2014-10-30T08:44:20-05:00 2013-12-31 990 2013-01-01 160743153 ST FRANCIS HOME OF WILLIAMSVILLE STFR 7169234868 144 GENESEE STREET 4TH FLOOR-FINACE BUFFALO NY 14203 DAVID P MACHOLZ VP FINANCE/CORPCONTROLLER 7168282974 2014-10-30 2013 2015-11-30 17:44:51Z X JOSEPH MCDONALD 144 GENESEE STREET BUFFALO NY 14203 12644805 0 X CHSBUFFALO.ORG X 1961 NY THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, CHS PROVIDERS CONTINUE THE HEALING MINISTRY OF JESUS SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2013 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 11 5 314 20 0 0 0 0 11705464 12597907 6767 3081 44479 43817 11756710 12644805 0 0 0 0 11137467 11172391 0 0 0 2767676 3002046 13905143 14174437 -2148433 -1529632 8318899 9271978 12534264 14054654 -4215365 -4782676 X THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, CHS PROVIDERS CONTINUE THE HEALING MINISTRY OF JESUS SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2013 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 0 0 12024094 12641724 NURSING HOME CARE: ST FRANCIS WILLIAMSVILLE IS A SKILLED NURSING FACILITY THAT TENDS PRIMARILY TO THE POOR AND ELDERLY AND IS LOCATED IN ERIE COUNTY, NY. IN 2013 OVER 56% OF RESIDENTS WERE COVERED BY MEDICAID. THIS 56% MEDICAID POPULATION EQUALLED 26,452 PATIENT BED DAYS. SEE COMMUNITY SERVICE PLAN AT WWW.CHSBUFFALO.ORG. 12024094 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 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 12 0 1 314 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID P MACHOLZ 7168282974 144 GEMESEE STREET 4TH FLOOR-FINANC BUFFALO NY 14203 JOSEPH MCDONALD PRESIDENT AND CEO, CHS 37.50 X X 0 1678073 23277 MARK SULLIVAN EXEC VP, COO 37.50 X X 0 748231 6740 CHRISTINE KLUCKHOHN PRES & CEO,CONTINUING CARE 37.50 X X 0 288295 -23731 EDWARD FLYNN DIRECTOR 1.00 X 0 0 0 JOYCE MARKIEWICZ DIRECTOR 37.50 X 0 315893 16402 MARK MEYERHOFER DIRECTOR 1.00 X 0 0 0 JAMES MILLARD DIRECTOR 37.50 X 0 329262 -54042 ROBERT NASSO DIRECTOR 1.00 X 0 0 0 SHERRY POMEROY PHD RN DIRECTOR 1.00 X 0 0 0 NANCY TRUVER DIRECTOR 1.00 X 0 0 0 SR MARY ANNE WELDON DIRECTOR 1.00 X 0 0 0 MONSIGNOR ROBERT E ZAPFEL DIRECTOR 1.00 X 0 0 0 JAMES A DUNLOP JR EXEC VP, FINANCE, CFO 37.50 X 0 674481 -51144 DAWN CLABEAUX ADMINISTRATOR 37.50 X 106029 0 16605 MICHAEL MOLEY SR. VP HUMAN RESOURCES 37.50 X 0 644598 23524 JOHN STAVROS SR. VP MARKETING/P.R. 37.50 X 0 278958 35521 BARTHOLOMEW RODRIGUES SR. VP MISSION INTEGRATION 37.50 X 0 217153 24073 DR MICHAEL GALANG CHIEF INFORMATION OFFICER 37.50 X 0 448522 4849 NANCY SHEEHAN VP LEGAL SVC, OGC 37.50 X 0 331332 7739 SANDRA PIDANICK NURSING 37.50 X 108010 0 34874 214039 5954798 64687 2 0 1 0 NURSEFINDERS PO BOX 910738 DALLAS TX 75391 NURSING SERVICES 117838 1 PRIVATE AND SSI 623000 12597907 12597907 12597907 3081 3081 MISC. 900099 30774 30774 DISCOUNTS/REBATES 900099 9848 9848 VENDING 900099 3195 3195 43817 12644805 12641724 0 3081 8458586 7199828 1258758 2180344 1935139 245205 533461 454075 79386 146620 76328 70292 238010 238010 83542 15128 68414 SUPPLIES 1042111 1022817 19294 PURCHASED SERVICES 754877 457459 297418 BAD DEBT EXPENSE 467144 467144 269742 158166 111576 14174437 12024094 2150343 0 376085 513277 418020 418647 1629198 2150280 16984 17248 1785 77426 11763996 9759619 1691121 2004377 1513835 1129193 2671871 2961530 8318899 9271978 1525019 1414981 11009245 12639673 12534264 14054654 X -4283972 -4856632 68607 73956 -4215365 -4782676 8318899 9271978 X -1529632 962321 X 0 1 X 1 1 1 X 9841818 12199219 13859780 11749943 12641724 60292484 9841818 12199219 13859780 11749943 12641724 60292484 0 0 0 60292484 5590 7568 8836 6764 3081 31839 5590 7568 8836 6764 3081 31839 9847408 12206787 13868616 11756707 12644805 60324323 0.99950 