2018-11-01T14:51:46-05:00 2017-12-31 990 2017-01-01 161523353 Mount St Mary's Hospital of Niagara Falls MOUN 7168282974 144 Genesee St Buffalo NY 14203 David P Macholz VP Finance/Corp.Controller CHS 7168282974 2018-11-01 204.68.186.4 2018-11-01 14:51:36 ED P 76FF2A6BB2396675DA7FC3BECCB7F23E28595D91 E6E6B1DEE2C3A01552DA3A94E9AF66566F60AB34 2017 2018-06-14 16:35:46Z Joseph D McDonald 144 Genesee Street Administration 6th Floor Buffalo NY 14203 98296525 0 X www.chsbuffalo.org X 1907 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in a (an) (acute care, long term care, home care) setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2017 Community Service Plan can be found at https://www.chsbuffalo.org/about-us/community 11 7 894 169 0 0 1432628 946608 96226820 95382280 12598 15287 2728650 1952350 100400696 98296525 0 0 0 0 64487690 56857715 0 0 0 34411086 42863703 98898776 99721418 1501920 -1424893 50025734 52156231 22846503 25841993 27179231 26314238 X The Catholic Health System (CHS) Mission is to provide quality healthcare services in an acute care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2017 Community Service Plan can be found at www.chsbuffalo.org. 0 0 52884837 59229662 Inpatient Routine/Surgery Visits:Acute Care Patient Days = 19,925Newborn Patient Days = 723Inpatient Surgeries = 984 17566987 19674576 Outpatient Routine/Surgery Services:Emergency Visits (Net of Admits) = 18,223Referred Ambulatory Visits = 80,169Operating Room = 3,443G.I. Laboratory = 2237Interventional Radiology = 354Transfusion = 131 14712874 16478042 Clinic/Primary Care Services:Clinic Visits = 34,925Primary Care Visits = 31,384 85164698 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 76 0 1 894 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X David P MacholzCorporate Controll 7168282974 144 Genesee St Buffalo NY 14203 Mark Sullivan Executive VP/COO 0.00 55.00 X X 0 892421 161256 Gary Tucker Pres. & CEO, Mount St. Mar 55.00 0.00 X X 323253 0 70511 David Macholz Treasurer 0.00 55.00 X X 0 265735 51732 Joyce Markiewicz Director 0.00 55.00 X 0 372553 82696 James Millard Director 0.00 55.00 X 0 322914 231028 Charles Urlaub Director 0.00 55.00 X 0 446938 47606 Martin Boryszak Director 0.00 55.00 X 0 326086 20914 Lynn Catalano Director 0.00 4.00 X 0 0 0 John Davanzo Director 0.00 4.00 X 0 0 0 Georgiana Ford Esq Director 0.00 4.00 X 0 0 0 Mark Jajkowski Director 0.00 55.00 X 0 24250 0 Raquel Martin DO Director 0.00 4.00 X 0 0 0 Mary Turkiewiecz MD Director 0.00 4.00 X 0 0 0 Katherine Vanderhorst Director 0.00 4.00 X 0 0 0 Monsignor Robert E Zapfel Director 0.00 4.00 X 0 0 0 Brian Beitz Director 0.00 8.00 X 0 0 0 Joseph McDonald President and CEO, CHS 0.00 55.00 X 0 1321419 187715 James A Dunlop Jr Executive VP, Finance/CFO 0.00 55.00 X 0 795936 278895 Dr Brian D'Arcy Senior VP, Medical Affairs 0.00 55.00 X 0 729372 51159 Dr Michael Edbauer Chief Clinical Officer 0.00 28.00 X 0 429423 78470 Maria Foti Sr. VP, Strategic Planning 0.00 55.00 X 0 392400 91558 Dr Michael Galang Sr. VP, Chief Information 0.00 55.00 X 0 546797 73371 Michael Moley Sr. VP, Human Resources 0.00 55.00 X 0 657729 135613 Nancy Sheehan SVP Legal Service, General 0.00 55.00 X 0 488411 51193 Dr Samuel Sirianni Physician 55.00 0.00 X 372367 0 51388 Dr Roger W Rogers Physician 55.00 0.00 X 495192 0 38562 Dr Benjamin G Rueda Physician 55.00 0.00 X 403152 0 45061 Dr Arif S Syed Physician 55.00 0.00 X 403419 0 39541 Dr Parag Parikh Physician 55.00 0.00 X 371293 0 38773 2368676 8012384 1827042 59 0 1 0 Trimedx LLC 5451 Lakeview Pkwy S Drive Indianapolis IN 46268 Clinical Engineering 1218541 Precision Healthcare LLC 1160 Southwest 21st Avenue Boca Raton FL 33486 Health Care Services 946672 Exigence Hospitalist Medical 1 John James Audubon Pkwy Buffalo NY 14228 Physician Services 756438 Atlas Healthcare Linen 414 W Taylor St Syacuse NY 13202 Linen Services 510806 CompHealth 7259 S Bingham Jct Road Midvale UT 84047 Nutrition Services 349666 22 946608 946608 All Other Payers 621990 66162588 66162588 Medicare/Medicaid 621990 29219692 29219692 95382280 10887 10887 53668 0 53668 53668 53668 4400 0 4400 4400 4400 340B Pharmacy 621990 463158 463158 Meaningful Use 621990 370963 370963 Cafeteria 722210 364271 364271 700290 309064 391226 1898682 98296525 96525465 0 824452 44268760 39399196 4869564 1646485 1465372 181113 10311615 9177337 1134278 630855 561461 69394 22805 22805 8257 8257 3260781 2480935 779846 166465 8612 157853 4433575 2151706 2281869 100169 39051 61118 1261200 945900 315300 23744 19386 4358 62645 55229 7416 4201 3446 755 4019657 3297639 722018 1039493 934153 105340 Dues and Shared Service 10785368 7765465 3019903 Medical Supplies 10088435 10118855 -30420 Purchased Services 6322364 5625996 696368 Other Supplies Non-Medi 1264544 1106702 157842 99721418 85164698 14556720 0 4230 6067089 6827159 10592651 10442755 296864 1668296 1859616 345156 417161 65203117 41841730 23999790 23361387 7055888 9243923 50025734 52156231 10129282 11906614 190106 14903 12527115 13920476 22846503 25841993 X 24429162 23952153 2702286 2310745 47783 51340 27179231 26314238 50025734 52156231 X -1424893 559900 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 8257 8257 0 Part II-B, Line 1: Lobbying expenses of $8,257 represent the total of dues paid to national and state associations that is specifically allocable to lobbying. Mount St. Mary's 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. 1227100 1227100 30556265 18833433 11722832 923452 67793 855659 32102346 23458255 8644091 393954 -517751 911705 23361387 Due From Affiliates 814833 Interest in Net Assets of Mount St. Mary's Hospital Foundation 6504621 Insurance Recoveries 1601271 Other Receivables 323198 9243923 Due to Affiliates 618772 Long-Term Portion of Insurance Liabilities 4352000 Pension Obligation 1181364 Asset Retirement Obligation 332623 Long-Term Portion of EIB Bank 190292 Contingent Liability 7242451 Long-Term Portion of Disposables 2974 13920476 99904735 2422488 2422488 97482247 814278 814278 98296525 100958310 1236892 1236892 99721418 0 99721418 Part XI, Line 2d - Other Adjustments: Childcare Revenue - 620548. Foundation Revenue - 1801940. Part XI, Line 4b - Other Adjustments: Contributions from Foundation 814278. Part XII, Line 2d - Other Adjustments: Childcare Expenses 625504. Foundation Expenses (net of eliminations) 611388. 1 1 1 X 1 X 500.000000000000 1 1 1 0 1 1 1023242 24405 998837 0.01000 17566439 11645661 5920778 0.05940 18589681 11670066 6919615 0.06940 750959 0 750959 0.00750 1157552 0 1157552 0.01160 7324239 5198619 2125620 0.02130 77079 0 77079 0.00080 327954 0 327954 0.00330 9637783 5198619 4439164 0.04450 28227464 16868685 11358779 0.11390 2144 2144 0.00000 34887 34887 0.00030 84888 84888 0.00090 6172 0 6172 0.00010 4345 4345 0.00000 132436 132436 0.00130 0 2739000 209623 18881454 16390120 2491334 X 1 1 1 1 Mount St Mary's Hospital of Niagara Falls 5300 Military Rd Lewiston NY 14092 www.chsbuffalo.org 3121001H X X X Ambulatory Surgery - Multi Specialty Mount St Mary's Hospital of Niagara Fal 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X https://www.chsbuffalo.org/mission/social-responsibility-community-benefit X 1 16 1 https://www.chsbuffalo.org/mission/social-responsibility-community-benefit 0 1 X 200.000000000000 500.000000000000 X X X X X 1 1 X X X X 1 X http://chsbuffalo.org/billing/finance X http://chsbuffalo.org/billing/finance X http://chsbuffalo.org/billing/finance X X X X X X X 1 X 0 X 1 X 0 0 Part V, Section A: Chemical Dependence - Rehabilitation Chemical Dependence - Withdrawal O/PClinic Part Time ServicesClinical Laboratory ServiceCoronary Care Emergency Department Intensive Care Lithotripsy Maternity Medical Services - Primary Care Medical Social Services Medical/Surgical Nuclear Medicine - Diagnostic Nuclear Medicine - Therapeutic Radiology - Diagnostic Renal Dialysis - Acute Therapy - Occupational O/P Therapy - Speech Language Pathology Mount St. Mary's Hospital of Niagara Falls Part V, Section B, Line 5: To identify and prioritize the MSMH community's health needs, this Community Health Needs Assessment (CHNA) considered multiple data sources, including written surveys,interviews, focus groups, demographic data, health status indicators, and disease prevalence data. MSMH compiled the data from these sources to arrive at potential priority health needs in the community. MSMH convened meetings with MSMH staff and external healthcare experts (including the Niagara County Department of Health) to share the survey results, discuss the potential priority health needs and to elicit considerations regarding secondary health needs. Collaboration included involvement from other local area local area hospitals, Niagara Falls Memorial, DeGraff Memorial, and Eastern Niagara. A countywide questionnaire was sent in addition to individual surveys sent to community organizations, local health officials and others of varying socioeconomic backgrounds:*Written Survey targeting local community organizations and non?profits that are active in the primary service area*Written Survey targeting local block clubs and church groups active in the primary service area*Focus Group at the Mount St. Mary's Neighborhood Health Center, located in the part of the service area with the lowest per capita income and underserved in a variety of ways*Focus Group at Mount St. Mary's Hospital involving associates*Input from Focus Groups conducted throughout Niagara County by Niagara County DOH*Written Request for input from physicians at Mount St. Mary's*Written Survey conducted by Niagara County Department of Health that was countywide,but also with the ability to gather input from our primary service area.These included members of the Creating a Healthier Niagara Falls Collaborative and Healthy BehaviorsWork Group:*Family and Children's Services of Niagara*Niagara County Office of the Aging*American Diabetes Association*Niagara County Department of Mental Health*Buffalo-Niagara YMCA*Planned Parenthood of Niagara*Native American Community Services*Isaiah 61 Project*Roswell Park Cancer Institute/Niagara Falls City Council*Niagara Falls School District/Niagara Falls City CouncilOther groups included:*Mom's Net*Family and Children's Services of Niagara*Heart, Love & Soul Food Pantry*Project Connect NiagaraFor more information about our CHNA, go to https://www.chsbuffalo.org/mission/social-responsibility-community-benefit Mount St. Mary's Hospital of Niagara Falls Part V, Section B, Line 6b: Catholic Health System, P2 Collaborative, Niagara County Department of Health and New York State Department of Health Mount St. Mary's Hospital of Niagara Falls Part V, Section B, Line 11: The 2016 Niagara County Community Health Needs Assessment began by bringing together the participants from the 2013 process. This included the Niagara County Department of Health, and representatives of the four hospitals in Niagara County: Mount St. Mary's, Niagara Falls Memorial,DeGraff Memorial, and Eastern Niagara. The process was coordinated by the P2 Collaborative of Western New York.Initial meetings focused on evaluating activities from the 2013 CHNA's and the County Health Department's Community Service Plan priorities. Despite posting our 2013-16 report on our website and providing notice in the media, we did not receive any written input on the report. Subsequent sessions were devoted to developing a countywide questionnaire to survey residents and initiatives to gather as much relevant data as possible from surveys, interviews, and focus groups.As part of this coordinated initiative, Mount St. Mary's worked to develop an updated three-year (2016-2018) Community Health Improvement Plan/Implementation Strategy (CHIP/IS) to continue the collaboration in our community to improve patient care, preventive services, overall health, and quality of life. Our input process covered many segments of the community including individual surveys, community organizations, local health officials and others of varying socioeconomic backgrounds.Through the needs assessment, numerous areas were identified as important and clearly impact the health of the community. Mount St. Mary's identified the "significant" needs as related to the New York State Department of Health Prevention Agenda priorities. Within the "priorities," Mount St. Mary's will address numerous health needs as described in the publicly available CHNA report.Two priorities not specifically addressed in the implementation plan: Neighborhood Safety and Food/Water Safety. We did not address in our plan because of a lack of expertise and resources to effectively address each of the issues. Mount St. Mary's Hospital of Niagara Falls Part V, Section B, Line 16j: Includes information in both English and Spanish on all signage and brochures for financial assistance. 8 1 - Mount St Mary's Hospital Rehab Svc 1 Columba Drive Niagara Falls NY 14305 Licensed, Extension Clinic: Therapy-Occupational O/P, Therapy-Physical O/P 2 - Mount St Mary's Diagnostic Imaging Svc 7300 Porter Road Niagara Falls NY 12414 Licensed, Extension Clinic: Medical Services-Primary Care 3 - Mount St Mary's Ear Nose and Throat Sv 6941 Elaine Drive Niagara Falls NY 14304 Licensed, Extension Clinic: Primary Medical Care O/P 4 - Mount St Mary's Orthopedic Services and 5320 Military Road Lewiston NY 14092 Licensed, Extension Clinic: Orthopedic Services General,Vascular & Cardiotho 5 - Mount St Mary's Primary Care Extension 1302 Main Street Niagara Falls NY 14301 Extension Clinic: Medical Services O/P, Primary Medical Care O/P, Radiology 6 - Mount St Mary's Neighborhood Health Ctr 3101 Ninth Street Niagara Falls NY 14305 Licensed, Extension Clinic: Medical Social Services O/P, Nutritional O/P 7 - Mount St Mary's Campus Medical Arts Bld 5290 Military Road Suite 8 Lewiston NY 14092 Extension Clinic: Primary Care 8 - Witmer Park Medical Center One Colomba Drive Suite 8 Niagara Falls NY 14304 Extension Clinic: Primary Care Part I, Line 6a: Mount St. Mary'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 Mount St. Mary's Hospital included Economic Development of $2,144 Community Support of $34,877, Environmental Improvements of $84,888, Leadership development of $6,172, and Workforce development of $4,345. Part III, Line 2: The amount in Part III line 2 is the actual bad debt expenses of $2,739,000. The amount in Part III line 3 is the estimate of bad debt from uninsured balance which is developed as follows: as policy is to write accounts to bad debt 120 days after discharge, the discharge date period of 10/1/2016 to 9/30/2017 was used to determine the population of uninsured accounts.The balance of these accounts was determined and the RCC was applied to develop the estimate in H Part III line 3. Part III, Line 3: As our determination of eligibility for the Healthcare Assistance Program (HAP) (Charity Care) is based solely on the presentation for care without insurance, which is now for each account, and the use of a sophiticated estimator (PARO) of each guarantor's ability to pay an estimate of "the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy if sufficient information had been avilale to make a determination of their eligibility" is not relevant.The organization's financial statements do not include a footnote that descibes bad debt expense, but the financial statements account for bad debt expenses in the statement of operations as actual expenses written off and an estmate of future write-offs less any recoveries. Part III, Line 4: The hospital does not have a footnote that describes bad debt in the financial statements. Part III, Line 8: Mount St. Mary's 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: As part of Catholic Health, Mount St. Mary's benefits from information received from evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors; from input from the physician community during doctor to doctor education programs; from physician and leadership participation in community boards, coalitions and forums to define the health needs of patient populations and seek community solutions; from participation in regional planning initiatives that look at the needs of the broader community; and input from Catholic Health Board including Board Committee (e.g. Mission Integration Committee). Examples of other sources of input include input from leadership of Family and Children's Services of Niagara, the Heart, Love and Soul Food Pantry, Stella Niagara Education Center, March of Dimes, Niagara Falls Block Club Council, Project Connect Niagara, Opportunities Unlimited of Niagara, and Complete Senior Care, among others. In each of the organizations listed, a member of the Mount St. Mary's leadership team serves on their board of directors or key committee with consistent dialogue about our services. Part VI, Line 3: Catholic Health's Mercy Hospital, Sisters Hospital, Kenmore Mercy and Mount St. Mary's 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, Mount St. Mary's, like our other 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 Revenue Management Center (RMC) and other areas throughout Catholic Health where eligible patients and family members are likely to be present. This information is also on the website CHSBuffalo.org and includes general information, our policy and application and is translated in Spanish and Arabic.Catholic Health also provides information about financial assistance and HAP contact information to patients as part of the intake process and during or within 90 days of their discharge from the hospital. To further assist patients, all patient bills include the following language: "The Catholic Health System has a Healthcare Assistance Program to assist those in need of financial assistance for qualified patients. If you would like to obtain additional information on the Healthcare Assistance Program, or in applying for health insurance through the NYS Department of Health, please call our Patient Financial Services Team at (716) 601-3600. Thank you." For free, confidential assistance in applying for financial aid, 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 will also assist them in applying for assistance at the time of registration. Interpreting services are also available for patients who do not speak English. We offer case management services, and we have 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: Mount St. Mary's Primary Service Area includes the City of Niagara Falls (Zip Codes 14301, 14302, 14303, 14304 and 14305), a city of about 49,000 where 60% of the population is on some form of public assistance. The towns of Lewiston (14092, 14107, 14109, and 14132), Niagara (portions of 14304 and 14305), Wheatfield (portions of 14305 and 14120), Grand Island (14072) and Porter (14174) are more suburban and rural areas with slightly higher income levels. Secondary Service Area includes the towns of Wilson (14172) a small agricultural community and Lockport (14094) a nearby city with similar characteristics to Niagara Falls. In general, the primary service area is described as Western Niagara County. 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. Our Mission Statement - 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 Catholic Health are in response to identified community needs, and reflect the System's emphasis on caring for the underserved. Catholic Health 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 Mount St. Mary's 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 Mount St. Mary's 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 hospital has a robust health professional education programs and participates in teaching programs for other allied health professionals. Our emergency department is 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. In 2017, the Catholic Health System provided more than $129 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 St. Vincent DePaul, United Way, Catholic Charities, Gerard Place, Care and Share Food Pantry, Casey House, Project Connect Niagara and the Health Science Charter School 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*Supporting nationally recognized "green" initiatives to remain good stewards of our natural resources and protect the environment.Each year, 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. One of the innovative ways Catholic Health is leading the transformation of healthcare is by supporting other organizations whose work has a direct impact on community health. For the second year, Catholic Health has allocated a portion of its net income ($137,700) for Community Benefit Grants to support programs that serve the poor and disadvantaged and address unmet health needs in our community. Recipients of the 2017 Community Benefit Grants include:*Pride Center of WNY, Inc. - Field Education on Health Disparities of LGBTQ People -$20,000*Durham's Central City Baby Caf - $20,000*RAHAMA: Trauma-informed domestic violence program for Muslims, immigrants, and refugee women - $20,000*Erie-Niagara Health Justice Alliance Planning Project (Medical-Legal Partnership) - $25,000*UB Partnership: Reduce Healthcare Disparities in Vulnerable Populations Through "Trauma Informed" Care Practices - $20,000*Sisters Hospital Chemical Dependency Treatment Services: Screening brief intervention and referral treatment (SBIRT) access in primary care with mental, emotional and behavioral (MEB) disorder screening - $10,000*Food Bank of WNY: School Backpack Program at West Hertel Academy - $17,700*Heart Love and Soul Soup Kitchen: Diabetes Self-Management and Support - $5,000As part of Catholic Health, Mount St. Mary's is supportive of the initiatives above. In addition, other ways the Hospital furthers its exempt purpose by promoting the health of the community include free health screenings (Lipid Panel each February as part of Heart Month and PSA in June as part of a Father's Day promotion) and health fairs as described further in our community benefit report in Schedule O. The organization extends medical staff privileges to all qualified physicians in its community for many of its departments. The organization applies funding to improvements in patient care, such as the expanded cardiology services Women's Center for Breast Health, and it's Center for Women, which provides services at both the main hospital and the Neighborhood Health Center facility in an underserved section of the City of Niagara Falls.Other substantive community benefit initiatives supported by Mount St. Mary's Hospital include: Advanced Directive / MOLST education, Baby and Me Program, Caring Smiles Dental Program, Community Health Fairs, Medicaid Enrollment Assistance, P2 Collaborative for Adult Mental Health and Substance Abuse Screening, Tower Grant for Pediatric Care Coordination, and Transportation Assistance. Part VI, Line 7, Reports Filed With States NY X X X X X X 0 1 0 0 0 0 0 0 0 Mark Sullivan Executive VP/COO 0 589554 0 181701 0 121166 0 134653 0 26603 0 1053677 0 181701 Gary Tucker Pres. & CEO, Mount St. Mar 262727 0 0 0 60526 0 45307 0 25204 0 393764 0 0 0 David Macholz Treasurer 0 222439 0 34402 0 8894 0 25118 0 26614 0 317467 0 0 Joyce Markiewicz Director 0 354692 0 0 0 17861 0 63393 0 19303 0 455249 0 0 James Millard Director 0 305290 0 0 0 17624 0 206285 0 24743 0 553942 0 0 Charles Urlaub Director 0 409653 0 0 0 37285 0 27553 0 20053 0 494544 0 0 Martin Boryszak Director 0 313904 0 0 0 12182 0 12092 0 8822 0 347000 0 0 Joseph McDonald President and CEO, CHS 0 748297 0 229770 0 343352 0 158886 0 28829 0 1509134 0 229770 James A Dunlop Jr Executive VP, Finance/CFO 0 528833 0 163443 0 103660 0 253453 0 25442 0 1074831 0 163443 Dr Brian D'Arcy Senior VP, Medical Affairs 0 504377 0 163178 0 61817 0 25101 0 26058 0 780531 0 155534 Dr Michael Edbauer Chief Clinical Officer 0 300713 0 106281 0 22429 0 65257 0 13213 0 507893 0 92418 Maria Foti Sr. VP, Strategic Planning 0 288899 0 86539 0 16962 0 80592 0 10966 0 483958 0 86539 Dr Michael Galang Sr. VP, Chief Information 0 406244 0 122651 0 17902 0 63847 0 9524 0 620168 0 122651 Michael Moley Sr. VP, Human Resources 0 388982 0 112624 0 156123 0 114645 0 20968 0 793342 0 112624 Nancy Sheehan SVP Legal Service, General 0 361936 0 108547 0 17928 0 30315 0 20878 0 539604 0 108547 Dr Samuel Sirianni Physician 242023 0 127281 0 3063 0 21682 0 29706 0 423755 0 0 0 Dr Roger W Rogers Physician 494385 0 0 0 807 0 14477 0 24085 0 533754 0 0 0 Dr Benjamin G Rueda Physician 359727 0 22963 0 20462 0 20973 0 24088 0 448213 0 0 0 Dr Arif S Syed Physician 283220 0 112271 0 7928 0 17488 0 22053 0 442960 0 0 0 Dr Parag Parikh Physician 343509 0 27423 0 361 0 10459 0 28314 0 410066 0 0 0 Part I, Line 4b Certain Officers and Key employees participated in a supplemental nonqualified retirement plan. The intention is to provide additional retirement compensation to address any gaps in the compensation limit. Pension Gap Joseph McDonald $26,000.00 Mark Sullivan $19,500.00 Dr. Brian D'Arcy $9,800.00 SERP Joseph McDonald $101,863.00 Certain portions of the incentive compensation paid in 2017 are a result of the targets that were achieved in previous years. Deferred compensation reported in 2017 includes both qualified deferred pension compensation and employer contribution for 403b for certain Sisters of Charity Hospital associates, as well as deferred compensation for the amounts that are able to be estimated in 2017. Actual W-2 compensation paid to the executive is as per Schedule J Part II B. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 90121 Corporate Nurse Educator 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 68944 HR Employee of CHS 0 Scott Markiewicz Son of Key Employee, Joyce Markiewicz 48434 Supervisor, Father Baker Manor 0 Julie Sullivan Daughter of Chief Operating Officer 33395 HR Employee, CHS 0 Form 990, Part VI, Section A, line 6 CHS has two members: Trinity Health, and the Diocese of Buffalo, NY. Each m0ember 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 associates on the Merit program; all Physicians and Non Physician Practitioners as well as Physician groups who are independent contractors or employees of CHS; and all board members must complete a Conflict of Interest Disclosure Statement (COIDS) in order to fulfill the annual requirements. COIDS are distributed to all parties, as per applicable policy, and once complete are followed up with as follows: 1. Associate and Physician completed COIDS are reviewed and signed off by the manager. If a disclosure is noted, it is discussed with the manager, and the document is forwarded to the Compliance officer who reviews and follows up as appropriate. Once review/follow up is completed the Compliance Officer will sign the COIDS, maintain a copy in the compliance office and return the original to HR for filing in the Personnel file. 2. All board member COIDS are returned to Compliance Officer for review and follow up as warranted. The compliance officer will sign each COIDS and retain on file in the compliance office in a confidential manner. Form 990, Part VI, Section B, line 15 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 2017, the Catholic Health System utilized a Compensation Committee of the Board of Directors to monitor the Executive Compensation as per the Executive Compensation Philosophy and Strategy for the CHS CEO 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 -458154. Transfer From Affiliate 474383. Change in Unrestricted Interest in Mount St. Mary's Foundation 931610. Change in Temporarily Restricted Interest in Mount St. Mary's Foundation -391541. Change in Permanently Restricted Interest in Mount St. Mary's Foundation 3557. Other 45. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501 c 3 Schedule A Line 10 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 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 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 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 Foundation Inc 5300 Military Road Lewiston NY 14092 161360884 Foundation NY 501 c 3 Schedule A Line 7 Mount St Mary's Hospital of Niagara Falls 0 Mount St Mary's Hospital Child Care Center 5310 Military Road Lewiston NY 14092 161523352 Child Care NY 501 c 3 Schedule A Line 10 Catholic Health System Inc 0 Board of Associates of Mount St Mary's Hospital Inc 5300 Military Road Lewiston NY 14092 161582926 Fund Raising NY 501 c 3 Schedule A Line 12a Mount St Mary's Hospital of Niagara Falls 0 The St Francis Guild of Mount St Mary's Hospital of Niagara Falls Inc 5300 Military Road Lewiston NY 14092 510217790 Fund Raising NY 501 c 3 Schedule A Line 12a Mount St Mary's Hospital of Niagara Falls 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1