2016-10-31T12:51:18-05:00 2015-12-31 990 2015-01-01 160756336 Mercy Hospital of Buffalo MERC 7168282974 144 Genesee St Finance 4th Floor Buffalo NY 14203 David P Macholz CHS VP Finance/Corp Controller 7168282974 2016-10-31 2015 2017-02-10 21:41:12Z Joseph D McDonald 144 Genesee Street Administration 6th Floor Buffalo NY 14203 400451761 0 X www.chsbuffalo.org X 1957 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in a (an) (acute care, long term care, 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 2951 160 0 0 863016 351318 383444677 393601492 456350 411837 5580906 6087114 390344949 400451761 0 0 0 0 175096486 191375322 0 0 0 193994169 205800506 369090655 397175828 21254294 3275933 289899928 313267635 306376928 324822726 -16477000 -11555091 None 0 0 218366698 256990904 Inpatient Routine/Surgery Visits: Acute Care Patient Days = 87,996Newborn Patient Days = 7,206Medical Rehab Patient Days = 6,449Skilled Nursing Patient Days = 30,444IP Surgeries = 7,875 105833337 124552898 Outpatient Routine/Surgery Services:Emergency Visits (Net of Admits) = 63,912Referred Ambulatory Visits = 164,845Operating Room = 6,595OPD = 43G.I. Laboratory = 1,532MAPU = 1,509Dialysis Access Center = 273Interventional Radiology = 1,091Cardiac (EP & Catheterizations) = 3,677Transfusion = 502 10245491 12057690 Clinic/Primary Care Services:Clinic Visits = 57Primary Care Visits = 61,083 334445526 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 210 0 1 2951 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 1 1 X X David P Macholz CHS VP Finance Corporate Controller Catholic Health 7168282974 144 Genesee Street Finance 4th Buffalo NY 14203 Mark Sullivan Executive VP / COO 0.00 55.00 X X 0 831321 134963 Charles Urlaub President, and CEO Mercy 55.00 0.00 X X 463085 0 36126 David Macholz Treasurer 0.00 55.00 X X 0 329578 24203 Peter Bergmann Director 0.00 55.00 X 0 495500 23556 James Millard Director 0.00 55.00 X 0 419951 34672 Gary Tucker Director 0.00 55.00 X 0 440125 68790 Joyce Markiewicz Director 0.00 55.00 X 0 367821 35357 Dr Michael Edbauer Director 0.00 27.50 X 0 362923 70687 Brian Beitz Director 0.00 4.00 X 0 0 0 Frances Crosby RN PhD Director 0.00 2.00 X 0 0 0 Richard Curran MD Director 0.00 2.00 X 0 0 0 John Davanzo Director 0.00 2.00 X 0 0 0 Joseph Gelormini MD Director 0.00 2.00 X 0 0 0 Mark Jajkowski Director 0.00 2.00 X 0 0 0 Raquel Martin DO Director 0.00 2.00 X 0 0 0 Sherry Pomeroy PhD Director 0.00 2.00 X 0 0 0 Mary Turkiewiecz MD Director 0.00 2.00 X 0 0 0 Monsignor Robert E Zapfel Director 0.00 2.00 X 0 0 0 Joseph McDonald President and CEO, CHS 0.00 55.00 X 0 1582915 204904 James A Dunlop Jr Executive VP, Finance / CFO 0.00 55.00 X 0 887602 110616 Dr Brian D'Arcy Senior VP, Medical Affairs 0.00 55.00 X 0 588913 86724 Eddie Bratko Chief Operating Officer, Mercy 55.00 0.00 X 156813 0 22232 Michael Moley Sr.VP, Human Resources 0.00 55.00 X 0 687938 105480 Dr Michael Galang Sr. VP/Chief Information Officer 0.00 55.00 X 0 509718 81005 Nancy Sheehan SVP Legal Service, General Counsel 0.00 55.00 X 0 380103 52928 Dr Thomas Raab Physician 55.00 0.00 X 491092 0 70641 Dr Timothy Gabryel VP Medical Affairs 55.00 0.00 X 447520 0 34729 Maria Foti Sr. VP, Strategic Planning 0.00 55.00 X 0 347846 63087 Dr Mark Adkins Physician 55.00 0.00 X 921890 0 28115 Dr Joseph Polcaro Physician 55.00 0.00 X 393268 0 22410 Dr Stephen Downing Physician 55.00 0.00 X 805981 0 38297 Dr Ahmet Guler Physician 55.00 0.00 X 368821 0 22537 Dr Syed Shah Physician 55.00 0.00 X 575336 0 32697 4623806 8232254 1404756 152 0 1 0 Telco Construction 500 Buffalo Road East Aurora NY 14052 Construction Services 2630314 Siemens Medical Solutions 51 Valley Stream Parkway Malverne PA 19355 Maintenance Services 2192727 Aramark Services Inc 1000 East Henrietta Road Rochester NY 14623 Dietary Services 1816205 Nuance Communications PO Box 7247-6924 Philadelphia PA 191706924 Consulting Services 1355887 Buffalo Gastroenterology (OP) 260 Redtail Road Orchard Park NY 14127 Physician Services 1221000 50 351318 351318 Patient Care Services 900099 393601492 393601492 393601492 395731 395731 362693 0 362693 362693 362693 16106 0 16106 16106 16106 Cafeteria Revenue 900099 1064698 1064698 Parking Revenue 900099 685324 685324 Meaningful Use Dollars 900099 216709 216709 3757690 1364524 2393166 5724421 400451761 395182725 0 4917718 139244342 124057770 15186572 16182377 14417459 1764918 26397986 23518911 2879075 9550617 8508987 1041630 423829 423829 35323 35323 11937349 11042185 895164 77093 77093 8939678 4332725 4606953 187775 12067 175708 7494903 5621177 1873726 161203 111325 49878 149361 133987 15374 2329578 2029331 300247 14026761 12218925 1807836 4327741 3822824 504917 Medical Supplies 79602326 80678654 -1076328 Dues & Shared Services 52342529 37686621 14655908 Purchased Services & Ot 20243866 3003957 17239909 Other Supplies- Non Med 3521191 3171528 349663 397175828 334445526 62730302 0 80350248 85817860 3942793 14138812 53405815 54045939 12901666 13615681 2014747 2573069 188241827 91572790 98192821 96669037 240842 229253 38850996 46177984 289899928 313267635 46310166 48495077 33270753 42898613 17761042 11574929 209034967 221854107 306376928 324822726 X -17379920 -12415762 780397 738148 122523 122523 -16477000 -11555091 289899928 313267635 X 3275933 1645976 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 35323 35323 0 Part II-B, Line 1: Other lobbying activities: Lobbying expenses represent the total of dues paid to national and state associations that is specifically allocable to lobbying. Mercy Hospital of Buffalo 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. 1409723 1409723 68128532 33666007 34462525 38695815 8608191 30087624 73954581 49096703 24857878 6053176 201889 5851287 96669037 Accrued Receivables 3758151 Due from Affiliates 310883 Interest in the Net Assets of Mercy Hospital Foundation Inc 2112196 Insurance Recoveries 39996754 46177984 Deferred Comp Liability 9903 Due to Affiliates 20911806 LT Disposables 16844 Interest Rate Swap 4290350 Asset Retirment Obligation 6228566 Accrued Pension Obligation 131824507 LT Gen Liab/Workers Comp IBNR 58572131 221854107 400797236 696793 696793 400100443 351318 351318 400451761 397750371 574543 574543 397175828 0 397175828 Part XI, Line 2d - Other Adjustments: Foundation Revenue - 696,793 Part XI, Line 4b - Other Adjustments: Contributions from Foundation to Mercy Hospital - 340,151 Grant Revenue - 11,167 Part XII, Line 2d - Other Adjustments: Foundation Expenses (net of eliminations) - 574,543 1 1 X 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2127681 131562 1996119 0.00500 60368845 40412415 19956430 0.05020 62496526 40543977 21952549 0.05520 894523 894523 0.00230 7461189 1176069 6285120 0.01580 23026111 17122355 5903756 0.01490 345889 345889 0.00090 557762 557762 0.00140 32285474 18298424 13987050 0.03530 94782000 58842401 35939599 0.09050 5227 5227 0.00000 5227 5227 0 9175208 1372234 70035577 69964407 71170 X 1 1 2 1 Mercy Hospital of Buffalo 565 Abbott Rd Buffalo NY 14220 www.chsbuffalo.org X X X X Ambulatory Surgery - Multi Speciality, Audiology O/P, Cardiac Catheterizatn 2 Mercy Ambulatory Care Center 3669 Southwestern Blvd Orchard Park NY 14127 www.chsbuffalo.org X X X X Clinical Laboratory Service, CT Scanner, Emergency Department, Medical Surg Mercy Hospital of Buffalo 0 0 1 X X X X X X X X X 13 1 1 1 1 X http://chsbuffalo.org/Community X 1 13 1 http://www.chsbuffalo.org/Community 0 0 1 X 110.000000000000 500.000000000000 X X X X 1 1 X X X X 1 X http://chsbuffalo.org/billing/finance X http://chsbuffalo.org/billing/finance X http://chsbuffalo.org/billing/finance X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section A: Mercy Hospital:(Adult Dianostic) Cardiac Catheterization - Electrophysiology (EP) Cardiac Catheterization - Percutaneous Coronary Intervention (PCI)Cardiac Surgery - Adult Certified Mental Health Services O/P Clinic Part Time Services Clinical Laboratory ServicesCoronary Care CT Scanner Dental O/P Emergency Department Family Planning O/P Health Fairs O/PIntensive Care Magnetic Resonance Imaging Maternity Medical Social Services Medical/Surgical Neonatal Continuing, Intensive & Intermediate Care Nuclear Medicine - Diagnostic Outpatient Surgery Pediatric & Pediatric O/P Pharmaceutical Service Physical Medical Rehabilitation Physical Medicine and Rehabilitation O/P Podiatry O/P Prenatal O/P Primary Medical Care O/P Radiology - Diagnostic Renal Dialysis - Acute Respiratory Care Therapy - Occupational, Physical O/P Therapy - Speech Language Pathology Mercy Ambulatory Care Center:Primary Medical Care O/P Radiology Diagnostic Therapy - Physical O/P Part V, Section B Facility Reporting Group A Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 5: Catholic Health utilized a variety of sources to develop the health needs assessment to ensure the inclusion of persons who represent the broad interest of the community and have special expertise in, or knowledge of, public health issues and concerns: * Survey of community representatives was conducted to ascertain their perception of the County's health needs * Facilitated group discussions with community and public health experts* Focus group with Catholic Health's Emergency Department Task Force* Erie County Department of Health created community-wide health needs survey* Erie County Department of Health led community forum* Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors. Group Interview Participants:Catholic Charities Alzheimer's AssociationBrylin HospitalsHarvest HouseSpectrum Human Services Buffalo State CollegeCommunity Health Center Health and Social ResearchErie County DOH Wellness InstituteAmerican Cancer Society P2 Collaborative of WNYHealthcare Community Consultant City of Buffalo communityPhysician representationErie County Department of Health Community Meeting Participants:FDA Cancer Service Program of Erie CountyBuffalo State College Catholic HealthP2 Collaborative of WNY American Cancer SocietyMonroe Plan UBMDWellness Institute EPICM.E.D.-V.A.R. Consulting KaleidaBuffalo Prenatal-Perinatal Network Erie County DOHUnited Way Prevention Focus Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 6a: Mercy Hospital was conducted with Mercy Ambulatory Care Center Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 6b: Mercy Hospital was conducted with Sisters Hospital and Kenmore Mercy Hospital as well as the Erie County Department of Health. Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 11: Through the needs assessment, numerous areas were identified as important and clearly impact the health of the community. Catholic Health identified the "significant" needs as the New York State Department of Health Prevention Agenda priorities. Within the "priorities", Catholic Health will address numerous health needs as described in the publicly available CHNA report. One priority area was prioritized lower and not addressed in the implementation plan: Promote a Healthy and Safe Environment. Contributing to this lower priority was lack of available funds and potential for less impact upon the community. Although, should opportunity arise, with resources available to effectively address this need, Catholic Health will reconsider for incorporation in the future. Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 16i: Includes information in both English and Spanish on all signage and brochures for financial assistance. Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 22d: Highest volume commercial payor rate. 8 1 - East Aurora Medical Center 94 Olean St East Aurura NY 14052 Extension Clinic, Therapy-Occupational O/P, Therapy-Physical O/P, Speech La 2 - Mercy Outpatient Clini OBGYN 515 Abbott Road Buffalo NY 14220 Extension Clinic: Prenatal O/P Primary Medical Care O/P 3 - Mercy Comprehensive Care Center 397 Louisana Street Buffalo NY 14202 Extension Clinic: Primary Medical Care O/P, Pediatric O/P, Clinical Laborato 4 - OLV Family Care Center 227 Ridge Road Lackawanna NY 14218 Extension Clinic: Prenatal O/P, Podiatry, Primary Medical Care O/P 5 - Mercy Nursing Facility 55 Melroy Avenue Lackawanna NY 14218 Long Term Care: Clinical Laboratory Servoce O/P, Radiology- Diagnostic O/P 6 - Pace Health Center 55 Melroy Avenue Lackawanna NY 14218 Extension Clinic: Therapy Occupational O/P, Therapy Physical O/P, Primary Me 7 - Mercy Ambulatory Care Center 550 Orchard Park West Seneca NY 14224 CT Scanner, Clinical Laboratory Service O/P, Primary Medical Care O/P, Radio 8 - Springville Primary Care Center 27 Franklin Street Springville NY 14141 Pediatric O/P, Primary Medical Care O/P, Prenatal O/P Part I, Line 6a: Mercy Hospital Community Benefit Report is contained in the annual report prepared by the Catholic Health System. Part I, Line 7: Costing is a full step down methodology of cost from non-revenue producing departments to revenue producing departments', with assignment of cost to individual charge items based on volume and charge amount. All patient accounts are cost with the same methodology regardless of patient type (inpatient, outpatient, emergency room, etc.) or insurance coverage (Medicare, Medicaid, private insurance, uninsured, etc.). Part II, Community Building Activities: Community Building Activities for Mercy Hospital included Community Support - Boards and Advisory Councils for $5,227. Part III, Line 2: The amount in Part III line 2 is the actual bad debt expenses of $9,175,208. The amount in Part III line 3 is the estimate of bad debt from uninsured balance which is developed as follows: as policy is to write accounts to bad debt 120 days after discharge, the discharge date period of 10/1/2014 to 9/30/2015 was used to determine the population of uninsured accounts. The balance of these accounts was determined and the RCC was applied to develop the estimate in H Part III Line 3. As our determination of eligibility for the Healthcare Assistance Program (HAP) (Charity Care) is based solely on the presentation for care without insurance, which is now for each account, and use of a sophisticated estimator (PARO) of each guarantor's ability to pay an estimate of "the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy if sufficient information had been available to make a determination of their eligibility" is not relevant. The organization's financial statements do not include a footnote that describes bad debt expense, but the financial statements account for bad debt expenses in the statement of operations as actual expenses written off and an estimate of future write-offs less any recoveries. Part III, Line 4: The hospital does not have a footnote that describes bad debt in the financial statements. Part III, Line 8: Mercy Hospital does not treat Medicare shortfall as a community benefit, as serving Medicare patients is not a differentiating feature of tax-exempt healthcare organizations. The existing community benefit framework allows community benefit programs that serve the Medicare population to be counted in other community benefit categories. Part III, Line 9b: The hospital's collection policies contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance. The hospital has implemented billing and collection practices for patient payment obligations that are fair, consistent, and compliant with state and federal regulations and no extraordinary collection practices are followed. Part VI, Line 2: In addition to its CHNA, Catholic Health utilizes multiple methods to assess the health care needs of the communities it serves, including:* Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors seeking input on other programs or topics of interest participants would like to see. Based on this feedback, program planners meet with service line leaders to develop programs or workshops that match community interest/need;* Input from physician community during doctor to doctor education programs. Based on this feedback, program planners meet with service line leaders to develop physician continuing education programs that address gaps in care or other pressing community health needs. * Patient, resident and caregiver satisfaction surveys conducted in our hospitals, health centers, nursing homes and among our home care patients, help alert us to health care needs among our patient population; * Physician and leadership participation in community boards, coalitions and forums to define the health needs of patient populations and seek community solutions; * Surveys conducted among high risk, high need Medicaid populations through our collaborative Health Home Program help alert us to the needs of individuals with developmental disabilities and behavioral health issues; * Participation in regional planning initiatives that look at the needs of the broader community; * Information management obtains from administrative data and payer mix to assist in evaluating the health needs and trends of the community; and* Input from Catholic Health Board including Board Committee (e.g. Mission Integration Committee). Part VI, Line 3: Catholic Health's Mercy Hospital, Sisters Hospital and Kenmore Mercy Hospital inform and educate patients and persons who may be billed for medical services about their eligibility for assistance under federal, state, or local government programs or our own Healthcare Assistance Program (HAP) in a variety of ways. For example, Sisters Hospital, like our other facilities, has posters and brochures available, which include eligibility and contact information for the Financial Clearance staff. This information is available in admissions areas, emergency rooms, primary care and outpatient rehabilitation centers, the Revenue Management Center (RMC) and other areas throughout Catholic Health where eligible patients and family members are likely to be present. Catholic Health also provides information about financial assistance and HAP contact information to patients as part of the intake process and during or within 90 days of their discharge from the hospital. To further assist patients, all patient bills include the following language: "The Catholic Health System has a Healthcare Assistance Program to assist those in need of financial assistance for qualified patients. If you would like to obtain additional information on the Healthcare Assistance Program, please call (716) 601-3600. Thank you." For free, confidential assistance in applying for financial aid, patients can also call our Financial Clearance department at 716-601-3600. A counselor will work with them to see if they qualify for free or low-cost insurance or other financial assistance. For patients who do not have insurance and need care at a Catholic Health hospital, a registration clerk will also assist them in applying for assistance at the time of registration. Interpreting services are also available for patients who do not speak English. Additionally, as part of our case management services, we discuss with patients the availability of various government benefits, such as Medicaid or other state and federal programs, and assist patients and families with eligibility and applications when necessary. There is also information about our financial assistance program in our patient handbooks and posted on the Catholic Health System website. Part VI, Line 4: The System's primary service area is Erie County, which accounts for 90% of its inpatient admissions and 85% of ambulatory care visits. Erie County consists of a mix of urban, suburban and rural populations, with about one-third of the population residing in the City of Buffalo. Buffalo is New York State's second largest city, surrounded by a ring of older suburbs. Beyond the first ring suburbs are newer suburban communities and established rural communities. The current population of Erie County is over nine hundred thousand.Erie County is less racially and ethnically diverse than New York State or the rest of the country, and the Non-White populations are concentrated in and immediately around the City of Buffalo. All of the 11 zip codes in Erie County that have a Non-White population of 50% or more are in Buffalo. Part VI, Line 5: One of the fundamental reasons for the creation of Catholic Health was to ensure the continued viability of faith-based health care to meet the needs of residents in Erie County and the surrounding communities. Our Mission Statement - We are called to reveal the healing love of Jesus to those in need - further articulates why we exist. Integral to this effort is caring for the needs of those who are poor and disadvantaged. The services provided by Catholic Health are in response to identified community needs, and reflect the System's emphasis on caring for the underserved. Catholic Health collaborates with other charitable organizations and social service agencies (i.e. Catholic Charities Spectrum Human Services, Evergreen Health Services, Erie County Department of Health, etc.) , to maximize its ability to provide needed services to the residents of our region.The governing Board of Directors of (Mercy Hospital, Sisters Hospital, and Kenmore Mercy Hospital) is comprised of community representatives from universities, legal communities, and business leaders. Religious orders are represented, as well as active and retired medical staff members. The (Mercy Hospital, Sisters Hospital, Kenmore Mercy Hospital) medical staff is considered an "open" medical staff, as any physician can apply for privileges. Each application is reviewed by a vigorous credentialing verification process. The hospitals have robust health professional education programs. Mercy Hospital and Sisters Hospital are physician teaching facilities. All sites participate in teaching programs for other allied health professionals. Our five emergency departments are open to all people regardless of their ability to pay. Our primary care centers are strategically located in areas deemed economically disadvantaged or where other medical services are lacking. Each year, Catholic Health touches tens of thousands of area residents through its community health education programs, health screenings, clinical and support services, and community service activities. Most of these program are free to encourage participation by people from all walks of life. Catholic Health will continue to meet community needs by providing charity care to the uninsured and underinsured, traditional Medicaid services, and community benefit programs, including collaborative community health improvement initiatives, health professional education programs, volunteering and community service activities, and cash and in-kind contributions to community organizations that serve the poor and disadvantaged. In 2015, the Catholic Health System provided more than $95 million in charity care and community benefit activities to help make our community a healthier place, especially for the poor and underserved. These activities included: " Spearheading Project Homeless Connect - An outreach initiative to link homeless individuals and families with medical and other support services; " Supporting charitable and educational organizations, like the Buffalo City Mission, Friends of Night People, and the Health Science Charter School that help the poor and vulnerable in our community; " Hosting numerous health education and screening programs to help people learn their health risks and take steps to improve their health; " Offering a Healthcare Assistance Program to ensure that people without insurance or financial means get the care they need; " Providing health and wellness information in places of worship through our Faith Community Nursing program; " Helping refugees access quality medical care through our Primary Care and School Based Health Centers, including the Mercy Comprehensive Care Center in Buffalo's Old First Ward; " Providing free care and services to those in need, like our "Cribs for Kids" program, which helps families provide a safe sleeping environment for their newborns; " Supporting children and families in need through our Reach Out and Read Program; Backpack Program for Kids; and Bridget Closet (clothes for the needy);" Sponsoring programs at the Mercy Comprehensive Care Center, which serve the local community, including refugees from Burma, Somalia, the Middle East, and Nepal ; " Providing services through our Social Work Department, which link patients with necessary services including: ESL (English as a Second Language), job opportunities, substance abuse treatment, health care navigators, senior services, insurance information, parenting assistance and more; and " Supporting nationally recognized "green" initiatives to remain good stewards of our natural resources and protect the environment. Part VI, Line 6: In 2013, Catholic Health (the System), including Kenmore Mercy Hospital, Mercy Hospital of Buffalo, Sisters of Charity Hospital, and Sisters of Charity Hospital St. Joseph Campus, jointly conducted a Community Health Needs Assessment (CHNA) to better understand the health needs of the community they serve and to fulfill the requirements of both the Internal Revenue Service (IRS) and the New York State Department of Health (DOH). To ensure the assessment was comprehensive, input from the public and several community organizations was solicited. As part of this coordinated initiative, the System developed a three-year Implementation Strategy to address the health needs identified in the assessment. Part VI, Line 7, Reports Filed With States NY X X X X X X 0 1 0 0 0 0 0 0 0 Mark Sullivan Executive VP / COO 0 504363 0 208657 0 118301 0 112959 0 22004 0 966284 0 0 Charles Urlaub President, and CEO Mercy 387430 0 40588 0 35067 0 15442 0 20684 0 499211 0 0 0 David Macholz Treasurer 0 210123 0 110699 0 8756 0 1925 0 22278 0 353781 0 0 Peter Bergmann Director 0 403467 0 63731 0 28302 0 3149 0 20407 0 519056 0 0 James Millard Director 0 330959 0 71925 0 17067 0 23675 0 10997 0 454623 0 0 Gary Tucker Director 0 243236 0 173623 0 23266 0 43271 0 25519 0 508915 0 0 Joyce Markiewicz Director 0 280167 0 70559 0 17095 0 14186 0 21171 0 403178 0 0 Dr Michael Edbauer Director 0 238222 0 111206 0 13495 0 59456 0 11231 0 433610 0 0 Joseph McDonald President and CEO, CHS 0 834985 0 536131 0 211799 0 180650 0 24254 0 1787819 0 0 James A Dunlop Jr Executive VP, Finance / CFO 0 501920 0 315368 0 70314 0 89631 0 20985 0 998218 0 0 Dr Brian D'Arcy Senior VP, Medical Affairs 0 440939 0 95588 0 52386 0 65094 0 21630 0 675637 0 0 Eddie Bratko Chief Operating Officer, Mercy 137226 0 19501 0 86 0 2530 0 19702 0 179045 0 0 0 Michael Moley Sr.VP, Human Resources 0 351252 0 175656 0 161030 0 82554 0 22926 0 793418 0 0 Dr Michael Galang Sr. VP/Chief Information Officer 0 343441 0 149570 0 16707 0 78087 0 2918 0 590723 0 0 Nancy Sheehan SVP Legal Service, General Counsel 0 290590 0 72446 0 17067 0 43525 0 9403 0 433031 0 0 Dr Thomas Raab Physician 477904 0 12000 0 1188 0 48190 0 22451 0 561733 0 0 0 Dr Timothy Gabryel VP Medical Affairs 406672 0 24060 0 16788 0 26276 0 8453 0 482249 0 0 0 Maria Foti Sr. VP, Strategic Planning 0 232624 0 98515 0 16707 0 54191 0 8896 0 410933 0 0 Dr Mark Adkins Physician 845702 0 75000 0 1188 0 7953 0 20162 0 950005 0 0 0 Dr Joseph Polcaro Physician 392854 0 0 0 414 0 0 0 22410 0 415678 0 0 0 Dr Stephen Downing Physician 614142 0 150000 0 41839 0 13964 0 24333 0 844278 0 0 0 Dr Ahmet Guler Physician 325083 0 35000 0 8738 0 2516 0 20021 0 391358 0 0 0 Dr Syed Shah Physician 516346 0 50000 0 8990 0 12768 0 19929 0 608033 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. Pension Gap Joseph McDonald 26,000.00 Mark Sullivan 19,500.00 Dr. Brian D'Arcy 9,800.00 Peter Bergmann 7,334.00 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. A Dormitory Authority of the State of New York 146000293 64983Q5R6 2006-11-29 13360000 See Part VI 0 0 0 B Dormitory Authority of the State of New York 146000293 64983Q5D9 2008-11-26 24700000 See Part VI 0 0 0 C Dormitory Authority of the State of New York 146000293 649906J96 2012-07-12 3080000 See Part VI 0 0 0 D Buffalo and Erie County Industrial Land Development Corporation 222413596 NoneAvail 2015-04-30 10020000 See Part VI 0 0 0 A 13360000 537015 79065 12743920 2006 1 0 1 1 B 24700000 111729 1150457 220774 23217040 2010 0 0 1 1 C 3080000 206564 110012 2763424 2013 0 0 0 1 D 11104100 731557 246262 325682 4292503 5508096 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 1 1 1 0 0.03450 0.00000 0.03450 0 0 1 A 1 1 1 HSBC Bank NA 18.500000000000 0 1 0 0 1 B 1 1 1 HSBC Bank NA 25.600000000000 0 0 0 1 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Part I A (f) Description of Purpose: To refinance outstanding commercial indebtedness, the proceeds of which were applied to finance the cost of Mercy's operating room expansion, other expansions/improvements at the facility. Part I B (f) Description of Purpose: To finance the cost of an approximately 48,300 square foot addition for a new emergency department, new CT/Radiology facilities, construction of a new main entrance and lobby area, a new ambulance entrance, construction of a rooftop helipad, renovation