2015-11-12T14:48:08-06:00 2014-12-31 KPMG LLP 515 Broadway 4th Floor Albany NY 122072974 990 2014-01-01 161533232 KALEIDA HEALTH % JONATHAN SWIATKOWSKI KALE 7168598501 726 EXCHANGE STREET BUFFALO NY 14210 Jon Swiatkowski EVP, CFO 5184274600 2015-11-12 true JEFFREY STAGG P01326885 5184274600 2014 2016-02-25 16:41:14Z JODY LOMEO 100 HIGH STREET BUFFALO NY 14203 1262093632 false X N/A X 1998 NY SEE SCHEDULE O 13 11 9111 1719 5953497 -16380 16833070 20185652 1094963150 1109372026 8682237 9670915 18748226 20508868 1139226683 1159737461 499180 318865 0 0 659283835 627065263 0 0 0 493783633 505805964 1153566648 1133190092 -14339965 26547369 1120308222 1169457849 857780288 935456911 262527934 234000938 X KALEIDA HEALTH IS A VOLUNTARY, NOT-FOR-PROFIT; NEW YORK STATE DEPARTMENT OF HEALTH ARTICLE 28 LICENSED HOSPITAL-BASED HEALTHCARE DELIVERY SYSTEM SERVICING THE COMMUNITIES OF WESTERN NEW YORK STATE AT VARIOUS LEVELS AND WITH FACILITIES IN MULTIPLE LOCATIONS THROUGHOUT THE REGION. KALEIDA HEALTH INCLUDES THE BUFFALO GENERAL MEDICAL CENTER (BUFFALO GENERAL), MILLARD FILLMORE SUBURBAN HOSPITAL (MILLARD SUBURBAN), WOMEN AND CHILDREN'S HOSPITAL OF BUFFALO (WOMEN & CHILDREN'S), AND DEGRAFF MEMORIAL HOSPITAL (DEGRAFF). IN ADDITION TO THE FOUR KALEIDA HEALTH (KALEIDA) HOSPITALS, KALEIDA OPERATES TWO SKILLED NURSING FACILITIES, AND NUMEROUS OUTPATIENT CLINICS. THE ABOVE FACILITIES OPERATE UNDER ONE TAX IDENTIFICATION NUMBER. OUR FAMILY OF HEALTH CARE ORGANIZATIONS IS BLENDED TOGETHER INTO ONE FRAMEWORK FOR LEADERSHIP, GOVERNANCE, SHARED SERVICES, FINANCIAL INFRASTRUCTURE AND INFORMATION TECHNOLOGY PLATFORMS. COLLECTIVELY, KALEIDA HEALTH'S MARKET SHARE IS 30.8% IN WESTERN NEW YORK, 39.1% IN ERIE false false 1020254700 318865 1104785419 See attachment 1 1020254700 true true false true false false false false false true true true false true true true true true false false false false false false false false true true true false true true false false false false false true false true true true true false false false true true true true false false true 468 0 true 9111 true true true false false false false false false false false false X 13 11 false true false false false false false true true false false true true true true true true true true true false NY X X JONATHAN SWIATKOWSKI 7168598836 100 HIGH STREET 11TH FLOOR SOUTH BUFFALO NY 14203 EVAN EVANS MD DIRECTOR 1.0 0.0 X 56710 0 249 JAMES KASKIE FORMER CEO EX-OFFICIO W/ VOTE 38.0 0.0 X X 1628787 0 24835 JODY LOMEO PRES/CEO EX-OFFICIO W/VOTE 38.0 0.0 X X 771444 0 228699 ROBERT J HALONEN DIRECTOR 1.0 0.0 X 0 0 0 JOHN R KOELMEL CHAIRMAN 1.0 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ATLANTA GA 303843421 PHYSICIAN BILLING 1332580 71 2561849 12221625 5402178 3027072 20185652 NET PATIENT SERVICE REVENUE 623990 1103848603 1103848603 MANAGEMENT FEES 561000 72900 72900 LAB SERVICES 621500 5450523 5450523 1109372026 4910989 36008 150146 4724835 0 0 2401525 2401525 0 2401525 69643 2331882 106963887 152210 102237237 118934 4726650 33276 4759926 4759926 0 0 0 REBATE REVENUE 900099 14926273 14926273 UNIVERSITY LEASE INCOME 531120 776228 776228 MANAGEMENT & CONSULTING FEES 541610 544203 539728 4475 1860639 361080 205810 1293749 18107343 1159737461 1104785419 5953497 28812893 318865 318865 0 0 0 8090373 8090373 0 458558287 430316643 28241644 30701222 27938112 2763110 95883952 87686991 8196961 33831429 31426541 2404888 0 2417681 1034870 1382811 512996 108000 404996 222679 222679 0 0 117645316 107794279 9851037 3228099 2556988 671111 2346097 1869837 476260 0 0 7407463 4004933 3402530 993961 740197 253764 0 0 15186760 12148209 3038551 0 63443763 49140698 14303065 16866659 12692794 