2012-11-13T13:08:00-06:00 2011-12-31 990 2011-01-01 222565278 Catholic Health System Inc CATH 7168283993 515 ABBOTT ROAD No 508 BUFFALO NY 14220 David P Macholz 7168282993 2012-11-13 2011 2016-02-24 21:20:13Z Joseph McDonald 2121 Main Street STE 300 Buffalo NY 14214 104090986 0 X www.CHSBUFFALO.ORG X 1998 NY The Catholic Health System (CHS) mission is to provide quality healthcare services in Acute Care, Long Term Care, Home Care, and Primary Care settings. 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 2011 Community Service Report can be found on our website at www.CHSBUFFALO.ORG. 22 15 1366 0 0 0 141570 106888 92900865 103963246 25659 20852 0 0 93068094 104090986 0 0 0 0 62457582 68855536 0 0 0 30610512 35235450 93068094 104090986 0 0 63587294 84019304 76314893 92724172 -12727599 -8704868 X The Catholic Health System (CHS) mission is to provide quality healthcare services in Acute Care, Long Term Care, Home Care, and Primary Care settings. 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 2011 Community Service Report can be found on our website at www.CHSBUFFALO.ORG. 0 0 95032053 103722974 The Catholic Health System (CHS) provides administrative support services to the Catholic Health System entities which include Acute Care, Continuing Care, Home Care, and Primary Care services. The program services are support services that are provided for the benefit of the health care delivery system. These include Compliance, Facility Planning, Finance, Human Resources, Information Technology, Legal Services, Marketing, Revenue Management Center, and other services. More informatin can be found on the Catholic Health System website www.CHSBUFFALO.ORG. 95032053 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 80 0 1 1366 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 22 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X David P Macholz VP Finance Corporate Controller 7168282993 515 Abbott Road Suite 500 Buffalo NY 142202039 James Boldt 1.00 X 0 0 0 Carlton Brock 1.00 X 0 0 0 William K Buscaglia Jr 1.00 X 0 0 0 Clotilde Dedecker 1.00 X 0 0 0 Dennis Dombek 1.00 X 0 0 0 Shelly Drake 1.00 X 0 0 0 David Durante MD 20.00 X 0 102816 0 Sr Nancy Hoff RSM 1.00 X 0 0 0 Li Ln PhD 1.00 X 0 0 0 Ramesh Luther MD 10.00 X 0 25000 0 Joseph McDonald 37.50 X X 1071254 0 41897 Kelli Arnold McLeod 1.00 X 0 0 0 John Notaro MD 1.00 X 0 0 0 Linus Ormsby 1.00 X 0 0 0 Jack Quinn Jr 1.00 X 0 0 0 Joseph Ralabate MD 20.00 X 0 120500 0 Sharon Randaccio 1.00 X 0 0 0 Authur Russ 1.00 X 0 0 0 Sr Margaret Tuley 1.00 X 0 0 0 Cary Vastola DO 1.00 X 0 0 0 Cynthia Zane EdD 1.00 X 0 0 0 Monsignor Robert E Zapfel 1.00 X 0 0 0 Mark Sullivan 37.50 X 499658 0 32323 James A Dunlop Jr 37.50 X 443085 0 112103 Dr Brian D'Arcy 37.50 X 602143 0 48686 Michael Moley 37.50 X 394218 0 39695 John Stravos 37.50 X 248323 0 39012 Christine Kluckhohn 37.50 X 297068 0 116618 Maria Foti 37.50 X 230710 0 30394 Bartholomew Rodrigues 37.50 X 218184 0 33095 Dr Michael Galang 37.50 X 331760 0 25686 Nancy Sheehan 37.50 X 269768 0 27110 Lee C Ruotsi MD 50.00 X 382090 0 26328 Richard J Ruh MD 37.50 X 347381 0 29456 Frederick Vincent MD 37.50 X 342145 0 16222 William J Lagaly DO 37.50 X 280571 0 11826 Lisa Cilano 37.50 X 257078 0 83079 6215436 248316 713530 80 0 1 0 Siemens Medical Solutions USA Dept At 40065 Atlanta GA 311920065 Prof/Maint Svcs 6807774 GE Medical Systems PO Box 640944 Pittsburg PA 152640944 Maintenance Svcs 2722245 Travers Collins & Company 726 Exchange St Suite 500 Buffalo NY 14210 Marketing 936400 Eastern Great Lakes Pathology C/O PO Box 440 Niagara Falls NY 143040440 Pathology Svcs 862000 Nexera Inc 555 West 57th St15 Floor New York NY 10019 Consulting 765240 37 106888 106888 Administrative/Clinica 621610 103644369 103644369 318877 57753 261124 103963246 20852 20852 104090986 103722974 0 261124 4336403 2765491 1570912 50113919 49577950 535969 5289348 5244765 44583 4379467 4349829 29638 4736399 4736399 810610 253548 557062 852451 852451 162420 162420 2364263 1545166 819097 2513691 2502261 11430 368456 363728 4728 10787250 10787250 2030197 1859135 171062 328207 290906 37301 114869 76711 38158 200845 200845 2843567 2843567 252808 252808 Contracted Services 4742574 4550350 192224 Dues 4545594 32936 4512658 Bank Fees 309486 309486 Telephone 284478 266961 17517 1723684 1207090 516594 104090986 95032053 9058933 0 90152 166795 12752932 15812254 1564471 2393302 23436509 9186122 15917055 14250387 2752175 2752176 30510509 48644390 63587294 84019304 19252869 24701978 8657319 8413716 48404705 59608478 76314893 92724172 X -12727599 -8704868 -12727599 -8704868 63587294 84019304 X 0 4022731 X 0 1 1 X 1 1 X 64407498 76702699 84540251 92795318 103572038 422017804 18380 24435 25998 29265 30947 129025 64425878 76727134 84566249 92824583 103602985 422146829 0 0 0 422146829 357045 234635 45978 22027 20186 679871 357045 234635 45978 22027 20186 679871 48942 34300 59914 57690 55706 256552 151327 114115 80314 102586 232224 680566 64983192 77110184 84752455 93006886 103911101 423763818 0.99620 0.99570 0.00160 0.00210 X Schedule A, Part II, Line 12, Explanation of Other Income: Wellness Programs Community Education Rebates & Refunds Vending Contracted Services RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 130200 0 1 32221 162421 0 Explanation of Lobbying Activities: Part II-B, Line 1: Other Lobbying Activities: Catholic Health System, Inc. pays dues (to American Hospital Association, Catholic Health Association, and Buffalo Niagara Partnership) that utilize a portion of the dues payment for lobbying activities. In 2011 the lobbying component of these dues amounted to approximately $32,221. Additionally, CHS retains individuals to advocate on behalf of the Catholic Health System, Inc. with New York State legislatures relating to issues that impact the system. Costs incurred in relation to such activities amounted to $130,200 in 2011. 2917003 50593 2866410 644591 417739 226852 14381051 7635659 6745392 5493864 1082131 4411733 14250387 Due From Related Subsidiaries 47571842 Insurance Recoveries 284995 Miscellaneous Other Receivables 787553 48644390 Due To Related Facilities 17791787 Accrued Pension 41816691 59608478 104090986 104090986 0 104090986 0 104090986 0 104090986 104090986 0 104090986 0 104090986 X X 1 1 X X X X X X 0 1 0 0 0 1 1 0 0 Joseph McDonald 583131 0 208063 0 280060 0 26855 0 15042 0 1113151 0 0 0 Mark Sullivan 373986 0 92715 0 32957 0 17728 0 14595 0 531981 0 0 0 James A Dunlop Jr 327293 0 82819 0 32973 0 94418 0 17685 0 555188 0 0 0 Dr Brian D'Arcy 253307 0 60760 0 288076 0 30581 0 18105 0 650829 0 0 0 Michael Moley 259903 0 58553 0 75762 0 25222 0 14473 0 433913 0 0 0 John Stravos 169269 0 39644 0 39410 0 21022 0 17990 0 287335 0 0 0 Christine Kluckhohn 186796 0 55065 0 55207 0 97902 0 18716 0 413686 0 0 0 Maria Foti 161084 0 36606 0 33020 0 23570 0 6824 0 261104 0 0 0 Bartholomew Rodrigues 145256 0 34317 0 38611 0 15377 0 17718 0 251279 0 0 0 Dr Michael Galang 265381 0 35389 0 30990 0 20485 0 5201 0 357446 0 0 0 Nancy Sheehan 187958 0 43103 0 38707 0 21899 0 5211 0 296878 0 0 0 Lee C Ruotsi MD 355760 0 0 0 26330 0 8617 0 17711 0 408418 0 0 0 Richard J Ruh MD 304824 0 0 0 42557 0 12713 0 16743 0 376837 0 0 0 Frederick Vincent MD 338502 0 0 0 3643 0 11303 0 4919 0 358367 0 0 0 William J Lagaly DO 277995 0 0 0 2576 0 0 0 11826 0 292397 0 0 0 Lisa Cilano 210693 0 27541 0 18844 0 66263 0 16816 0 340157 0 0 0 Part I, Line 1a Tax Indemnification and Gross up payments - Officers and key employees receive a tax indemnification and gross-up payemnt for reimbursement of withholding taxes in conjuction with certain taxable benefits paid on behalf of employee. Health or social club dues or initiation fees - Taxable benefits for Country Club expenses were paid per the terms and conditions of the employment for one key employee. Part I, Line 4b Certain officers and key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Joseph McDonald - Pension Gap Plan - $26,000 Joseph McDonald - Supplemental Employee Retirement Plan - $106,775 Dr. Brian D'Arcy - Pension Gap - $9,800 Dr. Brian D'Arcy - Supplemental Employee Retirement Plan - $142,750 Michael Moley - Pension Gap - $20,697 Part I, Line 6 Part I, Line 6: The 2011 Incentive payments were dependent upon achieving the Catholic Health System Operating Income target for Catholic Health System participants or the Ministry Operating Income target for the Ministry participants. Joseph McDonald - Incentive - $208,062.86 Mark Sullivan - Incentive - $ 92,715.35 James A. Dunlop, Jr. - Incentive - $ 82,818.71 Dr. Brian D'Arcy - Incentive - $ 60,760.29 Nancy Sheehan - Incentive - $ 43,103.46 Michael Moley - Incentive - $ 58,552.77 John Stavros - Incentive - $ 39,644.17 Christine Kluckhohn - Incentive - $ 55,064.95 Maria Foti - Incentive - $ 36,606.16 Bartholomew Rodrigues - Incentive - $ 34,317.41 Dr. Michael Galang - Incentive - $ 35.389.29 Lisa Cilano - Incentive - $ 27,541.43 David Zapfel Brother of BOD, Msgr Robert Zapfel 62906 HR Associate of CHS 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 58749 HR Associate of St. Francis Home of Williamsville 0 Allison Malikowski Daughter of BOD, Authur Ross 23702 HR Associate of CHS 0 Susan Gallagher-Stavros Wife of Key Employee 30035 Community Health Nurse, McAuley Seton Home Care 0 Marie Packard Daughter of BOD, Dennis Dombek 46301 Physical Therapist 0 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 Form 990, Part VI, Section A, line 7b Each member is entitled to one vote on each matter properly submitted to any membership meeting. 