2018-11-02T07:45:21-05:00 2017-12-31 990 2017-01-01 161310062 McAuley Seton Home Care MCAU 7168282974 144 Genesee Street Buffalo NY 14203 David P Macholz VP Finance, Corp Controller 7168282974 2018-11-02 204.68.186.4 2018-11-02 07:44:05 ED P E6E6B1DEE2C3A01552DA3A94E9AF66566F60AB34 C64610ABE23AD5845076C6771D0CCBF5592AB213 2017 2018-06-14 16:35:46Z Joseph D McDonald 144 Genesee Street Buffalo NY 14203 45216275 0 X www.chsbuffalo.org X 1988 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in a home care setting. Committed to a common mission, CHS providers 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 2017 Community Service Plan can be found at https://www.chsbuffalo.org/about-us/community 11 7 414 0 0 0 0 0 41374839 43250679 17511 41716 450635 1923880 41842985 45216275 0 0 0 0 32266675 32409698 0 0 0 6288010 7277754 38554685 39687452 3288300 5528823 41689706 45760230 14515227 14041465 27174479 31718765 X The Catholic Health System (CHS) Mission is to provide quality healthcare services in a home care setting. Committed to a common mission, CHS providers 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 2017 Community Service Plan can be found at https://www.chsbuffalo.org/about-us/community 0 0 31752564 43292395 McAuley Seton Home Care provides skilled nursing, physical therapy, speech therapy, occupational therapy, medical social work and home health aide services to individuals in their homes in the counties of Erie and Niagara. Committed to a common mission, Western New York's Catholic Health providers continue the healing ministry of Jesus. Seeking to improve the health of individuals and communities, we provide high quality service that is holistic, compassionate, and respectful of human dignity. Central to this endeavor is the service of persons who are poor and disadvantaged. For more detailed information, the 2017 Catholic Health Community Service report can be found at www.chsbuffalo.org. 31752564 1 0 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 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 10 0 1 414 1 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X David P Macholz 7168282974 144 Genesee Street Buffalo NY 14203 Mark Sullivan Executive VP/COO 0.00 55.00 X X 0 892421 161256 Joyce Markiewicz President & CEO Home and Community Based Care 0.00 55.00 X X 0 372553 82696 David Macholz Treasurer 0.00 55.00 X X 0 265735 51732 Brian Beitz Director 0.00 8.00 X 0 0 0 Martin Boryszak Director 0.00 55.00 X 0 326086 20914 Lynn Catalano Director 0.00 4.00 X 0 0 0 John Davanzo Director 0.00 4.00 X 0 0 0 Georgiana Ford Esq Director 0.00 4.00 X 0 0 0 Dr Mark Jajkowski Director 0.00 55.00 X 0 24250 0 Raquel Martin DO Director 0.00 4.00 X 0 0 0 James Millard Director 0.00 55.00 X 0 322914 231028 Gary Tucker Director 0.00 55.00 X 0 323253 70511 Mary Turkiewiecz MD Director 0.00 4.00 X 0 0 0 Charles Urlaub Director 0.00 55.00 X 0 446938 47606 Katherine Vanderhorst Director 0.00 4.00 X 0 0 0 Monsignor Robert E Zapfel Director 0.00 4.00 X 0 0 0 Joseph McDonald President and CEO, CHS 0.00 55.00 X 0 1321419 187715 James A Dunlop Jr Executive VP, Finance/CFO 0.00 55.00 X 0 795936 278895 Thomas Gleason COO, Home and Community Based Care 55.00 0.00 X 169707 0 34570 Dr Michael Edbauer Chief Clinical Officer 0.00 28.00 X 0 429423 78470 Maria Foti Sr.VP, Strategic Planning 0.00 55.00 X 0 392400 91557 Dr Michael Galang Sr.VP, Chief Information Officer 0.00 55.00 X 0 546797 73371 Michael Moley Sr.VP, Human Resources 0.00 55.00 X 0 657728 135613 Nancy Sheehan Sr.VP Legal Service, General