KENMORE MERCY HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- KENMORE MERCY HOSPITAL (EIN 16-0762843)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-07
- IRS object ID
- 201243129349300329
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-07T09:36:48-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160762843 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kenmore Mercy Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | KENM | NameControl |
| Phone | 7168282993 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 Abbott Road No 500 | AddressLine1 |
| City | Buffalo | City |
| State | NY | State |
| ZIP Code | 142202039 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | David P Macholz | Name |
| Title | VP, Finance/Corp Controller | Title |
| Phone | 7168282974 | Phone |
| Date Signed | 2012-11-07 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Joseph D McDonald | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2121 Main Street | AddressLine1 |
| City | Buffalo | City |
| State | NY | State |
| ZIP Code | 14214 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 141316289 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.chsbuffalo.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1957 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | 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 2011 Community Service Plan can be found at www.chsbuffalo.org | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1055 | TotalNbrEmployees |
| Total Nbr Volunteers | 376 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 673671 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 73162 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 140020393 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 137374537 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 159371 | InvestmentIncomePriorYear |
| Investment Income Current Year | 251069 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1481465 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3617521 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 142334900 | TotalRevenuePriorYear |
| Total Revenue Current Year | 141316289 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 73913119 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 77700114 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 69468565 | OtherExpensePriorYear |
| Other Expenses Current Year | 61867564 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 143381684 | TotalExpensesPriorYear |
| Total Expenses Current Year | 139567678 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1046784 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1748611 | RevenuesLessExpensesCY |
| Total Assets BOY | 93746757 | TotalAssetsBOY |
| Total Assets EOY | 105666087 | TotalAssetsEOY |
| Total Liabilities BOY | 74848782 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 92045822 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18897975 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13620265 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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 2011 Community Service Plan can be found at www.chsbuffalo.org. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 69544028 | Expense |
| Revenue | 96065571 | Revenue |
| Description | Inpatient services provided 2,607 Inpatient surgery visits, 517 visits for G.I. Lab, and 118 visits for urology. Inpatient services provided 32,390 acute care patient days and 5,139 medical rehab service days. The Skilled Nursing Facility provided 54,823 days of care. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 28090070 | Expense |
| Revenue | 38802595 | Revenue |
| Description | Outpatient services provides 3,161 outpatient surgery vistits, 4,335 G.I. visits, 2,089 Interventional Radiology visits and 331 Transfusion visits. Outpatient services also provided 21,869 Emergency Department visits net of admissions and 88,105 Referred Ambulatory visits. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1814419 | Expense |
| Revenue | 2506371 | Revenue |
| Description | Primary Care Centers and Clinics provided 31,591 visits. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 99448517 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 1 | InvestTaxExemptBonds |
| Escrow Account | 1 | EscrowAccount |
| On Behalf Of Issuer | 1 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 96 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1055 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | David P Macholz VP FinanceCorporate Controller | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7168282974 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 Abbott Road | AddressLine1 |
| City | Buffalo | City |
| State | NY | State |
| ZIP Code | 142202039 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (35 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Joseph McDonald | ||||||||
| President and CEO, CHS | 37.50 | X | X | 0 | 1071254 | 41897 | ||
| Mark Sullivan | ||||||||