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 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 goverance of the Catholic Health System. Form 990, Part VI, Section B, line 11 An electronic copy of the Form 990 was provided to the CHS Board 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: Goverance, Management, and Disclsure 3. Core Form Part VIII: Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Associates, 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 by 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, Non Physician Practioners, as well as Physician groups who are independent contractors or associates 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 completed 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 orginial 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 COID and retain on file in the compliance office in a confidential manner. Form 990, Part VI, Section B, line 15 The Catholic Health System utilized a Compensation Committee of the Board of Directors to monitor the Executive Compensation as per the Executive Compensation Philosopy and Strategy for 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 The Catholic Health System, Inc. makes the 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Pension Liability -9,792,368. Capital Equity Contributions/Distributions 8,045,089. Grant Revenue For Capital 5,770,010. Total to Form 990, Part XI, Line 5: 4,022,731. Mercy Hospital Of Buffalo 565 Abbott Road Buffalo NY 14220 160756336 Acute Care Hospital NY 501 (c) (3) Schedule A - Line 3 Catholic Health System Inc 0 Sisters Of Charity Hospital 2157 Main Street Buffalo NY 14214 160743187 Acute Care Hospital NY 501 (c) (3) Schedule A - Line 3 Catholic Health System Inc 0 Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore NY 14217 160762843 Acute Care Hospital NY 501 (c) (3) Schedule A - Line 3 Catholic Health System Inc 0 Nazareth Home Of The Francisan Sisters 291 North Street Buffalo NY 14201 160813142 Skilled Nursing Facility NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 St Clare Manor 543 Locust Street Lockport NY 14094 160782647 Skilled Nursing Facility NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 St Elizabeth Home For The Aged 5539 Broadway Lancaster NY 14086 160743154 Adult Home NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 St Francis Home Of Williamsville 147 Reist Street Williamsville NY 14221 160743153 Skilled Nursing Facility NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 St Francis Home Of Buffalo 34 Benwood Avenue Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501 (c) (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 501 (c) (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 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 St Mary's Mannor 515 6th Street Niagara Falls NY 14301 160924139 Skilled Nursing Facility NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 WNY Catholic Long Term Care 6400 Powers Road Orchard Park NY 14127 161434368 Skilled Nursing Facility NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 Niagara Homemakers Services(Mercy Home Care) Apple Tree Business Park 2875 Union Cheektowaga NY 14227 161317960 Home Care Provider NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 McAuley Seton Home Care Apple Tree Business Park 2875 Union Cheektowaga NY 14227 161310062 Home Care Provider NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 Catholic Health System Infusion Pharmacy Inc Apple Tree Business Park 2875 Union Cheektowaga NY 14227 200198518 Home Care Infusion Services NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 CHS Continuing Care Foundation 291 North Street Buffalo NY 14201 200947831 Foundation NY 501 (c) (3) Schedule A - Line 3 Catholic Health System Inc 0 OLV Renaissance Corporation 291 North Street Buffalo NY 14201 200167745 Real Estate Holding Company NY 501 (c) (3) Schedule A - Line 9 Catholic Health System Inc 0 CHS Program Of All-Inclusive Care For The Elderly 55 Melroy Avenue Lackawanna NY 14218 261252884 All-Inclusive Care For The Elderly NY 501 (c) (3) Schedule A - Line 3 Catholic Health System Inc 0 McAuley Mercy Corporation 515 Abbott Road Buffalo NY 14220 161279834 Management NY 501 (c) (3) Schedule A - Line 3 Catholic Health System Inc 0 Trinity Medical WNY PC 515 Abbott Road Buffalo NY 14220 272576645 Medical Practice NY C 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1