2023-11-14T11:36:41-06:00 2022-12-31 990 2022-01-01 161387890 KMH HOMES INC KMHH 7168282974 144 GENESEE STREET BUFFALO NY 14203 RUSSELL EDWARDS VP FINANCE/CORP. CONTROLLER 7169232968 2023-11-14 RUSSELL EDWARDS 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOYCE MARKIEWICZ 6TH FLOOR144 GENESEE ST BUFFALO NY 14203 823476 0 X WWW.CHSBUFFALO.ORG X 1991 NY KMH HOMES, INC. WAS ESTABLISHED IN 1991 AS A NOT-FOR PROFIT CORPORATION TO HOLD PROPERTY OPERATED BY KENMORE MERCY HOSPITAL, AN AFFILIATED NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX AND DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS 160-BED SKILLED NURSING FACILITY AND ISSUE THE RELATED ACQUISITION DEBT USED TO CONSTRUCT THE FACILITY. THE SOLE MEMBER OF KMH HOMES, INC. AND KENMORE MERCY HOSPITAL IS CATHOLIC HEALTH SYSTEM INC., A NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX AND DESCRIBED IN SECTION 501(C)(3)OF THE INTERNAL REVENUE CODE LOCATED IN BUFFALO, NY. KMH HOMES, INC. ADHERES TO AND IS GOVERNED BY THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH SYSTEM, INC. ADOPTED BY THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS. 2 0 0 0 0 0 0 0 823476 823476 0 0 0 0 823476 823476 0 0 0 0 0 0 0 0 0 590525 545021 590525 545021 232951 278455 7219246 6833576 5940932 5276807 1278314 1556769 X KMH HOMES,INC. WAS ESTABLISHED IN 1991 AS A NOT FOR PROFIT CORPORATION TO HOLD THE PROPERTY AND ISSUE RELATED DEBT, TO FINANCE CONSTRUCTION OF THE PROPERTY USED BY KENMORE MERCY HOSPITAL TO OPERATE A SKILLED NURSING FACILITY. THE SOLE MEMBER OF KMH HOMES, INC. IS CATHOLIC HEALTH SYSTEM,INC. A 501(C)(3)CORPORATION LOCATED IN BUFFALO, NY. 0 0 545021 823476 KMH HOMES, INC. WAS ESTABLISHED IN 1991 AS A NOT-FOR PROFIT CORPORATION TO HOLD PROPERTY OPERATED BY KENMOVE MERCY HOSPITAL, AN AFFILIATED NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX AND DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS 160-BED SKILLED NURSING FACILITY AND ISSUE THE RELATED ACQUISITION DEBT USED TO CONSTRUCT THE FACILITY. THE SOLE MEMBER OF KMH HOMES, INC. AND KENMORE MERCY HOSPITAL IS CATHOLIC HEALTH SYSTEM, INC. A NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX AND DESCRIBED IN SECTION 501(C)(3)OF THE INTERNAL REVENUE CODE, LOCATED IN BUFFALO, NY. KMH HOMES, INC. ADHERES TO AND IS GOVERNED BY THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH SYSTEM, INC. ADOPTED BY THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS.THE SKILLED NURSING FACILITY, CONSTRUCTED, AND OWNED BY KMH HOMES, INC. PREDOMINATELY SERVESK A MEDICAID AND MEDICARE POPULATION. KMH HOMES, INC. LEASES THE PROPERTY TO KENMORE MERCY HOSPITAL. THE LEASE PAYMENTS ARE GENERALLY SUFFICIENT ONLY TO COVER RETIREMENT OF THE DEBT AND ADMINISTRATIVE EXPENSES OF KMH HOMES, INC.KMH HOMES, INC. HAS BEEN AND IS IRREVOCABLY DEDICATED TO AND OPERATED EXCLUSIVELY FOR CHARITABLE OF PROVIDING LONG-TERM HEALTH CARE FOR THE ELDERLY. KMH HOMES, INC. SUPPORT AND ENHANCES THE EFFICIENCY OF THE HEALTH-RELATED MINISTRIES OF THE CATHOLIC HEALTH SYSTEM, INC. BY OWNING, LEASING, AND MAINTAINING REAL ESTATE. 545021 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 2 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X RUSSELL EDWARDS VP FINANCE CORPORATE CONTROLLER 7169232968 144 GENESEE STREET BUFFALO NY 14203 MARK SULLIVAN SECRETARY/DIRECTOR 0.00 55.00 X X 0 1314161 25888 WALT LUDWIG PRESIDENT/DIRECTOR 0.00 55.00 X X 0 351681 49177 DAVID MACHOLZ DIRECTOR 0.00 55.00 X 0 624031 15718 RUSSELL EDWARDS DIRECTOR 0.00 55.00 X 0 222888 469 0 2512761 91252 0 0 1 0 0 RENTAL 531120 823476 823476 823476 823476 823476 0 0 36791 36791 496916 496916 11314 11314 545021 545021 0 0 77401 77401 19305107 12548932 7141845 6756175 7219246 6833576 5940932 5276807 5940932 5276807 X 1278314 1556769 1278314 1556769 7219246 6833576 278455 0 X 0 1 X 1 0 X 823476 823476 823476 823476 823476 4117380 823476 823476 823476 823476 823476 4117380 0 0 0 4117380 823476 823476 823476 823476 823476 4117380 1.00000 1.00000 0.00000 X 16812033 11053693 5758340 735993 233905 502088 1757081 1261334 495747 6756175 DUE TO AFFILIATE 4822349 CURRENT PORTION OF LONG-TERM DEBT 454458 5276807 X X X X X X 0 0 0 0 0 0 0 0 0 MARK SULLIVAN SECRETARY/DIRECTOR 0 983779 0 62939 0 267443 0 9215 0 16673 0 1340049 0 0 DAVID MACHOLZ DIRECTOR 0 606188 0 0 0 17843 0 -5919 0 21637 0 639749 0 0 WALT LUDWIG PRESIDENT/DIRECTOR 0 333184 0 0 0 18497 0 33122 0 16055 0 400858 0 0 RUSSELL EDWARDS DIRECTOR 0 202179 0 0 0 20709 0 -7619 0 8088 0 223357 0 0 PART I, LINE 3: THE CHANGE IN PRESENT VALUE SHOWN FOR EACH PARTICIPANT REPRESENTS THE CHANGE IN THE ACTUARIAL VALUE OF THE ACCRUED BENEFIT, WHETHER OR NOT FUNDED, VESTED OR SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. NOTE THAT THE CHANGE IN PRESENT VALUE IS PARTLY DUE TO CHANGES IN THE DISCOUNT RATE AND, FOR THOSE ACCRUING UNDER THE CASH BALANCE FORMULA, THE ASSUMPTIONS FOR FUTURE CASH BALANCE INTEREST CREDITING RATES AND FACTORS APPLICABLE TO ANNUITY CONVERSIONS. DAVID A MACHOLZ NEPHEW OF CEO, DAVID MACHOLZ 15904 NETWORK TECHNICAL ANALYST, CHS 0 FORM 990, PART VI, SECTION A, LINE 6 CHS HAS TWO MEMBERS: THE FRANCISCAN SISTERS OF ST. JOSEPH OF HAMBURG, NY, 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 HAVE THE POWER TO APPROVE ANY PLAN OF DISSOLUTION OF THE CORPORATION AND THE DISTRIBUTION OF THE 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 ONE REPRESENTATIVE AND ONE ALTERNATIVE REPRESENTATIVE TO SERVE ON THE CORPORATE MEMBER COUNCIL AND TO SERVE AS A VOTING DIRECTOR ON THE CATHOLIC HEALTH SYSTEM BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B YES, THE CORPORATE MEMBERS DO HAVE RESERVE POWERS. FORM 990, PART VI, SECTION B, LINE 11B 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 THAT FILE A 990. 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 OFFICERS, DIRECTORS, AND KEY EMPLOYEES 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 BY THE MANAGER, 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 CHS, IN DETERMINING THE COMPENSATION FOR THE CEO, UTILIZES A PROCESS OF REVIEW AND APPROVAL, GOVERNED BY THE BOARD OF DIRECTORS THAT INCLUDES AN OUTSIDE NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NON-PROFIT HEALTHCARE ORGANIZATIONS, AND COMPARABILITY DATA. IN 2022, 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 AND TOP SENIOR EXECUTIVES. 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. CATHOLIC HEALTH SYSTEM INC 144 GENESEE STREET BUFFALO NY 14203 222565278 HEALTH CARE DELIVERY SYSTEM NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 MERCY HOSPITAL OF BUFFALO 565 ABBOTT ROAD BUFFALO NY 14220 160756336 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 SISTERS OF CHARITY HOSPITAL 2157 MAIN STREET BUFFALO NY 14214 160743187 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVENUE KENMORE NY 14217 160762843 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 NAZARETH HOME OF THE FRANCISCAN SISTERS 291 NORTH STREET BUFFALO NY 14201 160813142 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST ELIZABETH HOME FOR THE AGED 5539 BROADWAY LANCASTER NY 14086 160743154 ADULT HOME NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS HOME OF WILLIAMSVILLE 147 REIST STREET WILLIAMSVILLE NY 14221 160743153 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST FRANCIS OF BUFFALO INC 34 BENWOOD AVENUE BUFFALO NY 14214 161523535 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 WNY CATHOLIC LTC INC 6400 POWERS ROAD ORCHARD PARK NY 14127 161434368 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 NIAGARA HOMEMAKER SERVICES (MERCY HOME CARE) 144 GENESEE STREET BUFFALO NY 14203 161317960 HOME CARE PROVIDER NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 MCAULEY SETON HOME CARE 144 GENESEE STREET BUFFALO NY 14203 161310062 HOME CARE PROVIDER NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 CATHOLIC HEALTH SYSTEM INFUSION PHARMACY 6350 TRANSIT ROAD DEPEW NY 14043 200198518 HOME CARE INFUSION SERVICES NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 ST VINCENT MANOR 319 WASHINGTON AVENUE DUNKIRK NY 14048 160743167 ADULT HOME NY 501(C)(3) LINE 10 CATHOLIC HEALTH SYSTEM INC 0 TRINITY MEDICAL WNY PC 2625 HARLEM RD CHEEKTOWAGA NY 14225 272576645 PRIMARY CARE PROVIDER NY 501(C)(3) LINE 12 CATHOLIC HEALTH SYSTEM INC 0 MOUNT ST MARY'S HOSPITAL OF NIAGARA FALLS 5300 MILITARY ROAD LEWISTON NY 14092 161523353 ACUTE CARE HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH SYSTEM INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0