2015-10-28T14:28:37-05:00 2014-12-31 990 2014-01-01 160743187 Sisters of Charity Hospital SIST 7168282974 144 Genesee St Finance 4th Fl BUFFALO NY 14203 David Macholz President and CEO 7168282974 2015-04-24 2014 2016-02-25 16:41:14Z Joseph D McDonald 144 Genesse Street Buffalo NY 14203 325677806 0 X www.chsbuffalo.org X 1849 NY The Catholic Health System Mission is to provide quality healthcare services in an acute 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. 24 16 2607 740 0 0 122828 1282534 315493950 317819721 263159 270223 8332921 6305328 324212858 325677806 0 0 0 0 153563523 153947466 0 0 0 163954327 164172668 317517850 318120134 6695008 7557672 298093662 304757941 185005387 218281686 113088275 86476255 None 0 0 150409433 200931096 Inpatient Services:70,564 Acute Care Patient Days18,995 Newborn Patient Days28,402 Skilled Nursing Patient Days5,719 I/P Ambulatory Surgeries 79924656 106920326 Outpatient Services:61,596 ED Visits net of Admits280,141 Referred Ambulatory Visits10,192 Operating Room7,843 G.I. Laboratory1,738 Interventional Radiology (IXR)489 Windsong ASU595 Ambulatory Surgery Center357 Transfusion 7491554 9968300 Primary Care Clinics:24,632 Clinic/Prmiary Care Center Visits321,019 Substance Visits 237825643 1 1 0 0 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 1 0 0 0 0 0 1 0 0 0 1 261 0 2607 1 0 0 0 0 0 0 0 0 X 24 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X David Macholz VP Finance Corporate Controller Catholic 7168282974 Health- 144 Genesee StreetFinance Buffalo NY 14203 Joseph McDonald President and CEO, CHS 1.00 37.50 X X 0 1344183 55937 Mark Sullivan Executive VP/COO 1.00 37.50 X X 0 716018 47406 Peter Bergmann President and CEO, Sisters 37.50 X X 521653 0 39456 David Macholz Treasurer 1.00 37.50 X X 0 253185 42733 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 MD Director 1.00 18.80 X 0 113038 0 Dr Michael Edbauer Director 1.00 18.80 X 0 306246 23873 Joseph Gelormini MD Director 1.00 X 0 0 0 Mr William LawleyJr 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 Joyce Markiewicz Director 1.00 37.50 X 0 336389 49581 Raquel Martin DO Director 1.00 X 0 0 0 James Millard Director 1.00 37.50 X 0 360108 217116 Michael Montante Director 1.00 X 0 0 0 Mark Podlas MD Director 1.00 X 0 0 0 Sherry Pomeroy PHD 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 Charles J Urlaub Director 1.00 37.50 X 0 500168 48207 Cynthia Zane EdD Director 1.00 X 0 0 0 Monsignor Robert E Zapfel Director 1.00 X 0 0 0 James A Dunlop Jr Executive VP, Finance/CFO 1.00 37.50 X 0 610886 180721 Dr Brian D'Arcy Senior VP, Medical Affairs 1.00 37.50 X 0 528516 49956 Martin Borzyak COO, Sisters/SJC 37.50 X 199988 0 26039 Michael Moley Sr.VP, Human Resources 1.00 37.50 X 0 602383 52698 John Stavros Sr.VP, Marketing/P.R 1.00 37.50 X 0 299464 45380 Maria Foti Sr. VP Strategic Planning 1.00 37.50 X 0 302471 40116 Dr Michael Galang Chief Information Officer 1.00 37.50 X 0 415734 36231 Nancy Sheehan SVP Legal Service, General Counsel 1.00 37.50 X 0 340246 41133 Richard J Ruh MD Sr. VP Service lines 1.00 37.50 X 0 490180 43760 Dr Nady Shehata VP, Medical Affairs 37.50 X 329467 0 51046 Dr Ali Ghomi Physician 37.50 X 458155 0 32160 Dr Bruce Rodgers Physician 37.50 X 370901 0 24845 Dr Anthony Pivarunus Physician 37.50 X 355397 0 220931 Dr Margaret McDonnell Physician 37.50 X 334867 0 48681 Dr Jack R Lawler Physician 37.50 X 312726 0 22008 Christine Kluckhohn Pres. & CEO Continuing Care 0.00 0.00 X 0 289537 123443 2883154 7808752 1563457 100 1 1 0 SOdexho Inc & Affiliates PO Box 81049 Woburn MA 01813 Environmental Services 2744833 Buffalo Medical Group 85 High Street Buffalo NY 14203 Physician Services 2558736 Quest Diagnostics 2178 Collection Center Drive Chicago IL 60693 Laboratory Services 1575000 R & P Oak Hill Development Corporation 3556 Lakeshore Road Buffalo NY 14219 Construction Services 1502124 Atlas Healthcare Line Services 60 Grider Street Buffalo NY 14127 Laundry Services 894163 65 1282534 1282534 Patient Services 900099 177123662 177123662 Medicaid/Medicare 900099 140696059 140696059 317819721 270223 270223 785813 0 785813 785813 785813 Shared Services 900099 2599111 2599111 Cafeteria 900099 1128436 1128436 Meaningful Use 900099 933767 933767 858201 858201 5519515 325677806 320418832 0 3976440 119056824 108236144 10820680 7475730 6851684 624046 20846456 18913985 1932471 6568456 5959707 608749 13937 13937 11137332 9050862 2086470 15086 10540 4546 8452290 4220802 4231488 354253 83188 271065 3632263 977808 2654455 77441 64368 13073 128441 122099 6342 1837516 1837516 13110899 13110899 5146670 4754185 392485 Medical Expenses 52247270 53128894 -881624 Shared Services 51550861 51550861 Purchased Services 13970626 8530093 5440533 Non Medical Supplies 2497783 1972869 524914 318120134 237825643 80294491 0 29847 1737371 129874903 126920831 138545 140167 37376147 42153094 6013105 6377952 1536757 1365035 149193435 72936671 74535808 76256764 48588550 49806727 298093662 304757941 39199641 35893871 448112 627297 26894340 29863855 8100755 8342350 110362539 143554313 185005387 218281686 X 110436850 83901801 2528902 2451931 122523 122523 113088275 86476255 298093662 304757941 X 7557672 -34169692 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1958968 1958968 25708857 15760873 9947984 53635031 9162818 44472213 67370276 48012980 19357296 520303 520303 76256764 Other Receivables 2757720 Due from Affiliates 10957141 Workers Comp Funding Surplus 419701 Insurance Recoveries 27293073 Investment in Caritas Medical Arts Building 1821 Investment in Net Assests of the SOC Foundation 8377271 49806727 Due to Affiliates 19813607 Pension Obligation 79235007 Asset Retirement Obligation 2488077 L/T Disposables 2248 L/T General Liability IBNR 26390918 L/T Workers Comp IBNR 15624456 143554313 325865990 1388187 1388187 324477803 1200003 1200003 325677806 319214975 1094841 1094841 318120134 0 318120134 Part XI, Line 2d - Other Adjustments: SOC Foundation Inc Revenue Part XI, Line 4b - Other Adjustments: Contributions from Sisters Hospital Foundation Grant Income Part XII, Line 2d - Other Adjustments: Foundation Expenses less the SOC Foundation Contributions to the Hospital 1 1 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2993589 237535 2756054 0.00870 72377756 53747958 18629798 0.05860 75371345 53985493 21385852 0.06730 1526215 1526215 0.00480 12306904 2324936 9981968 0.03140 709791 709791 0.00220 344295 344295 0.00110 14887205 2324936 12562269 0.03950 90258550 56310429 33948121 0.10680 65800 65800 0.00020 5022 5022 0.00000 70822 70822 0.00020 0 7320473 1468286 47433606 45358630 2074976 X 1 1 2 1 Sisters of Charity Hospital 2157 Main Strret Buffalo NY 14214 X X X X X Amb Surg, Medical/Surgical, Therapy-I/P & O/P, Maternity, Neonatal Care, CT 2 Sisters of Charity Hospital-St Joseph Campus 2605 Harlem Road Cheektowaga NY 14225 X X X X X ED, Clinical Services, Intensive Care, Medical/Surgical, Radiology, O/P Surg Sisters of Charity Hospital 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X http://chsbuffalo.org/Community X http://guidestar.org X 1 14 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 X X X X X X X X 1 X 0 X X X X 1 0 1 Sisters of Charity Hospital Part V, Section B, Line 5: Section CCatholic 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 Association Brylin Hospitals Harvest House Spectrum Human Services Buffalo State College, Center for Community Health Center Health and Social Research Erie County DOH Wellness Institute American Cancer Society P2 Collaborative of WNY Healthcare Community Consultant City of Buffalo community Physician representation Erie County Department of Health Community Meeting Participants FDA Cancer Service Program of Erie County Buffalo State College Catholic Health P2 Collaborative of WNY American Cancer Society Monroe Plan UBMD Wellness Institute EPIC M.E.D.-V.A.R. Consulting Kaleida Buffalo Prenatal-Perinatal Network Erie County DOH United Way Prevention Focus Sisters of Charity Hospital Part V, Section B, Line 6a: Sisters Hospital was conducted with Sisters St. Joseph Campus. Sisters of Charity Hospital 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. 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. Sisters of Charity Hospital Part V, Section B, Line 16i: Includes information in both English and Spanish on all signage and brochures for financial assistance. Sisters of Charity Hospital Part V, Section B, Line 22d: Highest volume commercial payor rate. Sisters of Charity Hospital Part V, Section B, Line 24: There are instances where the full charges on the account are equal to or less than the highest volume commercial payor rate. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Sisters of Charity Hospital Part V, Section B, line 16a website: http://chsbuffalo.org/billing/finance Sisters of Charity Hospital Part V, Section B, line 16b website: http://chsbuffalo.org/billing/finance Sisters of Charity Hospital Part V, Section B, line 16c website: http://chsbuffalo.org/billing/finance 11 Harvey Austin School #97 1405 Sycamore Street Buffalo NY 14211 Clinic: Nursing, O/P, Immunology, Veneral Disease Prevention Pathways Methadone 158 Holden Avenue Buffalo NY 14214 Clinic: Methadone Maintenance O/P Rochester Pathways 79 Howell Street Rochester NY 14614 Clinic: Methadone Maintenance O/P Sisters Hospital STAR Program 1595 Bailey Avenue Buffalo NY 14212 Chemical Dependence St Vincents Health Center 1500 Broadway Avenue Buffalo NY 14212 Clinic: PT O/P, Primary Medical Care O/P, Prenatal O/P Sisters Hospital Star Program 3730 Sheridan Drive Amherst NY 14226 Clinic: Methadone Maintenance O/P, Chemical Dependence-Rehab O/P West Hertel Academy 489 Hertel Avenue Buffalo NY 14212 Clinic: Nursing, O/P, Immunology, Veneral Disease Prevention Southside Elementary School 430 Southside Parkway Buffalo NY 14210 Clinic: Nursing, O/P, Immunology, Veneral Disease Prevention St Catherine Laboure Health Care Center 2157 Main Street Buffalo NY 14214 LTC: Adult Day Healthcare, Clinical Lab Srvc O/P, Radiology-Diagnostic O/P CHS Partners in Rehab 6199 Transit Rd Depew NY 14043 Clinic: Occupational O/P, PT O/P Sisters Central Park Diagnostic Center 34 Benwood Ave Buffalo NY 14214 Clinical Lab Service O/P, Ragiology-Diagnostic O/P Part I, Line 3c: N/A Part I, Line 6a: Sisters Hospital Community Benefit Report is contained in a 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: Sisters Hospital participated in Community Building activities for Community Support of $65,800 and Environmental Improvements of $5,022. Community support included Ebola Readiness Taskforce for $34,245, and Executive Community Board participation of $31,555. Ebola Preparedness included participation in implementing plans associated with preparing the community for Ebola disaster preparedness (such as mental health resources costs associated with training, community partnerships, and outreach planning.) Environment improvements include participation in community pharmaceutical drop-offs. Part III, Line 2: The amount in Part III line 2 is the actual bad debt expenses of $7,320,473 written down to cost. 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 10/1/2013 to 9/30/2014 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: Sisters 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. 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: Catholic Health serves the eight counties of Western New York. 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.At the 2010 Census, the city's population was 50.4% White (45.8% non-Hispanic White alone), 38.6% Black or African-American, 0.8% American Indian and Alaska Native, 3.2% Asian, 3.9% from some other race, and 3.1% from two or more races. 10.5% of the total population was Hispanic or Latino of any race.The median income for a household in the city is $24,536, and the median income for a family is $30,614. The per capita income for the city is $14,991. 26.6% of the population and 23.0% of families are below the poverty line. Out of the total population, 38.4% of those under the age of 18 and 14.0% of those 65 and older are living below the poverty line.Erie County has an average income significantly lower than the national average and has a greater percentage of persons over the age of 55 than New York State and the United States. Erie County's population is projected to decrease between now and 2017, with the greatest decline expected in those ages 35-54, and the greatest increase projected in those 55 and over.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.The loss of traditional jobs in manufacturing, rapid suburbanization and high costs of labor led to the area's economic decline over the last few decades, making Buffalo one of the poorest among major U.S. cities with populations of more than 250,000 people. Recent investments in medical, educational and bio-tech sectors have led to improvements in the local economy. 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 2014, the Catholic Health System provided more than $82 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 1 1 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 Executive VP/COO 0 467326 0 113773 0 134919 0 28266 0 19140 0 763424 0 0 Peter Bergmann President and CEO, Sisters 391424 0 84427 0 45802 0 20550 0 18906 0 561109 0 0 0 David Macholz Treasurer 0 195706 0 31223 0 26256 0 22835 0 19898 0 295918 0 0 Dr Michael Edbauer Director 0 228520 0 52981 0 24745 0 13975 0 9898 0 330119 0 0 Joyce Markiewicz Director 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 Charles J Urlaub Director 0 369957 0 72644 0 57567 0 29025 0 19182 0 548375 0 0 James A Dunlop Jr Executive VP, Finance/CFO 0 400137 0 123435 0 87314 0 162397 0 18324 0 791607 0 0 Dr Brian D'Arcy Senior VP, Medical Affairs 0 391380 0 62250 0 74886 0 30981 0 18975 0 578472 0 0 Martin Borzyak COO, Sisters/SJC 167420 0 21512 0 11056 0 8337 0 17702 0 226027 0 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/P.R 0 213088 0 44797 0 41579 0 24145 0 21235 0 344844 0 0 Maria Foti Sr. VP Strategic Planning 0 214638 0 48282 0 39551 0 33051 0 7065 0 342587 0 0 Dr Michael Galang Chief Information Officer 0 326118 0 49909 0 39707 0 28978 0 7253 0 451965 0 0 Nancy Sheehan SVP Legal Service, General Counsel 0 291960 0 28135 0 20151 0 33594 0 7539 0 381379 0 0 Richard J Ruh MD Sr. VP Service lines 0 357065 0 93408 0 39707 0 23473 0 20287 0 533940 0 0 Dr Nady Shehata VP, Medical Affairs 283136 0 22557 0 23774 0 33674 0 17372 0 380513 0 0 0 Dr Ali Ghomi Physician 366775 0 75000 0 16380 0 14032 0 18128 0 490315 0 0 0 Dr Bruce Rodgers Physician 363463 0 6250 0 1188 0 24456 0 389 0 395746 0 0 0 Dr Anthony Pivarunus Physician 297145 0 40099 0 18153 0 199915 0 21016 0 576328 0 0 0 Dr Margaret McDonnell Physician 334093 0 0 0 774 0 31285 0 17396 0 383548 0 0 0 Dr Jack R Lawler Physician 311538 0 0 0 1188 0 21673 0 335 0 334734 0 0 0 Christine Kluckhohn Pres. & CEO Continuing Care 0 0 0 0 0 289537 0 106137 0 17306 0 412980 0 0 Part I, Line 1a Tax Indemnification and Gross up payments Yes one officer received a tax indemnification and gross-up payment for reimbursement of withholding taxes in conjunction with certain taxable benefits paid on behalf of employee. Part I, Lines 4a-b A severance payment of $288,763.47 was made for Christine Kluckhohn, an associate who was listed in Part 1a. Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Pension Gap Joseph McDonald $26,000.00 Mark Sullivan $19,500.00 Dr, Brian D'Arcy $9,800.00 Peter Bergmann $7,334.00 CHE SERP Joseph McDonald $117,093.00 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. A Dormitory Authority of the State of New York 146000293 64983Q5S4 2006-11-29 30295000 Part VI 0 0 0 B Dormitory Authority of the State of New York 146000293 64983Q5U9 2006-11-29 8435000 Part VI 0 0 0 A 30295000 1120911 179286 28994803 1994 1 0 1 1 B 8435000 341581 49919 8043500 2005 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 1 1 1 HSBC Bank NA 18.500000000000 0 1 0 0 1 B 1 1 1 JP Morgan Chase 18.500000000000 0 1 0 0 1 A 1 B 1 Part 1 A (F) Description of Purpose: To refund Sisters of Charity of Buffalo Insured Revenue Bonds, Series 2003, which were bonds issued for the purpose of refunding a series of bonds issued in 1991, the proceeds of which were applied to finance the construction and renovation of the Sisters of Charity facilities and to refinance outstanding indebtedness. Part I B (f) Description of Purpose: To finance the cost of the St. Joseph Campus emergency room expansion project. 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 govening 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 goverance 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 In 2013, 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: Pension Liability Adjustments -28,096,377. Equity Transfer to Affiliates -5,647,862. Change in unrestricted interest in Net Assets of Sisters Foundation -36,918. Interest Rate Swap Adjustment -311,564. Change in Temporary Restricted interest in Net Assets of Sisters Foundation -76,971. 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 Kenmore Mercy Hospital 2950 Elmwood Ave Buffalo 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 of 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 St 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 Ave Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501(c)(3) Line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Ave 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 Rd Orchard Park NY 14127 161434368 Skilled Nursing Facility NY 501(c)(3) Line 9 Catholic Health System Inc 0 Niagara Homemaker Services 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 Catholic Health System Infusion Pharmacy Inc 6350 Transit Rd Depew NY 14043 200198518 Home Care Infusion Services NY 501(c)(3) Line 9 Catholic Health System Inc 0 CHS Program of All-Inclusive Care for the Elderly Inc 55 Melroy Ave 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 Rd Cheektowaga NY 14225 272576645 Primary Care Provider NY 501(c)(3) Line 11a, I Catholic Health System Inc 0 Sisters Hospital Foundation 2130 Main Street Buffalo NY 14214 222283077 Foundation NY 501(c)(3) Line 7 Sisters of Charity Hospital 0 KMH Homes Inc 291 North Street Buffalo NY 14201 161387890 Real Estate Holding Company NY 501(c)(3) Line 9 Catholic Health System Inc 0 Caritas Medical Arts Building LLC 350 Essjay Road Suite 101 Williamsville NY 14221 161521486 Rental Real Estate NY Related 42054 73785 0 0 0 1 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 1 1