ST ELIZABETHS HOME FOR THE AGED: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ST ELIZABETHS HOME FOR THE AGED (EIN 16-0743154)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-12
IRS object ID
201313169349302581
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-12T07:55:21-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN160743154EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST ELIZABETHS HOME FOR THE AGEDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTELNameControl
Phone7169234868Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1291 NORTH STREETAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14201ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID P MACHOLZName
TitleVP FINANCE/CORPCONTROLLERTitle
Phone7168282794Phone
Date Signed2013-11-12DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOSEPH MCDONALDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12121 MAIN STREETAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14214ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2174248GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteCHSBUFFALO.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1959YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTHE 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 2012 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees76TotalNbrEmployees
Total Nbr Volunteers48TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2177247ProgramServiceRevenuePriorYear
Program Service Revenue CY2154947ProgramServiceRevenueCY
Investment Income Prior Year1328InvestmentIncomePriorYear
Investment Income Current Year-21751InvestmentIncomeCurrentYear
Other Revenue Prior Year8413OtherRevenuePriorYear
Other Revenue Current Year12853OtherRevenueCurrentYear
Total Revenue Prior Year2186988TotalRevenuePriorYear
Total Revenue Current Year2146049TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1968326SalariesEtcPriorYear
Salaries Etc Current Year1987293SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year692252OtherExpensePriorYear
Other Expenses Current Year706610OtherExpensesCurrentYear
Total Expenses Prior Year2660578TotalExpensesPriorYear
Total Expenses Current Year2693903TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-473590RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-547854RevenuesLessExpensesCY
Total Assets BOY4475919TotalAssetsBOY
Total Assets EOY4591010TotalAssetsEOY
Total Liabilities BOY3529962TotalLiabilitiesBOY
Total Liabilities EOY4268878TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY945957NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY322132NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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 2012 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2183412Expense
Revenue2144953Revenue
DescriptionNURSING HOME CARE: ST ELIZABETHS HOME IS AN ADULT NURSING FACILITY THAT TENDS PRIMARILY TO THE POOR AND ELDERLY AND IS LOCATED IN ERIE COUNTY, NEW YORK. IN 2012 OVER 51.83% OF THE RESIDENTS WERE COVERED BY MEDICAID. THIS 51.83% MEDICAID POPULATION EQUALLED 21,573 MEDICAID DAYS. SEE COMMUNITY SERVICE PLAN AT WWW.CHSBUFFALO.ORG.Description
Total Program Service Expense2183412TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10964NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees76NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAVID P MACHOLZBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7168282974TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1515 ABBOTT ROAD SUITE 500AddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14220ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployee
JOSEPH MCDONALD
PRESIDENT AND CEO, CHS37.50XX0147125738697
MARK SULLIVAN
EXEC VP/COO37.50XX083761331269
CHRISTINE KLUCKHOHN
PRES/CEO, CONTINUING CARE37.50XX0317922122567
EDWARD FLYNN
DIRECTOR1.00X000
JOYCE MARKIEWICZ
DIRECTOR37.50X030362038479
MARK MEYERHOFER
DIRECTOR1.00X000
JAMES MILLARD
DIRECTOR37.50X0322272146102
ROBERT NASSO
DIRECTOR1.00X000
SHERRY POMEROY PHD RN
DIRECTOR1.00X000
NANCY TRUVER
DIRECTOR1.00X000
SR MARY ANNE WELDON
DIRECTOR1.00X000
MONSIGNOR ROBERT E ZAPFEL
DIRECTOR1.00X000
JAMES A DUNLOP JR
EXEC VP, FINANCE/CFO37.50X0672604115267
JUDITH HUMES
ADMINISTRATOR37.50X74989025446
MICHAEL MOLEY
SR. VP HUMAN RESOURCES37.50061487136811X
JOHN STAVROS
SR. VP MARKETING37.50028345336599X
MARIA FOTI
SENIOR VP, PLANNING37.50021043026939X
BARTHOLOMEW RODRIGUES
SR. VP MISSION INTEGRATION37.50022456734605X
DR MICHAEL GALANG
CIO37.50039311025395X
NANCY SHEEHAN
VP LEGAL SVC, OGC37.50024944526369X
RICHARD J RUH MD
SR.VP.SERVICE LINES37.50036137132599X
FieldValueIRS element (for citing)
Total Reportable Comp From Org74989TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs6262535TotalReportableCompFrmRltdOrgs
Total Other Compensation737144TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1NURSEFINDERSBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 910738AddressLine1
CityDALLASCity
StateTXState
ZIP Code75391ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesNURSING SERVICESDescriptionOfServices
Compensation214673Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPRIVATE AND SSIDescription
Business Code623000BusinessCode
Total Revenue Column2154947TotalRevenueColumn
Related Or Exempt Function Income2154947RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue2154947TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1096TotalRevenueColumn
Exclusion$1,096ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other5352Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other28199Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-22847Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-22847TotalRevenueColumn
