ST FRANCIS HOME OF WILLIAMSVILLE: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ST FRANCIS HOME OF WILLIAMSVILLE (EIN 16-0743153)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201143189349302004
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2011-11-14T08:43:46-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN160743153EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS HOME OF WILLIAMSVILLEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTFRNameControl
Phone7166335400Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1291 NORTH STREETAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14201ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID P MACHOLZName
TitleVP FINANCE/CORPCONTROLLERTitle
Phone7168282974Phone
Date Signed2011-11-15DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOSEPH MCDONALDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12121 MAIN STREETAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14214ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12206787GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteCHSBUFFALO.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1961YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTHE 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 2010 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees300TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9784992ProgramServiceRevenuePriorYear
Program Service Revenue CY12128895ProgramServiceRevenueCY
Investment Income Prior Year5590InvestmentIncomePriorYear
Investment Income Current Year7568InvestmentIncomeCurrentYear
Other Revenue Prior Year56826OtherRevenuePriorYear
Other Revenue Current Year70324OtherRevenueCurrentYear
Total Revenue Prior Year9847408TotalRevenuePriorYear
Total Revenue Current Year12206787TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8641410SalariesEtcPriorYear
Salaries Etc Current Year9812074SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2740808OtherExpensePriorYear
Other Expenses Current Year2603229OtherExpensesCurrentYear
Total Expenses Prior Year11382218TotalExpensesPriorYear
Total Expenses Current Year12415303TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1534810RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-208516RevenuesLessExpensesCY
Total Assets BOY6399006TotalAssetsBOY
Total Assets EOY6862238TotalAssetsEOY
Total Liabilities BOY7489966TotalLiabilitiesBOY
Total Liabilities EOY8307995TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-1090960NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-1445757NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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 2010 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10577600Expense
Revenue12128895Revenue
DescriptionNURSING 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 2010 OVER 64% OF RESIDENTS WERE COVERED BY MEDICAID. THIS 64% MEDICAID POPULATION EQUALLED 30,281 PATIENT BED DAYS. SEE COMMUNITY SERVICE PLAN AT WWW.CHSBUFFALO.ORG.Description
Total Program Service Expense10577600TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees300NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums1FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAVID P MACHOLZBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7168282974TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1515 ABBOTT ROAD SUITE 500AddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14220ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeFormerFormer
JOSEPH MCDONALD
PRESIDENT AND CEO, CHS37.50XX0108869634591
CHRISTINE KLUCKHOHN
PRES & CEO,CONTINUING CARE37.50XX028239480000
JOYCE JOYCE PHD
DIRECTOR1.00X000
JOYCE MARKIEWICZ
DIRECTOR37.50X024844329392
MARK MEYERHOFER
DIRECTOR1.00X000
ROBERT NASSO
DIRECTOR1.00X000
EDWARD FLYNN
DIRECTOR1.00X000
NANCY TRUVER
DIRECTOR1.00X000
SR MARY ANNE WELDON
DIRECTOR1.00X000
JAMES MILLARD
DIRECTOR37.50X0283785107952
MONSIGNOR ROBERT E ZAPFEL
DIRECTOR1.00X000
BRUCE NAUGHTON MD
DIRECTOR1.00X000
SHERRY POMEROY PHD RN
DIRECTOR1.00X000
MICHAEL SULLIVAN
DIRECTOR1.00X000
MARK SULLIVAN
EXEC VP, COO37.50X045470323394
JAMES A DUNLOP JR
EXEC VP, FINANCE, CFO37.50X041817069366
DARLENE CRISPELL
ADMINISTRATOR37.50X112919015178
MARIA FOTI
SR. VP, PLANNING37.50022040018990X
MICHAEL MOLEY
SR. VP HUMAN RESOURCES37.50038679432632X
JOHN STAVROS
SR. VP MARKETING/P.R.37.50023781136530X
BARTHOLOMEW RODRIGUES
SR. VP MISSION INTEGRATION37.50020926126510X
DR MICHAEL GALANG
CHIEF INFORMATION OFFICER37.50032284718981X
K DAVID CRONE
FORMER SR.VP STRATEGIC SER028973539608X
JOHN DAVANZO
FORMER SR.VP REGIONAL DEVELOPMENT37.50029131547854X
FieldValueIRS element (for citing)
Total Reportable Comp From Org112919TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs4734354TotalReportableCompFrmRltdOrgs
Total Other Compensation580978TotalOtherCompensation
Number Individuals GT100 K14NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1NURSEFINDERSBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 910738AddressLine1
CityDALLASCity
StateTXState
ZIP Code75391ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesNURSING SERVICESDescriptionOfServices
Compensation116696Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPRIVATE AND SSIDescription
Business Code623000BusinessCode
Total Revenue Column12128895TotalRevenueColumn
Related Or Exempt Function Income12128895RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue12128895TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7568TotalRevenueColumn
Exclusion$7,568ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
MISC.90009945793$45,793
DISCOUNTS/REBATES90009916766$16,766
VENDING9000997765$7,765
FieldValueIRS element (for citing)
Total Other Revenue70324TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12206787TotalRevenueColumn
Related Or Exempt Function Income12128895RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$77,892ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total112919Total
Management And General112919ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7517040Total
Program Services6579887ProgramServices
Management And General937153ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1688388Total
Program Services1542827ProgramServices
Management And General145561ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total493727Total
Program Services424605ProgramServices
Management And General69122ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total200792Total
Program Services200792ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total63784Total
Program Services15221ProgramServices
Management And General48563ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES95595693552820428
PURCHASED SERVICES776056539918236138
MEDICAL & PROFESSIONAL17953976246103293
BAD DEBT EXPENSE173483173483

