2011-11-14T10:15:38-06:00 2010-12-31 990 2010-01-01 160762843 Kenmore Mercy Hospital KENM 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 142334900 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 1070 304 0 0 1005438 673671 137432128 140020393 120004 159371 1132513 1481465 139690083 142334900 0 0 0 0 70199337 73913119 0 0 0 66266820 69468565 136466157 143381684 3223926 -1046784 91718201 93746757 71675411 74848782 20042790 18897975 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 76120601 100187937 Inpatient surgical services provided 2,590 I/P surgery visits, 560 visits for G.I. Lab, and 117 visits for urology. Inpatient Surgical services provides 34,126 acute care patient days and 4,681 medical rehab service days. The Skilled Nursing Facility provided 56,272 days of care. 28871322 37999676 Outpatient surgical services provides 3,467 outpatient surgery vistits, 4,379 G.I. visits, 1,831 Interventional Radiology visits and 178 Transfusion visits. Outpatient services also provided 21,122 ED visits and 89,273 Referred Ambulatory visits. 1392507 1832780 Primary Care Centers and Clinics provided 29,997 visits. 106384430 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 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 0 0 0 0 1 88 0 1070 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 0 X David P Macholz VP FinanceCorporate 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 James Millard 37.50 X X 283785 0 107952 David Macholz 37.50 X X 0 213026 24885 Brian Beitz 1.00 X 0 0 0 Peter Bergmann 37.50 X 0 540698 22696 Frances Crosby 1.00 X 0 0 0 Richard Curran 1.00 X 0 0 0 Dennis Dombek 1.00 X 0 0 0 Michael Edbauer 25.00 X 0 263226 28072 Christine Kluckhohn 37.50 X X 0 282394 80000 William Lawley 1.00 X 0 0 0 James Manzella 1.00 X 0 0 0 Dr Paul Mason 1.00 X 25000 0 0 Dr David Serra 1.00 X 0 0 0 Cynthia Zane 1.00 X 0 0 0 Monsignor Robert E Zapfel 1.00 X 0 0 0 Michael Montante 1.00 X 0 0 0 Dr Carlos Santos 1.00 X 0 49913 0 Charles J Urlaub 37.50 X 0 390466 28411 James A Dunlop Jr 37.50 X 0 418170 69366 Dr Brian D'Arcy 37.50 X 0 593295 36492 Walter Ludwig 37.50 X 173166 0 15934 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 James Fitzpatrick 37.50 X 170307 0 27616 Dr Semira Khawar 37.50 X 149388 0 15143 Dr Avtar Samra 37.50 X 140389 0 27645 Dr Ayesha Butt 37.50 X 136014 0 16332 Cheryl Hayes 37.50 X 134588 0 11797 K David Crone 0.00 X 0 289735 39608 John Davanzo 0.00 X 0 291315 47854 1212637 6252750 791431 39 1 1 0 Elder Medical Services PC 132 Cayuga Rd Suite 1C Cheektowaga NY 14225 Medical Services 564060 Buffalo Niagara Hospitalists LLC 2950 Elmwood Ave Kenmore NY 14217 Medical Services 422500 Sodexho Operations LLC 60 Grider Street Buffalo NY 14215 Laundry Service 357610 R & P Oakhill Development LLC 3556 Lakeshore Rd Suite 620 Buffalo NY 14219 Construction Service 345373 Seton Imaging 3730 Sheridan Dr Amherst NY 14226 Medical Services 312800 14 673671 673671 Patient Service Revenu 900099 70367116 70367116 Medicare/Medicaid 900099 69653277 69653277 140020393 156225 156225 287317 287317 287317 287317 3146 3146 3146 3146 Shared Services 900099 658319 658319 Cafeteria 900099 252618 252618 Phone & Television 900099 28453 28453 254758 254758 1194148 142334900 140020393 0 1640836 481951 481951 57731762 41235335 16496427 2536684 1796845 739839 9716725 6882784 2833941 3445997 2440951 1005046 32659 32659 78390 57130 21260 36925971 36506861 419110 139986 19787 120199 2324787 376613 1948174 19729 13506 6223 15815 12791 3024 1351805 1351805 5980258 3443660 2536598 1058980 687892 371088 Purchase Services 9985700 4845453 5140247 Professional Fees 4260614 2157761 2102853 Bad Debt 3328188 3328188 Shared Service and Dues 1125573 1125573 2840110 1194409 1645701 143381684 106384430 36997254 0 17279252 15738719 16932804 19476223 439512 1454156 1167739 1385720 92367805 48498120 44463223 43869685 11435671 11822254 91718201 93746757 18446551 20746095 14182666 13318952 12131192 11520986 26915002 29262749 71675411 74848782 X 19969384 18746304 73406 151671 20042790 18897975 91718201 93746757 X -1046784 -98031 X 0 1 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 235852 235852 57578029 34129813 23448216 6570316 1092378 5477938 19933153 12912530 7020623 8050455 363399 7687056 43869685 Other Receivables 659436 Interest in net assets of KMH Foundation 3541132 Due from Affiliates 1510280 Assets Limited as to use 5954374 Other Assets 157032 11822254 Long Term portion of Insurance Liabilities 4625841 Interest Rate Swap 1193040 Due to Affiliates 2097753 Pension Obligation 21217161 Asset Retirement Obligation 128954 29262749 142334900 143381684 -1046784 -573671 -573671 -1620455 141761229 0 141761229 573671 573671 142334900 143381684 0 143381684 0 143381684 Part XI, Line 8 - Other Adjustments: Contributions from Foundation -573,671. Part XII, Line 4b - Other Adjustments: Contributions from Foundation 573,671. 1 1 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 1425490 193030 1232460 0.00860 10246818 7008622 3238196 0.02260 11672308 7201652 4470656 0.03120 450229 450229 0.00310 345390 345390 0.00240 30036 30036 0.00020 825655 825655 0.00570 12497963 7201652 5296311 0.03690 428 428 0.00000 80037 80037 0.00060 80465 80465 0.00060 1 1597197 1580145 30130983 31386659 -1255676 X 1 0 1 1 Kenmore Mercy Hospital

2950 Elmwood Ave Kenmore NY 14217

X X X Ambulatory Surgery, Dental O/P NA 1 3 Ken-Ton Family Care

300 Two Mile Creek Rd Tonawanda NY 14150

Extension Clinic: Pediatric O/P, Prenatal O/P, Primary Medical Care O/P Williamsville Diagnostic Center

400 International Drive Williamsville NY 14221

Extension Clinic: Primary Medical Care, PT O/P, Radiology O/P, CT Scan, McAuley Residence

1503 Military Rd Kenmore NY 14217

Long Term Care Part I, Line 6a: The Kenmore 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, L7 Col(f): Bad debt expenses of $3,328,188 are included in Part IX, line 25, column (A) but subtracted when calculating the percentage in column (f). Part II: Kenmore 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 $3,328,188 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 V, Section A: Audiology O/P, Clinic P/T Services, Clinical Laboratory Services, Coronary Care, CT Scanner, Emergency Department, Intensive Care, Medical Social Services, Health Fairs O/P, Medical/Surgical, Nuclear Medicine-Diagnostic, Nuclear Medicine-Therapeutic, Pediatric O/P, Pharmacuetical Service, Physical Medical Rehab, Physical Medicine and Rehab O/P, Primary Medical Care O/P, Radiology-Diagnostic, Renal Dialysis-Acute, Respiratory Care, PT O/P, OT O/P, and Therapy-Speech Language, Pathology Part VI, Line 2: Kenmore 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 OutpatientsB. 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 Kenmore 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 Kenmore 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 Kenmore Mercy Hospital surveys its medical staff annually. Physicians are surveyed on issues relating to the quality and efficiency of services offered throughout Catholic Health including at Kenmore Mercy Hospital. 5. External OrganizationsCatholic Health and Kenmore 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 Kenmore Mercy Hospital work closely with the following organizations to assess community health need:Niagara Health Quality CoalitionCommunity 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 WellnessFlu CoalitionEvery Parent Influences Children (EPIC)Tobacco CoalitionWNY Coalition for DiabetesCommunity Health FoundationErie Co. Coalition for DiabetesWNED Public TelevisionCatholic Charities Niagara University6. Statistical ResourcesCatholic Health and Kenmore 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: Kenmore 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, Kenmore 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: Kenmore Mercy Hospital serves a mostly suburban partially urban service area which is comprised of 89.1% white (non-Hispanic) and 3.8% African-American (non-Hispanic) households. The service area is more elderly than most with 19.2% of the population over the age of 65 compared to a national average of 12.9%. The community also consists of slightly fewer households than the national average with annual incomes below $15,000/year at 12.0% compared to a national average of 12.4%.Although Kenmore Mercy Hospital is not located in a designated Health Professional Shortage Area (HPSA), the hospital draws patients from other HPSAs in the region and one of its extension clinics is in a designated HPSA area. 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 eduaction programs, health screenings, clinical and support services, clerkships, internships, scholarships, in-kind donations and community support activities.The governing Board of Directors of Kenmore 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 Kenmore Mercy Hospital medical staff can be considered and "open" medical staff, as any physician can apply for privileges. Each application is reviewed by a vigorous credentialing verification process. Part VI, Line 7: Kenmore 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: Mercy Hospital of Buffalo, Sisters of Charity Hospital, Father Baker Manor, St. Elizabeth's Home of Lancaster, St. Francis Home of Williamsville, and 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 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 James Millard 205604 0 39478 0 38703 0 98184 0 9768 0 391737 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 Michael Edbauer 0 189092 0 42750 0 31384 0 8397 0 19675 0 291298 0 0 Christine Kluckhohn 0 202356 0 47107 0 32931 0 63114 0 16886 0 362394 0 0 Charles J Urlaub 0 277509 0 40866 0 72091 0 13640 0 14771 0 418877 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 Walter Ludwig 142273 0 0 0 30893 0 704 0 15230 0 189100 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 James Fitzpatrick 152734 0 16990 0 583 0 12644 0 14972 0 197923 0 0 0 Dr Semira Khawar 139272 0 10000 0 116 0 0 0 15143 0 164531 0 0 0 Dr Avtar Samra 129561 0 0 0 10828 0 12369 0 15276 0 168034 0 0 0 Dr Ayesha Butt 135917 0 0 0 97 0 451 0 15881 0 152346 0 0 0 K David Crone 0 243906 0 0 0 45829 0 29157 0 10451 0 329343 0 0 John Davanzo 0 155588 0 58579 0 77148 0 36050 0 11804 0 339169 0 0 Part I, Lines 4a-b Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. 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. Joseph McDoanld $214,448 Mark Sullivan $86,846 James A. Dunlop, Jr. $81,292 John Davanzo $58,579 Michael Moley $58,450 Christine Kluckhohn $47,107 John Stavros $39,533 Dr Michael Galang $35,327 Bartholonew Rodrigues $34,256 Maria Foti $31,835 Peter Bergmann $72,559 Dr. Brian D'Arcy $60,504 Michael Edbauer, M.D $57,000 Charles Urlaub $40,866 James Millard $39,478 David Macholz $23,586 Dr. James Fitzpatrick $16,990 Dormitory Authority of the State of New York 146000293 64983Q5T2 2006-11-29 16730000 Part V 0 0 0 16730000 657688 99008 15973304 1998 1 0 1 1 0 0 0 0 1 0 1 1 JP Morgan Chase NA 15.500000000000 1 0 0 0 0 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, Mercy 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 Moley Daughter of Key Employee, Michael Moley 37518 HR Employee, CHS 0 Kathleen Zapfel Sister-in-Law of BOD, Msgr. Robert Zapfel 53088 HR Employee, St. Francis 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 tp 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; CEOs for each Ministry; and all Senior Vice Presidents. The Compensation Committee provides oversight to management decisions which are based on outlines approved by the committee, and performs a review of data. The outcome of these meetings is documented. Form 990, Part VI, Section C, line 19 We make our form 990 open for public inspection upon request. Our website includes an annual report which includes selected financial information. Our financial statements, governing documents and conflict of interest policy are provided upon request according to applicable federal and state laws. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in unrestricted interest in KMH Foundation, Inc. $479,565 Change in Pension Obligation $(1,871,236) Distribution from parent $1,405,384 Change in unrealized loss on interest rate swap $(190,008) Change in temporarily restricted interest in KMH Foundation,Inc. $78,265 Catholic Health System Inc 515 Abbott Rd Buffalo NY 14220 222565278 Healthcare Delivery System NY 501c Scedule A line 1 0 Mercy Hospital Of Buffalo 565 Abbott Rd Buffalo NY 14220 160756336 Acute Care Hospital NY 501c Scedule A Line 3 Catholic Health System Inc 0 Sisters Of Charity Hospital 2157 Main Street Buffalo NY 14214 160743187 Acute Care Hospital NY 501c Scedule 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 501C Scedule A line 1 Catholic Health System Inc 0 ST Clare Manor 543 Locust Street Lockport NY 14094 160782647 Skilled Nursing Facility NY 501c Scedule A line 1 Catholic Health System Inc 0 St Elizabeth Home for Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501c Scedule A line 1 Catholic Health System Inc 0 St Francis Home of Williamsville 147 Reist Street Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501c Scedule A line 1 Catholic Health System Inc 0 St Francis of Buffalo Inc 34 Benwood Ave Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501c Scedule A line 1 Catholic Health System Inc 0 St Joseph Manor 2211 West State Street Olean NY 14760 160796400 Skilled Nursing Facility NY 501c Scedule 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 501c Scedule A line 1 Catholic Health System Inc 0 St Mary's Manor 515 6th Street Niagara Falls NY 14301 160924139 Skilled Nursing Facility NY 501c Scedule A line 1 Catholic Health System Inc 0 St Vincent Manor 319 Washington Ave Dunkirk NY 14048 160743167 Adult Home NY 501c Scedule 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 501c Scedule A line 1 Catholic Health System Inc 0 Niagara Homemakers Services(Mercy Homecare) 2875 Union Rd Suite 14 Cheektowaga NY 14227 161317960 Home Care Provider NY 501c Scedule A line 1 Catholic Health System Inc 0 McAuley Seton Home Care 2875 Union Rd Suite 14 Cheektowaga NY 14227 161310062 Home Care Provider NY 501c Scedule A line 1 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 501c Scedule A line 1 Catholic Health System Inc 0 CHS Program of All-Inclusive Care for the Elderly Inc 55 Melroy Ave Lackawanna NY 14218 261252884 All-inclusive Care for the Elderly NY 501c Scedule A line 3 Catholic Health System Inc 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1