TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) FRANCIS J SERBAROLI ESQ...................................................................... CHAIRMAN	0.10 ................. 1.70	X	X
(2) THOMAS M O'BRIEN...................................................................... VICE-CHAIR	0.10 ................. 1.70	X	X
(3) TARA A CORTES...................................................................... SECRETARY	0.10 ................. 1.70	X	X
(4) THOMAS E ALBERTO...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(5) JOHN CAHILL...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(6) JOHN T DUNLAP...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(7) MSGR CHARLES J FAHEY...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(8) THOMAS J FAHEY JR MD...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(9) ERIC P FELDMANN...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(10) KAREN GRAY...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(11) GEORGE IRISH...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(12) CLARION E JOHNSON MD...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(13) RORY KELLEHER...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(14) REV MSGR JOSEPH LAMORTE...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(15) KATHRYN ROONEY...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(16) GT SWEENEY...................................................................... BOARD MEMBER	0.10 ................. 1.70	X
(17) GENNARO VASILE PDD...................................................................... BOARD MEMBER	0.10 ................. 1.70	X

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) BISHOP GERALD WALSH........................................................................ BOARD MEMBER	0.10 .......................1.70	X				0	0	0
(19) STEVE BUJNO........................................................................ BOARD MEMBER	0.10 .......................1.70	X				0	0	0
(20) SISTER SELINE FLORES........................................................................ BOARD MEMBER	0.10 .......................1.70	X				0	0	0
(21) JOHN GLEASON........................................................................ BOARD MEMBER	0.10 .......................1.70	X				0	0	0
(22) JOSEPH SAPORITO........................................................................ BOARD MEMBER	0.10 .......................1.70	X				0	0	0
(23) SCOTT P LA RUE........................................................................ PRESIDENT/CEO	0.10 .......................38.70		X			0	1,410,218	353,773
(24) ANNMARIE COVONE........................................................................ EXECUTIVE VICE PRESIDENT/CFO	0.10 .......................38.70		X			0	876,551	199,201
(25) TAMI A SIEDLER........................................................................ VP HOME & COMMUNITY SERVICES	37.50 .......................0.00			X		380,609	0	95,070
(26) REGINA E TANCREDI........................................................................ DIRECTOR OF BUSINESS OPERATIONS	37.50 .......................0.00				X	179,327	0	39,452
(27) LAUREN DOLCE........................................................................ DIRECTOR OF COMPLIANCE AND EDUCATION	37.50 .......................0.00				X	159,518	0	35,163
(28) JACQUELYN D AUGUSTO........................................................................ COMMUNITY HEALTH NURSE	37.50 .......................0.00				X	129,454	0	23,048
(29) ROSA TORRES-EROSA........................................................................ CLINICAL MANAGER	37.50 .......................0.00				X	124,583	0	0
(30) WADEAA IBRAHIMM........................................................................ COMMUNITY HEALTH NURSE	37.50 .......................0.00				X	124,936	0	8,270

(A) Name and business address	(B) Description of services	(C) Compensation
THERADYNAMICS REHAB LLC 225 CROSSWAYS PARK DR WOODBURY,NY11797	REHABILITATION SERVICES	1,647,675
CATHOLIC HEALTH CARE SYSTEM 205 LEXINGTON AV 2ND FLOOR NEW YORK,NY10016	ADMINISTRATIVE SERVICES	1,437,500
BLACKTREE HEALTHCARE CONSULTING LLC 1030 CONTINENTAL DRIVE KING OF PRUSSIA,PA19406	BILLING SERVICES	626,283
CORE MEDICAL GROUP 655 SOUTH WILLOW STREET SUITE 128 MANCHESTER,NH03103	STAFFING AGENCY	342,394
HOMECARE HOMEBASE LLC PO BOX 678637 DALLAS,TX75267	HOME HEALTH CARE SERVICES	335,811
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 6

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

DOMINICAN SISTERS FAMILY HEALTH SERVICE
INC

Employer identification number

13-1740242

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	1,616,421	3,739,783	7,707,567	3,732,097	2,502,353	19,298,221
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose	32,749,284	16,332,081	16,661,780	19,087,316	21,879,089	106,709,550
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5	34,365,705	20,071,864	24,369,347	22,819,413	24,381,442	126,007,771
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons						0
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.						0
c	Add lines 7a and 7b..						0
8	Public support. (Subtract line 7c from line 6.)						126,007,771

