2017-01-10T10:20:40-06:00 2015-12-31 990 2015-01-01 161310062 McAuley Seton Home Care MCAU 7166854870 144 Genesee Street Buffalo NY 14203 David P Macholz VP Finance,CHS Corp Controller 7168282974 2016-10-31 2015 2021-01-29 14:40:06Z X Joseph D McDonald 144 Genesee Street 6th Floor Buffalo NY 14203 43537741 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 2015 Community Service Plan can be found at www.chsbuffalo.org. 13 9 457 0 0 0 0 0 43402521 43513075 19073 20704 9037 3962 43430631 43537741 0 0 0 0 29467365 30663370 0 0 0 6409021 7080652 35876386 37744022 7554245 5793719 32219481 38107921 15015079 15101267 17204402 23006654 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 2015 Community Service Plan can be found at www.chsbuffalo.org. 0 0 30650332 43513075 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 2015 Catholic Health Community Service report can be found at www.chsbuffalo.org. 30650332 1 0 0 1 0 0 0 0 0 0 1 0 0 0 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 14 0 1 457 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 9 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 VP Finance CHS Cor 7168282974 144 Genesee Street 4th Floor Buffalo NY 14203 Mark Sullivan Executive VP/COO, CHs 2.00 55.00 X X 0 831321 134963 Joyce Markiewicz President and CEO, Home and Community Based Care 55.00 X X 367821 0 35357 Brian Beitz Director 4.00 X 0 0 0 Peter Bergmann Director 2.00 55.00 X 0 495499 23556 Frances Crosby RN PhD Director 2.00 X 0 0 0 Richard Curran MD Director 2.00 X 0 0 0 John Davanzo Director 2.00 X 0 0 0 Dr Michael Edbauer Director 2.00 27.50 X 0 362923 70688 Joseph Gelormini MD Director 2.00 X 0 0 0 Mark Jajkowski Director 3.00 X 0 0 0 David Macholz Officer/Director 2.00 55.00 X X 0 329578 24203 Raquel Martin DO Director 2.00 X 0 0 0 James Millard Director 2.00 55.00 X 0 419950 34672 Sherry Pomeroy PhD Director 2.00 X 0 0 0 Gary Tucker Director 2.00 55.00 X 0 440125 68790 Mary Turkiewiecz MD Director 2.00 X 0 0 0 Charles Urlab Director 2.00 55.00 X 0 463086 36126 Monsignor Robert E Zapfet Director 2.00 X 0 0 0 Joseph McDonald President and CEO, CHS 2.00 55.00 X 0 1582915 204904 James Dunlop Jr Executive VP, Finance/CFO 2.00 55.00 X 0 887602 110616 Maria Foti Sr. VP, Strategic Planning 2.00 55.00 X 0 347846 63087 Dr Michael Galang Chief Information Officer 2.00 55.00 X 0 509718 81005 Michael Moley Sr. VP, Human Resources 2.00 55.00 X 0 687938 105480 Bartholomew Rodrigues Sr. VP, Mission Integration 2.00 55.00 X 0 244504 18413 Nancy Sheehan SVP Legal Service, General Councel 2.00 55.00 X 0 380104 52928 Brian Przybysz VP Operation Home Care 55.00 X 142965 0 21064 Marla Duerr Director 55.00 X 124429 0 32174 Estelle Brickner Director 55.00 X 141172 0 32839 Thomas Gleason Director 55.00 X 139382 0 22723 David Wojtowicz Physical Therapist 55.00 X 134436 0 25158 1050205 7983109 1198746 22 0 1 0 Select Data 4155 E LA Palma Avenue 250 Anahiem CA 92807 Consulting Services 264529 Telco Construction 500 Buffalo Road East Aurora NY 14052 Consulting Services 101084 2 Nursing 621610 18726310 18726310 Rehab 621610 12876093 12876093 Prospective Payment System 621610 11910672 11910672 43513075 20704 20704 Document Center Revenue 621610 3962 3962 3962 43537741 43533779 0 3962 915779 595256 320523 23793481 21490845 2302636 1198292 778890 419402 3133256 2036618 1096638 1622562 1054665 567897 7652 7652 242563 27160 215403 75486 68219 7267 1506841 1129600 377241 308901 308901 97207 57570 39637 926204 889612 36592 126494 126494 451535 451535 638811 638811 49820 49820 Bad Debt 1234798 1234798 Other Purchased Service 907199 907199 Dues and Subscriptions 158202 158202 348939 196753 152186 37744022 30650332 7093690 0 19459132 24534994 8377886 8781253 36203 53929 115855 24318 3265074 2163751 1082369 1101323 2650000 2650000 498036 962104 32219481 38107921 12660176 12813268 869726 813551 993750 516750 491427 957698 15015079 15101267 X 0 0 0 0 17204402 23006654 17204402 23006654 32219481 38107921 X 5793719 8533 X 0 1 X 1 1 1 X 24242482 28964387 36694175 43402521 43527223 176830788 24242482 28964387 36694175 43402521 43527223 176830788 0 0 0 176830788 2663 8379 4575 19073 19474 54164 2663 8379 4575 19073 19474 54164 20385 20787 16054 9037 5192 71455 24265530 28993553 36714804 43430631 43551889 176956407 0.99930 0.99920 0.00030 0.00020 X 0 0 0 0 0 0 0 0 1 7652 7652 0 Part II-B, Line 1: McAuley Seton Home Care pays dues to organizations (National Association for Homecare and Home Care Association of New York State) that utilizes a portion of the dues payment for lobbying activities. In 2015, the lobbying component of these dues amounted to $7,652. 