2011-11-14T10:28:32-06:00 2010-12-31 Catholic Health System Inc 515 Abbott Road Buffalo NY 14220 990 2010-01-01 160743187 Sisters of Charity Hospital SIST 7168282993 515 Abbott Road No 500 Buffalo NY 142202039 David P Macholz 7168282993 2011-11-14 7168282929 2010 2016-03-07 17:11:31Z Joseph D McDonald 2121 Main Street Buffalo NY 14214 299350211 0 X www.chsbuffalo.org X 1849 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in an acute care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2010 Community Service Plan can be found at www.chsbuffalo.org. 20 6 2755 339 0 0 8998678 1384359 256356246 291611514 373111 207663 5787650 6146675 271515685 299350211 0 0 0 0 120893186 135842750 0 0 0 130870289 153679869 251763475 289522619 19752210 9827592 202241620 215378663 128609187 138364753 73632433 77013910 X The Catholic Health System (CHS) Mission is to provide quality healthcare services in an acute care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2010 Community Service Plan can be found at www.chsbuffalo.org. 0 0 142041778 192135555 Inpatient Routine/Surgery Services:79,745 Acute Care Patient Days14,775 Newborn Patient Days28,456 Skilled Nursing Patient Days9,111 I/P Ambulatory Surgeries 67573283 91589406 Outpatient Routine/Surgery Services:50,572 ED Visits240,957 Referred Ambulatory Visits21,146 O/P Ambulatory Visits 5892477 7886554 31,247 Clinic/Primary Care Service visits313,451 Substance Visits 215507538 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 1 230 0 2755 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 20 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X David Macholz VP FinanceCorporate Controller 7168282974 515 Abbott Rd Buffalo NY 142202039 Joseph McDonald 37.50 X X 0 1088696 34591 Mark Sullivan 37.50 X X 0 454703 23394 Peter Bergmann 37.50 X X 540698 0 22696 David Macholz 37.50 X X 0 213026 24885 Christine Kluckhohn 37.50 X X 0 282394 80000 James Millard 37.50 X 0 283785 107952 Charles Urlaub 37.50 X 0 390466 28411 Dr Michael Edbauer 25.00 X 0 263226 28072 Brian Beitz 1.00 X 0 0 0 Frances Crosby RN PhD 1.00 X 0 0 0 Richard Curran MD 1.00 X 0 0 0 Dennis Dombek 1.00 X 0 0 0 Mr Williamm Lawley Jr 1.00 X 0 0 0 James Manzella 1.00 X 0 0 0 Dr Paul Mason 1.00 X 0 25000 0 Michael Montante 1.00 X 0 0 0 Dr Carlos Santos 1.00 X 0 49913 0 Cynthia Zane EdD 1.00 X 0 0 0 Monsignor Robert E Zapfel 1.00 X 0 0 0 Dr David Serra 1.00 X 0 0 0 James A Dunlop Jr 37.50 X 0 418170 69366 Dr Brian D'Arcy 37.50 X 0 593295 36492 Matthew Hamp 37.50 X 213718 0 84647 Michael Moley 37.50 X 0 386794 32632 John Stavros 37.50 X 0 237811 36530 Maria Foti 37.50 X 0 220400 18990 Dr Michael Galang 37.50 X 0 322847 18981 Bartholomew Rodrigues 37.50 X 0 209261 26510 Bruce Rodgers MD 37.50 X 336390 0 998 Dr Margaret McDonnell 37.50 X 331834 0 29440 Dr Anthony Pivarunus 37.50 X 274376 0 95219 Khalid Qazi 37.50 X 232872 0 175750 Dr Paul Updike 37.50 X 223650 0 23010 John Davanzo 0.00 X 0 291315 47854 K David Crone 0.00 X 0 289735 39608 2153538 6020837 1086028 68 1 1 0 Christa Construction 26 Mississippi Street Suite 200 Buffalo NY 14203 Construction Services 2678433 Sodexho Inc & Affiliates PO Box 81049 Woburn MA 01813 Environmental Services 2442849 Quest Diagnostics (Chicago) 2178 Collection Center Drive Chicago IL 60693 Laboratory Services 1205210 Siemens Medical Solutions (CHS) 51 Valley Stream Parkway Malverne PA 19355 Maintenance Services 1014730 Sodexo Operation LLC Box 360170 Pittsburgh PA 15251 Laundry 709526 50 1384359 1384359 Medicaid/Medicare 900099 146972203 146972203 Patient Service 900099 144639311 144639311 291611514 156361 156361 796950 796950 796950 796950 51302 51302 51302 51302 Shared Service 900099 3127631 3127631 Cafeteria 900099 1095751 1095751 Parking 900099 360392 360392 765951 765951 5349725 299350211 294739145 0 3226707 754416 754416 107001928 98440443 8561485 5459290 5043695 415595 15424211 14101223 1322988 7202905 6578108 624797 47767 5487 42280 8945066 6009295 2935771 38630 29347 9283 62537893 58847507 3690386 4665291 1110949 3554342 133030 120385 12645 99792 93900 5892 2061861 1688138 373723 9553217 7763155 1790062 2446574 2123873 322701 Shared Service 39999413 39999413 Purchase Services 15210081 5610779 9599302 Bad Debt 7941254 7941254 289522619 215507538 74015081 0 18421 11570 81825815 84083988 116724 142829 35116991 38642346 3091231 3573147 1648751 1957061 133845797 68068801 58034674 65776996 22389013 21190726 202241620 215378663 41293847 39894626 257184 783718 33568947 31961031 3552086 8695475 49937123 57029903 128609187 138364753 X 70800443 74665905 2705990 2225482 126000 122523 73632433 77013910 202241620 215378663 X 9827592 -6446115 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1958968 1958968 33268059 19274822 13993237 26034538 7850528 18184010 66638537 40943451 25695086 5945695 5945695 65776996 Other Receivables 1876070 Due from Affiliates 10814370 Workers Comp Funding 228416 Investments 8271870 21190726 Due to Affiliates 5534734 Due to Pension 38447232 Asset Retirement Obligation 1999526 LT Portion General Liability IBNR 2649550 LT Portion Workers Comp IBNR 5616095 Interest Rate Swap 2782766 57029903 299350211 289522619 9827592 -812783 -812783 9014809 299885475 1919623 1919623 297965852 1384359 1384359 299350211 290870667 1348048 1348048 289522619 0 289522619 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. 1 1 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2610834 441860 2168974 0.00770 52704770 41569066 11135704 0.03950 55315604 42010926 13304678 0.04720 2813551 2813551 0.01000 5955130 2299162 3655968 0.01300 84816 84816 0.00030 8853497 2299162 6554335 0.02330 64169101 44310088 19859013 0.07050 335 335 0.00000 3380 3380 0.00000 847 847 0.00000 843 843 0.00000 5405 5405 1 3554505 3630004 46540440 48354140 -1813700 X 1 0 2 1 Sisters of Charity Hospital

2157 Main Street Buffalo NY 14214

X X X X X Ambulatory Surgery - Multi Speciality, Audiology O/P, Chemical dependence- 2 Sisters of Charity Hospital - St Joseph

2605 Harlem Road Cheektowaga NY 14225

X X X X X Ambulatory Surgery - Multi Speciality, Audiology O/P, NA 1 13 Sisters Family Health Center

2157 Main St Buffalo NY 14214

Extension Clinic: Primary Medical Care O/P, Radiology- Diagnostic O/P Harvey Austin School #97

1405 Sycamore St Buffalo NY 14211

Extension Clinic Immunology, Medical Social Services O/P, Nursing, Veneral D Pathways Methadone

158 Holden Avenue Buffalo NY 14214

Extension Clinic: Methadone Maintenance O/P Rochester Pathways

79 Howell Street Rochester NY 14614

Extension Clinic: Methadone Maintenance O/P St Vincent Health Center

1595 Bailey Ave Buffalo NY 14211

Extension Clinic:Chemical Dependence-Rehabilitation O/P, Sisters Ambulatory Surgery Center

45 Spindrift Dr Williamsville NY 14221

Extension Clinic: Ambulatory Surgery-Multi Speciality Sisters Athleticare

100 Corporate Pky Amherst NY 14226

Extension Clinic: Therapy- Physical O/P Sisters Hospital Star Program

3730 Sheridan Dr Amherst NY 14226

Extension Clinic: Methadone Maintenance O/P, Chemical Dependence -Rehab West Hertel Academy

489 Hertel Ave Buffalo NY 14212

Extension Clinic Immunology, Medical Social Services O/P, Nursing, Veneral D Southside Elementary School #93

430 Southside Pkwy Buffalo NY 14210

Extension Clinic Immunology, Medical Social Services O/P, Nursing, Veneral D St Catherine Laboure Health Care Center

2157 Main Street Buffalo NY 14214

Long Term Care Clarence-Sheridan Medical Center

8600 Sheridan Dr Clarence NY 14031

Extension Clinic: Therapy- Physical O/P, Primary Medical Care O/P, Radiology CHS Partners in Rehab

6199 Transit Rd Depew NY 14043

Extension Clinic: Therapy- Physical O/P, Occupational O/P 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. Reports Filed With States Part VI, Line 7 NY X 1 1 X X X X X X 1 1 0 0 0 1 1 0 0 Joseph McDonald 0 582249 0 214448 0 291999 0 19255 0 15336 0 1123287 0 0 Mark Sullivan 0 334900 0 86846 0 32957 0 9990 0 13404 0 478097 0 0 Peter Bergmann 335855 0 167393 0 37450 0 6055 0 16641 0 563394 0 0 0 David Macholz 0 164219 0 23586 0 25221 0 7091 0 17794 0 237911 0 0 Christine Kluckhohn 0 202356 0 47107 0 32931 0 63114 0 16886 0 362394 0 0 James Millard 0 205604 0 39478 0 38703 0 98184 0 9768 0 391737 0 0 Charles Urlaub 0 277509 0 40866 0 72091 0 13640 0 14771 0 418877 0 0 Dr Michael Edbauer 0 189092 0 42750 0 31384 0 8397 0 19675 0 291298 0 0 James A Dunlop Jr 0 303923 0 81292 0 32955 0 53504 0 15862 0 487536 0 0 Dr Brian D'Arcy 0 244715 0 276792 0 71788 0 20231 0 16261 0 629787 0 0 Matthew Hamp 143193 0 22763 0 47762 0 69634 0 15013 0 298365 0 0 0 Michael Moley 0 249731 0 58450 0 78613 0 18611 0 14021 0 419426 0 0 John Stavros 0 158915 0 39533 0 39363 0 17862 0 18668 0 274341 0 0 Maria Foti 0 155554 0 31835 0 33011 0 12667 0 6323 0 239390 0 0 Dr Michael Galang 0 256674 0 35327 0 30846 0 14054 0 4927 0 341828 0 0 Bartholomew Rodrigues 0 136513 0 34256 0 38492 0 10610 0 15900 0 235771 0 0 Bruce Rodgers MD 335884 0 0 0 506 0 0 0 998 0 337388 0 0 0 Dr Margaret McDonnell 331420 0 0 0 414 0 14251 0 15189 0 361274 0 0 0 Dr Anthony Pivarunus 258012 0 0 0 16364 0 79567 0 15652 0 369595 0 0 0 Khalid Qazi 211196 0 0 0 21676 0 160375 0 15375 0 408622 0 0 0 Dr Paul Updike 218790 0 0 0 4860 0 10058 0 12952 0 246660 0 0 0 John Davanzo 0 155588 0 58579 0 77148 0 36050 0 11804 0 339169 0 0 K David Crone 0 243906 0 0 0 45829 0 29157 0 10451 0 329343 0 0 Part I, Line 1a Part 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-b Part 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 6 Part 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 Dormitory Authority of the State of New York 146000293 64983Q5S4 2006-11-29 30295000 Part V 0 0 0 Dormitory Authority of the State of New York 146000293 64983Q5U9 2006-11-29 8435000 Part V 0 0 0 30295000 1120911 179286 28994802 1994 1 0 1 1 8435000 341581 49919 8043500 2005 0 0 1 1 0 0 0 0 1 0 1 1 HSBC Bank NA 18.500000000000 1 0 0 0 0 0 1 1 JP Morgan Chase NA 18.500000000000 1 0 0 0 0 Schedule K Supplental Information Part 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. Karen Hamp Wife of COO, Matt Hamp 35662 RN 0 Susan Urlaub Wife of CEO, C.J. Urlaub 74933 Corporate Nurse Educator 0 Kathryn B Millard Daughter of BOD, CEO Kenmore Mercy, James Millard 14519 Registered Nurse, Mercy 0 James Manzella Acute Care Board Member 165088 Key Employee of Manzella Marketing 0 David Zapfel Brother of BOD, Msgr. Robert Zapfel 60600 HR Employee of CHS 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 53088 HR Employee, St. Francis 0 Kathleen Moley Daughter of Key Employee, Michael Moley 37518 HR Employee, CHS 0 Susan Gallagher-Stavros Wife of Key Employee, John Stavros 35158 Community Health Nurse, McAuley Seton Home Care 0 Marie Packard Daughter of BOD, Dennis Dombek 42975 Physical Therapist 0 Form 990, Part VI, Section A, line 6 CHS has three members: Ascension Health, Catholic Health East, and the Diocese of Buffalo, NY. Each member is able to participate equally in electing the governing body, approving significant decisions of the governing body, and in receiving a share of net assets upon dissolution, according to the CHS Bylaws. Form 990, Part VI, Section A, line 7a According to the CHS Bylaws, each member is equally allowed to appoint up to three individuals to act as its representatives on the Corporate Member Board, and in undertaking any action in its capacity as a Member. The Corporate Member Board oversees the governance of the Catholic Health System. Form 990, Part VI, Section A, line 7b Each member is entitled to one vote on each matter properly submitted at any membership meeting, and the members also have reserve powers which allow approval for certain business events and ratification of certain business transactions. Form 990, Part VI, Section B, line 11 Yes, an electronic copy of the Form 990 was provided to the CHS Boards of Directors before it was filed. The CHS Board of Directors has delegated the responsibility to review the 990 to the Audit Committee. The CHS Audit Committee reviewed in detail selected information for all CHS entities. Reviewed with the Audit Committee: 1.Core Form Part IV: Checklist of required schedules 2.Core Form Part VI: Governance, Management and Disclosure 3.Core Form Part VII: Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees and Independent Contractors 4.Schedule H: Hospitals 5.Schedule K: Supplemental information on Tax Exempt Bonds 6.Schedule J: Compensation Information 7.Schedule L: Transactions with Interested Persons 8.Schedule R: Related Organizations and Unrelated Partnerships 9.Process for which remaining Core Form was completed, utilizing audited financial information Form 990, Part VI, Section B, line 12c All associates on the Merit program, all Physicians and Non Physician Practitioners as well as Physician groups who are independent contractors or employees of CHS, and all board members must complete a Conflict of Interest Disclosure Statement (COIDS) in order to fulfill the annual requirements. COIDS are distributed to all parties, as per applicable policy, and once complete are followed up with as follows: 1. Associate and Physician completed COIDS are reviewed and signed off by the manager. If a disclosure is noted, it is discussed with the manager, and the document is forwarded to the Compliance Officer who reviews and follows up as appropriate. Once review/follow up is completed the Compliance Officer will sign the COIDS, maintain a copy in the compliance office and return the original to HR for filing in the Personnel file. 2. All board member COIDS are returned to Compliance Officer for review and follow up as warranted. The Compliance Officer will sign each COIDS and retain on file in the compliance office in a confidential manner. Form 990, Part VI, Section B, line 15 In 2010, the Catholic Health System utilized a Compensation Committee of the Board of Directors to monitor the Executive Compensation as per the Executive Compensation Philosophy and Strategy for the CHS CEO; COO; CFO; CEOs for each Ministry; and all Senior Vice Presidents. The Compensation Committee provides oversight to management decisions which are based on outlines approved by the committee, and performs a review of data. The outcome of these meetings is documented. Form 990, Part VI, Section C, line 19 We make our form 990 open for public inspection upon request. Our website includes an annual report which includes selected financial information. Our financial statements, governing documents and conflict of interest policy are provided upon request according to applicable federal and state laws. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: 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. Catholic Health System Inc 515 Abbott Road Buffalo NY 14220 222565278 Health Care Delivery System NY 501c3 Schedule A Line 1 N/A 0 Mercy Hospital of Buffalo 565 Abbott Road Buffalo NY 14220 160756336 Acute Care Hospital NY 501c3 Schedule A Line 3 Catholic Health System Inc 0 Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore NY 14217 160762843 Acute Care Hospital NY 501c3 Schedule A Line 3 Catholic Health System Inc 0 Nazareth Home of the Franciscan Sisters 291 North Street Buffalo NY 14201 160813142 Skilled Nursing Facility NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 St Clare Manor 543 Locust Street Lockport NY 14094 160782647 Skilled Nursing Facility NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 St Elizabeth Home for the Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 St Francis Home of Williamsville 147 Reist Street Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 St Francis of Buffalo Inc 34 Benwood Avenue Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 St Joseph Manor 2211 West State Street Olean NY 14760 160796400 Skilled Nursing Facility NY 501c3 Schedule A Line 9 Catholic Health System Inc 0 St Luke Manor for the Chronically Ill 17 Wiard Street Batavia NY 14020 160794811 Skilled Nursing Facility NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 St Mary's Manor 515 6th Street Niagara Falls NY 14301 160924139 Skilled Nursing Facility NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501c3 Schedule A 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 501c3 Schedule A Line 1 Catholic Health System Inc 0 Niagara Homemaker Services (Mercy Home Care) Union Road Suite 14 Cheektowaga NY 14227 161317960 Home Care Provider NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 McAuley Seton Home Care Union Road Suite 14 Cheektowaga NY 14227 161310062 Home Care Provider NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 Catholic Health System Infusion Pharmacy Inc 2875 Union Road Suite 14 Cheektowaga NY 14227 200198518 Home Care Infusion Services NY 501c3 Schedule A Line 1 Catholic Health System Inc 0 CHS Program of All-Inclusive Care for the Elderly Inc 55 Melroy Avenue Lackawanna NY 14218 261252884 All-inclusive Care for the Elderly NY 501c3 Schedule A Line 3 Catholic Health System Inc 0 Sisters Hospital Foundation 2130 Main Street Buffalo NY 14214 222283077 Foundation NY 501c3 Schedule A Line 7 Sisters of Charity Hospital 0 Caritas Medical Arts Building LLC 350 Essjay Road Suite 101 Williamsville NY 14221 161521486 Rental Real Estate NY related 27176 65024 0 0 0 1 1 1 0 0 0 0 1 0 1 1 1 1 1 1 1 1