2014-10-30T07:30:24-05:00 2013-12-31 990 2013-01-01 160743187 Sisters of Charity Hospital SIST 7168282993 144 Genesee Street Finance 4th Floor Buffalo NY 14203 DAVID P MACHOLZ VP Finance/Corp Controller 7168282993 2014-10-30 2013 2015-11-30 17:44:51Z Joseph D McDonald 144 Genesee Street Administration 6th Floor Buffalo NY 14203 324212858 0 X www.chsbuffalo.org X 1849 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 2631 501 0 0 845482 122828 307729834 315493950 221051 263159 8597440 8332921 317393807 324212858 0 0 0 0 148629651 153563523 0 0 0 159270636 163954327 307900287 317517850 9493520 6695008 282864096 298093662 211568358 185005387 71295738 113088275 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 150224571 200941712 Inpatient Services:75,489 Acute Care Patient Days16,798 Newborn Patient Days27,817 Skilled Nursing Patient Days6,373 I/P Ambulatory Surgeries 79086873 105941967 Outpatient Services:59,530 ED Visits net of Admits297,124 Referred Ambulatory Visits10,184 Operating Room6,257 G.I. Laboratory1,717 Interventional Radiology1,368 Windsong Ambulatory Surgery Center546 Transfusion 6497330 17159890 Primary Care Clinics:25,903 Clinic/Primary Care Center Visits322,132 Substance Visits 235808774 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 0 0 1 242 0 2631 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 0 X David MacholzVP 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 Peter Bergmann President, and CEO Sisters 37.50 0.00 X X 487172 0 16046 David Macholz Treasurer 0.00 37.50 X X 0 236152 6647 James Millard Director 0.00 37.50 X 0 329262 -54042 Charles Urlaub Officer/Director 0.00 37.50 X X 0 453029 23238 Christine Kluchhohn Pres. & CEO Continuing Care 0.00 37.50 X 0 288295 -23731 Michael Edbauer Director 0.00 18.80 X 0 256646 8384 Brian Beitz Director 1.00 0.00 X 0 0 0 Frances Crosby RN PhD Director 1.00 0.00 X 0 0 0 Richard Curran MD Director 1.00 0.00 X 0 0 0 Dennis Dombek Director 1.00 0.00 X 0 0 0 Dr Craig Fetterman Director 1.00 0.00 X 0 0 0 Mr William Lawley Jr Director 1.00 0.00 X 0 0 0 Judith Maness Director 1.00 0.00 X 0 0 0 James Manzella Director 1.00 0.00 X 0 0 0 Michael Montante Director 1.00 0.00 X 0 0 0 Cynthia Zane EdD Director 1.00 0.00 X 0 0 0 Monsignor Robert E Zapfel Director 1.00 0.00 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 Matthew Hamp COO, Sisters 37.50 0.00 X 232387 0 11438 Martin Borzyak COO, Sisters/SJC 37.50 0.00 X 170341 0 7208 Michael Moley Sr VP. Human Resource 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 Nady Shehata VP, Medical Affairs 37.50 0.00 X 330075 0 24280 Bartholomew Rodrigues Sr.VP, Mission Integration 0.00 37.50 X 0 217153 24073 Bruce Rodgers Physician 37.50 0.00 X 357026 0 14881 Dr Jack R Lawler Physician 37.50 0.00 X 311227 0 19683 Dr Margaret McDonnell Physician 37.50 0.00 X 320346 0 26904 Dr Anthony Pivarunus Physician 37.50 0.00 X 338644 0 -51679 Dr Ali Ghomi Physician 37.50 0.00 X 409020 0 25266 2956238 7420865 199103 65 0 1 0 Sodexho Inc & Affiliates PO Box 81049 Woburn MA 01813 Environmental Services 2989967 Quest Diagnostics (Chicago) 2178 Collection Center Drive Chicago IL 60693 Laboratory Services 1623366 Buffalo Medical Group 85 High Street Buffalo NY 14203 Physician Services 1575000 Siemens Medical Solutions Bank of Mello PO Box 120001 Dept 0733 Dallas TX 75312 Maintenance Services 739583 Endion Hospitalist Services PO Box 645037 Cincinnati OH 45264 Physician Services 677362 45 122828 122828 Medicaid/Medicare 900099 167256320 167256320 Patient Service 900099 148237630 148237630 315493950 263159 263159 821503 0 821503 821503 821503 Shared Service 900099 2402588 2402588 Meaningful Use Money 900099 2357888 2357888 Cafeteria 900099 1144768 1144768 1606174 1606174 7511418 324212858 317896538 0 6193492 119292536 108802968 10489568 10235676 9417606 818070 16590479 15116954 1473525 