KENMORE MERCY HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- KENMORE MERCY HOSPITAL (EIN 16-0762843)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-10-30
- IRS object ID
- 201433039349300913
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-10-30T10:05:57-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160762843 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kenmore Mercy Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KENM | BusinessNameControlTxt |
| Phone | 7168282993 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 144 Genesee Street Finance 4th | AddressLine1 |
| Address Line2 | Floor | AddressLine2 |
| City | Buffalo | City |
| State | NY | State |
| ZIP Code | 14203 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | David P Macholz | PersonNm |
| Person Title | VP Finance/Corp Controller | PersonTitleTxt |
| Phone | 7168282974 | PhoneNum |
| Signature | 2014-10-30 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Joseph D McDonald | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 144 Genesee Street Administration | AddressLine1 |
| Address Line2 | 6th Floor | AddressLine2 |
| City | Buffalo | City |
| State | NY | State |
| ZIP Code | 14203 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $154,073,777 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.chsbuffalo.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1957 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | 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 2013 Community Service Plan can be found at www.chsbuffalo.org. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 1098 | TotalEmployeeCnt |
| Total Volunteers | 300 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $311,010 | PYContributionsGrantsAmt |
| CY Contributions Grants | $329,260 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $148,925,847 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $150,959,596 | CYProgramServiceRevenueAmt |
| PY Investment Income | $85,333 | PYInvestmentIncomeAmt |
| CY Investment Income | $78,163 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,828,072 | PYOtherRevenueAmt |
| CY Other Revenue | $2,703,548 | CYOtherRevenueAmt |
| PY Total Revenue | $152,150,262 | PYTotalRevenueAmt |
| CY Total Revenue | $154,070,567 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $83,617,917 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $86,539,459 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $63,598,888 | PYOtherExpensesAmt |
| CY Other Expenses | $63,284,508 | CYOtherExpensesAmt |
| PY Total Expenses | $147,216,805 | PYTotalExpensesAmt |
| CY Total Expenses | $149,823,967 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,933,457 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,246,600 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $135,346,864 | TotalAssetsBOYAmt |
| Total Assets EOY | $143,885,497 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $117,870,939 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $108,077,019 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,475,925 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $35,808,478 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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 2013 Community Service Plan can be found at www.chsbuffalo.org. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $73,333,214 | ExpenseAmt |
| Revenue | $103,466,871 | RevenueAmt |
| Desc | Inpatient services provided 3,375 Inpatient Ambulatory Surgery visits. Inpatient services provided 31,157 acute care patient days and 4,600 medical rehab service days. The Skilled Nursing Facility provided 55,670 days of care. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $32,402,994 | ExpenseAmt |
| Revenue | $45,717,844 | RevenueAmt |
| Desc | Outpatient services provided 3,558 Outpatient Surgery vistits, 6,110 G.I. visits, 1,906 Interventional Radiology visits and 200 Transfusion visits. Outpatient services also provided 23,996 Emergency Department visits net of admissions and 78,001 Referred Ambulatory visits. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,257,965 | ExpenseAmt |
| Revenue | $1,774,881 | RevenueAmt |
| Desc | Primary Care Centers and Clinics provided 21,000 visits. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $106,994,173 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | Yes (1) | InvestTaxExemptBondsInd |
| Escrow Account | Yes (1) | EscrowAccountInd |
| On Behalf Of Issuer | Yes (1) | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 100 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1098 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Excess Business Holdings | 0 | ExcessBusinessHoldingsInd |
| Taxable Distributions | 0 | TaxableDistributionsInd |
