2012-11-05T08:26:01-06:00 2011-12-31 990 2011-01-01 200198518 Catholic Health System Infusion Pharmacy Inc CATH 7166854870 6350 Transit Road Depew NY 14043 David P Macholz 7168282974 2012-11-05 2011 2016-02-24 21:20:13Z Joseph D McDonald 2121 Main Street Suite 300 Buffalo NY 14214 4013593 0 X www.chsbuffalo.org X 2003 NY The Catholic Health System (CHS)Mission is to provide quality healthcare services in a home care setting. Committed to a common mission, CHS providers continue the healing ministry of 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.org 15 9 10 0 0 0 0 0 3459821 4012862 630 731 0 0 3460451 4013593 0 0 0 0 815854 977263 0 0 0 1914983 2192572 2730837 3169835 729614 843758 1203717 2582090 722314 1291671 481403 1290419 X 46183The 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. 0 0 2657554 4013593 Catholic 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. 2657554 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 4 0 10 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 9 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 Corpor 7168282974 515 Abbott Road Buffalo NY 142202039 Joseph McDonald 37.50 X X 0 1071254 41897 Mark Sullivan 37.50 X X 0 499659 32323 Joyce Markiewicz 37.50 X X 0 277164 37518 Peter Bergmann 37.50 X 0 558757 31685 Nils Gunnersen 37.50 X 0 300808 72939 Dennis Horrigan 1.00 X 0 0 0 Nancy Langer 1.00 X 0 0 0 Li Lin PHD 1.00 X 0 0 0 Brian O'Herron 1.00 X 0 0 0 Michael Osborne 37.50 X 0 184388 26303 Isabel Robitaille 1.00 X 0 0 0 Katherine Rogala 1.00 X 0 0 0 Miguel Santos 1.00 X 0 0 0 Gary Tucker 1.00 X 0 0 0 Sr Sheila Marie Walsh 1.00 X 0 0 0 Monsignor Robert E Zapfel 1.00 X 0 0 0 James A Dunlop Jr 37.50 X 0 443085 112103 Michael Moley 37.50 X 0 394218 39695 John Stavros 37.50 X 0 248323 39012 Maria Foti 37.50 X 0 230710 30394 Bartholomew Rodrigues 37.50 X 0 218184 33095 Dr Michael Galang 37.50 X 0 331760 25686 Nancy Sheehan 37.50 X 0 269769 27110 John Russell 37.50 X 162192 0 30638 Paul Bembinista 37.50 X 132969 0 65243 295161 5028079 645641 2 0 1 0 0 Home Care Infusion Ser 621610 4012862 4012862 4012862 731 731 4013593 4013593 0 0 192831 125340 67491 607869 395115 212754 21597 14038 7559 98692 64150 34542 56274 36578 19696 15842 15842 16809 14426 2383 -105 -105 1632915 1605591 27324 38653 38653 135300 135300 23145 18346 4799 3261 3261 49701 49701 16066 16066 Bad Debt 131302 131302 Contractual Allowances 66679 66679 Outside/Contracted Serv 47312 47312 Dues & Subscriptions 11627 11627 4065 988 3077 3169835 2657554 512281 0 592995 1380294 296074 520431 83618 332904 27472 38144 247164 86941 63558 160223 140000 150094 1203717 2582090 722314 1291671 722314 1291671 X 0 0 0 0 354808 809016 481403 1290419 1203717 2582090 X 843758 -34742 X 0 1 1 X 1 1 X 1344340 3459821 4012862 8817023 1344340 3459821 4012862 8817023 0 0 0 8817023 60 630 731 1421 60 630 731 1421 1344400 3460451 4013593 8818444 X 0.99980 247164 86941 160223 160223 4013593 3169835 843758 -34742 -34742 809016 3946914 0 3946914 66679 66679 4013593 3103156 0 3103156 66679 66679 3169835 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. X X X X X X 0 1 0 0 0 1 1 0 0 Joseph McDonald 0 583131 0 208063 0 280060 0 26855 0 15042 0 1113151 0 0 Mark Sullivan 0 373986 0 92715 0 32957 0 17728 0 14595 0 531981 0 0 Joyce Markiewicz 0 200536 0 39238 0 37390 0 19765 0 17753 0 314682 0 0 Peter Bergmann 0 346695 0 167259 0 44802 0 13217 0 18468 0 590441 0 0 Nils Gunnersen 0 219357 0 42744 0 38707 0 72681 0 258 0 373747 0 0 Michael Osborne 0 139492 0 19691 0 25205 0 11801 0 14502 0 210691 0 0 James A Dunlop Jr 0 327293 0 82819 0 32973 0 94418 0 17685 0 555188 0 0 Michael Moley 0 259903 0 58553 0 75762 0 25222 0 14473 0 433913 0 0 John Stavros 0 169269 0 39644 0 39410 0 21022 0 17990 0 287335 0 0 Maria Foti 0 161084 0 36606 0 33020 0 23570 0 6824 0 261104 0 0 Bartholomew Rodrigues 0 145256 0 34317 0 38611 0 15377 0 17718 0 251279 0 0 Dr Michael Galang 0 265381 0 35389 0 30990 0 20485 0 5201 0 357446 0 0 Nancy Sheehan 0 187958 0 43103 0 38707 0 21899 0 5211 0 296878 0 0 John Russell 124658 0 17229 0 20305 0 13260 0 17378 0 192830 0 0 0 Paul Bembinista 115164 0 0 0 17805 0 51826 0 13417 0 198212 0 0 0 Supplemental Information Part III Part 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 - $17,229.48 David Zapfel Brother of BOD, Msgr. Robert Zapfel 62906 HR Employee of CHS 0 Kathleen Zapfel Sister-in-law of BOD, Msgr. Robert Zapfel 58749 HR Employee of CHS 0 Susan Gallagher-Stavros Wife of Key Employee, John Stavros 30035 Nurse, McAuley Seton Home Care 0 Form 990, Part VI, Section A, line 6 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 7.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 7b 7.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 11 11 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 12c 12.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 15 15.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 19 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Minimum Pension Liability -34,742. Total to Form 990, Part XI, Line 5: -34,742. Catholic Health System Inc 515 Abbott Road Buffalo NY 14220 222565278 Health Care Delivery System NY 501 c 3 Schedule A line 9 N/A 0 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 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 0 Kenmore Mercy Hospital 2950 Elmwood Avenue Buffalo NY 14217 160762843 Acute Care Hospital NY 501 c 3 Schedule A line 3 Catholic Health System 0 Nazereth Home of the Franciscan Sisters 291 North Road Buffalo NY 14201 160813142 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System 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 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 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 0 St Francis of Buffalo Inc 34 Benwood Avenue Buffalo NY 14214 161523535 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System 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 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 0 St Mary's Manor 515 6th Street Niagara Falls NY 14301 160924139 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System 0 St Vincent Manor 319 Washington Avenue Dunkirk NY 14048 160743167 Adult Home NY 501 c 3 Schedule A line 9 Catholic Health System 0 WNY Catholic Long Term Care Inc 6400 Powers Road Orchard Park NY 14127 161434368 Skilled Nursing Facility NY 501 c 3 Schedule A line 9 Catholic Health System 0 Niagara Homemaker Services (Mercy Home Care) Apple Tree Business Park 287 Cheektowaga NY 14227 161317960 Home Care Provider NY 501 c 3 Schedule A line 9 Catholic Health System 0 McAuley Seton Home Care Apple Tree Business Park 287 Cheektowaga NY 14227 161310062 Home Care Provider NY 501 c 3 Schedule A line 9 Catholic Health System 0 CHS Continuing Care Foundation 291 North Road Buffalo NY 14201 200947831 Foundation NY 501 c 3 Schedule A line 7 Catholic Health System 0 OLV Renaissance Corporation 291 North Road Batavia NY 14201 200167745 Real Estate Holding Company NY 501 c 3 Schedule A line 9 Catholic Health System 0 CHS Program of All-Inclusive Care for the Elderly Inc 55 Melroy Lackawanna NY 14218 261252884 All-inclusive Care for the Elderly NY 501 c 3 Schedule A line 3 Catholic Health System 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1