Civic Intelligence

Good Samaritan Self Insurance Against Malpractice

EIN 11-2537396 • 501(c)3 • West Islip, NY

Profile

We, at ch, humbly join together to bring christs healing mission and the mission of mercy of the catholic church expressed in catholic health care to our communities.

Refreshing map…

1000 Montauk HighwayWest Islip, NY 11795

n/A

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

9th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)3 • $5M-$10M nonprofits • Source year 2024

Liabilities / Revenue

10th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)3 • $5M-$10M nonprofits • Source year 2024

Net Margin

100th percentile

100%

Higher net margin than 100% of similar nonprofits.

501(c)3 • $5M-$10M nonprofits • Source year 2024

Top Officer Pay

100th percentile

$4,755,111

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 1700.7% of source-year revenue.

501(c)3 • $5M-$10M nonprofits • Source year 2024

Asset Growth

51st percentile

5.2%

Faster asset growth than 51% of similar nonprofits.

501(c)3 • $5M-$10M nonprofits • Annualized from 2023 to 2024

Revenue Growth

6th percentile

-42%

Faster revenue growth than 6% of similar nonprofits.

501(c)3 • $5M-$10M nonprofits • Annualized from 2023 to 2024

Assets

Up

$5,611,318

Up $279,598 (+5.2%) from 2023

Liabilities

Flat

$0

Flat from 2023

Net Assets

Up

$5,611,318

Up $279,598 (+5.2%) from 2023

Revenue

Down

$279,598

Down $205,057 (-42%) from 2023

Expenses

Flat

$0

Flat from 2023

Net Income

Down

$279,598

Down $205,057 (-42%) from 2023

Trend Graphs

Balance Sheet Trend

Grouped bars show assets, liabilities, and net assets across loaded filings.

$6.0M$4.0M$2.0M$0Assets 2010: $3,488,054Liabilities 2010: $0Net Assets 2010: $3,488,0542010Assets 2011: $3,662,451Liabilities 2011: $0Net Assets 2011: $3,662,4512011Assets 2012: $3,778,865Liabilities 2012: $0Net Assets 2012: $3,778,8652012Assets 2013: $3,838,137Liabilities 2013: $0Net Assets 2013: $3,838,1372013Assets 2014: $3,951,583Liabilities 2014: $0Net Assets 2014: $3,951,5832014Assets 2015: $4,058,023Liabilities 2015: $0Net Assets 2015: $4,058,0232015Assets 2016: $4,156,924Liabilities 2016: $0Net Assets 2016: $4,156,9242016Assets 2017: $4,262,289Liabilities 2017: $0Net Assets 2017: $4,262,2892017Assets 2018: $4,419,862Liabilities 2018: $0Net Assets 2018: $4,419,8622018Assets 2019: $4,543,669Liabilities 2019: $0Net Assets 2019: $4,543,6692019Assets 2020: $4,703,631Liabilities 2020: $0Net Assets 2020: $4,703,6312020Assets 2021: $4,822,064Liabilities 2021: $0Net Assets 2021: $4,822,0642021Assets 2022: $4,847,065Liabilities 2022: $0Net Assets 2022: $4,847,0652022Assets 2023: $5,331,720Liabilities 2023: $0Net Assets 2023: $5,331,7202023Assets 2024: $5,611,318Liabilities 2024: $0Net Assets 2024: $5,611,3182024

Highlighted filing

2024

Assets$5,611,318
Liabilities$0
Net Assets$5,611,318

Operations Trend

Revenue, expenses, and net income by year, with the latest filing highlighted.

$600K$400K$200K$0Expenses 2010: $02010Expenses 2011: $02011Expenses 2012: $02012Revenue 2013: $59,272Expenses 2013: $0Net Income 2013: $59,2722013Revenue 2014: $113,446Expenses 2014: $0Net Income 2014: $113,4462014Revenue 2015: $106,440Expenses 2015: $0Net Income 2015: $106,4402015Revenue 2016: $98,901Expenses 2016: $0Net Income 2016: $98,9012016Revenue 2017: $105,365Expenses 2017: $0Net Income 2017: $105,3652017Revenue 2018: $157,573Expenses 2018: $0Net Income 2018: $157,5732018Revenue 2019: $123,807Expenses 2019: $0Net Income 2019: $123,8072019Revenue 2020: $159,962Expenses 2020: $0Net Income 2020: $159,9622020Revenue 2021: $118,433Expenses 2021: $0Net Income 2021: $118,4332021Revenue 2022: $25,001Expenses 2022: $0Net Income 2022: $25,0012022Revenue 2023: $484,655Expenses 2023: $0Net Income 2023: $484,6552023Revenue 2024: $279,598Expenses 2024: $0Net Income 2024: $279,5982024

Highlighted filing

2024

Revenue$279,598
Expenses$0
Net Income$279,598

Filings

Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2024Facts available. Structured filing facts are available, but richer extracted sections are limited.$5.61$0.00$5.61$0.28$0.00$0.28
2023Detailed filing. Detailed filing data is available for this year.$5.33$0.00$5.33$0.48$0.00$0.48
2022Facts available. Structured filing facts are available, but richer extracted sections are limited.$4.85$0.00$4.85$0.03$0.00$0.03
2021Detailed filing. Detailed filing data is available for this year.$4.82$0.00$4.82$0.12$0.00$0.12
2020XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$4.70$0.00$4.70$0.16$0.00$0.16
2019Detailed filing. Detailed filing data is available for this year.$4.54$0.00$4.54$0.12$0.00$0.12
2018Detailed filing. Detailed filing data is available for this year.$4.42$0.00$4.42$0.16$0.00$0.16
2017Facts available. Structured filing facts are available, but richer extracted sections are limited.$4.26$0.00$4.26$0.11$0.00$0.11
2016Facts available. Structured filing facts are available, but richer extracted sections are limited.$4.16$0.00$4.16$0.10$0.00$0.10
2015Facts available. Structured filing facts are available, but richer extracted sections are limited.$4.06$0.00$4.06$0.11$0.00$0.11
2014Detailed filing. Detailed filing data is available for this year.$3.95$0.00$3.95$0.11$0.00$0.11
2013Detailed filing. Detailed filing data is available for this year.$3.84$0.00$3.84$0.06$0.00$0.06
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$3.78$0.00$3.78$0.00
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.$3.66$0.00$3.66$0.00
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$3.49$0.00$3.49$0.00
Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2024 to Dec 31, 2024
Signed
Nov 12, 2025
Return Version
2024v5.2
Gross Receipts
$4,266,957
Mission and Program Overview

Mission

We, at ch, humbly join together to bring christs healing mission and the mission of mercy of the catholic church expressed in catholic health care to our communities.

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments in Publicly Traded Securities$5,331,720$5,611,318▲ $279,598
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Savings and Temporary Cash Investments$0$0→ $0
Accounts Receivable$0$0→ $0
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Other Securities$0$0→ $0
Investments Program Related$0$0→ $0
Land, Buildings, and Equipment, Net$0$0→ $0
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Prepaid Expenses and Deferred Charges$0$0→ $0
Total Assets$5,331,720$5,611,318▲ $279,598
Other Assets Total$0$0→ $0
Liabilities
Accounts Payable and Accrued Expenses$0$0→ $0
Grants Payable$0$0→ $0
Mortgage Notes Payable Secured by Investment Property$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Other Liabilities$0$0→ $0
Deferred Revenue$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$5,331,720$5,611,318▲ $279,598
Net Assets With Donor Restrictions$0$0→ $0
Total Net Assets Fund Balance$5,331,720$5,611,318▲ $279,598
Total Liabilities and Net Assets / Fund Balance$5,331,720$5,611,318▲ $279,598
Compensation and Service Providers

Employees

NameTitleFull / Part TimeOtherTotal
PATRICK O'SHAUGHNESSY DOPresident & CEOFT$4,755,111$4,755,111

Board Members and Trustees

Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$279,598
Other Revenue
$0
Change in Net Assets
$279,598
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$0
Other Expenses$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Fundraising Direct Expenses$0
Fundraising Gross Income$0
Gaming Direct Expenses$0
Gaming Gross Income$0
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Line 6 - Members of the Organization

Good samaritan self insurance against malpractice supports good samaritan university hospital and the sole member of good samaritan university hospital is catholic health, (d/b/a/ catholic health)(ch). Ch is a new york not-for-profit corporation organized to serve as the coordinating body of an integrated network of healthcare providers. Ch is sponsored by the roman catholic diocese of rockville center (diocese).

Form 990, Part VI, Line 7A - Election of the Governing Body

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 of good samaritan self insurance against malpractice trust.

Form 990, Part VI, Line 7B - Decisions of the Governing Body

Ch as the sole member and established co-operator of good samaritan university hospital is required to approve certain decisions made by the governing body of good samaritan self insurance against malpractice trust.

Form 990, Part VI, Line 11B - Review Process for Form 990

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.

Form 990, Part VI, Line 12C - Conflict of Interest Policy

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' 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.

Form 990, Part VI, Line 15 - Compensation Policy (of Ch, A Related Org)

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.

Form 990, Part VI, Line 19 - Documents Available for Public Inspection

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

Part VII, Section A - Line 1A

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. Ruth hennessey, president - 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); st. Catherine of siena medical center foundation (27-1459941) and mercy medical center foundation (51-0813603). Justin lundbye, president - 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); and good samaritan self insurance against malpractice (11-2537396).

Filing and Contact Details

Filer

Filer Name
Good Samaritan Self Insurance Against
EIN
11-2537396
In Care Of
% CHS SERVICES INC
Phone
6313763000
Address
1000 MONTAUK HIGHWAY, WEST ISLIP, NY 11795

Signing Officer

Name
Justin Lundbye
Title
President
Phone
5167051919
Signed
2025-11-12
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Justin Lundbye
Formed
1980
Legal Domicile
Ny
Voting Board Members
20
Independent Board Members
19
Employees
0
Volunteers
0

Preparer

Firm
PwC US Tax LLP
Address
2001 MARKET STREET SUITE 1800, PHILADELPHIA, PA 19103
Preparer
Eric M Mcneil
Phone
2673303000
Supplemental Narrative

Additional Explanations

FORM 990, PART III, LINE 1, ORGANIZATION'S MISSION

Good samaritan self insurance against malpractice 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.

Financial Statement Notes

Part X, Other Liabilities, Line 2, Fin 48 Footnote

Ch and most of its subsidiaries are 501(c)(3) organizations exempt from federal income taxes on related income under section 501(a) of the internal revenue code. These entities are also exempt from new york state income taxes. There are various subsidiaries of ch that are for-profit entities. Taxable operations and the potential for income taxes from these entities and from unrelated business activities of the tax exempt entities are not significant to the accompanying consolidated financial statements.

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IRS990/ActivityOrMissionDesc0WE, AT CH, HUMBLY JOIN TOGETHER TO BRING CHRISTS HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES.
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IRS990/Desc0GOOD SAMARITAN SELF INSURANCE AGAINST MALPRACTICE IS REQUIRED TO ACCOMPLISH GOOD SAMARITAN UNIVERSITY HOSPITAL'S AND NURSING HOME'S EXEMPT PURPOSE. THE AMOUNT FUNDED IS DEPENDENT UPON THE NEEDS OF THE HOSPITAL TO COVER MALPRACTICE CLAIMS. GOOD SAMARITAN UNIVERSITY HOSPITAL IS A 437 BED MEDICAL CENTER LOCATED ON THE SOUTH SHORE OF LONG ISLAND IN WEST ISLIP, NEW YORK. A PREMIER HEALTHCARE FACILITY, PROVIDING QUALITY AND COST EFFECTIVE HEALTH CARE SERVICES EXTENDING ACROSS THE CONTINUUM OF CARE TO ALL DISCIPLINES, BOTH FOR INPATIENTS AND OUTPATIENTS.
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IRS990/Form990PartVIISectionAGrp/TitleTxt20TRUSTEE
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