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total253619Total
Program Services89093ProgramServices
Management And General164526ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12415303Total
Program Services10577600ProgramServices
Management And General1837703ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY903032BOY
EOY1159880EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY415092BOY
EOY416339EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1373586BOY
EOY1512763EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY12140BOY
EOY9372EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY40907BOY
EOY7342EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10861499LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9010121LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1926497BOY
EOY1851378EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1523348BOY
EOY1509865EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY204404BOY
EOY395299EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6399006BOY
EOY6862238EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1609237BOY
EOY1193668EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5880729BOY
EOY7114327EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7489966BOY
EOY8307995EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-1117841BOY
EOY-1511971EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY26881BOY
EOY66214EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-1090960BOY
EOY-1445757EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6399006BOY
EOY6862238EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-208516ReconcilationRevenueExpenses
Reconcilation Other Changes-146281ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Church170b1 AiXChurch170b1Ai

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$6,715DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$1,023OtherActivitiesAmount
Total Lobbying Expenditures IIB7738TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationST. 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 2010 THE LOBBYING COMPONENT OF THESE DUES AMOUNTED TO APPROXIMATELY $1,023. 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 $6,715, IN 2010.Explanation

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6879234OtherCostOrOtherBasis
Depreciation5727395Depreciation
Book Value1151839BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3974665OtherCostOrOtherBasis
Depreciation3282726Depreciation
Book Value691939BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7600OtherCostOrOtherBasis
Book Value7600BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1851378TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionASSETS LIMITED AS TO USEDescription
Book Value1509865BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities1509865TotalOfBookValueSecurities

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM AFFILIATES136283
DUE FROM THIRD PARTY PAYORS192802
INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION66214
FieldValueIRS element (for citing)
Total Book Value Other Assets395299TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION$240,731
DUE TO AFFILIATES$2,843,094
DUE TO THIRD PARTY PAYORS$1,605,225
LONG TERM PENSION OBLIGATION$2,425,277
FieldValueIRS element (for citing)
Total Of Amounts7114327TotalOfAmounts
Total Revenue12206787TotalRevenue
Total Expenses12415303TotalExpenses
Excess Or Deficit For Year-208516ExcessOrDeficitForYear
Other-$146,281OtherAmount
Total Adjustments-146281TotalAdjustments
Excess Or Deficit Per FS-354797ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt12199219TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal12199219RevenueSubtotal
Other Revenues Not Included7568OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt7568RevenueNotRptdOnFinStmt
Total Revenue Per Form99012206787TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12415303TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal12415303ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99012415303TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:MINIMUM PENSION LIABILITY ADJUSTMENT -185,614. CHANGE IN INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 39,333.
PART XII, LINE 4B - OTHER ADJUSTMENTS:INTEREST INCOME 7,568.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JOSEPH MCDONALD
0582249021444802919990192550153360112328700
CHRISTINE KLUCKHOHN
0202356047107032931063114016886036239400
JOYCE MARKIEWICZ
0168033042752037658013463015929027783500
JAMES MILLARD
020560403947803870309818409768039173700
MARK SULLIVAN
033490008684603295709990013404047809700
JAMES A DUNLOP JR
0303923081292032955053504015862048753600
MARIA FOTI
015555403183503301101266706323023939000
MICHAEL MOLEY
0249731058450078613018611014021041942600
JOHN STAVROS
0158915039533039363017862018668027434100
BARTHOLOMEW RODRIGUES
0136513034256038492010610015900023577100
DR MICHAEL GALANG
025667403532703084601405404927034182800
K DAVID CRONE
024390600045829029157010451032934300
JOHN DAVANZO
0155588058579077148036050011804033916900