4173865 HEALTH CARE SUPPLIES 188355652 188317894 37758 EQUIPMENT RENTAL & MAINTENANCE 27656662 11838983 15817679 SERVICE CONTRACTS 10287299 8467136 1820163 UTILITIES 9908787 7947211 1961576 39326090 33905519 5420571 1133190092 1020254700 112935392 0 1888730 1650157 82767025 125884770 0 0 128810671 136503002 18832367 26982367 0 0 0 0 22934130 22794299 13398661 13640606 1448267248 1022140047 453721501 426127201 88428073 86642646 82265135 71923551 0 0 0 0 227261929 257309250 1120308222 1169457849 139788467 133088661 0 0 0 0 66000384 63946133 0 0 0 0 231654591 232383053 0 0 420336846 506039064 857780288 935456911 X 166131003 96795381 80996443 121724799 15400488 15480758 262527934 234000938 1120308222 1169457849 X 26547369 -1028026 -54046339 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false false false true 74115 true 148564 false false 222679 false false GRANTS TO OTHER ORGANIZATIONS & DIRECT CONTACT WITH LEGISLATIVE BODY SCHEDULE C, PART II-B, QUESTIONS 1F AND 1G THE AMOUNT REFLECTED FOR PART II-B, QUESTION 1F REPRESENTS THE PORTION OF THE DUES PAID TO THE GREATER NEW YORK HOSPITAL ASSOCIATION ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE AMOUNT REFLECTED FOR PART II-B, QUESTION 1G REPRESENTS PAYMENTS MADE TO ORGANIZATIONS IN AN EFFORT TO ADVOCATE ON THE ORGANIZATION'S BEHALF AT THE NEW YORK STATE AND FEDERAL LEVELS AS IT SPECIFICALLY RELATES TO HEALTH CARE LEGISLATION AND REGULATORY ISSUES. false 30087437 1656821 850732 1856001 30738989 28644541 1589183 1819135 1965422 30087437 46995623 3133756 2880650 24365488 28644541 72587179 5877436 28660 31497652 46995623 79899854 14188339 2153889 23654903 72587179 0.73340 0.26660 false true true 6713867 6713867 484332292 312113523 172218769 942126064 700943037 241183027 15095025 9083487 6011538 426127201 INTECH RISK-MANAGED L CAP FUND 4235836 F WTC CTF RESEAR VALUE PUR 4/06 4752736 F BENCHMARK PLUS INST PART L CAP 5116829 F WTC CIF OPPORTUNISTIC FUND 7466975 F CHARITABLE TEMPORARY INVEST FD 11 F KALEIDA MIT COMMON FUND LP 51890 F COMMON CAP VENTURE PTNRS VI 94876 F COMMON FND CAP PRIVATE EQ P V 107662 F KALEIDA MIT REALITY LP 319444 F KALEIDA SI REALITY LP 811480 F DWS GLOBAL COMMODITIES 5369755 F ROBECO GLOBAL EMERGING MARKETS 4467935 F AQR GLOBAL RISK 7648689 F PANAGORA RISK PARITY TOTAL RET 8470077 F ORCHARD LANDMARK LTD PTNRS 924958 F ABERDEEN EMERGING MARKETS 3188091 F PERMAL FIXED INCOME HOLDING 4868453 F CRESTLINE OFFSHORE FUND 1185124 F MACKAY SHIELDS HIGH YIELD LP 6117138 F MCM CF GLOBAL ALPHA I FUND 2819491 F KAYNE ANDERSON INST LTD PTSHP 3326769 F MONROE CAP LTD PTSHP 579332 F PICTET LOCAL EMERGING 0 F 71923551 DEFERRED FINANCING 11727932 INTEREST IN NET ASSETS OF FDNS 181680591 OTHER RECEIVABLES 17665245 OTHER ASSETS 26239446 INSURANCE RECOVERIES REC. 4660886 ESTIMATED 3RD PARTY PAYOR REC 15335150 257309250 0 DUE TO THIRD PARTY PAYORS 23350830 SELF INSURANCE LIABILITY 159098094 OTHER LIABILITIES 19177383 PENSION LIABILITY 279638479 ASSET RETIREMENT OBLIGATIONS 12325175 CAPITAL LEASE OBLIGATIONS 7254641 CONSTRUCTION PAYABLE 5194462 506039064 X 1151104875 -494845 -494845 1151599720 8137741 8137741 1159737461 1133301155 1967065 1967065 1131334090 1856002 1856002 1133190092 INTENDED USE OF ENDOWMENTS: SCHEDULE D, PART V, QUESTION 4 THE FOLLOWING ARE THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS: 1) CAPITAL EXPANSION AND IMPROVEMENT 2) ADVANCEMENT OF MEDICAL EDUCATION AND RESEARCH AND HEALTH CARE SERVICES 3) SUPPORT PEDIATRIC HEALTH CARE SERVICES FIN 48 FOOTNOTE: SCHEDULE D, PART X, QUESTION 2 KALEIDA RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE-LIKELY THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED. RECONCILIATION OF REVENUE PER AFS WITH REVENUE PER RETURN: OTHER REVENUE INCLUDED IN AFS, NOT INCLUDED IN 990: LESS: MINORITY INTEREST IN SUBSIDIARY SHOWN AS A REDUCTION IN GAINS IN AFS <494,845> RECONCILIATION OF REVENUE PER AFS WITH REVENUE PER RETURN: OTHER REVENUE INCLUDED ON 990, NOT IN AFS: CONTRIBUTIONS FOR CAPITAL ACQUISITIONS 5,643,126 RESTRICTED CONTRIBUTIONS 1,656,821 RESTRICTED INVESTMENT INCOME 837,794 TOTAL 8,137,741 RECONCILIATION OF EXPENSES PER AFS WITH EXPENSES PER RETURN: SCHEDULE D, PART XII, LINE 2D OTHER EXPENSES INCLUDED IN AFS, NOT IN 990 UNREALIZED LOSSES 1,967,065 RECONCILIATION OF EXPENSES PER AFS WITH EXPENSES PER RETURN: SCHEDULE D, PART XII, LINE 4B OTHER EXPENSES INCLUDED ON 990, NOT IN AFS NET ASSETS RELEASED FROM RESTRICTIONS 1,856,002 true true X true X true X true true true false false 10914925 4478594 6436331 0.00570 315183631 225592282 89591349 0.07910 326098556 230070876 96027680 0.08480 4620282 4620282 0.00410 45110507 21038223 24072284 0.02120 39065172 11983420 27081752 0.02390 141379 141379 0.00010 88937340 33021643 55915697 0.04930 415035896 263092519 151943377 0.13410 true 12235505 779402 169118506 154008046 15110460 X true true MFSC LLC PHYSICIAN SERVICES 0.51000 0.49000 COMMUNITY MEDICAL PHYSICIAN SERVICES 1.00000 GENERAL PHYSICIANS PHYSICIAN SERVICES 1.00000 HARLEM ROAD LEASING MRI EQUIPMENT LEASING 0.50000 AMTON IMAGING LLC HEALTH CARE SERVICES 0.40000 PARK CLUB LANE LLC HEALTH CARE SERVICES 0.30000 WNY HEALTHENET LLC HEALTH CARE SERVICES 0.14286 CHILD HEALTH INV I HEALTH CARE SERVICES 0.02972 CHILD HEALTH INV II HEALTH CARE SERVICES 0.01207 SITE E LLC REAL ESTATE LEASING CO. 0.50100 GNYHA PURCHASING ALL Group Purchasing Organization 0.02590 ALTUS MANAGEMENT Group Purchasing Organization 0.52548 SOUTHTOWNS IMAGING IMAGING EQUIPMENT LEASING 0.70000 4 1 BUFFALO GENERAL MEDICAL CENTER 100 HIGH STREET BUFFALO NY 14203 WWW.KALEIDAHEALTH.ORG 1401014H X X X X A 2 WOMEN & CHILDREN'S HOSPITAL OF BUFFAL 219 BRYANT STREET BUFFALO NY 14222 WWW.KALEIDAHEALTH.ORG 1401014H X X X X X A 3 MILLARD FILLMORE SUBURBAN HOSPITAL 1540 MAPLE ROAD WILLIAMSVILLE NY 14221 WWW.KALEIDAHEALTH.ORG 1401014H X X X X A 4 DEGRAFF MEMORIAL HOSPITAL 445 TREMONT STREET NORTH TONAWANDA NY 14120 WWW.KALEIDAHEALTH.ORG 1401014H X X X X A Group A false false true X X X X X X X X 13 true true true true X www.kaleidahealth.org/community X true 14 true www.kaleidahealth.org/community false false true X 200. 200. X X X X true true X X X true X X X X X X X X X X X X true X X false X true X false false PART V, SECTION B, LINE 5 IN ERIE COUNTY, KALEIDA HEALTH WORKED WITH THE ERIE COUNTY DEPARTMENT OF HEALTH, CATHOLIC HEALTH, BUFFALO STATE COLLEGE CENTER FOR HEALTH AND SOCIAL RESEARCH, P2 COLLABORATIVE OF WESTERN NEW YORK, UNITED WAY OF BUFFALO & ERIE COUNTY AND UNIVERSITY AT BUFFALO FAMILY MEDICINE. WHILE THE COUNTY BEGAN THE PROCESS BY DEVELOPING THE SURVEY TOOL AND ITS DISTRIBUTION METHODS IN THE FALL OF 2012, THE COMMUNITY PARTNERS CAME TOGETHER IN FEBRUARY 2013. THE SUBSEQUENT MEETINGS IN MARCH, JULY AND AUGUST OF 2013 SOLIDIFIED THE HEALTH DEPARTMENT, LOCAL HOSPITALS AND ACADEMIA EFFORTS. IN ADDITION TO RELYING ON NEW YORK STATE PREVENTION AGENDA DATA, ERIE COUNTY CONDUCTED A COUNTY-WIDE HEALTH ASSESSMENT WITH A SURVEY AND HELD A LIVING HEALTHY TASK FORCE TOWN HALL MEETING FOR PROFESSIONAL INPUT. IN NIAGARA COUNTY, THE NIAGARA COUNTY HEALTH DEPARTMENT, NIAGARA FALLS MEMORIAL MEDICAL CENTER, MT. ST. MARY'S HOSPITAL, EASTERN NIAGARA HOSPITAL, NIAGARA COUNTY DEPARTMENT OF MENTAL HEALTH AND UNIVERSITY AT BUFFALO PREVENTIVE MEDICINE RESIDENCY WITH ASSISTANCE FROM THE P2 COLLABORATIVE OF WESTERN NEW YORK, JOINED