2013-11-12T09:17:31-06:00 2012-12-31 990 2012-01-01 160743187 Sisters of Charity Hospital SIST 7168282993 515 Abbott Road No 500 Buffalo NY 142202039 David P Macholz 7168282993 2013-11-12 2012 2016-02-24 21:20:13Z Joseph D McDonald 2121 Main Street Suite 300 Buffalo NY 14214 317393807 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 2012 Community Service Plan can be found at www.chsbuffalo.org. 18 7 2686 396 0 0 5495911 845482 299301494 307729834 339283 221051 7757548 8597440 312894236 317393807 0 0 0 0 139998941 148629651 0 0 0 155903530 159270636 295902471 307900287 16991765 9493520 263524760 282864096 190770849 211568358 72753911 71295738 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 2012 Community Service Plan can be found at www.chsbuffalo.org. 0 0 153857621 205765424 Inpatient Services:78,834 Acute Care Patient Days18,317 Newborn Patient Days28,229 Skilled Nursing Patient Days6,586 I/P Ambulatory Surgeries 70207245 94037280 Outpatient Services:58,269 ED Visits286,561 Referred Ambulatory Visits19,720 O/P Ambulatory Visits 6073688 7927130 Primary Care Clinics:24,387 Clinic/Primary Care Service Visits278,760 Substance Visits 230138554 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 1 257 0 2686 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X David MacholzController Catholic Health System Finance 7168282974 515 Abbott Road Suite 500 Buffalo NY 142202039 Joseph McDonald 0.00 37.50 X X 0 1471257 38697 Mark Sullivan 0.00 37.50 X X 0 837613 31269 Peter Bergmann 37.50 0.00 X X 433289 0 33126 David Macholz 0.00 37.50 X X 0 232233 34122 Dr Michael Albert 5.00 0.00 X 32623 0 0 Dr Paul Anain 0.00 37.50 X 0 224265 12894 Brian Beitz 0.00 1.00 X 0 0 0 Frances Crosby RN PhD 0.00 1.00 X 0 0 0 Richard Curran MD 0.00 1.00 X 0 0 0 Dennis Dombek 0.00 1.00 X 0 0 0 Dr Michael Edbauer 0.00 25.00 X 0 282798 26400 Dr Craig Fetterman 0.00 1.00 X 0 0 0 Christine Kluckhohn 0.00 37.50 X 0 317921 122567 Mr William Lawley Jr 0.00 1.00 X 0 0 0 Judith Maness 0.00 1.00 X 0 0 0 James Manzella 0.00 1.00 X 0 0 0 James Millard 0.00 37.50 X 0 322272 146102 Michael Montante 0.00 1.00 X 0 0 0 Charles J Urlaub 0.00 37.50 X X 0 477156 36336 Cynthia Zane EdD 0.00 1.00 X 0 0 0 Monsignor Robert E Zapfel 0.00 1.00 X 0 0 0 James A Dunlop Jr 0.00 37.50 X 0 672603 115267 Dr Brian D'Arcy 0.00 37.50 X 0 578588 37824 Matthew Hamp 37.50 0.00 X 217740 0 111003 Michael Moley 0.00 37.50 X 0 614871 36811 John Stavros 0.00 37.50 X 0 283453 36599 Dr Michael Galang 0.00 37.50 X 0 393109 25395 Nancy Sheehan 0.00 37.50 X 0 249445 26369 Richard J Ruh MD 0.00 37.50 X 0 361371 32599 Dr Nady Shehata 37.50 0.00 X 300161 0 40933 Dr Bruce Rodgers 37.50 0.00 X 356449 0 19843 Dr Jack R Lawler 37.50 0.00 X 324111 0 21357 Dr Margaret McDonnell 37.50 0.00 X 321754 0 39897 Dr Anthony Pivarunus 37.50 0.00 X 330296 0 145779 Dr Paul Updike 37.50 0.00 X 241950 0 32207 2558373 7318955 1203396 61 0 1 0 Sodexho Inc & Affiliates PO Box 81049 Woburn MA 018131049 Environmental Services 3431298 Quest Diagnostic (Chicago) 2178 Collection Center Drive Chicago IL 60693 Laboratory Services 1690099 Siemens Medical Solutions PO Box 120001 Dept 0733 Dallas TX 753120733 Maintenance Services 934226 Endion Hospitalist Services PO Box 645037 Cincinnati OH 452645037 Physician Services 718750 IR Mueller Corporation 789 Colvin BLVD Kenmore NY 14217 Secruity Services 570901 61 845482 845482 Medicaid/Medicare 900099 156759399 156759399 Patient Service 900099 150970435 150970435 307729834 221051 221051 825995 0 825995 825995 825995 Meaningful Use Money 900099 3432711 3432711 Shared Service 900099 2415037 2415037 Cafeteria 900099 1056131 1056131 867566 867566 7771445 317393807 310144871 0 6403454 116196664 106175950 10020714 8688566 8019377 669189 16092330 14678182 1414148 7652091 6990440 661651 580673 4264 576409 11182170 7685238 3496932 14097 13153 944 8344220 4387994 3956226 426991 98401 328590 3663970 1104619 2559351 154479 138529 15950 79164 75552 3612 2049601 2049601 11150199 11150199 2904578 2679463 225115 Medical Supplies 52844168 53625187 -781019 Shared Service 49052618 49052618 Purchased Services 14350190 9244619 5105571 Non-Medical Supplies 2473518 2017786 455732 307900287 230138554 77761733 0 276916 178626 100212303 115701231 151469 136332 42614351 44346176 3980469 5285870 1585152 1572324 133864602 58374942 75049615 75489660 39654485 40153877 263524760 282864096 40818653 43269356 398060 272110 30288115 28648948 7808694 7648399 111457327 131729545 190770849 211568358 X 70680654 69184523 1950734 1988692 122523 122523 72753911 71295738 263524760 282864096 X 9493520 -10951692 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1958968 1958968 26802820 15398114 11404706 39369390 5760435 33608955 61348704 37216393 24132311 4384720 4384720 75489660 Other Receivables 2666600 Due from Affiliates 10817629 Workers Comp Funding Surplus 729951 Insurance Recoveries 18902583 Investment in Net Assets of the SOC Foundation 6936354 Investment in Caritas Medical Arts Building 100760 40153877 Due to Affiliates 19487288 Interest Rate Swap 5071179 Pension Obligation 75703302 Asset Retirement Obligation 2231290 L/T Disposables 185455 L/T General Liability IBNR 14412118 L/T Workers Comp IBNR 14638913 131729545 318230525 1682200 1682200 316548325 845482 845482 317393807 308997230 1096943 1096943 307900287 0 307900287 Part XI, Line 2d - Other Adjustments: SOC Foundation Inc Revenue Part XI, Line 4b - Other Adjustments: Contributions from Sisters Hospital Foundation Part XII, Line 2d - Other Adjustments: Foundation Expenses less the SOC Foundation Contributions to the Hospital 1 1 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 3570615 236935 3333680 0.01080 62348411 46725242 15623169 0.05070 65919026 46962177 18956849 0.06150 1811956 1811956 0.00590 6553778 2529340 4024438 0.01310 510086 510086 0.00170 8875820 2529340 6346480 0.02070 74794846 49491517 25303329 0.08220 2538 2538 0.00000 2538 2538 1 4553397 2211243 46537926 47143686 -605760 X 1 0 2 1 Sisters of Charity Hospital