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINES 4A-BCERTAIN 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 K. DAVID CRONE $17,000 JOHN DAVANZO $16,875 MICHAEL MOLEY $20,697
PART I, LINE 6THE 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 MCDONALD $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 BARTHOLOMEW RODRIGUES $ 34,256 MARIA FOTI $ 31,835 DARLENE CRISPELL $ 9,606

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
DAVID ZAPFEL
BROTHER OF BOD, MSGR. ROBERT ZAPFEL60600HR EMPLOYEE OF CHS0
KATHLEEN ZAPFEL
SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL53088HR EMPLOYEE, ST. FRANCIS0
KATHRYN B MILLARD
DAUGHTER OF BOD, CEO KENMORE MERCY, JAMES MILLARD14519REGISTERED NURSE, MERCY0
KATHLEEN MOLEY
DAUGHTER OF KEY EMPLOYEE, MICHAEL MOLEY37518HR EMPLOYEE, CHS0
SUSAN GALLAGHER-STAVROS
WIFE OF KEY EMPLOYEE, JOHN STAVROS35158COMMUNITY HEALTH NURSE, MCAULEY SETON HOME CARE0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6CHS 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 7AACCORDING 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 7BEACH 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 11YES, 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
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 12C
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 B, LINE 15
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 VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:MINIMUM PENSION LIABILITY ADJUSTMENT -185,614. CHANGE IN INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 39,333. TOTAL TO FORM 990, PART XI, LINE 5: -146,281.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CATHOLIC HEALTH SYSTEM INC
515 ABBOTT ROADBUFFALONY14220222565278HEALTHCARE DELIVERY SYSTEMNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
MERCY HOSPITAL OF BUFFALO
565 ABBOTT ROADBUFFALONY14220160756336ACUTE CARE HOSPITALNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
SISTERS OF CHARITY HOSPITAL
2157 MAIN STREETBUFFALONY14214160743187ACUTE CARE HOSPITALNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
KENMORE MERCY HOSPITAL
2950 ELMWOOD AVENUEKENMORENY14217160762843ACUTE CARE HOSPITALNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
NAZARETH HOME OF THE FRANCISCAN SISTERS
291 NORTH STREETBUFFALONY14201160813142SKILLED NURSING FACILITYNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
ST CLARE MANOR
543 LOCUST STREETLOCKPORTNY14094160782647SKILLED NURSING FACILITYNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
ST ELIZABETH HOME FOR THE AGED
5539 BROADWAYLANCASTERNY14086160743154ADULT HOMENY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
ST FRANCIS OF BUFFALOINC
34 BENWOOD AVENUEBUFFALONY14214161523535SKILLED NURSING FACILITYNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
ST JOSEPH MANOR
2211 WEST STATE STREETOLEANNY14760160796400SKILLED NURSING FACILITYNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
ST LUKE MANOR FOR THE CHRONICALLY ILL
17 WIARD STBATAVIANY14020160794811SKILLED NURSING FACILITYNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
ST MARY'S MANOR
515 6TH STREETNIAGARA FALLSNY14301160924139SKILLED NURSING FACILITYNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
ST VINCENT MANOR
319 WASHINGTON AVENUEDUNKIRKNY14048160743167ADULT HOMENY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
WNY CATHOLIC LONG TERM CARE INC
6400 POWERS ROADORCHARD PARKNY14127161434368SKILLED NURSING FACILITYNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE)
2875 UNION ROADCHEEKTOWAGANY14227161317960HOME CARE PROVIDERNY501(C)(3)LINE 9CATHOLIC HEALTH SYSTEM INC0
MCAULEY SETON HOME CARE
2875 UNION ROADCHEEKTOWAGANY14225161310062HOME CARE PROVIDERNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
CHS CONTINUING CARE FOUNDATION
291 NORTH STREETBUFFALONY14201200947831FOUNDATIONNY501(C)(3)LINE 7CATHOLIC HEALTH SYSTEM INC0
OLV RENAISSANCE CORPORATION
291 NORTH STREETBUFFALONY14201200167745REAL ESTATE HOLDING COMPANYNY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
CATHOLIC HEALTH SYSTEM INFUSION PARMACY INC
2875 UNION ROAD SUITE 14CHEEKTOWAGANY142271461200198518HOME CARE INFUSION SERVICENY501(C)(3)LINE 1CATHOLIC HEALTH SYSTEM INC0
CHS PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY INC
55 MELROY AVENUELACKAWANNANY14218261252884ALL-INCLUSIVE CARE FOR THE ELDERLYNY501(C)(3)LINE 3CATHOLIC HEALTH SYSTEM INC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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