2022-11-10T13:18:02-06:00 2021-12-31 990 2021-01-01 200198518 Catholic Health System Infusion Pharmacy Inc CATH 7168282974 144 Genesee Street Buffalo NY 14203 Russell Edwards VP Finance Corp Controller CHS 7169232968 2022-11-10 Russell Edwards 999009999 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MARK SULLIVAN 144 GENESEE STREET BUFFALO NY 14203 12998085 0 X www.chsbuffalo.org X 2003 NY The Mission of Catholic Health System Infusion Phamacy, as part of the Catholic Health System (CHS) in Western New York, is to provide quality healthcare services in a home care setting. Committed to a common mission, the providers of Catholic Health System Infusion Pharmacy 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 2021 Community Service Plan can be found at https://www.chsbuffalo.org/about-us/community 10 6 57 0 58008 0 227149 8881 12483032 12928665 2786 2531 35150 58008 12748117 12998085 0 0 0 0 3928719 3931294 0 0 0 8017118 8903764 11945837 12835058 802280 163027 8707877 9374931 2398598 2874487 6309279 6500444 X The Mission of Catholic Health System Infusion Phamacy, as part of the Catholic Health System (CHS) in Western New York, is to provide quality healthcare services in a home care setting. Committed to a common mission, the providers of Catholic Health System Infusion Pharmacy 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 2021 Community Service Plan can be found at https://www.chsbuffalo.org/about-us/community 0 0 10446078 12928665 Catholic Health system Infusion Pharmacy provides home health infusion care and supportive services to individuals throughout Western New York as well as pharmaceutical needs to Catholic Health System long term care facilities. Committed to a common mission, Western New York's Catholic Health providers continue the healing mission of Jesus. Seeking to improve the health of individuals and communities, we provide high quality service that is holistic, compassionate, and respectful of human dignity. Central to this endeavor is the service of persons who are poor and disadvantaged. For more detailed information, the 2021 Catholic Health Community Service report can be found at www.chsbuffalo.org. 10446078 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 5 0 1 57 1 1 1 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NY X X Russell Edwards 7169232968 144 Genesee Street Buffalo NY 14203 Mark Sullivan President and CEO 1.00 55.00 X X 0 1315130 27754 Walter Ludwig Director 1.00 55.00 X 0 339490 42817 Russell Edwards VP of Finance, Treasurer 1.00 55.00 X 0 215535 10780 Charles Urlaub Director 1.00 55.00 X 0 445075 35118 Eddie Bratko Director 1.00 55.00 X 0 357232 27726 Aaron Chang President and CEO, SOC 1.00 55.00 X 0 316845 23181 Thomas Gleason President and CEO, HCBC 1.00 55.00 X X 0 248977 29021 Carol Heckman Esq Director-Chair 0.00 8.00 X 0 0 0 Georgiana Ford Esq Director 0.00 4.00 X 0 0 0 Katherine Vanderhorst Director 0.00 4.00 X 0 0 0 Kevin Keenan Director 0.00 4.00 X 0 0 0 Monsignor Robert E Zapfel Director - Vice Chair 0.00 4.00 X 0 0 0 Ellen Grant Director 0.00 4.00 X 0 0 0 Alexis Agnello Director 0.00 4.00 X 0 0 0 Joyce Markiewicz Chief Business Development 1.00 55.00 X 0 517618 42634 David Macholz Chief Financial Officer 1.00 55.00 X 0 627451 27750 Dr Michael Galang Senior VP, Chief Informati 1.00 55.00 X 0 464201 35823 Dr Hans Cassagnol Executive VP, Chief Physic 1.00 55.00 X 0 584150 34969 William Pryor Executive VP, Chief Admin 1.00 55.00 X 0 639960 44029 Bartholomew Rodrigues Chief Mission Officer 1.00 55.00 X 0 256537 44813 James Garvey Executive VP, Chief Operat 1.00 55.00 X 0 704286 21499 Rebecca McCormick Boyle Chief Integration Officer 1.00 55.00 X 0 268232 18271 Leonardo Sette-Camara General Cousel-Secretary 1.00 55.00 X 0 297399 28558 Lisa Cilano Senior VP, RMC & Business 1.00 55.00 X 0 346982 27653 Martin Boryszak Senior VP, Acute Care 1.00 55.00 X 0 526071 26656 Edward Dybala Pharmacy Supervisor 55.00 X 152329 0 12818 Randall Smith Pharmacist 55.00 X 142572 0 32195 Josephine Rothenberger Pharmacist 55.00 X 149638 0 20952 Gregory Blette Pharmacist 55.00 X 130853 0 23413 Suzanne Eberle Pharmacist 55.00 X 127414 0 11754 Gary Tucker Director-Former 0.00 X 0 303349 21207 James A Dunlop Jr Executive VP, CFO-Former 0.00 X 0 514418 11088 Maria Foti Senior VP, Strategic Plan-Former 0.00 X 0 181530 2680 702806 9470468 685159 10 1 1 0 Peyton Barlow Co Inc 360 Delaware Avenue 300 Buffalo NY 14202 Construction Services 185913 1 8881 8881 Home Care Infusion Services 621610 5698971 5698971 Oral Pharmacy Services 621610 4735287 4735287 Specialty Pharmacy Services 900099 1785218 1785218 Retail Pharmacy Services 900099 709189 709189 12928665 2531 2531 Gift Shop Revenue 900099 62461 62461 CHS Shared Revenue 900099 6523 6523 Net Periodic Pension Cost 900099 -10976 -10976 58008 12998085 12928665 58008 2531 3174679 2063541 1111138 111167 72259 38908 434573 282472 152101 210875 137069 73806 399918 399918 7973509 7563054 410455 210267 210267 57301 52113 5188 5151 5151 70156 62577 7579 4070 4070 Outside Services 153889 153889 Dues and Subscriptions 16538 16538 12965 2726 10239 12835058 10446078 2388980 0 2810122 2951877 2263178 2364819 1080345 1488363 13674 30854 1289346 471726 658163 817620 140000 140000 1742395 1581398 8707877 9374931 1236924 1823723 1161674 1050764 2398598 2874487 X 0 0 0 0 6309279 6500444 6309279 6500444 8707877 9374931 X 163027 28138 X 0 1 X 1 0 X 227149 8881 236030 11461362 13054936 12629669 12542229 12991126 62679322 11461362 13054936 12629669 12769378 13000007 62915352 0 0 0 62915352 10826 11953 -11358 -21261 -1922 -11762 10826 11953 -11358 -21261 -1922 -11762 11472188 13066889 12618311 12748117 12998085 62903590 1.00000 0.99990 0.00000 0.00010 X 1289346 471726 817620 817620 Prof Liab Recovery 9225 WC LT Recovery 7393 Joint Venture 559180 ROU Asset-Operating Leases 1005600 1581398 Professional Liab LT IBNR 26928 Workers Comp LT IBNR 147538 LT Portion of Operating Lease 876298 1050764 X X X X X 1 0 0 0 0 0 0 0 0 Mark Sullivan President and CEO 0 915379 0 0 0 399751 0 11411 0 16343 0 1342884 0 0 James Garvey Executive VP, Chief Operat 0 663436 0 0 0 40850 0 5420 0 16079 0 725785 0 0 William Pryor Executive VP, Chief Admin 0 599073 0 0 0 40887 0 21859 0 22170 0 683989 0 0 David Macholz Chief Financial Officer 0 553317 0 56924 0 17210 0 5625 0 22125 0 655201 0 0 Dr Hans Cassagnol Executive VP, Chief Physic 0 547407 0 0 0 36743 0 12829 0 22140 0 619119 0 0 Joyce Markiewicz Chief Business Development 0 497725 0 0 0 19893 0 26730 0 15904 0 560252 0 0 Martin Boryszak Senior VP, Acute Care 0 461498 0 47777 0 16796 0 4619 0 22037 0 552727 0 0 James A Dunlop Jr Executive VP, CFO-Former 0 0 0 0 0 514418 0 0 0 11088 0 525506 0 131637 Dr Michael Galang Senior VP, Chief Informati 0 444759 0 0 0 19442 0 27679 0 8144 0 500024 0 0 Charles Urlaub Director 0 403558 0 0 0 41517 0 26994 0 8124 0 480193 0 0 Eddie Bratko Director 0 289066 0 32054 0 36112 0 5835 0 21891 0 384958 0 0 Walter Ludwig Director 0 320993 0 0 0 18497 0 24945 0 17872 0 382307 0 0 Lisa Cilano Senior VP, RMC & Business 0 307680 0 22282 0 17020 0 12615 0 15038 0 374635 0 0 Aaron Chang President and CEO, SOC 0 297277 0 3000 0 16568 0 1300 0 21881 0 340026 0 0 Leonardo Sette-Camara General Cousel-Secretary 0 297097 0 0 0 302 0 6680 0 21878 0 325957 0 0 Gary Tucker Director-Former 0 0 0 0 0 303349 0 1508 0 19699 0 324556 0 0 Bartholomew Rodrigues Chief Mission Officer 0 219185 0 0 0 37352 0 22987 0 21826 0 301350 0 0 Rebecca McCormick Boyle Chief Integration Officer 0 257916 0 25 0 10291 0 18012 0 259 0 286503 0 0 Thomas Gleason President and CEO, HCBC 0 232303 0 25 0 16649 0 7202 0 21819 0 277998 0 0 Russell Edwards VP of Finance, Treasurer 0 195854 0 0 0 19681 0 2853 0 7927 0 226315 0 0 Maria Foti Senior VP, Strategic Plan-Former 0 6726 0 0 0 174804 0 2680 0 0 0 184210 0 0 Randall Smith Pharmacist 141207 0 0 0 1365 0 10471 0 21724 0 174767 0 0 0 Josephine Rothenberger Pharmacist 149493 0 25 0 120 0 5399 0 15553 0 170590 0 0 0 Edward Dybala Pharmacy Supervisor 151489 0 25 0 815 0 12664 0 154 0 165147 0 0 0 Gregory Blette Pharmacist 130771 0 0 0 82 0 1692 0 21721 0 154266 0 0 0 Part I, Line 4a Severance Payments/Change of Control Payments were made to: James Dunlop: $317,972 Maria Foti: $173,696 Gary Tucker: $300,351 Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 100025 Clinical Document Specialist, SCH,SJC 0 Scott Markiewicz Son of Key Employee, Joyce Markiewicz 50476 Supervisor, Father Baker Manor 0 Julie Sullivan Daughter of Chief Executive Officer 92458 HR employee, CHS 0 Carrie Sette-Camara Wife of Key Employee, Leonardo Sette-Camara 87782 Public Relations Manager, Sisters 0 David A Macholz Nephew of Chief Finance Officer, David Macholz 66768 Network Technical Analyst, CHS 0 Form 990, Part VI, Section A, line 6 CHS has two members: Trinity Health, 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 one representative and one alternative representative to serve on the Corporate Member Council and to serve as a voting director on the Catholic Health System Board of Directors. Form 990, Part VI, Section A, line 7b Yes, the corporate members do have reserve powers. Form 990, Part VI, Section B, line 11b 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 that file a 990. 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 officers, directors, and key employees 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 CHS, in determining the compensation for the CEO, utilizes a process of review and approval, governed by the Board of Directors that includes an outside nationally recognized independent compensation consultant experienced in compensation and benefit matters for non-profit healthcare organizations, and comparability data. In 2021, the Catholic Health System utilized a Compensation Committee of the corporation Directors to monitor the Executive Compensation as per the Executive Compensation Philosophy and Strategy for the CHS CEO and top Senior Executives. 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. Form 990, Part XI, line 9: Minimum Pension Liability Adjustment 25,041. Lawson Suspense Accounts 3,097. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501 c 3 Schedule A line 10 0 Trinity Medical WNY PC 2625 Harlem Road Cheektowaga NY 14225 272576645 Primary Care Provider NY 501 c 3 Schedule A line 12 Catholic Health System Inc 0 CHS Program of All-Inclusive Care for the Elderly 55 Melroy Avenue Lackawanna NY 14218 261252884 All Inclusive Care for the Elderly NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 OLV Renaissance Corporation 144 Genesee Street Buffalo NY 14203 200167745 Real Estate Holding Company NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 CHS Continuing Care Foundation 144 Genesee Street Buffalo NY 14203 200947831 Foundation NY 501 c 3 Schedule A line 7 Catholic Health System Inc 0 McAuley Seton Home Care 144 Genesee Street Buffalo NY 14203 161310062 Home Care Provider NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 Niagara Homemaker Services (Mercy Home Care) 144 Genesee Street Buffalo NY 14203 161317960 Home Care Provider NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 WNY Catholic Long Term Care Inc 6400 Powers Road Orchard Park NY 14127 161434368 Skilled Nursing Facility NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 St Vincent Manor 319 Washington Street Dunkirk NY 14048 160743167 Adult Home NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 St Francis Home of Buffalo 34 Benwood Avenue Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 St Francis Home of Williamsville 147 Reist Street Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 St Elizabeth Home for the Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 Nazareth Home of the Fransican Sisters 291 North Street Buffalo NY 14201 160813142 Skilled Nursing Facility NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore NY 14217 160762843 Acute Care Hospital NY 501 c 3 schedule A line 3 Catholic Health System Inc 0 Sisters of Charity Hospital 2157 Main Street Buffalo NY 14214 160743187 Acute Care Hospital NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 Mercy Hospital of Buffalo 565 Abbott Road Buffalo NY 14220 160756336 Acute Care Hospital NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 KMH Homes Inc 144 Genesee Street Buffalo NY 14203 161387890 Real Estate Holding Company NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 Mount St Marys Hospital of Niagara Falls 5300 Military Road Lewiston NY 14092 161523353 Acute Care Hospital NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1