Related Or Exempt Function Income-22847RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MISC90009981548154
VENDING INCOME90009946994699
FieldValueIRS element (for citing)
Total Other Revenue12853TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2146049TotalRevenueColumn
Related Or Exempt Function Income2144953RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,096ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1503699Total
Program Services1206145ProgramServices
Management And General297554ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total402018Total
Program Services365389ProgramServices
Management And General36629ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total81576Total
Program Services65434ProgramServices
Management And General16142ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total128310Total
Program Services128310ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total30340Total
Program Services4118ProgramServices
Management And General26222ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASE SERVICES23831616156976747
SUPPLIES2001091951884921
BAD DEBTS EXPENSE4669646696
MEDICAL & PROFESSIONAL16760665710103

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total46079Total
Program Services3906ProgramServices
Management And General42173ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2693903Total
Program Services2183412ProgramServices
Management And General510491ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY284853BOY
EOY72545EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY138664BOY
EOY205050EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY992596BOY
EOY1336449EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3867559LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3186018LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY809591BOY
EOY681541EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2250215BOY
EOY2295425EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4475919BOY
EOY4591010EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY288803BOY
EOY244744EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3241159BOY
EOY4024134EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3529962BOY
EOY4268878EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY945957BOY
EOY322132EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY945957BOY
EOY322132EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4475919BOY
EOY4591010EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-547854ReconcilationRevenueExpenses
Reconcilation Other Changes-75971ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2279019CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2157684CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2208397CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2185660CurrentTaxYearMinus1Year
Current Tax Year2167800CurrentTaxYear
Total10998560Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2279019CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2157684CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2208397CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2185660CurrentTaxYearMinus1Year
Current Tax Year2167800CurrentTaxYear
Total10998560Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50910998560PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2058CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years674CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1378CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1328CurrentTaxYearMinus1Year
Current Tax Year1096CurrentTaxYear
Total6534Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2058CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years674CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1378CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1328CurrentTaxYearMinus1Year
Current Tax Year1096CurrentTaxYear
Total6534Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2281077CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2158358CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2209775CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2186988CurrentTaxYearMinus1Year
Current Tax Year2168896CurrentTaxYear
Total11005094Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99940PublicSupportPercentage509
Prior Year Support Percentage0.99890PriorYearSupportPercentage
Investment Income Percentage0.00060InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00110PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$152OtherActivitiesAmount
Total Lobbying Expenditures IIB152TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationST. ELIZABETHS HOME FOR THE AGED PAYS DUES TO ORGANIZATIONS (NEW YORK ASSOCIATION OF HOMES AND SERVICES FOR THE AGING) THAT UTILIZES A PORTION OF THE DUES PAYMENT FOR LOBBYING ACTIVITIES. IN 2012 THE LOBBYING COMPONENT OF THESE DUES AMOUNTED TO APPROXIMATELY $152.Explanation

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis860538OtherCostOrOtherBasis
Depreciation815405Depreciation
Book Value45133BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis586460OtherCostOrOtherBasis
Depreciation473792Depreciation
Book Value112668BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2420561OtherCostOrOtherBasis
Depreciation1896821Depreciation
Book Value523740BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings681541TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionDUE FROM AFFILIATEDescription
Book Value2295425BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets2295425TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
LONG TERM PENSION OBLIGATION$992,364
ASSET RETIREMENT OBLIGATION$128,168
OTHER LONG TERM LIABILITIES$1,502,608
DUE TO AFFILIATES$1,400,994
FieldValueIRS element (for citing)
Total Of Amounts4024134TotalOfAmounts

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JOSEPH MCDONALD
PRESIDENT AND CEO, CHS0691688043681503427540230550156420150995400
MARK SULLIVAN
EXEC VP/COO042001902530930164501017302013967086888200
CHRISTINE KLUCKHOHN
PRES/CEO, CONTINUING CARE02494370292770392080103254019313044048900
JOYCE MARKIEWICZ
DIRECTOR0206941057472039207019954018525034209900
JAMES MILLARD
DIRECTOR022304106018603904501457690333046837400
JAMES A DUNLOP JR
EXEC VP, FINANCE/CFO037261002313600686340101350013917078787100
MICHAEL MOLEY
SR. VP HUMAN RESOURCES028770501451640182002022381014430065168200
JOHN STAVROS
SR. VP MARKETING0193171050332039950020253016346032005200
MARIA FOTI
SENIOR VP, PLANNING016555501134403353102019506744023736900
BARTHOLOMEW RODRIGUES
SR. VP MISSION INTEGRATION0153335032085039147016226018379025917200
DR MICHAEL GALANG
CIO029513705906303891002039704998041850500
NANCY SHEEHAN
VP LEGAL SVC, OGC020629101606802708601989606473027581400
RICHARD J RUH MD
SR.VP.SERVICE LINES031190800049463017374015225039397000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTWO OFFICERS AND ONE KEY EMPLOYEE PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PER THE TERMS AND CONDITIONS OF THEIR EMPLOYMENT CONTRACT. PENSION GAP SERP JOSEPH MCDONALD $26,000 $150,012 MICHAEL MOLEY $20,697 MARK SULLIVAN $39,000
PART I, LINE 6THE 2012 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 $436,815 MARK SULLIVAN $253,093 JAMES A. DUNLOP, JR. $231,359 NANCY SHEEHAN $ 16,068 MICHAEL MOLEY $145,164 JOHN STAVROS $ 50,332 CHRISTINE KLUCKHOHN $ 29,277 MARIA FOTI $ 11,344 BARTHOLOMEW RODRIGUES$ 32,085 DR. MICHAEL GALANG $ 59,062 JAMES MILLARD $ 60,186 JOYCE MARKIEWICZ $ 57,472 JUDITH HUMES $ 574

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
DAVID ZAPFEL
BROTHER OF BOD, MSGR. ROBERT ZAPFEL66713HR EMPLOYEE OF CHS0
KATHLEEN ZAPFEL
SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL57335HR EMPLOYEE OF CHS0
SUSAN GALLAGHER-STAVROS
WIFE OF KEY EMPLOYEE, JOHN STAVROS21753NURSE, MCAULEY SETON HOME CARE0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6CHS 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 7AACCORDING 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 7BEACH 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 11YES, 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. SCHUDULE H: HOSPITAL 5. SCHUDULE 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 12CALL 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 IT NOTED, IT IS DISCUSSED BY THE MANAGER, 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 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 15THE 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 19WE 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:MINIMUM PENSION LIABILITY ADJUSTMENT -75,971.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART VI, SECTION B, LINE 16BTHE 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 FORMAIZE THE PROCESS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CATHOLIC HEALTH SYSTEM INC
515 ABBOTT ROADBUFFALONY14220222565278HEALTH CARE DELIVERY SYSTEMNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
MERCY HOSPITAL OF BUFFALO
565 ABBOTT ROADBUFFALONY14220160756336ACUTE CARE HOSPITALNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
SISTERS OF CHARITY HOSPITAL
2157 MAIN STREETBUFFALONY14214160743187ACUTE CARE HOSPITALNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
KENMORE MERCY HOSPITAL
2950 ELMWOOD AVENUEKENMORENY14217160762843ACUTE CARE HOSPITALNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
NAZARETH HOME OF THE FRANCISCAN SISTERS
291 NORTH STREETBUFFALONY14201160813142SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST CLARE MANOR
543 LOCUST STREETLOCKPORTNY14094160782647SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST FRANCIS HOME OF WILLIAMSVILLE
147 REIST STREETWILLIAMSVILLENY14221160743153SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST FRANCIS OF BUFFALO INC
34 BENWOOD AVENUEBUFFALONY14214161523535SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST JOSEPH MANOR
2211 WEST STATE STREETOLEANNY14760160796400SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST LUKE MANOR FOR THE CHRONICALLY ILL
17 WIARD STREETBATAVIANY14020160794811SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST MARY'S MANOR
515 6TH STREETNIAGARA FALLSNY14301160924139SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST VINCENT MANOR
319 WASHINGTON AVENUEDUNKIRKNY14048160743167ADULT HOMENY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
WNY CATHOLIC LONG TERM CARE INC
6400 POWERS ROADORCHARD PARKNY14127161434368SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE)
2875 UNION ROAD SUITE 14CHEEKTOWAGANY14227161317960HOME CARE PROVIDERNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
MCAULEY SETON HOME CARE
2875 UNION ROAD SUITE 14CHEEKTOWAGANY14227161310062HOME CARE PROVIDERNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
CATHOLICE HEALTH SYSTEM INFUSION PHARMACY INC
2875 UNION ROAD SUITE 14CHEEKTOWAGANY14227200198518HOME CARE INFUSION SERVICESNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
CHS CONTINUING CARE FOUNDATION
291 NORTH STREETBUFFALONY14201200947831FOUNDATIONNY501(C)(3)LINE 7CATHOLIC HEALTH SYSTEM INC0
OLV RENAISSANCE CORPORATION
291 NORTH STREETBUFFALONY14201200167745REAL ESTATE HOLDING COMPANYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
CHS PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY INC
55 MELROY AVENUELACKAWANANY14218261252884ALL-INCLUSIVE CARE FOR THE ELDERLYNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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