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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.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
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) DIOCESE OF ROCKVILLE CENTRE - CATHOLIC MINISTRIES
50 N PARK AVE ROCKVILLE CTRNY 11
ROCKVILLE CENTRE,NY11570 		11-1837437 501(C)(3) 750,000   NONE NONE  
(2) ROTACARE
20 COLONY LA SYOSSETNY 11791
SYOSSET,NY11791 		11-3135331 501(C)(3) 25,000   NONE NONE  
(3) UPLIFT HELP INTL INC
984 N VILLAGE AVEROCKVILLE CTR N
ROCKVILLE CENTER,NY11571 		20-3821339 501(C)(3) 25,000   NONE NONE  
(4) LJDR FOUNDATION
134-36 246 STREET ROSEDALE NY 114
ROSEDALE,NY11422 		46-2216693 501(C)(3) 25,000   NONE NONE  
(5) HELP DIOCESE KIKWIT ZAIRE
2115 SUMMIT AVEMAIL 4044ST PAULM
ST PAUL,MN55105 		94-3255354 501(C)(3) 20,000   NONE NONE  
(6) BUDDHIST TZU CHI FOUNDATION
1100 S VALLEY CTR AVE SAN DIMASCA
SAN DIMAS,CA91773 		94-2952782 501(C)(3) 15,000   NONE NONE  
(7) 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  
(8) ROADS OF SUCCESS
8618 MISSION DR ROSEMEAD CA 91770
ROSEMEAD,CA91770 		26-0809074 501(C)(3) 15,000   NONE NONE  
(9) NOVA HOPE FOR HAITI INC
176 PALISADE AVE EMERSON NJ 07630
EMERSON,NJ07630 		20-1854025 501(C)(3) 15,000   NONE NONE  
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
9
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
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 AND WSNCHS NORTH, INC. (ST JOSEPH), ST. CATHERINE OF SIENA HOSPITAL, MARYHAVEN CENTER OF HOPE, ST. CHARLES HOSPITAL, MERCY HOSPITAL, GOOD SAMARITAN HOSPITAL MEDICAL CENTER, ST. FRANCIS HOSPITAL & HEART CENTER, CATHOLIC HEALTH 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 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: CONTINUE PROVIDING PRIMARY CARE AND MEDICATIONS TO PATIENTS UPLIFT HELP INTL INC - (H) PURPOSE OF GRANT OR ASSISTANCE: PROVIDE SCREENING AND PROVISION OF FREE MEDICATIONS FOR ADULTS AND CHILDREN. OBTAIN MEDICAL EQUIPMENT AND SUPPLIES AND TO HIRE A MEDICAL TEAM TO PROVIDE ONGOING PRIMARY CARE SERVICES. LJDR FOUNDATION - (H) PURPOSE OF GRANT OR ASSISTANCE: CARRIED OUR SEVEN MEDICAL MISSIONS IN THE DISTRICT OF BRANDO HILL AND RESIDENTS FROM THE ISLAND OF JAMAICA. HELP DIOCESE KIKWIT ZAIRE - (H) PURPOSE OF GRANT OR ASSISTANCE: RENOVATE THE CURRENT MATERNITY UNIT THAT IS OVER 60 YEARS OLD. ACQUIRE 20 NEW BEDS AND MATTRESSES FOR THE MATERNITY AND DELIVERY ROOM. BUDDHIST TZU CHI FOUNDATION - (H) PURPOSE OF GRANT OR ASSISTANCE: FUNDS FOR LOCAL INITIATIVES LIKE ACCESS TO HEALTH CARE, HOST EVENTS, ADVERTISING, HEALTHY FOOD PROGRAM. FUNDS FOR INTERNATIONAL HAITI INITIATIVES INCLUDING COVID19 VACCINATIONS PLUS EIGHT FREE CLINICS. PROVINCE OF ST MARY OF THE CAPUCHIN ORDER - (H) PURPOSE OF GRANT OR ASSISTANCE: CONSTRUCTION OF WITHDRAWAL TREATMENT WARD AND SAFETY WALL FOR PERSON WITH ALCOHOL USE DISORDER. ROADS OF SUCCESS - (H) PURPOSE OF GRANT OR ASSISTANCE: FUNDS TO SEND A MEDICAL CONTAINER TO IRAQ TO SUPPORT THE PERSECUTED RELIGIOUS MINORITIES, SURVIVORS OF GENOCIDE, IDP'S, REFUGEES AND VICTIMS OF TERROR. NOVA HOPE FOR HAITI INC - (H) PURPOSE OF GRANT OR ASSISTANCE: FUNDS FOR CERVICAL AND BREAST CANCER SCREENING, AGRONOMY INITIATIVE, EQUIPMENT PLUS MEDICATIONS.
Schedule I (Form 990) 2021



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