7444832 6785661 659171 39476 14152 25324 13194043 9501911 3692132 28972 26206 2766 8530466 4858337 3672129 409756 121599 288157 3750387 1152852 2597535 147802 132442 15360 84346 74171 10175 1962912 1962912 11910067 11910067 3122973 2896331 226642 Medical Supplies 53151215 54226831 -1075616 Shared Service 51062919 51062919 Purchased Services & Ot 14044904 6785438 7259466 Non-Medical Supplies 2514089 2022336 491753 317517850 235808774 81709076 0 178626 29847 115701231 129874903 136332 138545 44346176 37376147 5285870 6013105 1572324 1536757 135481081 60945273 75489660 74535808 40153877 48588550 282864096 298093662 43269356 39199641 272110 448112 28648948 26894340 7648399 8100755 131729545 110362539 211568358 185005387 X 69184523 110436850 1988692 2528902 122523 122523 71295738 113088275 282864096 298093662 X 6695008 35097529 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1958968 1958968 25612920 14989455 10623465 32187643 7594892 24592751 72805135 38360926 34444209 2916415 2916415 74535808 Other Receivables 3913673 Due from Affiliates 10938658 Workers Comp Funding Surplus 1054198 Insurance Recoveries 24136294 Investment in Caritas Medical Arts Building 54567 Investment in Net Assets of the SOC Foundation 8491160 48588550 Due to Affiliates 21295051 Interest Rate Swap 3017203 Pension Obligation 49035900 Asset Retirement Obligation 2360078 L/T Disposables 73555 L/T General Liability IBNR 19071700 L/T Workers Comp IBNR 15509052 110362539 326159782 2069752 2069752 324090030 122828 122828 324212858 318553374 1035525 1035525 317517849 0 317517849 Part XI, Line 2d - Other Adjustments: SOC Foundation Inc Revenue Part XI, Line 4b - Other Adjustments: Contributions from Sisters Hospital Foundation and Grant Income Baby Cafe Grant Part XII, Line 2d - Other Adjustments: Foundation Expenses less the SOC Foundation Contributions to the Hospital 1 1 X 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 3464340 210225 3254115 0.01020 68955280 48623301 20331979 0.06400 72419620 48833526 23586094 0.07420 1986298 1986298 0.00630 9111274 2541373 6569901 0.02070 747584 747584 0.00240 340257 340257 0.00110 12185413 2541373 9644040 0.03050 84605033 51374899 33230134 0.10470 65925 65925 0.00020 4596 4596 0.00000 70521 70521 0.00020 1 3481841 1532941 48578989 49018072 -439083 X 1 0 2 1 Sisters of Charity Hospital 2157 Main Street Buffalo NY 14214 X X X X X Ambulatory Surgery - Multi Speciality Audiology O/P, Chemical Dependence 14 Sisters of Charity Hospital - St Joseph 2605 Harlem Road Cheektowaga NY 14225 X X X X X Ambulatory Surgery - Multi Speciality Clinic Part Time Services Sisters Hospital 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 Sisters Hospital 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. Sisters Hospital 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 HospitalsHarvest HouseSpectrum Human ServicesBuffalo State College, Center forCommunity Health Center Health and Social ResearchErie County DOHWellness InstituteAmerican Cancer SocietyP2 Collaborative of WNYHealthcare Community ConsultantCity of Buffalo communityPhysician representativeErie County Department of Health Community Meeting Participants:FDACancer Service Program of Erie CountyBuffalo State CollegeCatholic HealthP2 Collaborative of WNYAmerican Cancer SocietyMonroe PlanUBMDWellness InstituteEPICM.E.D.-V.A.R. ConsultingKaleidaBuffalo Prenatal-Perinatal NetworkErie County DOHUnited WayPrevention Focus Sisters Hospital Part V, Section B, Line 4: Sisters Hospital was conducted with Mercy Hospital and Kenmore Mercy Hospital. Sisters Hospital 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. Sisters Hospital Part V, Section B, Line 14g: Includes information in both English and Spanish on all signage and brochures for financial assistance. Sisters Hospital Part V, Section B, Line 20d: Highest volume commercial payor rate. Sisters Hospital 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. 