2015-10-28T12:48:12-05:00 2014-12-31 990 2014-01-01 160743154 ST ELIZABETHS HOME FOR THE AGED STEL 7168282974 144 GENESEE STREET4TH FLOOR-FINANCE BUFFALO NY 14203 DAVID P MACHOLZ VP FINANCE/CORPCONTROLLER 7168282794 2015-10-28 2014 2016-02-25 16:41:14Z JOSEPH MCDONALD ADMINISTRATION-6TH FLOOR144 GENESEE ST BUFFALO NY 14203 1990991 0 X CHSBUFFALO.ORG X 1959 NY THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM 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 2014 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 28 20 80 48 0 0 0 0 2046567 1976474 -4720 1219 10043 13298 2051890 1990991 0 0 0 0 2177127 2036962 0 0 0 697023 741944 2874150 2778906 -822260 -787915 4003426 3228550 4161954 4365134 -158528 -1136584 X THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM 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 2014 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 0 0 2261485 1989772 NURSING HOME CARE: ST ELIZABETHS HOME IS AN ADULT NURSING FACILITY THAT TENDS PRIMARILY TO THE POOR AND ELDERLY AND IS LOCATED IN ERIE COUNTY, NEW YORK. IN 2014 OVER 52.61% OF THE RESIDENTS WERE COVERED BY MEDICAID. THIS 52.61% MEDICAID POPULATION EQUALLED 20,537 MEDICAID DAYS. SEE COMMUNITY SERVICE PLAN AT WWW.CHSBUFFALO.ORG. 2261485 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 5 0 1 80 1 0 0 0 0 0 0 0 0 X 28 20 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 STREET4TH FLOOR-FINANCE BUFFALO NY 14203 JOSEPH MCDONALD PRESIDENT AND CEO, CHS 37.50 X X 0 1344183 55937 MARK SULLIVAN EXEC VP/COO 37.50 X X 0 716018 47406 EDWARD FLYNN DIRECTOR 1.00 X 0 0 0 JOYCE MARKIEWICZ PRESIDENT & CEO HOME AND COMMUNITY BASED CARE 37.50 X X 0 336389 49581 MARK MEYERHOFER DIRECTOR 1.00 X 0 0 0 JAMES MILLARD DIRECTOR 37.50 X 0 360108 217116 ROBERT NASSO DIRECTOR 1.00 X 0 0 0 SHERRY POMEROY PHD RN DIRECTOR 1.00 X 0 0 0 SR MARY ANNE WELDON DIRECTOR 1.00 X 0 0 0 MONSIGNOR ROBERT E ZAPFEL DIRECTOR 1.00 X 0 0 0 DAVID MACHOLZ OFFICER/DIRECTOR 37.50 X X 0 253185 42733 CHARLES J URLAUB OFFICER/DIRECTOR 37.50 X X 0 500168 48207 DRMICHAEL EDBAUER DIRECTOR 18.80 X 0 306246 23873 PETER BERGMANN DIRECTOR 37.50 X 0 521653 39456 LOUIS BAUMANN MD DIRECTOR 1.00 X 0 0 0 BRIAN BEITZ DIRECTOR 1.00 X 0 0 0 FRANCES CROSBY RN PHD DIRECTOR 1.00 X 0 0 0 RICHARD CURRAN MD DIRECTOR 1.00 X 0 0 0 JOHN DAVANZO DIRECTOR 1.00 X 0 0 0 DENNIS DOMBEK DIRECTOR 1.00 X 0 0 0 DAVID DURANTE MDDAVID DURANTE MD DIRECTOR 18.80 X 0 113038 0 JOSEPH GELORMINI MD DIRECTOR 1.00 X 0 0 0 WILLIAM LAWLEY JR DIRECTOR 1.00 X 0 0 0 LI LIN PHD CHAIRMAN OF MINISTRY SERVICES 1.00 X 0 0 0 JUDITH MANESS DIRECTOR 1.00 X 0 0 0 JAMES MANZELLA DIRECTOR 1.00 X 0 0 0 RAQUEL MARTIN DO DIRECTOR 1.00 X 0 0 0 MICHAEL MONTANTE DIRECTOR 1.00 X 0 0 0 ROBERT NASSO DIRECTOR 1.00 X 0 0 0 MARK PODLAS MD DIRECTOR 1.00 X 0 0 0 DONALD SLATE MD DIRECTOR 1.00 X 0 0 0 MARY TURKIEWIECZ MD DIRECTOR 1.00 X 0 0 0 SR MARY ANNE WELDON DIRECTOR 1.00 X 0 0 0 CYNTHIA ZANE EDD DIRECTOR 1.00 X 0 0 0 JAMES A DUNLOP JR EXEC VP, FINANCE/CFO 37.50 X 0 610886 180721 JUDITH HUMES ADMINISTRATOR 37.50 X 107555 0 30310 MICHAEL MOLEY SR. VP HUMAN RESOURCES 37.50 X 0 602383 52698 JOHN STAVROS SR. VP MARKETING 37.50 X 0 299464 45380 BARTHOLOMEW RODRIGUES SR. VP MISSION INTEGRATION 37.50 X 0 256461 42237 DR MICHAEL GALANG CIO 37.50 X 0 415734 36231 NANCY SHEEHAN VP LEGAL SVC, OGC 37.50 X 0 340246 41133 MARIA FOTI SR. VP, STRATEGIC PLANNING 37.50 X 0 302471 40116 CHRISTINE KLUCKHOHN FORMER-PRES/CEO, CONTINUING CARE 37.50 X 0 289537 123443 107555 7568170 1116578 1 1 1 0 NURSEFINDERS PO BOX 910738 DALLAS TX 75391 NURSING SERVICES 269612 1 PRIVATE AND SSI 623000 1976474 1976474 1976474 1219 1219 MISC 900099 8554 8554 VENDING INCOME 900099 4744 4744 13298 1990991 1989772 0 1219 137865 137865 1513897 1341865 172032 293095 260496 32599 92105 74825 17280 49943 7200 42743 108150 108150 -45402 4173 -49575 PURCHASE SERVICES 298393 181790 116603 SUPPLIES 221102 217018 4084 BAD DEBTS EXPENSE 62308 62308 47450 3660 43790 2778906 2261485 517421 0 121344 49081 334040 399995 812847 85694 3928235 3399529 581327 528706 2153868 2165074 4003426 3228550 358496 283324 3803458 4081810 4161954 4365134 X -158528 -1136584 -158528 -1136584 4003426 3228550 X -787915 -190141 X 0 1 X 1 0 X 2208397 2185660 2167800 2056610 1989772 10608239 2208397 2185660 2167800 2056610 1989772 10608239 0 0 0 10608239 1378 1328 1096 3167 1219 8188 1378 1328 1096 3167 1219 8188 2209775 2186988 2168896 2059777 1990991 10616427 0.99920 0.99930 0.00080 0.00070 X 857600 833649 23951 3070635 2565880 504755 528706 DUE FROM AFFILIATE 2165074 2165074 LONG TERM PENSION OBLIGATION 974556 ASSET RETIREMENT OBLIGATION 141626 OTHER LONG TERM LIABILITIES 122865 DUE TO AFFILIATES 2842763 4081810 X X X X X X 1 1 0 0 0 0 0 1 0 JOSEPH MCDONALD PRESIDENT AND CEO, CHS 0 748734 0 280841 0 314608 0 34856 0 21081 0 1400120 0 0 MARK SULLIVAN EXEC VP/COO 0 467326 0 113773 0 134919 0 28266 0 19140 0 763424 0 0 JOYCE MARKIEWICZ PRESIDENT & CEO HOME AND COMMUNITY B 0 263677 0 33005 0 39707 0 31253 0 18328 0 385970 0 0 JAMES MILLARD DIRECTOR 0 271916 0 48125 0 40067 0 216802 0 314 0 577224 0 0 DAVID MACHOLZ OFFICER/DIRECTOR 0 195706 0 31223 0 26256 0 22835 0 19898 0 295918 0 0 CHARLES J URLAUB OFFICER/DIRECTOR 0 369957 0 72644 0 57567 0 29025 0 19182 0 548375 0 0 DRMICHAEL EDBAUER DIRECTOR 0 228520 0 52981 0 24745 0 13975 0 9898 0 330119 0 0 PETER BERGMANN DIRECTOR 0 391424 0 84427 0 45802 0 20550 0 18906 0 561109 0 0 JAMES A DUNLOP JR EXEC VP, FINANCE/CFO 0 400137 0 123435 0 87314 0 162397 0 18324 0 791607 0 0 MICHAEL MOLEY SR. VP HUMAN RESOURCES 0 331461 0 85478 0 185444 0 33027 0 19671 0 655081 0 0 JOHN STAVROS SR. VP MARKETING 0 213088 0 44797 0 41579 0 24145 0 21235 0 344844 0 0 BARTHOLOMEW RODRIGUES SR. VP MISSION INTEGRATION 0 170867 0 45920 0 39674 0 23834 0 18403 0 298698 0 0 DR MICHAEL GALANG CIO 0 326118 0 49909 0 39707 0 28978 0 7253 0 451965 0 0 NANCY SHEEHAN VP LEGAL SVC, OGC 0 291960 0 28135 0 20151 0 33594 0 7539 0 381379 0 0 MARIA FOTI SR. VP, STRATEGIC PLANNING 0 214638 0 48282 0 39551 0 33051 0 7065 0 342587 0 0 CHRISTINE KLUCKHOHN FORMER-PRES/CEO, CONTINUING CARE 0 0 0 0 0 289537 0 106137 0 17306 0 412980 0 0 PART I, LINES 4A-B CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PER THE TERMS AND CONDITIONS OF THEIR EMPLOYMENT CONTRACT. PENSION GAP SERP JOSEPH MCDONALD $26,000 $117,093 MARK SULLIVAN $19,500 PETER BERGMANN $ 7,334 A SEVERANCE PAYMENT OF $288,763 WAS MADE FOR CHRISTINE KLUCKHOHN, AN ASSOCIATE WHO WAS LISTED IN PART 1A. PART I, LINE 7 EXECUTIVE MANAGEMENT EMPLOYED BY CATHOLIC HEALTH ARE COMPENSATED UNDER A MULTI-TIERED, GOAL-BASED PROGRAM WHICH INCLUDES BASE PAY AND A VARIABLE PORTION. THE VARIABLE PORTION IS REFERRED TO AS "AT RISK COMPENSATION." EACH OF THE ELIGIBLE MEMBERS OF EXECUTIVE MANAGEMENT IS ASSIGNED PERFORMANCE GOALS ALIGNED WITH ORGANIZATIONAL STRATEGIC GOALS. EACH GOAL HAS MINIMUM THRESHOLD CRITERIA, TARGET CRITERIA AND A MAXIMUM. JAMES MANZELLA ACUTE CARE BOARD MEMBER 161739 KEY EMPLOYEE OF MANZELLA MARKETING 0 SUSAN URLAUB WIFE OF MERCY CEO,C.J. URLAUB 82776 CORPORATE NURSE EDUCATOR 0 KATHLEEN ZAPFEL SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL 70537 HR EMPLOYEE OF CHS 0 MARIE PACKARD DAUGHTER OF BOD,DENNIS DOMBEK 84949 MERCY PHYSICAL THERAPIST 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 CATHOLIC HEALTH SYSTEM 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. SCHUDULE H: HOSPITAL 5. SCHUDULE 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 IT 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 THE 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 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; COO; CFO; CEO'S FOR EACH MINISTRY; AND ALL SENIOR VICE PRESIDENTS. THE COMPENSATION COMMITTEE PROVIDES OVERSIGHT TO MANAGEMENT DECISIONS WHICH ARE BASED ON OUTLINES APPROVED BY THE COMMITTEE, AND PERFORMS A REVIEW OF DATA. THE OUTCOME OF THESE MEETINGS IS DOCUMENTED. 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 -211,670. DONATION FOR CAPITAL ASSETS 21,529. FORM 990, PART VI, SECTION B, LINE 16B 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 FORMAIZE THE PROCESS. CATHOLIC HEALTH SYSTEM INC 144 GENESEE STREET BUFFALO NY 14203 222565278 HEALTH CARE DELIVERY SYSTEM NY 501(C)(3) LINE 9 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 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 MCAULEY SETON HOME CARE 144 GENESEE STREET BUFFALO NY 14203 161310062 HOME CARE PROVIDER NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 CATHOLICE HEALTH SYSTEM INFUSION PHARMACY INC 2875 UNION ROAD SUITE 14 CHEEKTOWAGA NY 14227 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 LACKAWANA 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 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1