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CATHOLIC HEALTH SYSTEM INFUSION PHARMACY INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CATHOLIC HEALTH SYSTEM INFUSION PHARMACY INC (EIN 20-0198518)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-05
IRS object ID
201213109349300706
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-05T08:26:01-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN200198518EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Catholic Health System Infusion Pharmacy IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCATHNameControl
Phone7166854870Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line16350 Transit RoadAddressLine1
CityDepewCity
StateNYState
ZIP Code14043ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDavid P MacholzName
TitleVP Finance, Corp ControllerTitle
Phone7168282974Phone
Date Signed2012-11-05DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJoseph D McDonaldNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12121 Main Street Suite 300AddressLine1
CityBuffaloCity
StateNYState
ZIP Code14214ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4013593GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.chsbuffalo.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2003YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionThe Catholic Health System (CHS)Mission is to provide quality healthcare services in a home care setting. Committed to a common mission, CHS providers continue the healing ministry of Jeses, 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 Plan can be found at www.chsbuffalo.orgActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees10TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3459821ProgramServiceRevenuePriorYear
Program Service Revenue CY4012862ProgramServiceRevenueCY
Investment Income Prior Year630InvestmentIncomePriorYear
Investment Income Current Year731InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year3460451TotalRevenuePriorYear
Total Revenue Current Year4013593TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year815854SalariesEtcPriorYear
Salaries Etc Current Year977263SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1914983OtherExpensePriorYear
Other Expenses Current Year2192572OtherExpensesCurrentYear
Total Expenses Prior Year2730837TotalExpensesPriorYear
Total Expenses Current Year3169835TotalExpensesCurrentYear
Revenues Less Expenses Prior Year729614RevenuesLessExpensesPriorYear
Revenues Less Expenses CY843758RevenuesLessExpensesCY
Total Assets BOY1203717TotalAssetsBOY
Total Assets EOY2582090TotalAssetsEOY
Total Liabilities BOY722314TotalLiabilitiesBOY
Total Liabilities EOY1291671TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY481403NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1290419NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission Description46183The Catholic Health System (CHS) Mission is to provide quality healthcare services in a home care setting. Committed to a common mission, CHS providers continue the healing ministry of Jesus, seeking to improve the health of individuals and communities. We provide high quality service that has reverence, compassion, justice, and excellence. The 2011 Communitiy Service Plan can be found at www.chsbuffalo.org.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2657554Expense
Revenue4013593Revenue
DescriptionCatholic Health System Infusion Pharmacy provides Home Care Infusion Services to individuals, primarily in Erie County. Committed to a common mission, Western New York's Catholic Health providers continue the healing ministry of Jesus. Seeking to improve the health of individuals and communities, we provide high quality service that is holistic, compassionate, and respectful of human dignity. Central to this endeavor is the service of persons who are poor and disadvantaged. For more detailed information, the 2011 Catholic Health Community Service report can be found at www.CHSBuffalo.org.Description
Total Program Service Expense2657554TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10964NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees10NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDavid P Macholz VP Finance CorporNamePerson
Telephone Number7168282974TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1515 Abbott RoadAddressLine1
CityBuffaloCity
StateNYState
ZIP Code142202039ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Joseph McDonald
President and CEO, CHS37.50XX0107125441897
Mark Sullivan
Executive VP/COO,CHS37.50XX049965932323
Joyce Markiewicz
President/CEO, CHS Homecare37.50XX027716437518
Peter Bergmann
Director37.50X055875731685
Nils Gunnersen
Director37.50X030080872939
Dennis Horrigan
Director1.00X000
Nancy Langer
Director1.00X000
Li Lin PHD
Director1.00X000
Brian O'Herron
Director1.00X000
Michael Osborne
Director37.50X018438826303
Isabel Robitaille
Director1.00X000
Katherine Rogala
Director1.00X000
Miguel Santos
Director1.00X000
Gary Tucker
Director1.00X000
Sr Sheila Marie Walsh
Director1.00X000
Monsignor Robert E Zapfel
Director1.00X000
James A Dunlop Jr
Executive VP, Finance37.50X0443085112103
Michael Moley
Sr. VP Human Resources37.50039421839695X
John Stavros
Sr. VP Marketing/P.R.37.50024832339012X
Maria Foti
Senior VP, Planning37.50023071030394X
Bartholomew Rodrigues
Sr. VP Mission Integration37.50021818433095X
Dr Michael Galang
Chief Information Officer37.50033176025686X
Nancy Sheehan
VP Legal Service, General Counsel37.50026976927110X
John Russell
Director, Pharmacy37.50162192030638X
Paul Bembinista
Pharmacist37.50132969065243X
FieldValueIRS element (for citing)
Total Reportable Comp From Org295161TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs5028079TotalReportableCompFrmRltdOrgs
Total Other Compensation645641TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionHome Care Infusion SerDescription
Business Code621610BusinessCode
Total Revenue Column4012862TotalRevenueColumn