of library space into conference rooms, other mechanical and electrical improvements and associated demolition and equipping costs. Part I C (f) Description of Purpose: To finance the cost of improvements to Mercy's existing approximately 381,000 square foot parking facility. Part IV 4 (e) The interest rate swap through HSBC Bank associated with the 2006 series were unwound and terminated on 11/26/14. Part I D ( c ) CUSIP #: The 2015 Bond Series were issued under numerous CUSIP #s with varying maturity dates. The associated CUSIP #s are as follows: 11943KBH4, 11943KBJ0, 11943KBK7, 11943KBL5, 11943KBM3, 11943KBN1, 11943KBP6, 11943KBQ4, 11943KBR2, 11943KBS0, 11943KBT8, 11943KBU5, 11943KBV3, 11943KBW1, 11943KBX9, 11943KBY7. Part I D (f) Description of Purpose: To finance the costs associated with improvements to the Labor & Delivery Department, Pre/Post Operative Holding areas, and upgrading the electrical switchgear at Mercy Hospital of Buffalo. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 80304 Corporate Nurse educator 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 65837 HR Employee of CHS 0 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 B, Line 16: The Catholic Health System has a process to evaluate its participation in joint venture arrangements under applicable federal tax law, and has taken steps to safeguard the organization's exempt status with respect to such arrangements, and has developed a formal policy to formalize the process. 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 11,857,216. Equity Transfer to Affiliates -10,237,979. Change in Interest in Foundation Restricted -42,249. Change in Interest in Foundation Unrestricted 107,286. Interest Rate Swap Adjustment -38,298. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501 c 3 Schedule A line 9 N/A 0 Sisters of Charity Hospital 2157 Main Street Buffalo NY 14214 160743187 Acute Care Hospital NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore NY 14217 160762843 Acute Care Hospital NY 501 c 3 Schedule A 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 Schedule A 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 Schedule A 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 Schedule A 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 Schedule A line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501 c 3 Schedule A 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 Schedule A 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 Schedule A line 9 Catholic Health System Inc 0 McAuley Seton Home Care 144 Genesee Street Buffalo NY 14203 161310062 Home Care Provider NY 501 c 3 Schedule A 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 Schedule A line 9 Catholic Health System Inc 0 OLV Renaissance Corporation 144 Genesee Street Buffalo NY 14203 200167745 Real Estate Holding Company NY 501 c 3 Schedule A 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 Schedule A 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 Schedule A line 11 Catholic Health System Inc 0 Mercy Hospital Foundation 515 Abbott Road Buffalo NY 14220 222209721 Foundation NY 501 c 3 Schedule A line 7 Mercy Hospital 0 Southtowns Catholic MRI Inc 200 International Drive Buffalo NY 14221 161554081 Imaging NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 KMH Homes Inc 144 Genesee Street Buffalo NY 14203 161387890 Real Estate Holding Company NY 501 c 3 Schedule A 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 Schedule A line 3 Catholic Health System Inc 0 OLV-Brierwood Healthcare Co LLC 6455 Lake Avenue Orchard Park NY 14127 161487207 Rental Real Estate NY N/A Related 22573 196641 0 0 Orchard Park Mercy Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161470350 Real Estate Holding Company NY Mercy Hospital C 138912 1.00000 0 Aurora Mercy Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161354302 Real Estate Development NY Mercy Hospital C 16913 1.00000 0 Alsace Abbott Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161355092 Partnership Holding Corporation NY Mercy Hospital C 364129 1.00000 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 Orchard Park Mercy Corporation Q 0