2011-11-14T08:43:46-06:00 2010-12-31 990 2010-01-01 160743153 ST FRANCIS HOME OF WILLIAMSVILLE STFR 7166335400 291 NORTH STREET BUFFALO NY 14201 DAVID P MACHOLZ 7168282974 2011-11-15 2010 2016-03-07 17:11:31Z JOSEPH MCDONALD 2121 MAIN STREET BUFFALO NY 14214 12206787 0 X CHSBUFFALO.ORG X 1961 NY THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, CHS PROVIDERS CONTINUE THE HEALING MINISTRY OF JESUS SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2010 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 14 9 300 0 0 0 0 0 9784992 12128895 5590 7568 56826 70324 9847408 12206787 0 0 0 0 8641410 9812074 0 0 0 2740808 2603229 11382218 12415303 -1534810 -208516 6399006 6862238 7489966 8307995 -1090960 -1445757 X THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM CARE SETTING. COMMITTED TO A COMMON MISSION, CHS PROVIDERS CONTINUE THE HEALING MINISTRY OF JESUS SEEKING TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE PROVIDE HIGH QUALITY SERVICE THAT HAS REVERENCE, COMPASSION, JUSTICE, AND EXCELLENCE. THE 2010 COMMUNITY SERVICE PLAN CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 0 0 10577600 12128895 NURSING HOME CARE: ST FRANCIS WILLIAMSVILLE IS A SKILLED NURSING FACILITY THAT TENDS PRIMARILY TO THE POOR AND ELDERLY AND IS LOCATED IN ERIE COUNTY, NY. IN 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. 10577600 1 0 0 1 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 300 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID P MACHOLZ 7168282974 515 ABBOTT ROAD SUITE 500 BUFFALO NY 14220 JOSEPH MCDONALD 37.50 X X 0 1088696 34591 CHRISTINE KLUCKHOHN 37.50 X X 0 282394 80000 JOYCE JOYCE PHD 1.00 X 0 0 0 JOYCE MARKIEWICZ 37.50 X 0 248443 29392 MARK MEYERHOFER 1.00 X 0 0 0 ROBERT NASSO 1.00 X 0 0 0 EDWARD FLYNN 1.00 X 0 0 0 NANCY TRUVER 1.00 X 0 0 0 SR MARY ANNE WELDON 1.00 X 0 0 0 JAMES MILLARD 37.50 X 0 283785 107952 MONSIGNOR ROBERT E ZAPFEL 1.00 X 0 0 0 BRUCE NAUGHTON MD 1.00 X 0 0 0 SHERRY POMEROY PHD RN 1.00 X 0 0 0 MICHAEL SULLIVAN 1.00 X 0 0 0 MARK SULLIVAN 37.50 X 0 454703 23394 JAMES A DUNLOP JR 37.50 X 0 418170 69366 DARLENE CRISPELL 37.50 X 112919 0 15178 MARIA FOTI 37.50 X 0 220400 18990 MICHAEL MOLEY 37.50 X 0 386794 32632 JOHN STAVROS 37.50 X 0 237811 36530 BARTHOLOMEW RODRIGUES 37.50 X 0 209261 26510 DR MICHAEL GALANG 37.50 X 0 322847 18981 K DAVID CRONE X 0 289735 39608 JOHN DAVANZO 37.50 X 0 291315 47854 112919 4734354 580978 14 1 0 0 NURSEFINDERS PO BOX 910738 DALLAS TX 75391 NURSING SERVICES 116696 1 PRIVATE AND SSI 623000 12128895 12128895 12128895 7568 7568 MISC. 900099 45793 45793 DISCOUNTS/REBATES 900099 16766 16766 VENDING 900099 7765 7765 70324 12206787 12128895 0 77892 112919 112919 7517040 6579887 937153 1688388 1542827 145561 493727 424605 69122 200792 200792 63784 15221 48563 SUPPLIES 955956 935528 20428 PURCHASED SERVICES 776056 539918 236138 MEDICAL & PROFESSIONAL 179539 76246 103293 BAD DEBT EXPENSE 173483 173483 253619 89093 164526 12415303 10577600 1837703 0 903032 1159880 415092 416339 1373586 1512763 12140 9372 40907 7342 10861499 9010121 1926497 1851378 1523348 1509865 204404 395299 6399006 6862238 1609237 1193668 5880729 7114327 7489966 8307995 X -1117841 -1511971 26881 66214 -1090960 -1445757 6399006 6862238 X -208516 -146281 X 0 1 1 X 0 X 0 0 0 0 0 0 1 6715 0 1 1023 7738 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: ST. FRANCIS HOME OF WILLIAMSVILLE PAYS DUES TO ORGANIZATIONS (NEW YORK ASSOCIATION OF HOMES AND SERVICES FOR THE AGING) THAT UTILIZES A PORTION OF THE DUES PAYMENT FOR LOBBYING ACTIVITIES. IN 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. 6879234 5727395 1151839 3974665 3282726 691939 7600 7600 1851378 ASSETS LIMITED AS TO USE 1509865 F 1509865 DUE FROM AFFILIATES 136283 DUE FROM THIRD PARTY PAYORS 192802 INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 66214 395299 ASSET RETIREMENT OBLIGATION 240731 DUE TO AFFILIATES 2843094 DUE TO THIRD PARTY PAYORS 1605225 LONG TERM PENSION OBLIGATION 2425277 7114327 12206787 12415303 -208516 -146281 -146281 -354797 12199219 0 12199219 7568 7568 12206787 12415303 0 12415303 0 12415303 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. 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 CHRISTINE KLUCKHOHN 0 202356 0 47107 0 32931 0 63114 0 16886 0 362394 0 0 JOYCE MARKIEWICZ 0 168033 0 42752 0 37658 0 13463 0 15929 0 277835 0 0 JAMES MILLARD 0 205604 0 39478 0 38703 0 98184 0 9768 0 391737 0 0 MARK SULLIVAN 0 334900 0 86846 0 32957 0 9990 0 13404 0 478097 0 0 JAMES A DUNLOP JR 0 303923 0 81292 0 32955 0 53504 0 15862 0 487536 0 0 MARIA FOTI 0 155554 0 31835 0 33011 0 12667 0 6323 0 239390 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 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 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 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 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 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 KATHRYN B MILLARD DAUGHTER OF BOD, CEO KENMORE MERCY, JAMES MILLARD 14519 REGISTERED NURSE, MERCY 0 KATHLEEN MOLEY DAUGHTER OF KEY EMPLOYEE, MICHAEL MOLEY 37518 HR EMPLOYEE, CHS 0 SUSAN GALLAGHER-STAVROS WIFE OF KEY EMPLOYEE, JOHN STAVROS 35158 COMMUNITY HEALTH NURSE, MCAULEY SETON HOME CARE 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 CATHOLIC HEALTH SYSTEM ENTITIES. REVIEWED WITH THE AUDIT COMMITTEE: 1. CORE FORM PART IV: CHECKLIST OF REQUIRED SCHEDULES 2. CORE FORM PART VI: GOVERNANCE, MANAGEMENT AND DISCLOSURE 3. CORE FORM PART VII: COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS 4. SCHEDULE H: HOSPITALS 5. SCHEDULE K: SUPLEMENTAL INFORMATION ON TAX EXEMPT BONDS 6. SCHEDULE J: COMPENSATION INFORMATION 7. SCHEDULE L: TRANSACTIONS WITH INTERESTED PERSONS 8. SCHEDULE R: RELATED ORGANIZATIONS AND UNRELATED PARTNERSHIPS 9. PROCESS FOR WHICH REMAINING CORE FORM WAS COMPLETED, UTILIZING AUDITED FINANCIAL INFORMATION FORM 990, PART VI, SECTION B, LINE 12C ALL ASSOCIATES ON THE MERIT PROGRAM; ALL PHYSICIANS AND NON PHYSICIAN PRACTITIONERS, AS WELL AS PHYSICIAN GROUPS, WHO ARE INDEPENDENT CONTRACTORS OR EMPLOYEES OF CHS; AND ALL BOARD MEMBERS MUST COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT (COIDS) IN ORDER TO FULFILL THE ANNUAL REQUIREMENTS. COIDS ARE DISTRIBUTED TO ALL PARTIES, AS PER APPLICABLE POLICY, AND ONCE COMPLETE ARE FOLLOWED UP WITH AS FOLLOWS: 1. ASSOCIATE AND PHYSICIAN COMPLETED COIDS ARE REVIEWED AND SIGNED OFF BY THE MANAGER. IF A DISCLOSURE IS NOTED, IT IS DISCUSSED BY THE MANAGER, THE DOCUMENT IS FORWARD TO THE COMPLIANCE OFFICER WHO REVIEWS AND FOLLOWS UP AS APPROPRIATE. ONCE REVIEW/FOLLOW UP IS COMPLETED THE COMPLIANCE OFFICER WILL SIGN THE COIDS, MAINTAIN A COPY IN THE COMPLIANCE OFFICE AND RETURN THE ORIGINAL TO HR FOR FILING IN THE PERSONNEL FILE. 2. ALL BOARD MEMBER COIDS' ARE RETURNED TO THE COMPLIANCE OFFICER FOR REVIEW AND FOLLOW UP AS WARRANTED. THE COMPLIANCE OFFICER WILL SIGN EACH COIDS AND RETAIN ON FILE IN THE COMPLIANCE OFFICE IN A CONFIDENTIAL MANNER. FORM 990, PART VI, SECTION B, LINE 15 CATHOLIC HEALTH SYSTEM UTILIZED A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS TO MONITOR THE EXECUTIVE COMPENSATION AS PER THE EXECUTIVE COMPENSATION PHILOSOPHY AND STRATEGY FOR THE CHS CEO; COO; CFO; CEO'S FOR EACH MINISTRY; AND ALL SENIOR VICE PRESIDENTS. THE COMPENSATION COMMITTEE PROVIDES OVERSIGHT TO MANAGEMENT DECISIONS WHICH ARE BASED ON OUTLINES APPROVED BY THE COMMITTEE, AND PERFORMS A REVIEW OF DATA. THE OUTCOME OF THESE MEETINGS IS DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 WE MAKE OUR FORM 990 OPEN FOR PUBLIC INSPECTION UPON REQUEST. OUR WEBSITE INCLUDES AN ANNUAL REPORT WHICH INCLUDES SELECTED FINANCIAL INFORMATION. OUR FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE PROVIDED UPON REQUEST ACCORDING TO APPLICABLE FEDERAL AND STATE LAW. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: 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. CATHOLIC HEALTH SYSTEM INC 515 ABBOTT ROAD BUFFALO NY 14220 222565278 HEALTHCARE DELIVERY SYSTEM NY 501(C)(3) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 SISTERS OF CHARITY HOSPITAL 2157 MAIN STREET BUFFALO NY 14214 160743187 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVENUE KENMORE NY 14217 160762843 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 NAZARETH HOME OF THE FRANCISCAN SISTERS 291 NORTH STREET BUFFALO NY 14201 160813142 SKILLED NURSING FACILITY NY 501(C)(3) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 ST CLARE MANOR 543 LOCUST STREET LOCKPORT NY 14094 160782647 SKILLED NURSING FACILITY NY 501(C)(3) 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) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS OF BUFFALOINC 34 BENWOOD AVENUE BUFFALO NY 14214 161523535 SKILLED NURSING FACILITY NY 501(C)(3) 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) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 ST LUKE MANOR FOR THE CHRONICALLY ILL 17 WIARD ST BATAVIA NY 14020 160794811 SKILLED NURSING FACILITY NY 501(C)(3) LINE 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) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501(C)(3) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 WNY CATHOLIC LONG TERM CARE INC 6400 POWERS ROAD ORCHARD PARK NY 14127 161434368 SKILLED NURSING FACILITY NY 501(C)(3) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE) 2875 UNION ROAD CHEEKTOWAGA NY 14227 161317960 HOME CARE PROVIDER NY 501(C)(3) LINE 9 CATHOLIC HEALTH SYSTEM INC 0 MCAULEY SETON HOME CARE 2875 UNION ROAD CHEEKTOWAGA NY 14225 161310062 HOME CARE PROVIDER NY 501(C)(3) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 CHS CONTINUING CARE FOUNDATION 291 NORTH STREET BUFFALO NY 14201 200947831 FOUNDATION NY 501(C)(3) LINE 7 CATHOLIC HEALTH SYSTEM INC 0 OLV RENAISSANCE CORPORATION 291 NORTH STREET BUFFALO NY 14201 200167745 REAL ESTATE HOLDING COMPANY NY 501(C)(3) LINE 1 CATHOLIC HEALTH SYSTEM INC 0 CATHOLIC HEALTH SYSTEM INFUSION PARMACY INC 2875 UNION ROAD SUITE 14 CHEEKTOWAGA NY 142271461 200198518 HOME CARE INFUSION SERVICE NY 501(C)(3) LINE 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) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1