0.99880 0.00050 0.00120 X 7490382 6072764 1417618 4273614 3686855 586759 2004377 ASSETS LIMITED AS TO USE 1129193 F 1129193 DUE FROM AFFILIATES 28827 DUE FROM THIRD PARTY PAYORS 260225 INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 73956 INSURANCE RECOVERY 2598522 2961530 ASSET RETIREMENT OBLIGATION 280671 DUE TO AFFILIATES 5925300 DUE TO THIRD PARTY PAYORS 486357 LONG TERM PENSION OBLIGATION 5947345 12639673 12641724 0 12641724 3081 3081 12644805 14174437 0 14174437 0 14174437 PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 3,081. X X X X X X 0 1 0 0 0 1 1 0 0 JOSEPH MCDONALD PRESIDENT AND CEO, CHS 0 707646 0 355199 0 615228 0 4992 0 18285 0 1701350 0 0 MARK SULLIVAN EXEC VP, COO 0 434186 0 180496 0 133549 0 -9590 0 16330 0 754971 0 0 CHRISTINE KLUCKHOHN PRES & CEO,CONTINUING CARE 0 83923 0 18464 0 185908 0 -46313 0 22582 0 264564 0 0 JOYCE MARKIEWICZ DIRECTOR 0 217471 0 59656 0 38766 0 838 0 15564 0 332295 0 0 JAMES MILLARD DIRECTOR 0 245733 0 43857 0 39672 0 -54323 0 281 0 275220 0 0 JAMES A DUNLOP JR EXEC VP, FINANCE, CFO 0 383536 0 221131 0 69814 0 -68063 0 16919 0 623337 0 0 MICHAEL MOLEY SR. VP HUMAN RESOURCES 0 309221 0 151753 0 183624 0 6662 0 16862 0 668122 0 0 JOHN STAVROS SR. VP MARKETING/P.R. 0 198733 0 38646 0 41579 0 17048 0 18473 0 314479 0 0 BARTHOLOMEW RODRIGUES SR. VP MISSION INTEGRATION 0 157996 0 20996 0 38161 0 1147 0 22926 0 241226 0 0 DR MICHAEL GALANG CHIEF INFORMATION OFFICER 0 304298 0 104516 0 39708 0 -1161 0 6010 0 453371 0 0 NANCY SHEEHAN VP LEGAL SVC, OGC 0 261089 0 50717 0 19526 0 1457 0 6282 0 339071 0 0 PART I, LINE 4B TWO OFFICERS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PER THE TERMS AND CONDITIONS OF THEIR EMPLOYMENT CONTRACT. PENSION GAP SERP JOSEPH MCDONALD $26,000 $299.904 MARK SULLIVAN $19.500 PART I, LINE 6 THE 2013 INCENTIVE PAYMENTS WERE DEPENDENT UPON ACHIEVING THE CATHOLIC HEALTH SYSTEM OPERATING INCOME TARGET FOR CATHOLIC HEALTH SYSTEM PARTICIPANTS OR THE MINISTRY OPERATING INCOME TARGET FOR MINISTRY PARTICIPANTS. JOSEPH MCDONALD $355,199 MARK SULLIVAN $180,496 JAMES A. DUNLOP,JR. $221,131 NANCY SHEEHAN $ 50,717 MICHAEL MOLEY $151,753 JOHN STAVROS $ 38,646 CHRISTINE KLUCKHOHN $ 18,464 BARTHOLOMEW RODRIGUES $ 20,996 DR. MICHAEL GALANG $104,516 JAMES MILLARD $ 43,857 JOYCE MARKIEWICZ $ 59,656 SANDRA PIDANICK $ 7,368 DAVID ZAPFEL BROTHER OF BOD, MSGR. ROBERT ZAPFEL 27471 HR EMPLOYEE OF CHS 0 KATHLEEN ZAPFEL SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL 65672 HR EMPLOYEE OF CHS 0 SUSAN GALLAGHER-STAVROS WIFE OF KEY EMPLOYEE, JOHN STAVROS 14437 NURSE, MCAULEY SETON HOME CARE 0 FORM 990, PART VI, SECTION A, LINE 6 CHS HAS THREE MEMBERS: ASCENSION HEALTH, CATHOLIC HEALTH EAST, AND THE DIOCESE OF BUFFALO, NY. EACH MEMBER IS ABLE TO PARTICIPATE EQUALLY IN ELECTING THE GOVERNING BODY, APPROVING SIGNIFICANT DECISIONS OF THE GOVERNING BODY, AND IN RECEIVING A SHARE OF NET ASSETS UPON DISSOLUTION, ACCORDING TO THE CHS BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE CHS BYLAWS, EACH MEMBER IS EQUALLY ALLOWED TO APPOINT UP TO THREE INDIVIDUALS TO ACT AS ITS REPRESENTATIVES ON THE CORPORATE MEMBER BOARD, AND IN UNDERTAKING ANY ACTION IN ITS CAPACITY AS A MEMBER. THE CORPORATE MEMBER BOARD OVERSEES THE GOVERNANCE OF THE CATHOLIC HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B EACH MEMBER IS ENTITLED TO ONE VOTE ON EACH MATTER PROPERLY SUBMITTED AT ANY MEMBERSHIP MEETING, AND THE MEMBERS ALSO HAVE RESERVE POWERS WHICH ALLOW APPROVAL FOR CERTAIN BUSINESS EVENTS AND RATIFICATION OF CERTAIN BUSINESS TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 11 YES, AN ELECTRONIC COPY OF THE FORM 990 WAS PROVIDED TO THE CHS BOARDS OF DIRECTORS BEFORE IT WAS FILED. THE CHS BOARD OF DIRECTORS HAS DELEGATED THE RESPONSIBILITY TO REVIEW THE 990 TO THE AUDIT COMMITTEE. THE CHS AUDIT COMMITTEE REVIEWED IN DETAIL SELECTED INFORMATION FOR ALL CATHOLIC HEALTH SYSTEM ENTITIES. REVIEWED WITH THE AUDIT COMMITTEE: 1. CORE FORM PART IV: CHECKLIST OF REQUIRED SCHEDULES 2. CORE FORM PART VI: GOVERNANCE, MANAGEMENT AND DISCLOSURE 3. CORE FORM PART VII: COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS 4. SCHEDULE H: HOSPITALS 5. SCHEDULE K: SUPLEMENTAL 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 BY THE MANAGER, THE DOCUMENT IS FORWARD TO THE COMPLIANCE OFFICER WHO REVIEWS AND FOLLOWS UP AS APPROPRIATE. ONCE REVIEW/FOLLOW UP IS COMPLETED THE COMPLIANCE OFFICER WILL SIGN THE COIDS, MAINTAIN A COPY IN THE COMPLIANCE OFFICE AND RETURN THE ORIGINAL TO HR FOR FILING IN THE PERSONNEL FILE. 2. ALL BOARD MEMBER COIDS' ARE RETURNED TO THE COMPLIANCE OFFICER FOR REVIEW AND FOLLOW UP AS WARRANTED. THE COMPLIANCE OFFICER WILL SIGN EACH COIDS AND RETAIN ON FILE IN THE COMPLIANCE OFFICE IN A CONFIDENTIAL MANNER. FORM 990, PART VI, SECTION B, LINE 15 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 LAW. FORM 990, PART XI, LINE 9: MINIMUM PENSION LIABILITY ADJUSTMENT 956,736. CHANGE IN INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 5,349. DONATION FOR CAPITAL ASSETS 236. CATHOLIC HEALTH SYSTEM INC 144 GENESEE STREET BUFFALO NY 14203 222565278 HEALTHCARE DELIVERY SYSTEM NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 SISTERS OF CHARITY HOSPITAL 2157 MAIN STREET BUFFALO NY 14214 160743187 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVENUE KENMORE NY 14217 160762843 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 NAZARETH HOME OF THE FRANCISCAN SISTERS 291 NORTH STREET BUFFALO NY 14201 160813142 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST CLARE MANOR 543 LOCUST STREET LOCKPORT NY 14094 160782647 SKILLED NURSING FACILITY NY 501(C)(3) 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) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS OF BUFFALOINC 34 BENWOOD AVENUE BUFFALO NY 14214 161523535 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST JOSEPH MANOR 2211 WEST STATE STREET OLEAN NY 14760 160796400 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST LUKE MANOR FOR THE CHRONICALLY ILL 17 WIARD ST BATAVIA NY 14020 160794811 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST MARY'S MANOR 515 6TH STREET NIAGARA FALLS NY 14301 160924139 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 WNY CATHOLIC LONG TERM CARE INC 6400 POWERS ROAD ORCHARD PARK NY 14127 161434368 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE) 144 GENESEE STREET BUFFALO NY 14203 161317960 HOME CARE PROVIDER NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 MCAULEY SETON HOME CARE 144 GENESEE STREET BUFFALO NY 14203 161310062 HOME CARE PROVIDER NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 CHS CONTINUING CARE FOUNDATION 144 GENESEE STREET BUFFALO NY 14203 200947831 FOUNDATION NY 501(C)(3) LINE 7 CATHOLIC HEALTH SYSTEM INC 0 OLV RENAISSANCE CORPORATION 144 GENESEE STREET BUFFALO NY 14203 200167745 REAL ESTATE HOLDING COMPANY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 CATHOLIC HEALTH SYSTEM INFUSION PARMACY INC 2875 UNION ROAD SUITE 14 CHEEKTOWAGA NY 142271461 200198518 HOME CARE INFUSION SERVICE NY 501(C)(3) 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) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 TRINITY MEDICAL WNYPC 2625 HARLEM ROAD CHEEKTOWAGA NY 14225 272576645 PRIMARY CARE PROVIDER NY 501(C)(3) LINE 11A, I CATHOLIC HEALTH SYSTEM INC 0 KMH HOMES INC 144 GENESEE STREET BUFFALO NY 14203 161387890 REAL ESTATE HOLDING COMPANY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1