SISTERS OF CHARITY HOSPITAL OF BUFFALO NEW YORK: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SISTERS OF CHARITY HOSPITAL OF BUFFALO NEW YORK (EIN 16-0743187)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201143189349302724
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)
Timestamp2011-11-14T10:28:32-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Catholic Health System IncBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1515 Abbott RoadAddressLine1
CityBuffaloCity
StateNYState
ZIP Code14220ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN160743187EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Sisters of Charity HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSISTNameControl
Phone7168282993Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1515 Abbott Road No 500AddressLine1
CityBuffaloCity
StateNYState
ZIP Code142202039ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDavid P MacholzName
TitleVP Finance/Corp ControllerTitle
Phone7168282993Phone
Date Signed2011-11-14DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone7168282929Phone
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 D McDonaldNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12121 Main StreetAddressLine1
CityBuffaloCity
StateNYState
ZIP Code14214ZIPCode
FieldValueIRS element (for citing)
Gross Receipts299350211GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.chsbuffalo.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1849YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionThe 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees2755TotalNbrEmployees
Total Nbr Volunteers339TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year8998678ContributionsGrantsPriorYear
Contributions Grants Current Year1384359ContributionsGrantsCurrentYear
Program Service Revenue Prior Year256356246ProgramServiceRevenuePriorYear
Program Service Revenue CY291611514ProgramServiceRevenueCY
Investment Income Prior Year373111InvestmentIncomePriorYear
Investment Income Current Year207663InvestmentIncomeCurrentYear
Other Revenue Prior Year5787650OtherRevenuePriorYear
Other Revenue Current Year6146675OtherRevenueCurrentYear
Total Revenue Prior Year271515685TotalRevenuePriorYear
Total Revenue Current Year299350211TotalRevenueCurrentYear
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 Year120893186SalariesEtcPriorYear
Salaries Etc Current Year135842750SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year130870289OtherExpensePriorYear
Other Expenses Current Year153679869OtherExpensesCurrentYear
Total Expenses Prior Year251763475TotalExpensesPriorYear
Total Expenses Current Year289522619TotalExpensesCurrentYear
Revenues Less Expenses Prior Year19752210RevenuesLessExpensesPriorYear
Revenues Less Expenses CY9827592RevenuesLessExpensesCY
Total Assets BOY202241620TotalAssetsBOY
Total Assets EOY215378663TotalAssetsEOY
Total Liabilities BOY128609187TotalLiabilitiesBOY
Total Liabilities EOY138364753TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY73632433NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY77013910NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense142041778Expense
Revenue192135555Revenue
DescriptionInpatient Routine/Surgery Services:79,745 Acute Care Patient Days14,775 Newborn Patient Days28,456 Skilled Nursing Patient Days9,111 I/P Ambulatory SurgeriesDescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense67573283Expense
Revenue91589406Revenue
DescriptionOutpatient Routine/Surgery Services:50,572 ED Visits240,957 Referred Ambulatory Visits21,146 O/P Ambulatory VisitsDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense5892477Expense
Revenue7886554Revenue
Description31,247 Clinic/Primary Care Service visits313,451 Substance VisitsDescription
FieldValueIRS element (for citing)
Total Program Service Expense215507538TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account1EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
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 With1096230NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees2755NumberOfEmployees
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 Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
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 Macholz VP FinanceCorporate ControllerBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7168282974TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1515 Abbott RdAddressLine1
CityBuffaloCity
StateNYState
ZIP Code142202039ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (35 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Joseph McDonald
President and CEO, CHS37.50XX0108869634591
Mark Sullivan
Executive VP/COO37.50XX045470323394
Peter Bergmann
President and CEO, Sister's37.50XX540698022696
David Macholz
Treasuer37.50XX021302624885
Christine Kluckhohn
Pres and CEO, ContinuingCare37.50X028239480000X
James Millard
Director37.50X0283785107952
Charles Urlaub
Director37.50X039046628411
Dr Michael Edbauer