2157 Main Street Buffalo NY 14214

X X X X X Ambulatory Surgery - Multi Speciality 2 Sisters of Charity Hospital-St Jospeh Ca

2605 Harlem RD Cheektowaga NY 14225

X X X X X Ambulatory Surgery - Multi Speciality Sisters Of Charity Hospital 1 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 12 Harvey Austin School #97

1405 Sycamore St Buffalo NY 14211

Extension Clinic:Medical Social Services O/P, Well Child Care OP,Health ED Pathways Methadone

158 Holden Avenue Buffalo NY 14214

Extension Clinic: Methadone Maintenance O/P Rochester Pathways

79 Howell Street Rochester NY 14614

Extension Clinic: Methadone Maintenance O/P St Vincent Health Center

1595 Bailey Ave Buffalo NY 14212

Extension Clinic:Primary Med Care O/P, Chemical Dependency Rehab O/P, Sisters Ambulatory Surgery Center

45 Spindrift Dr Williamsville NY 14221

Extension Clinic: Ambulatory Surgery - Multi Speciality 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 Maintenance O/P Chemical Dependence - Rehabilitat West Hertel Academy

489 Hertel Ave Buffalo NY 14212

Extension Clinic:Medical Social Services O/P, Well Child Care OP,Health ED Southside Elementary School #93

