ST FRANCIS HOME OF WILLIAMSVILLE: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ST FRANCIS HOME OF WILLIAMSVILLE (EIN 16-0743153)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-02
- IRS object ID
- 201233079349300508
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-02T08:43:23-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160743153 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST FRANCIS HOME OF WILLIAMSVILLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STFR | NameControl |
| Phone | 7166335400 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 291 NORTH STREET | AddressLine1 |
| City | BUFFALO | City |
| State | NY | State |
| ZIP Code | 14201 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID P MACHOLZ | Name |
| Title | VP FINANCE/CORPCONTROLLER | Title |
| Phone | 7168282974 | Phone |
| Date Signed | 2012-11-02 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOSEPH MCDONALD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2121 MAIN STREET | AddressLine1 |
| City | BUFFALO | City |
| State | NY | State |
| ZIP Code | 14214 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 13918496 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | CHSBUFFALO.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1961 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | 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 2011 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 308 | TotalNbrEmployees |
| Total Nbr Volunteers | 26 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 12128895 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 13822610 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 7568 | InvestmentIncomePriorYear |
| Investment Income Current Year | -71284 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 70324 | OtherRevenuePriorYear |
| Other Revenue Current Year | 37170 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12206787 | TotalRevenuePriorYear |
| Total Revenue Current Year | 13788496 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9812074 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10785417 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2603229 | OtherExpensePriorYear |
| Other Expenses Current Year | 2880313 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12415303 | TotalExpensesPriorYear |
| Total Expenses Current Year | 13665730 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -208516 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 122766 | RevenuesLessExpensesCY |
| Total Assets BOY | 6862238 | TotalAssetsBOY |
| Total Assets EOY | 8722421 | TotalAssetsEOY |
| Total Liabilities BOY | 8307995 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10750539 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -1445757 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -2028118 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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 2011 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11747971 | Expense |
| Revenue | 13822610 | Revenue |
| Description | NURSING HOME CARE: ST FRANCIS WILLIAMSVILLE IS A SKILLED NURSING FACILITY THAT TENDS PRIMARILY TO THE POOR AND ELDERLY AND IS LOCATED IN ERIE COUNTY, NY. IN 2011 OVER 62% OF RESIDENTS WERE COVERED BY MEDICAID. THIS 62% MEDICAID POPULATION EQUALLED 29,064 PATIENT BED DAYS. SEE COMMUNITY SERVICE PLAN AT WWW.CHSBUFFALO.ORG. | Description |
| Total Program Service Expense | 11747971 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 17 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 308 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID P MACHOLZ | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7168282974 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 ABBOTT ROAD SUITE 500 | AddressLine1 |
| City | BUFFALO | City |
| State | NY | State |
| ZIP Code | 14220 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|
| JOSEPH MCDONALD | |||||||
| PRESIDENT AND CEO, CHS | 37.50 | X | X | 0 | 1071254 | 41897 | |
| MARK SULLIVAN | |||||||
| EXEC VP, COO | 37.50 | X | X | 0 | 499658 | 32323 | |
| CHRISTINE KLUCKHOHN | |||||||
| PRES & CEO,CONTINUING CARE | 37.50 | X | X | 0 | 297068 | 116618 | |
| EDWARD FLYNN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JOYCE MARKIEWICZ | |||||||
| DIRECTOR | 37.50 | X | 0 | 277164 | 37518 | ||
| MARK MEYERHOFER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JAMES MILLARD | |||||||
| DIRECTOR | 37.50 | X | 0 | 296692 | 157819 | ||
| ROBERT NASSO | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| SHERRY POMEROY PHD RN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| NANCY TRUVER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| SR MARY ANNE WELDON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MONSIGNOR ROBERT E ZAPFEL | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JAMES A DUNLOP JR | |||||||