| Distribution To Donor | 0 | DistributionToDonorInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | David P Macholz VP FinanceCorporate Controller | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7168282974 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 144 Genesee Street 4th Floor | AddressLine1 |
| City | Buffalo | City |
| State | NY | State |
| ZIP Code | 14203 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Joseph McDonald | |||||||||
| President and CEO, CHS | 0.00 | 37.50 | Yes (X) | Yes (X) | $0 | $1,678,073 | $23,277 | ||
| Mark Sullivan | |||||||||
| Executive VP/COO | 0.00 | 37.50 | Yes (X) | Yes (X) | $0 | $748,231 | $6,740 | ||
| James Millard | |||||||||
| Pres.& CEO, Kenmore Mercy | 37.50 | 0.00 | Yes (X) | Yes (X) | $329,262 | $0 | -$54,042 | ||
| David Macholz | |||||||||
| Treasurer | 0.00 | 37.50 | Yes (X) | Yes (X) | $0 | $236,152 | $6,647 | ||
| Peter Bergmann | |||||||||
| Director | 0.00 | 37.50 | Yes (X) | $0 | $487,172 | $16,046 | |||
| Charles J Urlaub | |||||||||
| Officer/Director | 0.00 | 37.50 | Yes (X) | Yes (X) | $0 | $453,029 | $23,238 | ||
| Christine Kluckhohn | |||||||||
| Pres.& CEO, Continuing Care | 0.00 | 37.50 | Yes (X) | $0 | $288,295 | -$23,733 | |||
| Dr Michael Edbauer | |||||||||
| Director | 0.00 | 18.80 | Yes (X) | $0 | $256,646 | $8,384 | |||
| Brian Beitz | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Frances Crosby RN PhD | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Richard Curran MD | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Dennis Dombek | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Dr Craig Fetterman | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| William Lawley Jr | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Judith Maness | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| James Manzella | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael Montante | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Cynthia ZaneEdD | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Monsignor Robert E Zapfel | |||||||||
| Director | 0.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| James A Dunlop Jr | |||||||||
| Executive VP, Finance/CFO | 0.00 | 37.50 | Yes (X) | $0 | $674,481 | -$51,144 | |||
| Dr Brian D'Arcy | |||||||||
| Senior VP, Medical Affairs | 0.00 | 37.50 | Yes (X) | $0 | $434,608 | $47,365 | |||
| Walter Ludwig | |||||||||
| Chief Operating Officer | 37.50 | 0.00 | Yes (X) | $199,223 | $0 | $21,704 | |||
| Michael Moley | |||||||||
| Sr. VP Human Resources | 0.00 | 37.50 | $0 | $644,598 | $23,524 | Yes (X) | |||
| John Stavros | |||||||||
| Sr. VP Marketing/P.R. | 0.00 | 37.50 | $0 | $278,958 | $35,521 | Yes (X) | |||
| Dr Michael Galang | |||||||||
| Chief Information Officer | 0.00 | 37.50 | $0 | $448,522 | $4,849 | Yes (X) | |||
| Nancy Sheehan | |||||||||
| SVP Legal Service, General Counsel | 0.00 | 37.50 | $0 | $331,332 | $7,739 | Yes (X) | |||
| Richard J Ruh MD | |||||||||
| SVP Service Lines | 0.00 | 37.50 | $0 | $401,525 | $22,636 | Yes (X) | |||
| Dr James Fitzpatrick | |||||||||
| Medical Director | 37.50 | 0.00 | $219,558 | $0 | $32,717 | Yes (X) | |||
| Thomas Brewer MD | |||||||||
| Physician | 37.50 | 0.00 | $349,232 | $0 | $16,624 | Yes (X) | |||
| Michael Gough MD | |||||||||
| Physician | 37.50 | 0.00 | $264,794 | $0 | $16,956 | Yes (X) | |||
| Dr Sanford Pleskow | |||||||||
| Physician | 37.50 | 0.00 | $170,373 | $0 | $14,097 | Yes (X) | |||
| Dr Nadezhda Polataiko | |||||||||
| Physician | 37.50 | 0.00 | $160,145 | $0 | -$2,097 | Yes (X) | |||
| Dr Qamrunnisa Rahman | |||||||||
| Physician | 37.50 | 0.00 | $160,395 | $0 | $7,218 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,852,982 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,361,622 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $204,266 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 35 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| R&P Oak Hill Development Corporation | |||||
| 3556 Lakeshore Road Suite 620 | Buffalo | NY | 142191460 | Construction Services | $10,114,168 |
| Buffalo Niagara Hospitalists | |||||
| 2950 Elmwood Ave/Med Staff Office | Kenmore | NY | 14217 | Physician Services | $826,313 |
| Siemens Medical Solutions | |||||
| Bank of NY Mellon PO Box 120001 | Dallas | TX | 75312 | Maintenance Services | $662,418 |
| McGuire Development | |||||
| 560 Delaware Ave Suite 300 | Buffalo | NY | 14202 | Construction Services | $605,745 |
| Seton MRI Kenmore | |||||
| 3730 Sheridan Drive | Amherst | NY | 14226 | Imaging Services | $468,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 25 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $329,260 | AllOtherContributionsAmt |
| Total Contributions | $329,260 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 900099 | $104,166,413 | $104,166,413 |
| Medicare/Medicaid | 900099 | $46,793,183 | $46,793,183 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $150,959,596 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $81,373 | TotalRevenueColumnAmt |
