2016-10-31T12:53:44-05:00 2015-12-31 990 2015-01-01 160743187 Sisters of Charity Hospital SIST 7168282974 144 Genesee St Finance 4th Fl Buffalo NY 14203 DAVID MACHOLZ CHS VP Finance/Corp Controller 7168282974 2016-04-22 2015 2017-02-10 21:41:12Z Joseph D McDonald 144 Genesee Street Buffalo NY 14203 322041476 0 X www.chsbuffalo.org X 1849 NY 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 2015 Community Service Plan can be found at www.chsbuffalo.org. 13 9 2581 1082 0 0 1282534 208632 317819721 314306088 270223 291165 6305328 7235591 325677806 322041476 0 0 0 0 153947466 158307832 0 0 0 164172668 165394645 318120134 323702477 7557672 -1661001 304757941 319784919 218281686 234146471 86476255 85638448 None 0 0 174716638 195822810 Inpatient Services:67,378 Acute Care Patient Days18,593 Newborn Patient Days28,509 Skilled Nursing Patient Days5,370 I/P Surgeries 96901371 108762786 Outpatient Services:63,212 ED Visits net of Admits268,830 Referred Ambulatory Visits10,253 Operating Room8,850 G.I. Laboratory1,726 Interventional Radiology (IXR)1,127 Ambulatory Surgery Center349 Transfusion 8703745 9720491 Primary Care Clinics:24,096 Clinic/Prmiary Care Center Visits321,788 Substance Visits 280321754 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 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 1 266 0 1 2581 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X David Macholz CHS VP Finance Corporate Controller Catholic 7168282974 Health- 144 Genesee StreetFinance Buffalo NY 14203 Mark Sullivan Executive VP / COO 0.00 55.00 X X 0 831321 134963 Peter Bergmann President, and CEO Sisters 55.00 0.00 X X 495499 0 23556 David Macholz Treasurer 0.00 55.00 X X 0 329578 24203 James Millard Director 0.00 55.00 X 0 419950 34672 Charles Urlaub Director 0.00 55.00 X 0 463086 36126 Gary Tucker Director 0.00 55.00 X 0 440125 68790 Dr Michael Edbauer Director 0.00 27.50 X 0 362923 70688 Joyce Markiewicz Director 0.00 55.00 X 0 367821 35357 Brian Beitz Director 4.00 0.00 X 0 0 0 Frances Crosby RN PhD Director 2.00 0.00 X 0 0 0 Richard Curran MD Director 2.00 0.00 X 0 0 0 John Davanzo Director 2.00 0.00 X 0 0 0 Joseph Gelormini MD Director 2.00 0.00 X 0 0 0 Mark Jajkowski Director 2.00 0.00 X 0 0 0 Raquel Martin DO Director 2.00 0.00 X 0 0 0 Sherry Pomeroy PhD Director 2.00 0.00 X 0 0 0 Mary Turkiewiecz MD Director 2.00 0.00 X 0 0 0 Monsignor Robert E Zapfel Director 2.00 0.00 X 0 0 0 Joseph McDonald President and CEO, CHS 0.00 55.00 X 0 1582915 204904 James A Dunlop Jr Executive VP, Finance / CFO 0.00 55.00 X 0 887602 110616 Dr Brian D'Arcy Senior VP, Medical Affairs 0.00 55.00 X 0 588913 86724 Martin Borzyak COO, Sisters/SJC 55.00 0.00 X 192575 0 15178 Maria Foti Sr. VP, Strategic Planning 0.00 55.00 X 0 347846 63087 Dr Michael Galang Sr. VP, Chief Information Officer 0.00 55.00 X 0 509718 81005 Michael Moley Sr.VP, Human Resources 0.00 55.00 X 0 687938 105480 Dr Nady Shehata VP, Medical Affairs 55.00 0.00 X 332925 0 33351 Nancy Sheehan SVP Legal Service, General Counsel 0.00 55.00 X 0 380104 52928 Dr Ali Ghomi Physician 55.00 0.00 X 551331 0 25025 Dr Bruce Rodgers Physician 55.00 0.00 X 357440 0 18427 Dr Anthony Pivarunus Physician 55.00 0.00 X 321572 0 26533 Dr Margaret McDonnell Physician 55.00 0.00 X 322069 0 34102 Dr Jack R Lawler Physician 55.00 0.00 X 299188 0 25396 2872599 8199840 1311111 81 0 1 0 Sodexho Inc & Affiliates PO Box 81049 Woburn MA 018131049 Environmental Services 3204386 Quest Diagnostics (Chicago) 2178 Collection Center Drive Chicago IL 60693 Laboratory Services 1732545 Buffalo Medical Group 85 High Street Buffalo NY 14203 Physician Services 1378384 Renova 4 Executive Circle Suite 185 Irvine CA 92614 Consulting Services 1251565 Siemens Medical Solutions 51 Valley Stream Parkway Malverne PA 19355 Maintenance Services 1184013 35 208632 208632 Patient Services 900099 201057325 201057325 Medicaid/Medicare 900099 113248763 113248763 314306088 285515 285515 655875 0 655875 655875 655875 5650 0 5650 5650 5650 Shared Services 900099 3763306 3763306 Cafeteria 900099 945714 945714 340b Pharmacy 900099 643730 643730 1226966 1226966 6579716 322041476 318069394 0 3763450 119876833 110268500 9608333 10457321 9696353 760968 20064097 18469082 1595015 7909581 7277523 632058 67409 67409 29180 29180 11392540 9189664 2202876 6477 4860 1617 8554125 4130767 4423358 392089 88812 303277 3319648 2488853 830795 63051 58300 4751 118639 114782 3857 1541445 1528015 13430 13012130 11069979 1942151 4775554 3543562 1231992 Shared Service 53307961 39233408 14074553 Medical Supplies 51730644 52457550 -726906 Purchase Services & Oth 14115547 8337823 5777724 Non Medical Supplies 2968206 2363921 604285 323702477 280321754 43380723 0 1737371 4316 126920831 134354409 140167 168117 42153094 42507801 6377952 7130407 1365035 1473319 159360147 85461127 76256764 73899020 49806727 60247530 304757941 319784919 35893871 37843098 627297 573443 29863855 28129362 8342350 7834568 143554313 159766000 218281686 234146471 X 83901801 82804142 2451931 2711783 122523 122523 86476255 85638448 304757941 319784919 X -1661001 823194 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 29180 29180 0 Part II-B, Line 1: Lobbying expenses represent the total of dues paid to national and state associations that is specifically allocable to lobbying. Sisters of Charity 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. 1958968 1958968 25708857 16479209 9229648 37974214 11204307 44902307 89964740 57777611 14054729 3753368 3753368 73899020 Other Receivables 3070825 Due from Affiliates 11415206 Insurance Recoveries 32903597 Investment in Caritas Medical Arts Building 21834 Investment in Net Assets of the SOC Foundation 8307147 Assets Whose Use is Limited - DSRIP 4528921 60247530 Due to Affiliates 27384752 Pension Obligation 77019326 Asset Retirement Obligation 2624468 L/T Disposables 589217 L/T General Liability IBNR 32422731 L/T Workers Comp IBNR 15196585 DSRIP - Funds 4528921 159766000 322327039 490615 490615 321836424 205052 205052 322041476 324734881 1032404 1032404 323702477 0 323702477 Part XI, Line 2d - Other Adjustments: SOC Foundation Revenue Part XI, Line 4b - Other Adjustments: Distributions from Foundations Grant Revenue Part XII, Line 2d - Other Adjustments: Foundation Expense less the SOC Foundation Contributions to the Hospital 1 1 X 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2266855 158340 2108515 0.00650 72877129 51099069 21778060 0.06730 75143984 51257409 23886575 0.07380 1371117 1371117 0.00420 11550895 2273583 9277312 0.02870 10885024 5950706 4934318 0.01520 572945 572945 0.00180 322464 322464 0.00100 24702445 8224289 16478156 0.05090 99846429 59481698 40364731 0.12470 34890 34890 0.00010 34890 34890 0.00010 0 7841960 2240593 45610513 45734245 -123732 X 1 1 2 1 Sisters of Charity Hospital 2157 Main St Buffalo NY 14214 www.chsbuffalo.org 1401013H X X X X X Ambulatory Surgery - Multi Speciality 2 Sisters of Charity Hospital - St Joseph Campus 2605 Harlem Road Cheektowaga NY 14225 www.chsbuffalo.org X X X X X Ambulatory Surgery - Multi Speciality Sisters of Charity Hospital 0 0 1 X X X X X X X X X 13 1 1 1 1 X http://chsbuffalo.org/Community X 1 13 1 http://chsbuffalo.org/Community 0 0 1 X 110.000000000000 500.000000000000 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 1 X 0 X X X X 1 X 0 0 Part V, Section A: Sisters of Charity Hospital continued - Audiology O/P Chemical Dependence - Rehabilitation O/P Clinical Laboratory Service Clinic Part Time Services Coronary Care CT Scanner Dental O/P Emergency Department Health Fairs O/P Intensive Care Magnetic Resonance Imaging Maternity Medical Social Services Medical/Surgical Neonatal Continuing Care Neonatal Intensive Care Neonatal Intermediate Care Nuclear Medicine - Diagnostic Nuclear Medicine - Therapeutic Pediatric O/P Pharmaceutical Service Physical Medical Rehabilitation Physical Medicine and Rehabilitation O/P Podiatry O/P Prenatal O/P Primary Medical Care O/P Psychology O/P Radiology - Diagnostic Renal Dialysis - Acute Therapy - Occupational O/P Therapy - Physical O/P Therapy - Speech Language Pathology Therapy - Vocational Rehabilitation O/P Sisters of Charity Hosptial - St. Joseph Campus continued - Clinic Part Time Services Clinical Laboratory ServicesCoronary Care CT Scanner Emergency Department Intensive Care Magnetic Resonance Imaging Medical Social Services Medical/Surgical Nuclear Medicine - Diagnostic Outpatient Surgery Pharmaceutical Service Primary Medical Care O/P Radiology - Diagnostic Renal Dialysis - Acute Therapy - Speech Language Pathology Health Fairs O/P O/P Surgery Part V, Section B Facility Reporting Group A Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 5: 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: * Survey of community representatives was conducted to ascertain their perception of the County's health needs * Facilitated group discussions with community and public health experts* Focus group with Catholic Health's Emergency Department Task Force* Erie County Department of Health created community-wide health needs survey* Erie County Department of Health led community forum* Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors. Group Interview Participants: Catholic Charities Alzheimer's Association Brylin Hospitals Harvest House Spectrum Human Services Buffalo State College, Center for Community Health Center Health and Social Research Erie County DOH Wellness Institute American Cancer Society P2 Collaborative of WNY Healthcare Community Consultant City of Buffalo community Physician representation Erie County Department of Health Community Meeting Participants FDA Cancer Service Program of Erie County Buffalo State College Catholic Health P2 Collaborative of WNY American Cancer Society Monroe Plan UBMD Wellness Institute EPIC M.E.D.-V.A.R. Consulting Kaleida Buffalo Prenatal-Perinatal Network Erie County DOH United Way Prevention Focus Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 6a: Sisters Hospital was conducted with Sisters St. Joseph Campus Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 6b: Sisters Hospital was conducted with Mercy Hospital and Kenmore Mercy Hospital as well as the Erie County Department of Health. Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph 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. Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 16i: Includes information in both English and Spanish on all signage and brochures for financial assistance. Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 22d: Highest volume commercial payor rate. 11 1 - Harvey Austin School #97 1405 Sycamore St Buffalo NY 14211 Extension Clinic: Nursing, O/P, Immunology, Veneral Disease Prevention 2 - Pathways Methadone 158 Holden Avenue Buffalo NY 14214 Extension Clinic: Methadone Maintenance O/P, Part 822 Opiode Treatment progr 3 - Rochester Pathways 79 Howell Street Rochester NY 14614 Extension Clinic: Methadone Maintenance O/P 4 - Sisters Hospital STAR Program 1595 Bailey Ave Buffalo NY 14212 Chemical Dependence 5 - St Vincents Health Center 1500 Broadway Avenue Buffalo NY 14212 Extension Clinic: Therapy Physical O/P, Primary Medical Care O/P, Prenatal O 6 - Sisters Hospital Star Program 3730 Sheridan Dr Amherst NY 14226 Extension Clinic: Methadone Maintenance O/P, Chemical Dependence-Rehab O/P 7 - West Hertel Academy 489 Hertel Ave Buffalo NY 14212 Extension Clinic: Nursing, O/P, Immunology, Veneral Disease Prevention 8 - Southside Elementary School #93 430 Southside Pkwy Buffalo NY 14210 Extension Clinic: Nursing, O/P, Immunology, Veneral Disease Prevention 9 - St Catherine Laboure Health Care Center 2157 Main Street Buffalo NY 14214 LTC: Adult Day Healthcare, Clinical Lab Srvc O/P, Radiology-Diagnostic O/P 10 - CHS Partners in Rehab 6199 Transit Rd Depew NY 14043 Extension Clinic: Occupational O/P, PT O/P 11 - Sisters Central Park Diagnostic Center 34 Benwood Ave Buffalo NY 14214 Clinical Lab Service O/P, Ragiology-Diagnostic O/P Part I, Line 6a: Sisters 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: Community Building Activities for Sisters Hospital included Community Support - Boards and Advisory Councils for $34,890. Part III, Line 2: The amount in Part III line 2 is the actual bad debt expenses of $7,841,960 written down to cost. 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 10/1/2014 to 9/30/2015 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. 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 use of a sophisticated 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 available to make a determination of their eligibility" is not relevant. The organization's financial statements do not include a footnote that describes bad debt expense, but the financial statements account for bad debt expenses in the statement of operations as actual expenses written off and an estimate 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: Sisters 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, Catholic Health utilizes multiple methods to assess the health care needs of the communities it serves, including:* Evaluations administered by 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 service line leaders 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 service line leaders 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, 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 regional planning initiatives that look at the needs of the broader community; * Information management obtains from administrative data and payer mix to assist in evaluating the health needs and trends of the community; and* Input from Catholic Health Board including Board Committee (e.g. Mission Integration Committee). Part VI, Line 3: Catholic Health's Mercy Hospital, Sisters Hospital and Kenmore Mercy Hospital inform and educate patients and persons who may be billed for medical services about their eligibility for assistance under federal, state, or local government programs or our own Healthcare Assistance Program (HAP) in a variety of ways. For example, Sisters Hospital, like our other facilities, has posters and brochures available, which include eligibility and contact information for the Financial Clearance staff. 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. 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, please call (716) 601-3600. Thank you." For free, confidential assistance in applying for financial aid, patients can also call our Financial Clearance department 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. Additionally, as part of our case management services, we 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. There is also information about our financial assistance program in our patient handbooks and posted on the Catholic Health System website. Part VI, Line 4: The System's primary service area is Erie County, which accounts for 90% of its inpatient admissions and 85% of ambulatory care visits. Erie County 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. 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 (Mercy Hospital, Sisters Hospital, and 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 (Mercy Hospital, Sisters Hospital, 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 five 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, 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 2015, the Catholic Health System provided more than $95 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 Buffalo City Mission, Friends of Night People, 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; and * Supporting nationally recognized "green" initiatives to remain good stewards of our natural resources and protect the environment. Part VI, Line 6: In 2013, Catholic Health (the System), including Kenmore Mercy Hospital, Mercy Hospital of Buffalo, Sisters of Charity Hospital, and Sisters of Charity Hospital St. Joseph Campus, jointly conducted a Community Health Needs Assessment (CHNA) to better understand the health needs of the community they serve and to fulfill the requirements of both the Internal Revenue Service (IRS) and the New York State Department of Health (DOH). To ensure the assessment was comprehensive, input from the public and several community organizations was solicited. As part of this coordinated initiative, the System developed a three-year Implementation Strategy to address the health needs identified in the assessment. Part VI, Line 7, Reports Filed With States NY X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 Mark Sullivan Executive VP / COO 0 504363 0 208657 0 118301 0 112959 0 22004 0 966284 0 0 Peter Bergmann President, and CEO Sisters 403466 0 63731 0 28302 0 3149 0 20407 0 519055 0 0 0 David Macholz Treasurer 0 210123 0 110699 0 8756 0 1925 0 22278 0 353781 0 0 James Millard Director 0 330958 0 71925 0 17067 0 23675 0 10997 0 454622 0 0 Charles Urlaub Director 0 387431 0 40588 0 35067 0 15442 0 20684 0 499212 0 0 Gary Tucker Director 0 243236 0 173623 0 23266 0 43271 0 25519 0 508915 0 0 Dr Michael Edbauer Director 0 238222 0 111206 0 13495 0 59457 0 11231 0 433611 0 0 Joyce Markiewicz Director 0 280167 0 70559 0 17095 0 14186 0 21171 0 403178 0 0 Joseph McDonald President and CEO, CHS 0 834985 0 536131 0 211799 0 180650 0 24254 0 1787819 0 0 James A Dunlop Jr Executive VP, Finance / CFO 0 501920 0 315368 0 70314 0 89631 0 20985 0 998218 0 0 Dr Brian D'Arcy Senior VP, Medical Affairs 0 440939 0 95588 0 52386 0 65094 0 21630 0 675637 0 0 Martin Borzyak COO, Sisters/SJC 179454 0 12981 0 140 0 2373 0 12805 0 207753 0 0 0 Maria Foti Sr. VP, Strategic Planning 0 232624 0 98515 0 16707 0 54191 0 8896 0 410933 0 0 Dr Michael Galang Sr. VP, Chief Information Officer 0 343441 0 149570 0 16707 0 78087 0 2918 0 590723 0 0 Michael Moley Sr.VP, Human Resources 0 351252 0 175656 0 161030 0 82554 0 22926 0 793418 0 0 Dr Nady Shehata VP, Medical Affairs 302608 0 29543 0 774 0 14489 0 18862 0 366276 0 0 0 Nancy Sheehan SVP Legal Service, General Counsel 0 290590 0 72447 0 17067 0 43525 0 9403 0 433032 0 0 Dr Ali Ghomi Physician 370562 0 180589 0 180 0 5353 0 19672 0 576356 0 0 0 Dr Bruce Rodgers Physician 350002 0 6250 0 1188 0 18038 0 389 0 375867 0 0 0 Dr Anthony Pivarunus Physician 303863 0 17295 0 414 0 3977 0 22556 0 348105 0 0 0 Dr Margaret McDonnell Physician 321295 0 0 0 774 0 15216 0 18886 0 356171 0 0 0 Dr Jack R Lawler Physician 298000 0 0 0 1188 0 23061 0 2335 0 324584 0 0 0 Part I, Line 1a One Officer received a tax indemnification and gross-up payment for reimbursement of withholding taxes in conjunction with certain taxable benefits paid on behalf of employee. 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 Peter Bergmann $7,334.00 Certain portions of the incentive compensation paid in 2015 are a result of the targets that were achieved in 2014. Deferred compensation reported in 2015 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 2015. 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 64983Q5S4 2006-11-29 30295000 See Part VI 0 0 0 B Dormitory Authority of the State of New York 146000293 64983Q5U9 2006-11-29 8435000 See Part VI 0 0 0 C Buffalo and Erie County Industrial Land Development Corporation 222413596 NoneAvail 2015-04-30 4725000 See Part VI 0 0 0 A 30295000 1120911 179286 28994803 1994 1 0 1 1 B 8435000 341581 49919 8043500 2005 1 0 1 1 C 5239482 344971 153575 4605126 135810 2014 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 1 1 1 0 0.01980 0.01980 0 0 1 A 1 1 1 HSBC Bank NA 18.500000000000 0 1 0 0 1 B 1 1 1 JP Morgan Chase 18.500000000000 0 1 0 0 1 C 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 Part I A (f) Description of Purpose: To refund Sisters of Charity of Buffalo Insured Revenue Bonds, Series 2003, which were bonds issued for the purpose of refunding a series of bonds issued in 1991, the proceeds of which were applied to finance the construction and renovation of the Sisters of Charity facilities and to refinance outstanding indebtedness. Part I B (f) Description of Purpose: To finance the cost of the St. Joseph Campus emergency room expansion project. Part IV 4 (e) The interest rate swaps through HSBC Bank and JP Morgan Chase associated with the 2006 series were unwound and terminated on 11/26/14. Part I C ( 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 C (f) Description of Purpose: To finance the costs of improvements made to the Ambulatory Surgery Center at Sisters Hospital, St. Joseph Campus. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 80304 Corporate Nurse educator 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 65837 HR Employee of CHS 0 Form 990, Part VI, Section A, line 6 CHS has three members: Ascension Health, 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 up to three individuals to act as its representatives on the Corporate Member Board, and in undertaking any action in its capacity as a Member. The Corporate Member Board oversees the governance of the Catholic Health System. Form 990, Part VI, Section A, line 7b Each member is entitled to one vote on each matter properly submitted at any membership meeting, and the members also have reserve powers which allow approval for certain business events and ratification of certain business transactions. Form 990, Part VI, Section B, line 11 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. 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 2015, 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: Pension Liability Adjustments 6,932,002. Equity Transfer to Affiliates -6,569,645. Change in unrestricted interest in Net Assets of Sisters Foundation -329,974. Interest Rate Swap Adjustment 530,959. Change in Temporary Restricted interest in Net Assets of Sisters Foundation 259,852. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501(c)(3) Line 9 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 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 9 Catholic Health System Inc 0 St Elizabeth Home for the Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501(c)(3) Line 9 Catholic Health System Inc 0 St Francis Home of Williamsville 147 Reist St Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501(c)(3) Line 9 Catholic Health System Inc 0 St Francis of Buffalo Inc 34 Benwood Ave Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501(c)(3) Line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501(c)(3) Line 9 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) Line 9 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 9 Catholic Health System Inc 0 McAuley Seton Home Care 144 Genesee Street Buffalo NY 14203 161310062 Home Care Provider NY 501(c)(3) Line 9 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 9 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 Rd Cheektowaga NY 14225 272576645 Primary Care Provider NY 501(c)(3) Line 11a, I Catholic Health System Inc 0 Sisters Hospital Foundation 2130 Main Street Buffalo NY 14214 222283077 Foundation NY 501(c)(3) Line 7 Sisters of Charity Hospital 0 KMH Homes Inc 144 Genesee Street Buffalo NY 14203 161387890 Real Estate Holding Company NY 501(c)(3) Line 9 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 Caritas Medical Arts Building LLC 350 Essjay Road Suite 101 Williamsville NY 14221 161521486 Rental Real Estate NY Related -5234 -2136 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1