| Executive VP/COO | 37.50 | X | X | 0 | 499658 | 32323 | ||
| James Millard | ||||||||
| Pres.& CEO, Kenmore Mercy | 37.50 | X | X | 296692 | 0 | 157819 | ||
| David Macholz | ||||||||
| Treasurer | 37.50 | X | X | 0 | 220214 | 31882 | ||
| Dr Michael Albert | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Dr Joseph Anain | ||||||||
| Director | 1.00 | X | 0 | 117000 | 0 | |||
| Brian Beitz | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Peter Bergmann | ||||||||
| Director | 37.50 | X | 0 | 558756 | 31685 | |||
| Frances Crosby RN PhD | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Richard Curran MD | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Dennis Dombek | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Dr Michael Edbauer | ||||||||
| Director | 25.00 | X | 0 | 197492 | 43593 | |||
| Christine Kluckhohn | ||||||||
| Pres.& CEO Continuing Care | 37.50 | X | 0 | 297068 | 116618 | X | ||
| William Lawley Jr | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| James Manzella | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Dr Paul Mason | ||||||||
| Director | 1.00 | X | 0 | 25000 | 0 | |||
| Michael Montante | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Dr David Serra | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Charles J Urlaub | ||||||||
| President and CEO Mercy | 37.50 | X | X | 0 | 436009 | 32828 | ||
| Cynthia ZaneEdD | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Monsignor Robert E Zapfel | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| James A Dunlop Jr | ||||||||
| Executive VP, Finance/CFO | 37.50 | X | 0 | 443085 | 112103 | |||
| Dr Brian D'Arcy | ||||||||
| Senior VP, Medical Affairs | 37.50 | X | 0 | 602143 | 48686 | |||
| Walter Ludwig | ||||||||
| Chief Operating Officer | 37.50 | X | 197007 | 0 | 27687 | |||
| Michael Moley | ||||||||
| Sr.VP, Human Resources | 37.50 | 0 | 394218 | 39695 | X | |||
| John Stavros | ||||||||
| Sr.VP Marketing/P.R. | 37.50 | 0 | 248323 | 39012 | X | |||
| Maria Foti | ||||||||
| Senior VP, Planning | 37.50 | 0 | 230710 | 30394 | X | |||
| Bartholomew Rodrigues | ||||||||
| Sr.VP, Mission Integration | 37.50 | 0 | 218184 | 33095 | X | |||
| Dr Michael Galang | ||||||||
| Chief Information Officer | 37.50 | 0 | 331760 | 25686 | X | |||
| Nancy Sheehan | ||||||||
| VP Legal Service,General Counsel | 37.50 | 0 | 269768 | 27110 | X | |||
| Dr James Fitzpatrick | ||||||||
| VP Medical Affairs | 37.50 | 156539 | 0 | 32208 | X | |||
| Dr Sanford Pleskow | ||||||||
| Physician | 37.50 | 154919 | 0 | 858 | X | |||
| Dr Qamrunnisa Rahman | ||||||||
| Physician | 37.50 | 149667 | 0 | 77936 | X | |||
| Dr Suchitra Koneru | ||||||||
| Physician | 37.50 | 135718 | 0 | 31627 | X | |||
| Dr Nadezhda Polataiko | ||||||||
| Physician | 37.50 | 136950 | 0 | 55339 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1227492 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 6160642 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1070081 | TotalOtherCompensation |
| Number Individuals GT100 K | 32 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Siemens Medical Solutions | |||||
| 51 Valley Stream Parkway | Malverne | PA | 19355 | Maintenance Services | 661615 |
| Kideney Architects | |||||
| 200 John James Audubon Pkwy | W Amherst | NY | 14228 | Architect Services | 442722 |
| Sodexho Operations LLC | |||||
| 60 Grider Street | Buffalo | NY | 14215 | Laundry Services | 384194 |
| Elder Medical Services PC | |||||
| 132 Cayuga Rd Suite 1C | Cheektowaga | NY | 14225 | Medical Services | 383561 |
| Seton Imaging | |||||
| 3730 Sheridan Dr | Amherst | NY | 14226 | Medical Services | 314000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 16 | NumberOfContractorsGT100K |
| All Other Contributions | 73162 | AllOtherContributions |
| Total Contributions | 73162 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Revenu | 900099 | 93337693 | 93337693 |
| Medicare/Medicaid | 900099 | 44036844 | 44036844 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 137374537 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 198621 | TotalRevenueColumn |
| Exclusion | $198,621 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 260262 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 260262 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 260262 | TotalRevenueColumn |
| Exclusion | $260,262 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 52448 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 52448 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 52448 | TotalRevenueColumn |
| Exclusion | $52,448 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Meaningful Use | 900099 | 2657136 | $2,657,136 |
| Cafeteria | 900099 | 238407 | $238,407 |
| Shared Services | 900099 | 114898 | $114,898 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 346818 | TotalRevenueColumn |
| Exclusion | $346,818 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3357259 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 141316289 | TotalRevenueColumn |