Counsel 0.00 55.00 X 0 488411 51193 Marla Duerr Director 55.00 0.00 X 179871 0 44456 Brian Przybysz VP Operations Home Care 55.00 0.00 X 140120 0 37070 Estelle Brickner Director 55.00 0.00 X 136443 0 34300 Michael Dimitri Physical Therapist 55.00 0.00 X 119591 0 28510 Michael Zielinski Physical Therapist 55.00 0.00 X 118690 0 17527 864422 7606264 1758990 21 0 1 0 Select Data 4155 E LA Palma Avenue Anahiem CA 92807 Consulting Service 283325 1 Nursing 621610 16505679 16505679 Rehab 621610 14457825 14457825 Prospective Payment System 621610 12287175 12287175 43250679 41716 41716 Gain on Investment Income 621610 1903940 1903940 CHS Non Operating Income 621610 19940 19940 1923880 45216275 43292395 0 1923880 25815772 22719164 3096608 1056944 687014 369930 3835524 2493092 1342432 1701458 1105948 595510 7855 7855 242212 107052 135160 83065 62198 20867 1658494 1221217 437277 573943 573943 81064 49206 31858 802808 752963 49845 23788 23788 306470 306470 558501 558501 87354 87354 Bad Debts 1527742 1527742 Other Purchased Service 894051 894051 Dues and Subscriptions 184377 184377 246030 161997 84033 39687452 31752564 7934888 0 8022889 9625877 8548661 9449276 52916 52640 89134 20918 3329517 2814153 693947 515364 20320656 22253349 2650000 2650000 1311503 1192806 41689706 45760230 12510209 11816252 693515 1032407 1311503 1192806 14515227 14041465 X 0 0 0 0 27174479 31718765 27174479 31718765 41689706 45760230 X 5528823 -984537 X 0 1 X 1 0 X 36694175 43402521 43513075 41374839 43250679 208235289 36694175 43402521 43513075 41374839 43250679 208235289 0 0 0 208235289 4575 19073 19474 76964 61656 181742 4575 19073 19474 76964 61656 181742 16054 9037 5192 391182 1903940 2325405 36714804 43430631 43537741 41842985 45216275 210742436 0.98810 0.99710 0.00090 0.00070 X 0 0 0 0 0 0 0 0 1 8728 8728 0 Part II-B, Line 1: Lobbying expenses of $8,728 represent the total of dues paid to national and state associations that is specifically allocable to lobbying. McAuley Seton Home Care 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. 3329517 2814153 515364 515364 Investment 22253349 C 22253349 Accrued Medical Malpractice 185873 Accrued Workers Compensation 1006933 1192806 X X X X X X 0 1 0 0 0 0 0 0 0 Mark Sullivan Executive VP/COO 0 589554 0 181701 0 121166 0 134653 0 26603 0 1053677 0 181701 Joyce Markiewicz President & CEO Home and Community B 0 354692 0 0 0 17861 0 63393 0 19303 0 455249 0 0 David Macholz Treasurer 0 222439 0 34402 0 8894 0 25118 0 26614 0 317467 0 0 Martin Boryszak Director 0 313904 0 0 0 12182 0 12092 0 8822 0 347000 0 0 James Millard Director 0 305290 0 0 0 17624 0 206285 0 24743 0 553942 0 0 Gary Tucker Director 0 262727 0 0 0 60526 0 45307 0 25204 0 393764 0 0 Charles Urlaub Director 0 409653 0 0 0 37285 0 27553 0 20053 0 494544 0 0 Joseph McDonald President and CEO, CHS 0 748297 0 229770 0 343352 0 158886 0 28829 0 1509134 0 229770 James A Dunlop Jr Executive VP, Finance/CFO 0 528833 0 163443 0 103660 0 253453 0 25442 0 1074831 0 163443 Thomas Gleason COO, Home and Community Based Care 169561 0 0 0 146 0 10252 0 24318 0 204277 0 0 0 Dr Michael Edbauer Chief Clinical Officer 0 300713 0 106281 0 22429 0 65257 0 13213 0 507893 0 92418 Maria Foti Sr.VP, Strategic Planning 0 288899 0 86539 0 16962 0 80592 0 10965 0 483957 0 86539 Dr Michael Galang Sr.VP, Chief Information Officer 0 406244 0 122651 0 17902 0 63847 0 9524 0 620168 0 122651 Michael Moley Sr.VP, Human Resources 0 388982 0 112624 0 156122 0 114645 0 20968 0 793341 0 112624 Nancy Sheehan Sr.VP Legal Service, General Counsel 0 361936 0 