2020-11-12T12:47:02-06:00 2019-12-31 990 2019-01-01 160762843 Kenmore Mercy Hospital KENM 7169232968 144 Genesee Street Buffalo NY 14203 Russell Edwards VP Finance/Corp. Controller 7169232968 2020-11-12 204.68.186.4 2020-11-12 12:46:55 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CCC2802FD33C98784776EE3B4A7BA94AEA207375 2019 2021-01-29 14:40:06Z Mark Sullivan 144 Genesee Street Administration 6th Floor Buffalo NY 14203 174717618 0 X www.chsbuffalo.org X 1957 NY The Mission of Kenmore 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 Kenmore 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 1468 158 0 0 276746 121956 181936350 170875676 -602536 3662576 -49948 57410 181560612 174717618 0 0 0 0 78095911 77458800 0 0 0 96145975 99368854 174241886 176827654 7318726 -2110036 167922912 169668527 119575211 126125598 48347701 43542929 X The Mission of Kenmore 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 Kenmore 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 100595077 115164976 Inpatient Routine/Surgery Visits: Acute Care Patient Days = 25,779Medical Rehab Patient Days = 4,494Skilled Nursing Patient Days = 51,096IP Surgeries = 2,850 45997161 52659256 Outpatient Routine/Surgery Services:Emergency Visits (Net of Admits) = 30,578Referred Ambulatory Visits = 61,736Operating Room = 3,229G.I. Laboratory = 1,436Interventional Radiology = 1,228Transfusion/Infusion = 48 2665396 3051445 Clinic/Primary Care Services:Primary Care Visits = 12,494 149257634 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 0 1 0 0 0 0 0 0 1 0 0 0 1 102 0 1 1468 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 0 X X Russell Edwards VP FinanceCorp Controller CHS 7169232968 144 Genesee Street Buffalo NY 14203 Mark Sullivan President & CEO 0.00 55.00 X X 0 1290346 128283 Walter Ludwig President & CEO KMH 55.00 0.00 X X 323082 0 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 468645 55181 Eddie Bratko Director 0.00 55.00 X 0 250307 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 395001 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 74535 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 James Fitzpatrick Physician 55.00 0.00 X 356620 0 49508 Dr Michael Gough Physician 55.00 0.00 X 339935 0 34677 Dr Erik Diringer Physician 55.00 0.00 X 296432 0 11726 Dr Nadia Polataiko Physician 55.00 0.00 X 216330 0 152029 Dr Ayesha Butts Physician 55.00 0.00 X 198588 0 34682 Joseph McDonald President & CEO - Former 0.00 0.00 X 0 1154669 36171 James Millard President & CEO KHM - Former 0.00 0.00 X 12155 0 -131033 Gary Tucker Director-Former 0.00 0.00 X 0 308648 40829 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 1743142 9357019 1432252 70 1 1 0 AMN HEALTHCARE INC 2735 Collection Center Drive Chicago IL 60693 Healthcare Services 1883047 BUFFALO NIAGARA HOSPITALISTS 2950 Elmwood Ave/Med Staff Office Kenmore NY 14217 Physician Services 878867 TELCO CONSTRUCTION INC 500 Buffalo Rd East Aurora NY 14052 Construction Services 521451 FRESENIUS MANAGEMENT SERVICES 920 Winter Street Waltham MA 02451 Commercial Services 408408 BUFFALO MEDICAL GROUP 85 High Street Buffalo NY 14203 Healthcare Services 254965 26 121956 121956 Patient Service Revenu 900099 121927933 121927933 Medicare/Medicaid 900099 48947743 48947743 170875676 3662576 3067078 595498 317422 0 317422 317422 317422 Cafeteria Revenue 900099 251847 251847 Net Periodic Pension 900099 -1166659 -344659 -822000 654800 57456 597344 -260012 174717618 173655551 0 940111 61837607 55093503 6744104 2113489 1882989 230500 9167433 8167619 999814 4340271 3866914 473357 26532 26532 4262593 3578706 683887 70231 478 69753 4398831 1389191 3009640 95249 3000 92249 1385075 1038806 346269 7200 6335 865 4347 3166 1181 1688785 1249385 439400 7249445 5363233 1886212 1628778 1389099 239679 Medical Supplies 37151145 37349012 -197867 Dues & Shared Services 31058061 22982965 8075096 Purchased Services & Ot 8713540 4684664 4028876 Other Supplies Non Medi 1629042 1208569 420473 176827654 149257634 27570020 0 2432 2432 48498699 60872586 18050959 17541573 2503261 2538271 571006 119985 141388188 88447947 55518565 52940241 22008441 16158076 20769549 19495363 167922912 169668527 21573820 23597986 21117315 30709713 12146642 2978129 64737434 68839770 119575211 126125598 X 48171148 43124002 176553 418927 48347701 43542929 167922912 169668527 X -2110036 -2694736 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8990 8990 0 Part II-B, Line 1: Other lobbying activities: Lobbying expenses of $8,990 represent the total of dues paid to national and state associations that is specifically allocable to lobbying. Kenmore 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. 235852 235852 61490621 39577902 21912719 22160931 7046923 15114008 55661646 41151183 14510463 1839138 671939 1167199 52940241 Ascension Investment Management 16158076 F 16158076 Insurance Recoveries 13234180 Interest in Net Assets of KMH Foundation, Inc. 3959548 Due from Affiliates 1504141 Other Receivables 184637 Interest in Net Assets of CCD Foundation, Inc. 10110 Operating Lease Right of Use Assets 602747 19495363 Pension Obligation 34242965 Long-Term Portion Of Insurance Liabilities 21815976 Due to Affiliates 12206689 Asset Retirement Obligation 216186 Debt Issuance Costs -918008 Operating Lease Liabilities 602748 LT Portion of Dispoables 673214 68839770 175671734 965433 965433 174706301 11317 11317 174717618 177270726 478840 478840 176791886 35768 35768 176827654 Part XI, Line 2d - Other Adjustments: Kenmore Mercy Foundation Activity 965433. Part XI, Line 4b - Other Adjustments: Contributions from Kenmore Mercy Foundation to Kenmore 11317. Part XII, Line 2d - Other Adjustments: Kenmore Mercy Foundation Expenses (net of eliminations) 478840. Part XII, Line 4b - Other Adjustments: KMH Homes Expense 35768. 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 1684578 52699 1631879 0.00920 23519131 14278122 9241009 0.05230 25203709 14330821 10872888 0.06150 717134 717134 0.00410 1611407 1611407 0.00910 8764077 7900297 863780 0.00490 297475 297475 0.00170 421106 421106 0.00240 11811199 7900297 3910902 0.02220 37014908 22231118 14783790 0.08370 22211 22211 0.00010 67468 67468 0.00040 15558 15558 0.00010 105237 105237 0.00060 0 28188917 28718248 -529331 X 1 1 1 1 Kenmore Mercy Hospital 2950 Elmwood Ave Kenmore NY 14217 www.chsbuffalo.org 1404000H X X X Ambulatory Surgery - Multi Specialty Kenmore Mercy Hospital 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X Part V line 7a page 8 X 1 19 1 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: Audiology O/PCT Scanner Clinic Part Time ServicesClinical Laboratory Services Coronary Care Dental O/P Emergency Department Health Fairs O/P Intensive Care Medical Social Services Medical/Surgical Nuclear Medicine - Diagnostic Nuclear Medicine - Therapeutic Pediatric O/P Pharmaceutical Service Physical Medical Rehabilitation Physical Medicine and Rehabilitation O/PPrimary Medical Care O/P Radiology - Diagnostic Renal Dialysis - Acute Respiratory Care Therapy - Occupational O/P Therapy - Physical O/P Therapy - Speech Language Pathology Kenmore Mercy Hospital Part V, Section B, Line 5: Kenmore 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 Kenmore Mercy Hospital Part V, Section B, Line 6b: Kenmore Mercy Hospital was conducted with Mercy Hospital and Sisters Hospital and Mount St. Mary's Hospital as well as the Erie County Department of Health. Kenmore Mercy Hospital 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 other important 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 "food deserts 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 asthma management and dangers of lead poisoning * Slowing the rate of HIV infection especially within minority communities (NYS Prep program with local support from Evergreen)The 2019 Erie County Community Health Needs Assessment began by first re-evaluating the needs prioritized in the previous cycle (2016) and the impact of the projects corresponding to those needs that were selected for implementation. Catholic Health's understanding of the communities it serves was then updated by soliciting new input from the public and several community organizations as outlined in the Process and Methods section of this report. This assessment represents a collaborative effort across Catholic Health's facilities as well as with external organizations to identify the health needs of the community and to develop a strategy for addressing them. The systematic process used helped identify significant health needs across Catholic Health's Erie County service area including vulnerable and under-represented populations. 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 Kenmore Mercy Hospital Part V, Section B, Line 16j: Includes information in both English and Spanish on all signage and brochures for financial assistance. 2 1 - Ken-Ton Family Care 300 Two Mile Creek Road Tonawanda NY 14150 Extension Clinic: Medical Services - Primary Care 2 - McAuley Residence 1503 Military Road Kenmore NY 14217 Long Term Care: Clinical Laboratory Service/Radiology - Diagnostic Part I, Line 6a: Kenmore Mercy Hospital 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: Kenmore Mercy Hospital participated in Community Building activities including Community support of $22,211 Environmental improvements of $67,468 and Coalition building of $15,558. Part III, Line 2: Kenmore Mercy 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: Kenmore Mercy 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: Kenmore Mercy Hospital does not have a footnote that describes bad debt in the financial statements. Part III, Line 8: Kenmore 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, Kenmore 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 Kenmore 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 Kenmore Mercy Hospital informs and educates 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, Kenmore 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-assistanceand 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.Kenmore 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.Kenmore 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 Kenmore 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 Kenmore 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 Kenmore 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 Kenmore 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, Kenmore 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 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 & CEO 0 827922 0 164916 0 297508 0 107674 0 20609 0 1418629 0 164916 Walter Ludwig President & CEO KMH 304682 0 25 0 18375 0 38947 0 20115 0 382144 0 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 38498 0 47619 0 7562 0 523826 0 0 Eddie Bratko Director 0 240929 0 0 0 9378 0 12611 0 20050 0 282968 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 55466 0 43900 0 19309 0 458210 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 68265 0 7538 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 15685 0 558646 0 0 William Pryor Executive VP, Chief Admin Officer 0 491200 0 12500 0 24104 0 62126 0 18047 0 607977 0 0 Bartholomew Rodrigues Chief Mission Officer 0 206167 0 0 0 36229 0 18917 0 20028 0 281341 0 0 Dr James Fitzpatrick Physician 352196 0 0 0 4424 0 35010 0 14498 0 406128 0 0 0 Dr Michael Gough Physician 314113 0 6529 0 19293 0 14582 0 20095 0 374612 0 0 0 Dr Erik Diringer Physician 277180 0 0 0 19252 0 11409 0 317 0 308158 0 0 0 Dr Nadia Polataiko Physician 190990 0 24592 0 748 0 137688 0 14341 0 368359 0 0 0 Dr Ayesha Butts Physician 171833 0 26521 0 234 0 14710 0 19972 0 233270 0 0 0 Joseph McDonald President & CEO - Former 0 0 0 129246 0 1025423 0 21214 0 14957 0 1190840 0 129246 James Millard President & CEO KHM - Former 0 0 0 0 12155 0 -131600 0 567 0 -118878 0 0 0 Gary Tucker Director-Former 0 221250 0 0 0 87398 0 19996 0 20833 0 349477 0 0 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 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 649906J62 2012-07-12 14235000 See Part VI 0 0 0 B Buffalo and Erie County Industrial Land Development Corporation 222413596 SeePartVI 2015-04-30 3515000 See Part VI 0 0 0 C Dormitory Authority of the State of New York - Series A 146000293 SeePartVI 2019-04-25 13647770 See Part VI 0 0 0 D Dormitory Authority of the State of New York - Series B 146000293 64990GMH2 2019-04-25 332776 See Part VI 0 0 0 A 14235000 954691 286690 563473 12430146 2013 0 0 1 1 B 3897746 256629 113581 3527536 2014 0 0 1 1 C 14841516 167384 9606585 4647451 420097 2020 1 0 0 1 D 336354 3578 47544 285233 2020 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 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 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 Part I A (f) Description of Purpose: To finance the cost of construction, reconstruction, and equipping certain improvements to Kenmore's existing approximately 347,661 square foot hospital facility located at 2950 Elmwood Avenue, Kenmore, NY,including a new two-story addition that includes approximately 19,000 square feet on the first floor to house Kenmore's Emergency Department 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 the Operating Room Expansion project at Kenmore Mercy Hospital. 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) Purpose - Series B 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. 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 -3424252. Equity Transfer to Affiliates -160653. Change in Temporarily Restricted Interest in Related Foundations 242374. Change in Unrestricted Interest in KMH Foundation, Inc. 490066. Amortization of Terminated Interest Rate Swaps 152912. Other 4817. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501C 3 Schedule A Line 10 N/A 0 Mercy Hospital of Buffalo 565 Abbott Road Buffalo NY 14220 160756336 Acute Care Hospital NY 501C 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 501C 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 501C 3 Schedule A Line 10 Catholic Health System Inc 0 St Elizabeth Home of the Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501C 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 501C 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 501C 3 Schedule A Line 10 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501C 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 501C 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 501C 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 501C 3 Schedule A Line 10 Catholic Health System Inc 0 Catholic Health System Infusion Pharmacy Inc 6350 Transic Road Depew NY 14043 200198518 Home Care Infusion Services NY 501C 3 Schedule A Line 10 Catholic Health System Inc 0 CHS Program of All-Inclusive Care of the Elderly Inc 55 Melroy Avenue Lackawanna NY 14218 261252884 All-inclusive Care for the Elderly NY 501C 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 501C 3 Schedule A Line 12 Catholic Health System Inc 0 Kenmore Mercy Hospital Foundation 2950 Elmwood Avenue Kenmore NY 14217 161162971 Foundation NY 501C 3 Schedule A Line 7 Kenmore Mercy Hospital 0 KMH Homes Inc 144 Genesee Street Buffalo NY 14203 161387890 Real Estate Holding Company NY 501C 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 501C 3 Schedule A Line 3 Catholic Health System Inc 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1