| Exclusion | $81,373 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $325,776 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $325,776 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $325,776 | TotalRevenueColumnAmt |
| Exclusion | $325,776 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,210 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$3,210 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,210 | TotalRevenueColumnAmt |
| Exclusion | -$3,210 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Meaningful Use | 900099 | $1,368,595 | $1,368,595 |
| Cafeteria | 900099 | $334,400 | $334,400 |
| Shared Services | 900099 | $217,910 | $217,910 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $456,867 | TotalRevenueColumnAmt |
| Exclusion | $456,867 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,377,772 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $154,070,567 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $150,959,596 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,781,711 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,965,237 | TotalAmt |
| Program Services | $47,036,810 | ProgramServicesAmt |
| Management And General | $18,928,427 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,263,406 | TotalAmt |
| Program Services | $3,040,041 | ProgramServicesAmt |
| Management And General | $1,223,365 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,480,186 | TotalAmt |
| Program Services | $8,899,053 | ProgramServicesAmt |
| Management And General | $3,581,133 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,830,630 | TotalAmt |
| Program Services | $2,731,448 | ProgramServicesAmt |
| Management And General | $1,099,182 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,888 | TotalAmt |
| Program Services | $20,888 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,000 | TotalAmt |
| Program Services | $10,000 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,564,001 | TotalAmt |
| Program Services | $1,809,406 | ProgramServicesAmt |
| Management And General | $2,754,595 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,995 | TotalAmt |
| Program Services | $17,420 | ProgramServicesAmt |
| Management And General | $47,575 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,061 | TotalAmt |
| Program Services | $167,938 | ProgramServicesAmt |
| Management And General | $35,123 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,800 | TotalAmt |
| Program Services | $24,325 | ProgramServicesAmt |
| Management And General | $140,475 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,801,693 | TotalAmt |
| Program Services | $6,628 | ProgramServicesAmt |
| Management And General | $1,795,065 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,610 | TotalAmt |
| Program Services | $12,269 | ProgramServicesAmt |
| Management And General | $10,341 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,500 | TotalAmt |
| Program Services | $20,317 | ProgramServicesAmt |
| Management And General | $16,183 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,484,411 | TotalAmt |
| Program Services | $1,484,411 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,497,212 | TotalAmt |
| Program Services | $3,762,106 | ProgramServicesAmt |
| Management And General | $2,735,106 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,377,146 | TotalAmt |
| Program Services | $793,095 | ProgramServicesAmt |
| Management And General | $584,051 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $30,093,338 | $30,362,331 | -$268,993 |
| Purchased Services | $10,724,839 | $4,208,201 | $6,516,638 |
| Equipment Rental & Main | $3,453,314 | $1,485,215 | $1,968,099 |
| Non Medical Supplies | $1,490,685 | $1,102,271 | $388,414 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,275,015 | TotalAmt |
| Management And General | $1,275,015 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,823,967 | TotalAmt |
| Program Services | $106,994,173 | ProgramServicesAmt |
| Management And General | $42,829,794 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,474,540 | BOYAmt |
| EOY | $42,233,303 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,376,680 | BOYAmt |
| EOY | $17,964,422 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,887,486 | BOYAmt |
| EOY | $2,180,672 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,754,233 | BOYAmt |
| EOY | $1,883,883 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $112,452,150 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $55,728,644 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,381,047 | BOYAmt |
| EOY | $56,723,506 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,472,878 | BOYAmt |
| EOY | $22,899,711 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,346,864 | BOYAmt |
