2013-11-12T14:25:25-06:00 2012-12-31 990 2012-01-01 161317960 Mercy Home Care MERC 7166854870 2875 Union Road No 14 Cheektowaga NY 14227 David P Macholz 7166854870 2013-11-12 2012 2016-02-24 21:20:13Z Mercy Home Care of Western New York David P Macholz 515 Abbott Road Buffalo NY 14220 7127513 0 X www.chsbuffalo.org X 1988 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in a home 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. 13 7 340 2 0 0 0 0 6274821 7100513 193 270 20312 26730 6295326 7127513 0 0 0 0 5202023 6007560 0 0 0 1431318 1582791 6633341 7590351 -338015 -462838 2060378 2155525 2159829 2745745 -99451 -590220 X The Catholic Health System (CHS) Mission is to provide quality healthcare services in a home 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 5969481 7100783 Throughout 2012, the staff at Niagara Homemaker Services, Inc. delivered 151,912 HHA hours of care. Additionally, 38,388 PCA hours were also made. Mery Home Care's Shared Aides provided 8,616 hours of care to residents in senior housing. Our registered nurses visits totalled 349 hours.The Home Response program monitored an average of 1,412 units/month during 2012. 5969481 1 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 1 0 0 0 1 3 0 340 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 7 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 Corp C 7168282974 515 Abbott Road Buffalo NY 142202039 Joseph McDonald 37.50 X X 0 1471257 38697 Mark Sullivan 37.50 X X 0 837613 31269 Joyce Markiewicz 37.50 X X 0 303620 38479 Peter Bergman 37.50 X 0 433289 33126 Nils Gunnersen 37.50 X 0 252984 77694 Dennis Horrigan 1.00 X 0 0 0 Li Lin PhD 1.00 X 0 0 0 Brian O'Herron 1.00 X 0 0 0 Michael Osborne 37.50 X 0 200163 27510 Katherine Rogala 1.00 X 0 0 0 Miguel Santos 1.00 X 0 0 0 Gary Tucker 1.00 X 0 0 0 Sr Sheila Marie Walsh 1.00 X 0 0 0 Monsignor Robert E Zapfel 1.00 X 0 0 0 James A Dunlop Jr 37.50 X 0 672603 115267 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 393109 25395 Nancy Sheehan 37.50 X 0 249445 26369 Richard j Ruh MD 37.50 X 0 361371 32599 0 6508775 581359 0 0 1 0 Doyle Security System Inc 792 Calkins Road Rochester NY 146239985 Personal Response Monitoring 206268 1 Program Service Revenu 621610 7100513 7100513 7100513 270 270 Rental Income from Aff 621610 24660 24660 Allocated from CHS 621610 2070 2070 26730 7127513 7100783 0 26730 4352116 3853664 498452 98690 87387 11303 1216252 1076953 139299 340502 301504 38998 614069 208801 405268 3561 3561 328056 32513 295543 139996 73658 66338 188157 186063 2094 5564 4193 1371 25154 25154 88380 88380 Contractual Allowances 121606 121606 CHS Dues 33061 33061 Bad Debt Expense 17340 17340 Employee Related 10628 152 10476 7219 2086 5133 7590351 5969481 1620870 0 871563 477820 624860 893622 11438 4247 552517 779836 2060378 2155525 1607312 1965909 552517 779836 2159829 2745745 X 0 0 0 0 -390353 -490769 -99451 -590220 2060378 2155525 X -462838 -27931 X 0 1 X 1 1 1 X 4469202 5368186 6252316 6274821 7100513 29465038 4469202 5368186 6252316 6274821 7100513 29465038 0 0 0 29465038 21403 3049 557 193 240 25442 21403 3049 557 193 240 25442 22945 20990 21250 20312 30980 116477 4513550 5392225 6274123 6295326 7131733 29606957 0.99520 0.99380 0.00090 0.00230 X 0 Workers Comp Insurance Recovery 779836 779836 Workers Comp Insurance Recovery 779836 779836 7005907 0 7005907 121606 121606 7127513 7468745 0 7468745 121606 121606 7590351 Part XI, Line 4b - Other Adjustments: Contractual Allowances Part XII, Line 4b - Other Adjustments: Contractual Allowances 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 Joyce Markiewicz 0 206941 0 57472 0 39207 0 19954 0 18525 0 342099 0 0 Peter Bergman 0 355818 0 32583 0 44888 0 14545 0 18581 0 466415 0 0 Nils Gunnersen 0 201350 0 12427 0 39207 0 77436 0 258 0 330678 0 0 Michael Osborne 0 150042 0 24409 0 25712 0 12454 0 15056 0 227673 0 0 James A Dunlop Jr 0 372610 0 231359 0 68634 0 101350 0 13917 0 787870 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 59062 0 38910 0 20397 0 4998 0 418504 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 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: $26,000 CHE SERP: $150,012 Mark Sullivan: Pension Gap: $39,000 Michael Moley: Pension Gap: $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 - $436,814.82 Mark Sullivan - $253,093.07 James A. Dunlop, Jr. - $231,359.41 Nancy Sheehan - $16,068.24 Michael Moley - $145,164.42 John Stavros - $50,331.57 Maria Foti - 11,344.26 Bartholomew Rodrigues - $32,085.26 Dr. Michael Galang - $59,062.48 Peter Bergmann - $32,583.13 Nils Gunnerson - $12,426.51 Joyce Markiewicz - $57,471.86 Mike Osborne - $24,409.30 David Zapfel Brother of BOD, Msgr. Robert Zapfel 66713 HR Employee of CHS 0 Kathleen Zapfel Sister-in-law of BOD, Mrgr. 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 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 2012, 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; CEOs 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 -27,931. Catholic Health System 515 Abbott Road Buffalo NY 14220 222565278 Health Care Delivery System NY 501 c 3 Schedule A line 9 N/A 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 Sisters of Charity Hospital 2157 Main Street Buffalo NY 14214 160743187 Acute Care Hospital NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore NY 14217 160762843 Acute Care Hospital NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 Nazareth Home of the Franciscan Sisters 291 North Street Buffalo NY 14201 160813142 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Clare Manor 543 Locust Street Lockport NY 14094 160782647 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Elizabeth Home for the Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Francis Home of Williamsville 147 Reist Street Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Francis of Buffalo Inc 34 Benwood Avenue Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Joseph Manor 2211 West State Street Olean NY 14760 160796400 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Luke Manor for the Chronically Ill 17 Wiard Street Batavia NY 14020 160794811 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Mary's Manor 515 6th Street Niagara Falls NY 14301 160924139 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 WNY Catholic Long Term Care Inc 6400 Powers Road Orchard Park NY 14217 161434368 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 McAuley Seton Home Care 2875 Union Rd Suite 14 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 2875 Union Rd Suite 14 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 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 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1