TOGETHER FOR THE COMMUNITY HEALTH EFFORTS. THE NIAGARA COUNTY GROUP LAUNCHED THEIR EFFORTS IN MARCH 2013 AND HELD SUBSEQUENT MEETINGS IN APRIL, MAY, JULY, AUGUST, SEPTEMBER AND OCTOBER. NIAGARA COUNTY CONDUCTED A COMMUNITY HEALTH SURVEY, WHICH HAD 1,455 RESPONSES, AND OUTREACH EVENTS INCLUDED HOSTING THREE FOCUS GROUPS AND A COUNTY-WIDE COMMUNITY HEALTH MEETING. IN ADDITION TO THE OUTREACH AND FEEDBACK IN BOTH COUNTIES, KALEIDA HEALTH ALSO REACHED OUT TO OTHER PARTNERS IN THE COMMUNITY INCLUDING, BUT NOT LIMITED TO, THE NEAR EAST AND WEST SIDE (NEWS) TASK FORCE, LASTING EDUCATION FOR WOMEN, ADULTS & CHILDREN (LEWAC) AND GREATER BUFFALO UNITED ACCOUNTABLE HEALTHCARE NETWORK (GBUAHN). PART V, SECTION B, LINE 6A KALEIDA HEALTH IS COMPRISED OF FOUR HOSPITALS - BUFFALO GENERAL MEDICAL CENTER/GATES VASCULAR INSTITUTE, DEGRAFF MEMORIAL HOSPITAL, MILLARD FILLMORE SUBURBAN HOSPITAL AND WOMEN & CHILDREN'S HOSPITAL OF BUFFALO. PART V, SECTION B, LINE 6B THREE KALEIDA HEALTH HOSPITALS ARE LOCATED IN ERIE COUNTY AND ONE, DEGRAFF MEMORIAL HOSPITAL, IS LOCATED IN NIAGARA COUNTY LESS THAN ONE MILE FROM THE ERIE COUNTY BORDER. IN ERIE COUNTY, KALEIDA HEALTH WORKED WITH CATHOLIC HEALTH THROUGH THE ERIE COUNTY DEPARTMENT OF HEALTH FOR COMMUNITY COLLABORATION. IN NIAGARA COUNTY, KALEIDA HEALTH WORKED WITH NIAGARA FALLS MEMORIAL MEDICAL CENTER, MT. ST. MARY'S HOSPITAL AND EASTERN NIAGARA HOSPITAL THROUGH THE NIAGARA COUNTY HEALTH DEPARTMENT. PART V, SECTION B, LINE 7D AVAILABLE UPON REQUEST AT THE HOSPITAL FACILITY WITHOUT CHARGE. PART V, SECTION B, LINE 11 WITH HOSPITALS LOCATED IN BOTH ERIE AND NIAGARA COUNTIES, KALEIDA HEALTH, WORKING COLLABORATIVELY WITH BOTH COUNTY GROUPS, IDENTIFIED THREE PROJECTS TO UNDERTAKE AS PART OF THE COMMUNITY SERVICE PLAN. IN ERIE COUNTY, KALEIDA HEALTH WILL WORK TO INCREASE BREASTFEEDING RATES AND CARDIOVASCULAR DISEASE SCREENINGS. IN NIAGARA COUNTY, KALEIDA HEALTH WILL ALSO INCREASE CARDIOVASCULAR DISEASE SCREENINGS AND WORK TO REDUCE THE NUMBER OF FALLS FOR THOSE OVER AGE 65. THESE THREE AFOREMENTIONED INITIATIVES ARE IN ACCORDANCE WITH THE NEEDS IDENTIFIED BY THE COMMUNITY AND SUPPORTED THROUGH THE DETAILED ANALYSIS OUTLINED IN THE 2014-2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY SERVICE PLAN AVAILABLE AT WWW.KALEIDAHEALTH.ORG/COMMUNITY/PUBLICATIONS.ASP AND ATTACHED TO THIS RETURN. TWO OTHER TOPICS IDENTIFIED BY THE COMMUNITY AS AREAS OF CONCERN WERE CANCER AND BEHAVIORAL HEALTH. ADJACENT TO BUFFALO GENERAL MEDICAL CENTER IS THE ROSWELL PARK CANCER INSTITUTE, WHICH HOLDS THE NATIONAL CANCER INSTITUTE DESIGNATION AS A COMPREHENSIVE CANCER CENTER AND HAS A PROVEN MULTIDISCIPLINARY APPROACH. KALEIDA HEALTH IS COLLABORATING WITH ROSWELL ON THE PROPOSED INTEGRATED HEMATOLOGY/ONCOLOGY FLOOR IN THE NEW JOHN R. OISHEI CHILDREN'S HOSPITAL. AS SUCH, KALEIDA HEALTH IS CONFIDENT THAT ROSWELL PARK, ALTHOUGH NOT REQUIRED TO SUBMIT A COMMUNITY SERVICE PLAN AS A PUBLIC BENEFIT CORPORATION, ALONG WITH SEVERAL PRIVATE OUTPATIENT CANCER TREATMENT CENTERS PROVIDE ADEQUATE CANCER RESOURCES FOR THE COMMUNITY. UNDER GREAT LAKES HEALTH, KALEIDA HEALTH JOINTLY DEVELOPED A $25 MILLION REGIONAL BEHAVIORAL HEALTH CENTER OF EXCELLENCE WITH THE ERIE COUNTY MEDICAL CENTER ON THEIR GRIDER STREET CAMPUS. THE CENTER HOUSES CONSOLIDATED MENTAL HEALTH AND DRUG DEPENDENCY TREATMENT PORGRAMS WITH A 180-BED INPATIENT PSYCHIATRIC PROGRAM AND A COMPREHENSIVE PSYCHIATRIC EMERGENCY PROGRAM. THIS CENTER OF EXCELLENCE IS IN LINE WITH THE BERGER COMMISSION AND SUPPORTED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. PART V, SECTION B, LINE 16I INFORMATION THAT EXPLAINS HOW QUALIFIED PATIENTS CAN ACCESS FINANCIAL ASSISTANCE THROUGH THE HOSPITAL IS INCLUDED ON BILLS AND STATEMENTS TO PATIENTS. APPLICATION MATERIALS INCLUDE A NOTICE TO THE PATIENTS THAT ONCE THEY SUBMIT A COMPLETED APPLICATION AND DOCUMENTATION, THEY MAY DISREGARD ANY BILLS UNTIL THE HOSPITAL HAS RENDERED A WRITTEN DECISION ON THE APPLICATION. THE HOSPITAL MAY NOT FORWARD ACCOUNTS TO COLLECTION WHILE AN APPLICATION IS PENDING. PART V, SECTION B, LINE 18D UPON VERIFICATION OF EMPLOYMENT WAGES, THE AGENCY WILL GARNISH WAGES ON KALEIDA HEALTH'S BEHALF. 27 HighPointe on Michigan 1031 Michigan Ave Buffalo NY 14203 Inpatient Skilled Nursing Facility Center for Laboratory Medicine 115 Flint Road Amherst NY 14226 Hospital based lab services Millard Fillmore Surgery Center 215 Klein Road Williamsville NY 14221 Ambulatory surgery center Degraff Skilled Nursing Facility 445 Tremont Street North Tonowanda NY 14120 Inpatient skilled nursing facility Elmwood OBGYN 239 Bryant Street Buffalo NY 14222 Medical Services Primary care services Prenatal outpatient Williamsville Community Health Center 115 Flint Road Amherst NY 14226 Outpatient Therapy Services Primary care services Medical services North Buffalo Medical Park 900 Hertel Ave Buffalo NY 14207 Medical services Primary care services Outpatient services Community Mental Health Center 1028 Main Street Buffalo NY 14203 Hospital based outpatient Behavioral health services KALEIDA HEALTH FAMILY PLANNING CENTER 1313 MAIN STREET Buffalo NY 14209 Outpatient family planning services Hodge Pediatrics 125 HODGE STREET BUFFALO NY 14222 HOSPITAL BASED OUTPATIENT PRIMARY CARE SERVICES WCHOB Specialty Clinics 140 Hodge Street AMHERST NY 14222 HOSPITAL BASED OUTPATIENT Primary care services TOWNE GARDEN PEDIATRICS 461 WILLIAM STREET BUFFALO NY 14204 Hospital based outpatient PRIMARY CARE SERVICES WCHOB Women's OBGYN Health Center 462 Grider Street BUFFALO NY 14215 Hospital based outpatient Primary care services WCHOB McKinley OBGYN 3860 McKinley Parkway Hamburg NY 14219 Medical services PRIMARY CARE SERVICES Prenatal outpatient WCHOB Child Protection Center 556 Franklin Street Buffalo NY 14202 Medical services Primary care services Stanley Makowski SBHC 1095 Jefferson Ave Buffalo NY 14214 School based primary care services WCHOB Lancaster OBGYN 6363 Transit Road Lancaster NY 14086 Medical services Primary care services Prenatal outpatient Bennett High School SBHC 2885 Main Street BUFFALO NY 14214 SCHOOL BASED PRIMARY CARE SERVICES Westminster #86 SBHC 24 Westminster Ave Buffalo NY 14215 School based primary care services ML King #39 SBHC 487 High Street Buffalo NY 14211 School based primary care services WCHOB Lockport OBGYN 475 South Transit Road Lockport NY 14094 Medical services Primary care services Prenatal outpatient Build Academy #91 SBHC 340 Fougeron Street Buffalo NY 14211 School based primary care services Buffalo School of Technology SBHC 414 South Division Street Buffalo NY 14204 School based primary care services Herman Badillo #76 SBHC 315 Caroline Street Buffalo NY 14201 School based primary care services HILLERY PARK #27 SBHC 72 Pawnee Parkway BUFFALO NY 14210 SCHOOL BASED PRIMARY CARE SERVICES DR Lydia Wright #89 SBHC 106 Appenheimer Street LANCASTER NY 14214 School based primary care services Southtowns Clinic 4535 Southwestern BLVD HAMBURG NY 14075 Medical services PRIMARY CARE SERVICES Part I, LINE 3C KALEIDA HEALTH (KALEIDA) HAS DEVELOPED, IMPLEMENTED AND COMMUNICATES ITS FINANCIAL ASSISTANCE (CHARITY CARE) POLICY, WHICH ASSISTS LOW INCOME, UNINSURED OR UNDERINSURED INDIVIDUALS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR MEDICAL SERVICES RENDERED. LEVELS OF DISCOUNTS ARE AWARDED BASED UPON INCOME AND ASSET VERIFICATION AND IN ACCORDANCE WITH THE FEDERAL POVERTY GUIDELINES AS PUBLISED ANNUALLY BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. INDIVIDUALS ARE NOTIFIED DURING INTAKE AND REGISTRATION OF KALEIDA'S CHARITY CARE PROGRAM. AFTER REVIEW OF INCOME AND ASSETS, AN INDIVIDUAL MAY BE APPROVED FOR FREE CARE (100% DISCOUNT) OR A DISCOUNT LEVEL OF 50, 60, 75, OR 90%, FOR MEDICALLY NECESSARY INPATIENT, OUTPATIENT, EMERGENCY ROOM OR NURSING HOME SERVICES RENDERED AT A KALEIDA FACILITY, AS FOLLOWS: LESS THAN 200% OF FEDERAL POVERTY GUIDELINE IS AWARDED 100% DISCOUNT 200% - 249% OF FEDERAL POVERTY GUIDELINE IS AWARDED 90% DISCOUNT 250% - 299% OF FEDERAL POVERTY GUIDELINE IS AWARDED 75% DISCOUNT 300% - 349% OF FEDERAL POVERTY GUIDELINE IS AWARDED 60% DISCOUNT 350% - 400% OF FEDERAL POVERTY GUIDELINE IS AWARDED 50% DISCOUNT. THE APPLICANT FOR FREE OR REDUCED PRICE CARE IS CONTACTED BY A FACILITATED ENROLLER OR A NAVIGATOR FOR FINANCIAL SCREENING AND ENROLLMENT IN A GOVERMENT-FUNDED PROGRAM, IF ELIGIBLE. PART I, LINE 7 THE AMOUNTS REPORTED IN THE TABLE UNDER PART 1, LINE 7 WERE DETERMINED USING THE HEALTH SYSTEM'S DECISION SUPPORT SOFTWARE PROGRAM AND REVENUE AND EXPENSES FROM THE GENERAL LEDGER. THE OVERALL REVENUE AND EXPENSES INCLUDED IN THE DECISION SUPPORT SOFTWARE PROGRAM WERE RECONCILED TO THE GENERAL LEDGER WHICH RECONCILES TO THE AUDITED FINANCIAL STATEMENTS. THE DECISION SUPPORT SOFTWARE PROGRAM ALLOCATES DIRECT COSTS TO EACH PATIENT ACCOUNT BASED ON THE RESOURCES USED BY THAT PATIENT WITHIN THE SPECIFIC COST CENTER. INDIRECT COSTS ARE ALLOCATED USING SIMILAR STEPDOWN METHODOLOGY USED BY CMS IN THE INSTITUTIONAL COST REPORT. PART III, LINES 2 AND 3 BAD DEBT EXPENSE IS RECORDED USING THE VALUATION METHOD AS OUTLINED IN HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15, WHICH REQUIRES BAD DEBT EXPENSE TO BE RECORDED AT THE AMOUNT THAT THE PAYER IS EXPECTED TO PAY. IN ORDER TO REPORT THE COSTS ASSOCIATED WITH BAD DEBT EXPENSE, THE REPORTED BAD DEBT EXPENSE NEEDS TO BE ADJUSTED SO THAT THE AMOUNT EXPECTED TO BE PAID REFLECTS GROSS CHARGES, PRIOR TO THE APPLICATION OF AN RCC. KALEIDA HEALTH ADJUSTS BAD DEBT EXPENSE PRIOR TO THE APPLICATION OF AN RCC SO THAT THE REPORTED BAD DEBT EXPENSE AT COST, ON PART III, LINE 2 OF IRS FORM 990, SCHEDULE H REFLECTS THE TRUE COST OF THE BAD DEBTS. THE ORGANIZATION HAS A CHARITY CARE POLICY, AND ANY WRITE-OFFS AS A RESULT OF THIS POLICY ARE RECORDED AS CHARITY CARE ALLOWANCES AND ARE A REDUCTION OF THE NET PATIENT REVENUE. INDIVIDUALS WHO MAY QUALIFY FOR CHARITY CARE ASSISTANCE UNDER THE POLICY, BUT DO NOT VOLUNTEER TO COMPLETE THE APPLICATION PROCESS WOULD NOT BE GRANTED CHARITY CARE ASSISTANCE. KALEIDA USES A PRESUMPTIVE CHARITY CARE PROCESS, WHICH HAS DETERMINED THAT 26% OF SELF-PAY BAD DEBT EXPENSE IN 2014 WOULD HAVE BEEN ELIGIBLE FOR CHARITY CARE ASSISTANCE.THEREFORE, WE BELIEVE THAT THE LEVEL OF CHARITY CARE INCLUDED IN BAD DEBT EXPENSE TO BE APPROXIMATELY $779,402. WE ESTIMATED THIS AMOUNT BY USING THE 2014 CALCULATED PRESUMPTIVE ELIGIBILITY PERCENTAGE ON BAD DEBT WRITE-OFF AMOUNTS OVER $500 (24.5%), TO DETERMINE THE BAD DEBT WRITE-OFFS THAT WOULD BE ELIGIBLE, IF THEY WERE SCORED USING THE PRESUMPTIVE ELIGIBILITY PROCESS. BAD DEBT IS NOT INCLUDED AS A COMMUNITY BENEFIT. Part III, LINE 4 KALEIDA PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE KALEIDA DOES NOT ANTICIPATE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. KALEIDA GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED BY COMMERCIAL AND GOVERNMENT INSURANCE PLANS. ADDITIONS TO THE ESTIMATED ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE BY MEANS OF THE PROVISION OF BAD DEBTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE AMOUNT OF THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. THE PROVISION FOR BAD DEBTS PRIMARILY RELATES TO PATIENTS WITHOUT INSURANCE AND TO THOSE THAT ARE EITHER UNDERINSURED OR WITHOUT THE NECESSARY RESOURCES TO PAY CONISURANCE AND DEDUCTIBLE BALANCES. Part III, LINE 8 THERE ARE NO MEDICARE SHORTFALLS INCLUDED IN THE CALCULATION OF COMMUNITY BENEFIT. COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT, AS REFLECTED IN PART III, LINE 6: KALEIDA HEALTH USED THE FILED, BUT UNAUDITED 2014 CMS MEDICARE COST REPORT TO DETERMINE THE AMOUNTS REPORTED ON THESE LINES. PART III, LINE 9B ONLY AFTER A PATIENT'S LIABILITY HAS BEEN DETERMINED FOLLOWING PROCESSING OF APPLICATIONS FOR GOVERNMENT ASSISTANCE, CHARITY CARE AND/OR INSURANCE CARRIER REMITTANCE, WILL THE PATIENT STATEMENT BE MAILED FOR PAYMENT RECOVERY. KALEIDA HEALTH HAS IMPLEMENTED A PRE-COLLECTION PROCESS FOR ACCOUNTS WITH AN INSURANCE BALANCE OF ZERO, A POSITIVE PATIENT BALANCE GREATER THAN $4.99 AND A FIRST BILL DATE OLDER THAN 60 DAYS BUT NOT PREVIOUSLY PAID IN FULL BY THE PATIENT (EXCLUDING ACCOUNTS FOR PATIENTS THAT HAVE SUBMITTED A COMPLETED APPLICATION FOR CHARITY CARE, MEDICAID, OR CHILD HEALTH PLUS, AND AN ELIGIBILITY DETERMINATION IS PENDING). AT THE TIME THAT A PATIENT EXPRESSES A FINANCIAL CONCERN, THE PATIENT WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR CHARITY CARE. ONCE THE PATIENT SUBMITS THE COMPLETED CHARITY CARE APPLICATION, THE ACCOUNT IS PLACED ON HOLD AND ALL COLLECTION ACTIVITIES ARE SUSPENDED UNTIL AN ELIGIBILITY DETERMINATION IS MADE. IF THE PATIENT IS ELIGIBLE FOR CHARITY CARE, THEN THE PATIENT IS NOTIFIED OF THE LEVEL OF CHARITY CARE AWARDED. IF 100% CHARITY CARE IS AWARDED, THEN NO BILL IS SENT TO THE PATIENT. IF LESS THAN 100% CHARITY CARE IS AWARDED, THEN THE PATIENT WILL RECEIVE A BILL PURSUANT TO THE PRIVATE PAY COLLECTION POLICY. Community Health Needs Assessment Process Kaleida Health assesses the needs of the community through a Community Health Needs Assessment. The CHNA was completed in 2013. A copy of the CHNA can be found on our website at www.kaleidahealth.org/community/publications.asp and is attached to this return. Patient Education of Eligibility for Assistance Kaleida Health informs individuals of available free or reduced price services at the time of registration into the inpatient, outpatient, emergency department, and long-term care facility. Posters informing the patient/family of assistance are available throughout the Kaleida locations. Brochures and pamphlets informing the community are widely distributed in the community at health fairs, churches, schools and other public locations. Information regarding the availability of financial assistance is also available through Kaleida's website. Kaleida Health offers assistance to individuals in our community for accessing affordable health care, including: * NY Health Exchange Navigation: Assists with navigating, selecting, and applying for enrollment in NY Health Exchange offerings. Dedicated and state-trained staff assist individuals in person or via the phone. In addition to offering in-person appointments at Kaleida Health sites, Kaleida Health opened a community-based location in late 2013. * Centers for Medicaid & Medicare Services (CMS): Kaleida Health staff facilitate enrollment with a targeted focus on children up to the age of 21 enrolled in Buffalo Public Schools and throughout Western New York. * Facilitated Enrollment: Assists eligible individuals with health insurance enrollment by offering education and application assistance for