2015-10-29T08:52:17-05:00 2014-12-31 990 2014-01-01 200198518 Catholic Health System Infusion Pharmacy Inc CATH 7166854870 144 Genesee Street Buffalo NY 14203 David P Macholz VP Finance, Corp Controller 7168282974 2015-10-29 2014 2016-02-25 16:41:14Z Joseph D McDonald 144 Genesee Street Buffalo NY 14203 10437734 0 X www.chsbuffalo.org X 2003 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in a 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 2014 Community Service Plan can be found at www.chsbuffalo.org. 30 20 33 0 0 0 0 0 9173440 10431317 2469 6417 0 0 9175909 10437734 0 0 0 0 2136636 2431971 0 0 0 6348921 7503058 8485557 9935029 690352 502705 3979113 4259765 1657806 1487945 2321307 2771820 X The Catholic Health System (CHS) Mission is to provide quality healthcare services in a 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 2014 Community Service Plan can be found at www.chsbuffalo.org. 0 0 8695103 10437734 Catholic Health system Infusion Pharmacy provides home health infusion care and supportive services to individuals throughout Western New York as well as pharmaceutical needs to Catholic Health System long term care facilities. Committed to a common mission, Western New York's Catholic Health providers continue the healing mission of Jesus. Seeking to improve the health of individuals and communities, we provide high quality service that is holistic, compassionate, and respectful of human dignity. Central to this endeavor is the service of persons who are poor and disadvantaged. For more detailed information, the 2014 Catholic Health Community Service report can be found at www.chsbuffalo.org. 8695103 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 3 0 33 1 0 0 0 0 0 0 0 0 X 30 20 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X David P Macholz VP Finance Corp C 7168282974 144 Genesee Street 4th Floor Buffalo NY 14203 Joseph McDonald President and CEO, CHS 1.00 37.50 X X 0 1344183 55939 Mark Sullivan Executive VP/COO, CHS 1.00 37.50 X X 0 716018 47406 Joyce Markiewicz President and CEO Home and Community Based Care 1.00 37.50 X X 0 336389 49581 Louis Baumann MD Director 1.00 X 0 0 0 Brian Beitz Director 1.00 X 0 0 0 Peter Bergmann Director 1.00 37.50 X 0 521653 39456 Frances Crosby RN PhD Director 1.00 X 0 0 0 Richard Curran MD Director 1.00 X 0 0 0 John Davanzo Director 1.00 X 0 0 0 Dennis Dombek Director 1.00 X 0 0 0 David Durante MD Director 1.00 18.80 X 0 113038 0 Dr Michael Edbauer Director 1.00 18.80 X 0 306246 23873 Joseph Gelormini MD Director 1.00 X 0 0 0 Nils Gunnersen Director 1.00 37.50 X 0 263110 115810 Dennis Horrigan Director 1.00 X 0 0 0 Mr William Lawley Jr Director 1.00 X 0 0 0 Li Lin PhD Chariman of Ministry Services 1.00 X 0 0 0 David Macholz Office/Director 1.00 37.50 X X 0 253185 42733 Judith Maness Director 1.00 X 0 0 0 James Manzella Director 1.00 X 0 0 0 Raquel Martin DO Director 1.00 X 0 0 0 James Millard Director 1.00 37.50 X 0 360108 217116 Michael Montante Director 1.00 X 0 0 0 Brian O'Herron Director 1.00 X 0 0 0 Michael Osborne Director 1.00 37.50 X 0 236642 40868 Mark Podlas MD Director 1.00 X 0 0 0 Sherry Pomeroy PhD Director 1.00 X 0 0 0 Donald Slate MD Director 1.00 X 0 0 0 Gary Tucker Director 1.00 X 0 0 0 Mary Tukiewiecz MD Director 1.00 X 0 0 0 Charles J Urlaub Office/Director 1.00 37.50 X X 0 500168 48207 Sr Sheila Marie Walsh Director 1.00 X 0 0 0 Cynthia Zane EdD Director 1.00 X 0 0 0 Monsignor Robert E Zapfel Director 1.00 X 0 0 0 James A Dunlop Jr Executive VP, Finance/CFO 1.00 37.50 X 0 610886 180721 Michael Moley Sr.VP, Human Resources 1.00 37.50 X 0 602383 52698 John Stavros Sr.VP, Marketing/PR 1.00 37.50 X 0 299464 45380 Bartholomew Rodrigues Sr.VP, Mission Integration 1.00 37.50 X 0 256461 42237 Dr Michael Galang Chief Information Officer 1.00 37.50 X 0 415734 36231 Nancy Sheehan SVP Legal Service, General Councel 1.00 37.50 X 0 340246 41133 Maria Foti Sr. VP, Strategic Planning 1.00 37.50 X 0 302471 40116 Mark Czaplicki Manager Pharmacist 37.50 X 101095 0 1907 Paul Bembinista Pharmacist 37.50 X 143398 0 92448 Kelly Ruffner Pharmacist 37.50 X 125402 0 27745 Edward Dybala Supervisor Pharmacist 37.50 X 141386 0 2655 511281 7778385 1244260 4 0 1 0 0 Home Care Infusion Services 621610 5447224 5447224 Oral Pharmacy Services 621610 4984093 4984093 10431317 6417 6417 10437734 10437734 0 0 2024394 1315856 708538 54737 35579 19158 206458 134198 72260 146382 95148 51234 87099 41675 45424 6723809 6606294 117515 137622 137622 69456 61523 7933 5829 5829 13469 13469 53888 38225 15663 5839 5839 Bad Debt 225708 225708 Outside Contracted Serv 139866 139866 Dues and Subscriptions 19548 19548 20925 3275 17650 9935029 8695103 1239926 0 1876493 1875071 900985 1284518 637150 557734 23962 22472 245526 134624 108727 110902 140000 140000 291796 269068 3979113 4259765 1537169 1468029 120637 19916 1657806 1487945 X 0 0 0 0 709894 450513 2321307 2771820 3979113 4259765 X 502705 -52192 X 0 1 X 1 1 1 X 3137002 3946183 7847221 9173440 10431317 34535163 3137002 3946183 7847221 9173440 10431317 34535163 0 0 0 34535163 630 731 2059 2469 6417 12306 630 731 2059 2469 6417 12306 3137632 3946914 7849280 9175909 10437734 34547469 0.99960 0.99980 0.00040 0.00020 X 245526 134624 110902 110902 Workers Comp Recovery 5056 Medical Malpractice Recovery 14860 Investment in Joint Venture 249152 269068 Workers Comp Recovery 5056 Medical Malpractice Recovery 14860 19916 10437734 0 10437734 0 10437734 9935029 0 9935029 0 9935029 X X X X X X 0 1 0 0 0 0 0 0 0 Joseph McDonald President and CEO, CHS 0 748734 0 280841 0 314608 0 34858 0 21081 0 1400122 0 0 Mark Sullivan Executive VP/COO, CHS 0 467326 0 113773 0 134919 0 28266 0 19140 0 763424 0 0 Joyce Markiewicz President and CEO Home and Community 0 263677 0 33005 0 39707 0 31253 0 18328 0 385970 0 0 Peter Bergmann Director 0 391424 0 84427 0 45802 0 20550 0 18906 0 561109 0 0 Dr Michael Edbauer Director 0 228520 0 52981 0 24745 0 13975 0 9898 0 330119 0 0 Nils Gunnersen Director 0 223043 0 0 0 40067 0 115556 0 254 0 378920 0 0 David Macholz Office/Director 0 195706 0 31223 0 26256 0 22835 0 19898 0 295918 0 0 James Millard Director 0 271916 0 48125 0 40067 0 216802 0 314 0 577224 0 0 Michael Osborne Director 0 181206 0 29101 0 26335 0 21392 0 19476 0 277510 0 0 Charles J Urlaub Office/Director 0 369957 0 72644 0 57567 0 29025 0 19182 0 548375 0 0 James A Dunlop Jr Executive VP, Finance/CFO 0 400137 0 123435 0 87314 0 162397 0 18324 0 791607 0 0 Michael Moley Sr.VP, Human Resources 0 331461 0 85478 0 185444 0 33027 0 19671 0 655081 0 0 John Stavros Sr.VP, Marketing/PR 0 213088 0 44797 0 41579 0 24145 0 21235 0 344844 0 0 Bartholomew Rodrigues Sr.VP, Mission Integration 0 170867 0 45920 0 39674 0 23834 0 18403 0 298698 0 0 Dr Michael Galang Chief Information Officer 0 326118 0 49909 0 39707 0 28978 0 7253 0 451965 0 0 Nancy Sheehan SVP Legal Service, General Councel 0 291960 0 28135 0 20151 0 33594 0 7539 0 381379 0 0 Maria Foti Sr. VP, Strategic Planning 0 214638 0 48282 0 39551 0 33051 0 7065 0 342587 0 0 Paul Bembinista Pharmacist 126329 0 0 0 17069 0 74168 0 18280 0 235846 0 0 0 Kelly Ruffner Pharmacist 112331 0 0 0 13071 0 9679 0 18066 0 153147 0 0 0 Part I, Line 4b Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Joseph McDonald-Pension Gap: $26,000.00 CHE SERP: $117,093.00 Mark Sullivan-Pension Gap: $19,500.00 Peter Bergmann-Pension Gap: $7,334.00 James Manzella Acute Care Board Member 161739 Key Employee of Manzella Marketing 0 Susan Urlaub Wife of Mercy CEO, CJ Urlaub 82776 Corporate Nurse educator 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 70537 HR Employee of CHS 0 Marie Packard Daughter of BOD, Dennis Dombek 84949 Mercy Physical Therapist 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 In 2014, 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; COO; CFO; CEO's for each Ministry; and all Senior Vice Presidents. The Compensation Committee provides oversight to management decisions which are based on outlines approved by the committee, and performs a review of data. The outcome of these meetings is documented. 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 -52,192. Catholic Health System Inc 144 Genesee Street Buffalo NY 14203 222565278 Health Care Delivery System NY 501 c 3 Schedule A line 9 N/A 0 Mercy Hospital of Buffalo 545 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 the Franciscan Sisters 291 North Street Buffalo NY 14201 160813142 Skilled Nursing Facility NY 501 c 3 Schedule A 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 Schedule A line 9 Catholic Health System Inc 0 St Francis Home of Williamsville 147 Reist Street Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Francis of Buffalo Inc 34 Benwood Avenue Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 WNY Catholic Long Term Care Inc 6400 Powers Road Orchard Park NY 14127 161434368 Skilled Nursing Facility NY 501 c 3 Schedule A 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 Schedule A 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 Schedule A line 9 Catholic Health System Inc 0 CHS Continuing Care Foundation 144 Genesee Street Buffalo NY 14203 200947831 Foundation NY 501 c 3 Schedule A 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 Schedule A 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 Schedule A 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 Schedule A line 11 Catholic Health System Inc 0 KMH Homes Inc 291 North Street Buffalo NY 14201 161387890 Real Estate Holding Company NY 501 c 3 Schedule A line 9 Catholic Health System Inc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0