| Related Or Exempt Function Income | 137374537 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $3,868,590 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60112319 | Total |
| Program Services | 41925521 | ProgramServices |
| Management And General | 18186798 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2973820 | Total |
| Program Services | 2074100 | ProgramServices |
| Management And General | 899720 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11098305 | Total |
| Program Services | 7740547 | ProgramServices |
| Management And General | 3357758 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3515670 | Total |
| Program Services | 2452015 | ProgramServices |
| Management And General | 1063655 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41708 | Total |
| Program Services | 41708 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10000 | Total |
| Program Services | 10000 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4591129 | Total |
| Program Services | 2181973 | ProgramServices |
| Management And General | 2409156 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89900 | Total |
| Program Services | 70382 | ProgramServices |
| Management And General | 19518 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 171476 | Total |
| Program Services | 137599 | ProgramServices |
| Management And General | 33877 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178105 | Total |
| Program Services | 27415 | ProgramServices |
| Management And General | 150690 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2295911 | Total |
| Program Services | 6325 | ProgramServices |
| Management And General | 2289586 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19946 | Total |
| Program Services | 15024 | ProgramServices |
| Management And General | 4922 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24503 | Total |
| Program Services | 18015 | ProgramServices |
| Management And General | 6488 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1287110 | Total |
| Program Services | 1287110 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5877184 | Total |
| Program Services | 3255470 | ProgramServices |
| Management And General | 2621714 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1134795 | Total |
| Program Services | 653685 | ProgramServices |
| Management And General | 481110 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 27473743 | 27707408 | -233665 |
| Purchased Services | 9335340 | 4212436 | 5122904 |
| Bad Debt | 3593465 | 3593465 | |
| Shared Services & Dues | 1404648 | 1404648 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4338601 | Total |
| Program Services | 2038319 | ProgramServices |
| Management And General | 2300282 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139567678 | Total |
| Program Services | 99448517 | ProgramServices |
| Management And General | 40119161 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15738719 | BOY |
| EOY | 29570381 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19476223 | BOY |
| EOY | 14589083 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1454156 | BOY |
| EOY | 1641514 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1385720 | BOY |
| EOY | 833296 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 93502661 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 49875114 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43869685 | BOY |
| EOY | 43627547 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11435671 | BOY |
| EOY | 15404268 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93746757 | BOY |
| EOY | 105666087 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20746095 | BOY |
| EOY | 18399995 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13318952 | BOY |
| EOY | 12420239 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11520986 | BOY |
| EOY | 10477175 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29262749 | BOY |
| EOY | 50748413 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74848782 | BOY |
| EOY | 92045822 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18746304 | BOY |
| EOY | 12839819 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151671 | BOY |
| EOY | 780446 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18897975 | BOY |
| EOY | 13620265 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93746757 | BOY |
| EOY | 105666087 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1748611 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -7026321 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 235852 | InvestmentCostOrOtherBasis |
| Book Value | 235852 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 56688399 | InvestmentCostOrOtherBasis |
| Depreciation | 34534046 | Depreciation |
| Book Value | 22154353 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 7051055 | InvestmentCostOrOtherBasis |
| Depreciation | 1524565 | Depreciation |
| Book Value | 5526490 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 20886237 | InvestmentCostOrOtherBasis |
