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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and 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
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORP
  		27-3722095 86476RAU8 12-14-2011 192,616,434 CAPITAL EXPEN, REFUNDING 1999,2000 X     X   X
B NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORP
  		27-4291221 63165BAK0 12-14-2011 65,530,479 CAPITAL EXPEN, REFUNDING 1999,2000   X   X   X
C SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORP
  		27-3722095 86476RCU6 09-24-2014 91,553,113 CAPITAL EXPENDITURES   X   X   X
D NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORP
  		27-4291221 63166LCZ2 05-21-2014 85,724,031 REFUND 2004 BONDS   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 79,691,915 62,773,085 0 0
2 Amount of bonds legally defeased .............. 15,000,000 0 0 0
3 Total proceeds of issue .................. 192,616,434 65,530,479 91,553,113 85,724,031
4 Gross proceeds in reserve funds ............. 0 0 0 0
5 Capitalized interest from proceeds ............. 0 0 0 0
6 Proceeds in refunding escrows ............... 0 0 0 0
7 Issuance costs from proceeds ............... 3,077,681 1,093,112 1,209,113 1,359,656
8 Credit enhancement from proceeds ............. 0 0 0 0
9 Working capital expenditures from proceeds ............. 0 0 0 0
10 Capital expenditures from proceeds ............. 11,128,918 26,766,090 90,344,000 0
11 Other spent proceeds ............. 178,409,835 37,671,277 0 84,364,375
12 Other unspent proceeds ............. 0 0 0 0
13 Year of substantial completion .............
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		  X   X   X X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X   X   X   X
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ............... X   X   X   X  
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X   X   X   X  
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ...   X   X       X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X       X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............   X   X       X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? ....... X   X     X   X
b Exception to rebate? ........   X   X   X X  
c No rebate due? .........   X   X X     X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X   X   X
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider .......... 0
  		0
  		0
  		0
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider .......... 0
  		0
  		0
  		0
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
FORM 990 SCHEDULE K THE TAX-EXEMPT BOND ISSUANCES REFLECTED IN SCHEDULE K, PART I ARE ISSUED ON BEHALF OF CATHOLIC HEALTH'S RELATED OPERATING ENTITIES. PLEASE NOTE THAT SCHEDULE K, PARTS II, III AND IV HAVE BEEN COMPLETED BASED ON THE TOTAL AMOUNT OF THE TAX-EXEMPT BOND ISSUANCES FOR THE GROUP, NOT BY EACH INDIVIDUAL ENTITY, AS THE OFFERING WAS ON BEHALF OF THE GROUP AS A WHOLE.
SCHEDULE K, PART III ALL THE BONDS LISTED ON SCHEDULE K REPORT PRIVATE BUSINESS USE OF 0% FOR TAX YEAR ENDED 12/31/2021. CATHOLIC HEALTH'S BOND COUNSEL HAS A PROCESS IN PLACE TO MONITOR PRIVATE BUSINESS USE. FOR CERTAIN PROJECTS, IN ADDITION TO USING BOND PROCEEDS, CATHOLIC HEALTH HAS USED EQUITY AND SUCH EQUITY HAS BEEN ALLOCATED TO POTENTIAL PRIVATE BUSINESS USE OF SUCH PROJECTS.
SCHEDULE K, PART I, LINE C SUPPLEMENTAL INFORMATION SECOND ISSUER FOR LINE C IS: NASSAU COUNTY LOCAL ECONOMIC ASSISTANCE CORP, EIN #27-4291221, CUSIP# 63166LDJ7
SCHEDULE K, PART I, LINE D SUPPLEMENTAL INFORMATION THIS BOND FULLY REFUNDED THE 2004 BONDS, WHICH WERE REPORTED ON THE ST. FRANCIS HOSPITAL FORM 990, SCHEDULE K.
SCHEDULE K, PART IV FOR THE SUFFOLK COUNTY ECONOMIC DEVELOPMENT CORP 2014 BONDS THE CALCULATION WAS PERFORMED ON MARCH 22, 2019 AND NO REBATE WAS DUE.
Schedule K (Form 990) 2021

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