| EXEC VP, FINANCE, CFO | 37.50 | X | 0 | 443085 | 112103 | ||
| DARLENE CRISPELL | |||||||
| ADMINISTRATOR | 37.50 | X | 133822 | 0 | 21210 | ||
| MICHAEL MOLEY | |||||||
| SR. VP HUMAN RESOURCES | 37.50 | 0 | 394218 | 39695 | X | ||
| JOHN STAVROS | |||||||
| SR. VP MARKETING/P.R. | 37.50 | 0 | 248323 | 39012 | X | ||
| MARIA FOTI | |||||||
| SR. VP, PLANNING | 37.50 | 0 | 230710 | 30394 | X | ||
| BARTHOLOMEW RODRIGUES | |||||||
| SR. VP MISSION INTEGRATION | 37.50 | 0 | 218184 | 33095 | X | ||
| DR MICHAEL GALANG | |||||||
| CHIEF INFORMATION OFFICER | 37.50 | 0 | 331760 | 25686 | X | ||
| NANCY SHEEHAN | |||||||
| VP LEGAL SVC, GENERAL COUNSEL | 37.50 | 0 | 269768 | 27110 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 133822 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4577884 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 714480 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NURSEFINDERS | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 910738 | AddressLine1 |
| City | DALLAS | City |
| State | TX | State |
| ZIP Code | 75391 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | NURSING SERVICES | DescriptionOfServices |
| Compensation | 320154 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PRIVATE AND SSI | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 13822610 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13822610 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 13822610 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8836 | TotalRevenueColumn |
| Exclusion | $8,836 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 49880 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 130000 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -80120 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -80120 | TotalRevenueColumn |
| Exclusion | -$80,120 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MISC. | 900099 | 22849 | 22849 |
| DISCOUNTS/REBATES | 900099 | 7993 | 7993 |
| VENDING | 900099 | 6328 | 6328 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 37170 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13788496 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13859780 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$71,284 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133822 | Total |
| Management And General | 133822 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8310680 | Total |
| Program Services | 7290143 | ProgramServices |
| Management And General | 1020537 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1832261 | Total |
| Program Services | 1651147 | ProgramServices |
| Management And General | 181114 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 508654 | Total |
| Program Services | 437442 | ProgramServices |
| Management And General | 71212 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 212570 | Total |
| Program Services | 212570 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65148 | Total |
| Program Services | 14399 | ProgramServices |
| Management And General | 50749 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 1022755 | 996129 | 26626 |
| PURCHASED SERVICES | 738740 | 491774 | 246966 |
| BAD DEBT EXPENSE | 449687 | 449687 | 0 |
| MEDICAL & PROFESSIONAL | 138303 | 78429 | 59874 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 253110 | Total |
| Program Services | 126251 | ProgramServices |
| Management And General | 126859 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13665730 | Total |
| Program Services | 11747971 | ProgramServices |
| Management And General | 1917759 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1159880 | BOY |
| EOY | 1072646 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 416339 | BOY |
| EOY | 417319 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1512763 | BOY |
| EOY | 1850502 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9372 | BOY |
| EOY | 16124 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7342 | BOY |
| EOY | 2277 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11057952 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9296894 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1851378 | BOY |
| EOY | 1761058 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1509865 | BOY |
| EOY | 1504192 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 395299 | BOY |
| EOY | 2098303 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6862238 | BOY |
| EOY | 8722421 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1193668 | BOY |
| EOY | 1269668 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7114327 | BOY |
| EOY | 9480871 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8307995 | BOY |
| EOY | 10750539 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1511971 | BOY |