Director25.00X026322628072
Brian Beitz
Director1.00X000
Frances Crosby RN PhD
Director1.00X000
Richard Curran MD
Director1.00X000
Dennis Dombek
Director1.00X000
Mr Williamm Lawley Jr
Director1.00X000
James Manzella
Director1.00X000
Dr Paul Mason
Director1.00X0250000
Michael Montante
Director1.00X000
Dr Carlos Santos
Director1.00X0499130
Cynthia Zane EdD
Director1.00X000
Monsignor Robert E Zapfel
Director1.00X000
Dr David Serra
Director1.00X000
James A Dunlop Jr
Executive VP, Finance/CFO37.50X041817069366
Dr Brian D'Arcy
Senior VP, Medical Affairs37.50X059329536492
Matthew Hamp
COO, Sister's37.50X213718084647
Michael Moley
Sr VP Human Resources37.50038679432632X
John Stavros
Sr VP Marketing/PR37.50023781136530X
Maria Foti
Sr VP Planning37.50022040018990X
Dr Michael Galang
Chief Information Officer37.50032284718981X
Bartholomew Rodrigues
Sr VP, Mission Integration37.50020926126510X
Bruce Rodgers MD
Physician37.503363900998X
Dr Margaret McDonnell
Physician37.50331834029440X
Dr Anthony Pivarunus
Physician37.50274376095219X
Khalid Qazi
Physician37.502328720175750X
Dr Paul Updike
Physician37.50223650023010X
John Davanzo
Former Sr VP Regional Development0.00029131547854X
K David Crone
Former Sr VP Strategic Services0.00028973539608X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2153538TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs6020837TotalReportableCompFrmRltdOrgs
Total Other Compensation1086028TotalOtherCompensation
Number Individuals GT100 K68NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Christa Construction
26 Mississippi Street Suite 200BuffaloNY14203Construction Services2678433
Sodexho Inc & Affiliates
PO Box 81049WoburnMA01813Environmental Services2442849
Quest Diagnostics (Chicago)
2178 Collection Center DriveChicagoIL60693Laboratory Services1205210
Siemens Medical Solutions (CHS)
51 Valley Stream ParkwayMalvernePA19355Maintenance Services1014730
Sodexo Operation LLC
Box 360170PittsburghPA15251Laundry709526
FieldValueIRS element (for citing)
Number Of Contractors GT100 K50NumberOfContractorsGT100K
All Other Contributions1384359AllOtherContributions
Total Contributions1384359TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Medicaid/Medicare900099146972203146972203
Patient Service900099144639311144639311
FieldValueIRS element (for citing)
Total Program Service Revenue291611514TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column156361TotalRevenueColumn
Exclusion$156,361ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real796950Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real796950Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column796950TotalRevenueColumn
Exclusion$796,950ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other51302Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other51302Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column51302TotalRevenueColumn
Exclusion$51,302ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
Shared Service90009931276313127631
Cafeteria9000991095751$1,095,751
Parking900099360392$360,392

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column765951TotalRevenueColumn
Exclusion$765,951ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue5349725TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column299350211TotalRevenueColumn
Related Or Exempt Function Income294739145RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,226,707ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total754416Total
Management And General754416ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total107001928Total
Program Services98440443ProgramServices
Management And General8561485ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total5459290Total
Program Services5043695ProgramServices
Management And General415595ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total15424211Total
Program Services14101223ProgramServices
Management And General1322988ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7202905Total
Program Services6578108ProgramServices
Management And General624797ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total47767Total
Program Services5487ProgramServices
Management And General42280ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8945066Total
Program Services6009295ProgramServices
Management And General2935771ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total38630Total
Program Services29347ProgramServices
Management And General9283ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total62537893Total
Program Services58847507ProgramServices
Management And General3690386ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4665291Total
Program Services1110949ProgramServices
Management And General3554342ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total133030Total
Program Services120385ProgramServices
Management And General12645ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total99792Total
Program Services93900ProgramServices