3265074 2163751 1101323 1101323 Workers Comp Recovery 855905 Medical Malpractice Recovery 101793 957698 43537741 0 43537741 0 43537741 37744022 0 37744022 0 37744022 X X X X X X 0 1 0 0 0 0 0 0 0 Mark Sullivan Executive VP/COO, CHs 0 504363 0 208657 0 118301 0 112959 0 22004 0 966284 0 0 Joyce Markiewicz President and CEO, Home and Communit 280167 0 70559 0 17095 0 14186 0 21171 0 403178 0 0 0 Peter Bergmann Director 0 403466 0 63731 0 28302 0 3149 0 20407 0 519055 0 0 Dr Michael Edbauer Director 0 238222 0 111206 0 13495 0 59457 0 11231 0 433611 0 0 David Macholz Officer/Director 0 210123 0 110699 0 8756 0 1925 0 22278 0 353781 0 0 James Millard Director 0 330958 0 71925 0 17067 0 23675 0 10997 0 454622 0 0 Gary Tucker Director 0 243236 0 173623 0 23266 0 43271 0 25519 0 508915 0 0 Charles Urlab Director 0 387431 0 40588 0 35067 0 15442 0 20684 0 499212 0 0 Joseph McDonald President and CEO, CHS 0 740806 0 536131 0 305978 0 180650 0 24254 0 1787819 0 0 James Dunlop Jr Executive VP, Finance/CFO 0 501920 0 315368 0 70314 0 89631 0 20985 0 998218 0 0 Maria Foti Sr. VP, Strategic Planning 0 232624 0 98515 0 16707 0 54191 0 8896 0 410933 0 0 Dr Michael Galang Chief Information Officer 0 343441 0 149570 0 16707 0 78087 0 2918 0 590723 0 0 Michael Moley Sr. VP, Human Resources 0 351252 0 175656 0 161030 0 82554 0 22926 0 793418 0 0 Bartholomew Rodrigues Sr. VP, Mission Integration 0 190453 0 37360 0 16691 0 12457 0 5956 0 262917 0 0 Nancy Sheehan SVP Legal Service, General Councel 0 290590 0 72447 0 17067 0 43525 0 9403 0 433032 0 0 Brian Przybysz VP Operation Home Care 119745 0 14564 0 8656 0 294 0 20770 0 164029 0 0 0 Marla Duerr Director 115844 0 8414 0 171 0 5476 0 26698 0 156603 0 0 0 Estelle Brickner Director 126586 0 13929 0 657 0 9939 0 22900 0 174011 0 0 0 Thomas Gleason Director 121656 0 17644 0 82 0 2966 0 19757 0 162105 0 0 0 David Wojtowicz Physical Therapist 131282 0 100 0 3054 0 5591 0 19567 0 159594 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 - Pension $26,000.00 SERP $94,179.00 Mark Sullivan - Pension $19,500.00 Peter Bergman - $7,334.00 PART II B Certain portions of the incentive compensation paid in 2015 are a result of the targets that were achieved in 2014. Deferred compensation reported in 2015 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 2015. Actual W-2 compensation paid to the executive is as per Schedule J Part II B. Susan Urlab Wife of Mercy CEO, CJ Urlab 80304 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 65837 0 990 Page 1 section B, Schedule J Page 2 Part II An amended 990 return has been prepared to correct the W2 compensation listed on Part II of Schedule J for one officer. The original filing did not have the appropriate breakdown between base compensation and other reportable compensation. Total compensation that was originally submitted was reported accurately. Form 990, Part VI, Section A, line 6 CHS has three members: Ascension Health, 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 up to three individuals to act as its representatives on the Corporate Member Board, and in undertaking any action in its capacity as a Member. The Corporate Member Board oversees the governance of the Catholic Health System. Form 990, Part VI, Section A, line 7b Each member is entitled to one vote on each matter properly submitted at any membership meeting, and the members also have reserve powers which allow approval for certain business events and ratification of certain business transactions. Form 990, Part VI, Section B, line 11 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. 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 2015, 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 Adjustment 8,533. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501(c)(3) Line 9 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 9 Catholic Health System Inc 0 St Elizabeth Home for the Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501(c)(3) Line 9 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 9 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 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501(c)(3) Line 9 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 9 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 9 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 9 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 9 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 11a, I Catholic Health System Inc 0 KMH Homes Inc 144 Genesee Street Buffalo NY 14203 161387890 Real Estate Holding Company NY 501(c)(3) Line 9 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