| EOY | -2095744 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66214 | BOY |
| EOY | 67626 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1445757 | BOY |
| EOY | -2028118 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6862238 | BOY |
| EOY | 8722421 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 122766 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -705127 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 10136550 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 9963336 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9841818 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 12199219 | CurrentTaxYearMinus1Year |
| Current Tax Year | 13859780 | CurrentTaxYear |
| Total | 56000703 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 10136550 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 9963336 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9841818 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 12199219 | CurrentTaxYearMinus1Year |
| Current Tax Year | 13859780 | CurrentTaxYear |
| Total | 56000703 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 56000703 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 96971 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 39962 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 5590 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 7568 | CurrentTaxYearMinus1Year |
| Current Tax Year | 8836 | CurrentTaxYear |
| Total | 158927 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 96971 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 39962 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 5590 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 7568 | CurrentTaxYearMinus1Year |
| Current Tax Year | 8836 | CurrentTaxYear |
| Total | 158927 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 10233521 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 10003298 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9847408 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 12206787 | CurrentTaxYearMinus1Year |
| Current Tax Year | 13868616 | CurrentTaxYear |
| Total | 56159630 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99720 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99500 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00280 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00500 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Direct Contact Legislators | $6,464 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $422 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 6886 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | ST. FRANCIS HOME OF WILLIAMSVILLE 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 2011 THE LOBBYING COMPONENT OF THESE DUES AMOUNTED TO APPROXIMATELY $422. ADDITIONALLY, SFW RETAINS CERTAIN INDIVIDUALS TO ADVOCATE ON BEHALF OF ST. FRANCIS HOME OF WILLIAMSVILLE WITH NEW YORK STATE LEGISLATURES RELATING TO ISSUES THAT IMPACT SKILLED NURSING FACILITY HEALTH CARE. COSTS INCURRED IN RELATION TO SUCH ACTIVITIES AMOUNTED TO $6,464, IN 2011. | Explanation |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6937315 | OtherCostOrOtherBasis |
| Depreciation | 5887083 | Depreciation |
| Book Value | 1050232 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4107037 | OtherCostOrOtherBasis |
| Depreciation | 3409811 | Depreciation |
| Book Value | 697226 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13600 | OtherCostOrOtherBasis |
| Book Value | 13600 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1761058 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ASSETS LIMITED AS TO USE | Description |
| Book Value | 1504192 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1504192 | TotalOfBookValueSecurities |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM AFFILIATES | 45732 |
| DUE FROM THIRD PARTY PAYORS | 192739 |
| INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION | 67626 |
| INSURANCE RECOVERY | 1792206 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2098303 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ASSET RETIREMENT OBLIGATION | $253,369 |
| DUE TO AFFILIATES | $3,620,315 |
| DUE TO THIRD PARTY PAYORS | $415,800 |
| LONG TERM PENSION OBLIGATION | $5,191,387 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 9480871 | TotalOfAmounts |
| Total Revenue | 13788496 | TotalRevenue |
| Total Expenses | 13665730 | TotalExpenses |
| Excess Or Deficit For Year | 122766 | ExcessOrDeficitForYear |
| Other | -$705,127 | OtherAmount |
| Total Adjustments | -705127 | TotalAdjustments |
| Excess Or Deficit Per FS | -582361 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 13859780 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 13859780 | RevenueSubtotal |