Management And General5892ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2061861Total
Program Services1688138ProgramServices
Management And General373723ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total9553217Total
Program Services7763155ProgramServices
Management And General1790062ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2446574Total
Program Services2123873ProgramServices
Management And General322701ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
Shared Service3999941339999413
Purchase Services1521008195993025610779
Bad Debt79412547941254

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total289522619Total
Program Services215507538ProgramServices
Management And General74015081ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY18421BOY
EOY11570EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY81825815BOY
EOY84083988EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY116724BOY
EOY142829EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY35116991BOY
EOY38642346EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3091231BOY
EOY3573147EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1648751BOY
EOY1957061EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis133845797LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec68068801LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY58034674BOY
EOY65776996EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY22389013BOY
EOY21190726EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY202241620BOY
EOY215378663EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY41293847BOY
EOY39894626EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY257184BOY
EOY783718EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY33568947BOY
EOY31961031EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3552086BOY
EOY8695475EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY49937123BOY
EOY57029903EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY128609187BOY
EOY138364753EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY70800443BOY
EOY74665905EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2705990BOY
EOY2225482EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY126000BOY
EOY122523EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY73632433BOY
EOY77013910EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY202241620BOY
EOY215378663EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses9827592ReconcilationRevenueExpenses
Reconcilation Other Changes-6446115ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1958968OtherCostOrOtherBasis
Book Value1958968BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis33268059OtherCostOrOtherBasis
Depreciation19274822Depreciation
Book Value13993237BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis26034538OtherCostOrOtherBasis
Depreciation7850528Depreciation
Book Value18184010BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis66638537OtherCostOrOtherBasis
Depreciation40943451Depreciation
Book Value25695086BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5945695OtherCostOrOtherBasis
Book Value5945695BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings65776996TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables1876070
Due from Affiliates10814370
Workers Comp Funding228416
Investments8271870
FieldValueIRS element (for citing)
Total Book Value Other Assets21190726TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
Due to Affiliates$5,534,734
Due to Pension$38,447,232
Asset Retirement Obligation$1,999,526
LT Portion General Liability IBNR$2,649,550
LT Portion Workers Comp IBNR$5,616,095
Interest Rate Swap$2,782,766
FieldValueIRS element (for citing)
Total Of Amounts57029903TotalOfAmounts
Total Revenue299350211TotalRevenue
Total Expenses289522619TotalExpenses
Excess Or Deficit For Year9827592ExcessOrDeficitForYear
Other-$812,783OtherAmount
Total Adjustments-812783TotalAdjustments
Excess Or Deficit Per FS9014809ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt299885475TotRevenueEtcAuditedFinclStmt
Other Revenues1919623OtherRevenues
Revenue Not Rptd F9901919623RevenueNotRptdF990
Revenue Subtotal297965852RevenueSubtotal
Other Revenues Not Included1384359OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1384359RevenueNotRptdOnFinStmt
Total Revenue Per Form990299350211TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt290870667TotExpensesEtcAuditedFinclStmt
Other Expenses Included1348048OtherExpensesIncluded
Expenses Not Rptd F9901348048ExpensesNotRptdF990
Expenses Subtotal289522619ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990289522619TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 8 - Other Adjustments:SOC Foundation Revenue before SOC Foundation Contributions 571,576. Contributions from Sisters Foundation Inc. -1,384,359.
Part XII, Line 2d - Other Adjustments:Sisters Foundation Inc Revenue 1,919,623.
Part XII, Line 4b - Other Adjustments:Contributions from Sisters Hospital Foundations 1,384,359.