108547 0 17928 0 30315 0 20878 0 539604 0 108547 Marla Duerr Director 179186 0 0 0 685 0 18437 0 26019 0 224327 0 0 0 Brian Przybysz VP Operations Home Care 131439 0 0 0 8681 0 10813 0 26257 0 177190 0 0 0 Estelle Brickner Director 135723 0 0 0 720 0 13597 0 20703 0 170743 0 0 0 Part I, Line 4b Certain Officers and Key employees participated in a supplemental nonqualified retirement plan. The intention is to provide additional retirement compensation to address any gaps in the compensation limit. Joseph McDonald $26,000.00 SERP $101,863.00 Mark Sullivan $19,500.00 Part II B Certain portions of the incentive compensation paid in 2017 are a result of the targets that were achieved in previous years. Deferred compensation reported in 2017 includes both qualified deferred pension compensation and employer contribution for 403b for certain Sisters of Charity Hospital associates, as well as deferred compensation for the amounts that are able to be estimated in 2017. Actual W-2 compensation paid to the executive is as per Schedule J Part II B. Susan Urlaub Wife of Mercy CEO, CJ Urlaub 90121 Corporate Nurse Educator 0 Kathleen Zapfel Sister-in-Law of BOD, Msgr. Robert Zapfel 68944 HR Employee of CHS 0 Scott Markiewicz Son of Key Employee, Joyce Markiewicz 48434 Supervisor, Father Baker Manor 0 Julie Sullivan Daughter of Cheif Operating Officer 33395 HR Employee, CHS 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 Catholic Health System 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 associates on the Merit program; all Physicians and Non Physician Practitioners as well as Physician groups who are independent contractors or employees of CHS; and all board members must 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 with the manager, and 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 2017, 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 -984,537. CATHOLIC HEALTH SYSTEM INC 144 GENSEE STREET BUFFALO NY 14203 222565278 HEALTH CARE DELIVERY SYSTEM NY 501 C 3 LINE 10 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 SISTER 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 10 CATHOLIC HEALTH SYSTEM INC 0 ST ELIZABETH HOME FOR THE AGED 5539 BROADWAY LANCASTER NY 14086 160743154 ADULT HOME NY 501 C 3 LINE 10 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 10 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS OF BUFFALO INC 134 BENWOOD AVENUE BUFFALO NY 14214 161523535 SKILLED NURSING FACILITY NY 501 C 3 LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501 C 3 LINE 10 CATHOLIC HEALTH SYSTEM INC 0 WNY CATHOLIC LONG TERM CARE INC 6400 POWERS ROAD ORCHARD PARK NY 14127 161434368 SKILLED NURSING FACILITY NY 501 C 3 LINE 10 CATHOLIC HEALTH SYSTEM INC 0 NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE) 144 GENSEE STREET BUFFALO NY 14203 161317960 HOME CARE PROVIDER NY 501 C 3 LINE 10 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 10 CATHOLIC HEALTH SYSTEM INC 0 CHS CONTINUING CARE FOUNDATION 144 GENSEE STREET BUFFALO NY 14203 200947831 FOUNDATION NY 501 C 3 LINE 7 CATHOLIC HEALTH SYSTEM INC 0 OLV RENAISSANCE CORPORATION 144 GENSEE STREET BUFFALO NY 14203 200167745 REAL ESTATE HOLDING COMPANY NY 501 C 3 LINE 10 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 INC 2625 HARLEM ROAD CHEEKTOWAGA NY 14225 272576645 PRIMARY CARE PROVIDER NY 501 C 3 LINE 12 CATHOLIC HEALTH SYSTEM INC 0 KMH HOMES INC 144 GENSEE STREET BUFFALO NY 14203 161387890 REAL ESTATE HOLDING COMPANY NY 501 C 3 LINE 10 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 0 0 0 0 0 0 0 0