2013-11-12T07:55:21-06:00 2012-12-31 990 2012-01-01 160743154 ST ELIZABETHS HOME FOR THE AGED STEL 7169234868 291 NORTH STREET BUFFALO NY 14201 DAVID P MACHOLZ 7168282794 2013-11-12 2012 2016-02-25 16:41:14Z JOSEPH MCDONALD 2121 MAIN STREET BUFFALO NY 14214 2174248 0 X CHSBUFFALO.ORG X 1959 NY THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, CHS PROVIDERS CONTINUE THE HEALING MINISTRY OF JESUS SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2012 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 11 6 76 48 0 0 0 0 2177247 2154947 1328 -21751 8413 12853 2186988 2146049 0 0 0 0 1968326 1987293 0 0 0 692252 706610 2660578 2693903 -473590 -547854 4475919 4591010 3529962 4268878 945957 322132 X THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, CHS PROVIDERS CONTINUE THE HEALING MINISTRY OF JESUS SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2012 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 0 0 2183412 2144953 NURSING 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. 2183412 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 4 0 1 76 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID P MACHOLZ 7168282974 515 ABBOTT ROAD SUITE 500 BUFFALO NY 14220 JOSEPH MCDONALD 37.50 X X 0 1471257 38697 MARK SULLIVAN 37.50 X X 0 837613 31269 CHRISTINE KLUCKHOHN 37.50 X X 0 317922 122567 EDWARD FLYNN 1.00 X 0 0 0 JOYCE MARKIEWICZ 37.50 X 0 303620 38479 MARK MEYERHOFER 1.00 X 0 0 0 JAMES MILLARD 37.50 X 0 322272 146102 ROBERT NASSO 1.00 X 0 0 0 SHERRY POMEROY PHD RN 1.00 X 0 0 0 NANCY TRUVER 1.00 X 0 0 0 SR MARY ANNE WELDON 1.00 X 0 0 0 MONSIGNOR ROBERT E ZAPFEL 1.00 X 0 0 0 JAMES A DUNLOP JR 37.50 X 0 672604 115267 JUDITH HUMES 37.50 X 74989 0 25446 MICHAEL MOLEY 37.50 X 0 614871 36811 JOHN STAVROS 37.50 X 0 283453 36599 MARIA FOTI 37.50 X 0 210430 26939 BARTHOLOMEW RODRIGUES 37.50 X 0 224567 34605 DR MICHAEL GALANG 37.50 X 0 393110 25395 NANCY SHEEHAN 37.50 X 0 249445 26369 RICHARD J RUH MD 37.50 X 0 361371 32599 74989 6262535 737144 0 0 1 0 NURSEFINDERS PO BOX 910738 DALLAS TX 75391 NURSING SERVICES 214673 1 PRIVATE AND SSI 623000 2154947 2154947 2154947 1096 1096 5352 28199 -22847 -22847 -22847 MISC 900099 8154 8154 VENDING INCOME 900099 4699 4699 12853 2146049 2144953 0 1096 1503699 1206145 297554 402018 365389 36629 81576 65434 16142 128310 128310 30340 4118 26222 PURCHASE SERVICES 238316 161569 76747 SUPPLIES 200109 195188 4921 BAD DEBTS EXPENSE 46696 46696 MEDICAL & PROFESSIONAL 16760 6657 10103 46079 3906 42173 2693903 2183412 510491 0 284853 72545 138664 205050 992596 1336449 3867559 3186018 809591 681541 2250215 2295425 4475919 4591010 288803 244744 3241159 4024134 3529962 4268878 X 945957 322132 945957 322132 4475919 4591010 X -547854 -75971 X 0 0 0 X 2279019 2157684 2208397 2185660 2167800 10998560 2279019 2157684 2208397 2185660 2167800 10998560 0 0 0 10998560 2058 674 1378 1328 1096 6534 2058 674 1378 1328 1096 6534 2281077 2158358 2209775 2186988 2168896 11005094 0.99940 0.99890 0.00060 0.00110 X 0 0 0 0 0 0 0 0 1 152 152 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: ST. 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. 860538 815405 45133 586460 473792 112668 2420561 1896821 523740 681541 DUE FROM AFFILIATE 2295425 2295425 LONG TERM PENSION OBLIGATION 992364 ASSET RETIREMENT OBLIGATION 128168 OTHER LONG TERM LIABILITIES 1502608 DUE TO AFFILIATES 1400994 4024134 X X X X X X 0 1 0 0 0 1 1 0 0 JOSEPH MCDONALD 0 691688 0 436815 0 342754 0 23055 0 15642 0 1509954 0 0 MARK SULLIVAN 0 420019 0 253093 0 164501 0 17302 0 13967 0 868882 0 0 CHRISTINE KLUCKHOHN 0 249437 0 29277 0 39208 0 103254 0 19313 0 440489 0 0 JOYCE MARKIEWICZ 0 206941 0 57472 0 39207 0 19954 0 18525 0 342099 0 0 JAMES MILLARD 0 223041 0 60186 0 39045 0 145769 0 333 0 468374 0 0 JAMES A DUNLOP JR 0 372610 0 231360 0 68634 0 101350 0 13917 0 787871 0 0 MICHAEL MOLEY 0 287705 0 145164 0 182002 0 22381 0 14430 0 651682 0 0 JOHN STAVROS 0 193171 0 50332 0 39950 0 20253 0 16346 0 320052 0 0 MARIA FOTI 0 165555 0 11344 0 33531 0 20195 0 6744 0 237369 0 0 BARTHOLOMEW RODRIGUES 0 153335 0 32085 0 39147 0 16226 0 18379 0 259172 0 0 DR MICHAEL GALANG 0 295137 0 59063 0 38910 0 20397 0 4998 0 418505 0 0 NANCY SHEEHAN 0 206291 0 16068 0 27086 0 19896 0 6473 0 275814 0 0 RICHARD J RUH MD 0 311908 0 0 0 49463 0 17374 0 15225 0 393970 0 0 PART I, LINE 4B TWO 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 6 THE 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 DAVID ZAPFEL BROTHER OF BOD, MSGR. ROBERT ZAPFEL 66713 HR EMPLOYEE OF CHS 0 KATHLEEN ZAPFEL SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL 57335 HR EMPLOYEE OF CHS 0 SUSAN GALLAGHER-STAVROS WIFE OF KEY EMPLOYEE, JOHN STAVROS 21753 NURSE, MCAULEY SETON HOME CARE 0 FORM 990, PART VI, SECTION A, LINE 6 CHS HAS THREE MEMBERS: ASCENSION HEALTH, CATHOLIC HEALTH EAST, AND THE DIOCESE OF BUFFALO, NY. EACH MEMBER IS ABLE TO PARTICIPATE EQUALLY IN ELECTING THE GOVERNING BODY, APPROVING SIGNIFICANT DECISIONS OF THE GOVERNING BODY, AND IN RECEIVING A SHARE OF NET ASSETS UPON DISSOLUTION, ACCORDING TO THE CHS BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE CHS BYLAWS, EACH MEMBER IS EQUALLY ALLOWED TO APPOINT UP TO THREE INDIVIDUALS TO ACT AS ITS REPRESENTATIVES ON THE CORPORATE MEMBER BOARD, AND IN UNDERTAKING ANY ACTION IN ITS CAPACITY AS A MEMBER. THE CORPORATE MEMBER BOARD OVERSEES THE GOVERNANCE OF THE CATHOLIC HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B EACH MEMBER IS ENTITLED TO ONE VOTE ON EACH MATTER PROPERLY SUBMITTED AT ANY MEMBERSHIP MEETING, AND THE MEMBERS ALSO HAVE RESERVE POWERS WHICH ALLOW APPROVAL FOR CERTAIN BUSINESS EVENTS AND RATIFICATION OF CERTAIN BUSINESS TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 11 YES, AN ELECTRONIC COPY OF THE FORM 990 WAS PROVIDED TO THE CHS BOARDS OF DIRECTORS BEFORE IT WAS FILED. THE CHS BOARD OF DIRECTORS HAS DELEGATED THE RESPONSIBILITY TO REVIEW THE 990 TO THE AUDIT COMMITTEE. THE CHS AUDIT COMMITTEE REVIEWED IN DETAIL SELECTED INFORMATION FOR ALL CATHOLIC HEALTH SYSTEM ENTITIES. REVIEWED WITH THE AUDIT COMMITTEE: 1. CORE FORM PART IV: CHECKLIST OF REQUIRED SCHEDULES 2. CORE FORM PART VI: GOVERNANCE, MANAGEMENT AND DISCLOSURE 3. CORE FORM PART VII: COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS 4. 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 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 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 15 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: MINIMUM PENSION LIABILITY ADJUSTMENT -75,971. FORM 990, PART VI, SECTION B, LINE 16B 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 FORMAIZE THE PROCESS. CATHOLIC HEALTH SYSTEM INC 515 ABBOTT ROAD BUFFALO NY 14220 222565278 HEALTH CARE DELIVERY SYSTEM NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 SISTERS OF CHARITY HOSPITAL 2157 MAIN STREET BUFFALO NY 14214 160743187 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVENUE KENMORE NY 14217 160762843 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 NAZARETH HOME OF THE FRANCISCAN SISTERS 291 NORTH STREET BUFFALO NY 14201 160813142 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST CLARE MANOR 543 LOCUST STREET LOCKPORT NY 14094 160782647 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS HOME OF WILLIAMSVILLE 147 REIST STREET WILLIAMSVILLE NY 14221 160743153 SKILLED NURSING FACILITY NY 501(C)(3) 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) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST JOSEPH MANOR 2211 WEST STATE STREET OLEAN NY 14760 160796400 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST LUKE MANOR FOR THE CHRONICALLY ILL 17 WIARD STREET BATAVIA NY 14020 160794811 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST MARY'S MANOR 515 6TH STREET NIAGARA FALLS NY 14301 160924139 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 WNY CATHOLIC LONG TERM CARE INC 6400 POWERS ROAD ORCHARD PARK NY 14127 161434368 SKILLED NURSING FACILITY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE) 2875 UNION ROAD SUITE 14 CHEEKTOWAGA NY 14227 161317960 HOME CARE PROVIDER NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 MCAULEY SETON HOME CARE 2875 UNION ROAD SUITE 14 CHEEKTOWAGA NY 14227 161310062 HOME CARE PROVIDER NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 CATHOLICE HEALTH SYSTEM INFUSION PHARMACY INC 2875 UNION ROAD SUITE 14 CHEEKTOWAGA NY 14227 200198518 HOME CARE INFUSION SERVICES NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 CHS CONTINUING CARE FOUNDATION 291 NORTH STREET BUFFALO NY 14201 200947831 FOUNDATION NY 501(C)(3) LINE 7 CATHOLIC HEALTH SYSTEM INC 0 OLV RENAISSANCE CORPORATION 291 NORTH STREET BUFFALO NY 14201 200167745 REAL ESTATE HOLDING COMPANY NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 CHS PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY INC 55 MELROY AVENUE LACKAWANA NY 14218 261252884 ALL-INCLUSIVE CARE FOR THE ELDERLY NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1