2019-11-04T10:06:28-06:00 2018-12-31 990 2018-01-01 161434368 WNY CATHOLIC LONG TERM CARE INC WNYC 7168282974 144 GENESEE STREET BUFFALO NY 14203 DAVID P MACHOLZ TREASURER, CHS MS BOARD 7168282794 2019-11-04 204.68.186.4 2019-11-04 10:06:24 ES P C6DE77DF7EAFCE64E84CE20962AB172FB6FF0A8D 06E798C64FE9B4A74D95EF11437255C02E87A9E2 2018 2020-01-14 16:20:31Z MARK SULLIVAN 6TH FLOOR144 GENESEE ST BUFFALO NY 14203 18600223 0 X WWW.CHSBUFFALO.ORG X 1992 NY THE MISSION OF FATHER BAKER MANOR, AS PART OF THE CATHOLIC HEALTH SYSTEM (CHS) IN WESTERN NEW YORK, IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, THE PROVIDERS OF FATHER BAKER MANOR CONTINUE THE HEALING MINISTRY OF JESUS, SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2018 COMMUNITY SERVICE PLAN CAN BE FOUND AT HTTPS://WWW.CHSBUFFALO.ORG/ABOUT-US/COMMUNITY 9 6 349 4 0 2254 0 0 17399521 18565968 85875 97005 119170 -62750 17604566 18600223 0 0 0 0 14251613 14774016 0 0 0 5791433 4844775 20043046 19618791 -2438480 -1018568 24073951 23239577 23152433 23260041 921518 -20464 X THE MISSION OF FATHER BAKER MANOR, AS PART OF THE CATHOLIC HEALTH SYSTEM (CHS) IN WESTERN NEW YORK, IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, THE PROVIDERS OF FATHER BAKER MANOR CONTINUE THE HEALING MINISTRY OF JESUS, SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2018 COMMUNITY SERVICE PLAN CAN BE FOUND AT HTTPS://WWW.CHSBUFFALO.ORG/ABOUT-US/COMMUNITY 0 0 17930400 18646554 FATHER BAKER IS A SKILLED NURSING FACILITY THAT TENDS PRIMARILY TO THE POOR AND ELDERLY AND IS LOCATED IN ERIE COUNTY, NEW YORK. IN 2018 OVER 34% OF THE RESIDENTS WERE COVERED BY MEDICAID; THIS 34% MEDICAID POPULATION EQUALED 18,647 MEDICAID DAYS. SEE COMMUNITY SERVICE PLAN AT CHSBUFFALO.ORG 17930400 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 12 0 1 349 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X DAVID MACHOLZCONTROLLER CHS FINANC 7168282974 144 GENESEE STREET BUFFALO NY 14203 MARK A SULLIVAN PRES & CEO CHS 0.00 55.00 X X 0 1126042 93913 JOYCE MARKIEWICZ PRESIDENT & CEO HOME AND C 0.00 55.00 X X 0 425967 78638 DAVID MACHOLZ TREASURER 0.00 55.00 X X 0 286087 33427 CHARLES J URLAUB DIRECTOR 0.00 55.00 X 0 461578 45568 KATHERINE VANDERHORST DIRECTOR 0.00 4.00 X 0 0 0 BRIAN BEITZ DIRECTOR 0.00 8.00 X 0 0 0 MARTIN BORYSZAK DIRECTOR 0.00 55.00 X 0 371258 27945 LYNN CATALANO DIRECTOR 0.00 4.00 X 0 0 0 GEORGIANA FORD ESQ DIRECTOR 0.00 4.00 X 0 0 0 JOHN DAVANZO DIRECTOR 0.00 4.00 X 0 0 0 DR DONALD J LARGO JR DIRECTOR 0.00 55.00 X 0 93606 0 WALTER F LUDWIG DIRECTOR 0.00 4.00 X 0 296019 49141 GARY TUCKER DIRECTOR 0.00 55.00 X 0 379138 49345 MARY TURKIEWIECZ MD DIRECTOR 0.00 4.00 X 0 0 0 MONSIGNOR ROBERT E ZAPFEL DIRECTOR 0.00 4.00 X 0 0 0 JOSEPH MCDONALD PRES & CEO CHS 0.00 55.00 X 0 1217317 29530 JAMES A DUNLOP JR EXEC VP, FINANCE/CFO 0.00 55.00 X 0 774324 18105 THOMAS GLEASON COO,HOME & COMMUNITY BASED 0.00 55.00 X 0 184877 29354 MARK WHEELER ADMINISTRATOR 55.00 0.00 X 160697 0 8961 DR MICHAEL EDBAUER CHIEF CLINICAL OFFICER 0.00 28.00 X 0 508629 18325 MICHAEL MOLEY SR.VP HUMAN RESOURCES 0.00 55.00 X 0 604916 42703 DR MICHAEL GALANG SR.VP CHEIF INFORMATION OF 0.00 55.00 X 0 533930 33302 NANCY SHEEHAN SR.VP LEGAL SERVICE, GENER 0.00 55.00 X 0 393915 46854 MARIA FOTI SR.VP, STRATEGIC PLANNING 0.00 55.00 X 0 391140 46311 AMY HIAM HIGHEST COMPENSATED 55.00 0.00 X 110364 0 1013 TIMOTHY FARRELL HIGHEST COMPENSATED 55.00 0.00 X 104138 0 26807 AMANDA JETTY HIGHEST COMPENSATED 55.00 0.00 X 103851 0 26318 JAMES HESSLER HIGHEST COMPENSATED 55.00 0.00 X 100962 0 6413 JAMES MILLARD FORMER DIRECTOR 0.00 0.00 X 0 316719 -50019 580012 8365462 661954 5 1 1 0 AMN HEALTHCARE INC 2735 COLLECTION CENTER DRIVE CHICAGO IL 60693 HEALTHCARE SERVICES 771499 1 PRIVATE,MEDICARE,MEDICAID,& OTHER 623000 18565968 18565968 18565968 97005 97005 OTHER MISCELLANEOUS 900099 69751 69751 VENDING INCOME 900099 10835 10835 OTHER NON-OPERATING INCOME 900099 7666 7666 -151002 -151002 -62750 18600223 18646554 0 -46331 161204 161204 11510797 11510797 2209107 2209107 892908 880576 12332 15950 15950 148785 136566 12219 9936 9936 305771 74306 231465 533120 533120 560932 560932 SUPPLIES 1282677 1263138 19539 PURCHASES SERVICES 1086666 672174 414492 OTHER EXPENSES 837551 89684 747867 PROVISIONS FOR BAD DEBT 63387 0 63387 19618791 17930400 1688391 0 267240 422049 3068723 3101940 41282 50516 19739588 15356527 4680299 4383061 16016407 15282011 24073951 23239577 1596042 1556450 21556391 21703591 23152433 23260041 X 816726 -134700 104792 114236 921518 -20464 24073951 23239577 X -1018568 -25276 101862 X 0 1 X 1 0 X 16247621 16134970 15017986 17399521 18565968 83366066 16247621 16134970 15017986 17399521 18565968 83366066 0 0 0 83366066 100086 47616 86534 85876 97005 417117 100086 47616 86534 85876 97005 417117 16347707 16182586 15104520 17485397 18662973 83783183 0.99500 0.99470 0.00500 0.00530 X 0 0 0 0 0 0 0 0 1 1064 1064 0 PART II-B, LINE 1: OTHER LOBBYING ACTIVITIES: LOBBYING EXPENSES OF $1,064 REPRESENT THE TOTAL OF DUES PAID TO NATIONAL AND STATE ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. FATHER BAKER MANOR DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENT) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR OPPOSITION TO) ANY CANDIDATE. 241550 241550 13460182 10598479 2861703 5472380 4375755 1096625 565476 382293 183183 4383061 OTHER RECEIVALBES 14205 DUE FROM AFFILIATES 19843 INTEREST IN NET ASSETS OF RELATED FOUNDATION 114236 ASSETS LIMITED AS TO USE 10827394 OTHER ASSETS 4306333 15282011 CURRENT PORTION OF LONT-TERM OBLIGATIONS 561723 DUE TO THIRD-PARTY PAYORS 256346 DUE TO AFFILIATES 9623262 LONG-TERM OBLIGATIONS,NET 3278038 OTHER LONG-TERM LIABILITIES 7984222 