2011-11-14T12:02:22-06:00 2010-12-31 990 2010-01-01 160756336 Mercy Hospital of Buffalo MERC 7168282993 515 Abbott Road No 500 Buffalo NY 142202039 David P Macholz 7168282974 2011-11-14 2010 2016-03-07 17:11:31Z Joseph D McDonald 2121 Main Street Buffalo NY 14214 298205296 0 X www.chsbuffalo.org X 1957 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 2010 Community Service Plan can be found at www.chsbuffalo.org. 20 6 2488 177 0 0 707209 55513 279390584 294142910 363860 606766 2315523 3400107 282777176 298205296 0 0 0 0 128449426 133819672 0 0 0 143551057 153370778 272000483 287190450 10776693 11014846 147377799 167549524 163294246 184450721 -15916447 -16901197 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 2010 Community Service Plan can be found at www.chsbuffalo.org. 0 0 149249133 206350947 Inpatient Routine/Surgery Visits: Acute Care Patient Days = 86,484Newborn Patient Days = 6,491Medical Rehab Patient Days = 5,683Skilled Nursing Patient Days = 30,443Inpatient Ambulatory Surgery Visits = 8,116 54048779 74727514 Outpatient Routine/Surgery Services:Emergency Visits = 56,690Referred Ambulatory Visits =248,235Outpatient Ambulatory Surgery Visits = 13,712 9449231 13064448 Clinic/Primary Care Services:clinic Visits = 3,289Primary Care Visits = 85,220 212747143 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 1 0 1 180 0 2488 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 20 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X David P Macholz VP Finance Corporate Controller 7168282974 515 Abbott Road Buffalo NY 142202039 Joseph McDonald 37.50 X X 0 1088696 34591 Mark Sullivan 37.50 X X 0 454703 23394 Charles Urlaub 37.50 X X 390466 0 28411 David Macholz 37.50 X X 0 213026 24885 Peter Bergmann 37.50 X 0 540698 22696 Christine Kluckhohn 37.50 X X 0 282394 80000 James Millard 37.50 X 0 283785 107952 Dr Michael Edbauer 25.00 X 0 263226 28072 Brian Beitz 1.00 X 0 0 0 Frances Crosby RN PhD 1.00 X 0 0 0 Richard Curran MD 1.00 X 0 0 0 Dennis Dombek 1.00 X 0 0 0 Mr William Lawley Jr 1.00 X 0 0 0 James Manzella 1.00 X 0 0 0 Dr Paul Mason 1.00 X 0 25000 0 Michael Montante 1.00 X 0 0 0 Dr Carlos Santos 1.00 X 0 49913 0 Dr David Serra 1.00 X 0 0 0 Cynthia Zane EdD 1.00 X 0 0 0 Monsignor Robert E Zapfel 1.00 X 0 0 0 James A Dunlop Jr 37.50 X 0 418170 69366 Dr Brian D'Arcy 37.50 X 0 593295 36492 John Herman 37.50 X 186817 0 36900 Michael Moley 37.50 X 0 386794 32632 John Stavros 37.50 X 0 237811 36530 Maria Foti 37.50 X 0 220400 18990 Bartholomew Rodrigues 37.50 X 0 209261 26510 Dr Michael Galang 37.50 X 0 322847 18981 Dr Thomas Raab 37.50 X 344187 0 123388 Dr Timothy Gabryel 37.50 X 352773 0 24179 Dr Donald Schmidt 37.50 X 296068 0 107654 Nils Gunnersen 37.50 X 283710 0 49141 Dr Anshu Bais 37.50 X 267786 0 19941 Dr Lynne Aronica 37.50 X 205942 0 5582 Dr Thomas Dilamarter Jr 37.50 X 204232 0 18313 John Davanzo X 0 291315 47854 K David Crone X 0 289735 39608 2531981 6171069 1062062 68 1 1 0 Ellicott Development Ellicott Square Building 295 Main Buffalo NY 14203 Contruction Services 2198511 Siemens Medical Solutions 51 Valley Stream Parkway Malverne PA 19355 Maintenance Services 1982029 Sodexho Operations LLC 60 Grider Street Buffalo NY 14215 Laundry Services 1035508 Aurora Hospitalist PC 400 Clifton Corporate Pkwy Suite 4 Clifton Park NY 120653839 Medical Services 960180 Telco Construction 500 Buffalo Road East Aurora NY 14052 Contruction Services 938638 37 55513 55513 Patient Care Services 900099 216343782 216343782 Medicaid/Medicare Paym 900099 76962876 76962876 VA Contract Revenue 621400 836252 836252 294142910 601625 601625 -11504 -11504 173103 173103 173103 173103 16645 16645 16645 16645 Cafeteria Revenue 900099 977824 977824 Parking Revenue 900099 631740 631740 Shared Services 900099 422391 422391 1195049 1195049 3227004 298205296 294565301 0 3584482 1274243 1274243 99262822 86899616 12363206 9612210 8308352 1303858 16533357 14290674 2242683 7137040 6168929 968111 292837 35325 257512 7606247 6689212 917035 37879 11391 26488 67140783 64042937 3097846 7817115 493085 7324030 54106 33476 20630 86704 74000 12704 1813711 1491848 321863 9340055 7682558 1657497 2221543 1904728 316815 Dues & Shared Services 33228602 33228602 Purchase Services & Oth 15961768 6851584 9110184 Bad Debts 7769428 7769428 287190450 212747143 74443307 0 28835314 31458970 15054794 7311999 34057348 38602396 938346 4578406 2349383 2693650 129451037 53356585 60924026 76094452 1838175 154792 3380413 6654859 147377799 167549524 29514455 36097034 36091089 35249219 3900644 7788300 93788058 105316168 163294246 184450721 X -17773670 -18846407 1731223 1822687 126000 122523 -15916447 -16901197 147377799 167549524 X 11014846 -11999596 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1409723 1409723 65062655 24882936 40179719 8443861 1363168 7080693 50959671 27038629 23921042 3575127 71852 3503275 76094452 Deferred Comp Liability 157552 Due to Affiliates 2550986 Interest Rate Swap 2712221 Asset Retirement Obligation 5220440 Accrued Pension 84474517 LT Gen Liab/Workers Comp IBNR 10200452 105316168 298205296 287190450 11014846 -253511 -253511 10761335 298964017 814234 814234 298149783 55513 55513 298205296 288202682 1012232 1012232 287190450 0 287190450 Part XI, Line 8 - Other Adjustments: Contributions from Foundation - 55,513 Foundation Bottom Line - 197,998 Part XII, Line 2d - Other Adjustments: Foundation Activity - 814,234 Part XII, Line 4b - Other Adjustments: Contributions from Foundation - 55,513 Part XIII, Line 2d - Other Adjustments: Foundation Expenses - 1,012,232 1 1 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 1938500 444635 1493865 0.00050 31711192 24720287 6990905 0.02500 0 0 0.00000 33649692 25164922 8484770 0.02550 1173076 0 1173076 0.00000 2694511 1372527 1321984 0.00470 0 0 0.00000 0 0 0.00000 61139 0 61139 0.00020 3928726 1372527 2556199 0.00490 37578418 26537449 11040969 0.03040 18100 0 18100 0.00000 11426 0 11426 0.00000 29526 29526 1 3169150 1965998 51514022 51998052 -484030 X 1 0 2 1 Mercy Hospital of Buffalo

565 Abbott Road Buffalo NY 14220

X X X X Ambulance, Ambulatory Surgery, Audiology, Cardiac Cath, Cardiac Surgery, 2 Mercy Ambulatory Care Center

3669 Southwestern Blvd Orchard Park NY 14127

X X X X ER, PT, Medical Surgical, Radiology, Lab and CT Scanner NA 1 7 East Aurora Medical Center

94 Olean St East Aurora NY 14052

Extension Clinic: PT, OT, ST, Lab & Radiology Chestnut Ridge Family Practice

6300 Powers Rd Orchard Park NY 14127

Extension Clinic: Primary Medical Care O/P Mercy Outpatient Clinc ObGyn

515 Abbott Rd Buffalo NY 14220

Extension Clinic: Peds, Prenatal & Primary Medical Care O/P Mercy Comprehensive Care Center

430 South Park Ave Buffalo NY 14204

Extension Clinic: Primary Medical Care O/P & Pediatric OLV Family Care Center

227 Ridge Rd Lackawanna NY 14218

Extension Clinic: Prenatal O/P & Primary Medical Care O/P Mercy Nursing Facility

55 Melroy Avenue Lackawanna NY 14218

Long Term Care Pace Health Center

55 Melroy Avenue Lackawanna NY 14218

Extension Clinic: PT, OT, ST & Medical Care O/P Part I, Line 3c: N/A Part I, Line 6a: Mercy Hospital Community Benefit Report is contained in a report prepared by the Catholic Health System. 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 $7,769,428 are included in Part IX, line 25, column (A) but subtracted when calculating the percentage in column (f). Part II: Mercy Hospital provided Community Building in the form of Leadership Development which improved community leadership by promoting understanding of community healthcare needs and services at various events throughout the community. Additionally Workforce Development was provided by mentoring and education to students regarding healthcare careers throughout the community. Part III, Line 4: The amount in Part III line 2 is the actual bad debt expenses of $7,769,428 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 10/1/2009 to 9/30/2010 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 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 organization's 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: Certified Mental Health Services O/P, Clinic Part Time Services, Clinical Laboratory Services, Coronary Care, CT Scanner, Dental O/P, Emergency Department, Family Planning O/P , Health Fairs O/P, Intensive Care, Magnetic Resonance Imaging, Maternity, Medical Social Services, Medical/Surgical, Neonatal Continuing, Intensive & Intermediate Care, Nuclear Medicine - Diagnostic, Outpatient Surgery, Pediatric & 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, Radiology - Diagnostic, Renal Dialysis - Acute, Respiratory Care, Therapy OT & SP. Part VI, Line 2: Mercy Hospital, as part of Catholic Health, involves 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 Outpatients B. Nursing Home Residents and Families C. Rehabilitation Patients D. Primary Care Center Patients E. Home Care Clients 4. Physicians 5. External Organizations6. 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. 2. Health Consumers In creating the Catholic Health and Mercy Hospital 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 Mercy Hospital continues to participate in a regional patient satisfaction survey through a cooperative effort with the Buffalo Niagara Health Quality Coalition and area hospitals. Patient participation is voluntary. This survey takes 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. 4. Physicians Mercy Hospital surveys its medical staff annually. Physicians are surveyed on issues relating to the quality and efficiency of services offered throughout Catholic Health. 5. External OrganizationsCatholic Health and Mercy Hospital 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 Mercy Hospital work closely with the following organizations to assess community health need:Niagara Health Quality Coalition American Heart Association Baker Victory Services WNY Osteoporosis Resource Ctr. Living Healthy Task Force of Erie Co. Buffalo Public Schools Worksite Wellness Every Parent Influences Children (EPIC) WNY Coalition for Diabetes Erie Co. Coalition for Diabetes Catholic Charities Community Cancer CoalitionNear East & West Side Task ForceCommunity Health Center of BuffaloWNY Health Equity Work GroupMinority Health CoalitionFlu CoalitionTobacco CoalitionCommunity Health FoundationWNED Public TelevisionNiagara University6. Statistical ResourcesCatholic Health and Mercy Hospital 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 include: "A Community Report What People Want for the Future of Healthcare in WNY" "NYS Expanded Behavioral Risk Factor Surveillance System" January 2008 "Buffalo Public Schools: Student Body Mass Index" 2008-2009 school year "Erie County Health Assessment Indicators" 2005-2007 "Erie County Health Indicators Profile" 2003-2007 Part VI, Line 3: Mercy 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, Mercy 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 organization's 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: Mercy Hospital's service area is a mix of urban, suburban, and rural areas comprised of 94.3% white (non-Hispanic) and 1.9% African-American (non-Hispanic) households. The service area is more elderly than most with 18.1% of the population over the age of 65 compared to a national average of 12.9%. The community consists of fewer households than the national average with annual incomes below $15,000/year at 10.4% compared to a national average of 12.4%.Although Mercy Hospital is not located in a designated Health Professional Shortage Area (HPSA), it draws patients from identified HPSA areas. Additionally, the hospital has at least one extension in a designated HPSA. Part VI, Line 6: Catholic Health System's 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, clinical and support services, clerkships, internships, scholarships, in-kind donations and community support activities. The governing Board of Directors of Mercy Hospital 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 Mercy 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 7: Mercy Hospital is affiliated with the Catholic Health System, Inc., a New York State licensed corporation. Catholic Health System, located in Buffalo, New York is exempt from taxation and is 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, Sisters of Charity Hospital, Father Baker Manor, St. Elizabeth's Home of Lancaster, St. Francis Home of Williamsville, St. Vincent's Home for the Aged, and Our Lady of Victory Senior Neighborhood. Reports Filed With States Part VI, Line 7 NY X X 1 1 X X X X X X 1 1 0 0 0 1 1 0 0 Joseph McDonald 0 582249 0 214448 0 291999 0 19255 0 15336 0 1123287 0 0 Mark Sullivan 0 334900 0 86846 0 32957 0 9990 0 13404 0 478097 0 0 Charles Urlaub 277509 0 40866 0 72091 0 13640 0 14771 0 418877 0 0 0 David Macholz 0 164219 0 23586 0 25221 0 7091 0 17794 0 237911 0 0 Peter Bergmann 0 335855 0 167393 0 37450 0 6055 0 16641 0 563394 0 0 Christine Kluckhohn 0 202356 0 47107 0 32931 0 63114 0 16886 0 362394 0 0 James Millard 0 205604 0 39478 0 38703 0 98184 0 9768 0 391737 0 0 Dr Michael Edbauer 0 189092 0 42750 0 31384 0 8397 0 19675 0 291298 0 0 James A Dunlop Jr 0 303923 0 81292 0 32955 0 53504 0 15862 0 487536 0 0 Dr Brian D'Arcy 0 244715 0 276792 0 71788 0 20231 0 16261 0 629787 0 0 John Herman 164535 0 13567 0 8715 0 23091 0 13809 0 223717 0 0 0 Michael Moley 0 249731 0 58450 0 78613 0 18611 0 14021 0 419426 0 0 John Stavros 0 158915 0 39533 0 39363 0 17862 0 18668 0 274341 0 0 Maria Foti 0 155554 0 31835 0 33011 0 12667 0 6323 0 239390 0 0 Bartholomew Rodrigues 0 136513 0 34256 0 38492 0 10610 0 15900 0 235771 0 0 Dr Michael Galang 0 256674 0 35327 0 30846 0 14054 0 4927 0 341828 0 0 Dr Thomas Raab 271413 0 50000 0 22774 0 104855 0 18533 0 467575 0 0 0 Dr Timothy Gabryel 309836 0 26563 0 16374 0 18617 0 5562 0 376952 0 0 0 Dr Donald Schmidt 273298 0 0 0 22770 0 91001 0 16653 0 403722 0 0 0 Nils Gunnersen 198279 0 46750 0 38681 0 48922 0 219 0 332851 0 0 0 Dr Anshu Bais 265090 0 0 0 2696 0 3806 0 16135 0 287727 0 0 0 Dr Lynne Aronica 189330 0 0 0 16612 0 5377 0 205 0 211524 0 0 0 Dr Thomas Dilamarter Jr 170986 0 0 0 33246 0 12554 0 5759 0 222545 0 0 0 John Davanzo 0 155588 0 58579 0 77148 0 36050 0 11804 0 339169 0 0 K David Crone 0 243906 0 0 0 45829 0 29157 0 10451 0 329343 0 0 Part I, Line 1a 3. Tax Indemnification and Gross up payments YES Officers received a tax indemnification and gross-up payment for reimbursement of withholding taxes in conjunction with certain taxable benefits paid on behalf of employee. Part I, Line 1a 5. Housing allowance or residence for personal residence YES Applicable taxable payments were made for expenses due to relocating for one official who relocated, as per policy. Part I, Lines 4a-b Certain Officers and Key employees participated in a supplemental non-qualified retirement plan per the terms and conditions of their employment arrangement. MERCY Pension Gap CHE SERP Joseph McDonald $26,000 114,535 Dr. Brian D'Arcy 9,800 K. David Crone 17,000 John Davanzo 16,875 Michael Moley 20,697 Part I, Line 6 The 2010 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. MERCY Joseph McDonald $214,448 Mark Sullivan 86,846 James A. Dunlop, Jr. 81,292 Peter Bergmann 72,559 Dr. Brian D'Arcy 60,504 John Davanzo 58,579 Michael Moley 58,450 Michael Edbauer, M.D. 57,000 Dr. Thomas Raab 50,000 Christine Kluckhohn 47,107 Nils Gunnersen 46,750 Charles Urlaub 40,866 John Stavros 39,533 James Millard 39,478 Dr. Michael Galang 35,327 Bartholomew Rodrigues 34,256 Maria Foti 31,835 Dr. Timothy Gabryel 26,563 David Macholz 23,586 John Herman 13,567 Dormitory Authority of the State of New York 146000293 64983Q5R6 2006-11-29 13360000 Part V 0 0 0 Dormitory Authority of the State of New York 146000293 6499035D9 2008-11-26 24700000 Part V 0 0 0 13360000 537015 79065 12743920 2006 1 0 1 1 24700000 111729 5282735 1150457 220774 42348 17891957 2010 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 1 1 HSBC Bank NA 18.500000000000 1 0 0 0 0 0 1 1 HSBC Bank NA 25.600000000000 1 0 0 0 0 Part I A (f) Description of Purpose: To refinance outstanding commercial indebtedness, the proceeds of which were applied to finance the cost of Mercy's operating room expansion, other expansions/improvements at the facility. Part I B (f) Description of Purpose: To finance the cost of an approximately 48,300 square foot addition for a new emergency department, new CT/Radiology facilities, construction of a new main entrance and lobby area, a new ambulance entrance, construction of a rooftop helipad, renovation of library space into conference rooms, other mechanical and electrical improvements and associated demolition and equipping costs. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 74933 Corporate Nurse Educator 0 Kathryn B Millard Daughter of BOD, CEO Kenmore Mercy, James Millard 14519 Registered Nurse 0 James Manzella Acute Care Board Member 165088 Key Employee of Manzella Marketing 0 David Zapfel Brother of BOD, Msgr. Robert Zapfel 60600 HR Employee of CHS 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 53088 HR Employee, St. Francis 0 Kathleen Moley Daughter of Key Employee, Michael Moley 37518 HR Employee of CHS 0 Susan Gallagher-Stavros Wife of Key Employee, John Stavros 35158 Community Health Nurse, McAuley Seton Home Care 0 Marie Packard Daughter of BOD, Dennis Dombek 42975 Physical Therapist 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 2010, 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 B, Line 16: The Catholic Health System has a process to evaluate its participation in joint venture arrangements under applicable federal tax law, and has taken steps to safeguard the organization's exempt status with respect to such arrangements, and has developed a formal policy to formalize the process. 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 5: Mimimum Pension Liability Adjustment (8,000,589) Equity Transfer to Affiliates (3,615,058) Change in Interest in Foundation 84,661 Interest Rate Swap Adjustment (468,610) Catholic Health System Inc 515 Abbott Road Buffalo NY 14220 222565278 Health Care Delivery System NY 501 c 3 Schedule A Line 1 N/A 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 Buffalo 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 1 Catholic Health System Inc 0 St Clare Manor 543 Locust Street Buffalo NY 14094 160782647 Skilled Nursing Facility NY 501 c 3 Schedule A Line 1 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 1 Catholic Health System Inc 0 St Francis Home of Williamsville 147 Reist St Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501 c 3 Schedule A Line 1 Catholic Health System Inc 0 St Francis Home of Buffalo Inc 34 Benwood Ave Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501 c 3 Schedule A Line 1 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 St Batavia NY 14020 160794811 Skilled Nursing Facility NY 501 c 3 Schedule A Line 1 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 1 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501 c 3 Schedule A Line 1 Catholic Health System Inc 0 WNY Catholic Long Term Care Inc 6400 Powers Rd Orchard Park NY 14127 161434368 Skilled Nursing Facility NY 501 c 3 Schedule A Line 1 Catholic Health System Inc 0 Niagara Homemaker Services (Mercy Home Care) Apple Tree Business Park 2875 union Cheektowaga NY 14227 161317960 Home Care Provider NY 501 c 3 Schedule A Line 1 Catholic Health System Inc 0 McAuley Seton Home Care Apple Tree Business Park 2875 union Cheektowaga NY 14227 161310062 Home Care Provider NY 501 c 3 Schedule A Line 1 Catholic Health System Inc 0 Catholic Health System Infusion Pharmacy Inc 2875 Union Road Suite 14 Cheektowaga NY 142271461 200198518 Home Care Infusion Services NY 501 c 3 Schedule A Line 1 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 1 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 Mercy Hospital Foundation 515 Abbott Road Buffalo NY 14220 222209721 Foundation NY 501 c 3 Schedule A Line 7 Mercy Hospital 0 Southtowns Catholic MRI Inc 200 International Drive Buffalo NY 14221 161554081 Imaging NY 501 c 3 Schedule A Line 9 Catholic Health System Inc 0 Marian Professional Center Associates LP 350 Essjay Road Suite 101 Williamsville NY 14221 161360469 Rental Real Estate NY N/A Related 107592 0 0 OLV-Brierwood Healthcare Co LLC 6455 Lake Avenue Orchard Park NY 14127 161487207 Rental Real Estate NY N/A Related 32474 152736 0 0 Orchard Park Mercy Corporation Marian Professional Bldg Suite 500 Buffalo NY 14220 161470350 Real Estate Holding Company NY Mercy Hospital C 70133 1.00000 Aurora Mercy Corporation 565 Abbott Road Buffalo NY 14220 161354302 Real Estate Development NY Mercy Hospital C 32844 1.00000 Alsace Abbott Corporation 515 Abbott Road Suite 408 Buffalo NY 14220 161355092 Partnership Holding Corporation NY Mercy Hospital C 288292 1.00000 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 Orchard Park Mercy Corporation Q 109429