2014-10-30T08:03:25-05:00 2013-12-31 990 2013-01-01 160756336 Buffalo Mercy Hospital BUFF 7168282993 144 Genesee Street Finance 4th Floor Buffalo NY 14203 DAVID P MACHOLZ VP Finance/Corp Controller 7168282974 2014-10-30 2013 2015-11-30 17:44:51Z Joseph D McDonald 144 Genesee Street Administration 6th Floor Buffalo NY 14203 374438592 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 2013 Community Service Plan can be found at www.chsbuffalo.org. 16 7 2765 243 0 0 140829 1016555 340731217 362664484 359633 597906 7016823 10159647 348248502 374438592 0 0 0 0 163705546 173792996 0 0 0 170924265 180639482 334629811 354432478 13618691 20006114 245545386 268051408 298022068 259009550 -52476682 9041858 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 2013 Community Service Plan can be found at www.chsbuffalo.org. 0 0 174620535 238350776 Inpatient Routine/Surgery Visits: Acute Care Patient Days = 86,855Newborn Patient Days = 7,213Medical Rehab Patient Days = 6,835Skilled Nursing Patient Days = 30,380Operating Room = 6,327OPD = 745G.I. Laboratory = 2,335Dialysis Access Center = 647Interventional Radiology = 918Cardiac (EP & Catheterizations) = 3,272Transfusion = 1,009 81155974 110774998 Outpatient Routine/Surgery Services:Emergency Visits (Net of Admits) = 60,565Referred Ambulatory Visits = 189,018Outpatient Ambulatory Surgery Visits = 15,253 9918729 13538710 Clinic/Primary Care Services:Clinic Visits = 5,339Primary Care Visits = 67,293 265695238 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 1 1 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 1 0 1 198 0 2765 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 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 1678073 23277 Mark Sullivan Executive VP / COO 0.00 37.50 X X 0 748231 6740 Charles Urlaub President, and CEO Mercy 37.50 0.00 X X 453029 0 23238 David Macholz Treasurer 0.00 37.50 X X 0 236152 6647 Peter Bergmann Director 0.00 37.50 X 0 487172 16046 James Millard Director 0.00 37.50 X 0 329262 -54042 Christine Kluckhohn Pres.& CEO ContinuingCare 0.00 37.50 X 0 288295 -23731 Dr Michael Edbauer Director 0.00 18.80 X 0 256646 8384 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 Dennis Dombek Director 0.00 1.00 X 0 0 0 Dr Craig Fetterman Director 0.00 1.00 X 0 0 0 Mr William Lawley Jr Director 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 Michael Montante 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 674481 -51144 Dr Brian D'Arcy Senior VP, Medical Affairs 0.00 37.50 X 0 434608 47365 John Herman Chief Operating Officer, Mercy 37.50 0.00 X 231512 0 -2977 Michael Moley Sr.VP, Human Resources 0.00 37.50 X 0 644598 23524 John Stavros Sr.VP, Marketing / P.R. 0.00 37.50 X 0 278958 35521 Dr Michael Galang Chief Information Officer 0.00 37.50 X 0 448522 4849 Nancy Sheehan SVP Legal Service, General Counsel 0.00 37.50 X 0 331332 7739 Richard J Ruh MD Sr. VP, Service Lines 0.00 37.50 X 0 401525 22636 Dr Thomas Raab Physician 37.50 0.00 X 492369 0 7929 Dr Timothy Gabryel VP Medical Affairs 37.50 0.00 X 440501 0 24008 Dr Syed Shah Physician 37.50 0.00 X 486374 0 27557 Dr Lawrence Gugino Physician 37.50 0.00 X 268187 0 21834 Dr Nicholas Cromwell Physician 37.50 0.00 X 256783 0 12046 Dr Stephen Downing Physician 37.50 0.00 X 274892 0 10925 Nils Gunnerson Leased Administrator 37.50 0.00 X 297339 0 -10549 3200986 7237855 187822 106 0 1 0 Telco Construction Inc 500 Buffalo Road East Aurora NY 14052 Construction Services 3914565 Siemens Medical Solutions 51 Valley Stream Parkway Malverne PA 19355 Maintenance Services 3034045 Aramark Services Inc 1000 East Henrietta Road Rochester NY 14623 Dietery Services 1827935 Nursefinders Inc PO Box 910738 Dallas TX 753910738 Nursing Services 1196806 Buffalo Gastroenterology 260 Redtail Road Orchard Park NY 14127 Physician Services 1112000 47 1016555 1016555 Patient Care Services 900099 260055279 260055279 Medicaid/Medicare 900099 102609205 102609205 362664484 597906 597906 383877 0 383877 383877 383877 Lawsuit Settlement 900099 4000000 4000000 Meaningful Use Dollars 900099 2118073 2118073 Cafeteria Revenue 900099 1064187 1064187 2593510 743325 1850185 9775770 374438592 365525882 0 7896155 126274730 110858723 15416007 16463391 14453490 2009901 22344931 19616993 2727938 8709944 7646607 1063337 85695 6207 79488 10408073 9365788 1042285 144870 13259 131611 8402210 4362450 4039760 264815 31950 232865 7163129 762755 6400374 126651 86995 39656 166505 152500 14005 2272581 1772835 499746 12834604 10012242 2822362 3010440 2665350 345090 Medical Supplies 70783015 72025972 -1242957 Dues and Shared Service 46209571 46209571 Purchase Services and O 15794567 9311223 6483344 2972756 2549899 422857 354432478 265695238 88737240 0 56644895 62006084 7636387 3222203 47457302 54105226 6628992 11112862 2304804 1997489 165466674 64346093 96738817 101120581 135102 147683 27999087 34339280 245545386 268051408 48127796 51576417 35964324 34662730 18801923 16415790 195128025 156354613 298022068 259009550 X -54269577 7886053 1670372 1033282 122523 122523 -52476682 9041858 245545386 268051408 X 20006114 41512426 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1409722 1409722 68128532 29562087 38566445 31805143 4492155 27312988 62856460 30149425 32707035 1266817 142426 1124391 101120581 Accrued Receivables 5345106 Due From Affiliates 119943 Interest in the Net Assets of Mercy Hospital Foundation Inc 2178883 Workers Compensation Funding 671750 Insurance Recoveries 26023598 34339280 Deferred Comp Liability 11095 Due to Affiliates 9906249 Interest Rate Swap 3223924 Asset Retirement Obligation 5689954 Accrued Pension Obligation 96901865 LT Gen Liab/Workers Comp IBNR 40427822 LT Disposables 193704 156354613 374511655 1062413 1062413 373449242 989350 989350 374438592 354970447 537969 537969 354432478 0 354432478 Part XI, Line 2d - Other Adjustments: Foundation Activity - 1,062,414 Part XI, Line 4b - Other Adjustments: Contributions from Foundation to Mercy Hospital - 988,410 Contributions from Grants - 940 Part XII, Line 2d - Other Adjustments: Foundation Expenses (net of eliminations) - 537,969 1 1 X 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 3118969 227821 2891148 0.00820 50332474 37961489 12370985 0.03490 53451443 38189310 15262133 0.04310 1926316 1926316 0.00540 6846155 1392672 5453483 0.01540 749047 749047 0.00210 281295 281295 0.00080 9802813 1392672 8410141 0.02370 63254256 39581982 23672274 0.06680 60493 60493 0.00020 320585 320585 0.00090 381078 381078 0.00110 1 3769764 2721872 65017329 62457379 2559950 X 1 0 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 1 X X X X X X X X X X 13 1 1 1 X http://www.chsbuffalo.org/AboutUs/Communi X X X X X X X X X 0 0 1 1 110.000000000000 1 500.000000000000 1 X X X X X X 1 1 X X X X X X X 1 0 1 X 0 1 Mercy Hospital of Buffalo Part V, Section B, Line 1j: In addition to the IRS requirements Catholic Health complied with the NYS Department of Health Community Health Needs Assessment requirements, Community Service Plan. Mercy Hospital of Buffalo Part V, Section B, Line 3: 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 CharitiesAlzheimer'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 representativeErie County Department of Health Community Meeting Participants:FDA Cancer Service Program of Erie CountyBuffalo State College Catholic HealthP2 Collaborative of WNYAmerican 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 4: Mercy Hospital was conducted with Sisters Hospital and Kenmore Mercy Hospital. Mercy Hospital of Buffalo Part V, Section B, Line 7: 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 14g: Includes information in both English and Spanish on all signage and brochures for financial assistance. Mercy Hospital of Buffalo Part V, Section B, Line 20d: Highest volume commercial payor rate. Mercy Hospital of Buffalo Part V, Section B, Line 22: There are instances where the full charges on the account are equal to or less than the highest volume commercial payor rate. 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 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: Mercy Hospital provided Community Building in the form of Community Support and Leadership Development which improved community leadership by promoting understanding of community healthcare needs and services at various events throughout the community. Part III, Line 4: The amount in Part III line 2 is the actual bad debt expenses of $8,742,496 written down to cost, utilizing the Uninsured Ratio of Cost to Charges (RCC) obtained from the full step down methodology of cost described in Part 1, line 7. 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 10/1/2012 to 9/30/2013 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 VI, Line 2: Catholic Health utilizes multiple methods to assess the health care needs of the commuities it serves, including:* Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors;* Patient, resident and caregiver satisfaction surveys;* Physician and leadership participation in forums to define health needs of patient populations; and* Participation in regional planning initiatives. Part VI, Line 3: Mercy Hospital informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the Catholic Health System Healthcare Assistance Program (HAP) policy. For example, Mercy Hospital has posters and brochures available which include contact information for the Financial Clearance staff in admissions areas, emergency rooms, primary care and outpatient rehabilitation clinics, Revenue Management Center (RMC) and other areas of the organization's facilities where eligible patients are likely to be present; provides information about financial assistance and HAP contact information to patients as part of the intake process; provides financial assistance and HAP contact information to inpatients either during or within 90 days of discharge of their hospital stay; 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.Our Customer Service area is our front end team to assist all patients in this process." Additionally, we discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable, and there is information about financial aid 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. It includes the City of Buffalo, New York State's second largest city, surrounded by a ring of older suburbs, which is followed by a ring of more newly developed suburbs, and then rural communities. The current population of Erie County is over nine hundred thousand, with about one-third living in Buffalo.Erie County has an average income significantly lower than 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 decreasebetween 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. 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. Integral to this effort is caring for the needs of those who are poor and disadvantaged. The services provided by Catholic Health organizations are provided in response to identified community needs, and reflect the System's emphasis on caring for the underserved. Catholic Health collaborates with other organizations to maximize its ability to provide needed services to the residents of our region.Each year, Catholic Health touches tens of thousands of community residents through community health education programs, health screenings, clinical and support services, and community support activities. Catholic Health will continue to meet community needs by providing charity care and Medicaid services, in addition to various other community benefit programs, including community health improvement, community benefit operations, health professions education, community building, as well as cash and in-kind contributions. 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 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 Executive VP / COO 0 434186 0 180496 0 133549 0 -9590 0 16330 0 754971 0 0 Charles Urlaub President, and CEO Mercy 343560 0 51902 0 57567 0 6518 0 16720 0 476267 0 0 0 David Macholz Treasurer 0 182055 0 27841 0 26256 0 -11013 0 17660 0 242799 0 0 Peter Bergmann Director 0 364848 0 76524 0 45800 0 -6310 0 22356 0 503218 0 0 James Millard Director 0 245733 0 43857 0 39672 0 -54323 0 281 0 275220 0 0 Christine Kluckhohn Pres.& CEO ContinuingCare 0 83923 0 18464 0 185908 0 -46313 0 22582 0 264564 0 0 Dr Michael Edbauer Director 0 203206 0 28710 0 24730 0 -304 0 8688 0 265030 0 0 James A Dunlop Jr Executive VP, Finance / CFO 0 383536 0 221131 0 69814 0 -68063 0 16919 0 623337 0 0 Dr Brian D'Arcy Senior VP, Medical Affairs 0 311162 0 49658 0 73788 0 24059 0 23306 0 481973 0 0 John Herman Chief Operating Officer, Mercy 176203 0 29060 0 26249 0 -18525 0 15548 0 228535 0 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 Dr Michael Galang Chief Information Officer 0 304298 0 104516 0 39708 0 -1161 0 6010 0 453371 0 0 Nancy Sheehan SVP Legal Service, General Counsel 0 261089 0 50717 0 19526 0 1457 0 6282 0 339071 0 0 Richard J Ruh MD Sr. VP, Service Lines 0 326942 0 29786 0 44797 0 5158 0 17478 0 424161 0 0 Dr Thomas Raab Physician 418181 0 50000 0 24188 0 -17785 0 25714 0 500298 0 0 0 Dr Timothy Gabryel VP Medical Affairs 383571 0 40142 0 16788 0 15033 0 8975 0 464509 0 0 0 Dr Syed Shah Physician 429650 0 31250 0 25474 0 11579 0 15978 0 513931 0 0 0 Dr Lawrence Gugino Physician 267413 0 0 0 774 0 5386 0 16448 0 290021 0 0 0 Dr Nicholas Cromwell Physician 240041 0 0 0 16742 0 11793 0 253 0 268829 0 0 0 Dr Stephen Downing Physician 265072 0 0 0 9820 0 0 0 10925 0 285817 0 0 0 Nils Gunnerson Leased Administrator 207890 0 49742 0 39707 0 -10805 0 256 0 286790 0 0 0 Part I, Lines 4a-b A severance payment of $176,379.28 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 26,000.00 299,904.00 Mark Sullivan 19,500.00 Dr. Brian D'Arcy 9,800.00 Peter Bergmann 7,334.00 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 $355,199.37 James A. Dunlop, Jr. $221,130.56 Mark Sullivan $180,495.91 Michael Moley $151,752.84 Dr. Michael Galang $104,515.96 Peter Bergmann $76,523.85 Dr. Michael Edbauer $57,419.55 Charles Urlaub $51,901.70 Nancy Sheehan $50,717.26 Dr. Thomas Raab $50,000.00 Nils Gunnerson $49,741.58 Dr. Brian D'Arcy $49,658.25 James Millard $43,857.45 Dr. Timothy Gabryel $40,141.88 John Stavros $38,645.95 Dr. Syed Shah $31,250.00 John Herman $29,059.58 David Macholz $27,841.37 Bartholomew Rodrigues $20,996.27 Christine Kluckhohn $18,463.54 A Dormitory Authority of the State of NY 146000293 64983Q5R6 2006-11-29 13360000 Part VI 0 0 0 B Dormitory Authority of the State of NY 146000293 64983Q5D9 2008-11-26 24700000 Part VI 0 0 0 C Dormitory Authority of the State of NY 146000293 649906J96 2012-07-12 3080000 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 1983065 780359 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 USA NA 18.500000000000 0 0 0 0 0 B 1 1 1 HSBC Bank USA NA 25.600000000000 0 0 0 1 0 C 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 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 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. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 78195 Corporate Nurse educator 0 James Manzella Acute Care Board Member 224880 Key Employee of Manzella Marketing 0 David Zapfel Brother of BOD, Msgr. Robert Zapfel 27471 HR Employee of CHS 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 65673 HR Employee of CHS 0 Susan Gallagher-Stavros Wife of Key Employee, John Stavros 14437 Nurse, McAuley Seton Home Care 0 Marie Packard Daughter of BOD, Dennis Dombek 79972 Mercy Physical Therapist 0 Dr Craig Fetterman Partner of Buffalo Niagara Hospitalists 826313 Acute Care Board Member 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 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 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 45,520,264. Equity Transfer to Affiliates -7,310,772. Change in Interest in Foundation Unrestricted 527,508. Change in Interest in Foundation Restricted -637,090. Interest Rate Swap Adjustment 3,412,516. 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 Clare Manor 543 Locust Street Lockport NY 14094 160782647 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 Joseph Manor 2211 West State Street Olean NY 14760 160796400 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Luke Manor for the Chronically Ill 17 Wiard Street Batavia NY 14020 160794811 Skilled Nursing Facility NY 501 c 3 Schedule A 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 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 Batavia 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 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 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 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 Marian Professional Center Associates LP 350 Essjay Road Suite 101 Williamsville NY 14221 161360469 Rental Real Estate NY N/A Related 144703 0 0 OLV-Brierwood Helathcare Co LLC 6455 Lake Avenue Orchard Park NY 14127 161487207 Rental Real Estate NY N/A Related 35949 157331 0 0 Orchard Park Mercy Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161470350 Real Estate Holding Company NY Mercy Hospital C 139625 1.00000 0 Aurora Mercy Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161354302 Real Estate Development NY Mercy Hospital C 46514 1.00000 0 Alsace Abbott Corporation 144 Genesee Street Finance 4th Floo Buffalo NY 14203 161355092 Partnership Holding Corporation NY Mercy Hospital C 338326 1.00000 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 Orchard Park Mercy Corporation Q 86465