch or an operating entity that represents a substantial portion of the activities, assets, income, or expenses of ch or an operating entity, compared to the organization as a whole; or g) family members of any of those described in the preceding d, e, or f. Once approved by the ch ceo, these recommendations are sent to the executive compensation committee of the ch board of directors for review. The executive compensation committee, with an independent compensation consultant engaged by the board, will review proposed salary adjustments and incentive awards to ensure reasonableness by reviewing comparable total compensation data (including incentives) paid to similarly situated executives at the median of the defined marketplace with possible adjustment made for special skill, experience, competence and performance, including contribution to the system as a whole. Reviews are performed annually by an independent consultant. The compensation committee sets standards to ensure that the criteria used to determine incentive compensation are specific, objective, measureable and related to indicators of performance. Based on the information provided, the committee will then make its recommendation to the ch board of directors.”

“Governing documents-certificate of incorporation filed with nys department of state; conflict of interest policy is not made publicly available; ch consolidated financial statements are available at dac bond.”

“Hours for trustees are the estimated weekly hours (2.0) trustees contribute to this and all other related organizations, not necessarily equally but in the proportion necessary, for which they receive no compensation. Donald teplitz, chief medical officer - the total hours worked reported reflects time worked as an officer or key employee for all of the following related entities: good samaritan hospital medical center (11-1888924); good samaritan hospital foundation (77-0611240) and samaritan emergency medical services, p.c. (20-8243412). Ruth hennessey, president/cao - the total hours worked reported reflects time worked as an officer for all of the following related entities: good samaritan hospital medical center (11-1888924); good samaritan hospital foundation (77-0611240); good samaritan self insurance against malpractice (11-2537396); st francis hospital (11-2050523); st francis hospital research & education corporation, inc. (11-3090867); and st francis hospital foundation (11-2916033). Patrick o'shaughnessy, president & ceo - the total hours worked reflects time worked as an officer for all of the following related entities: chs services, inc. (11-3555766); rvc insurance company, inc. (20-8067039); catholic health systems of long island (11-3403968); st. Francis hospital (11-2050523); st francis hospital research & education corporation, inc. (11-3090867); mercy medical center (11-1635088); wsnchs north, inc. (11-3438973); good samaritan hospital medical center (11- 1888924); good samaritan self insurance against malpractice (11-2537396); st. Catherine of siena medical center (06-1562701); st. Charles hospital corp (11-1871039); st. Joseph hospital foundation (47-2353387); rvc ii insurance company, inc. (92-1136144) and mercy medical center foundation (51-0813603). Patrick minicus, evp & cfo - the total hours worked reflects time worked as an officer for all of the following related entities: chs services, inc. (11-3555766); rvc insurance company, inc. (20-8067039); catholic health systems of long island (11-3403968); st. Francis hospital (11-2050523); st francis hospital research & education corporation, inc. (11-3090867); mercy medical center (11-1635088); wsnchs north, inc. (11-3438973); good samaritan hospital medical center (11- 1888924); good samaritan self insurance against malpractice (11-2537396); st. Catherine of siena medical center (06-1562701); st. Charles hospital corp (11-1871039); st francis hospital foundation (11-2916033); st. Charles hospital foundation (41-2076312); good samaritan hospital foundation (77-0611240) and st. Catherine of siena medical center foundation (27-1459941). Foundation (77-0611240); st. Catherine of siena medical center foundation (27-1459941) and mercy medical center foundation (51-0813603).”

“The tax-exempt bond issuances reflected on part x, line 20 are issued on behalf of the catholic health obligated group project which includes the filing entity and related entities. Three bonds were issued to the obligated group, suffolk county economic development corporation (series 2011 suffolk bonds), suffolk county economic development corporation (series 2014c suffolk bonds) and nassau county local economic assistance and financing corporation (series 2011 nassau bonds). The bonds are reported on schedule k of the parent organization, catholic health.”

“Good samaritan university hospital is a member of catholic health. We, at catholic health, humbly join together to bring christ's healing mission and the mission of mercy of the catholic church expressed in catholic health care to our communities. I-care values integrity: we are who we say we are and act in accordance with the splendor of truth of our catholic moral teaching and our catholic values. Compassion: we have compassion for our patients, see the suffering christ in them, strive to alleviate suffering and serve the spiritual, physical and emotional needs of our patients. Accountability: we take responsibility for our actions and their consequences. Respect: we honor the sanctity of life at every stage of life and the dignity of every person, and incorporate all the principles of catholic social teaching in our relationships and advocacy. Excellence: we seek the glory of god in the compassionate service of our patients, and we strive to do the best that can be done, whatever our role.”

“Post retirement benefit plan change $(395,000) post retirement adjustment non operating gain $261,000 related party transfers $1,884,450 rounding $5,162 ----------- total: $ 1,755,612”