2015-10-28T13:46:43-05:00 2014-12-31 990 2014-01-01 160756336 Mercy Hospital of Buffalo MERC 7168282993 144 Genesee St Finance 4th Floor Buffalo NY 14203 DAVID P MACHOLZ VP Finance/Corp Controller 7168282974 2015-10-28 2014 2016-04-25 22:37:26Z Joseph D McDonald 144 Genesee Street Administration 6th Floor Buffalo NY 14203 390344949 0 X www.chsbuffalo.org X 1957 NY The Catholic Health System (CHS) 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 2824 278 0 0 1016555 863016 362664484 383444677 597906 456350 10159647 5580906 374438592 390344949 0 0 0 0 173792996 175096486 0 0 0 180639482 193994169 354432478 369090655 20006114 21254294 268051408 289899928 259009550 306376928 9041858 -16477000 X The Catholic Health System (CHS) 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. 0 0 184735092 256869966 Inpatient Routine/Surgery Visits: Acute Care Patient Days = 88,896Newborn Patient Days = 7,009Medical Rehab Patient Days = 6,781Skilled Nursing Patient Days = 30,334Operating Room = 6,610OPD = 546G.I. Laboratory = 1,842Dialysis Access Center = 887Interventional Radiology = 934Cardiac (EP & Catheterizations) = 3,507Transfusion = 855 81894983 113873122 Outpatient Routine/Surgery Services:Emergency Visits (Net of Admits) = 63,354Referred Ambulatory Visits = 168,186Outpatient Ambulatory Surgery Visits = 15,181 9134696 12701589 Clinic/Primary Care Services:Clinic Visits = 5,353Primary Care Visits = 66,948 275764771 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 0 0 0 0 0 0 1 0 1 0 1 202 0 2824 1 0 0 0 0 0 0 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 1 1 X X David P Macholz VP Finance Corporate Controller 7168282974 144 Genesee Street Finance 4th Buffalo NY 14203 Joseph McDonald President and CEO, CHS 0.00 37.50 X X 0 1344183 55937 Mark Sullivan Executive VP / COO 0.00 37.50 X X 0 716018 47406 Charles Urlaub President, and CEO Mercy 37.50 0.00 X X 500168 0 48207 David Macholz Treasurer 0.00 37.50 X X 0 253185 42733 Peter Bergmann Director 0.00 37.50 X 0 521653 39456 James Millard Director 0.00 37.50 X 0 360108 217116 Joyce Markiewicz Director 0.00 37.50 X 0 336389 49581 Dr Michael Edbauer Director 0.00 18.80 X 0 306246 23873 Louis Baumann MD Director 0.00 1.00 X 0 0 0 Brian Beitz Director 0.00 1.00 X 0 0 0 Frances Crosby RN PhD Director 0.00 1.00 X 0 0 0 Richard Curran MD Director 0.00 1.00 X 0 0 0 John Davanzo Director 0.00 1.00 X 0 0 0 Dennis Dombek Director 0.00 1.00 X 0 0 0 David Durante MD Director 18.80 0.00 X 113038 0 0 Joseph Gelormini MD Director 0.00 1.00 X 0 0 0 Mr William Lawley Jr Director 0.00 1.00 X 0 0 0 Li Lin PhD Chairman of Ministry Services 0.00 1.00 X 0 0 0 Judith Maness Director 0.00 1.00 X 0 0 0 James Manzella Director 0.00 1.00 X 0 0 0 Raquel Martin DO Director 0.00 1.00 X 0 0 0 Michael Montante Director 0.00 1.00 X 0 0 0 Mark Podlas MD Director 0.00 1.00 X 0 0 0 Sherry Pomeroy PhD Director 0.00 1.00 X 0 0 0 Donald Slate MD Director 0.00 1.00 X 0 0 0 Mary Turkiewiecz MD Director 0.00 1.00 X 0 0 0 Cynthia Zane EdD Director 0.00 1.00 X 0 0 0 Monsignor Robert E Zapfel Director 0.00 1.00 X 0 0 0 James A Dunlop Jr Executive VP, Finance / CFO 0.00 37.50 X 0 610886 180721 Dr Brian D'Arcy Senior VP, Medical Affairs 0.00 37.50 X 0 528516 49956 John Herman Chief Operating Officer, Mercy 37.50 0.00 X 198886 0 91492 Michael Moley Sr.VP, Human Resources 0.00 37.50 X 0 602383 52698 John Stavros Sr.VP, Marketing / P.R. 0.00 37.50 X 0 299464 45380 Dr Michael Galang Chief Information Officer 0.00 37.50 X 0 415734 36231 Nancy Sheehan SVP Legal Service, General Counsel 0.00 37.50 X 0 340246 41133 Richard J Ruh MD Sr. VP, Service Lines 0.00 37.50 X 0 490180 43760 Dr Thomas Raab Physician 37.50 0.00 X 546424 0 206610 Dr Timothy Gabryel VP Medical Affairs 37.50 0.00 X 445197 0 33012 Dr Syed Shah Physician 37.50 0.00 X 545903 0 36748 Dr Joseph Polcaro Physician 37.50 0.00 X 417833 0 18765 Dr Stephen Downing Physician 37.50 0.00 X 769131 0 34924 Dr David Capaccio Physician 37.50 0.00 X 326349 0 30160 Dr Kevin Shiley Physician 37.50 0.00 X 308130 0 31203 Christine Kluckhohn Pres.& CEO ContinuingCare 0.00 0.00 X 0 289537 123443 4171059 7414728 1580545 153 1 1 0 Telco Construction Inc 500 Buffalo Road East Aurora NY 14052 Construction Services 2946637 Aramark Services Inc 1000 East Henrietta Road Rochester NY 14623 Dietery Services 2547055 Buffalo Gastroenterology 260 Redtail Road Orchard Park NY 14127 Physician Services 1932641 Siemens Medical Solutions 51 Valley Stream Parkway Malverne PA 19355 Maintenance Services 1220000 Atlas Healthcare Linen Services 60 Grider Street Buffalo NY 14215 Laundry Services 1136169 54 863016 863016 Patient Care Services 900099 277534388 277534388 Medicaid/Medicare 900099 105910289 105910289 383444677 450850 450850 332632 0 332632 332632 332632 5500 0 5500 5500 5500 Meaningful Use Dollars 900099 1297627 1297627 Cafeteria Revenue 900099 1105255 1105255 Parking Revenue 900099 670679 670679 2174713 900965 1273748 5248274 390344949 385643269 0 3838664 132434930 116923681 15511249 11876322 10485325 1390997 21682671 19143120 2539551 9102563 8036438 1066125 44306 3625 40681 10497049 9320733 1176316 151967 7670 144297 8486239 4097765 4388474 217335 29070 188265 7237150 790513 6446637 123320 93505 29815 133125 118425 14700 2458521 1970027 488494 14204556 11382194 2822362 3545006 3135402 409604 Medical Supplies 75692871 76653710 -960839 Dues & Shared Services 50224145 50224145 Purchased Services & Ot 17346160 10454517 6891643 3632419 3119051 513368 369090655 275764771 93325884 0 62006084 80350248 3222203 3942793 54105226 53405815 11112862 12901666 1997489 2014747 176318499 78125678 101120581 98192821 147683 240842 34339280 38850996 268051408 289899928 51576417 46310166 34662730 33270753 16415790 17761042 156354613 209034967 259009550 306376928 X 7886053 -17379920 1033282 780397 122523 122523 9041858 -16477000 268051408 289899928 X 21254294 -46773152 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1409723 1409723 68128532 31840095 36288437 33169204 6504839 26664365 68912054 39608063 29303991 4698986 172681 4526305 98192821 Accrued Receivables 4244171 Due From Affiliates 22417 Interest in the Net Assets of Mercy Hospital Foundation Inc 2047160 Workers Compensation Funding 15315 Insurance Recoveries 32521933 38850996 Deferred Comp Liability 10570 Due to Affiliates 13801671 Interest Rate Swap 4061057 Asset Retirement Obligation 5991010 Accrued Pension Obligation 136618346 LT Gen Liab/Workers Comp IBNR 48449050 LT Disposables 103263 209034967 390340573 771359 771359 389569214 775735 775735 390344949 369723968 633313 633313 369090655 0 369090655 Part XI, Line 2d - Other Adjustments: Foundation Activity - 771,359 Part XI, Line 4b - Other Adjustments: Contributions from Foundation to Mercy Hospital - 607,743 Contributions from Grants - 167,992 Part XII, Line 2d - Other Adjustments: Foundation Expenses (net of eliminations) - 633,313 1 1 X 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2498190 174647 2323543 0.00630 59593324 43605786 15987538 0.04330 62091514 43780433 18311081 0.04960 1365097 1365097 0.00370 8720165 1186908 7533257 0.02040 664959 664959 0.00180 561840 561840 0.00150 11312061 1186908 10125153 0.02740 73403575 44967341 28436234 0.07700 1700 1700 0.00000 441189 441189 0.00120 442889 442889 0.00120 0 10081047 1051195 68149415 64376746 3772669 X 1 1 2 1 Mercy Hospital of Buffalo 565 Abbott Road Buffalo NY 14220 X X X X Ambulatory Surgery - Multi Specialty, Audiology O/P, Cadriac Cathereization, 2 Mercy Ambulatory Care Center 3669 Southwestern Blvd Orchard Park NY 14127 X X X X Clinical Laboratory Service, CT Scanner, Emeregency Department, Medical Sur Mercy Hospital of Buffalo 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 Mercy Hospital of Buffalo 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 Hospitals Harvest HouseSpectrum Human Services Buffalo State College Center for Community 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 Mercy Hospital of Buffalo Part V, Section B, Line 6a: Mercy Hospital was conducted with Mercy Ambulatory Care Center. Mercy Hospital of Buffalo Part V, Section B, Line 7d: Mercy Hospital was conducted with Sisters Hospital and Kenmore Mercy Hospital. Mercy Hospital of Buffalo 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. Mercy Hospital of Buffalo Part V, Section B, Line 16i: Includes information in both English and Spanish on all signage and brochures for financial assistance. Mercy Hospital of Buffalo Part V, Section B, Line 22d: Highest volume commercial payor rate. Mercy Hospital of Buffalo 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 Mercy Hospital of Buffalo Part V, Section B, line 16a website: http://chsbuffalo.org/billing/finance Mercy Hospital of Buffalo Part V, Section B, line 16b website: http://chsbuffalo.org/billing/finance Mercy Hospital of Buffalo Part V, Section B, line 16c website: http://chsbuffalo.org/billing/finance 8 East Aurora Medical Center 94 Olean St East Aurora NY 14052 Extension Clinic: OT-O/P, PT-O/P, Speech-O/P, Radiology-O/P, Lab-O/P Mercy Outpatient Clinic OBGYN 515 Abbott Rd Buffalo NY 14220 Extension Clinic: Prenatal O/P, Primary Medical Care O/P Mercy Comprehensive Care Center 397 Louisiana St Buffalo NY 14202 Extension Clinic: Primary Care, Pediatric, Lab, Podiatry, Prenatal,Radiology OLV Family Care Center 227 Ridge Rd Lackawanna NY 14218 Extension Clinic: Prenatal O/P, Primary Medical Care O/P Mercy Nursing Facility 55 Melroy Ave Lackawanna NY 14218 Long Term Care, Lab-O/P, Radiology- Diagnostic O/P Pace Health Center 55 Melroy Ave Lackawanna NY 14218 Extension Clinic: OT-O/P, PT-O/P, Speech-O/P, Primary Care, Psychology O/P Mercy Ambulatory Care Center 550 Orchard Park Rd West Seneca NY 14224 CT, Lab-O/P, Primary Care, Radiology-O/P, OT-O/P, PT-O/P, Speech-O/P Springville Primary Care Center 27 Franklin St Springville NY 14141 Pediatric-O/P, Primary Medical Care-O/P Part I, Line 6a: Part 1, 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 include Economic Development for $1,700, for participation in Chamber of Commerce. Additionally, Community Support of $441,189 including $143,510 for Ebola preparedness, and $297,679 Winter Storm Preparation and response. Ebola Preparedness included participation in implementing plans associated with preparing the community for Ebola disaster preparedness (such as mental health resources costs associated with triaining, community partnerships, and outreach planning.) Winter Storm preparation included the time the associates spent in disaster relief for the community. Part III, Line 2: The amount in Part III line 2 is the actual bad debt expenses of $10,081,047. 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: 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. 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 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 Charles Urlaub President, and CEO Mercy 369957 0 72644 0 57567 0 29025 0 19182 0 548375 0 0 0 David Macholz Treasurer 0 195706 0 31223 0 26256 0 22835 0 19898 0 295918 0 0 Peter Bergmann Director 0 391424 0 84427 0 45802 0 20550 0 18906 0 561109 0 0 James Millard Director 0 271916 0 48125 0 40067 0 216802 0 314 0 577224 0 0 Joyce Markiewicz Director 0 263677 0 33005 0 39707 0 31253 0 18328 0 385970 0 0 Dr Michael Edbauer Director 0 228520 0 52981 0 24745 0 13975 0 9898 0 330119 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 John Herman Chief Operating Officer, Mercy 159609 0 15075 0 24202 0 75823 0 15669 0 290378 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 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 Thomas Raab Physician 495236 0 50000 0 1188 0 185687 0 20923 0 753034 0 0 0 Dr Timothy Gabryel VP Medical Affairs 398606 0 29203 0 17388 0 25398 0 7614 0 478209 0 0 0 Dr Syed Shah Physician 463913 0 50000 0 31990 0 18320 0 18428 0 582651 0 0 0 Dr Joseph Polcaro Physician 362929 0 54142 0 762 0 0 0 18765 0 436598 0 0 0 Dr Stephen Downing Physician 595717 0 150000 0 23414 0 16281 0 18643 0 804055 0 0 0 Dr David Capaccio Physician 270401 0 36791 0 19157 0 12177 0 17983 0 356509 0 0 0 Dr Kevin Shiley Physician 223485 0 68316 0 16329 0 10063 0 21140 0 339333 0 0 0 Christine Kluckhohn Pres.& CEO ContinuingCare 0 0 0 0 0 289537 0 106137 0 17306 0 412980 0 0 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. Mercy Pension Gap CHE SERP 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. 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 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 2642081 121343 2013 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 1 A 1 B 1 C 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. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 82776 Corporate Nurse educator 0 James Manzella Acute Care Board Member 161739 Key Employee of Manzella Marketing 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, CHE/Trinity, 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 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 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: Mimimum Pension Liability Adjustment -36,482,858. Equity Transfer to Affiliates -8,197,853. Change in Interest in Foundation Unrestricted 121,161. Change in Interest in Foundation Restricted -252,885. Interest Rate Swap Adjustment -1,960,717. Catholic Health System Inc 144 Genessee 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 Genessee 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 Genessee 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 Genessee 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 Catholic Health System Inc 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 291 North Street Buffalo NY 14201 161387890 Real Estate Holding Company NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 OLV-Brierwood Helathcare Co LLC 6455 Lake Avenue Orchard Park NY 14127 161487207 Rental Real Estate NY N/A Related 0 0 Orchard Park Mercy Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161470350 Real Estate Holding Company NY Mercy Hospital C 1.00000 0 Aurora Mercy Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161354302 Real Estate Development NY Mercy Hospital C 1.00000 0 Alsace Abbott Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161355092 Partnership Holding Corporation NY Mercy Hospital C 1.00000 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 Orchard Park Mercy Corporation Q