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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
CATHOLIC HEALTH SYSTEM OF LONG ISLAND
 
Employer identification number
11-3403968
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) MERCY MEDICAL CENTER
1000 N VILLAGE AVEROCKVILLE CTRN
ROCKVILLE CENTRE,NY11570 		11-1635088 501(C)(3) 18,273,971   NONE NONE  
(2) WSNCHS NORTH INC (ST JOSEPH)
4295 HEMPSTEAD TURNPIKE BETHPAGE
BETHPAGE,NY11714 		11-3438973 501(C)(3) 10,118,572   NONE NONE  
(3) ST CATHERINE OF SIENA MEDICAL CENTER

 
  		06-1562701 501(C)(3) 9,904,767   NONE NONE  
(4) ST CHARLES HOSPITAL CORP
200 BELLE TERRE RD PORT JEFFERSON
PORT JEFFERSON,NY11777 		11-1871039 501(C)(3) 7,425,370   NONE NONE  
(5) GOOD SAMARITAN HOSPITAL MEDICAL CENTER

 
  		11-1888924 501(C)(3) 5,540,579   NONE NONE  
(6) ST FRANCIS HOSPITAL

 
  		11-2050523 501(C)(3) 3,471,834   NONE NONE  
(7) DIOCESE OF ROCKVILLE CENTRE - CATHOLIC MINISTRIES

 
  		11-1837437 501(C)(3) 750,000   NONE NONE  
(8) OUR LADY OF CONSOLATION

 
  		11-3284066 501(C)(3) 309,695   NONE NONE  
(9) GOOD SHEPHERD HOSPICE

 
  		11-2958438 501(C)(3) 66,561   NONE NONE  
(10) CATHOLIC HOME CARE
1150 PORTION RD STE 1 HOLTSVILLE
HOLTSVILLE,NY11742 		11-2126736 501(C)(3) 58,607   NONE NONE  
(11) ROTACARE

 
  		11-3135331 501(C)(3) 25,000   NONE NONE  
(12) UPLIFT HELP INTL INC
984 N VILLAGE AVEROCKVILLE CTR N
ROCKVILLE CENTRE,NY11571 		20-3821339 501(C)(3) 25,000   NONE NONE  
(13) HELP DIOCESE KIKWIT ZAIRE
2115 SUMMIT AVEMAIL 4044ST PAULM
ST PAUL,MN55105 		94-3255354 501(C)(3) 22,500   NONE NONE  
(14) PROVINCE OF ST MARY OF THE CAPUCHIN ORDER
30 GEDNEY PARK DR WHITE PLAINS NY
WHITE PLAINS,NY10605 		05-6008676 501(C)(3) 15,000   NONE NONE  
(15) NOVA HOPE FOR HAITI INC

 
  		20-1854025 501(C)(3) 15,000   NONE NONE  
(16) TAKE HEART INC

 
  		47-5266388 501(C)(3) 15,000   NONE NONE  
(17) CATHOLIC MEDICAL MISSION BOARD
100 WALL ST 9TH FL NEW YORK NY 1
NEW YORK,NY10005 		13-5602319 501(C)(3) 10,000   NONE NONE  
(18) ROADS OF SUCCESS

 
  		26-0809074 501(C)(3) 10,000   NONE NONE  
(19) OM FOUNDATION

 
  		27-4116566 501(C)(3) 10,000   NONE NONE  
(20) GLOBAL OUTREACH INTERNATIONAL

 
  		48-1256219 501(C)(3) 10,000   NONE NONE  
(21) SISTERS OF ST DOMINIC

 
  		11-1635109 501(C)(3) 6,000   NONE NONE  
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
21
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020

Schedule I (Form 990) 2020
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2 - PROCEDURE FOR MONITORING GRANT FUND USE THE DIOCESE OF ROCKVILLE CENTRE PROVIDES ANNUAL UPDATES TO ALL CONTRIBUTORS TO THE CATHOLIC MINISTRIES APPEAL; WHETHER PARISHIONERS OR CORPORATE CONTRIBUTORS LIKE CHSLI. CHS SERVICES, A RELATED ENTITY, MAINTAINS THE BOOKS AND RECORDS FOR CATHOLIC HEALTH SYSTEM OF LONG ISLAND AND WSNCHS NORTH, INC. (ST JOSEPH), ST. CATHERINE OF SIENA MEDICAL CENTER, MARYHAVEN CENTER OF HOPE, ST. CHARLES HOSPITAL CORP, MERCY MEDICAL CENTER, GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. FRANCIS HOSPITAL, CATHOLIC HOME CARE, GOOD SHEPHERD HOSPICE AND OUR LADY OF CONSOLATION GERIATRIC CARE CENTER AND IS THEREFORE ABLE TO MONITOR THAT THE GRANT FUNDS ARE USED AS GENERAL SUPPORT. THE CATHOLIC HEALTH SERVICES OF LONG ISLAND CAREGIVERS FUND WAS FORMED WITH THE MISSION TO ASSIST OUR FELLOW CAREGIVERS ON THE FRONT LINES, HERE AND ABROAD, WHO STRUGGLE JUST TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. THE CAREGIVERS COMMITTEE, COMPRISED OF STAFF WHO ARE DONATING THEIR SERVICES, MANAGE THE CAREGIVERS FUND. THROUGHOUT THE YEAR, ORGANIZATIONS SUBMIT GRANT APPLICATIONS TO REQUEST FUNDS THAT ARE USED TO OBTAIN BASIC RESOURCES TO PROVIDE CARE TO THOSE DESPERATELY IN NEED. THE CAREGIVERS COMMITTEE REVIEWS THESE APPLICATIONS, AND CHOOSES RECIPIENTS BASED ON THE FOLLOWING CRITERIA: I) CLEAR AND IDENTIFIED NEED, II) ABILITY TO USE THE FUNDS RESPONSIBLY, III) CARE FOR THE CAREGIVERS ON THE FRONT LINE, IV) ABILITY OF THE RECIPIENTS TO USE THE FUNDS FOR THE RECOMMENDED PURPOSES, AND V) CONFIRMATION OF THE LEGAL STATUS OF THE RECIPIENT. FOLLOWING SELECTION, THE COMMITTEE DIRECTS THE GIFTS TO BE MADE TO RECIPIENTS WITH COVER LETTERS INDICATING THE INTENDED PURPOSES. RECIPIENTS ARE ASKED TO PROVIDE FOLLOW-UPS ON THE USE OF THE FUNDS TO THE COMMITTEE WITHIN SIX MONTHS OF THE USE OF FUNDS.
PART II, LINE 1 COLUMN (H) NAME OF ORGANIZATION OR GOVERNMENT: DIOCESE OF ROCKVILLE CENTRE - CATHOLIC MINISTRIES APPEAL (H) PURPOSE OF GRANT OR ASSISTANCE: 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. ROTOCARE - (H) PURPOSE OF GRANT OR ASSISTANCE: TO PROVIDE PRIMARY CARE AND MEDICATIONS TO PATIENTS UPLIFT HELP INTL INC - (H) PURPOSE OF GRANT OR ASSISTANCE: Complete water project by building a reservoir to collect water; secure generator to provide light and operate medical equipment HELP DIOCESE KIKWIT ZAIRE - (H) PURPOSE OF GRANT OR ASSISTANCE: Purchase of Ambulance to transfer emergency patients. Province of St Mary of the Capuchin Order - (H) PURPOSE OF GRANT OR ASSISTANCE: Assist in purchase of vehicle to transport special needs children to Development Center. NOVA HOPE FOR HAITI INC - (H) PURPOSE OF GRANT OR ASSISTANCE: Implement electronic health record, medications, dental services and agriculture. TAKE HEART INC - (H) PURPOSE OF GRANT OR ASSISTANCE: Serve the persecuted in Egypt, Iraq and Syria. Catholic Medical Mission Board - (H) PURPOSE OF GRANT OR ASSISTANCE: Provide medical care to vulnerable women and children. Roads of Success - (H) PURPOSE OF GRANT OR ASSISTANCE: Funds for medical missions, medical equipment and medications, etc. OM FOUNDATION - (H) PURPOSE OF GRANT OR ASSISTANCE: Purchase of insulin for 200 patients per year. GLOBAL OUTREACH INTERNATIONAL - (H) PURPOSE OF GRANT OR ASSISTANCE: Pregnancy care center focusing on pregnant moms and babies at risk/transporting sick children. SISTERS OF ST DOMINIC - (H) PURPOSE OF GRANT OR ASSISTANCE: Purchase of three mechanical lifts for patients unable to transfer from sitting position.
Schedule I (Form 990) 2020



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