Part XIII, Line 2d - Other Adjustments:Foundation Expenses less SOC Foundation Contributions 1,348,048.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage110.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage500.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2610834TotalCommunityBenefitExpense
Direct Offsetting Revenue441860DirectOffsettingRevenue
Net Community Benefit Expense2168974NetCommunityBenefitExpense
Percent Of Total Expense0.00770PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense52704770TotalCommunityBenefitExpense
Direct Offsetting Revenue41569066DirectOffsettingRevenue
Net Community Benefit Expense11135704NetCommunityBenefitExpense
Percent Of Total Expense0.03950PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense55315604TotalCommunityBenefitExpense
Direct Offsetting Revenue42010926DirectOffsettingRevenue
Net Community Benefit Expense13304678NetCommunityBenefitExpense
Percent Of Total Expense0.04720PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense2813551TotalCommunityBenefitExpense
Net Community Benefit Expense2813551NetCommunityBenefitExpense
Percent Of Total Expense0.01000PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense5955130TotalCommunityBenefitExpense
Direct Offsetting Revenue2299162DirectOffsettingRevenue
Net Community Benefit Expense3655968NetCommunityBenefitExpense
Percent Of Total Expense0.01300PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense84816TotalCommunityBenefitExpense
Net Community Benefit Expense84816NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8853497TotalCommunityBenefitExpense
Direct Offsetting Revenue2299162DirectOffsettingRevenue
Net Community Benefit Expense6554335NetCommunityBenefitExpense
Percent Of Total Expense0.02330PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense64169101TotalCommunityBenefitExpense
Direct Offsetting Revenue44310088DirectOffsettingRevenue
Net Community Benefit Expense19859013NetCommunityBenefitExpense
Percent Of Total Expense0.07050PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense335TotalCommunityBuildingExpense
Net Community Building Expense335NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense3380TotalCommunityBuildingExpense
Net Community Building Expense3380NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense847TotalCommunityBuildingExpense
Net Community Building Expense847NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense843TotalCommunityBuildingExpense
Net Community Building Expense843NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense5405TotalCommunityBuildingExpense
Net Community Building Expense5405NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,554,505BadDebtExpenseAmount
Amount Attributable To3630004AmountAttributableTo
Amount Reimbursed By Medicare46540440AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare48354140CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1813700MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalTeaching HospitalTeachingHospitalResearch FacilityResearchFacilityEr24 HoursEr24HoursOtherOther
Sisters of Charity Hospital
12157 Main StreetBuffaloNY14214XXXXXAmbulatory Surgery - Multi Speciality, Audiology O/P, Chemical dependence-
Sisters of Charity Hospital - St Joseph
22605 Harlem RoadCheektowagaNY14225XXXXXAmbulatory Surgery - Multi Speciality, Audiology O/P,

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities13NumberOfOtherFacilities

Other Facilities OtherFacilities (13 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Sisters Family Health Center
2157 Main StBuffaloNY14214Extension Clinic: Primary Medical Care O/P, Radiology- Diagnostic O/P
Harvey Austin School #97
1405 Sycamore StBuffaloNY14211Extension Clinic Immunology, Medical Social Services O/P, Nursing, Veneral D
Pathways Methadone
158 Holden AvenueBuffaloNY14214Extension Clinic: Methadone Maintenance O/P
Rochester Pathways
79 Howell StreetRochesterNY14614Extension Clinic: Methadone Maintenance O/P
St Vincent Health Center
1595 Bailey AveBuffaloNY14211Extension Clinic:Chemical Dependence-Rehabilitation O/P,
Sisters Ambulatory Surgery Center
45 Spindrift DrWilliamsvilleNY14221Extension Clinic: Ambulatory Surgery-Multi Speciality
Sisters Athleticare
100 Corporate PkyAmherstNY14226Extension Clinic: Therapy- Physical O/P
Sisters Hospital Star Program
3730 Sheridan DrAmherstNY14226Extension Clinic: Methadone Maintenance O/P, Chemical Dependence -Rehab
West Hertel Academy
489 Hertel AveBuffaloNY14212Extension Clinic Immunology, Medical Social Services O/P, Nursing, Veneral D
Southside Elementary School #93
430 Southside PkwyBuffaloNY14210Extension Clinic Immunology, Medical Social Services O/P, Nursing, Veneral D
St Catherine Laboure Health Care Center
2157 Main StreetBuffaloNY14214Long Term Care
Clarence-Sheridan Medical Center
8600 Sheridan DrClarenceNY14031Extension Clinic: Therapy- Physical O/P, Primary Medical Care O/P, Radiology
CHS Partners in Rehab
6199 Transit RdDepewNY14043Extension Clinic: Therapy- Physical O/P, Occupational O/P

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 3c: N/A
Part I, Line 6a: The Sisters of Charity Hospital/Sisters of Charity Hospital, St. Joseph Campus 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 $7,941,254 are included in Part IX, line 25, column (A) but subtracted when calculating the percentage in column (f).
Part II: Sisters Hospital provided Community Building in various ways, including Community Support by identifying the need to educate Senior Citizens in regards to Healthcare amenities. Additionally, Sisters Hospital provided Workforce Development by mentoring and educating students regarding healthcare careers throughout the community. The Environmental Improvements were noted in the form of Pharmaceutical Waste Disposal that was provided for the community throughout the year. Coalition Building was provided with community leaders to assess community health needs.
Part III, Line 4: The amount in Part III line 2 is the actual bad debt expenses of $7,941,254 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 Schedule 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: Other:Sisters of Charity Hospital - Rehabilitation O/P Clinical Laboratory Service Clinic Part Time Services Coronary Care CT Scanner Dental O/P Emergency Department Health Fairs O/P Intensive Care Magnetic Resonance Imaging Maternity Medical Social Services Medical/Surgical Neonatal Continuing Care Neonatal Intensive Care Neonatal Intermediate Care Nuclear Medicine - Diagnostic Nuclear Medicine - Therapeutic 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 Psychology O/P Radiology - Diagnostic Renal Dialysis - Acute Therapy - Occupational O/P Therapy - Physical O/P Therapy - Speech Language Pathology Therapy - Vocational Rehabilitation O/P Other- Sisters of Charity- St Joseph Campus Clinic Part Time Services Clinical Laboratory ServicesCoronary Care CT Scanner Emergency Department Intensive Care Magnetic Resonance Imaging Medical Social Services Medical/Surgical Nuclear Medicine - Diagnostic O/P Therapy Pharmaceutical Service Primary Medical Care O/P Radiology - Diagnostic Renal Dialysis - Acute Therapy - Speech Language Pathology
Part VI, Line 2: Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus, 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 Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus 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 Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus 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 Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus surveys its medical staff annually. Physicians are surveyed on issues relating to the quality and efficiency of services offered throughout Catholic Health including at Sisters Hospital. 5. External OrganizationsCatholic Health and Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus 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 Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus 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 Wellness Flu CoalitionEvery Parent Influences Children (EPIC) Tobacco CoalitionWNY Coalition for Diabetes Community Health FoundationErie Co. Coalition for Diabetes WNED Public TelevisionCatholic Charities Niagara University6. Statistical ResourcesCatholic Health and Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus 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: Sisters 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, Sisters 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: Sisters of Charity Hospital including Sisters of Charity Hospital/St. Joseph Campus serves a mixed suburban and urban service area which is comprised of 74.9% white (non-Hispanic) and 17.2% African-American (non-Hispanic) households. The service area is more elderly than most with 18.2% of the population over the age of 65 compared to a national average of 13.2%. The community is also poorer than the national average with 15.8% of the households with annual incomes below $15,000/year compared to a national average of 12.1%.
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 Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus 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 Sisters 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: Sisters of Charity Hospital/Sisters of Charity Hospital St. Joseph Campus 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, Mercy Hospital of Buffalo, Father Baker Manor, St. Elizabeth's Home of Lancaster, St. Francis of Buffalo, St. Francis Home of Williamsville, St. Vincent's Home for the Aged, and Our Lady of Victory Senior Neighborhood.
NYReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
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 (23 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
Mark Sullivan
033490008684603295709990013404047809700
Peter Bergmann
3358550167393037450060550166410563394000
David Macholz
016421902358602522107091017794023791100
Christine Kluckhohn
0202356047107032931063114016886036239400
James Millard
020560403947803870309818409768039173700
Charles Urlaub
0277509040866072091013640014771041887700
Dr Michael Edbauer
018909204275003138408397019675029129800
James A Dunlop Jr
0303923081292032955053504015862048753600
Dr Brian D'Arcy
02447150276792071788020231016261062978700
Matthew Hamp
1431930227630477620696340150130298365000
Michael Moley
0249731058450078613018611014021041942600
John Stavros
0158915039533039363017862018668027434100
Maria Foti
015555403183503301101266706323023939000
Dr Michael Galang
025667403532703084601405404927034182800
Bartholomew Rodrigues
0136513034256038492010610015900023577100
Bruce Rodgers MD
3358840005060009980337388000
Dr Margaret McDonnell
3314200004140142510151890361274000
Dr Anthony Pivarunus
258012000163640795670156520369595000
Khalid Qazi
2111960002167601603750153750408622000
Dr Paul Updike
21879000048600100580129520246660000
John Davanzo
0155588058579077148036050011804033916900
K David Crone
024390600045829029157010451032934300

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aPart I, Line 1a: Officers received a tax inedminification and gross-up payment for reimbursement of withholding taxes in conjunction with certain taxable benefits paid on behalf of the employee.
Part I, Lines 4a-bPart 1, Line 4a: Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Sisters 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 6Part 1, Line 6a: 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. Sister's 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, MD $57,000 Christine Kluckhohn $47,107 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 David Macholz $23,586 Matthew Hamp $22,763

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
Dormitory Authority of the State of New York
14600029364983Q5S42006-11-2930295000Part V000
Dormitory Authority of the State of New York
14600029364983Q5U92006-11-298435000Part V000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
3029500011209111792862899480219941011
843500034158149919804350020050011

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateBusiness Name Line2NameOfHedgeProvider/BusinessNameLine2
HSBC Bank NA
01118.50000000000010000
JP Morgan Chase
01118.50000000000010000NA

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
IdentifierSchedule K Supplental InformationIdentifier
ExplanationPart I A (f) Description of Purpose: To refund Sisters of Charity of Buffalo Insured Revenue Bonds, Series 2003, which were bonds issued for the purpose of refunding a series of bonds issued in 1991, the proceeds of which were applied to finance the construction and renovation of the Sisters of Charity facilities and to refinance outstanding indebtedness. Part I B (f) Description of Purpose: To finance the cost of the St. Joseph Campus emergency room expansion project.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (9 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Karen Hamp
Wife of COO, Matt Hamp35662RN0
Susan Urlaub
Wife of CEO, C.J. Urlaub74933Corporate Nurse Educator0
Kathryn B Millard
Daughter of BOD, CEO Kenmore Mercy, James Millard14519Registered Nurse, Mercy0
James Manzella
Acute Care Board Member165088Key Employee of Manzella Marketing0
David Zapfel
Brother of BOD, Msgr. Robert Zapfel60600HR Employee of CHS0
Kathleen Zapfel
Sister-in-law of BOD, Msgr. Robert Zapfel53088HR Employee, St. Francis0
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
Marie Packard
Daughter of BOD, Dennis Dombek42975Physical Therapist0

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 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
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 12c
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 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 laws.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Pension Liability Adjustment -5,547,050. Equity Transfer to Affiliates -43,610. Change in unrestricted interest in Sisters Foundation Inc. 112,806. Interest Rate Swap Adjustment -483,948. Change in temporarily restricted interest in Sisters Foundation Inc. -480,509. Change in permanently restricted interest in Sisters Foundation Inc. -3,477. Rounding Adjustment -327. Total to Form 990, Part XI, Line 5: -6,446,115.Form 990, Part XI, line 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (18 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Catholic Health System Inc
515 Abbott RoadBuffaloNY14220222565278Health Care Delivery SystemNY501c3Schedule A Line 1N/A0
Mercy Hospital of Buffalo
565 Abbott RoadBuffaloNY14220160756336Acute Care HospitalNY501c3Schedule A Line 30Catholic Health System Inc
Kenmore Mercy Hospital
2950 Elmwood AvenueKenmoreNY14217160762843Acute Care HospitalNY501c3Schedule A Line 30Catholic Health System Inc
Nazareth Home of the Franciscan Sisters
291 North StreetBuffaloNY14201160813142Skilled Nursing FacilityNY501c3Schedule A Line 10Catholic Health System Inc
St Clare Manor
543 Locust StreetLockportNY14094160782647Skilled Nursing FacilityNY501c3Schedule A Line 10Catholic Health System Inc
St Elizabeth Home for the Aged
5539 BroadwayLancasterNY14086160743154Adult HomeNY501c3Schedule A Line 10Catholic Health System Inc
St Francis Home of Williamsville
147 Reist StreetWilliamsvilleNY14221160743153Skilled Nursing FacilityNY501c3Schedule A Line 10Catholic Health System Inc
St Francis of Buffalo Inc
34 Benwood AvenueBuffaloNY14214161523535Skilled Nursing FacilityNY501c3Schedule A Line 10Catholic Health System Inc
St Joseph Manor
2211 West State StreetOleanNY14760160796400Skilled Nursing FacilityNY501c3Schedule A Line 90Catholic Health System Inc
St Luke Manor for the Chronically Ill
17 Wiard StreetBataviaNY14020160794811Skilled Nursing FacilityNY501c3Schedule A Line 10Catholic Health System Inc
St Mary's Manor
515 6th StreetNiagara FallsNY14301160924139Skilled Nursing FacilityNY501c3Schedule A Line 10Catholic Health System Inc
St Vincent Manor
319 Washington AvenueDunkirkNY14048160743167Adult HomeNY501c3Schedule A Line 10Catholic Health System Inc
WNY Catholic Long Term Care Inc
6400 Powers RoadOrchard ParkNY14127161434368Skilled Nursing FacilityNY501c3Schedule A Line 10Catholic Health System Inc
Niagara Homemaker Services (Mercy Home Care)
Union Road Suite 14CheektowagaNY14227161317960Home Care ProviderNY501c3Schedule A Line 10Catholic Health System Inc
McAuley Seton Home Care
Union Road Suite 14CheektowagaNY14227161310062Home Care ProviderNY501c3Schedule A Line 10Catholic Health System Inc
Catholic Health System Infusion Pharmacy Inc
2875 Union Road Suite 14CheektowagaNY14227200198518Home Care Infusion ServicesNY501c3Schedule A Line 10Catholic Health System Inc
CHS Program of All-Inclusive Care for the Elderly Inc
55 Melroy AvenueLackawannaNY14218261252884All-inclusive Care for the ElderlyNY501c3Schedule A Line 30Catholic Health System Inc
Sisters Hospital Foundation
2130 Main StreetBuffaloNY14214222283077FoundationNY501c3Schedule A Line 70Sisters of Charity Hospital

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Caritas Medical Arts Building LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1350 Essjay Road Suite 101AddressLine1
CityWilliamsvilleCity
StateNYState
ZIP Code14221ZIPCode
FieldValueIRS element (for citing)
EIN161521486EIN
Primary ActivityRental Real EstatePrimaryActivity
Legal Domicile StateNYLegalDomicileState
Predominant Income TyperelatedPredominantIncomeType
Share Of Total Income27176ShareOfTotalIncome
Share Of EOY Assets65024ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
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 Orgs1RentalOfFacilitiesToOtherOrgs
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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