2014-10-30T10:05:57-05:00 2013-12-31 990 2013-01-01 160762843 Kenmore Mercy Hospital KENM 7168282993 144 Genesee Street Finance 4th Floor Buffalo NY 14203 David P Macholz VP Finance/Corp Controller 7168282974 2014-10-30 2013 2015-11-30 17:44:51Z Joseph D McDonald 144 Genesee Street Administration 6th Floor Buffalo NY 14203 154073777 0 X www.chsbuffalo.org X 1957 NY The Catholic Health System (CHS) Mission is to provide quality healthcare services in an acute care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2013 Community Service Plan can be found at www.chsbuffalo.org. 16 7 1098 300 0 0 311010 329260 148925847 150959596 85333 78163 2828072 2703548 152150262 154070567 0 0 0 0 83617917 86539459 0 0 0 63598888 63284508 147216805 149823967 4933457 4246600 135346864 143885497 117870939 108077019 17475925 35808478 X The Catholic Health System (CHS) Mission is to provide quality healthcare services in an acute care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2013 Community Service Plan can be found at www.chsbuffalo.org. 0 0 73333214 103466871 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. 32402994 45717844 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. 1257965 1774881 Primary Care Centers and Clinics provided 21,000 visits. 106994173 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 100 0 1098 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 7 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 FinanceCorporate Controller 7168282974 144 Genesee Street 4th Floor Buffalo NY 14203 Joseph McDonald President and CEO, CHS 0.00 37.50 X X 0 1678073 23277 Mark Sullivan Executive VP/COO 0.00 37.50 X X 0 748231 6740 James Millard Pres.& CEO, Kenmore Mercy 37.50 0.00 X X 329262 0 -54042 David Macholz Treasurer 0.00 37.50 X X 0 236152 6647 Peter Bergmann Director 0.00 37.50 X 0 487172 16046 Charles J Urlaub Officer/Director 0.00 37.50 X X 0 453029 23238 Christine Kluckhohn Pres.& CEO, Continuing Care 0.00 37.50 X 0 288295 -23733 Dr Michael Edbauer Director 0.00 18.80 X 0 256646 8384 Brian Beitz Director 0.00 1.00 X 0 0 0 Frances Crosby RN PhD Director 0.00 1.00 X 0 0 0 Richard Curran MD Director 0.00 1.00 X 0 0 0 Dennis Dombek Director 0.00 1.00 X 0 0 0 Dr Craig Fetterman Director 0.00 1.00 X 0 0 0 William Lawley Jr Director 0.00 1.00 X 0 0 0 Judith Maness Director 0.00 1.00 X 0 0 0 James Manzella Director 0.00 1.00 X 0 0 0 Michael Montante Director 0.00 1.00 X 0 0 0 Cynthia ZaneEdD Director 0.00 1.00 X 0 0 0 Monsignor Robert E Zapfel Director 0.00 1.00 X 0 0 0 James A Dunlop Jr Executive VP, Finance/CFO 0.00 37.50 X 0 674481 -51144 Dr Brian D'Arcy Senior VP, Medical Affairs 0.00 37.50 X 0 434608 47365 Walter Ludwig Chief Operating Officer 37.50 0.00 X 199223 0 21704 Michael Moley Sr. VP Human Resources 0.00 37.50 X 0 644598 23524 John Stavros Sr. VP Marketing/P.R. 0.00 37.50 X 0 278958 35521 Dr Michael Galang Chief Information Officer 0.00 37.50 X 0 448522 4849 Nancy Sheehan SVP Legal Service, General Counsel 0.00 37.50 X 0 331332 7739 Richard J Ruh MD SVP Service Lines 0.00 37.50 X 0 401525 22636 Dr James Fitzpatrick Medical Director 37.50 0.00 X 219558 0 32717 Thomas Brewer MD Physician 37.50 0.00 X 349232 0 16624 Michael Gough MD Physician 37.50 0.00 X 264794 0 16956 Dr Sanford Pleskow Physician 37.50 0.00 X 170373 0 14097 Dr Nadezhda Polataiko Physician 37.50 0.00 X 160145 0 -2097 Dr Qamrunnisa Rahman Physician 37.50 0.00 X 160395 0 7218 1852982 7361622 204266 35 0 1 0 R&P Oak Hill Development Corporation 3556 Lakeshore Road Suite 620 Buffalo NY 142191460 Construction Services 10114168 Buffalo Niagara Hospitalists 2950 Elmwood Ave/Med Staff Office Kenmore NY 14217 Physician Services 826313 Siemens Medical Solutions Bank of NY Mellon PO Box 120001 Dallas TX 75312 Maintenance Services 662418 McGuire Development 560 Delaware Ave Suite 300 Buffalo NY 14202 Construction Services 605745 Seton MRI Kenmore 3730 Sheridan Drive Amherst NY 14226 Imaging Services 468000 25 329260 329260 Patient Service Revenue 900099 104166413 104166413 Medicare/Medicaid 900099 46793183 46793183 150959596 81373 81373 325776 0 325776 325776 325776 3210 -3210 -3210 -3210 Meaningful Use 900099 1368595 1368595 Cafeteria 900099 334400 334400 Shared Services 900099 217910 217910 456867 456867 2377772 154070567 150959596 0 2781711 65965237 47036810 18928427 4263406 3040041 1223365 12480186 8899053 3581133 3830630 2731448 1099182 20888 20888 10000 10000 4564001 1809406 2754595 64995 17420 47575 203061 167938 35123 164800 24325 140475 1801693 6628 1795065 22610 12269 10341 36500 20317 16183 1484411 1484411 6497212 3762106 2735106 1377146 793095 584051 Medical Supplies 30093338 30362331 -268993 Purchased Services 10724839 4208201 6516638 Equipment Rental & Main 3453314 1485215 1968099 Non Medical Supplies 1490685 1102271 388414 1275015 1275015 149823967 106994173 42829794 0 46474540 42233303 19376680 17964422 1887486 2180672 1754233 1883883 112452150 55728644 46381047 56723506 19472878 22899711 135346864 143885497 22357655 21245998 25724309 24585973 9298824 8385115 60490151 53859933 117870939 108077019 X 13554419 31186053 3921506 4622425 17475925 35808478 135346864 143885497 X 4246600 14085954 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 235852 235852 71614979 37915142 33699837 7293817 2026713 5267104 31813258 15354749 16458509 1494244 432040 1062204 56723506 Insurance Recoveries 14442655 Interest in net assets of KMH Foundation 4616215 Due from Affiliates 1475491 Other Receivables 1981551 Workers Compensation Funding Surplus 377590 Interest in net assets of CCD Foundation 6210 22899712 Pension Obligation 23821628 Long Term portion of Insurance Liabilities 20719458 Due to Affiliates 7628652 Interest Rate Swap 1167798 Asset Retirement Obligation 169579 Other Long Term Liabilities 352818 53859933 153741307 0 153741307 329260 329260 154070567 149823967 0 149823967 0 149823967 Part XI, Line 4b - Other Adjustments: Contributions from Foundations Contributions from Grants 1 1 1 X 110.000000000000 1 X 500.000000000000 1 1 1 0 1 1 1221400 100959 1120441 0.00750 21642316 14132370 7509946 0.05010 22863716 14233329 8630387 0.05760 780473 780473 0.00520 2410248 2410248 0.01610 251533 251533 0.00170 196112 196112 0.00130 3638366 3638366 0.02430 26502082 14233329 12268753 0.08190 100432 100432 0.00070 3402 3402 0.00000 3588 3588 0.00000 265 265 0.00000 47106 47106 0.00030 154793 154793 0.00100 1 1242851 555058 29087895 30049014 -961119 X 1 0 1 1 Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore NY 14217 X X X Ambulatory Surgery-Multi Specialty, Audiology O/P Kenmore Mercy Hospital 1 1 X X X X X X X X X X 13 1 1 1 X http://www.chsbuffalo.org/AboutUs/Communi X X X X X X X X X 0 0 1 1 110.000000000000 1 500.000000000000 1 X X X X X X 1 1 X X X X X X X 1 0 1 X 0 1 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. 3 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 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 1 X X X X X X 1 1 0 0 0 1 1 0 0 Joseph McDonald President and CEO, CHS 0 707646 0 355199 0 615228 0 4992 0 18285 0 1701350 0 0 Mark Sullivan Executive VP/COO 0 434186 0 180496 0 133549 0 -9590 0 16330 0 754971 0 0 James Millard Pres.& CEO, Kenmore Mercy 245733 0 43857 0 39672 0 -54323 0 281 0 275220 0 0 0 David Macholz Treasurer 0 182055 0 27841 0 26256 0 -11013 0 17660 0 242799 0 0 Peter Bergmann Director 0 364848 0 76524 0 45800 0 -6310 0 22356 0 503218 0 0 Charles J Urlaub Officer/Director 0 343560 0 51902 0 57567 0 6518 0 16720 0 476267 0 0 Christine Kluckhohn Pres.& CEO, Continuing Care 0 83923 0 18464 0 185908 0 -46313 0 22580 0 264562 0 0 Dr Michael Edbauer Director 0 203206 0 28710 0 24730 0 -304 0 8688 0 265030 0 0 James A Dunlop Jr Executive VP, Finance/CFO 0 383536 0 221131 0 69814 0 -68063 0 16919 0 623337 0 0 Dr Brian D'Arcy Senior VP, Medical Affairs 0 311162 0 49658 0 73788 0 24059 0 23306 0 481973 0 0 Walter Ludwig Chief Operating Officer 156867 0 10928 0 31428 0 5914 0 15790 0 220927 0 0 0 Michael Moley Sr. VP Human Resources 0 309221 0 151753 0 183624 0 6662 0 16862 0 668122 0 0 John Stavros Sr. VP Marketing/P.R. 0 198733 0 38646 0 41579 0 17048 0 18473 0 314479 0 0 Dr Michael Galang Chief Information Officer 0 304298 0 104516 0 39708 0 -1161 0 6010 0 453371 0 0 Nancy Sheehan SVP Legal Service, General Counsel 0 261089 0 50717 0 19526 0 1457 0 6282 0 339071 0 0 Richard J Ruh MD SVP Service Lines 0 326942 0 29786 0 44797 0 5158 0 17478 0 424161 0 0 Dr James Fitzpatrick Medical Director 193089 0 17993 0 8476 0 11962 0 20755 0 252275 0 0 0 Thomas Brewer MD Physician 348397 0 0 0 835 0 1662 0 14962 0 365856 0 0 0 Michael Gough MD Physician 247150 0 0 0 17644 0 1588 0 15368 0 281750 0 0 0 Dr Sanford Pleskow Physician 146423 0 0 0 23950 0 13327 0 770 0 184470 0 0 0 Dr Nadezhda Polataiko Physician 159828 0 0 0 317 0 -24111 0 22014 0 158048 0 0 0 Dr Qamrunnisa Rahman Physician 136524 0 0 0 23871 0 -411 0 7629 0 167613 0 0 0 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 A Dormitory Authority of the State of NY 146000293 64983Q5T2 2006-11-29 16730000 Part VI 0 0 0 B Dormitory Authority of the State of NY 146000293 649906J62 2012-07-12 14235000 Part VI 0 0 0 A 16730000 657688 99008 15973304 1998 1 0 1 1 B 14235000 954691 286690 563473 8444251 3985895 2013 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 1 1 1 JP Morgan Chase NA 15.500000000000 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 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. Susan Urlaub Wife of Mercy CEO, C.J. Urlaub 78195 Corporate Nurse educator 0 James Manzella Acute Care Board Member 224880 Key Employee of Manzella Marketing 0 David Zapfel Brother of BOD, Msgr. Robert Zapfel 27471 HR Employee of CHS 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 65673 HR Employee of CHS 0 Susan Gallagher-Stavros Wife of Key Employee, John Stavros 14437 Nurse, McAuley Seton Home Care 0 Marie Packard Daughter of BOD, Dennis Dombek 79972 Mercy Physical Therapist 0 Dr Craig Fetterman Partner of Buffalo Niagara Hospitalists 826313 Acute Care Board Member 0 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. 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 Catholic Health System Inc 0 Sisters of Charity Hospital 2157 Main Street Buffalo NY 14214 160743187 acute Care Hospital NY 501c 3 Schedule A lIne 3 Catholic Health System Inc 0 Nazareth Home of the Fransiscan Sisters 291 North Street Buffalo NY 14201 160813142 Skilled Nursing Facility NY 501c 3 Schedule A Line 9 Catholic Health System Inc 0 St Clare Manor 543 Locust Street Lockport NY 14094 160782647 Skilled Nursing Facility NY 501c 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 501c 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 501c 3 Schedule A Line 9 Catholic Health System Inc 0 St Francis of Buffalo Inc 34 Benwood Ave Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501c 3 Schedule A Line 9 Catholic Health System Inc 0 St Joseph Manor 2211 West State Street Olean NY 14760 160796400 Skilled Nursing Facility NY 501c 3 Schedule A Line 9 Catholic Health System Inc 0 St Luke Manor for the Chronically Ill 17 Wiard Street Batavia NY 14020 160794811 Skilled Nursing Facility NY 501c 3 Schedule A Line 9 Catholic Health System Inc 0 St Mary's Manor 515 6th Street Niagara Falls NY 14301 160924139 Skilled Nursing Facility NY 501c 3 Schedule A Line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Ave Dunkirk NY 14048 160743167 Adult Home NY 501c 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 501c 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 501c 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 501c 3 Schedule A Line 9 Catholic Health System Inc 0 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 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1