2013-11-12T11:02:43-06:00 2012-12-31 990 2012-01-01 222565278 Catholic Health System Inc CATH 7168282993 515 Abbott Road No 508 Buffalo NY 14220 David P Macholz 7168282993 2013-11-12 2012 2016-02-24 21:20:13Z Joseph McDonald 2121 Main Street Suite 300 Buffalo NY 14214 118107255 0 X www.chsbuffalo.org X 1998 NY The Catholic Health System (CHS) mission is to provide quality healthcare services in Acute Care, Long Term Care, Home Care, and Primary Care settings. 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 Report can be found on our website at www.CHSBUFFALO.ORG. 23 15 1447 0 0 0 106888 0 103963246 117779131 20852 19586 0 308538 104090986 118107255 0 0 0 0 68855536 75890449 0 0 0 35235450 42216806 104090986 118107255 0 0 84019304 99537969 92724172 103533592 -8704868 -3995623 X The Catholic Health System (CHS) mission is to provide quality healthcare services in Acute Care, Long Term Care, Home Care, and Primary Care settings. 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 Report can be found on our website at www.CHSBUFFALO.ORG. 0 0 108703319 117779131 The Catholic Health System (CHS) provides administrative support services to the Catholic Health System entities which include: Acute Care, Continuing Care, Home Care, and Primary Care services. The program services are support services that are provided for the benefit of the health care delivery system. These include Compliance, Facility Planning, Finance, Human Resources, Information Technology, Legal Services, Marketing, Revenue Management Center, and other services. More information can be found on the Catholic Health System website www.CHSBUFFALO.ORG. T 108703319 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 130 0 1 1447 1 0 0 0 0 0 0 0 0 0 0 0 X 23 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X David P Macholz VP Finance Corporate Controller 7168282993 515 Abbott Road Suite 500 Buffalo NY 142202039 James Boldt 1.00 X 0 0 0 Carlton Brock 1.00 X 0 0 0 William K Buscaglia Jr 1.00 X 0 0 0 Clotilde Dedecker 1.00 X 0 0 0 Dennis Dombek 1.00 X 0 0 0 Shelley Drake 1.00 X 0 0 0 David Durante MD 20.00 X 0 99975 0 Sr Nancy Hoff RSM 1.00 X 0 0 0 Li Ln PhD 1.00 X 0 0 0 Ramesh Luther MD 1.00 X 0 25000 0 Joseph McDonald 37.50 X X 1471257 0 38697 Kelli Arnold McLeod 1.00 X 0 0 0 John Notaro MD 1.00 X 0 0 0 Linus Ormsby 1.00 X 0 0 0 Sr Patricia Prinzig 1.00 X 0 0 0 Jack Quinn Jr 1.00 X 0 0 0 Joseph Ralabate MD 25.00 X 0 108000 0 Sharon Randaccio 1.00 X 0 0 0 Arthur Russ Jr 1.00 X 0 0 0 Sr Margaret Tuley 1.00 X 0 0 0 Cary Vastola DO 1.00 X 0 0 0 Cynthia Zane EdD 1.00 X 0 0 0 Monsignor Robert E Zapfel 1.00 X 0 0 0 Mark Sullivan 37.50 X 837613 0 31269 James A Dunlop Jr 37.50 X 672603 0 115267 Dr Brian D'Arcy 37.50 X 578588 0 37824 Maria Foti 37.50 X 210430 0 26939 Dr Michael Galang 37.50 X 393109 0 25395 Christine Kluckhohn 37.50 X 317921 0 122567 Michael Moley 37.50 X 614871 0 36811 Bartholomew Rodrigues 37.50 X 224567 0 34605 Richard J Ruh MD 37.50 X 361371 0 32599 Nancy Sheehan 37.50 X 249445 0 26369 John Stavros 37.50 X 283453 0 36599 Lee Guterman MD 37.50 X 404298 0 41410 Catalina Ionita MD 37.50 X 353390 0 32421 Lee C Ruotsi MD 50.00 X 352835 0 36324 Thomas P Smith Jr MD 22.50 X 297171 0 10935 William J Lagaly DO 37.50 X 297732 0 24174 7920654 232975 710205 94 0 1 0 Siemens Medical Solutions Dept At 40065 Atlanta GA 311920065 Prof/Maint Svcs 7517728 GE Medical Systems PO Box 640944 Pittsburg PA 152640944 Maintenance Svcs 2632987 Travers Collins & Company 726 Exchange Street Suite 500 Buffalo NY 14210 Marketing 1675494 Soft Computer Consultants Inc 5400 Tech Data Drive Clearwater FL 33760 Prof/Maint Svcs 1132603 Promedical LLC PO Box 650 Lexington MA 02420 Svc Patient Accts 1063947 44 Administrative/Clinica 621610 117610706 117610706 168425 168425 117779131 19586 19586 IT Support Svcs 561000 263169 263169 Physician Fees 621110 45369 45369 308538 118107255 117779131 0 328124 6865797 4556927 2308870 51983850 51822223 161627 6559759 6519402 40357 5346687 5317078 29609 5134356 5134356 1460559 445851 1014708 846265 846265 151787 151787 1901499 1336366 565133 3095254 3093142 2112 297260 292346 4914 15324583 15324583 2083121 1919595 163526 366571 340673 25898 244308 226934 17374 191789 191789 3011481 3011481 249404 249404 Contracted Services 6039299 5841862 197437 Dues 4566851 33228 4533623 Bank Fees 319887 319887 Telephone 314897 292294 22603 1751991 1435846 316145 118107255 108703319 9403936 0 166795 175909 15812254 15491897 2393302 2788500 26231850 9805855 14250387 16425995 2752176 2752188 48644390 61903480 84019304 99537969 24701978 25960471 8413716 8620467 59608478 68952654 92724172 103533592 X -9102601 -4124326 397733 128703 -8704868 -3995623 84019304 99537969 X 0 4709245 X 0 1 X 1 0 X 76702699 84540251 92795318 103572038 117603442 475213748 24435 25998 29265 30947 28180 138825 76727134 84566249 92824583 103602985 117631622 475352573 0 0 0 475352573 234635 45978 22027 20186 19586 342412 234635 45978 22027 20186 19586 342412 34300 59914 57690 55706 45368 252978 114114 80314 160163 411443 284939 1050973 77110183 84752455 93064463 104090320 117981515 476998936 0.99650 0.99620 0.00070 0.00160 X Schedule A, Part IV, Supplemental Information: Schedule A, Part III, Line 12, Explanation for Other Income: Wellness Programs Community Education Other Operating LIFE Contracted Services RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 120000 0 1 31784 151784 0 Explanation of Lobbying Activities: Part II-B, Line 1: Other Lobbying Activities: Catholic Health System, Inc. pays dues (to American Hospital Association, Catholic Health Association, and Buffalo Niagara Partnership) that utilize a portion of the dues payment for lobbying activities. In 2012 the lobbying component of these dues amounted to approximately $31,784. Additionally, CHS retains individuals to advocate on behalf of the Catholic Health System, Inc. with New York State legislature relating to issues that impact the system. Costs incurred in relation to such activities amounted to $120,000 in 2012. 2917003 196444 2720559 368137 157115 211022 18354602 8880902 9473700 4592108 571394 4020714 16425995 Due From Related Subsidiaries 60313047 Insurance Recoveries 824015 Miscellaneous Other Receivables 766418 61903480 Due To Related Facilities 17868313 Accrued Pension 50124341 Key Equipment Financing 960000 68952654 118107255 0 118107255 0 118107255 118107255 0 118107255 0 118107255 X X X 1 1 X X X X X X 0 1 0 0 0 1 1 0 0 Joseph McDonald 691688 0 436815 0 342754 0 23055 0 15642 0 1509954 0 0 0 Mark Sullivan 420019 0 253093 0 164501 0 17302 0 13967 0 868882 0 0 0 James A Dunlop Jr 372610 0 231359 0 68634 0 101350 0 13917 0 787870 0 0 0 Dr Brian D'Arcy 272987 0 29115 0 276486 0 19190 0 18634 0 616412 0 0 0 Maria Foti 165555 0 11344 0 33531 0 20195 0 6744 0 237369 0 0 0 Dr Michael Galang 295137 0 59062 0 38910 0 20397 0 4998 0 418504 0 0 0 Christine Kluckhohn 249437 0 29277 0 39207 0 103254 0 19313 0 440488 0 0 0 Michael Moley 287705 0 145164 0 182002 0 22381 0 14430 0 651682 0 0 0 Bartholomew Rodrigues 153335 0 32085 0 39147 0 16226 0 18379 0 259172 0 0 0 Richard J Ruh MD 311908 0 0 0 49463 0 17374 0 15225 0 393970 0 0 0 Nancy Sheehan 206291 0 16068 0 27086 0 19896 0 6473 0 275814 0 0 0 John Stavros 193171 0 50332 0 39950 0 20253 0 16346 0 320052 0 0 0 Lee Guterman MD 403884 0 0 0 414 0 20022 0 21388 0 445708 0 0 0 Catalina Ionita MD 325992 0 27128 0 270 0 14607 0 17814 0 385811 0 0 0 Lee C Ruotsi MD 327811 0 0 0 25024 0 18992 0 17332 0 389159 0 0 0 Thomas P Smith Jr MD 297171 0 0 0 0 0 0 0 10935 0 308106 0 0 0 William J Lagaly DO 293658 0 0 0 4074 0 11454 0 12720 0 321906 0 0 0 Part I, Line 1a Tax Indemnification and Gross Up Payments. Yes, Officers and key employees received a tax indemnification and gross-up payment for reimbursement of withholding taxes in conjunction with certain taxable benefits paid on behalf of employee. Health or Social Club Dues or Initiation Fees. Yes, Taxable benefits for Country Club expenses are paid per the terms and conditions of the employment agreement for one key employee. Personal Services. Yes, Taxable benefits for tax preparation expenses were paid per the terms and conditions of the employment agreement for one key employee. Part I, Line 4b Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Joseph McDonald - Pension Gap Plan - $26,000 Joseph McDonald - Supplemental Employee Retirement Plan - $150,012 Mark Sullivan - Pension Gap Plan - $39,000 Dr. Brian D'Arcy - Pension Gap Plan - $9,800 Dr. Brian D'Arcy - Supplemental Employee Retirement Plan - $142,750 Michael Moley - Pension Gap Plan - $20,697 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 - Incentive - $436,814.82 Mark Sullivan - Incentive - $253,093.07 James A. Dunlop, Jr.- Incentive - $231,359.41 Dr. Brian D'Arcy - Incentive - $ 29,115.18 Nancy Sheehan - Incentive - $ 16,068.24 Michael Moley - Incentive - $145,164.42 John Stavros - Incentive - $ 50,331.57 Christine Kluckhohn - Incentive - $ 29,277.18 Maria Foti - Incentive - $ 11,344.26 Bartholomew Rodigues - Incentive - $ 32,085.26 Dr. Michael Galang - Incentive - $ 59,062.48 Dr. Catalina Ionita - Incentive - $ 27,128.00 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 Marie Packard Daughter of BOD, Dennis Dombeck 55983 Mercy Hospital Physical Therapist 0 Allison Malikowski Daughter of CHS Board member, Arthur Russ, Jr. 33119 HR Employee of CHS 0 Cary Vastola DO Partner of WNY Primary Care 220250 Catholic Health Board Member 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 by-laws. Form 990, Part VI, Section A, line 7a According to the CHS by-laws, 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 to any membership meeting. 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 An electronic copy of the Form 990 was provided to the CHS Board 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 VIII: Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Associates, 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 by 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, Non Physician Practioners, as well as Physician groups who are independent contractors or associates 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 completed 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 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 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 The Catholic Health System, Inc. makes the 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: Pension Liability -5,078,935. Capital Equity Contributions/Distributions 9,810,332. Grant Revenue For Capital 146,107. Other Changes To Net Assets -168,259. Mercy Hospital of Buffalo 565 Abbott Raod Buffalo NY 14220 160756336 Acute Care Hospital NY 501(c)(3) Schedule A-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) 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 Francisian 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 160743154 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 Home of Buffalo 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 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 Homemakers Services(Mercy Home Care) Apple Tree Business Park 2875 Union Cheektowaga NY 14227 161317960 Home Care Provider NY 501(c)(3) Schedule A-Line 9 Catholic Health System Inc 0 McAuley Seton Home Care Apple Tree Business Park 2875 Union Cheektowaga NY 14227 161310062 Home Care Provider NY 501(c)(3) Schedule A-Line 9 Catholic Health System Inc 0 Catholic Health System Infusion Pharmacy Apple Tree Business Park 2875 Union Cheektowaga NY 14227 200198518 Home Care Infusion Services NY 501(c)(3) Schedule A-Line 9 Catholic Health System Inc 0 CHS Continuing Care Foundation 291 North Street Buffalo NY 14201 200947831 Foundation NY 501(c)(3) Schedule A-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) Schedule A-Line 9 Catholic Health System Inc 0 OLV Community Housing(CHODO) 291 North Street Buffalo NY 14201 200372194 Community Housing Development 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 Buffalo NY 14201 261252884 All-Inclusive Care For The Elderly NY 501(c)(3) Schedule A-Line 3 Catholic Health System Inc 0 McAuley Mercy Corporation 515 Abbott Road Buffalo NY 14220 161279834 Management NY 501(c)(3) Schedule A-Line 9 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 Trinity Medical WNY PC 515 Abbott Road Buffalo NY 14220 272576645 Medical Practice NY C 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1