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...	34,365,705	20,071,864	24,369,347	22,819,413	24,381,442	126,007,771
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	16,940	2,854	1,850	1,228	2,629	25,501
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.	16,940	2,854	1,850	1,228	2,629	25,501
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..	286,118	223,066	95,657	63,890	104,446	773,177
13	Total support. (Add lines 9, 10c, 11, and 12.)..	34,668,763	20,297,784	24,466,854	22,884,531	24,488,517	126,806,449

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

99.370 %

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

99.410 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

0.020 %

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

0.050 %

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:	OTHER REVENUE - 2017 AMOUNT: $ 72,224. 2018 AMOUNT: $ 9,156. 2019 AMOUNT: $ 5,501. 2020 AMOUNT: $ 7,316. 2021 AMOUNT: $ 96,148. MEDICAL RECORD - 2017 AMOUNT: $ 7,966. 2018 AMOUNT: $ 8,112. 2019 AMOUNT: $ 8,391. 2020 AMOUNT: $ 6,666. 2021 AMOUNT: $ 8,298. FLU IMMUNIZATIONS - 2017 AMOUNT: $ 130. FORGIVENESS OF DEBT - 2017 AMOUNT: $ 205,798. 2018 AMOUNT: $ 205,798. 2019 AMOUNT: $ 81,765. 2020 AMOUNT: $ 34,300. REIMBURSEMENT FORM AFFILIATES - 2020 AMOUNT: $ 15,608.

Return Reference

Explanation

SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:

OTHER REVENUE - 2017 AMOUNT: $ 72,224. 2018 AMOUNT: $ 9,156. 2019 AMOUNT: $ 5,501. 2020 AMOUNT: $ 7,316. 2021 AMOUNT: $ 96,148. MEDICAL RECORD - 2017 AMOUNT: $ 7,966. 2018 AMOUNT: $ 8,112. 2019 AMOUNT: $ 8,391. 2020 AMOUNT: $ 6,666. 2021 AMOUNT: $ 8,298. FLU IMMUNIZATIONS - 2017 AMOUNT: $ 130. FORGIVENESS OF DEBT - 2017 AMOUNT: $ 205,798. 2018 AMOUNT: $ 205,798. 2019 AMOUNT: $ 81,765. 2020 AMOUNT: $ 34,300. REIMBURSEMENT FORM AFFILIATES - 2020 AMOUNT: $ 15,608.

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

DOMINICAN SISTERS FAMILY HEALTH SERVICE
INC

Employer identification number

13-1740242

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization DOMINICAN SISTERS FAMILY HEALTH SERVICE INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization DOMINICAN SISTERS FAMILY HEALTH SERVICE INC		Employer identification number 13-1740242

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization DOMINICAN SISTERS FAMILY HEALTH SERVICE INC			Employer identification number 13-1740242
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DOMINICAN SISTERS FAMILY HEALTH SERVICE
INC

Employer identification number

13-1740242

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....	74,819	74,819	0
c	Leasehold improvements	685,010	613,208	71,802
d	Equipment ....	2,934,999	2,769,668	165,331
e	Other .....	3,332,357	2,659,045	673,312
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				910,445

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)SECURITY DEPOSITS				110,742
(2)INSURANCE RECOVERY RECEIVABLE				1,038,000
(3)DUE FROM RELATED PARTY				458,823
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				1,607,565

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	4,179,372
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	38,670,985
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	14,387,133
e	Add lines 2a through 2d .....................			2e	14,387,133
3	Subtract line 2e from line 1..................			3	24,283,852
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	204,665
c	Add lines 4a and 4b....................			4c	204,665
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	24,488,517

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	37,943,784
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	16,040,170
e	Add lines 2a through 2d....................			2e	16,040,170
3	Subtract line 2e from line 1...................			3	21,903,614
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	204,665
c	Add lines 4a and 4b.....................			4c	204,665
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	22,108,279

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	THE AGENCY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE AGENCY HAS NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE AGENCY IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2018.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	REVENUE ATTRIBUTED TO RELATED PARTY: 14,387,133.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	ELIMINATIONS FROM CONSOLIDATED ENTITY 122,952. RECLASS OF BAD DEBT EXPENSES TO PART IX, LINE 24 81,713.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	EXPENSES ATTRIBUTED TO RELATED PARTY: 16,040,170.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	ELIMINATIONS FROM CONSOLIDATED ENTITY 122,952. RECLASS OF BAD DEBT EXPENSES TO PART IX, LINE 24 81,713.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DOMINICAN SISTERS FAMILY HEALTH SERVICE
INC