21703591 18654220 0 18654220 -53997 -53997 18600223 19618791 0 19618791 0 19618791 PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 97,005. OTHER PERIODIC PENSION -151,002. X X X X X 1 0 0 0 0 0 0 0 0 MARK A SULLIVAN PRES & CEO CHS 0 695527 0 156198 0 274317 0 65865 0 28048 0 1219955 0 156198 JOYCE MARKIEWICZ PRESIDENT & CEO HOME AND C 0 407828 0 0 0 18139 0 58453 0 20185 0 504605 0 0 DAVID MACHOLZ TREASURER 0 229943 0 47229 0 8915 0 5658 0 27769 0 319514 0 0 CHARLES J URLAUB DIRECTOR 0 423637 0 0 0 37941 0 26189 0 19379 0 507146 0 0 MARTIN BORYSZAK DIRECTOR 0 354592 0 0 0 16666 0 2824 0 25121 0 399203 0 0 WALTER F LUDWIG DIRECTOR 0 277875 0 0 0 18144 0 22756 0 26385 0 345160 0 0 GARY TUCKER DIRECTOR 0 270048 0 72907 0 36183 0 22058 0 27287 0 428483 0 72907 JOSEPH MCDONALD PRES & CEO CHS 0 124093 0 191491 0 901733 0 8633 0 20897 0 1246847 0 191491 JAMES A DUNLOP JR EXEC VP, FINANCE/CFO 0 547002 0 140504 0 86818 0 -8500 0 26605 0 792429 0 140504 THOMAS GLEASON COO,HOME & COMMUNITY BASED 0 184625 0 0 0 252 0 3874 0 25480 0 214231 0 0 MARK WHEELER ADMINISTRATOR 160395 0 0 0 302 0 8777 0 184 0 169658 0 0 0 DR MICHAEL EDBAUER CHIEF CLINICAL OFFICER 0 173522 0 117972 0 217135 0 10293 0 8032 0 526954 0 321406 MICHAEL MOLEY SR.VP HUMAN RESOURCES 0 354293 0 96820 0 153803 0 23426 0 19277 0 647619 0 96820 DR MICHAEL GALANG SR.VP CHEIF INFORMATION OF 0 413567 0 102217 0 18146 0 23361 0 9941 0 567232 0 102217 NANCY SHEEHAN SR.VP LEGAL SERVICE, GENER 0 374956 0 25 0 18934 0 26085 0 20769 0 440769 0 0 MARIA FOTI SR.VP, STRATEGIC PLANNING 0 299755 0 74394 0 16991 0 36561 0 9750 0 437451 0 74394 JAMES MILLARD FORMER DIRECTOR 0 8001 0 0 0 308718 0 -68320 0 18301 0 266700 0 0 PART I, LINE 4A CERTAIN PORTIONS OF THE INCENTIVE COMPENSATION PAID IN 2018 ARE A RESULT OF THE TARGETS THAT WERE ACHIEVED IN PREVIOUS YEARS. DEFERRED COMPENSATION REPORTED IN 2018 INCLUDES BOTH QUALIFIED DEFERRED PENSION COMPENSATION, AS WELL AS DEFERRED COMPENSATION AND EMPLOYER CONTRIBUTION FOR 403B FOR CERTAIN ASSOCIATES FOR THE AMOUNTS THAT ARE ABLE TO BE ESTIMATED IN 2018. ACTUAL W-2 COMPENSATION PAID TO THE EXECUTIVE IS AS PER SCHEDULE J PART II B. CHANGE OF CONTROL PAYMENTS WERE MADE TO: JOSEPH MCDONALD: $618,613 JIM MILLARD: $305,963 SUSAN URLAUB WIFE OF MERCY CEO, C.J. URLAUB 93874 CORPORATE NURSE EDUCATOR 0 KATHLEEN ZAPFEL SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL 63506 HR EMPLOYEE OF CHS 0 SCOTT MARKIEWICZ SON OF KEY EMPLOYEE, JOYCE MARKIEWICZ 52480 SUPERVISOR, FATHER BAKER MANOR 0 JULIE SULLIVAN DAUGHTER OF CHIEF EXECUTIVE OFFICER 54655 HR EMPLOYEE, CHS 0 JACOB TUCKER SON OF DIRECTOR, GARY TUCKER 5403 IMAGING ASSOCIATE, MSMH 0 FORM 990, PART VI, SECTION A, LINE 6 CHS HAS TWO MEMBERS: TRINITY HEALTH, AND THE DIOCESE OF BUFFALO, NY. EACH MEMBER IS ABLE TO PARTICIPATE EQUALLY IN ELECTING THE GOVERNING BODY, APPROVING SIGNIFICANT DECISIONS OF THE GOVERNING BODY, AND IN RECEIVING A SHARE OF NET ASSETS UPON DISSOLUTION, ACCORDING TO THE CHS BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE CHS BYLAWS, EACH MEMBER IS EQUALLY ALLOWED TO APPOINT ONE REPRESENTATIVE AND ONE ALTERNATIVE REPRESENTATIVE TO SERVE ON THE CORPORATE MEMBER COUNCIL AND TO SERVE AS A VOTING DIRECTOR ON THE CHS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B YES, THE CORPORATE MEMBERS DO HAVE RESERVE POWERS. FORM 990, PART VI, SECTION B, LINE 11B YES, AN ELECTRONIC COPY OF THE FORM 990 WAS PROVIDED TO THE CHS BOARDS OF DIRECTORS BEFORE IT WAS FILED. THE CHS BOARD OF DIRECTORS HAS DELEGATED THE RESPONSIBILITY TO REVIEW THE 990 TO THE AUDIT COMMITTEE. THE CHS AUDIT COMMITTEE REVIEWED IN DETAIL SELECTED INFORMATION FOR ALL CHS ENTITIES THAT FILE A 990. REVIEWED WITH THE AUDIT COMMITTEE: 1.CORE FORM PART IV: CHECKLIST OF REQUIRED SCHEDULES 2.CORE FORM PART VI: GOVERNANCE, MANAGEMENT AND DISCLOSURE 3.CORE FORM PART VII: COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES AND INDEPENDENT CONTRACTORS 4.SCHEDULE H: HOSPITALS 5.SCHEDULE K: SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS 6.SCHEDULE J COMPENSATION INFORMATION 7.SCHEDULE L: TRANSACTIONS WITH INTERESTED PERSONS 8.SCHEDULE R: RELATED ORGANIZATIONS AND UNRELATED PARTNERSHIPS 9.PROCESS FOR WHICH REMAINING CORE FORM WAS COMPLETED, UTILIZING AUDITED FINANCIAL INFORMATION FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT (COIDS) IN ORDER TO FULFILL THE ANNUAL REQUIREMENTS. COIDS ARE DISTRIBUTED TO ALL PARTIES, AS PER APPLICABLE POLICY, AND ONCE COMPLETE ARE FOLLOWED UP WITH AS FOLLOWS: 1. ASSOCIATE AND PHYSICIAN COMPLETED COIDS ARE REVIEWED AND SIGNED OFF BY THE MANAGER. IF A DISCLOSURE IS NOTED, IT IS DISCUSSED BY THE MANAGER, THE DOCUMENT IS FORWARDED TO THE COMPLIANCE OFFICER WHO REVIEWS AND FOLLOWS UP AS APPROPRIATE. ONCE REVIEW/FOLLOW UP IS COMPLETED THE COMPLIANCE OFFICER WILL SIGN THE COIDS, MAINTAIN A COPY IN THE COMPLIANCE OFFICE AND RETURN THE ORIGINAL TO HR FOR FILING IN THE PERSONNEL FILE. 2. ALL BOARD MEMBER COIDS ARE RETURNED TO COMPLIANCE OFFICER FOR REVIEW AND FOLLOW UP AS WARRANTED. THE COMPLIANCE OFFICER WILL SIGN EACH COIDS AND RETAIN ON FILE IN THE COMPLIANCE OFFICE IN A CONFIDENTIAL MANNER. FORM 990, PART VI, SECTION B, LINE 15 CHS, IN DETERMINING THE COMPENSATION FOR THE CEO, UTILIZES A PROCESS OF REVIEW AND APPROVAL, GOVERNED BY THE BOARD OF DIRECTORS THAT INCLUDES AN OUTSIDE NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NON-PROFIT HEALTHCARE ORGANIZATIONS, AND COMPARABILITY DATA. IN 2018, THE CATHOLIC HEALTH SYSTEM UTILIZED A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS TO MONITOR THE EXECUTIVE COMPENSATION AS PER THE EXECUTIVE COMPENSATION PHILOSOPHY AND STRATEGY FOR THE CHS CEO AND TOP SENIOR EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 WE MAKE OUR FORM 990 OPEN FOR PUBLIC INSPECTION UPON REQUEST. OUR WEBSITE INCLUDES AN ANNUAL REPORT WHICH INCLUDES SELECTED FINANCIAL INFORMATION. OUR FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE PROVIDED UPON REQUEST ACCORDING TO APPLICABLE FEDERAL AND STATE LAWS. FORM 990, PART XI, LINE 9: MINIMUM PENSION LIABILITY ADJUSTMENT 9,241. CHANGE IN INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 9,444. DISTRIBUTIONS FROM PARENT 83,177. CATHOLIC HEALTH SYSTEM INC 144 GENESEE STREET BUFFALO NY 14203 222565278 HEALTH CARE DELIVERY SYSTEM NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 SISTERS OF CHARITY HOSPITAL 2157 MAIN STREET BUFFALO NY 14214 160743187 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVENUE KENMORE NY 14217 160762843 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 NAZARETH HOME OF THE FRANCISCAN SISTERS 291 NORTH STREET BUFFALO NY 14201 160813142 SKILLED NURSING FACILITY NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 ST ELIZABETH HOME FOR THE AGED 5539 BROADWAY LANCASTER NY 14086 160743154 ADULT HOME NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS HOME OF WILLIAMSVILLE 147 REIST STREET WILLIAMSVILLE NY 14221 160743153 SKILLED NURSING FACILITY NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS OF BUFFALO INC 34 BENWOOD AVENUE BUFFALO NY 14214 161523535 SKILLED NURSING FACILITY NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE) 144 GENESEE STREET BUFFALO NY 14203 161317960 HOME CARE PROVIDER NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 MCAULEY SETON HOME CARE 144 GENESEE STREET BUFFALO NY 14203 161310062 HOME CARE PROVIDER NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 CATHOLIC HEALTH SYSTEM INFUSION PHARMACY INC 6350 TRANSIT ROAD DEPEW NY 14043 200198518 HOME CARE INFUSION SERVICES NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 CHS CONTINUING CARE FOUNDATION 144 GENESEE STREET BUFFALO NY 14203 200947831 FOUNDATION NY 501(C)(3) LINE 7 CATHOLIC HEALTH SYSTEM INC 0 OLV RENAISSANCE CORPORATION 144 GENESEE STREET BUFFALO NY 14203 200167745 REAL ESTATE HOLDING COMPANY NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 CHS PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY INC 55 MELROY AVENUE LACKAWANNA NY 14218 261252884 ALL-INCLUSIVE CARE FOR THE ELDERLY NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 TRINITY MEDICAL WNY PC 2625 HARLEM ROAD CHEEKTOWAGA NY 14225 272576645 PRIMARY CARE PROVIDER NY 501(C)(3) LINE 12B, II CATHOLIC HEALTH SYSTEM INC 0 KMH HOMES INC 144 GENESEE STREET BUFFALO NY 14203 161387890 REAL ESTATE HOLDING COMPANY NY 501(C)(3) LINE 11 CATHOLIC HEALTH SYSTEM INC 0 MOUNT ST MARY'S HOSPITAL OF NIAGARA FALLS 5300 MILITARY ROAD LEWISTON NY 14092 161523353 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1