| Depreciation | 13423145 | Depreciation |
| Book Value | 7463092 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 8641118 | InvestmentCostOrOtherBasis |
| Depreciation | 393358 | Depreciation |
| Book Value | 8247760 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 43627547 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Insurance Recoveries | 9667929 |
| Interest in net assets of KMH Foundation | 3268942 |
| Due from Affiliates | 1481620 |
| Other Receivables | 808355 |
| Workers Compensation Funding Surplus | 165870 |
| Interest in net assets of CCD Foundation | 11552 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 15404268 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Pension Obligation | $28,823,065 |
| Long Term portion of Insurance Liabilities | $15,063,072 |
| Due to Affiliates | $4,622,179 |
| Interest Rate Swap | $1,805,747 |
| Asset Retirement Obligation | $141,809 |
| Other Long Term Liabilities | $292,541 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 50748413 | TotalOfAmounts |
| Total Revenue | 141316289 | TotalRevenue |
| Total Expenses | 139567678 | TotalExpenses |
| Excess Or Deficit For Year | 1748611 | ExcessOrDeficitForYear |
| Other | -$7,026,321 | OtherAmount |
| Total Adjustments | -7026321 | TotalAdjustments |
| Excess Or Deficit Per FS | -5277710 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 141243127 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 141243127 | RevenueSubtotal |
| Other Revenues Not Included | 73162 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 73162 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 141316289 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 139567678 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 139567678 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 139567678 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | Change in unrestricted interest in KMH Foundation, Inc. -889,413. Change in Pension Obligation -6,552,184. Distribution from parent 380,275. Change in unrealized loss on interest rate swap -593,774. Change in temporarily restricted interest in KMH Foundation,Inc. 628,775. Total to Schedule D, Part XI, Line 8: -7,026,321. |
| Part XII, Line 4b - Other Adjustments: | Contributions from Foundation 58,562. HEPP Grant 14,600. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 110.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 500.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1333566 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 115700 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1217866 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00870 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9419136 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6877133 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2542003 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01820 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10752702 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6992833 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3759869 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02690 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 466447 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 466447 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00330 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 622473 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 622473 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00450 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 152145 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 152145 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1241065 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1241065 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00890 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11993767 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6992833 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5000934 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03580 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1006 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1006 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 77917 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 77917 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4100 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4100 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1256 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1256 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 637 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 637 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 62153 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 62153 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 147069 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 147069 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,109,340 | BadDebtExpenseAmount |
| Amount Attributable To | 502589 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 28366716 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 29720848 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1354132 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kenmore Mercy Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2950 Elmwood Avenue | AddressLine1 |
| City | Kenmore | City |
| State | NY | State |
| ZIP Code | 14217 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | Ambulatory Surgery, Dental O/P, Pediatric O/P, Audiology O/P | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kenmore Mercy Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 110.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 500.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 Drive | 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 I, L7 Col(f): Bad debt expenses of $3,036,432 are included in Part IX, line 25, column (A) but subtracted when calculating the percentage in column (f). | ||
| Part II: Kenmore Mercy Hospital provided Community Building in the form of Economic Development, Community Support, Environmental Improvements, Coalition Building, Community Health Improvement Advocacy, and Workforce Development which improved community leadership by promoting understanding of community healthcare needs and services at various events throughout the community as well as mentoring and education to students regarding healthcare careers. | ||
| Part III, Line 4: The amount in Part III line 2 is the actual bad debt expenses of $3,036,432 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 10/1/2010 to 9/30/2011 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 III, Line 8: The costing methodology used to determine the Medicare Allowable costs is Cost to Charge. The shortfall is not treated as a community benefit. | ||
| Part V, Section A: Audiology O/P, Clinic Part Time Services, Clinical Laboratory Services, Coronary Care, CT Scanner, Emergency Department, Health Fairs O/P,Intensive Care, Medical Social Services, Medical/Surgical, Nuclear Medicine-Diagnostic, Nuclear Medicine-Therapeutic, 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 | ||
| Part V, Section B, Line 13g: Includes information in both English and Spanish on all signage and brochures for financial assistance. | Kenmore Mercy Hospital | |
| Part V, Section B, Line 19d: Highest volume commercial payor rate | Kenmore Mercy Hospital | |
| Part V, Section B, Line 21: There are instances where the full charges on the account are equal to or less than the highest volume commercial payor rate. | Kenmore Mercy Hospital | |
| Part VI, Line 2: Kenmore Mercy Hospital, as part of Catholic Health, involved many participants in assessing community health needs including: 1. New York State Department of Health Prevention Agenda for the Healthiest State Erie County Department of Health Catholic Health Kaleida Health Erie County Medical Center Sheehan Memorial Hospital 2. Health Consumers 3. Patients/residents/clients A. Hospital Inpatients and Outpatients B. Nursing Home Residents and Families C. Rehabilitation Patients D. Primary Care Center Patients E. Home Care Clients 4. Physicians 5. External Organizations, such as Academia, Community-based organizations, elected officials, employers and business, Faith based organizations, governmental organizations, media, philanthropists and schools.6. Statistical Resources1. New York State Department of Health Prevention Agenda for the Healthiest State Catholic Health worked in collaboration with the Erie County Department of Health, Kaleida Health, ECMC and Sheehan Memorial on the Erie Co. DOH Prevention Agenda for the Healthiest State. In February 2009, an Erie County Joint Planning Committee formed to identify prevention priorities and strategies to focus on collaboratively over the next 3 years, which included: Chronic Disease, Healthy Mothers, Healthy Babies, Healthy Children, Physical Activity and Nutrition and Tobacco Use.2. Health Consumers In creating the Catholic Health and Kenmore Mercy Hospital strategic plan, input was sought from a variety of constituents including consumers. In August 2008, eight (8) consumer focus groups were conducted asking consumers what they wanted from their patient care experience. These focus groups were created by reaching out to 8,000 area residents who were asked to contact friends/families/neighbors to participate. 3. Patients/residents/clients A. Hospital Inpatients and Outpatients Kenmore Mercy Hospital continues to participate in a regional patient satisfaction survey through a cooperative effort with the Buffalo Niagara Health Quality Coalition and area hospitals. Patient participation is voluntary. This survey takes place twice per year. Through hospital admission and outpatient ancillary sites, surveys were distributed to individuals to gain an understanding about their healthcare needs and how well their needs were being met. 4. Physicians Kenmore Mercy Hospital surveys its medical staff annually. Physicians are surveyed on issues relating to the quality and efficiency of services offered throughout Catholic Health including at Kenmore Mercy Hospital. 5. External OrganizationsCatholic Health and Kenmore Mercy Hospital also engaged in the P2 Collaborative (Pursuing Perfection) dedicated to improving the health of people across the region. There are more than 200 participant organizations including the provider community, payers, community based organizations, religious organizations, local business, colleges & universities, and governmental agencies. Areas of focus include working with physicians and organizations to enhance access to care and improve efficiency of care and empowering all of the Western New York community to take responsibility for and act on their own wellness.In an effort to engage health care needs at the grass roots level, Catholic Health and Kenmore Mercy Hospital work closely with the following organizations to assess community health need:Niagara Health Quality Coalition, Community Cancer Coalition, American Heart Association, Near East & West Side Task Force, Baker Victory Services, Community Health Center of BuffaloWNY Osteoporosis Resource Ctr., WNY Health Equity Work Group, Living Healthy Task Force of Erie Co., Minority Health Coalition, Buffalo Public Schools Worksite Wellness, Flu CoalitionEvery Parent Influences Children (EPIC), Tobacco Coalition, WNY Coalition for Diabetes, Community Health Foundation, Erie Co. Coalition for Diabetes, WNED Public Television, Catholic Charities, Niagara University6. Statistical ResourcesCatholic Health and Kenmore Mercy Hospital used PQI (Preventable Quality Indicators) to map specific areas by zip code to better understand needs and target for need. We mapped specifically for Congestive Heart Failure, Hypertension, Angina & Diabetes to identify target areas for community education & screening initiatives. Other statistical resources used to assess the needs of the communities served included: "Buffalo Public Schools: Student Body Mass Index", "Erie County Health Assessment Indicators", and "Erie County Health Indicators Profile". Goals/Objectives for the priorities identified for Catholic Health and Kenmore Mercy include: -Increase consumer knowledge and adoption of healthy lifestyle behaviors by encouraging frequent physical activity and healthy nutrition, leading to improved health status and reduced chronic disease prevalence for residents of Buffalo and Erie County. -Increase participants' ability to identify risk factors for cardiovascular disease. -Lower body mass index (BMI) in youth; early identification of adolescents and adults with high blood pressure, high blood cholesterol and high blood glucose through screening and prevention interventions. -Implement a social marketing campaign to positively influence voluntary behavior of target population to take action to maximize health. -Restrict the availability of less healthy foods and beverages in public service venues in Buffalo and Erie County, such as schools, community centers and hospitals.In addition, Catholic Health and Kenmore Mercy utilize resources to manage their public relations and social marketing initiatives (public facing website, Facebook and Twitter); exponentially increasing the effectiveness of its outreach and the success of its Community Service Plan. 2012 Community Education targets: 9,000 biometric screenings (5,610 in underserved areas); 240 community programs held; 4,328 people in attendance at community programs.Measures of Effectiveness: -Number of educational programs held (240) and number of participants (4,328). Number of visits to website (617,380) -Number of program attendees who attended cardiovascular presentations (1,084). -Social media metrics: Facebook pages (4), Facebook fans (4,571), Twitter followers (1,325), website visitors (617,380). -Local government facilities, hospitals and school districts adopt policies that limit the portion size of any entree by either reducing the standard portion size of entrees or offering smaller portion sizes in addition to standard portion sizes | ||
| 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: Kenmore Mercy Hospital serves a mostly suburban partially urban service area which is comprised of 88.5% white (non-Hispanic) and 3.9% African-American (non-Hispanic) households. The service area is more elderly than most with 18% of the population over the age of 65 compared to a national average of 13.3%. The community consists of fewer households than the national average with annual incomes below $15,000/year at 12.5% compared to a national average of 12.9%.Although Kenmore Mercy Hospital is not located in a designated Health Professional Shortage Area (HPSA), the hospital draws patients from other HPSAs in the region and one of its extension clinics is in a designated HPSA area. | ||