430 Southside Pkwy Buffalo NY 14210

Extension Clinic:Medical Social Services O/P, Well Child Care OP,Health ED St Catherine Laboure Health Care Center

2157 Main Street Buffalo NY 14214

Long Term Care,Adult Day Healthcare, Clinical Laboratory Service O/P,Radiolo CHS Partners in Rehab

6199 Transit Rd Depew NY 14043

Extension Clinic:Therapy - Occupational O/P, Therapy - Physical O/P Sisters Central Pk Diagnostic Center

34 Benwood Ave Buffalo NY 14214

Clinical Laboratory Service O/P,Radiology - Diagnostic O/P Part I, Line 3c: n/a Part I, Line 6a: The Sisters of Charity Hospital/Sisters of Charity Hospital, St. Joseph Campus Community Benefit Report is contained in a report prepared by the Catholic Health System.Part 1, line 6 b. Yes, the report is made available to the public by posting on the Catholic Health website, www.chsbuffalo.org, as well as the annual submission to NYS for the Community Service Plan. 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 I, Line 7g: N/A Part I, L7 Col(f): Bad debt expenses of $10,255,398 are included in Part IX, line 25, column (A) but subtracted when calculating the percentage in column (f). Part II: Sisters Hospital provided Community Building in various ways, including the Environmental Improvements were noted in the form of Pharmaceutical Waste Disposal that was provided for the community throughout the year. Part III, Line 4: The amount in Part III line 2 is the actual bad debt expenses of $10,255,398 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 10/1/2011 to 9/30/2012 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 Schedule 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 organizations 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 III, Line 8: The costing methodology used to determine the Medicare Allowable costs is Cost to Charge. The shortfall is not treated as a community benefit. Part III, Line 9b: n/a Part V, Section A: Audiology O/P Chemical Dependence - Rehabilitation O/P Clinical Laboratory Service Clinic Part Time Services Coronary Care CT Scanner Dental O/P Emergency Department Health Fairs O/P Intensive Care Magnetic Resonance Imaging Maternity Medical Social Services Medical/Surgical Neonatal Continuing Care Neonatal Intensive Care Neonatal Intermediate Care Nuclear Medicine - Diagnostic Nuclear Medicine - Therapeutic Pediatric O/P Pharmaceutical Service Physical Medical Rehabilitation Physical Medicine and Rehabilitation O/P Podiatry O/P Prenatal O/P Primary Medical Care O/P Psychology O/P Radiology - Diagnostic Renal Dialysis - Acute Therapy - Occupational O/P Therapy - Physical O/P Therapy - Speech Language Pathology Therapy - Vocational Rehabilitation O/P Sisters Of Charity Hospital Part V, Section B, Line 10: N/A Sisters Of Charity Hospital Part V, Section B, Line 11: N/A Sisters Of Charity Hospital Part V, Section B, Line 12h: N/A Sisters Of Charity Hospital Part V, Section B, Line 14g: Includes information in both English and Spanish on all signage and brochures for financial assistance. Sisters Of Charity Hospital Part V, Section B, Line 19c: N/A Sisters Of Charity Hospital Part V, Section B, Line 20d: Highest volume commercial payor rate Sisters Of Charity Hospital Part V, Section B, Line 21: N/A Sisters Of Charity 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. Part VI, Line 2: The Catholic Health System has recently conducted a Community Health Needs Assessment in 2013, which will be reported on the 12/31/2013 990 returns. For the 12/31/2012 990, the assessment conducted in previous years is being reported. In 2009, Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus, as part of Catholic Health, involved many participants in assessing community health needs including: 1. New York State Department of Health Prevention Agenda for the Healthiest State Erie County Department of Health Catholic Health Kaleida Health Erie County Medical Center Sheehan Memorial Hospital 2. Health Consumers 3. Patients/residents/clients A. Hospital Inpatients and OutpatientsB. Nursing Home Residents and Families C. Rehabilitation Patients D. Primary Care Center Patients E. Home Care Clients 4. Physicians 5. External Organizations, such as Academia, Community-based organizations, elected officials, employers and business, Faith based organizations, governmental organizations, media, philanthropists and schools.6. Statistical Resources1. New York State Department of Health Prevention Agenda for the Healthiest State Catholic Health worked in collaboration with the Erie County Department of Health, Kaleida Health, ECMC and Sheehan Memorial on the Erie Co. DOH Prevention Agenda for the Healthiest State. In February 2009, an Erie County Joint Planning Committee formed to identify prevention priorities and strategies to focus on collaboratively over the next 3 years, , which included: Chronic Disease, Healthy Mothers, Healthy Babies, Healthy Children, Physical Activity and Nutrition and Tobacco Use. 2. Health Consumers In creating the Catholic Health and Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus strategic plan, input was sought from a variety of constituents including consumers. In August 2008, eight (8) consumer focus groups were conducted asking consumers what they wanted from their patient care experience. These focus groups were created by reaching out to 8,000 area residents who were asked to contact friends/families/neighbors to participate. 