2020-11-12T12:23:02-06:00 2019-12-31 990 2019-01-01 160756336 Mercy Hospital of Buffalo MERC 7169232968 144 Genesee Street Buffalo NY 14203 Russell Edwards VP Finance/Corp. Controller 7169232968 2020-11-12 204.68.186.4 2020-11-12 12:22:57 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7CF2C1CBAA923E6EF855025F349B24B4BA0F3383 2019 2021-01-29 14:40:06Z Mark Sullivan 144 Genesee Street Administration 6th Floor Buffalo NY 14203 428911803 0 X www.chsbuffalo.org X 1957 NY The Mission of Mercy Hospital, as part of the Catholic Health System (CHS) in Western New York, is to provide quality healthcare services in an acute care setting. Committed to a common mission, the providers of Mercy Hospital 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 2019 Community Service Plan can be found at https://www.chsbuffalo.org/about-us/community 9 6 2951 118 0 0 997921 1143832 437493649 421438317 -390916 5576577 -2116851 753077 435983803 428911803 0 0 0 0 200514590 200210713 0 0 0 226990048 242811008 427504638 443021721 8479165 -14109918 319662967 361081997 340510275 414442047 -20847308 -53360050 X The Mission of Mercy Hospital, as part of the Catholic Health System (CHS) in Western New York, is to provide quality healthcare services in an acute care setting. Committed to a common mission, the providers of Mercy Hospital 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 2019 Community Service Plan can be found at https://www.chsbuffalo.org/about-us/community 0 0 251843307 282977368 Inpatient Routine/Surgery Visits: Acute Care Patient Days = 78,287Newborn Patient Days = 6,273Medical Rehab Patient Days = 5,655Skilled Nursing Patient Days = 30,253IP Surgeries = 7,929 115832119 130151833 Outpatient Routine/Surgery Services:Emergency Visits (Net of Admits) = 61,346Referred Ambulatory Visits = 138,270Operating Room = 5,290G.I. Laboratory = 1,159MAPU = 1,290Interventional Radiology = 1,594Cardiac (EP & Catheterizations) = 2,863Transfusion/Infusion = 511 7394921 8309116 Clinic/Primary Care Services:Primary Care Visits = 45,8201 375070347 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 170 0 1 2951 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Russell Edwards VP FinanceCorp Controller CHS 7169232968 144 Genesee Street Buffalo NY 14203 Mark Sullivan President and CEO 0.00 55.00 X X 0 1290346 128283 Walter Ludwig Director 0.00 55.00 X 0 323082 59062 David Macholz Treasurer 0.00 55.00 X X 0 289804 43017 Martin Boryszak Director 0.00 55.00 X 0 474752 74809 Charles Urlaub Director 0.00 55.00 X 0 468646 55182 Eddie Bratko President & CEO MHB 55.00 0.00 X X 250307 0 32661 Brian Beitz Director 0.00 8.00 X 0 0 0 Georgiana Ford Esq Director 0.00 4.00 X 0 0 0 John Davanzo Director 0.00 4.00 X 0 0 0 Katherine Vanderhorst Director 0.00 4.00 X 0 0 0 Lynn Catalano 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 0.00 4.00 X 0 0 0 Dr Donald J Largo Jr Director 0.00 55.00 X 0 131891 8511 James A Dunlop Jr Executive VP, CFO 0.00 55.00 X 0 800257 271627 Dr Brian D'Arcy Senior VP, Medical Affairs 0.00 55.00 X 0 395000 63209 Joyce Markiewicz Chief Business Development 0.00 55.00 X 0 590271 89432 Dr Michael Galang Senior VP, Chief Information Officer 0.00 55.00 X 0 447062 75803 Nancy Sheehan Senior VP, Legal Services 0.00 55.00 X 0 406637 40172 Hans Cassagnol Executive VP, Chief Physician 0.00 55.00 X 0 484111 74534 William Pryor Executive VP, Chief Admin Officer 0.00 55.00 X 0 527804 80173 Bartholomew Rodrigues Chief Mission Officer 0.00 55.00 X 0 242396 38945 Dr Timothy Gabryel VP Medical Affairs 55.00 0.00 X 436710 0 46110 Dr Stephen Downing Physician 55.00 0.00 X 973821 0 35935 Dr Harsh Jain Physician 55.00 0.00 X 673420 0 34877 Dr Mark Jajkowski Physician 55.00 0.00 X 550039 0 33575 Dr Alexandros Karavas Physician 55.00 0.00 X 484149 0 1228 Dr William Coplin Physician 55.00 0.00 X 452810 0 33963 Joseph McDonald President & CEO - Former 0.00 0.00 X 0 1154669 36171 Maria Foti Senior VP, Strategic Planning - Former 0.00 0.00 X 0 391767 30626 Michael Moley Senior VP, Human Resources - Former 0.00 0.00 X 0 702651 37617 James Millard Director - Former 0.00 0.00 X 0 12155 -131033 Gary Tucker Director-Former 0.00 0.00 X 0 308648 40829 3821256 9441949 1335318 235 1 1 0 Buffalo Medical Group 325 Essjay Rd Williamsville NY 14221 Physician Services 6310232 Quackenbush Co Inc 495 Kennedy Rd Buffalo NY 14227 Construction Services 2241792 Telco Construction Inc 500 Buffalo Rd East Aurora NY 14052 Construction Services 2193498 Ronco Specialized Systems Inc 84 Grand Island Blvd Tonawanda NY 14150 Technology Services 2041882 Comphealth 35 Nutfmeg Dr 360 Trumbill CT 06611 Healthcare Services 1824940 54 1143832 1143832 Patient Care Services 900099 299652567 299652567 Medicaid/Medicare 900099 121785750 121785750 421438317 5576577 4988035 588542 284283 0 284283 284283 284283 Shared Service Revenue 900099 1178747 1178747 Cafeteria Revenue 900099 1010436 1010436 Net Periodic Pension C 900099 -5089650 -4265000 -824650 3369261 3231790 137471 468794 428911803 426856172 0 911799 158589314 141461052 17128262 7421858 6620269 801589 23106543 20610947 2495596 11092998 9894911 1198087 23423 23423 30900 30900 17736844 17339682 397162 37367 1611 35756 11694707 3816117 7878590 257388 10175 247213 6917821 5188366 1729455 31356 16447 14909 115966 110750 5216 6656087 5462963 1193124 13830309 11351184 2479125 4949097 4324843 624254 Medical Supplies 86212728 86902179 -689451 Dues & Shared Services 69443144 49999064 19444080 Purchased Services & Ot 21238267 8901599 12336668 Other Supplies-Non Medi 3635604 3058188 577416 443021721 375070347 67951374 0 54993191 46573298 19577385 48431425 44896505 45272466 11784637 10964424 1968165 411568 245067444 137144122 104063260 107923322 30842457 22643800 417144 391303 51120223 78470391 319662967 361081997 48438259 50594341 37811199 82210709 20555189 6866647 233705628 274770350 340510275 414442047 X -22351508 -54917512 1504200 1557462 -20847308 -53360050 319662967 361081997 X -14109918 -18402824 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 30900 30900 0 Part II-B, Line 1: Lobbying expenses of $30,900 represent the total of dues paid to national and state associations that is specifically allocable to lobbying. Mercy Hospital does not participate in or intervene in (including the publishing or distributing of statement) any political campaign on behalf of (or opposition to) any candidate. 1409723 1409723 74419380 41098907 33320473 56913868 20133467 36780401 98854320 75593038 23261282 13470153 318710 13151443 107923322 Ascension Investment Management 22643800 F 22643800 Accrued Receivables 1226721 Due from Affiliates 1099520 Interest in the Net Assets of Mercy Hospital Foundation Inc 3030310 Insurance Recoveries 48176184 Short Term Workers Compensation Recovery 181740 Operating Lease Right of Use Assets 24755916 78470391 Debt Issuance Costs -1201236 Deferred Comp Liability 7370 Due to Affiliates 20067343 LT Disposables 237289 Asset Retirement Obligation 6484525 Accrued Pension Obligation 153567307 LT Gen Liab/Workers Comp IBNR 70844737 Current Portion of Operating Lease Liabilities 4556834 Long Term Portion of Operating Lease Liabilities 20206181 274770350 429225871 1409915 1409915 427815956 1095847 1095847 428911803 443971381 949660 949660 443021721 0 443021721 Part XI, Line 2d - Other Adjustments: Foundation Revenue, Net of Eliminations - 1,409,915 Part XI, Line 4b - Other Adjustments: Contributions from Mercy Foundation to Mercy Hospital - 935,402 Contributions from NYS DOH to Mercy Hospital - 160,445 Part XII, Line 2d - Other Adjustments: Foundation Expenses (net of eliminations) - 949,660 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 3175142 139375 3035767 0.00680 68691605 49978045 18713560 0.04220 0 0 0.00000 71866747 50117420 21749327 0.04900 1666012 0 1666012 0.00380 14374219 1442177 12932042 0.02910 16237146 14625848 1611298 0.00360 737455 0 737455 0.00170 814638 0 814638 0.00180 33829470 16068025 17761445 0.04000 105696217 66185445 39510772 0.08900 0 0 12964 12964 0.00000 89986 89986 0.00020 0 0 0 0 0 102950 102950 0.00020 0 69996561 71552936 -1556375 X 1 1 2 1 Mercy Hospital of Buffalo 565 Abbott Rd Buffalo NY 14220 www.chsbuffalo.org X X X X Ambulance, Ambulatory Surgery - Multi Specialty, 2 Mercy Ambulatory Care Center 3669 Southwestern Blvd Orchard Park NY 14127 www.chsbuffalo.org X X X X Clinical Laboratory Service, Emergency Department, Mercy Hospital of Buffalo 0 0 1 X X X X X X X X X 19 1 1 1 1 X See Part V, line 7a Page 8 X 1 19 1 See Part V, line 10a Page 8 0 1 X 200.000000000000 500.000000000000 X X X X 1 1 X X X X 1 X https://www.chsbuffalo.org/billing-insurance/financial-assistance X https://www.chsbuffalo.org/sites/default/files/files/billing/catholic-healt X https://www.chsbuffalo.org/sites/default/files/files/billing/catholic-healt X X X X X X X 1 X 0 X 1 X 0 0 Part V, Section A: Mercy Hospital:Audiology O/P Cardiac Catheterization (Adult Diagnostic)Cardiac Catheterization - Electrophysiology (EP)Cardiac Catheterization - Percutaneous Coronary Intervention (PCI)Cardiac Surgery - Adult Certified Mental Health Services O/P Clinic Part Time ServicesClinical Laboratory ServicesCoronary CareDental O/PEmergency DepartmentIntensive CareLevel II Perinatal CareMaternityMedical Service - Other Medical SpecialtiesMedical Services - Primary CareMedical Social Services Medical/Surgical Neonatal Continuing, Intensive & Intermediate Care Nuclear Medicine - Diagnostic Pediatric Physical Medical Rehabilitation Podiatry O/PRadiology - Diagnostic Renal Dialysis - Acute Respiratory CareStroke Center Therapy - Occupational, Physical O/P Therapy - Speech Language PathologyMercy Ambulatory Care Center:Medical Services - Other Medical SpecialtiesMedical Services - Primary CareMedical SurgicalRadiology DiagnosticTherapy - Physical O/P Part V, Section B Facility Reporting Group A Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 5: Mercy Hospital, as part of Catholic Health utilized a variety of sources to develop the health needs assessment to ensure the inclusion of persons who represent the broad interest of the community and have special expertise in, or knowledge of, public health issues and concerns: * Disseminating and promoting the completion of a fifty-seven question survey developed by the Erie County Department of Health to the community at large including Catholic Health's own staff. * Two focus groups including representation from a broad range of health care and social service organizations in Erie County * Western New York Community Health Needs Assessment (December 2014) jointly sponsored by the two Performing Provider Systems in the region linked the Delivery System Reform Incentive Program (DSRIP). * 50 patient interviews (verbal survey) targeting individuals utilizing services at Catholic Health clinics operating within federally designated Health Professional Shortage Areas (HPSA)Focus group participants: Catholic Charities Brylin Hospitals Erie County DOH P2 Collaborative of WNY City of Buffalo community Physician representation Erie County Department of Health Community Meeting Participants Catholic Health American Cancer Society Cazenovia Recovery Systems Friends of Night People Buffalo Fire Department Northwest Community Center Mid Erie Counseling and Treatment Center American Heart Association Meals on Wheels Evergreen Services Pride Center of Western New York United WayFor more information about our CHNA, go to https://www.chsbuffalo.org/mission/social-responsibility-community-benefit Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 6a: Mercy Hospital was conducted with Mercy Ambulatory Care Center. Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 6b: Mercy Hospital was conducted with Sisters Hospital, Kenmore Mercy Hospital and Mount St. Mary's Hospital as well as the Erie County Department of Health. Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 11: Through the needs assessment, numerous areas were identified as important and clearly impact the health of the community. Catholic Health identified the "significant" needs as the New York State Department of Health Prevention Agenda priorities. Within the "priorities", Catholic Health will address numerous health needs as described in the publicly available CHNA report. One priority area was prioritized lower and not addressed in the implementation plan: Promote a Healthy and Safe Environment. Contributing to this lower priority was lack of available funds and potential for less impact upon the community. Although, should opportunity arise, with resources available to effectively address this need, Catholic Health will reconsider for incorporation in the future.Other needs were identified as part of the Community Health Needs Assessments conducted by Erie County Department of Health, the local DSRIP PPS organizations, and Catholic Health. However, a number of those needs were not incorporated into CH's individual 2019-2021 Community Health Implementation Plans for each of its acute care operations for one or more of the following reasons: Was not deemed as impactful on the overall health of the community as compare to other identified need Is being targeted or addressed by other entities within the community Requires resources that CH does not currently have available without compromising otherimportant initiatives. But, should community circumstances change or additional resources become available, CH will consider incorporating other initiatives into its plan.Among those additional needs not addressed in the 2019-2021 CHIP are: Need for greater integration of primary care and behavioral health services (being addressed by local PPS organizations via NYS DSRIP *) Need to address childhood obesity through improved nutrition especially in urban "fooddeserts and increased exercise programming for children Continued need to improve access to smoking cessation programs (Roswell Park Cancer Institute leading efforts of local PPS organizations as part of the NYS DSRIP program) Need to improve educational services to parents in urban areas with regard to asthmamanagement and dangers of lead poisoning Slowing the rate of HIV infection especially within minority communities (NYS Prepprogram with local support from Evergreen)The 2016 Erie County Community Health Needs Assessment began by first re-evaluating theneeds prioritized in the previous cycle (2013) and the impact of the projects corresponding tothose needs that were selected for implementation. Catholic Health's understanding of thecommunities it serves was then updated by soliciting new input from the public and severalcommunity organizations as outlined in the Process and Methods section of this report. Thisassessment represents a collaborative effort across Catholic Health's facilities as well as withexternal organizations to identify the health needs of the community and to develop a strategyfor addressing them. The systematic process used helped identify significant health needsacross Catholic Health's Erie County service area including vulnerable and under-representedpopulations. Part V, line 7a page 8: https://www.chsbuffalo.org/mission/social-responsibility-community-benefitPart V, line 10a page 8: https://www.chsbuffalo.org/mission/social-responsibility-community-benefit Group A-Facility 2 -- Mercy Ambulatory Care Center Part V, Section B, line 16j: Includes information in both English and Spanish on all signage and brochures for financial assistance. 7 1 - East Aurora Medical Center 94 Olean Street East Aurora NY 14052 Extension Clinic, Clinical Laboratory Service O/P, Radiology - Diagnostic O/ 2 - Mercy Outpatient Clinic ObGyn 515 Abbott Road Buffalo NY 14220 Extension Clinic, Medical Services - Primary Care 3 - Mercy Comprehensive Care Center 397 Louisiana Street Buffalo NY 14202 Extension Clinic, Clinical Laboratory Service O/P, Medical Services - Other 4 - OLV Family Care Center 227 Ridge Road Lackawanna NY 14218 Extension Clinic, Medical Services - Primary Care, Podiatry - O/P 5 - Mercy Nursing Facility 55 Melroy Avenue Lackawanna NY 14218 Long Term Care, Clinical Laboratory Service O/P, Radiology - Diagnostic O/P 6 - Mercy Ambulatory Care Center 550 Orchard Park Road West Seneca NY 14224 Extension Clinic, CT Scanner, Clinical Laboratory Service O/P, Primary Medic 7 - Springville Primary Care Center 27 Franklin Street Springville NY 14141 Extension Clinic, Medical Services - Primary Care Part I, Line 6a: Mercy Hospital's Community Benefit Report is contained in the annual 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 II, Community Building Activities: Community Building Activities for Mercy Hospital included Community support of $12,964, and Environmental improvements of $89,986. Part III, Line 2: The Hospital did not report bad debt on their financial statements, as they adopted ASU 2014-09 Revenue from Contracts with Customers in 2019. Upon adoption, the majority of what was previously classified as provision for bad debts and presented as a reduction to net patient service revenue on the statement of operations and changes in net assets is treated as an implicit price concession that reduces the transacton price, which is reported as net patient service revenue. Part III, Line 3: The Hospital did not report bad debt on their financial statements, as they adopted ASU 2014-09 Revenue from Contracts with Customers in 2019. Upon adoption, the majority of what was previously classified as provision for bad debts and presented as a reduction to net patient service revenue on the statement of operations and changes in net assets is treated as an implicit price concession that reduces the transacton price, which is reported as net patient service revenue. Part III, Line 4: The Hospital does not have a footnote that describes bad debt in the financial statements. Part III, Line 8: Mercy Hospital does not treat Medicare shortfall as a community benefit, as serving Medicare patients is not a differentiating feature of tax-exempt healthcare organizations. The existing community benefit framework allows community benefit programs that serve the Medicare population to be counted in other community benefit categories. Part III, Line 9b: The hospital's collection policies contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance. The hospital has implemented billing and collection practices for patient payment obligations that are fair, consistent, and compliant with state and federal regulations and no extraordinary collection practices are followed. Part VI, Line 2: In addition to its CHNA, Mercy Hospital as part of Catholic Health utilizes multiple methods to assess the health care needs of the communities it serves, including:* Evaluations administered by Mercy Hospital in coordination with the Catholic Health Community Education Department after each class, workshop, or program it sponsors seeking input on other programs or topics of interest participants would like to see. Based on this feedback, program planners meet with leadership to develop programs or workshops that match community interest/need;* Input from physician community during doctor to doctor education programs. Based on this feedback, program planners meet with leadership to develop physician continuing education programs that address gaps in care or other pressing community health needs. * Patient, resident and caregiver satisfaction surveys conducted in our hospitals, health centers, and nursing homes and among our home care patients, help alert us to health care needs among our patient population;* Physician and leadership participation in community boards, coalitions and forums to define the health needs of patient populations and seek community solutions; * Surveys conducted among high risk, high need Medicaid populations through our collaborative Health Home Program help alert us to the needs of individuals with developmental disabilities and behavioral health issues; * Participation in NYS Delivery System Reform Incentive Program (DSRIP) with Community Partners of WNY initiatives that look at transforming the care of the Medicaid population; * Information management obtains from administrative data and payer mix to assist in evaluating the health needs and trends of the community; and* Input from Catholic Health Board including Board Committee (e.g. Mission Integration Committee). Part VI, Line 3: Catholic Health's Mercy Hospital inform and educate patients and persons who may be billed for medical services about their eligibility for assistance under federal, state, or local government programs or our own Healthcare Assistance Program (HAP) in a variety of ways. For example, Mercy Hospital, like our other Catholic Health facilities, has posters and brochures available, which include eligibility and contact information for the Patient Financial Services Team. This information is available in admissions areas, emergency rooms, primary care and outpatient rehabilitation centers, the Administrative and Regional Training Center (ARTC) and other areas throughout Catholic Health where eligible patients and family members are likely to be present. This information is also on the website https://www.chsbuffalo.org/billing-insurance/financial-assistance and includes general information, our policy and application and is translated in Spanish and Arabic. In addition, information on financial assistance is included on our website.Mercy Hospital also provides information about financial assistance and Healthcare Assistance program (HAP) contact information to patients as part of the intake process and during or within 90 days of their discharge from the hospital via patient statements or outreach. To further assist patients, all patient bills include the following language: "If you need financial assistance: Catholic Health offers a healthcare assistance program to help those in need. For more details please visit www.chsbuffalo.org/financial assistance, or call our Patient Financial Services Team at (716) 601-3600". For free, confidential assistance in applying for financial assistance, patients can also call our Patient Financial Services team at 716-601-3600. A counselor will work with them to see if they qualify for free or low-cost insurance or other financial assistance. For patients who do not have insurance and need care at a Catholic Health hospital, a registration clerk can put the patient in touch with one of our Certified Application Counselors. Interpreting services are also available for patients who do not speak English. We offer case management services, and our Certified Application Counselors who discuss with patients the availability of various government benefits, such as Medicaid or other state and federal programs, and assist patients and families with eligibility and applications when necessary. Part VI, Line 4: Catholic Health is a not-for-profit integrated healthcare delivery system that operates four acute care operations in Erie County and one in Niagara County. For all intents and purposes, the primary service area for Catholic Health's Erie County based acute care operations is Erie County. In fact, Erie County residents account for 79% of all inpatient volume.Mercy Hospital is located in Erie County, which consists of a mix of urban, suburban and rural populations, with about one-third of the population residing in the City of Buffalo. Buffalo is New York State's second largest city, surrounded by a ring of older suburbs. Beyond the first ring suburbs are newer suburban communities and established rural communities. The current population of Erie County is over nine hundred thousand.Erie County is less racially and ethnically diverse than New York State or the rest of the country, and the Non-White populations are concentrated in and immediately around the City of Buffalo. All of the 11 zip codes in Erie County that have a Non-White population of 50% or more are in Buffalo. Part VI, Line 5: One of the fundamental reasons for the creation of Catholic Health was to ensure the continued viability of faith-based health care to meet the needs of residents in Erie County and the surrounding communities. The Mission statement of Mercy Hospital, as part of Catholic Health - We are called to reveal the healing love of Jesus to those in need - further articulates why we exist. Integral to this effort is caring for the needs of those who are poor and disadvantaged. The services provided by Mercy Hospital are in response to identified community needs, and reflect the Hospitals's emphasis on caring for the underserved. The Hospital collaborates with other charitable organizations and social service agencies (i.e. Catholic Charities, Spectrum Human Services, Evergreen Health Services, Erie County Department of Health, etc.), to maximize its ability to provide needed services to the residents of our region.The governing Board of Directors of Mercy Hospital is comprised of community representatives from universities, legal communities, and business leaders. Religious orders are represented, as well as active and retired medical staff members. The Mercy Hospital medical staff is considered an "open" medical staff, as any physician can apply for privileges. Each application is reviewed by a vigorous credentialing verification process. The hospitals have robust health professional education programs. Mercy Hospital and Sisters Hospital are physician teaching facilities. All sites participate in teaching programs for other allied health professionals. Our six emergency departments are open to all people regardless of their ability to pay. Our primary care centers are strategically located in areas deemed economically disadvantaged or where other medical services are lacking. Each year, Mercy Hospital, as part of Catholic Health, touches tens of thousands of area residents through its community health education programs, health screenings, clinical and support services, and community service activities. Most of these program are free to encourage participation by people from all walks of life. Catholic Health will continue to meet community needs by providing charity care to the uninsured and underinsured, traditional Medicaid services, and community benefit programs, including collaborative community health improvement initiatives, health professional education programs, volunteering and community service activities, and cash and in-kind contributions to community organizations that serve the poor and disadvantaged. In 2019, the Catholic Health System provided more than $135 million in charity care and community benefit activities to help make our community a healthier place, especially for the poor and underserved. These activities included: - Spearheading Project Homeless Connect An outreach initiative to link homeless individuals and families with medical and other support services; - Supporting charitable and educational organizations, like the Global Health Ministry, United Way, Harvest House, St. Luke's Mission of Mercy, The CRIB Maternity Group Home in Niagara Falls, MY (part of Family & Children Services of Niagara), Care and Share Food Pantry, and the Project Connect Niagara that help the poor and vulnerable in our community; - Hosting numerous health education and screening programs to help people learn their health risks and take steps to improve their health; - Offering a Healthcare Assistance Program to ensure that people without insurance or financial means get the care they need; - Providing health and wellness information in places of worship through our Faith Community Nursing program; - Helping refugees access quality medical care through our Primary Care and School Based Health Centers, including the Mercy Comprehensive Care Center in Buffalo's Old First Ward; - Providing free care and services to those in need, like our "Cribs for Kids" program, which helps families provide a safe sleeping environment for their newborns; - Supporting children and families in need through our Reach Out and Read Program; Backpack Program for Kids; and Bridget Closet (clothes for the needy); - Sponsoring programs at the Mercy Comprehensive Care Center, which serve the local community, including refugees from Burma, Somalia, the Middle East, and Nepal ; - Providing services through our Social Work Department, which link patients with necessary services including: ESL (English as a Second Language), job opportunities, substance abuse treatment, health care navigators, senior services, insurance information, parenting assistance and more; and - Supporting nationally recognized "green" initiatives to remain good stewards of our natural resources and protect the environment.Additional initiatives that the hospital participates in as part of CHS provide benefit to the community including: Advanced Directive / MOLST education, Community Health Fairs , Footprints on the Heart(perinatal bereavement) , McGowan Grant for Health Care Tabling Events , Marian Building & Springville, OB/GYN Clinics, Medicaid Enrollment Assistance, Neonatal Abstinence Syndrome Program in Mercy, NICU Cuddler Program, Open Access Scheduling, Osteoporosis Screening, Prenatal-perinatal Network of WNY, Quest Fit Testing, Refugee Programs, Transitional contact to Catholic Charities from Primary Care Sites, and Transportation Assistance.One of the ways Catholic Health is working to improve the health of our community is by supporting local non-profit organizations whose work has a direct impact on our region's most vulnerable citizens. For the fourth consecutive year, Catholic Health has allocated a portion of its net income to award Community Benefit Grants to area groups who share a similar mission serving the poor and disadvantaged in their communities. This year, eight local organizations will receive funding for various projects. The awards, ranging from $2,500 to $10,000, total $76,000. The following are the recipients of the 2019-2020 Catholic Health Community Benefit Grants include: -Buffalo City Mission New Building: A One-Stop-Shop for food, shelter, primary care medical clinic, $10,000 -Little Portion Friary Homeless Shelter: Healthcare for the Homeless, $10,000 -Kenmore United Methodist Church and Pre-school: Better Nutrition through Education and Fresh Foods, $2,500 -Response to Love Center: Wholistic Approach to Healthy Living, $10,000 -Save the Michaels of the World (STM): STM Access to Treatment and Aftercare, $10,000 -Mercy Comprehensive Care Center: Mercy Hospital Stroke Support Group, $10,000 -Canopy of Neighbors: New pathways to aging well in Buffalo, $10,000 -Community Missions, Inc.: Improving Food Access through Client Choice & Supports, $10,000 -Red Thread Theatre Inc.: A Conversation with OxyContin, $3,500/- Part VI, Line 7, Reports Filed With States NY X X X X X 1 0 0 0 0 0 0 0 0 Mark Sullivan President and CEO 0 827922 0 164916 0 297508 0 107674 0 20609 0 1418629 0 164916 Walter Ludwig Director 0 304682 0 25 0 18375 0 38947 0 20115 0 382144 0 0 David Macholz Treasurer 0 256628 0 24246 0 8930 0 22973 0 20044 0 332821 0 0 Martin Boryszak Director 0 458042 0 0 0 16710 0 54599 0 20210 0 549561 0 0 Charles Urlaub Director 0 430147 0 0 0 38499 0 47619 0 7563 0 523828 0 0 Eddie Bratko President & CEO MHB 240929 0 0 0 9378 0 12611 0 20050 0 282968 0 0 0 James A Dunlop Jr Executive VP, CFO 0 567533 0 145869 0 86855 0 251209 0 20418 0 1071884 0 130869 Dr Brian D'Arcy Senior VP, Medical Affairs 0 339535 0 0 0 55465 0 43900 0 19309 0 458209 0 0 Joyce Markiewicz Chief Business Development 0 454100 0 116632 0 19539 0 74805 0 14627 0 679703 0 101632 Dr Michael Galang Senior VP, Chief Information Officer 0 428800 0 0 0 18262 0 68264 0 7539 0 522865 0 0 Nancy Sheehan Senior VP, Legal Services 0 387581 0 25 0 19031 0 25616 0 14556 0 446809 0 0 Hans Cassagnol Executive VP, Chief Physician 0 430783 0 10000 0 43328 0 58850 0 15684 0 558645 0 0 William Pryor Executive VP, Chief Admin Officer 0 491200 0 12500 0 24104 0 62125 0 18048 0 607977 0 0 Bartholomew Rodrigues Chief Mission Officer 0 206167 0 0 0 36229 0 18917 0 20028 0 281341 0 0 Dr Timothy Gabryel VP Medical Affairs 412688 0 0 0 24022 0 38572 0 7538 0 482820 0 0 0 Dr Stephen Downing Physician 821915 0 130025 0 21881 0 21568 0 14367 0 1009756 0 0 0 Dr Harsh Jain Physician 666591 0 25 0 6804 0 14473 0 20404 0 708297 0 0 0 Dr Mark Jajkowski Physician 530128 0 0 0 19911 0 13197 0 20378 0 583614 0 0 0 Dr Alexandros Karavas Physician 483494 0 0 0 655 0 0 0 1228 0 485377 0 0 0 Dr William Coplin Physician 452000 0 25 0 785 0 20246 0 13717 0 486773 0 0 0 Joseph McDonald President & CEO - Former 0 0 0 129246 0 1025423 0 21214 0 14957 0 1190840 0 129246 Maria Foti Senior VP, Strategic Planning - Form 0 236046 0 69116 0 86605 0 23723 0 6903 0 422393 0 69091 Michael Moley Senior VP, Human Resources - Former 0 27219 0 87505 0 587927 0 22590 0 15027 0 740268 0 87505 James Millard Director - Former 0 0 0 0 0 12155 0 -131600 0 567 0 -118878 0 0 Gary Tucker Director-Former 0 221250 0 0 0 87398 0 19996 0 20833 0 349477 0 0 Part I, Line 4a Severance Payments/Change of Control Payments were made to: Joseph McDonald: $765,901 Michael Moley: $446,180 Maria Foti: $72,705 Gary Tucker: $57,760 Jim Millard: $12,239 Certain portions of the incentive compensation paid in 2019 are a result of the targets that were achieved in previous years. Deferred compensation reported in 2019 includes both qualified deferred pension compensation, as well as deferred compensation and employer contribution for 403b for certain associates for the amounts that are able to be estimated in 2019. Actual W-2 compensation paid to the executive is as per Schedule J Part II B. A Dormitory Authority of the State of New York 146000293 649906J96 2012-07-12 3080000 See Part VI 0 0 0 B Buffalo and Erie County Industrial Land Development Corporation 222413596 SeePartVI 2015-04-30 10020000 See Part VI 0 0 0 C Dormitory Authority of the State of New York - Series A 146000293 SeePartVI 2019-04-25 54323249 See Part VI 0 0 0 D Dormitory Authority of the State of New York - Series B 146000293 64990GMH2 2019-04-25 10158956 See Part VI 0 0 0 A 3080000 206564 110012 2763424 2013 0 0 1 1 B 11107065 246262 731558 328646 9785277 15322 2016 0 0 0 1 C 59073617 666236 23278047 24042386 11086948 2020 1 0 0 1 D 10268193 109237 2533817 7625138 2020 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 1 D 0 1 0 0 1 0 0 1 A 1 B 1 C 1 D 1 Part I A (f) Description of Purpose: To finance the cost of improvements to Mercy's existing approximately 381,000 square foot parking facility. Part I B ( c ) CUSIP #: The 2015 Bond Series were issued under numerous CUSIP #s with varying maturity dates. The associated CUSIP #s are as follows: 11943KBH4, 11943KBJ0, 11943KBK7, 11943KBL5, 11943KBM3, 11943KBN1, 11943KBP6, 11943KBQ4, 11943KBR2, 11943KBS0, 11943KBT8, 11943KBU5, 11943KBV3, 11943KBW1, 11943KBX9, 11943KBY7 Part I B (f) Description of Purpose: To finance the costs associated with improvements to the Labor & Delivery Department, Pre/Post Operative Holding areas, and upgrading the electrical switchgear at Mercy Hospital of Buffalo. Part I C ( c ) CUSIP #: The 2019 Bond Series A were issued under numerous CUSIP #s with varying maturity dates. The associated CUSIP #s are as follows: 64990GLN0, 64990GLP5, 64990GLQ3, 64990GLR1, 64990GLS9, 64990GLT7, 64990GLU4, 64990GLV2, 64990GLW0, 64990GLX8, 64990GLY6, 64990GLZ3, 64990GMA7, 64990GMB5, 64990GMC3, 64990GMD1, 64990GME9 Part I C (f) Purpose Series A Proceeds of bonds used to (i) finance portions of certain improvements, equipment and strategic investments, including but not limited to a new electronic medical records system, maternity services renovations and new sterile processing department; (ii) refund in full certain existing bank credit facilities; (iii) refund All of the Catholic Health System Obligated Groups, Series 2006 and Series 2008. Part I D (f) Proceeds of bonds used to (i) finance portions of certain improvements, equipment and strategic investments, including but not limited to a new electronic medical records system, maternity services renovations and new sterile processing department. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 97893 Clinical Documentation Specialist, SCH/SJC 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 77058 HR Employee of CHS 0 Scott Markiewicz Son of Key Employee, Joyce Markiewicz 54259 Supervisor, Father Baker Manor 0 Julie Sullivan Daughter of Chief Executive Officer 64441 HR employee, CHS 0 Jacob Tucker Son of Director, Gary Tucker 4732 Imaging associate, MSMH 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 2019, 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. 16. b. The Catholic Health System has a process to evaluate its participation in joint venture arrangements under applicable federal tax law, and has taken steps to safeguard the organization's exempt status with respect to such arrangements, and has developed a formal policy to formalize the process. 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: Change in Pension Obligation, Other than Net Periodic Cost -18824143. Equity Transfer to Affiliates -2564121. Change in Restricted Interest in Mercy Hospital Foundation Inc 53262. Change in Unrestricted Interest in Mercy Hospital Foundation Inc 159542. Change in Unrealized Gain on Interest Rate Swap -351845. Amoritization of Terminated Interest Rate Swap 3124481. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Healthcare Delivery System NY 501 c 3 Schedule A line 10 N/A 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 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 Nazareth Home of the Franciscan Sisters 291 North Street Buffalo NY 14201 160813142 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 St Francis Home of Williamsville 147 Reist St Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 St Francis of Buffalo Inc 34 Benwood Ave Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501 c 3 Schedule A line 10 Catholic Health System Inc 0 WNY Catholic Long Term Care Inc 6400 Powers Rd Orchard Park NY 14127 161434368 Skilled Nursing Facility 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 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 Catholic Health System Infusion Pharmacy Inc 6350 Transit Road Depew NY 14043 200198518 Home Care Infusion Services NY 501 c 3 Schedule A line 10 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 Program of All-Inclusive Care for the Elderly Inc 55 Melroy Avenue Lackawanna NY 14218 261252884 All-inclusive Care for the Elderly NY 501 c 3 Schedule A line 3 Catholic Health System Inc 0 Trinity Medical WNY PC 2625 Harlem Rd Cheektowaga NY 14225 272576645 Primary Care Provider NY 501 c 3 Schedule A line 12 Catholic Health System Inc 0 Mercy Hospital Foundation 515 Abbott Road Buffalo NY 14220 222209721 Foundation NY 501 c 3 Schedule A line 7 Mercy Hospital 0 Southtowns Catholic MRI Inc 200 International Drive Buffalo NY 14221 161554081 Imaging NY 501 c 3 Schedule A line 10 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 Mary's 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 Orchard Park Mercy Corporation 565 Abbott Road Buffalo NY 14220 161470350 Real Estate Holding Company NY Mercy Hospital C 134206 1.00000 0 Aurora Mercy Corporation 565 Abbott Road Buffalo NY 14220 161354302 Real Estate Development NY Mercy Hospital C 5021 1.00000 0 Alsace Abbott Corporation 565 Abbott Road Buffalo NY 14220 161355092 Partnership Holding Corporation NY Mercy Hospital C 160887 1.00000 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 Orchard Park Mercy Corporation P 102894 Alsace Abbott Corporation P 61255