Employer identification number

13-1740242

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1SCOTT P LA RUE PRESIDENT/CEO	(i) (ii)	0 ------------- 988,763	0 ------------- 281,992	0 ------------- 139,463	0 ------------- 330,725	0 ------------- 23,048	0 ------------- 1,763,991	0 ------------- 291,706
2ANNMARIE COVONE EXECUTIVE VICE PRESIDENT/CFO	(i) (ii)	0 ------------- 668,383	0 ------------- 131,713	0 ------------- 76,455	0 ------------- 165,931	0 ------------- 33,270	0 ------------- 1,075,752	0 ------------- 131,713
3TAMI A SIEDLER VP HOME & COMMUNITY SERVICES	(i) (ii)	311,209 ------------- 0	56,650 ------------- 0	12,750 ------------- 0	61,800 ------------- 0	33,270 ------------- 0	475,679 ------------- 0	56,650 ------------- 0
4REGINA E TANCREDI DIRECTOR OF BUSINESS OPERATIONS	(i) (ii)	169,327 ------------- 0	10,000 ------------- 0	0 ------------- 0	4,289 ------------- 0	35,163 ------------- 0	218,779 ------------- 0	0 ------------- 0
5LAUREN DOLCE DIRECTOR OF COMPLIANCE AND EDUCATION	(i) (ii)	159,518 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	35,163 ------------- 0	194,681 ------------- 0	0 ------------- 0
6JACQUELYN D AUGUSTO COMMUNITY HEALTH NURSE	(i) (ii)	129,454 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	23,048 ------------- 0	152,502 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT ITS EXECUTIVE COMPENSATION IS REASONABLE. TOWARD THAT END, THE BOARD OF TRUSTEES HAS A COMPENSATION COMMITTEE OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN ANY PROPOSED COMPENSATION ARRANGEMENT. THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT WHO CONDUCTED INDEPENDENT RESEARCH AND UTILIZED A WIDE RANGE OF INDUSTRY DATA TO DEVELOP COMPARABILITY OR BENCHMARKING DATA FOR APPROPRIATE LEVELS OF COMPENSATION FOR TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES. THE CONSULTANT PROJECTED THE DATA FOR THE FOLLOWING THREE YEARS FOR EACH SALARY LEVEL. THE COMPENSATION COMMITTEE, TAKING THE CONSULTANT'S RECOMMENDATIONS UNDER ADVISEMENT, HELD A MEETING AT WHICH CONTEMPORANEOUS MINUTES WERE KEPT AND AT THAT MEETING DETERMINED TO MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN CONSIDERED AND APPROVED THE RECOMMENDATIONS OF THE COMPENSATION COMMITTEE, WHICH APPROVAL WAS RECORDED IN THE MINUTES OF THE MEETING OF THE BOARD OF TRUSTEES. IN 2021, THE CONSULTANT UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE OF TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES FOLLOWING THE METHOD DESCRIBED ABOVE. IN ADDITION, THE ORGANIZATION UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE FOR ALL OTHER POSITIONS (NON-UNION).
PART I, LINE 4B	SCOTT P. LA RUE AND ANNMARIE COVONE ALSO PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE DISTRIBUTED $139,463 TO SCOTT AND $63,705 TO ANNMARIE IN THEIR 2021 W-2S.
PART I, LINE 7	THE ORGANIZATION PAID DISCRETIONARY BONUSES TO CERTAIN INDIVIDUALS LISTED IN PART II AS REPORTED IN COLUMN B(II), ROW (II) FOR THE APPLICABLE INDIVIDUALS.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