| Other Revenues Not Included | -71284 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -71284 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 13788496 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 13665730 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 13665730 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 13665730 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | MINIMUM PENSION LIABILITY ADJUSTMENT -692,378. CHANGE IN INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 1,412. EQUITY TRANSFER TO AFFILIATE -15,965. DONATIONS FOR CAPITAL ASSETS 1,804. TOTAL TO SCHEDULE D, PART XI, LINE 8: -705,127. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | INTEREST INCOME 8,836. LOSS ON SALE OF ASSET -80,120. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOSEPH MCDONALD | |||||||||||||
| 0 | 583131 | 0 | 208063 | 0 | 280060 | 0 | 26855 | 0 | 15042 | 0 | 1113151 | 0 | 0 |
| MARK SULLIVAN | |||||||||||||
| 0 | 373986 | 0 | 92715 | 0 | 32957 | 0 | 17728 | 0 | 14595 | 0 | 531981 | 0 | 0 |
| CHRISTINE KLUCKHOHN | |||||||||||||
| 0 | 186796 | 0 | 55065 | 0 | 55207 | 0 | 97902 | 0 | 18716 | 0 | 413686 | 0 | 0 |
| JOYCE MARKIEWICZ | |||||||||||||
| 0 | 200536 | 0 | 39238 | 0 | 37390 | 0 | 19765 | 0 | 17753 | 0 | 314682 | 0 | 0 |
| JAMES MILLARD | |||||||||||||
| 0 | 214698 | 0 | 43291 | 0 | 38703 | 0 | 156544 | 0 | 1275 | 0 | 454511 | 0 | 0 |
| JAMES A DUNLOP JR | |||||||||||||
| 0 | 327293 | 0 | 82819 | 0 | 32973 | 0 | 94418 | 0 | 17685 | 0 | 555188 | 0 | 0 |
| DARLENE CRISPELL | |||||||||||||
| 117776 | 0 | 15716 | 0 | 330 | 0 | 14611 | 0 | 6599 | 0 | 155032 | 0 | 0 | 0 |
| MICHAEL MOLEY | |||||||||||||
| 0 | 259903 | 0 | 58553 | 0 | 75762 | 0 | 25222 | 0 | 14473 | 0 | 433913 | 0 | 0 |
| JOHN STAVROS | |||||||||||||
| 0 | 169269 | 0 | 39644 | 0 | 39410 | 0 | 21022 | 0 | 17990 | 0 | 287335 | 0 | 0 |
| MARIA FOTI | |||||||||||||
| 0 | 161084 | 0 | 36606 | 0 | 33020 | 0 | 23570 | 0 | 6824 | 0 | 261104 | 0 | 0 |
| BARTHOLOMEW RODRIGUES | |||||||||||||
| 0 | 145256 | 0 | 34317 | 0 | 38611 | 0 | 15377 | 0 | 17718 | 0 | 251279 | 0 | 0 |
| DR MICHAEL GALANG | |||||||||||||
| 0 | 265381 | 0 | 35389 | 0 | 30990 | 0 | 20485 | 0 | 5201 | 0 | 357446 | 0 | 0 |
| NANCY SHEEHAN | |||||||||||||
| 0 | 187958 | 0 | 43103 | 0 | 38707 | 0 | 21899 | 0 | 5211 | 0 | 296878 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | ONE OFFICER 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 $106,775 MICHAEL MOLEY $20,697 |
| PART I, LINE 6 | THE 2011 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 $208,063 MARK SULLIVAN $ 92,715 JAMES A. DUNLOP,JR. $ 82,819 NANCY SHEEHAN $ 43,103 MICHAEL MOLEY $ 58,553 JOHN STAVROS $ 39,644 CHRISTINE KLUCKHOHN $ 55,065 MARIA FOTI $ 36,606 BARTHOLOMEW RODRIGUES $ 34,317 DR. MICHAEL GALANG $ 35,389 JAMES MILLARD $ 43,291 JOYCE MARKIEWICZ $ 39,238 DARLENE CRISPELL $ 15,716 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| DAVID ZAPFEL | |||
| BROTHER OF BOD, MSGR. ROBERT ZAPFEL | 62906 | HR EMPLOYEE OF CHS | 0 |
| KATHLEEN ZAPFEL | |||
| SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL | 58749 | HR EMPLOYEE, ST. FRANCIS | 0 |
| SUSAN GALLAGHER-STAVROS | |||
| WIFE OF KEY EMPLOYEE, JOHN STAVROS | 30035 | COMMUNITY HEALTH NURSE, MCAULEY SETON HOME CARE | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. SCHEDULE H: HOSPITALS 5. SCHEDULE K: SUPLEMENTAL 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 BY THE MANAGER, THE DOCUMENT IS FORWARD 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 | 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 LAW. | |
| FORM 990, PART XI, LINE 5: | MINIMUM PENSION LIABILITY ADJUSTMENT -692,378. CHANGE IN INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 1,412. EQUITY TRANSFER TO AFFILIATE -15,965. DONATIONS FOR CAPITAL ASSETS 1,804. TOTAL TO FORM 990, PART XI, LINE 5: -705,127. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| CATHOLIC HEALTH SYSTEM INC | ||||||||||
| 515 ABBOTT ROAD | BUFFALO | NY | 14220 | 222565278 | HEALTHCARE 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 ELIZABETH HOME FOR THE AGED | ||||||||||
| 5539 BROADWAY | LANCASTER | NY | 14086 | 160743154 | ADULT HOME | NY | 501(C)(3) | LINE 9 | CATHOLIC HEALTH SYSTEM INC | 0 |
| ST FRANCIS OF BUFFALOINC | ||||||||||
| 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 ST | 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 | 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 | CHEEKTOWAGA | NY | 14225 | 161310062 | HOME CARE PROVIDER | 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 |
| CATHOLIC HEALTH SYSTEM INFUSION PARMACY INC | ||||||||||
| 2875 UNION ROAD SUITE 14 | CHEEKTOWAGA | NY | 142271461 | 200198518 | HOME CARE INFUSION SERVICE | NY | 501(C)(3) | 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) | LINE 3 | CATHOLIC HEALTH SYSTEM INC | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Comments