Related Or Exempt Function Income4012862RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue4012862TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column731TotalRevenueColumn
Related Or Exempt Function Income731RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4013593TotalRevenueColumn
Related Or Exempt Function Income4013593RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total192831Total
Program Services125340ProgramServices
Management And General67491ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total607869Total
Program Services395115ProgramServices
Management And General212754ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total21597Total
Program Services14038ProgramServices
Management And General7559ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total98692Total
Program Services64150ProgramServices
Management And General34542ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total56274Total
Program Services36578ProgramServices
Management And General19696ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total15842Total
Management And General15842ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total16809Total
Program Services14426ProgramServices
Management And General2383ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total-105Total
Management And General-105ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1632915Total
Program Services1605591ProgramServices
Management And General27324ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total38653Total
Management And General38653ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total135300Total
Program Services135300ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total23145Total
Program Services18346ProgramServices
Management And General4799ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total3261Total
Management And General3261ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total49701Total
Program Services49701ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total16066Total
Management And General16066ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt131302131302
Contractual Allowances6667966679
Outside/Contracted Serv4731247312
Dues & Subscriptions1162711627

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4065Total
Program Services988ProgramServices
Management And General3077ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3169835Total
Program Services2657554ProgramServices
Management And General512281ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY592995BOY
EOY1380294EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY296074BOY
EOY520431EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY83618BOY
EOY332904EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY27472BOY
EOY38144EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis247164LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec86941LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY63558BOY
EOY160223EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY140000BOY
EOY150094EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1203717BOY
EOY2582090EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY722314BOY
EOY1291671EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY722314BOY
EOY1291671EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY354808BOY
EOY809016EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY481403BOY
EOY1290419EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1203717BOY
EOY2582090EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses843758ReconcilationRevenueExpenses
Reconcilation Other Changes-34742ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years1344340CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3459821CurrentTaxYearMinus1Year
Current Tax Year4012862CurrentTaxYear
Total8817023Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years1344340CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3459821CurrentTaxYearMinus1Year
Current Tax Year4012862CurrentTaxYear
Total8817023Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total5098817023PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years60CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year630CurrentTaxYearMinus1Year
Current Tax Year731CurrentTaxYear
Total1421Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years60CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year630CurrentTaxYearMinus1Year
Current Tax Year731CurrentTaxYear
Total1421Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years1344400CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3460451CurrentTaxYearMinus1Year
Current Tax Year4013593CurrentTaxYear
Total8818444Total
FieldValueIRS element (for citing)
First5 Years509XFirst5Years509
Public Support Percentage5090.99980PublicSupportPercentage509

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis247164OtherCostOrOtherBasis
Depreciation86941Depreciation
Book Value160223BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings160223TotalOfBookValueLandBuildings
Total Revenue4013593TotalRevenue
Total Expenses3169835TotalExpenses
Excess Or Deficit For Year843758ExcessOrDeficitForYear
Other-$34,742OtherAmount
Total Adjustments-34742TotalAdjustments
Excess Or Deficit Per FS809016ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3946914TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal3946914RevenueSubtotal
Other Revenues Not Included66679OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt66679RevenueNotRptdOnFinStmt
Total Revenue Per Form9904013593TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3103156TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal3103156ExpensesSubtotal
Other Expenses Not Included66679OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt66679ExpensesNotRptdOnFinStmt
Total Expenses Per Form9903169835TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 8 - Other Adjustments:Minimum Pension Liability
Part XII, Line 4b - Other Adjustments:Contractual Allowances 66,679.
Part XIII, Line 4b - Other Adjustments:Contractual Allowances 66,679.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Joseph McDonald
0583131020806302800600268550150420111315100
Mark Sullivan
0373986092715032957017728014595053198100
Joyce Markiewicz
0200536039238037390019765017753031468200
Peter Bergmann
03466950167259044802013217018468059044100
Nils Gunnersen
02193570427440387070726810258037374700
Michael Osborne
0139492019691025205011801014502021069100
James A Dunlop Jr
0327293082819032973094418017685055518800
Michael Moley
0259903058553075762025222014473043391300
John Stavros
0169269039644039410021022017990028733500
Maria Foti
016108403660603302002357006824026110400
Bartholomew Rodrigues
0145256034317038611015377017718025127900
Dr Michael Galang
026538103538903099002048505201035744600
Nancy Sheehan
018795804310303870702189905211029687800
John Russell
1246580172290203050132600173780192830000
Paul Bembinista
115164000178050518260134170198212000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental InformationIdentifier
Return ReferencePart IIIReturnReference
ExplanationPart I, Line 4a:Certain Officers and Key employees participated in a supplemental nonqualified retirement plan per the terms and conditions of their employment arrangement. Joseph McDonald: Pension Gap:$26,000 CHE SERP:$106,775 Michael Moley: Pension Gap: $20,697 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 Ministry participants. Joseph McDonald - $208,062.86 Mark Sullivan - $92,715.35 James A. Dunlop, Jr. - $82,818.71 Nancy Sheehan - $43,103.46 Michael Moley - $58,552.77 John Stavros - $39,644.17 Maria Foti - $36,606.16 Bartholomew Rodrigues - $34,317.41 Dr. Michael Galang - $35,389.29 Peter Bergmann - $76,257.65 Nils Gunnerson - $42,743.61 Joyce Markiewicz - $39,238.00 Mike Osborne - $19,691.20 John Russell - $17,229.48Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
David Zapfel
Brother of BOD, Msgr. Robert Zapfel62906HR Employee of CHS0
Kathleen Zapfel
Sister-in-law of BOD, Msgr. Robert Zapfel58749HR Employee of CHS0
Susan Gallagher-Stavros
Wife of Key Employee, John Stavros30035Nurse, McAuley Seton Home Care0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 66. 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 7a7.a. 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 7b7.b. 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 1111 a. 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 reponsibility to review the 990 to the 990 to the Audit Committee. The CHS Audit Committee reviewed in detail selected information for all CHS entities. Reviewed with Audit Committee: 1. Core Form Part IV: Checklist of required schedules 2. Core Form Part VI: Governence, Mangagement 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 and 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 12c12.c. 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 1515.b. In 2011, 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 1919. 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 5:Minimum Pension Liability -34,742. Total to Form 990, Part XI, Line 5: -34,742.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Catholic Health System Inc
515 Abbott RoadBuffaloNY14220222565278Health Care Delivery SystemNY501 c 3Schedule A line 9N/A0
Mercy Hospital of Buffalo
565 Abbott RoadBuffaloNY14220160756336Acute Care HospitalNY501 c 3Schedule A line 30Catholic Health System
Sisters of Charity Hospital
2157 Main StreetBuffaloNY14214160743187Acute Care HospitalNY501 c 3Schedule A line 30Catholic Health System
Kenmore Mercy Hospital
2950 Elmwood AvenueBuffaloNY14217160762843Acute Care HospitalNY501 c 3Schedule A line 30Catholic Health System
Nazereth Home of the Franciscan Sisters
291 North RoadBuffaloNY14201160813142Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
St Clare Manor
543 Locust StreetLockportNY14094160782647Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
St Elizabeth Home for the Aged
5539 BroadwayLancasterNY14086160743154Adult HomeNY501 c 3Schedule A line 90Catholic Health System
St Francis Home of Williamsville
147 Reist StreetWilliamsvilleNY14221160743153Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
St Francis of Buffalo Inc
34 Benwood AvenueBuffaloNY14214161523535Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
St Joseph Manor
2211 West State StreetOleanNY14760160796400Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
St Luke Manor for the Chronically Ill
17 Wiard StreetBataviaNY14020160794811Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
St Mary's Manor
515 6th StreetNiagara FallsNY14301160924139Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
St Vincent Manor
319 Washington AvenueDunkirkNY14048160743167Adult HomeNY501 c 3Schedule A line 90Catholic Health System
WNY Catholic Long Term Care Inc
6400 Powers RoadOrchard ParkNY14127161434368Skilled Nursing FacilityNY501 c 3Schedule A line 90Catholic Health System
Niagara Homemaker Services (Mercy Home Care)
Apple Tree Business Park 287CheektowagaNY14227161317960Home Care ProviderNY501 c 3Schedule A line 90Catholic Health System
McAuley Seton Home Care
Apple Tree Business Park 287CheektowagaNY14227161310062Home Care ProviderNY501 c 3Schedule A line 90Catholic Health System
CHS Continuing Care Foundation
291 North RoadBuffaloNY14201200947831FoundationNY501 c 3Schedule A line 70Catholic Health System
OLV Renaissance Corporation
291 North RoadBataviaNY14201200167745Real Estate Holding CompanyNY501 c 3Schedule A line 90Catholic Health System
CHS Program of All-Inclusive Care for the Elderly Inc
55 MelroyLackawannaNY14218261252884All-inclusive Care for the ElderlyNY501 c 3Schedule A line 30Catholic Health System
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg