SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
MERCY MEDICAL CENTER
 
Employer identification number

11-1635088
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)CATHOLIC HEALTH SYSTEM OF LONG ISLAND
992 NORTH VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
11-3403968 		SUPPORT ORG NY 501(C)(3) 12A-I NA
 
 
No
(2)CHS SERVICES INC
992 NORTH VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
11-3555766 		SUPPORT ORG NY 501(C)(3) 12B-II CHSLI
 
Yes
 
(3)CHS AMBULANCE SERVICES INC
992 NORTH VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
14-1801961 		DORMANT NY 501(C)(3) 3 CHSLI
 
 
No
(4)GOOD SAMARITAN HOSPITAL MEDICAL CENTER
1000 MONTAUK HIGHWAY

WEST ISLIP,NY11795
11-1888924 		HOSPITAL NY 501(C)(3) 3 CHSLI
 
Yes
 
(5)GOOD SAMARITAN SELF INSURANCE AGAINST
MALPRACTICE 1000 MONTAUK HIGHWAY

WEST ISLIP,NY11795
11-2537396 		SELF INSURANC NY 501(C)(3) 12A-I GOOD SAMARTN
 
Yes
 
(6)MARYHAVEN TRANSPORTATION SERVICES
51 TERRYVILLE ROAD

PORT JEFFERSN ST,NY11776
11-3434776 		TRANSPORTATIO NY 501(C)(3) 12A-I MARYHAVENCTR
 
 
No
(7)MARYHAVEN CENTER OF HOPE
51 TERRYVILLE ROAD

PORT JEFFERSN ST,NY11776
11-2861698 		Prgm-disabled NY 501(C)(3) 10 CHSLI
 
 
No
(8)MARYHAVEN SCHOOL CORPORATION
51 TERRYVILLE ROAD

PORT JEFFERSN ST,NY11776
11-2861690 		Schl-disabled NY 501(C)(3) 2 MARYHAVENCTR
 
 
No
(9)THE CENTER OF HOPE FOUNDATION
51 TERRYVILLE ROAD

PORT JEFFERSN ST,NY11776
11-3638367 		SUPPORT ORG NY 501(C)(3) 12A-I MARYHAVENCTR
 
 
No
(10)CATHOLIC HOME CARE
110 Bi-County Blvd Suite 114

FARMINGDALE,NY11735
11-2126736 		HOME CARE NY 501(C)(3) 10 CHSLI
 
 
No
(11)OUR LADY OF CONSOLATION GERIATRIC CARE
111 BEACH DRIVE

WEST ISLIP,NY11795
11-3284066 		LT NURSE CARE NY 501(C)(3) 10 CHSLI
 
 
No
(12)RIVERHEAD HOSTEL HOLDING CORPORATION
51 TERRYVILLE ROAD

PORT JEFFERSN ST,NY11776
11-2499790 		RENTING NY 501(C)(2)   MARYHAVENCTR
 
 
No
(13)ST CATHERINE OF SIENA MEDICAL CENTER
50 ROUTE 25A

SMITHTOWN,NY11787
06-1562701 		HOSPITAL NY 501(C)(3) 3 CHSLI
 
Yes
 
(14)ST CHARLES HOSPITAL CORP
200 BELLE TERRE ROAD

PORT JEFFERSN ST,NY11777
11-1871039 		HOSPITAL NY 501(C)(3) 3 CHSLI
 
Yes
 
(15)ST FRANCIS HOSPITAL
100 PORT WASHINGTON BLVD

ROSLYN,NY11576
11-2050523 		HOSPITAL NY 501(C)(3) 3 CHSLI
 
Yes
 
(16)ST FRANCIS HOSPITAL FOUNDATION
100 PORT WASHINGTON BLVD

ROSLYN,NY11576
11-2916033 		SUPPORT ORG NY 501(C)(3) 12A-I ST FRANCIS
 
 
No
(17)ST FRANCIS HOSPITAL RESEARCH & EDUCATIO
100 PORT WASHINGTON BLVD

ROSLYN,NY11576
11-3090867 		RESEARCH ORG NY 501(C)(3) 12A-I ST FRANCIS
 
Yes
 
(18)WSNCHS NORTH INC
4295 HEMPSTEAD TURNPIKE

BETHPAGE,NY11714
11-3438973 		HOSPITAL NY 501(C)(3) 3 CHSLI
 
Yes
 
(19)THE ST CHARLES CORPORATION
200 BELLE TERRE ROAD

PORT JEFFERSN ST,NY11777
11-2983148 		SUPPORT ORG NY 501(C)(3) 12A-I CHSLI
 
 
No
(20)THE SAMARITAN CORPORATION
992 NORTH VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
11-2716640 		SUPPORT ORG NY 501(C)(3) 12A-I CHSLI
 
 
No
(21)WISDOM GARDENS HOUSING DEVELOPMENT FUND
51 TERRYVILLE ROAD

PORT JEFFERSN ST,NY11776
11-3559713 		SR HOUSING NY 501(C)(3) 10 MARYHAVENCTR
 
 
No
(22)GOOD SHEPHERD HOSPICE
110 Bi-County Blvd Suite 114

FARMINGDALE,NY11735
11-2958438 		HOSPICE SVC NY 501(C)(3) 10 CHSLI
 
 
No
(23)ST CHARLES HOSPITAL FOUNDATION
200 BELLE TERRE ROAD

PORT JEFFERSON,NY11777
41-2076312 		SUPPORT ORG NY 501(C)(3) 12A-I ST CHARLES
 
 
No
(24)GOOD SAMARITAN HOSPITAL FOUNDATION
1000 MONTAUK HIGHWAY

WEST ISLIP,NY11795
77-0611240 		SUPPORT ORG NY 501(C)(3) 12A-I GOOD SAMARTN
 
 
No
(25)MERCY MEDICAL CENTER FOUNDATION
1000 NORTH VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
55-0813603 		SUPPORT ORG NY 501(C)(3) 12A-I MERCY MEDCTR
 
Yes
 
(26)ST CATHERINE OF SIENA MEDICAL CTR FDN
50 ROUTE 25A

SMITHTOWN,NY11787
27-1459941 		SUPPORT ORG NY 501(C)(3) 12A-I STCATHERINE
 
 
No
(27)CHS HOME CARE AND HOSPICE FOUNDATION
110 Bi-County Blvd Suite 114

FARMINGDALE,NY11735
45-2907761 		SUPPORT ORG NY 501(C)(3) 12A-I CATHHOMECARE
 
 
No
(28)GOOD SHEPHERD HOSPICE FOUNDATION
110 Bi-County Blvd Suite 114

FARMINGDALE,NY11735
26-3169427 		SUPPORT ORG NY 501(C)(3) 12A-I GOODSHEPHERD
 
 
No
(29)OUR LADY OF CONSOLATION FOUNDATION
111 BEACH DRIVE

WEST ISLIP,NY11795
45-0517566 		SUPPORT ORG NY 501(C)(3) 12A-I OURLADYOFC
 
 
No
(30)RVC SUPPORT
992 NORTH VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
27-1531084 		REAL ESTATE NY 501(C)(3) 12A-I CHSLI
 
 
No
(31)CHS PHYSICIAN PARTNERS PC
100 PORT WASHINGTON BLVD

ROSLYN,NY11576
11-3613997 		HEALTHCARESVC NY 501(C)(3) 12A-I ST FRANCIS
 
 
No
(32)RVC INSURANCE COMPANYINC
992 NORTH VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
20-8067039 		CAPTIVE INS NY 501(C)(3) 12B-II CHSLI
 
 
No
(33)SAMARITAN EMERGENCY MEDICAL SERVICES PC
1000 MONTAUK HIGHWAY

WEST ISLIP,NY11795
20-8243412 		HEALTHCARESVC NY 501(C)(4)   GOOD SAMARTN
 
 
No
(34)ST JOSEPH HOSPITAL FOUNDATION
992 N VILLAGE AVENUE

ROCKVILLE CENTRE,NY11570
47-2353387 		SUPPORT ORG NY 501(C)(3) 12A-I WSNCHS NORTH
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2020
Page 2
Schedule R (Form 990) 2020
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) BIPO HOLDINGS LLC

992 N VILLAGE AVE ROCKVILLE CENTRE
ROCKVILLE CENTRE,NY11570
46-4763720 		PHYSICIAN ASSN NY NA
  		N/A                
(2) IDHC LLC

2500 YORK RDJAMISONPA 18929
JAMISON,PA18929
45-2411095 		HEALTH SERVICES PA NA
  		N/A                
(3) BEACON HEALTH PTNRS

992 N VILLAGE AVE ROCKVILLE CENTRE
ROCKVILLE CENTRE,NY11570
45-4229842 		HEALTHCARE NY NA
  		N/A                
(4) WISDOM GARDENS LP

51 TERRYVILLE RD
PORT JEFFERSON,NY11776
11-3567947 		SR HOUSING NY NA
  		N/A                
(5) CHS PHYSICIAN PARTNERS ACO LLC

992 N Village Ave Rockville Centre
ROCKVILLE CENTRE,NY11570
99-9999999 		HEALTHCARE NY NA
  		N/A                




Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) RADIOLOGY CONSULTING OF LONG ISLANDPLLC

1000 MONTAUK HIGHWAY
WEST ISLIP,NY11795
42-1646134 		HEALTHCARE SVC NY GOOD SAMARITAN
  		C-CORP         No
(2) SAMARITAN PEDIATRIC SERVICES PC

1000 MONTAUK HIGHWAY
WEST ISLIP,NY11795
20-8180263 		HEALTHCARE SVC NY GOOD SAMARITAN
  		C-CORP         No
(3) SAMARITAN MEDICAL SERVICES PC

1000 MONTAUK HIGHWAY
WEST ISLIP,NY11795
20-8088453 		HEALTHCARE SVC NY GOOD SAMARITAN
  		C-CORP         No
(4) SOUTHWEST SUFFOLK MEDICAL PC

580 UNION BOULEVARD
WEST ISLIP,NY11795
06-1603195 		HEALTHCARE SVC NY GOOD SAMARITAN
  		C-CORP         No
(5) CARDIAC EKG INTERPRETATION PC

992 N VILLAGE AVENUE
ROCKVILLE CENTRE,NY11570
11-2924518 		HEALTHCARE SVC NY GOOD SAMARITAN
  		C-CORP         No
(6) LI REGIONAL ARTHRITIS & OSTEOPOROSIS CAR

1000 MONTAUK HIGHWAY
WEST ISLIP,NY11795
20-8964140 		HEALTHCARE SVC NY GOOD SAMARITAN
  		C-CORP         No
(7) SAMARITAN MANAGEMENT SERVICES

1000 MONTAUK HIGHWAY
WEST ISLIP,NY11795
11-2838185 		HEALTHCARE SVC NY CHSLI
  		C-CORP         No
(8) ADVANCED REHABILIATION MEDICINE PLLC

200 BELLE TERRE ROAD
PORT JEFFERSON,NY11777
11-3640709 		HEALTHCARE SVC NY STCHARLES HOSP
  		C-CORP         No
(9) ST FRANCIS CARDIAC PREVENTION SERVICES

100 PORT WASHINGTON BLVD
ROSLYN,NY11576
11-3224885 		HEALTHCARE SVC NY STFRANCIS HOSP
  		C-CORP         No
(10) SOUTH SHORE PRACTICE MANAGEMENT

1000 MONTAUK HIGHWAY
WEST ISLIP,NY11795
11-3307977 		HEALTHCARE SVC NY SAMARITAN MGMT
  		C-CORP         No
(11) SAMARITAN HOME CARE AMERICA

1000 MONTAUK HIGHWAY
WEST ISLIP,NY11795
11-3319259 		HEALTHCARE SVC NY SAMARITAN MGMT
  		C-CORP         No
(12) MERCY INTERNAL MEDICINE PC

992 N VILLAGE AVENUE
ROCKVILLE CENTRE,NY11570
51-0639649 		HEALTHCARE SVC NY MERCY MED CTR
  		C-CORP         No
(13) LONG ISLAND EMERGENCY CARE PC

1000 N VILLAGE AVE
ROCKVILLE,NY11571
11-3633515 		PHYSICIAN SVC NY MERCY MED CTR
  		S-CORP         No
(14) MY CHS RX INC

992 N VILLAGE AVENUE
ROCKVILLE CENTRE,NY11570
84-2359236 		PHARMACY NY CHSLI
  		C-CORP         No
Schedule R (Form 990) 2020
Page 3
Schedule R (Form 990) 2020
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
Yes
 
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CHS SERVICES INC

 LMPR 18,066,990 COST
(2) CHS SERVICES INC

 A 1,424,196 COST
(3) GOOD SAMARITAN HOSPITAL MEDICAL CENTER

 LM 2,486,797 COST
(4) ST FRANCIS HOSPITAL

 LM 684,362 COST
(5) ST CHARLES HOSPITAL CORP

 LM 611,117 COST
(6) WSNCHS NORTH INC

 LM 288,220 COST
Schedule R (Form 990) 2020
Page 4
Schedule R (Form 990) 2020
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2020
Page 5
Schedule R (Form 990) 2020
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
SCHEDULE R, PART IV FOR ALL PROFESSIONAL CORPORATIONS REPORTED ON SCHEDULE R, PART IV, THE PHYSICIAN IS THE SOLE SHAREHOLDER OF THE ENTITY AND THE DIRECT CONTROLLING ENTITY REPORTED IN COLUMN (D) IS THE BENEFICIAL OWNER. THIS STRUCTURE IS CONSISTENT WITH THE NEW YORK CORPORATE PRACTICE OF MEDICINE.
Schedule R (Form 990) 2020

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