3. Patients/residents/clients A. Hospital Inpatients and Outpatients At the time of the assessment, Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus participated in a regional patient satisfaction survey through a cooperative effort with the Buffalo Niagara Health Quality Coalition and area hospitals. Patient participation was voluntary. This survey took place twice per year. Through hospital admission and outpatient ancillary sites, surveys were distributed to individuals to gain an understanding about their healthcare needs and how well their needs were being met. Currently, Hospital Care Quality Information (HCHAPS) is publicly reported. 4. Physicians Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus surveys its medical staff annually. Physicians are surveyed on issues relating to the quality and efficiency of services offered throughout Catholic Health including at Sisters Hospital. 5. External OrganizationsCatholic Health and Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus also engaged in the P2 Collaborative (Pursuing Perfection) dedicated to improving the health of people across the region. There are more than 200 participant organizations including the provider community, payers, community based organizations, religious organizations, local business, colleges & universities, and governmental agencies. Areas of focus include working with physicians and organizations to enhance access to care and improve efficiency of care and empowering all of the Western New York community to take responsibility for and act on their own wellness.In an effort to engage health care needs at the grass roots level, Catholic Health and Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus work closely with the following organizations to assess community health need:Niagara Health Quality Coalition Community Cancer CoalitionAmerican Heart Association Near East & West Side Task ForceBaker Victory Services Community Health Center of BuffaloWNY Osteoporosis Resource Ctr. WNY Health Equity Work GroupLiving Healthy Task Force of Erie Co. Minority Health CoalitionBuffalo Public Schools Worksite Wellness Flu CoalitionEvery Parent Influences Children (EPIC) Tobacco CoalitionWNY Coalition for Diabetes Community Health FoundationErie Co. Coalition for Diabetes WNED Public TelevisionCatholic Charities Niagara University6. Statistical ResourcesCatholic Health and Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus used PQI (Preventable Quality Indicators) to map specific areas by zip code to better understand needs and target for need. We mapped specifically for Congestive Heart Failure, Hypertension, Angina & Diabetes to identify target areas for community education & screening initiatives. Other statistical resources used to assess the needs of the communities served included: "Buffalo Public Schools: Student Body Mass Index", "Erie County Health Assessment Indicators", and "Erie County Health Indicators Profile". Goals/Objectives for the priorities identified for Catholic Health and Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus include: Increase consumer knowledge and adoption of healthy lifestyle behaviors by encouraging frequent physical activity and healthy nutrition, leading to improved health status and reduced chronic disease prevalence for residents of Buffalo and Erie County. Increase participants ability to identify risk factors for cardiovascular disease. Lower body mass index (BMI) in youth; early identification of adolescents and adults with high blood pressure, high blood cholesterol and high blood glucose through screening and prevention interventions. Implement a social marketing campaign to positively influence voluntary behavior of target population to take action to maximize health. Restrict the availability of less healthy foods and beverages in public service venues in Buffalo and Erie County, such as schools, community centers and hospitals. 