| EOY | $143,885,497 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,357,655 | BOYAmt |
| EOY | $21,245,998 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,724,309 | BOYAmt |
| EOY | $24,585,973 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,298,824 | BOYAmt |
| EOY | $8,385,115 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,490,151 | BOYAmt |
| EOY | $53,859,933 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,870,939 | BOYAmt |
| EOY | $108,077,019 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,554,419 | BOYAmt |
| EOY | $31,186,053 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,921,506 | BOYAmt |
| EOY | $4,622,425 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,475,925 | BOYAmt |
| EOY | $35,808,478 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,346,864 | BOYAmt |
| EOY | $143,885,497 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $4,246,600 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $14,085,954 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $235,852 | InvestmentCostOrOtherBasisAmt |
| Book Value | $235,852 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $71,614,979 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $37,915,142 | DepreciationAmt |
| Book Value | $33,699,837 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $7,293,817 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $2,026,713 | DepreciationAmt |
| Book Value | $5,267,104 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $31,813,258 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $15,354,749 | DepreciationAmt |
| Book Value | $16,458,509 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,494,244 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $432,040 | DepreciationAmt |
| Book Value | $1,062,204 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $56,723,506 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Insurance Recoveries | $14,442,655 |
| Interest in net assets of KMH Foundation | $4,616,215 |
| Due from Affiliates | $1,475,491 |
| Other Receivables | $1,981,551 |
| Workers Compensation Funding Surplus | $377,590 |
| Interest in net assets of CCD Foundation | $6,210 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $22,899,712 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| Pension Obligation | $23,821,628 |
| Long Term portion of Insurance Liabilities | $20,719,458 |
| Due to Affiliates | $7,628,652 |
| Interest Rate Swap | $1,167,798 |
| Asset Retirement Obligation | $169,579 |
| Other Long Term Liabilities | $352,818 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $53,859,933 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $153,741,307 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $153,741,307 | RevenueSubtotalAmt |
| Other Revenues Not Included | $329,260 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $329,260 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $154,070,567 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $149,823,967 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $149,823,967 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $149,823,967 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part XI, Line 4b - Other Adjustments: | FormAndLineReferenceDesc |
| Explanation | Contributions from Foundations Contributions from Grants | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 110.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 500.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,221,400 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $100,959 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,120,441 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,642,316 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,132,370 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,509,946 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05010 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,863,716 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,233,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,630,387 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05760 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $780,473 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $780,473 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,410,248 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,410,248 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01610 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $251,533 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $251,533 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $196,112 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $196,112 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,638,366 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,638,366 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02430 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,502,082 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,233,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,268,753 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08190 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $100,432 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $100,432 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,402 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,402 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,588 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,588 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $265 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $265 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,106 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $154,793 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $154,793 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,242,851 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $555,058 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $29,087,895 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $30,049,014 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$961,119 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kenmore Mercy Hospital | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2950 Elmwood Avenue | AddressLine1 |
| City | Kenmore | City |
| State | NY | State |
| ZIP Code | 14217 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Ambulatory Surgery-Multi Specialty, Audiology O/P | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kenmore Mercy Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.chsbuffalo.org/AboutUs/Communi | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 110.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 500.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Section A: | Clinic Part Time Services, Clinical Laboratory Services, Coronary Care, CT Scanner, Dental O/P, Emergency Department, Health Fairs O/P, Intensive Care, Medical Social Services, Medical/Surgical Nuclear Medicine - Diagnostic, Nuclear Medicine - Therapeutic, Pediatric O/P, Pharmaceutical Service, Physical Medical Rehabilitation, Physical Medicine and Rehabilitation O/P, Primary Medical Care O/P, Radiology - Diagnostic, Renal Dialysis - Acute, Respiratory Care, Therapy - Occupational O/P, Therapy - Physical O/P, Therapy - Speech Language Pathology. |
| Kenmore Mercy Hospital | Part V, Section B, Line 1j: In addition to the IRS requirements Catholic Health complied with the NYS Department of Health Community Health Needs Assessment requirements, Community Service Plan. |
| Kenmore Mercy Hospital | Part V, Section B, Line 3: 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 representativeErie 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 |
| Kenmore Mercy Hospital | Part V, Section B, Line 4: Kenmore Mercy Hospital was conducted with Mercy Hospital and Sister's Hospital. |
| Kenmore Mercy Hospital | Part V, Section B, Line 7: 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. 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. |
| Kenmore Mercy Hospital | Part V, Section B, Line 14g: Includes information in both English and Spanish on all signage and brochures for financial assistance. |
| Kenmore Mercy Hospital | Part V, Section B, Line 20d: Highest volume commercial payor rate. |
| Kenmore Mercy Hospital | Part V, Section B, Line 22: There are instances where the full charges on the account are equal to or less than the highest volume commercial payor rate. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| Ken-Ton Family Care | ||||
| 300 Two Mile Creek Road | Tonawanda | NY | 14150 | Extension Clinic: Pediatric O/P, Prenatal O/P, Primary Medical Care O/P |
| Williamsville Diagnostic Center | ||||
| 400 International Dr | Williamsville | NY | 14221 | Extension Clinic: Primary Medical Care, PT O/P, Radiology O/P, CT Scan, MRI |
| McAuley Residence | ||||
| 1503 Military Road | Kenmore | NY | 14217 | Long Term Care, Radiology O/P, Clinical Laboratory O/P |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | N/A |
| Part I, Line 6a: | The Kenmore Mercy Hospital Community Benefit Report is contained in a report prepared by the Catholic Health System. |
| Part I, Line 7: | Costing is a full step down methodology of cost from non-revenue producing departments to revenue producing departments', with assignment of cost to individual charge items based on volume and charge amount. All patient accounts are cost with the same methodology regardless of patient type (inpatient, outpatient, emergency room, etc.) or insurance coverage (Medicare, Medicaid, private insurance, uninsured, etc.). |
| Part II, Community Building Activities: | Kenmore Mercy Hospital provided Community Building in the form of Community Support, Environmental Improvements, Leadership development and training, Coalition building, and Workforce development which improved community leadership by promoting understanding of community healthcare needs and services at various events throughout the community. |
| Part III, Line 4: | The amount in Part III line 2 is the actual bad debt expenses of $1,242,851 written down to cost, utilizing the Uninsured Ratio of Cost to Charges (RCC) obtained from the full step down methodology of cost described in Part 1, line 7. 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 10/1/2012 to 9/30/2013 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 VI, Line 2: | Catholic Health utilizes multiple methods to assess the health care needs of the commuities it serves, including:* Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors;* Patient, resident and caregiver satisfaction surveys;* Physician and leadership participation in forums to define health needs of patient populations; and* Participation in regional planning initiatives. |
| Part VI, Line 3: | Kenmore Mercy Hospital informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the Catholic Health System Healthcare Assistance Program (HAP) policy. For example, Kenmore Mercy Hospital has posters and brochures available which include contact information for the Financial Clearance staff in admissions areas, emergency rooms, primary care and outpatient rehabilitation clinics, Revenue Management Center (RMC) and other areas of the organization's facilities where eligible patients are likely to be present; provides information about financial assistance and HAP contact information to patients as part of the intake process; provides financial assistance and HAP contact information to inpatients either during or within 90 days of discharge of their hospital stay; 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. Our Customer Service area is our front end team to assist all patients in this process." Additionally, we discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable, and there is information about financial aid posted on the Catholic Health System website. |
| Part VI, Line 4: | Catholic Health serves the eight counties of Western New York. 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. It includes the City of Buffalo, New York State's second largest city, surrounded by a ring of older suburbs, which is followed by a ring of more newly developed suburbs, and then rural communities. The current population of Erie County is over nine hundred thousand, with about one-third living in Buffalo.Erie County has an average income significantly lower than and has a greater percentage of persons over the age of 55 than New York State and the United States. Erie County's population is projected to decreasebetween now and 2017, with the greatest decline expected in those ages 35-54, and the greatest increase projected in those 55 and over.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. Integral to this effort is caring for the needs of those who are poor and disadvantaged. The services provided by Catholic Health organizations are provided in response to identified community needs, and reflect the System's emphasis on caring for the underserved. Catholic Health collaborates with other organizations to maximize its ability to provide needed services to the residents of our region.Each year, Catholic Health touches tens of thousands of community residents through community health education programs, health screenings, clinical and support services, and community support activities. Catholic Health will continue to meet community needs by providing charity care and Medicaid services, in addition to various other community benefit programs, including community health improvement, community benefit operations, health professions education, community building, as well as cash and in-kind contributions. |
| 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 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (22 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Joseph McDonald | ||||||||||||||
| President and CEO, CHS | $0 | $707,646 | $0 | $355,199 | $0 | $615,228 | $0 | $4,992 | $0 | $18,285 | $0 | $1,701,350 | $0 | $0 |
| Mark Sullivan | ||||||||||||||
| Executive VP/COO | $0 | $434,186 | $0 | $180,496 | $0 | $133,549 | $0 | -$9,590 | $0 | $16,330 | $0 | $754,971 | $0 | $0 |
| James Millard | ||||||||||||||
| Pres.& CEO, Kenmore Mercy | $245,733 | $0 | $43,857 | $0 | $39,672 | $0 | -$54,323 | $0 | $281 | $0 | $275,220 | $0 | $0 | $0 |
| David Macholz | ||||||||||||||
| Treasurer | $0 | $182,055 | $0 | $27,841 | $0 | $26,256 | $0 | -$11,013 | $0 | $17,660 | $0 | $242,799 | $0 | $0 |
| Peter Bergmann | ||||||||||||||
| Director | $0 | $364,848 | $0 | $76,524 | $0 | $45,800 | $0 | -$6,310 | $0 | $22,356 | $0 | $503,218 | $0 | $0 |
| Charles J Urlaub | ||||||||||||||
| Officer/Director | $0 | $343,560 | $0 | $51,902 | $0 | $57,567 | $0 | $6,518 | $0 | $16,720 | $0 | $476,267 | $0 | $0 |
| Christine Kluckhohn | ||||||||||||||
| Pres.& CEO, Continuing Care | $0 | $83,923 | $0 | $18,464 | $0 | $185,908 | $0 | -$46,313 | $0 | $22,580 | $0 | $264,562 | $0 | $0 |
| Dr Michael Edbauer | ||||||||||||||
| Director | $0 | $203,206 | $0 | $28,710 | $0 | $24,730 | $0 | -$304 | $0 | $8,688 | $0 | $265,030 | $0 | $0 |
| James A Dunlop Jr | ||||||||||||||
| Executive VP, Finance/CFO | $0 | $383,536 | $0 | $221,131 | $0 | $69,814 | $0 | -$68,063 | $0 | $16,919 | $0 | $623,337 | $0 | $0 |
| Dr Brian D'Arcy | ||||||||||||||
| Senior VP, Medical Affairs | $0 | $311,162 | $0 | $49,658 | $0 | $73,788 | $0 | $24,059 | $0 | $23,306 | $0 | $481,973 | $0 | $0 |
| Walter Ludwig | ||||||||||||||
| Chief Operating Officer | $156,867 | $0 | $10,928 | $0 | $31,428 | $0 | $5,914 | $0 | $15,790 | $0 | $220,927 | $0 | $0 | $0 |
| Michael Moley | ||||||||||||||
| Sr. VP Human Resources | $0 | $309,221 | $0 | $151,753 | $0 | $183,624 | $0 | $6,662 | $0 | $16,862 | $0 | $668,122 | $0 | $0 |
| John Stavros | ||||||||||||||
| Sr. VP Marketing/P.R. | $0 | $198,733 | $0 | $38,646 | $0 | $41,579 | $0 | $17,048 | $0 | $18,473 | $0 | $314,479 | $0 | $0 |
| Dr Michael Galang | ||||||||||||||
| Chief Information Officer | $0 | $304,298 | $0 | $104,516 | $0 | $39,708 | $0 | -$1,161 | $0 | $6,010 | $0 | $453,371 | $0 | $0 |
| Nancy Sheehan | ||||||||||||||
| SVP Legal Service, General Counsel | $0 | $261,089 | $0 | $50,717 | $0 | $19,526 | $0 | $1,457 | $0 | $6,282 | $0 | $339,071 | $0 | $0 |
| Richard J Ruh MD | ||||||||||||||
| SVP Service Lines | $0 | $326,942 | $0 | $29,786 | $0 | $44,797 | $0 | $5,158 | $0 | $17,478 | $0 | $424,161 | $0 | $0 |
| Dr James Fitzpatrick | ||||||||||||||
| Medical Director | $193,089 | $0 | $17,993 | $0 | $8,476 | $0 | $11,962 | $0 | $20,755 | $0 | $252,275 | $0 | $0 | $0 |
| Thomas Brewer MD | ||||||||||||||
| Physician | $348,397 | $0 | $0 | $0 | $835 | $0 | $1,662 | $0 | $14,962 | $0 | $365,856 | $0 | $0 | $0 |
| Michael Gough MD | ||||||||||||||
| Physician | $247,150 | $0 | $0 | $0 | $17,644 | $0 | $1,588 | $0 | $15,368 | $0 | $281,750 | $0 | $0 | $0 |
| Dr Sanford Pleskow | ||||||||||||||
| Physician | $146,423 | $0 | $0 | $0 | $23,950 | $0 | $13,327 | $0 | $770 | $0 | $184,470 | $0 | $0 | $0 |
| Dr Nadezhda Polataiko | ||||||||||||||
| Physician | $159,828 | $0 | $0 | $0 | $317 | $0 | -$24,111 | $0 | $22,014 | $0 | $158,048 | $0 | $0 | $0 |
| Dr Qamrunnisa Rahman | ||||||||||||||
| Physician | $136,524 | $0 | $0 | $0 | $23,871 | $0 | -$411 | $0 | $7,629 | $0 | $167,613 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Lines 4a-b | A severance payment of $176,379.28 was made for Christine Kluckhohn, an associate who was listed in Part 1a. Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Pension Gap CHE SERP Joseph McDonald $26,000 $299,904 Mark Sullivan $19,500 Dr.Brian D'Arcy $9,800 Peter Bergmann $7,334 |
| Part I, Line 6 | The 2013 Incentive payments were dependent upon achieving the Catholic Health System Operating Income target for Catholic Health System participants. Joseph McDonald $355,199.37 James A. Dunlop, Jr. $221,130.56 Mark Sullivan $180,495.91 Michael Moley $151,752.84 Dr. Michael Galang $104,515.96 Peter Bergmann $76,523.85 Dr. Michael Edbauer $57,419.55 Charles Urlaub $51,901.70 Nancy Sheehan $50,717.26 Dr. Brian D'Arcy $49,658.25 Jim Millard $43,857.45 John Stavros $38,645.95 David Macholz $27,841.37 Bartholomew Rodrigues $20,996.27 Christine Kluckhohn $18,463.54 Dr James Fitzpatrick $17,993.05 Walter Ludwig $10,928.46 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| Dormitory Authority of the State of NY | ||||||||
| A | 146000293 | 64983Q5T2 | 2006-11-29 | $16,730,000 | Part VI | 0 | 0 | 0 |
| Dormitory Authority of the State of NY | ||||||||
| B | 146000293 | 649906J62 | 2012-07-12 | $14,235,000 | Part VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | In Reserve FundInReserveFundAmt | Capitalized InterestCapitalizedInterestAmt | UnspentUnspentAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $16,730,000 | $657,688 | $99,008 | $15,973,304 | 1998 | Yes (1) | 0 | Yes (1) | Yes (1) | |||
| B | $14,235,000 | $563,473 | $8,444,251 | 2013 | 0 | 0 | 0 | Yes (1) | $954,691 | $286,690 | $3,985,895 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Business Name Line2HedgeProviderName/BusinessNameLine2 | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JP Morgan Chase | |||||||||||||
| A | Yes (1) | Yes (1) | Yes (1) | NA | 15.500000000000 | 0 | 0 | 0 | 0 | 0 | |||
| (no name) | |||||||||||||
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) | 0 | 0 | ||||
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I A (f) | To refund the New York State Medical Care Facilities Finance Adency FHA - Insured mortgage Project Revenue Bonds, 1995 Series B, which were applied to finance the construction of a three floor patient tower and to refinance outstanding indebtedness. |
| Part I B (f) | To finance the cost of construction, reconstruction, and equipping certain improvements to Kenmore's existing approximately 347,661 square foot hosptial facility located at 2950 Elmwood Avenue, Kenmore, NY, including a new two-story addition that includes approximately 19,000 square feet on the first floor to house Kenmore's Emergency Department. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Susan Urlaub | |||
| Wife of Mercy CEO, C.J. Urlaub | $78,195 | Corporate Nurse educator | 0 |
| James Manzella | |||
| Acute Care Board Member | $224,880 | Key Employee of Manzella Marketing | 0 |
| David Zapfel | |||
| Brother of BOD, Msgr. Robert Zapfel | $27,471 | HR Employee of CHS | 0 |
| Kathleen Zapfel | |||
| Sister-in-law of BOD, Msgr. Robert Zapfel | $65,673 | HR Employee of CHS | 0 |
| Susan Gallagher-Stavros | |||
| Wife of Key Employee, John Stavros | $14,437 | Nurse, McAuley Seton Home Care | 0 |
| Marie Packard | |||
| Daughter of BOD, Dennis Dombek | $79,972 | Mercy Physical Therapist | 0 |
| Dr Craig Fetterman | |||
| Partner of Buffalo Niagara Hospitalists | $826,313 | Acute Care Board Member | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | CHS has three members: Ascension Health, Catholic Health East, 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 2012, 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: | Change in Pension Obligation 10,803,856. Transfer (to)from affiliate 1,937,829. Rate Swap 643,350. Change in interest in KMH Foundation 701,377. Change in Temp Restricted Net Assets of KMH Foundation -458. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (19 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| Catholic Health Systems Inc | ||||||||||
| 144 Genesee Street | Buffalo | NY | 14203 | 222565278 | Health Care Delivery System | NY | 501c 3 | Schedule A Line 9 | 0 | |
| Mercy Hospital of Buffalo | ||||||||||
| 565 Abbott Road | Buffalo | NY | 14220 | 160756336 | Acute Care Hospital | NY | 501c 3 | Schedule A lIne 3 | 0 | Catholic Health System Inc |
| Sisters of Charity Hospital | ||||||||||
| 2157 Main Street | Buffalo | NY | 14214 | 160743187 | acute Care Hospital | NY | 501c 3 | Schedule A lIne 3 | 0 | Catholic Health System Inc |
| Nazareth Home of the Fransiscan Sisters | ||||||||||
| 291 North Street | Buffalo | NY | 14201 | 160813142 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Clare Manor | ||||||||||
| 543 Locust Street | Lockport | NY | 14094 | 160782647 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Elizabeth Home for the Aged | ||||||||||
| 5539 Broadway | Lancaster | NY | 14086 | 160743154 | Adult Home | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Francis Home of Williamsville | ||||||||||
| 147 Reist Street | Williamsville | NY | 14221 | 160743153 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Francis of Buffalo Inc | ||||||||||
| 34 Benwood Ave | Buffalo | NY | 14214 | 161523535 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Joseph Manor | ||||||||||
| 2211 West State Street | Olean | NY | 14760 | 160796400 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Luke Manor for the Chronically Ill | ||||||||||
| 17 Wiard Street | Batavia | NY | 14020 | 160794811 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Mary's Manor | ||||||||||
| 515 6th Street | Niagara Falls | NY | 14301 | 160924139 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| St Vincent Manor | ||||||||||
| 319 Washington Ave | Dunkirk | NY | 14048 | 160743167 | Adult Home | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| WNY Catholic Long Term Care Inc | ||||||||||
| 6400 Powers Road | Orchard Park | NY | 14127 | 161434368 | Skilled Nursing Facility | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| Niagara Homemaker Services (Mercy Home Care) | ||||||||||
| 144 Genesee Street | Buffalo | NY | 14203 | 161317960 | Home Care Provider | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| McAuley Seton Home Care | ||||||||||
| 144 Genesee Street | Buffalo | NY | 14203 | 161310062 | Home Care Provider | NY | 501c 3 | Schedule A Line 9 | 0 | Catholic Health System Inc |
| Catholic Health System Infusion Pharmacy Inc | ||||||||||
| 2875 Union Road Suite 14 | Cheektowaga | NY | 14227 | 200198518 | Home Care Infusion Services | NY | 501c 3 | Schedule A Line 9 | 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 | 501c 3 | Schedule A lIne 3 | 0 | |
| Trinity Medical WNY PC | ||||||||||
| 144 Genesee Street | Buffalo | NY | 14203 | 272576645 | Primary Care Provider | NY | 501c 3 | Schedule A lIne 11 | 0 | |
| KMH Homes Inc | ||||||||||
| 144 Genesee Street | Buffalo | NY | 14203 | 161387890 | Real Estate Holding Company | NY | 501c 3 | Schedule A lIne 9 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |