2020-11-12T14:40:09-06:00 2019-12-31 861065772 DELOITTE TAX LLP 200 RENAISSANCE CENTER SUITE 3900 DETROIT MI 482431313 990 2019-01-01 161417199 INDEPENDENT HEALTH FOUNDATION INDE 7166313001 777 INTERNATIONAL DRIVE BUFFALO NY 14221 MICHAEL W CROPP MD PRESIDENT 7166313001 2020-11-10 1 ALICIA JANISCH P00741382 3133963000 23.117.53.176 2020-11-10 12:25:13 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 36349DFDC8A41F8514BA56231B42690B2223D4A6 2019 2021-01-29 14:40:06Z MICHAEL W CROPP MD 777 INTERNATIONAL DRIVE BUFFALO NY 14221 3308961 0 X WWW.INDEPENDENTHEALTH.COM/FOUNDATION X 1992 NY TO IMPROVE THE HEALTH AND WELL BEING OF WESTERN NEW YORK RESIDENTS THROUGH AWARENESS, PREVENTION, WELLNESS, AND OTHER EDUCATION PROGRAMS FOCUSED ON COMMUNITY HEALTH PRIORITIES. 14 9 16 467 0 0 2057823 2658594 58801 76431 72807 22834 1115 1645 2190546 2759504 30170 37888 0 0 873598 1071227 0 0 78861 1035896 1143423 1939664 2252538 250882 506966 2836157 3495740 186986 207855 2649171 3287885 TO IMPROVE THE HEALTH AND WELL BEING OF WESTERN NEW YORK RESIDENTS THROUGH AWARENESS, PREVENTION, WELLNESS, AND OTHER EDUCATION PROGRAMS FOCUSED ON COMMUNITY HEALTH PRIORITIES. 0 0 1951967 37888 76431 IN SUPPORT OF INDEPENDENT HEALTH ASSOCIATION'S PRIORITIES, THE PURPOSE OF THE FOUNDATION IS TO IMPROVE THE HEALTH AND WELL BEING OF WNY RESIDENTS THROUGH HEALTH AWARENESS, PREVENTION, WELLNESS EDUCATION AND OTHER PROGRAMS FOCUSED ON COMMUNITY HEALTH PRIORITIES. SEE SCHEDULE O FOR ADDITIONAL DETAILS. 1951967 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 1 32 0 1 16 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 9 1 0 0 0 1 1 0 1 0 1 0 1 1 1 1 1 1 0 0 0 NY X ANN PENTKOWSKI 7166313001 511 FARBER LAKES DRIVE BUFFALO NY 14221 ANN MCCARTHY SECRETARY 1.00 0.00 X X 0 0 0 CASIMIRO RODRIQUEZ SR BOARD MEMBER 1.00 0.00 X 0 0 0 DAN GAGLIARDO CHAIRPERSON (END 3/19) 1.00 5.00 X X 0 40000 8205 JOHN ANTKOWIAK MD VICE CHAIRPERSON 1.00 12.00 X X 0 100000 8205 JOHN N WALSH III BOARD MEMBER 1.00 5.00 X 0 47000 0 JOHN REID RODGERS BOARD MEMBER 1.00 51.00 X 0 1009183 550828 KAREN BRIM TREASURER 1.00 38.00 X X 0 137807 66103 KHALID J QAZI MD BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL W CROPP PRESIDENT 1.00 52.00 X X 0 3122947 426307 PASTOR RICHARD HAGUE BOARD MEMBER 1.00 0.00 X 0 0 0 PATRICIA C CLABEAUX BOARD MEMBER 1.00 46.00 X 0 557161 332311 R JAY TILLOTSON END 419 BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERTA D RIFKIN BOARD MEMBER 1.00 46.00 X 0 408031 173384 STUART H ANGERT CHAIRPERSON (START 4/19) 5.00 5.00 X 0 40000 1140 YVONNE S MINOR-RAGAN PHD BOARD MEMBER 1.00 5.00 X 0 39000 411 CARRIE MEYER EXECUTIVE DIRECTOR 38.00 0.00 X 158072 0 54281 MICHAEL J FASO DIR. OF FINANCE (END 6/19) 1.00 38.00 X 0 646730 73038 STEVEN TIMMEL DIR OF FINANCE (START 6/19) 1.00 37.00 X 0 121991 15925 158072 6269850 1710138 2 0 1 0 UNITED WAY OF BUFFALO AND ERIE COUNTY 742 DELAWARE AVE BUFFALO NY 142092295 COMM. PROGRAM SERVICE SUPPORT 239581 DUAL PRINT & MAIL LLC 3235 GRAND ISLAND BLVD GRAND ISLAND NY 14072 PRINTING SERVICES 136028 2 31029 1972400 655165 58158 2658594 ADMISSIONS - P.S. EVEN 900099 76431 76431 76431 27844 27844 540479 545489 -5010 -5010 -5010 5613 31029 3968 1645 1645 2759504 76431 0 24479 X 37888 37888 212353 57335 146524 8494 679757 590000 38638 51119 23929 17992 4275 1662 93807 96991 -11216 8032 61381 46224 10913 4244 20000 15000 3600 1400 8158 8158 399776 399489 206 81 195462 193552 1375 535 309360 295908 11533 1919 29097 27277 1310 510 29907 29236 483 188 8805 7870 673 262 14018 13266 542 210 RENTAL EXPENSES 86506 86506 0 ARTISTS & SPEAKERS 29064 29064 0 OTHER EXPENSES 9103 8369 529 205 IMPAIRMENT 4167 4167 2252538 1951967 221710 78861 421214 487519 1645882 1943900 147245 28275 27482 740786 889594 2836157 3495740 159084 193455 27902 14400 186986 207855 X 556986 687546 2092185 2600339 2649171 3287885 2836157 3495740 506966 131748 0 X 0 1 X 1 0 X X X 1 INDEPENDENT HEALTH ASSOCIATION INC 161080163 10 1 0 1951967 1 0 1951967 1 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART IV, SECTION A, LINE 3B: INDEPENDENT HEALTH FOUNDATION KEEPS A COPY OF THE INDEPENDENT HEALTH ASSOCIATION, INC.'S IRS DETERMINATION LETTER ON FILE. IN ADDITION, INDEPENDENT HEALTH FOUNDATION REQUESTED THAT INDEPENDENT HEALTH ASSOCIATION, INC. PROVIDE A COMPLETED PUBLIC SUPPORT TEST FOR SCHEDULE A, PART III ON AN ANNUAL BASIS SHOWING THAT THE 509(A)(2) PUBLIC SUPPORT TEST HAS BEEN PASSED. PART I, SCHEDULE A, LINE 12G, COLUMN VI IN SUPPORT OF INDEPENDENT HEALTH ASSOCIATION, INC'S. MISSION TO PROVIDE HEALTH-RELATED PRODUCTS AND SERVICES THAT ENABLE AFFORDABLE ACCESS TO QUALITY HEALTH CARE INDEPENDENT HEALTH FOUNDATION HAS SUPPORTED PROGRAMS TOTALING $1,951,967 DURING 2019. SEE SCHEDULE O (PART III) FOR ADDITIONAL DETAIL REGARDING THE PROGRAMS THAT WERE FUNDED. SCHEDULE A, PART IV, SECTION A, LINE 3C: INDEPENDENT HEALTH FOUNDATION DOES NOT PROVIDE ANY DIRECT SUPPORT/GRANTS TO ITS SUPPORTED ORGANIZATION; THEREFORE, NO CONTROLS ARE REQUIRED. SCHEDULE A, PART IV, SECTION A, LINE 6: GRANTS PROVIDED TO OTHER ORGANIZATIONS MUST ALIGN WITH INDEPENDENT HEALTH FOUNDATION AND INDEPENDENT HEALTH ASSOCIATION, INC.'S MISSIONS. GRANTS ARE MONITORED BY CONDUCTING MONTHLY/QUARTERLY MEETINGS AND/OR REQUESTING UPDATED REPORTS FROM THE GRANTEES TO ENSURE THE FUNDS ARE USED CONSISTENT WITH THE 501(C)(3) PURPOSES AS DESCRIBED IN SECTION 170(C)(2)(B). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INTERCOMPANY PAYABLE - INDEPENDENT HEALTH ASSOCIATION, INC 14400 14400 5458160 131749 549900 2027794 2709443 2748717 14755 -3968 10787 2759504 2787486 549902 -14755 535147 2252339 4167 -3968 199 2252538 PART XI, LINE 2D - OTHER ADJUSTMENTS: IMPAIRMENT LOSS -4,167. RESTRICTED ASSETS RELEASED FROM RESTRICTION 2,031,961. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -3,968. PART XII, LINE 2D - OTHER ADJUSTMENTS: BANK FEES -14,755. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -3,968. TAPS & APPS 36642 31029 5613 6 415 20 3527 36642 31029 5613 6 415 20 3527 3968 1645 1 BUFFALO MEDICAL GROUP PO BOX 8000 DEPT 316 BUFFALO NY 142670002 161000580 5100 PHYSICIAN GROUP TRAINING 0 1 PART I, LINE 2: DONATIONS/CONTRIBUTIONS: ONLY REMIT TO COLLABORATING COMMUNITY PARTNERS WHO ALIGN WITH OUR MISSION TO IMPROVE THE HEALTH AND WELL-BEING OF THE WNY COMMUNITY. THE GRANTS OR SPONSORSHIPS ARE RECORDED TO THE SAME ACCOUNT NUMBER ON THE GENERAL LEDGER SYSTEM UNDER "COMMUNITY PROGRAMS AND COPIES OF ALL PAYMENTS ARE KEPT ON FILE (PAPER & ELECTRONICALLY). 1 1 0 0 0 0 0 0 0 JOHN REID RODGERS BOARD MEMBER 0 550561 0 422613 0 36009 0 521592 0 29236 0 1560011 0 129109 KAREN BRIM TREASURER 0 130184 0 5983 0 1640 0 44791 0 21312 0 203910 0 0 MICHAEL W CROPP PRESIDENT 0 1005652 0 2068109 0 49186 0 407675 0 18632 0 3549254 0 1409047 PATRICIA C CLABEAUX BOARD MEMBER 0 356177 0 194772 0 6212 0 290125 0 42186 0 889472 0 53796 ROBERTA D RIFKIN BOARD MEMBER 0 257868 0 142442 0 7721 0 148970 0 24414 0 581415 0 48939 CARRIE MEYER EXECUTIVE DIRECTOR 133265 0 24018 0 789 0 32194 0 22087 0 212353 0 0 0 MICHAEL J FASO DIR. OF FINANCE (END 6/19) 0 368242 0 243620 0 34868 0 58418 0 14620 0 719768 0 129949 PART I, LINE 3 INDPENDENT HEALTH ASSOCIATION, INC., A RELATED TAX-EXEMPT ORGANIZATION OF INDEPENDENT HEALTH FOUNDATION USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION SURVEY OR STUDY PART I, LINES 4A-B PART I, LINES 4A THE FOLLOWING LISTED PERSON FROM PART VII, SECTION A RECEIVED SEVERANCE PAYMENTS AS PART OF A SEPARATION AGREEMENT WITH INDEPENDENT HEALTH DURING 2019: MICHAEL FASO - $199,833 PART I, LINES 4B ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F), 457A, AND 409A. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. SUPPLEMENTAL NON-QUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: MICHAEL CROPP $1,409,047 JOHN REID RODGERS - $129,109 PATRICIA CLABEAUX - $53,796 MICHAEL FASO - $129,949 ROBERTA RIFKIN - $48,939 X EQUIPMENT 7550 39386 X GIFT BASKET 1026 15572 X TICKETS 16 3200 0 1 0 PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: THE FITNESS FOR KIDS CHALLENGE THE FITNESS FOR KIDS CHALLENGE WAS CREATED TO FIGHT THE SIGNIFICANT INCREASE IN CHILDHOOD OBESITY AND TYPE 2 DIABETES. THE CHALLENGE ENCOURAGES CHILDREN TO COMPLETE HEALTH AND FITNESS ACTIVITIES AND ADOPT HABITS TO ENSURE HEALTHY FUTURES. THE PROGRAM INCLUDES REWARDS, INCENTIVES, A SCHOOL COMPETITION, AND COMMUNITY-WIDE EVENTS. THIS INITIATIVE HAS REACHED OVER 10,000 YOUTH TO DATE WORKING DIRECTLY WITH OVER 60 ELEMENTARY SCHOOLS. FITNESS FOR KIDS CHALLENGE IS A YEAR-LONG EVENT FUNDED BY MULTIPLE SOURCES. FITNESS FOR KIDS CHALLENGE - BUFFALO BILLS YOUTH FOUNDATION THIS IS A RESTRICTED GRANT IN SUPPORT OF THE FITNESS FOR KIDS CHALLENGE PROGRAM TOTALING $6,000. KIDS RUN KIDS RUN WAS CREATED TO ENCOURAGE FAMILIES TO EXERCISE AND STAY ACTIVE TOGETHER. THIS FREE EVENT HAS GROWN CONTINUALLY EACH YEAR. TROPHIES ARE AWARDED TO TOP RUNNERS, AND ALL PARTICIPANTS RECEIVE A MEDAL. THE EVENT SERVED OVER 5,600 UNDERSERVED FAMILIES THAT ARE OFTEN LACKING THE OPPORTUNITY TO PARTICIPATE IN PHYSICAL ACTIVITIES. KIDS RUN DEMONSTRATES THE IMPORTANCE OF LIVING A HEALTHY LIFESTYLE. 77 VOLUNTEERS ASSISTED WITH THIS INITIATIVE IN 2018. FIRST NIGHT BUFFALO FIRST NIGHT BUFFALO HAS BEEN A COMMUNITY-WIDE TRADITION IN WESTERN NEW YORK FOR MORE THAN 20 YEARS. THIS DRUG AND ALCOHOL-FREE, FAMILY FRIENDLY EVENT ATTRACTS THOUSANDS OF PEOPLE TO DOWNTOWN BUFFALO. FIRST NIGHT BUFFALO FEATURES A VARIETY OF LOCAL AND MULTI-CULTURAL ENTERTAINMENT AT AN AFFORDABLE COST. IT HAS SERVED APPROXIMATELY 5,000 PEOPLE. 43 VOLUNTEERS ASSISTED WITH THIS INITIATIVE IN 2018. THE VOLUNTEERS ARE ASKED TO MONITOR CROWDS, DISTRIBUTE BROCHURES, ASSIST WITH GAMES, EVENT SET UP OR TAKE-DOWN, COMMUNICATIONS OR WEAR A CHARACTER COSTUME. SOCCER FOR SUCCESS SOCCER FOR SUCCESS IS A FREE AFTERSCHOOL SOCCER PROGRAM THAT IS PROVIDED IN THE WESTERN NEW YORK REGION TO STUDENTS IN GRADES K-8. THE PROGRAM FOCUSES ON THE ESSENTIALS OF SOCCER, NUTRITION EDUCATION, AND COACH MENTORSHIP TO THE STUDENTS. IT IS A CURRICULUM DEVELOPED BY THE U.S. SOCCER FOUNDATION. IT SERVED APPROXIMATELY 2,250 KIDS THROUGHOUT THE ACADEMIC YEAR. GOOD FOR THE NEIGHBORHOOD GOOD FOR THE NEIGHBORHOOD IS A COMMUNITY-BASED WELLNESS INITIATIVE THAT BRINGS HEALTHY LIVING TRAINING AND LEARNING TOOLS TO AT-RISK NEIGHBORHOODS WHERE ACCESS TO HEALTHCARE IS LIMITED DUE TO SOCIAL AND ECONOMIC BARRIERS. OUR CURRENT AREAS OF FOCUS INCLUDE THE EAST AND WEST SIDES OF BUFFALO, AND NIAGARA FALLS AND HAS RECENTLY EXPANDED INTO LACKAWANNA AND AKRON. THIS PROGRAM ENCOURAGES FAMILIES TO MANAGE AND IMPROVE THEIR HEALTH MORE EFFECTIVELY. THIS PROGRAM SERVED APPROXIMATELY 2,500 PEOPLE. 124 VOLUNTEERS CONTRIBUTED TO THIS INITIATIVE. THE VOLUNTEERS ARE ASKED TO DISTRIBUTE FOOD SAMPLES, ASSIST WITH CRAFTS, REGISTRATION OR SIGN UP PEOPLE FOR HEALTH SCREENINGS RESILIENCY LIT2 "GROWING UP STRONG" IN COLLABORATION WITH WESTERN NEW YORK UNITED AGAINST DRUG & ALCOHOL ABUSE, INC., THE FOUNDATION WAS AWARDED $40,000 FROM THE OISHEI FOUNDATION. THIS IS A MULTI-PHASED PROGRAM, WHICH WILL WORK TO REDUCE THE IMPACT OF ADVERSE CHILDHOOD EXPERIENCES (ACES) ON THE YOUTH OF WNY. THE FIRST PHASE OF THE PROJECT IS THE CREATION OF LEADERS INTO TOMORROW (LIT2), AN EXTENSION OF THE LEADERS IN TRAINING PROGRAM, WHICH CREATES A HEALTH ADVOCATE/MENTORSHIP PROGRAM IN THE BUFFALO PUBLIC HIGH SCHOOLS. THE SECOND PHASE OF THIS PROJECT IS GROWING UP STRONG, WHICH WILL PARTNER WITH WESTERN NEW YORK PEDIATRIC AND OBSTETRICIAN HEALTH CARE PROVIDERS TO BETTER SUPPORT CHILDREN AGES 0-5 AND PROVIDE THESE CHILDREN AND THEIR FAMILIES THE APPROPRIATE TOOLS AND RESOURCES TO FULLY THRIVE. THIS PROJECT WILL FOCUS ON 3 KEY COMPONENTS TO ENSURE NO CHILD FALLS THROUGH THE CRACKS AND MISSES OUT ON NEEDED SERVICES. PAIN MANAGEMENT CME THE PAIN MANAGEMENT CME IS AN EDUCATIONAL SEMINAR ENTITLED "PAIN MEDICINE FOR NON-PAIN SPECIALISTS." THIS FORUM HAD 120 ATTENDEES AND WAS ORGANIZED TO PROVIDE A COMPREHENSIVE REVIEW OF THE BASIC SCIENCE OF OPIOIDS AND ADDICTION, CLINICAL ASPECTS OF OPIOID PRESCRIBING AND THE LEGAL IMPLICATIONS IN EVERYDAY PRACTICE. BY THE END OF THIS PROGRAM PARTICIPANTS WERE ABLE TO: 1. OUTLINE THE BASIC SCIENCE AND CLINICAL APPLICATION RELEVANT TO THE PRACTICE OF PAIN MANAGEMENT MEDICINE. 2. USE THE RESOURCES AND TOOLS PROVIDED TO OBJECTIVELY PRESCRIBE OPIOIDS FOR CHRONIC PAIN. 3. DISCUSS THE LEGAL IMPLICATIONS IN OPIOIDS PRESCRIBING. WELLNESS PROGRAMS HEALTHY OPTIONS: THE HEALTHY OPTIONS PROGRAM WORKS WITH OVER 250 LOCAL RESTAURANTS AND FOOD TRUCKS TO ANALYZE AND MODIFY MENU ITEMS INTO HEALTHY ALTERNATIVES. THROUGH THIS, THE PROGRAM AIMS TO EDUCATE OUR COMMUNITY TO MAKE MORE INFORMED DECISIONS WHEN DINING OUT AND WHILE COOKING AT HOME. HEALTHY OPTIONS PARTNERS WITH FOOD FESTIVALS AROUND WNY TO SHOWCASE GREAT-TASTING, HEALTHY OPTIONS ITEMS AS WELL AS LOCAL RESTAURANT CHEFS TO HOST HEALTHY COOKING CLASSES FOR THE COMMUNITY. 52 VOLUNTEERS CONTRIBUTED TO THIS INITIATIVE. COLON CANCER ALLIANCE GRANT THE COLON CANCER PROGRAM IS AN ONGOING EDUCATION AND SCREENING PROGRAM. THIS PROGRAM IS FUNDED THROUGH GRANTS FROM THE COLON CANCER ALLIANCE AND IS AN ONGOING EDUCATION AND SCREENING PROGRAM. NOTE: FUNDS ARE NOT REQUIRED TO BE USED BY A CERTAIN DATE-THIS APPLIES TO PAST GRANTS AS WELL. HEALTHY FUN CHALLENGE THE FOUNDATION RECEIVED FUNDS FROM ARTS SERVICES INITIATIVE (ASI) AND ERIE COUNTY HARBOR DEVELOPMENT CORPORATION (ECHDC) TO FUND HEALTH AND WELLNESS ACTIVITIES TO BE INSTALLED AT THE BUFFALO OUTER HARBOR. THE FOUNDATION USED THIS FUNDING TO INSTALL HEALTH AND WELLNESS SIGNAGE ENCOURAGING FAMILIES TO BE MORE ACTIVE. WELLNESS INITIATIVES THE PROGRAM INCLUDES VARIOUS PROJECTS THROUGHOUT WNY THAT THE FOUNDATION IS ASKED TO ASSIST WITH THROUGHOUT THE YEAR. THESE MAY RANGE FROM EDUCATION CLASSES TO SCREENING EVENTS AND MORE. KABOOM! FFKC THE FOUNDATION WAS AWARDED $28,000 IN COLLABORATION WITH GROVER L PREISS ELEMENTARY SCHOOL (EDEN CENTRAL SCHOOLS) TO BUILD AN INDOOR PLAY SPACE, WHICH WILL BE ACCESSIBLE TO STUDENTS AND THE EDEN COMMUNITY. TAPS & APPS A FUNDRAISER THAT FEATURES HEALTHY OPTIONS RESTAURANTS, WINERIES, BREWERIES AND DRINKERIES. ALL PROCEEDS FROM THE EVENT SUPPORT THE FOUNDATION'S CHILDHOOD OBESITY INITIATIVES. THIS EVENT HAD 300 ATTENDEES AND 30 VOLUNTEERS CONTRIBUTED TO THIS INITIATIVE. FORM 990, PART VI, SECTION A, LINE 2 MICHAEL W. CROPP, MD AND STUART H. ANGERT HAVE A BUSINESS RELATIONSHIP (BOARD MEMBERS OF AN AFFILIATED TAXABLE ENTITY). FORM 990, PART VI, SECTION A, LINE 6 INDEPENDENT HEALTH ASSOCIATION, INC. IS THE SOLE CORPORATE MEMBER OF INDEPENDENT HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A INDEPENDENT HEALTH ASSOCIATION, INC. IS THE SOLE CORPORATE MEMBER OF INDEPENDENT HEALTH FOUNDATION AND APPOINTS THE BOARD OF DIRECTORS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 8B INDEPENDENT HEALTH FOUNDATION DOES NOT HAVE COMMITTEES THAT HAVE THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. AS SUCH, THERE ARE NO MEETINGS OR WRITTEN ACTIONS TO DOCUMENT. FORM 990, PART VI, SECTION B, LINE 11B A FINAL FORM 990 WAS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO THE FILING OF THE RETURN FOR COMMENT AND REVIEW. FORM 990, PART VI, SECTION B, LINE 12C INDEPENDENT HEALTH FOUNDATION (IHF) FOLLOWS INDEPENDENT HEALTH ASSOCIATION, INC.'S (A RELATED TAX-EXEMPT ORGANIZATION OF INDEPENDENT HEALTH FOUNDATION) CORPORATE CONFLICT OF INTEREST REPORTING POLICY. THIS POLICY ENCOMPASSES ALL CURRENT IHF OFFICERS/EMPLOYEES (INCLUDING KEY EMPLOYEES) OF THE ORGANIZATION. EMPLOYEES ARE REQUIRED AS PART OF THEIR EMPLOYMENT WITH IHF TO IMMEDIATELY REPORT CONFLICTS OF INTEREST THAT THEY ARE PARTY TO OR THAT THEY OBSERVED, TO THE MANAGEMENT OR INDEPENDENT HEALTH'S CORPORATE COMPLIANCE OFFICER FOR REVIEW BY THE CONFLICT OF INTEREST COMMITTEE OF INDEPENDENT HEALTH. CONFLICTS ARE ALSO IDENTIFIED ANNUALLY WHEN THE SIGNED EMPLOYEE ATTESTATIONS, CONFIDENTIAL QUESTIONNAIRES & PLEDGE OF CONFIDENTIALITY AND CONTINUING DISCLOSURE FORM (FOR BOD MEMBERS) ARE RECEIVED. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE INDIVIDUAL IS PROHIBITED FROM PARTICIPATING IN THE DELIBERATIONS OR DECISIONS RELATED TO THIS TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE: A COPY OF ITS 990, ITS AUDITED FINANCIAL STATEMENTS, AND ANY OTHER DOCUMENTS AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 9: MICHAEL FASO - 9187 BEECH MEADOW CT. CLARENCE CENTER, NY 14032 FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 399,489. MANAGEMENT AND GENERAL EXPENSES 206. FUNDRAISING EXPENSES 81. TOTAL EXPENSES 399,776. INDEPENDENT HEALTH ASSOCIATION 511 FARBER LAKES DRIVE BUFFALO NY 14221 161080163 SEE SUPPLEMENTAL NY 501(C)(4) N/A 0 INDEPENDENT HEALTH CORPORATION AND SUBSIDIARY 511 FARBER LAKES DRIVE BUFFALO NY 14221 161237733 THIRD PARTY CLAIMS ADMINISTRATION NY N/A C 1 INDEPENDENT HEALTH BENEFITS CORPORATION 511 FARBER LAKES DRIVE BUFFALO NY 14221 161483784 POS AND INDEMNITY PRODUCT ADMINISTRATION NY N/A C 1 MASON INSURANCE COMPANY LTD FB FERRY BUILDING 40 CHURCH STRE PO BOX HM HAMILTON HNHX BD REINSURANCE BD N/A C 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1 INDEPENDENT HEALTH ASSOCIATION C 1972400 FMV INDEPENDENT HEALTH ASSOCIATION M 70275 FMV INDEPENDENT HEALTH ASSOCIATION Q 197595 FMV INDEPENDENT HEALTH ASSOCIATION P 211097 FMV INDEPENDENT HEALTH ASSOCIATION S 1593360 FMV INDEPENDENT HEALTH ASSOCIATION O 315446 FMV PART II, COLUMN (B): PRIMARY ACTIVITY PROVIDE HEALTH RELATED PRODUCTS AND SERVICES THAT ENABLE AFFORDABLE ACCESS TO QUALITY HEALTH CARE.