2015-10-29T09:18:36-05:00 2014-12-31 990 2014-01-01 222565278 CATHOLIC HEALTH SYSTEM INC CATH 7168282007 144 GENESEE ST No 4TH FL BUFFALO NY 14203 DAVID P MACHOLZ VP FINANCE, CORP CONTROLLER 7168282974 2015-10-29 2014 2016-04-25 22:37:26Z JOSEPH D MCDONALD 144 GENESEE STREET BUFFALO NY 14203 128271200 0 X WWW.CHSBUFFALO.ORG X 1998 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in 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 2014 Community Service Plan can be found at www.chsbuffalo.org. 19 15 1453 9 0 56897 31736 0 122814570 126255996 31537 348021 726505 1667183 123604348 128271200 0 0 0 0 81439049 79316512 0 0 0 42165299 48300713 123604348 127617225 0 653975 112223659 190071792 92159810 166558179 20063849 23513613 X The Catholic Health System (CHS) Mission is to provide quality healthcare services in 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 2014 Community Service Plan can be found at www.chsbuffalo.org. 0 0 119490459 126255996 The Catholic Health System (CHS) provides administrative support services to the Catholic Health System entities which include: Acute Care, Continuing Care, Home Care, and Primary Care services. The program services are support services that are provided for the benefits of the health care delivery system. These include Compliance, Facility Planning, Finance, Human Resources, Information Technology, Legal Services, Marketing, Revenue Management Center, and other services. More information can be found on the Catholic Health System website www.CHSBUFFALO.ORG. 119490459 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 117 0 1 1453 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 19 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X DAVID P MACHOLZ 7168282974 144 GENESEE STREET 4TH FLOOR BUFFALO NY 14203 JAMES BOLDT CHAIRMAN OF THE BOARD, MAY - OCT 2014 1.00 X 0 0 0 CARLTON BROCK DIRECTOR 1.00 X 0 0 0 WILLIAM J BUSCAGLIA JR CHAIRMAN OF THE BOARD 1.00 X 0 0 0 PEGGY CHOONG PHD DIRECTOR 1.00 X 0 0 0 DENNIS DOMBEK CHAIRMAN OF THE BOARD THROUGH MAY 2014 1.00 X 0 0 0 KEVIN KEENAN DIRECTOR 1.00 X 0 0 0 MARSHA LEWIS PHD DIRECTOR 1.00 X 0 0 0 LI LIN PHD DIRECTOR 1.00 X 0 0 0 JOSEPH MCDONALD PRESIDENT & CEO 37.50 X X 1344183 0 55937 KELLI ARNOLD MCLEOD DIRECTOR 1.00 X 0 0 0 JOHN NATARO MD DIRECTOR 1.00 X 0 0 0 SR PATRICIA PRINZIG DIRECTOR 1.00 X 0 0 0 JACK QUINN JR DIRECTOR 1.00 X 0 0 0 JOSEPH RALABATE MD DIRECTOR 1.00 X 0 111115 0 SHARON RANDACCIO DIRECTOR 1.00 X 0 0 0 ARTHUR RUSS JR DIRECTOR 1.00 X 0 0 0 HONORABLE HUGH B SCOTT DIRECTOR 1.00 X 0 0 0 CYNTHIA ZANE EdD DIRECTOR 1.00 X 0 0 0 MONSIGNOR ROBERT E ZAPFEL DIRECTOR 1.00 X 0 0 0 MARK SULLIVAN EXECUTIVE VP/COO 37.50 X 716018 0 47406 JAMES A DUNLOP JR EXECUTIVE VP FINANCE/CFO 37.50 X 610886 0 180721 DR BRIAN D'ARCY SENIOR VP, MEDICAL AFFAIRS 37.50 X 528516 0 49956 MICHAEL MOLEY SENIOR VP, HUMAN RESOURCES 37.50 X 602383 0 52698 JOHN STAVROS SENIOR VP, MARKETING/P.R. 37.50 X 299464 0 45380 MARIA FOTI SENIOR VP, STRATEGIC PLANNING 37.50 X 302471 0 40116 BARTHOLOMEW RODRIGUES SENIOR VP, MISSION INTEGRATION 37.50 X 256461 0 42237 DR MICHAEL GALANG CHIEF INFORMATION OFFICER 37.50 X 415734 0 36231 NANCY SHEEHAN SENIOR VP, LEGAL SERVICES/GENERAL COUNSEL 37.50 X 340246 0 41133 RICHARD J RUH MD SENIOR VP, SERVICE LINES 37.50 X 490180 0 43760 LEE GUTERMAN MD PHYSICIAN 37.50 X 623006 0 51927 CATALINA IONITA MD PHYSICIAN 37.50 X 441216 0 40929 LEE C RUOTSI MD PHYSICIAN/MEDICAL DIRECTOR 37.50 X 373623 0 42964 JASON JANKOWIAK VP CARDIOVASCULAR SERVICE LINE 37.50 X 311453 0 28973 WILLIAM J LAGALY DO PHYSICIAN 37.50 X 319315 0 36424 CHRISTINE KLUCKHOHN FORMER PRESIDENT & CEO CONTINUING CARE 0.00 X 289537 0 123443 8264692 111115 960235 126 1 1 0 SIEMENS MEDICAL SOLUTIONS USA DEPT AT 40065 ATLANTA GA 311920065 MAINTENANCE SERVICES 6834709 INFOR (US) INC NW 7418 PO BOX 1450 MINNEAPOLIS MN 554857418 CONSULTING SERVICES 3671365 DELOITTE CONSULTING LLP PO BOX 844717 DALLAS TX 752844717 CONSULTING SERVICES 2054761 SOFT COMPUTER CONSULTANTS INC 5400 TECH DATA DRIVE CLEARWATER FL 33760 CONSULTING SERVICES 1384298 HANYS ONE EMPIRE DRIVE RENSSELAER NY 12144 HEALTHCARE SUPPORT SERVICES 1133334 41 ADMINISTRATIVE/CLINICAL 621610 126247587 126247587 8409 8409 126255996 348021 348021 HEALTHHOME PARTNERS 621610 874248 874248 IT SUPPORT SERVICES 561000 663489 663489 MISCELLANEOUS INCOME 900099 68361 68361 61085 61085 1667183 128271200 126255996 0 2015204 6955100 5554980 1400120 55492785 55265192 227593 6018634 5983778 34856 5319547 5298466 21081 5530446 5530446 913081 247789 665292 833694 833694 150900 150900 1712415 1401185 311230 2075602 1910285 165317 409564 401499 8065 19245051 19245051 1901272 1776110 125162 344003 309167 34836 250401 149831 100570 1450714 1450714 4658997 4658997 312673 312673 CONTRACTED SERVICES 7105598 6944384 161214 DUES 4614762 47243 4567519 BANK FEES 371760 371760 TELEPHONE 353492 348615 4877 1596734 1297700 299034 127617225 119490459 8126766 0 31053 117476 27929897 31772885 3689342 4144020 91438977 14214020 14987851 77224957 5378709 5353731 60206807 71458723 112223659 190071792 27319126 27593226 11283006 9211900 53557678 129753053 92159810 166558179 X 17308630 23513613 2755219 0 20063849 23513613 112223659 190071792 X 653975 2795789 X X 0 1 X 1 1 1 X 92795318 103572038 117603442 122166373 126247587 562384758 29265 30947 28180 21680 2290 112362 92824583 103602985 117631622 122188053 126249877 562497120 0 0 0 562497120 22027 20186 19586 20566 35915 118280 22027 20186 19586 20566 35915 118280 57690 55706 45368 76875 437669 673308 92904300 103678877 117696576 122285494 126723461 563288708 0.99860 0.99610 0.00020 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 120000 0 1 30900 150900 0 Part II-B, Line 1: LINE 1i: OTHER LOBBYING ACTIVITIES: CATHOLIC HEALTH SYSTEM, INC. PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, CATHOLIC HEALTH ASSOCIATION, AND THE BUFFALO NIAGARA PARTNERSHIP THAT UTILIZE A PORTION OF THOSE DUES FOR LOBBYING ACTIVITIES. IN 2014, THE LOBBYING COMPONENT OF THESE DUES WAS APPROXIMATELY $30,900. ADDITIONALLY, CHS RETAINS INDIVIDUALS TO ADVOCATE ON BEHALF OF THE CATHOLIC HEALTH SYSTEM, INC. WITH THE NEW YORK STATE LEGISLATURE RELATING TO ISSUES THAT IMPACT THE SYSTEM. COSTS INCURRED IN RELATION TO SUCH ACTIVITIES AMOUNTED TO $120,000 IN 2014. 41376030 1129128 40246902 8222162 547803 7674359 31816960 12537089 19279871 10023825 10023825 77224957 DUE FROM RELATED SUBSIDIARIES 67019474 INSURANCE RECOVERIES 2605274 MISCELLANEOUS RECEIVABLES 1833975 71458723 DUE TO RELATED FACILITIES 14436625 ACCRUED PENSION 53460228 EQUIPMENT CAPITAL LEASES/LOANS 7041742 INSURANCE IBNR 4036688 REGIONAL TRAINING CENTER CAPITAL LEASE 50777770 129753053 X 128271200 0 128271200 0 128271200 127617225 0 127617225 0 127617225 Part X, Line 2: THE FINANCIAL STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES, AS CHS IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. THE TAX-EXEMPT ORGANIZATIONS ARE SUBJECT TO FEDERAL TAXES ON UNRELATED BUSINESS INCOME UNDER SECTION 511 OF THE INTERNAL REVENUE CODE WHICH ARE REPORTED AS OTHER EXPENSES IN THE FINANCIAL STATEMENTS. X X X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 JOSEPH MCDONALD PRESIDENT & CEO 748734 0 280841 0 314608 0 34856 0 21081 0 1400120 0 0 0 MARK SULLIVAN EXECUTIVE VP/COO 467326 0 113773 0 134919 0 28266 0 19140 0 763424 0 0 0 JAMES A DUNLOP JR EXECUTIVE VP FINANCE/CFO 400137 0 123435 0 87314 0 162397 0 18324 0 791607 0 0 0 DR BRIAN D'ARCY SENIOR VP, MEDICAL AFFAIRS 391380 0 62250 0 74886 0 30981 0 18975 0 578472 0 0 0 MICHAEL MOLEY SENIOR VP, HUMAN RESOURCES 331461 0 85478 0 185444 0 33027 0 19671 0 655081 0 0 0 JOHN STAVROS SENIOR VP, MARKETING/P.R. 213088 0 44797 0 41579 0 24145 0 21235 0 344844 0 0 0 MARIA FOTI SENIOR VP, STRATEGIC PLANNING 214638 0 48282 0 39551 0 33051 0 7065 0 342587 0 0 0 BARTHOLOMEW RODRIGUES SENIOR VP, MISSION INTEGRATION 170867 0 45920 0 39674 0 23834 0 18403 0 298698 0 0 0 DR MICHAEL GALANG CHIEF INFORMATION OFFICER 326118 0 49909 0 39707 0 28978 0 7253 0 451965 0 0 0 NANCY SHEEHAN SENIOR VP, LEGAL SERVICES/GENERAL CO 291960 0 28135 0 20151 0 33594 0 7539 0 381379 0 0 0 RICHARD J RUH MD SENIOR VP, SERVICE LINES 357065 0 93408 0 39707 0 23473 0 20287 0 533940 0 0 0 LEE GUTERMAN MD PHYSICIAN 462592 0 160000 0 414 0 31272 0 20655 0 674933 0 0 0 CATALINA IONITA MD PHYSICIAN 424571 0 16375 0 270 0 22871 0 18058 0 482145 0 0 0 LEE C RUOTSI MD PHYSICIAN/MEDICAL DIRECTOR 349849 0 0 0 23774 0 24035 0 18929 0 416587 0 0 0 JASON JANKOWIAK VP CARDIOVASCULAR SERVICE LINE 259176 0 26039 0 26238 0 11179 0 17794 0 340426 0 0 0 WILLIAM J LAGALY DO PHYSICIAN 316201 0 0 0 3114 0 19055 0 17369 0 355739 0 0 0 CHRISTINE KLUCKHOHN FORMER PRESIDENT & CEO CONTINUING CA 0 0 0 0 289537 0 106137 0 17306 0 412980 0 0 0 Part I, Line 1a Tax Indemnification and Gross up payments: Officers and key employees received a tax indemnification and gross-up payment for reimbursement of withholding taxes in conjunction with certain taxable benefits paid on behalf of employee. Health or social club dues or initiation fees: Taxable benefits for Country Club expenses were paid per the terms and conditions of the employment agreement for one key employee. Personal services: Personal services for income tax preparation expenses were paid per the terms and conditions of the employment agreement for one key employee. Part I, Lines 4a-b 4a: A severance payment of $ 288,763.47 was made for Christine Kluckhohn, an associate who was listed in Part 1a. 4b: Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Pension Gap Supplemental Executive Retirement Plan Joseph McDonald $26,000.00 $117,093.00 Mark Sullivan $19,500.00 Dr. Brian D'Arcy $ 9,800.00 Peter Bergmann $ 7,334.00 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. KATHLEEN ZAPFEL SISTER-IN-LAW OF BOARD OF DIRECTOR MEMBER, MSGR ROBERT ZAPFEL 70537 HUMAN RESOURCE EMPLOYEE OF CATHOLIC HEALTH SYSTEM 0 MARIE PACKARD DAUGHTER OF BOARD OF DIRECTOR MEMBER, DENNIS DOMBEK 84949 MERCY HOSPITAL 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 An electronic copy of the Form 990 was provided to the CHS Board 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 2014, 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 -14,030,856. CAPITAL EQUITY CONTRIBUTIONS/DISTRIBUTIONS (INTERCOMPANY) 12,326,260. GRANT REVENUE FOR CAPITAL 4,525,375. OTHER CHANGES IN NET ASSETS -24,990. Form 990, Part XII, Line 2c: Oversight of the financial statement audit process has not changed from the prior year. SCHEDULE B - CONTRIBUTIONS CONTRIBUTIONS AND PLEDGES THAT ARE RESTRICTED BY THE DONOR ARE REPORTED AS INCREASES IN TEMPORARILY OR PERMANENTLY RESTRICTED NET ASSETS, DEPENDING ON THE NATURE OF THE RESTRICTION. WHEN A RESTRICTION EXPIRES, TEMPORARILY RESTRICTED NET ASSETS ARE RECLASSIFIED TO UNRESTRICTED NET ASSETS AND REPORTED IN THE STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RELEASED FROM RESTRICTIONS. AS SUCH, CONTRIBUTIONS ARE NOT RECOGNIZED ON SECTION VIII, STATEMENT OF REVENUE, WITHIN THIS RETURN. MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 ACUTE CARE HOSPITAL NY 501 C 509(a)(1),170(b)(1)( CATHOLIC HEALTH SYSTEM INC 0 SISTERS OF CHARITY HOSPITAL 2157 MAIN STREET BUFFALO NY 14214 160743187 ACUTE CARE HOSPITAL NY 501 C 509(a)(1),170(b)(1)( CATHOLIC HEALTH SYSTEM INC 0 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVENUE KENMORE NY 14217 160762843 ACUTE CARE HOSPITAL NY 501 C 509(a)(1),170(b)(1)( CATHOLIC HEALTH SYSTEM INC 0 NAZARETH HOME OF THE FRANCISCAN SISTERS 291 NORTH STREET BUFFALO NY 14201 160813142 SKILLED NURSING FACILITY NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 ST ELIZABETH HOME FOR THE AGED 5539 BROADWAY LANCASTER NY 14086 160743154 ADULT HOME NY 501 C 509(A)(2) CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS HOME OF WILLIAMSVILLE 147 REIST STREET WILLIAMSVILLE NY 14221 160743153 SKILLED NURSING FACILITY NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS OF BUFFALO INC 34 BENWOOD AVENUE BUFFALO NY 14214 161523535 SKILLED NURSING FACILITY NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501 C 509(a)(2) 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 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE) 144 GENESEE STREET BUFFALO NY 14203 161317960 HOMECARE PROVIDER NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 MCAULEY SETON HOMECARE 144 GENESEE STREET BUFFALO NY 14203 161310062 HOMECARE PROVIDER NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 CATHOLIC HEALTH SYSTEM INFUSION PHARMACY INC 6350 TRANSIT ROAD DEPEW NY 14043 200198518 HOMECARE INFUSION SERVICES NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 CHS CONTINUING CARE FOUNDATION 144 GENESEE STREET BUFFALO NY 14203 200947831 FOUNDATION NY 501 C 509(a)(1),170(b)(1)( CATHOLIC HEALTH SYSTEM INC 0 OLV RENAISSANCE CORPORATION 144 GENESEE STREET BUFFALO NY 14203 200167745 REAL ESTATE HOLDING COMPANY NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 OLV COMMUNITY HOUSING (CHODO) 144 GENESEE STREET BUFFALO NY 14203 200372194 COMMUNITY HOUSING DEVELOPMENT (CHODO) NY 501 C 509(a)(2) 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 509(a)(1),170(b)(1)( CATHOLIC HEALTH SYSTEM INC 0 TRINITY MEDICAL WNY PC 2625 HARLEM ROAD CHEEKTOWAGA NY 14225 272576645 PRIMARY CARE PROVIDER NY 501 C 509(a)(3) CATHOLIC HEALTH SYSTEM INC 0 MCAULEY MERCY CORPORATION 144 GENESEE STREET BUFFALO NY 14203 161279834 MANAGEMENT NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 KMH HOMES INC 144 GENESEE STREET BUFFALO NY 14203 161387890 REAL ESTATE HOLDING COMPANY NY 501 C 509(a)(2) CATHOLIC HEALTH SYSTEM INC 0 HEALTH HOME PARTNERS OF WNY LLC 227 THORN AVENUE BOX 631 ORCHARD PARK NY 14127 455343851 HEALTH HOME NY RELATED 424792 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1