12 Harvey Austin School #97 1405 Sycamore St Buffalo NY 14211 Extension Clinic: Pathways Methadone 158 Holden Avenue Buffalo NY 14214 Extension Clinic: Rochester Pathways 79 Howell Street Rochester NY 14614 Extension Clinic: St Vincent Health Center 1595 Bailey Ave Buffalo NY 14212 Extension Clinic: Chemical Dependence - Sisters Ambulatory Surgery Center 45 Spindrift Dr Williamsville NY 14221 Extension Clinic: Ambulatory Surgery - Mul Sisters Athleticare 100 Corporate Pky Amherst NY 14226 Extension Clinic: Therapy - Physical O/P Sisters Hospital Star Program 3730 Sheridan Dr Amherst NY 14226 Extension Clinic: Methadone West Hertel Academy 489 Hertel Ave Buffalo NY 14212 Extension Clinic: Immunology Med Southside Elementary School #93 430 Southside Pkwy Buffalo NY 14210 Extension Clinic: Immunology Medical Socia St Catherine Laboure Health Care Center 2157 Main Street Buffalo NY 14214 Long Term Care: CHS Partners in Rehab 6199 Transit Rd Depew NY 14043 Extension Clinic: Therapy - Occupational O Sisters Central Park Diagnostic Center 34 Benwood Ave Buffalo NY 14214 Clinical Laboratory Service O/P Radiology - Part I, Line 3c: N/A Part I, Line 6a: Sisters Hospital Community Benefit Report is contained in a report prepared by the Catholic Health System. Part I, Line 7: Costing is a full step down methodology of cost from non-revenue producing departments to revenue producing departments', with assignment of cost to individual charge items based on volume and charge amount. All patient accounts are cost with the same methodology regardless of patient type (inpatient, outpatient, emergency room, etc.) or insurance coverage (Medicare, Medicaid, private insurance, uninsured, etc.). Part II, Community Building Activities: Sisters Hospital 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 $3,481,841 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: Sisters 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, Sisters 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 X 1 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 Peter Bergmann President, and CEO Sisters 364848 0 76524 0 45800 0 -6310 0 22356 0 503218 0 0 0 David Macholz Treasurer 0 182055 0 27841 0 26256 0 -11013 0 17660 0 242799 0 0 James Millard Director 0 245733 0 43857 0 39672 0 -54323 0 281 0 275220 0 0 Charles Urlaub Officer/Director 0 343560 0 51902 0 57567 0 6518 0 16720 0 476267 0 0 Christine Kluchhohn Pres. & CEO Continuing Care 0 83923 0 18464 0 185908 0 -46313 0 22582 0 264564 0 0 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 Matthew Hamp COO, Sisters 158303 0 24234 0 49850 0 -6363 0 17801 0 243825 0 0 0 Martin Borzyak COO, Sisters/SJC 144261 0 18702 0 7378 0 -503 0 7711 0 177549 0 0 0 Michael Moley Sr VP. Human Resource 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 Nady Shehata VP, Medical Affairs 268673 0 37878 0 23524 0 2117 0 22163 0 354355 0 0 0 Bartholomew Rodrigues Sr.VP, Mission Integration 0 157996 0 20996 0 38161 0 1147 0 22926 0 241226 0 0 Bruce Rodgers Physician 350002 0 6250 0 774 0 14492 0 389 0 371907 0 0 0 Dr Jack R Lawler Physician 310039 0 0 0 1188 0 17822 0 1861 0 330910 0 0 0 Dr Margaret McDonnell Physician 319572 0 0 0 774 0 4717 0 22187 0 347250 0 0 0 Dr Anthony Pivarunus Physician 287357 0 34923 0 16364 0 -70212 0 18533 0 286965 0 0 0 Dr Ali Ghomi Physician 303340 0 90000 0 15680 0 2460 0 22806 0 434286 0 0 0 Part I, Line 1a One Officer received a tax indemnification and gross-up payment for reimbursement of withholding taxes in conjunction with certain taxable benefits paid on behalf of employee. Part I, Lines 4a-b A severance payment of $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. Pension CHS & Acutes Pension GAP Joseph McDonald $26,000.00 Mark Sullivan $19,500.00 Dr. Brian D'Arcy $ 9,800.00 Peter Bergmann $ 7,334.00 CHE SERP Joseph McDonald $299,904.00 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 Mark Sullivan $180,495.91 James A Dunlop Jr $221,130.56 Dr. Brian D'Arcy $ 49,658.25 Nancy Sheehan $ 50,717.26 Michael Moley $151,752.84 John Stravos $ 38,645.95 Christine Kluckhohn $ 18,463.54 Bartholomew Rodriques$ 20,996.27 Dr. Michael Galang $104,515.96 Dr. Michael Edbauer $ 57,419.55 Dave Macholz $ 27,841.37 Dr. Ali Ghomi $ 90,000.00 Peter Bergmann $ 76,523.85 Charles Urlaub $ 51,901.70 James Millard $ 43,857.45 Dr. Nady Shehata $ 37,878.03 Dr. Anthony Pivarunus$ 34,922.50 Matthew Hamp $ 24,234.21 Martin Boryszak $ 18,702.21 Dr. Bruce Rodgers $ 6,250.00 A Dormitory Authority of the State of NY 146000293 64983Q5S4 2006-11-29 30295000 Part VI 0 0 0 B Dormitory Authority of the State of NY 146000293 64983Q5U9 2006-11-29 8435000 Part VI 0 0 0 A 30295000 1120911 179286 28994803 1994 1 0 1 1 B 8435000 341581 49919 8043500 2005 1 0 1 1 A 0 0 0 0 0 0 0 B 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 JP Morgan Chase NA 18.500000000000 0 0 0 0 0 A 0 B 0 Part I A (f) Description of Purpose: To refund Sisters of Charity of Buffalo Insured Revenue Bonds, Series 2003, which were bonds issued for the purpose of refunding a series of bonds issued in 1991, the proceeds of which were applied to finance the construction and renovation of the Sisters of Charity facilities and to refinance outstanding indebtedness. Part I B (f) Description of Purpose: To finance the cost of the St. Joseph Campus emergency room expansion project. Karen Hamp Wife of COO, Matt Hamp 42718 RN, Kenmore 0 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 Gallaher-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 836313 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 C, line 19 We make our form 990 open for public inspection upon request. Our website includes an annual report which includes selected financial information. Our financial statements, governing documents and conflict of interest policy are provided upon request according to applicable federal and state laws. Form 990, Part XI, line 9: Pension Liability Adjustments 31,530,077. Equity Transfer from Affiliates 18,715. Change in Unrestricted Interest in Net Assets of Sisters Foundation 1,014,596. Interest Rate Swap Adjustment 1,993,931. Change in Temporary Restricted Interest in Net Assets of Sisters Foundation 540,210. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501 c 3 Schedule A line 9 0 Mercy Hospital of Buffalo 565 Abbott Road Buffalo NY 14220 160756336 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 St 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 Ave 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 St 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 Rd 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 Genesee Street Cheektowaga NY 14203 161317960 Home Care Provider NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 McAuley Seton Home Care 144 Genesee Street Cheektowaga 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 144 Genesee Street Cheektowaga NY 14203 200198518 Home Care Infusion Services 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 Sisters Hospital Foundation 2130 Main Street Buffalo NY 14214 222283077 Foundation NY 501 c 3 Schedule A line 7 Sisters of Charity Hospital 0 KMH Homes Inc 144 Genesee Street Buffalo NY 14203 161387890 Real Estate Holding Company NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 Trinity Medical WNY PC 144 Genesee Street Cheektowaga NY 14203 272576645 Primary Care Provider NY 501 c 3 Schedule A line 11 Catholic Health System Inc 0 Caritas Medical Arts Building LLC 350 Essjay Road Suite 101 Williamsville NY 14221 161521486 Rental Real Estate NY Related 42305 73785 0 0 0 1 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 1 1