DOMINICAN SISTERS FAMILY HEALTH SERVICE
INC

Employer identification number

13-1740242

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 3	THE ORGANIZATION HAS A MANAGEMENT AGREEMENT FOR CERTAIN ADMINISTRATIVE AND CONSULTING SERVICES WITH CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. CATHOLIC HEALTH CARE SYSTEM SHALL PROVIDE HUMAN RESOURCES, IT SERVICES, FINANCE SERVICES, LEGAL SERVICES, COMPLIANCE, AND SUPPLY CHAIN MANAGEMENT TO THE ORGANIZATION. ANNMARIE COVONE AND SCOTT LA RUE (OFFICERS OF THE FILING ORGANIZATION) WERE PAID BY CATHOLIC HEALTH CARE SYSTEM. THEIR 2021 COMPENSATION IS REPORTED IN PART VII, SECTION A AND SCHEDULE J, PART II. CATHOLIC HEALTH CARE SYSTEM WAS PAID $1,100,000 FOR SERVICES IN 2021.
FORM 990, PART VI, SECTION A, LINE 6	THE MEMBER OF THE CORPORATION SHALL BE CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER OF THE ORGANIZATION SHALL NOMINATE AND APPOINT TWO DIRECTORS TO SERVE ON THE DSFHS BOARD. OTHER THAN THE MEMBER'S TWO APPOINTMENTS TO THE DSFHS BOARD OF DIRECTORS, DSFHS SHALL HAVE THE SOLE RIGHT TO NOMINATE DIRECTORS TO SERVE ON THE DSFHS BOARD, SUBJECT TO ARCHCARE'S FINAL APPROVAL. ARCHCARE SHALL ALSO HAVE THE RIGHT TO REMOVE ANY DIRECTOR FROM THE CORPORATION'S BOARD AT ANY TIME FOR THE FOLLOWING REASONS: 1. FAILURE TO TAKE APPROPRIATE ACTION(S) TO MEET WITH THE APPROVED BUDGET AND/OR OVERALL CHCS HEALTH SYSTEM STRATEGY; OR 2. INTERFERING WITH THE PROMPT INTEGRATION OF THE CORPORATION INTO THE MEMBER'S HEALTH CARE SYSTEM, INCLUDING FAILING TO TAKE ADVANTAGE OF SYNERGIES AMONG THE CHCS INSTITUTIONS; OR 3. FAILURE TO RECUSE ONESELF FROM DISCUSSION/VOTING RELATED TO A MATTER WHICH CREATES A POTENTIAL CONFLICT OF INTEREST OR THE APPEARANCE OF IMPROPRIETY.
FORM 990, PART VI, SECTION A, LINE 7B	THE FOLLOWING POWERS ARE RESERVED TO THE MEMBER OF THE CORPORATION: A) APPROVAL, UPON RECOMMENDATION FROM THE CORPORATION'S BOARD, OF ANY AMENDMENT TO THE BYLAWS AND CERTIFICATE OF INCORPORATION OF THE CORPORATION; B) APPROVAL, UPON RECOMMENDATION OF THE CORPORATION'S BOARD, OF THE OPERATING AND CAPITAL BUDGETS OF CORPORATION; C) APPROVAL, UPON RECOMMENDATION OF THE CORPORATION'S BOARD, OF THE BUSINESS AND STRATEGIC PLAN FOR THE CORPORATION OR ANY AMENDMENT THERETO; D) APPROVAL, UPON RECOMMENDATION OF THE CORPORATION'S BOARD, OF THE FORMATION OR PURCHASE OF AN ENTITY THAT IS A RELATED ENTITY OF THE CORPORATION; E) NOMINATE AND APPOINT TWO DIRECTORS TO SERVE ON THE DSFHS BOARD. OTHER THAN THE MEMBER'S TWO APPOINTMENTS TO THE DSFHS BOARD OF DIRECTORS, DSFHS SHALL HAVE THE SOLE RIGHT TO NOMINATE DIRECTORS TO SERVE ON THE DSFHS BOARD, SUBJECT TO ARCHCARE'S FINAL APPROVAL. ARCHCARE SHALL ALSO HAVE THE RIGHT TO REMOVE ANY DIRECTOR FROM THE CORPORATION'S BOARD AT ANY TIME FOR THE FOLLOWING REASONS: (I) FAILURE TO TAKE APPROPRIATE ACTION(S) TO MEET WITH THE APPROVED BUDGET AND/OR OVERALL CHCS HEALTH SYSTEM STRATEGY; OR (II) INTERFERING WITH THE PROMPT INTEGRATION OF THE CORPORATION INTO THE MEMBER'S HEALTH CARE SYSTEM, INCLUDING FAILING TO TAKE ADVANTAGE OF SYNERGIES AMONG THE CHCS INSTITUTIONS; OR (III)FAILURE TO RECUSE ONESELF FROM DISCUSSION/VOTING RELATED TO A MATTER WHICH CREATES A POTENTIAL CONFLICT OF INTEREST OR THE APPEARANCE OF IMPROPRIETY. F) APPROVAL OF ANY REAL ESTATE TRANSACTION INVOLVING THE SALE, PLEDGE OR TRANSFER OF REAL PROPERTY WITH A VALUE ABOVE $30,000 AND BELOW $400,000 OR ANY CAPITAL PROJECT INVOLVING THE SALE, PLEDGE OR TRANSFER OF FIXED ASSETS WITH A VALUE ABOVE $30,000 AND BELOW $400,000; G) APPROVAL OF ANY PROGRAM OR SERVICE CHANGES BY THE CORPORATION THAT RESULT IN: (A) CLOSURE OR ESTABLISHMENT OF A LICENSED SERVICE OR PROGRAM; OR (B) CHANGE IN LOCATION OF A LICENSED SERVICE OR LICENSED PROGRAM OUTSIDE THE SERVICE AREA OF THE CORPORATION; AND H) APPROVAL OF ANY MERGER, PURCHASE, JOINT OPERATING AGREEMENT OR OTHER AFFILIATION (EACH AN "AFFILIATION") BY THE CORPORATION WITH A THIRD PARTY, OR WITHDRAWAL FROM, DISPOSITION OF AN INTEREST IN, OR DISSOLUTION OF ANY SUCH AFFILIATION.