| Part VI, Line 5: Catholic Health System's community service activities at the acute facilities include benefits to the broader community, which include non-billed services and provided services paid below costs. Charity care and benefits to the community are provided through long term care facilities, home care programs and Catholic Health system-wide community programs. These programs touch more than 40,000 Western New York residents through community health education programs, health screenings (including: glucose, blood pressure, and cholesterol screenings; and cardiac, stroke, vascular, diabetes, nutrition, stress management, and women's community programming) clinical and support services, clerkships, internships, scholarships, in-kind donations and community support activities. Additionally, thousands of people make unique visits to the Catholic Health website seeking information about an individual or family healthcare issue, and follow Catholic Health on Facebook and Twitter where daily posts talk to education and prevention of the priority areas.The governing Board of Directors of Kenmore Mercy Hospital is comprised of community representatives from universities, legal communities, & business leaders. Religious orders are represented, as well as active and retired medical staff members.The Kenmore Mercy Hospital medical staff can be considered an "open" medical staff, as any physician can apply for privileges. Each application is reviewed by a vigorous credentialing verification process. | ||
| Part VI, Line 6: Kenmore Mercy Hospital is affiliated with the Catholic Health System, Inc., a New York State licensed corporation. Catholic Health System, located in Buffalo, New York exempt from taxation and a charitable organization described in Section 501(c) (3) of the Internal Revenue Code of 1986. Catholic Health is also the parent company of the following New York State corporations: Mercy Hospital of Buffalo, Sisters of Charity Hospital (Main Street Campus) , and Sisters of Charity Hospital (St. Joseph Campus). Its outpatient and post-acute facilities (and services) include Mercy Ambulatory Care Center, Mercy Diagnostic and Treatment Center, Mercy Diagnostic Center, Sheridan Health Care Center, Sisters Central Park Diagnostic Center, Williamsville Diagnostic Center, Kenmore Specialty Center, Ken-Ton Family Care Center, Lovejoy/St. Vincent Health Center, Mercy Comprehensive Care Center, Mercy OB/GYN Center, OLV Family Care Center, Sisters OB/GYN Center, Springville Primary Care Center, Williamsville Primary Care Center, Catholic Health Home Care, St. Elizabeth's Home, St. Vincent's Home, Father Baker Manor, McAuley Residence, Mercy Nursing Facility at OLV, St. Catherine Laboure Health Care Center, and St. Francis of Williamsville. | ||
| NY | Reports Filed With States | Part VI, Line 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (22 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| James Millard | |||||||||||||
| 214698 | 0 | 43291 | 0 | 38703 | 0 | 156544 | 0 | 1275 | 0 | 454511 | 0 | 0 | 0 |
| David Macholz | |||||||||||||
| 0 | 171337 | 0 | 23650 | 0 | 25227 | 0 | 13750 | 0 | 18132 | 0 | 252096 | 0 | 0 |
| Peter Bergmann | |||||||||||||
| 0 | 346695 | 0 | 167259 | 0 | 44802 | 0 | 13217 | 0 | 18468 | 0 | 590441 | 0 | 0 |
| Dr Michael Edbauer | |||||||||||||
| 0 | 96362 | 0 | 59284 | 0 | 41846 | 0 | 16807 | 0 | 26786 | 0 | 241085 | 0 | 0 |
| Christine Kluckhohn | |||||||||||||
| 0 | 186796 | 0 | 55065 | 0 | 55207 | 0 | 97902 | 0 | 18716 | 0 | 413686 | 0 | 0 |
| Charles J Urlaub | |||||||||||||
| 0 | 324839 | 0 | 72463 | 0 | 38707 | 0 | 18124 | 0 | 14704 | 0 | 468837 | 0 | 0 |
| James A Dunlop Jr | |||||||||||||
| 0 | 327293 | 0 | 82819 | 0 | 32973 | 0 | 94418 | 0 | 17685 | 0 | 555188 | 0 | 0 |
| Dr Brian D'Arcy | |||||||||||||
| 0 | 253307 | 0 | 60760 | 0 | 288076 | 0 | 30581 | 0 | 18105 | 0 | 650829 | 0 | 0 |
| Walter Ludwig | |||||||||||||
| 147400 | 0 | 18860 | 0 | 30747 | 0 | 11173 | 0 | 16514 | 0 | 224694 | 0 | 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 |
| Dr James Fitzpatrick | |||||||||||||
| 139650 | 0 | 16383 | 0 | 506 | 0 | 15521 | 0 | 16687 | 0 | 188747 | 0 | 0 | 0 |
| Dr Sanford Pleskow | |||||||||||||
| 132315 | 0 | 0 | 0 | 22604 | 0 | 0 | 0 | 858 | 0 | 155777 | 0 | 0 | 0 |
| Dr Qamrunnisa Rahman | |||||||||||||
| 135045 | 0 | 0 | 0 | 14622 | 0 | 71854 | 0 | 6082 | 0 | 227603 | 0 | 0 | 0 |
| Dr Suchitra Koneru | |||||||||||||
| 121076 | 0 | 0 | 0 | 14642 | 0 | 7498 | 0 | 24129 | 0 | 167345 | 0 | 0 | 0 |
| Dr Nadezhda Polataiko | |||||||||||||
| 136743 | 0 | 0 | 0 | 207 | 0 | 38559 | 0 | 16780 | 0 | 192289 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. Pension Gap CHE SERP Joseph McDonald $26,000 $106,775 Dr.Brian D'Arcy $9,800 $142,750 Michael Moley $20,697 Peter Bergmann $7,334 |
| 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 $208,063 Mark Sullivan $92,715 James A. Dunlop, Jr. $82,819 Dr. Brian D'Arcy $60,760 Nancy Sheehan $43,103 Michael Moley $58,553 John Stavros $39,644 Christine Kluckhohn $55,065 Maria Foti $36,606 Bartholomew Rodrigues $34,317 Dr. Michael Galang $35,389 Dr. Michael Edbauer $59,284 David Macholz $23,650 Peter Bergmann $76,258 James Millard $43,291 Walter Ludwig $18,860 Dr. James Fitzpatrick $16,383 Charles Urlaub $72,463 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dormitory Authority of State of New York | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 146000293 | IssuerEIN |
| CUSIP Number | 64983Q5t2 | CUSIPNumber |
| Date Issued | 2006-11-29 | DateIssued |
| Issue Price | 16730000 | IssuePrice |
| Description Of Purpose | Part V | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 16730000 | TotalProceeds |
| Issuance Costs From Proceeds | 657688 | IssuanceCostsFromProceeds |
| Credit Enhancement | 99008 | CreditEnhancement |
| Capital Expenditures | 15973304 | CapitalExpenditures |
| Year Of Subst Completion | 1998 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 1 | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JP Morgan Chase NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 15.500000000000 | TermOfHedge |
| Superintegrated Hedge | 0 | SuperintegratedHedge |
| Hedge Terminated | 0 | HedgeTerminated |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part I A (f) | Identifier |
| Return Reference | Description of Purpose | ReturnReference |
| Explanation | To refund the New York State Medical Care Facilities Finance Agency 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. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Susan Uralub | |||
| Wife of Mercy CEO, C.J. Urlaub | 76045 | Corporate Nurse Educator | 0 |
| James Manzella | |||
| Acute Care Board Member | 326330 | Key Employee of Manzella Marketing | 0 |
| 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 |
| Marie Packard | |||
| Daughter of BOD, Dennis Dombek | 46301 | Mercy Physical Therapist | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 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 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 | 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: | Change in unrestricted interest in KMH Foundation, Inc. -889,413. Change in Pension Obligation -6,552,184. Distribution from parent 380,275. Change in unrealized loss on interest rate swap -593,774. Change in temporarily restricted interest in KMH Foundation,Inc. 628,775. Total to Form 990, Part XI, Line 5: -7,026,321. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (17 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| Catholic Health System Inc | ||||||||||
| 515 Abbott Road | Buffalo | NY | 14220 | 222565278 | Health Care Delivery System | NY | 501c | Schedule A line 9 | 0 | |
| Mercy Hospital of Buffalo | ||||||||||
| 565 Abbott Road | Buffalo | NY | 14220 | 160756336 | Acute Care Hospital | NY | 501c | Schedule A line 3 | 0 | Catholic Health System Inc |
| Sisters of Charity Hospital | ||||||||||
| 2157 Main Street | Buffalo | NY | 14214 | 160743187 | Acute Care Hospital | NY | 501c | Schedule A line 3 | 0 | Catholic Health System Inc |
| Nazareth Home of the Franciscan Sisters | ||||||||||
| 291 North Street | Buffalo | NY | 14201 | 160813142 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Clare Manor | ||||||||||
| 543 Locust Street | Lockport | NY | 14094 | 160782647 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Elizabeth Home for the Aged | ||||||||||
| 5539 Broadway | Lancaster | NY | 14086 | 160743154 | Adult Home | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Francis Home of Williamsville | ||||||||||
| 147 Reist St | Williamsville | NY | 14221 | 160743153 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Francis of Buffalo Inc | ||||||||||
| 34 Benwood Ave | Buffalo | NY | 14214 | 161523535 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Joseph Manor | ||||||||||
| 2211 West State Street | Olean | NY | 14760 | 160796400 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Luke Manor for the Chronically Ill | ||||||||||
| 17 Wiard St | Batavia | NY | 14020 | 160794811 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Mary's Manor | ||||||||||
| 515 6th Street | Niagara Falls | NY | 14301 | 160924139 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| St Vincent Manor | ||||||||||
| 319 Washington Avenue | Dunkirk | NY | 14048 | 160743167 | Adult Home | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| WNY Catholic Long Term Care Inc | ||||||||||
| 6400 Powers Rd | Orchard Park | NY | 14127 | 161434368 | Skilled Nursing Facility | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| Niagara Homemaker Services (Mercy Home Care) | ||||||||||
| 2875 Union Rd Suite 14 | Cheektowaga | NY | 14227 | 161317960 | Home Care Provider | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| McAuley Seton Home Care | ||||||||||
| 2875 Union Rd Suite 14 | Cheektowaga | NY | 14227 | 161310062 | Home Care Provider | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| Catholic Health System Infusion Pharmacy Inc | ||||||||||
| 2875 Union Road Suite 14 | Cheektowaga | NY | 14227 | 200198518 | Home Care Infusion Services | NY | 501c | Schedule A line 9 | 0 | Catholic Health System Inc |
| 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 | Schedule A line 3 | 0 | Catholic Health System Inc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |