2017-11-13T09:55:24-06:00 2016-12-31 990 2016-01-01 161434368 WNY CATHOLIC LONG TERM CARE INC WNYC 7168282974 144 GENESEE STREET BUFFALO NY 14203 DAVID P MACHOLZ VP FINANCE/CHS CORP CONTROLLER 7168282794 2017-11-13 204.68.186.4 2017-11-13 09:54:47 ES P 132B2ABE9083A98423CCB6D939BA17B6DC3E9CA5 132B2ABE9083A98423CCB6D939BA17B6DC3E9CA5 2016 2017-02-10 21:41:12Z JOSEPH MCDONALD ADMIN-6TH FLOOR144 GENESEE STREET BUFFALO NY 14203 15167957 0 X CHSBUFFALO.ORG X 1992 NY THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM 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 2016 COMMUNITY SERVICE REPORT CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 11 7 343 37 0 0 0 0 16134970 15017986 47616 86535 130253 63436 16312839 15167957 0 0 0 0 12723032 13468532 0 0 0 4622982 4362068 17346014 17830600 -1033175 -2662643 22727210 22432318 16614691 18822088 6112519 3610230 X THE CATHOLIC HEALTH SYSTEM (CHS) MISSION IS TO PROVIDE QUALITY HEALTHCARE SERVICES IN A LONG TERM 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 2016 COMMUNITY SERVICE REPORT CAN BE FOUND AT WWW.CHSBUFFALO.ORG. 0 0 17337831 15081422 FATHER BAKER IS A SKILLED NURSING FACILITY THAT TENDS PRIMARILY TO THE POOR AND ELDERLY AND IS LOCATED IN ERIE COUNTY, NEW YORK. IN 2016 OVER 49.70% OF THE RESIDENTS WERE COVERED BY MEDICAID; THIS 55.05% MEDICAID POPULATION EQUALED 27,415 MEDICAID DAYS. SEE COMMUNITY SERVICE PLAN AT CHSBUFFALO.ORG 17337831 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 13 0 1 343 1 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 MACHOLZCONTROLLER CHS FINANC 7168282974 144 GENESEE STREET BUFFALO NY 14203 MARK SULLIVAN EXEC. VP/COO, CHS 0.00 55.00 X X 0 868844 298589 JOYCE MARKIEWICZ PRESIDENT & CEO HOME & COM 0.00 55.00 X X 0 356171 48930 DAVID MACHOLZ OFFICER/DIRECTOR 0.00 55.00 X X 0 268947 35004 CHARLES J URLAUB DIRECTOR 0.00 55.00 X 0 435436 39771 JAMES MILLARD DIRECTOR 0.00 55.00 X 0 315450 151407 BRIAN BEITZ DIRECTOR 4.00 X 0 0 0 PETER BERGMANN DIRECTOR 0.00 55.00 X 0 436915 35599 MARTY BORYSZAK DIRECTOR 0.00 55.00 X 0 201548 5587 LYNN CATALANO DIRECTOR 2.00 X 0 0 0 JOHN DAVANZO DIRECTOR 2.00 X 0 0 0 GEORGIANA FORD ESQ DIRECTOR 2.00 X 0 0 0 MARK JAJKOWSKI DIRECTOR 0.00 55.00 X 0 98000 0 RAQUEL MARTIN DO DIRECTOR 2.00 X 0 0 0 GARY TUCKER DIRECTOR 0.00 55.00 X 0 327138 71712 MARY TURKIEWIECZ MD DIRECTOR 2.00 X 0 0 0 KATHERINE VANDERHORST DIRECTOR 2.00 X 0 0 0 MONSIGNOR ROBERT E ZAPFEL DIRECTOR 2.00 X 0 0 0 JOSEPH MCDONALD PRESIDENT AND CEO, CHS 0.00 55.00 X 0 1392009 382381 JAMES A DUNLOP JR EXEC VP, FINANCE/CFO 0.00 55.00 X 0 739625 344451 MARK WHEELER ADMINISTRATOR 55.00 X 142247 0 18163 THOMAS GLEASON COO, HOME AND COMMUNITY BASED CARE 0.00 55.00 X 0 164516 28581 MICHAEL MOLEY SR.VP HUMAN RESOURCES 0.00 55.00 X 0 639095 207439 DR MICHAEL GALANG SR.VP, CHIEF INFORMATION OFFICER 0.00 55.00 X 0 476331 191735 DR MICHAEL EDBAUER CHIEF CLINICAL OFFICERCHIEF CLINICAL OFFICER 0.00 28.00 X 0 187804 153258 NANCY SHEEHAN SR.VP LEGAL SERVICE, GENERAL COUNSEL 0.00 55.00 X 0 431398 147216 MARIA FOTI SR.VP,STRATEGIC PLANNING 0.00 55.00 X 0 347897 151644 AMY HIAM NURSE 55.00 X 104025 0 8559 246272 7687124 2320026 2 0 1 0 TELCO CONSTRUCTION 500 BUFFALO ROAD EAST AURORA NY 14052 CONSTRUCTION SERVICES 258622 TRY-LOCK ROOFING CO INC 440 NORTHWOOD DRIVE TONAWANDA NY 14223 CONSTRUCTION SERVICES 157787 AMN HEALTHCARE INC 2735 COLLECTION CENTER DRIVE CHICAGO IL 50693 HEALTHCARE SERVICES 107099 THOMANN ASPHALT PAVNG CORP 56 GUNNVILLE ROAD LANCASTER NY 14086 CONSTRUCTION SERVICES 105471 4 PRIVATE,MEDICARE,MEDICAID,& OTHER 623000 15017986 15017986 15017986 86535 86535 OTHER MISCELLANEOUS 900099 52450 52450 VENDING INCOME 900099 10986 10986 63436 15167957 15081422 0 86535 160411 160411 10221063 10221063 2412464 2412464 674594 662323 12271 71272 71272 160667 160667 510 510 13241 13241 355555 321029 34526 483748 483748 527476 524895 2581 SUPPLIES 1157291 1140424 16867 PURCHASES SERVICES 942021 760931 181090 PROVISIONS FOR BAD DEBT 280906 280906 369381 369381 17830600 17337831 492769 0 1568419 539340 3063493 3406251 45731 62687 18906810 14330382 4177542 4576428 13872025 13847612 22727210 22432318 2118611 1918781 14496080 16903307 16614691 18822088 X 6020148 3511396 92371 98834 6112519 3610230 22727210 22432318 X -2662643 -25218 185572 X 0 1 X 1 0 X 16678304 17002112 16247621 16134970 15017986 81080993 16678304 17002112 16247621 16134970 15017986 81080993 0 0 0 81080993 176770 113664 100086 47616 86534 524670 176770 113664 100086 47616 86534 524670 16855074 17115776 16347707 16182586 15104520 81605663 0.99360 0.99200 0.00640 0.00800 X 241550 241550 12895963 10134472 2761491 4083484 3332982 750502 1685813 862928 822885 4576428 OTHER RECEIVALBES 5965 DUE FROM AFFILIATES 7123 INTEREST IN NET ASSETS OF RELATED FOUNDATION 98834 ASSETS LIMITED AS TO USE 11475207 OTHER ASSETS 2260483 13847612 CURRENT PORTION OF LONT-TERM OBLIGATIONS 504591 DUE TO THIRD-PARTY PAYORS 3056787 DUE TO AFFILIATES 4899235 LONG-TERM OBLIGATIONS,NET 2995665 OTHER LONG-TERM LIABILITIES 5447029 16903307 15081423 0 15081423 86534 86534 15167957 17830600 0 17830600 0 17830600 PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 86,534. X X X X X X 0 1 0 0 0 0 0 0 0 MARK SULLIVAN EXEC. VP/COO, CHS 0 573434 0 176409 0 119001 0 273307 0 25282 0 1167433 0 58215 JOYCE MARKIEWICZ PRESIDENT & CEO HOME & COM 0 338634 0 0 0 17537 0 31113 0 17817 0 405101 0 0 DAVID MACHOLZ OFFICER/DIRECTOR 0 260167 0 0 0 8780 0 9691 0 25313 0 303951 0 0 CHARLES J URLAUB DIRECTOR 0 397617 0 0 0 37819 0 20655 0 19116 0 475207 0 0 JAMES MILLARD DIRECTOR 0 297882 0 0 0 17568 0 127811 0 23596 0 466857 0 0 PETER BERGMANN DIRECTOR 0 408137 0 0 0 28778 0 12153 0 23446 0 472514 0 0 MARTY BORYSZAK DIRECTOR 0 201401 0 0 0 147 0 4887 0 700 0 207135 0 0 GARY TUCKER DIRECTOR 0 259019 0 48355 0 19764 0 46832 0 24880 0 398850 0 0 JOSEPH MCDONALD PRESIDENT AND CEO, CHS 0 756655 0 306361 0 328993 0 355355 0 27026 0 1774390 0 101099 JAMES A DUNLOP JR EXEC VP, FINANCE/CFO 0 510950 0 157684 0 70991 0 320331 0 24120 0 1084076 0 52036 MARK WHEELER ADMINISTRATOR 141999 0 0 0 248 0 8181 0 9982 0 160410 0 0 0 THOMAS GLEASON COO, HOME AND COMMUNITY BASED CARE 0 164430 0 0 0 86 0 5611 0 22970 0 193097 0 0 MICHAEL MOLEY SR.VP HUMAN RESOURCES 0 377753 0 108014 0 153328 0 187632 0 19807 0 846534 0 35645 DR MICHAEL GALANG SR.VP, CHIEF INFORMATION OFFICER 0 353459 0 105025 0 17847 0 182634 0 9101 0 668066 0 34658 DR MICHAEL EDBAUER CHIEF CLINICAL OFFICERCHIEF CLINIC 0 94214 0 83957 0 9633 0 140631 0 12627 0 341062 0 29185 NANCY SHEEHAN SR.VP LEGAL SERVICE, GENERAL COUNSEL 0 324583 0 89242 0 17573 0 129403 0 17813 0 578614 0 29450 MARIA FOTI SR.VP,STRATEGIC PLANNING 0 259490 0 71592 0 16815 0 141148 0 10496 0 499541 0 23625 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 SERP JOSEPH MCDONALD $26,000 $97,946 MARK SULLIVAN $19,500 PETER BERGMANN $ 7,334 SCHEDULE J PART II B CERTAIN PORTIONS OF THE INCENTIVE COMPENSATION PAID IN 2016 ARE A RESULT OF THE TARGETS THAT WERE ACHIEVED IN PREVIOUS YEARS. DEFERRED COMPENSATION REPORTED IN 2016 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 2016. 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 86475 CORPORATE NURSE EDUCATOR 0 KATHLEEN ZAPFEL SISTER-IN-LAW OF BOD, MSGR. ROBERT ZAPFEL 70649 HR EMPLOYEE OF CHS 0 FORM 990, PART VI, SECTION A, LINE 6 CHS HAS TWO MEMBERS: TRINITY HEALTH, AND THE DIOCESE OF BUFFALO, NY. EACH MEMBER IS ABLE TO PARTICIPATE EQUALLY IN ELECTING THE GOVERNING BODY, APPROVING SIGNIFICANT DECISIONS OF THE GOVERNING BODY, AND IN RECEIVING A SHARE OF NET ASSETS UPON DISSOLUTION, ACCORDING TO THE CHS BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE CHS BYLAWS, EACH MEMBER IS EQUALLY ALLOWED TO APPOINT ONE REPRESENTATIVE AND ONE ALTERNATIVE REPRESENTATIVE TO SERVE ON THE CORPORATE MEMBER COUNCIL AND TO SERVE AS A VOTING DIRECTOR ON THE CHS 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 BY THE MANAGER, 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 2016, 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 179,108. CHANGE IN INTEREST IN NET ASSETS OF SUPPORTING FOUNDATION 6,464. CATHOLIC HEALTH SYSTEM INC 144 GENESEE STREET BUFFALO NY 14203 222565278 HEALTH CARE DELIVERY SYSTEM NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 ACUTE CARE HOSPITAL NY 501(C)(3) 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) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVENUE KENMORE NY 14217 160762843 ACUTE CARE HOSPITAL NY 501(C)(3) 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) 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) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS HOME OF WILLIAMSVILLE 147 REIST STREET WILLIAMSVILLE NY 14221 160743153 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS OF BUFFALO INC 34 BENWOOD AVENUE BUFFALO NY 14214 161523535 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501(C)(3) 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) 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) 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) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 CHS CONTINUING CARE FOUNDATION 144 GENESEE STREET BUFFALO NY 14203 200947831 FOUNDATION NY 501(C)(3) LINE 7 CATHOLIC HEALTH SYSTEM INC 0 OLV RENAISSANCE CORPORATION 144 GENESEE STREET BUFFALO NY 14203 200167745 REAL ESTATE HOLDING COMPANY NY 501(C)(3) 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) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 TRINITY MEDICAL WNY PC 2625 HARLEM ROAD CHEEKTOWAGA NY 14225 272576645 PRIMARY CARE PROVIDER NY 501(C)(3) LINE 12A, I CATHOLIC HEALTH SYSTEM INC 0 KMH HOMES INC 144 GENESEE STREET BUFFALO NY 14203 161387890 REAL ESTATE HOLDING COMPANY NY 501(C)(3) 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) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1