FORM 990, PART VI, SECTION B, LINE 11B	DOMINICAN SISTERS FAMILY HEALTH SERVICE, INC. HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD MEMBERS OF THE ORGANIZATION FOR ANY COMMENTS. ANY COMMENTS ARE THEN GROUPED, SUMMARIZED AND PROVIDED TO THE OUTSIDE ACCOUNTANTS. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED FOR FILING.
FORM 990, PART VI, SECTION B, LINE 12C	THE ORGANIZATIONS CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. AN INTERESTED PERSON WITH A POTENTIAL CONFLICT OF INTEREST IN A PARTICULAR MATTER SHALL PROMPTLY AND FULLY DISCLOSE THE POTENTIAL CONFLICT TO HIS SUPERVISOR. THE INTERESTED PERSON SHALL THEREAFTER REFRAIN FROM PARTICIPATING IN DELIBERATIONS AND DISCUSSION, AS WELL AS ANY DECISIONS, RELATING TO THE MATTER. THE PRESIDENT SHALL BE RESPONSIBLE FOR DETERMINING THE PROPER WAY FOR THE ORGANIZATION TO HANDLE DECISIONS WHICH INVOLVE UNRESOLVED CONFLICTS OF INTEREST. THE POLICY SHALL BE OVERSEEN AND ADMINISTERED BY THE BOARD OF DIRECTORS WITH ONLY INDEPENDENT DIRECTORS PARTICIPATING OR BY A COMMITTEE OF THE BOARD COMPRISED OF AT LEAST THREE MEMBERS AND OF WHICH ALL COMMITTEE MEMBERS SHALL BE DIRECTORS WHO ARE INDEPENDENT DIRECTORS. THIS PROCESS IS CONDUCTED ANNUALLY, AND IS GIVEN OVERSIGHT BY THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15B	THE CORPORATION UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT ITS EXECUTIVE COMPENSATION IS REASONABLE AND COMPETITIVE. TOWARD THAT END, THE BOARD OF TRUSTEES HAS A COMPENSATION COMMITTEE OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN ANY PROPOSED COMPENSATION ARRANGEMENT. THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT WHO CONDUCTED INDEPENDENT RESEARCH AND UTILIZED A WIDE RANGE OF INDUSTRY DATA TO DEVELOP COMPARABILITY OR BENCHMARKING DATA FOR APPROPRIATE LEVELS OF COMPENSATION FOR TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES. IN ADDITION, THE CONSULTANT CREATED A COMPENSATION STRUCTURE FOR ALL OTHER POSITIONS (NON-UNION). THIS STRUCTURE IS REVIEWED EVERY THREE YEARS. THE CONSULTANT REVIEWS EXECUTIVE COMPENSATION ANNUALLY AND REVIEWS THESE RESULTS WITH THE COMPENSATION COMMITTEE. THE CONSULTANT PROJECTED THE DATA FOR THE FOLLOWING THREE YEARS FOR EACH SALARY LEVEL. THE COMPENSATION COMMITTEE, TAKING THE CONSULTANT'S RECOMMENDATIONS UNDER ADVISEMENT, HELD A MEETING AT WHICH CONTEMPORANEOUS MINUTES WERE KEPT AND AT THAT MEETING DETERMINED TO MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN CONSIDERED AND APPROVED THE RECOMMENDATIONS OF THE COMPENSATION COMMITTEE, WHICH APPROVAL WAS RECORDED IN THE MINUTES OF THE MEETING OF THE BOARD OF TRUSTEES. IN 2021, THE CONSULTANT UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE OF TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES FOLLOWING THE METHOD DESCRIBED ABOVE. IN ADDITION, THE ORGANIZATION UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE FOR ALL OTHER POSITIONS (NON-UNION).
FORM 990, PART VI, SECTION C, LINE 19	THE CORPORATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE BY POSTING IT ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST AT 299 NORTH HIGHLAND AVENUE, OSSINING, NY 10562 OR BY CALLING THE ORGANIZATION DIRECTLY AT (914)-941-1710.
FORM 990, PART XII, LINE 2C:	THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE OVERSIGHT PROCESS DID NOT CHANGE FROM THE PRIOR YEAR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DOMINICAN SISTERS FAMILY HEALTH SERVICE
INC

Employer identification number

13-1740242

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?
(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	Yes	No
(1)BENEFICE ADVANTAGE INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 13-4201050	DORMANT/PROVIDE ADMIN., BENFITS COORDINATING AND OTHER SERVICES TO ARCHCARE	NY	501(C)(3)	LINE 1	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(2)CALVARY FUND INC 1740 EASTCHESTER ROAD BRONX,NY10461 13-3259649	SUPPORT CALVARY HOSPITAL	NY	501(C)(3)	LINE 12A, I	CALVARY HOLDING COMPANY INC		No
(3)CALVARY HOLDING COMPANY 1740 EASTCHESTER ROAD BRONX,NY10461 06-1531426	SUPPORT THE CALVARY HOSPITAL AND ITS AFFILIATED ORGANIZATIONS	NY	501(C)(3)	LINE 12A, I	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(4)CALVARY HOSPITAL INC 1740 EASTCHESTER ROAD BRONX,NY10461 13-1740274	OPERATE A TAX EXEMPT HOSPITAL	NY	501(C)(3)	LINE 3	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(5)CARMEL RICHMOND NURSING HOME INC 88 OLD TOWN ROAD STATEN ISLAND,NY103044229 13-2720248	OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(6)KATERI RESIDENCE 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 13-3086309	DORMANT/OPERATE SKILLED NURSING & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(7)CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 13-3896624	MGT SVCS FOR HEALTH-RELATED FACILITIES IN THE ARCHDIOCESE	NY	501(C)(3)	LINE 10	PROVIDENCE HEALTH SERVICES		No
(8)CATHOLIC HEALTH CARE FOUNDATION OF THE ARCHDIOCESE OF NY 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 13-4054158	PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES	NY	501(C)(3)	LINE 7	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(9)CATHOLIC MANAGED LONG TERM CARE INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 20-8180809	OPERATE A MANAGED LONG-TERM CARE PLAN	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(10)CATHOLIC RESOURCES INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 26-1306110	SUPPORT CATHOLIC MANAGED LONG TERM CARE, INC.	NY	501(C)(3)	LINE 1	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(11)EMPIRE STATE HOME CARE SERVICES INC 15 METROTECH CENTER 11 FL BROOKLYN,NY11201 11-3618585	HOME HEALTH CARE SERVICES	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(12)FERNCLIFF NURSING HOME COMPANY INC 21 FERNCLIFF DRIVE RHINEBECK,NY12572 14-1514053	OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(13)MARY MANNING WALSH NURSING HOME COMPANY INC 1339 YORK AVENUE NEW YORK,NY100214707 13-6220617	OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(14)OUR LADY OF MERCY FUND OF NEW YORK NY 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 13-3452084	DORMANT/PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES	NY	501(C)(3)	LINE 7	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(15)OUR LADY OF MERCY HEALTHCARE SYSTEM INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 13-3395946	DORMANT/PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES	NY	501(C)(3)	LINE 12A, I	OUR LADY OF MERCY HEALTHCARE SYSTEM INC		No
(16)PROVIDENCE HEALTH SERVICES 1011 1ST AVENUE NEW YORK,NY10022 13-3354940	SPONSOR OF CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE	NY	501(C)(3)	LINE 3	N/A		No
(17)ST TERESA'S NURSING HOME INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 23-7012219	OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(18)ST THERESA'S RESIDENCE 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 13-3110063	INTERMEDIATE CARE FACILITY FOR DEVELOPMENTALLY DISABLED	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(19)ST VINCENT DE PAUL RESIDENCE 900 INTERVALE AVENUE BRONX,NY10459 13-3598842	OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(20)TERENCE CARDINAL COOKE HEALTH CARE CENTER 1249 FIFTH AVENUE NEW YORK,NY10029 13-3007801	OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(21)VISITING NURSE REGIONAL HEALTH CARE SYSTEM INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 11-3574017	DORMANT/SUPPORT AND MANAGEMENT SERVICES FOR ITS AFFILIATES	NY	501(C)(3)	PF	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(22)VISITING NURSE ASSOCIATION OF BROOKLYN INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 11-1977434	DORMANT/HOME HEALTH CARE	NY	501(C)(3)	PF	VISITING NURSE REGIONAL HEALTH CARE SYSTEM INC		No
(23)BROOKLYN VISITING NURSE FOUNDATION 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 11-3312248	DORMANT/RAISE FUNDS FOR AFFILIATED ORGANIZATIONS	NY	501(C)(3)	LINE 12B, II	VISITING NURSE REGIONAL HEALTH CARE SYSTEM INC		No
(24)ARCHCARE COMMUNITY SERVICES INC 205 LEXINGTON AVE 2ND FLOOR NEW YORK,NY10016 81-3563801	PROVIDE COMMUNITY AND PASTORAL SERVICES AND SUPPORTIVE HOUSING	NY	501(C)(3)	LINE 12B, II	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(25)FAMILY HOME HEALTH CARE INC 65 SOUTH BROADWAY TARRYTOWN,NY10591 13-3831377	HOME CARE	NY	501(C)(3)	LINE 10	DOMINICAN SISTERS FAMILY HEALTH SERVICE INC	Yes
(26)ULSTER HOME HEALTH SERVICES INC PO BOX 1850 KINGSTON,NY12402 14-1513989	HOME CARE	NY	501(C)(3)	LINE 10	UMC INC		No
(27)UMC INC PO BOX 1850 KINGSTON,NY12402 14-1701702	MANAGEMENT SERVICES	NY	501(C)(3)	LINE 12B, II	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No
(28)ULSTER HOME CARE INC PO BOX 1850 KINGSTON,NY12402 14-1702962	HOME CARE	NY	501(C)(3)	LINE 10	UMC INC		No
(29)PROVIDENCE REST 3304 WATERBURY AVENUE BRONX,NY10465 13-1740301	OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY	NY	501(C)(3)	LINE 10	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

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?
(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	Yes	No
(1) ST AGNES HOSPITAL 305 NORTH STREET WHITE PLAINS,NY10605 13-1740121	DORMANT/OPERATE A HOSPITAL	NY	CATHOLIC HEALTHCARE SYSTEM DBA ARCHCARE	C					No

Schedule R (Form 990) 2021

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

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) FAMILY HOME HEALTH CARE INC	M	122,952	COST

Schedule R (Form 990) 2021

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: DSFHS PROVIDES COMPREHENSIVE AND FAMILY FOCUSED CARE TO PERSONS IN NEED AS A CERTIFIED COMMUNITY BASED, NON-PROFIT HOME HEALTH AGENCY. OUR PROGRAMS AND SERVICES PROMOTE HEALTH, INDEPENDENCE AND QUALITY OF LIFE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	22
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	215
6	Total number of volunteers (estimate if necessary) .............	6	22
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,732,097	2,502,353
9	Program service revenue (Part VIII, line 2g) .........	19,087,316	21,879,089
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,228	2,629
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	63,890	104,446
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	22,884,531	24,488,517
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	15,082,531	15,298,553
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	6,666,488	6,809,726
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	21,749,019	22,108,279
19	Revenue less expenses. Subtract line 18 from line 12.......	1,135,512	2,380,238
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	10,427,294	9,975,868
21	Total liabilities (Part X, line 26).............	11,224,760	8,393,096
22	Net assets or fund balances. Subtract line 21 from line 20.....	-797,466	1,582,772

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 12,280,606 including grants of $ ) (Revenue $ 20,878,149 )
	THE CERTIFIED HOME HEALTH AGENCY PROVIDES CARE AND SUPPORT TO THOSE WHO HAVE HOME HEALTH CARE NEEDS THAT ARE FOR LIMITED DURATION. CARE MAY INVOLVE SKILLED NURSING, CASE MANAGEMENT, MEDICAL SOCIAL WORKER, HOME HEALTH AIDES, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES. ADDITIONAL SPECIALTY SERVICES PROVIDED ARE MATERIAL/CHILD HEALTH, WOUND CARE PAIN MANAGEMENT, HEALTH EDUCATION AND SUPERVISION AND SCREENING FOR NURSING HOME PLACEMENT. PASTORAL CARE COUNSELING IS PROVIDED IN BOTH ENGLISH AND SPANISH TO HELP PATIENTS AND FAMILIES OF ALL FAITHS COPE SPIRITUALLY AND EMOTIONALLY WITH ILLNESS AND HEALING.

4b	(Code: ) (Expenses $ 289,407 including grants of $ ) (Revenue $ 1,000,940 )
	ADJUNCT PROGRAMS PROVIDE NON-MEDICAL SERVICES, WHICH ARE GRANT FUNDED, TO THE MOST VULNERABLE MEMBERS OF SOCIETY IN THE SOUTH BRONX AND SUFFOLK COUNTY. IN THE SOUTH BRONX, THE RYAN WHITE PROGRAM ADDRESSES THE NEEDS OF THE HIV/AIDS POPULATION, OFFERING TESTING AND COUNSELING SERVICES.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses12,570,013

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,098,427	2,286,769	753,977

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	1,984,719

f	All other contributions, gifts, grants, and similar amounts not included above		1f	517,634

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,502,353

		Business Code
2a	NET PATIENT SERVICE REVENUE	623000	21,879,089	21,879,089
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		21,879,089

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,629			2,629
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	OTHER REVENUE		900099	96,148			96,148
b	MEDICAL RECORD		900099	8,298			8,298
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			104,446
12	Total revenue. See instructions.....			24,488,517	21,879,089	0	107,075

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	429,662		429,662
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	11,581,083	7,435,526	4,145,557
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	47,673	29,595	18,078
9	Other employee benefits .......	2,103,641	1,326,578	777,063
10	Payroll taxes ...........	1,136,494	705,527	430,967
11	Fees for services (non-employees):
a	Management ......	1,100,000		1,100,000
b	Legal .........	94,696		94,696
c	Accounting ...........	40,000		40,000
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,686,944	1,116,509	570,435
12	Advertising and promotion ....
13	Office expenses .......	327,412	196,446	130,966
14	Information technology ......	829,080	65,816	763,264
15	Royalties ..
16	Occupancy ...........	1,013,838	806,327	207,511
17	Travel ............	268,780	169,208	99,572
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	3,196	3,196
20	Interest ...........	33,323		33,323
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	440,194		440,194
23	Insurance ...	132,477		132,477
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	418,987	418,987
b	PURCHASED SERVICES AND	128,851	128,851
c	OTHER DIRECT EXPENSE	90,586	59,810	30,776
d	BAD DEBT EXPENSE	81,713		81,713
e	All other expenses	119,649	107,637	12,012
25	Total functional expenses. Add lines 1 through 24e	22,108,279	12,570,013	9,538,266	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			1,871,185	1	2,678,166
2	Savings and temporary cash investments .........			1,522,526	2	440,339
3	Pledges and grants receivable, net ......			448,709	3
4	Accounts receivable, net .............			2,984,117	4	3,986,651
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			345,541	9	352,702
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	7,027,185
b	Less: accumulated depreciation	10b	6,116,740	1,253,159	10c	910,445
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			2,002,057	15	1,607,565
16	Total assets. Add lines 1 through 15 (must equal line 33)...			10,427,294	16	9,975,868

17	Accounts payable and accrued expenses .....	4,795,627	17	3,581,883
18	Grants payable ...		18
19	Deferred revenue .........	700,000	19	631,841
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	5,729,133	25	4,179,372
26	Total liabilities. Add lines 17 through 25..	11,224,760	26	8,393,096

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-860,085	27	1,520,153
28	Net assets with donor restrictions ...........	62,619	28	62,619
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-797,466	32	1,582,772
33	Total liabilities and net assets/fund balances ........	10,427,294	33	9,975,868