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 organizations 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: Sisters of Charity Hospital including Sisters of Charity Hospital/St. Joseph Campus serves a mixed suburban and urban service area which is comprised of 72.5% white (non-Hispanic) and 17.5% African-American (non-Hispanic) households. The service area is more elderly than most with 16.5% of the population over the age of 65 compared to a national average of 12.9%. The community is also poorer than the national average with 16.7% of the households with annual incomes below $15,000/year compared to a national average of 13%. Part VI, Line 5: Catholic Health Systems community service activities at the acute facilities include benefits to the broader community, which include non-billed services and provided services paid below costs. Charity care and benefits to the community are provided through long term care facilities, home care programs and Catholic Health system-wide community programs. These programs touch more than 40,000 Western New York residents through community health education programs, health screenings (including: glucose, blood pressure, and cholesterol screenings; and cardiac, stroke, vascular, diabetes, nutrition, stress management, and womens community programming) clinical and support services, clerkships, internships, scholarships, in-kind donations and community support activities. Additionally, thousands of people make unique visits to the Catholic Health website seeking information about an individual or family healthcare issue, follow Catholic Health on Facebook and Twitter (where daily posts talk to education and prevention of the priority areas) and receive relevant health information through the Catholic Health wellness blog and monthly email newsletter.The governing Board of Directors of Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus is comprised of community representatives from universities, legal communities, & business leaders. Religious orders are represented, as well as active and retired medical staff members.The Sisters Hospital medical staff can be considered an "open" medical staff, as any physician can apply for privileges. Each application is reviewed by a vigorous credentialing verification process. Part VI, Line 6: Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus is affiliated with the Catholic Health System, Inc., a New York State licensed corporation. Catholic Health System, located in Buffalo, New York exempt from taxation and a charitable organization described in Section 501(c) (3) of the Internal Revenue Code of 1986. Catholic Health is also the parent company of the following New York State corporations: Kenmore Mercy Hospital, and Mercy Hospital of Buffalo, Its outpatient and post-acute facilities (and services) include Mercy Ambulatory Care Center, Mercy Diagnostic and Treatment Center, Mercy Diagnostic Center, Sheridan Health Care Center, Sisters Central Park Diagnostic Center, Williamsville Diagnostic Center, Kenmore Specialty Center, Ken-Ton Family Care Center, Lovejoy/St. Vincent Health Center, Mercy Comprehensive Care Center, Mercy OB/GYN Center, OLV Family Care Center, Sisters OB/GYN Center, Springville Primary Care Center, Williamsville Primary Care Center, Catholic Health Home Care, St. Elizabeths Home, St. Vincents Home, Father Baker Manor, McAuley Residence, Mercy Nursing Facility at OLV, St. Catherine Laboure Health Care Center, and St. Francis of Williamsville. Reports Filed With States Part VI, Line 7 NY 1 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 Peter Bergmann 355818 0 32583 0 44888 0 14545 0 18581 0 466415 0 0 0 David Macholz 0 177154 0 29346 0 25733 0 15747 0 18375 0 266355 0 0 Dr Paul Anain 0 223995 0 0 0 270 0 12631 0 263 0 237159 0 0 Dr Michael Edbauer 0 207109 0 43465 0 32224 0 13275 0 13125 0 309198 0 0 Christine Kluckhohn 0 249437 0 29277 0 39207 0 103254 0 19313 0 440488 0 0 James Millard 0 223041 0 60186 0 39045 0 145769 0 333 0 468374 0 0 Charles J Urlaub 0 332714 0 87875 0 56567 0 21316 0 15020 0 513492 0 0 James A Dunlop Jr 0 372610 0 231359 0 68634 0 101350 0 13917 0 787870 0 0 Dr Brian D'Arcy 0 272987 0 29115 0 276486 0 19190 0 18634 0 616412 0 0 Matthew Hamp 154177 0 14734 0 48829 0 95304 0 15699 0 328743 0 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 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 Dr Nady Shehata 266516 0 10500 0 23145 0 23265 0 17668 0 341094 0 0 0 Dr Bruce Rodgers 349425 0 6250 0 774 0 19223 0 620 0 376292 0 0 0 Dr Jack R Lawler 322923 0 0 0 1188 0 19240 0 2117 0 345468 0 0 0 Dr Margaret McDonnell 320980 0 0 0 774 0 22396 0 17501 0 361651 0 0 0 Dr Anthony Pivarunus 286584 0 27348 0 16364 0 129425 0 16354 0 476075 0 0 0 Dr Paul Updike 237090 0 0 0 4860 0 18603 0 13604 0 274157 0 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. Pension CHS & Acutes Pension GAP Joseph McDonald $26,000.00 Mark Sullivan $39,000.00 Dr. Brian D'Arcy $ 9,800.00 Michael Moley $20,697.00 Peter Bergmann $ 7,334.00 CHE SERP Joseph McDonald $150,012.00 Dr. Brian D'Arcy $142,750.00 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 Dr. Brian D'Arcy $ 29,115.18 Nancy Sheehan $ 16,068.24 Michael Moley $145,164.42 John Stravos $ 50,331.57 Christine Kluckhohn $ 29,277.18 Maria Foti $ 11,344.26 Bartholomew Rodriques$ 32,085.26 Dr. Michael Galang $ 59,062.48 Dr. Michael Edbauer $ 43,464.85 Dave Macholz $ 29,345.53 Peter Bergmann $ 32,583.13 Matthew Hamp $ 14,733.82 Dr. Bruce Rodgers $ 6,250.00 Dr. Anthony Pivarunus$ 27,348.01 Charles Urlaub $ 87,875.19 James Millard $ 60,186.07 Dr. Nady Shehata $ 10 499.67 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 28994802 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 0 0 0 0 1 1 HSBC Bank NA 18.500000000000 1 0 0 0 0 B 0 0 0 0 1 1 JP Morgan Chase NA 18.500000000000 1 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 Pupose: To finance the cost of the St. Joseph Campus emergency room expansion project. Part IV (1) The bonds were issued by the Dormitory Authority of the State of New York on November 29,2006. On or around December 1, 2011, DASNY performed a rebate analysis that indicated no rebate liability had accrued. An analysis completed by the Bond Trustee in October 2012 indicated that DASNY mistakenly excluded from their analysis bond proceeds that had been deposited into the current refunding escrow for the Refunded Bonds. Sisters of Charity was first made aware of this error on October 24, 2012. Payment of the rebate, plus interest, was made to the IRS on March 29, 2013, within 180 days of the discovery. Karen Hamp Wife of COO, Matt Hamp 39703 RN, Kenmore 0 Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 76847 Corporate Nurse Educator 0 James Manzella Acute Care Board Member 204991 Key Employee of Manzella Marketing 0 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 Dombek 55983 Mercy Physical Therapist 0 Dr Craig Fetterman Partner of Buffalo Niagara Hospitalists 448438 Acute Care 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 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; 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: Pension Liability Adjustments -8,680,685. Equity Transfer to Affiliates -2,102,854. Change in Unrestricted Interest in net assets of Sisters Foundation 9,825. Interest Rate Swap Adjustment -215,936. Change in Temporary Restricted Interest in net assets of Sisters Foundation 37,958. Catholic Health System Inc 515 Abbott Road Buffalo NY 14220 222565278 Health Care Delivery System NY 501c3 Schedule A Line 9 N/A 0 Mercy Hospital of Buffalo 565 Abbott Road Buffalo NY 14220 160756336 Acute Care Hospital NY 501c3 Schedule A Line 3 Catholic Health System Inc 0 Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore NY 14217 160762843 Acute Care Hospital NY 501c3 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 501c3 Schedule A Line 9 Catholic Health System Inc 0 St Clare Manor 543 Locust Street Lockport NY 14094 160782647 Skilled Nursing Facility NY 501c3 Schedule A Line 9 Catholic Health System Inc 0 St Elizabeth Home for the Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501c3 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 501c3 Schedule A Line 9 Catholic Health System Inc 0 St Francis of Buffalo 34 Benwood Avenue Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501c3 Schedule A Line 9 Catholic Health System Inc 0 St Joseph Manor 2211 West State Street Olean NY 14760 160796400 Skilled Nursing Facility NY 501c3 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 501c3 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 501c3 Schedule A Line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501c3 Schedule A 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 501c3 schedule A Line 9 Catholic Health System Inc 0 Niagara Homemaker Services (Mercy Home Care) Appletree Business Park 2875 Union Cheektowaga NY 14227 161317960 Home Care Provider NY 501c3 Schedule A Line 9 Catholic Health System Inc 0 McAuley Seton Home Care Appletree Business Park 2875 Union Cheektowaga NY 14227 161310062 Home Care Provider NY 501c3 Schedule A Line 9 Catholic Health System Inc 0 Catholic Health System Infusion Pharmacy Inc 2875 Union Rd Suite 14 Cheektowaga NY 14227 200198518 Home Care Infusion Services NY 501c3 Schedule A Line 9 Catholic Health System Inc 0 CHS Program of All-Inclusive Care for the Elderly Inc 55 Melroy Avenue Lancaster NY 14218 261252884 All-inclusive Care for the Elderly NY 501c3 Schedule A Line 3 Catholic Health System Inc 0 Sisters Hospital Foundation 2130 Main Street Buffalo NY 14214 222283077 Foundation NY 501c3 Schedule A Line 7 Sisters of Charity Hospital 0 Caritas Medical Arts Building LLC 350 Essjay Road Suite 101 Williamsville NY 14221 161521486 Rental Real Estate NY N/A Related to exempt pu 42305 106731 0 0 0 1 1 1 0 0 0 0 1 0 0 1 1 1 1 1 1 1 1