Medicaid, Child Health Plus, Prenatal Care Assistance Program, State Aid for Children with Special Needs, and Qualified Health Plans through the Affordable Care Act. A dedicated telephone number is available and information is published in pamphlets at Kaleida sites and at various locations throughout the community. * Financial Assistance Program: As described above, the Kaleida Financial Assistance Program offers free or reduced-prices for patients treated at Kaleida Health hospitals, outpatient, emergency room, or long-term care facilities. Discounts are awarded based upon income and asset verification. Community Information Three Kaleida Health hospitals are located in Erie County and one, DeGraff Memorial Hospital, is located in Niagara County less than one mile from the Erie County border. Erie County According to MedStat Market Expert 2013 data, less than one million people reside in Erie County. The population continues to decline and has done so even since the 2010 census where there were 925,717 residents in comparison to the 922,988 who live in the county today. Similar to New York State, there are more females than males. However, there are fewer children under age 18 and more residents over age 55 in comparison to New York and the United States. Erie County residents also have a lower household income than the New York State average, which is evident in a higher percentage of residents earning less than $25,000 per year and fewer earning over $100,000. In addition, 67 census tracks are identified as medically underserved areas/populations. The largest municipality in Erie County is the City of Buffalo with 277,681 residents. The average household income in the City of Buffalo, $44,979, is significantly less than the state average. Over 42 percent of households earn less than $25,000 per year including 26.8 percent earning less than $15,000 and only 8.4 percent earning over $100,000. A direct correlation can be drawn to income from the fact that over 17 percent of residents over age 25 do not have a high school degree. The population in the City of Buffalo also has a higher percentage of black non-Hispanics and Hispanics as compared to the rest of the county, 35.6 percent to 13 percent respectively. Niagara County According to MedStat Market Expert 2013 data, just over 215,000 people reside in Niagara County. Like other upstate New York municipalities, the population continues to decline and has done so even since the 2010 census where there were 216,149 residents. Also similar to neighboring counties, there are more females than males, a low percentage of children under age 18 and a high percentage of residents over age 55. Niagara County residents also have a lower household income than the New York State and national averages. Here, 21 census tracks are identified as medically underserved areas/populations. The City of Niagara Falls is the largest municipality in Niagara County. Residents in Niagara Falls have an average salary equivalent to the City of Buffalo. Like most inner cities in comparison to the suburbs, there are a high percentage of households, here close to 40 percent, that earn less than $25,000. As compared to North Tonawanda and the county, there are fewer white non-Hispanics, fewer residents over age 25 with a bachelor's degree or higher and a higher percentage of residents that do not have a high school degree. North Tonawanda, where DeGraff is physically located on the Erie County border, has a high percentage of white non-Hispanics and only one percent of non-Hispanic blacks. Residents in North Tonawanda also have a higher average household income in comparison to the rest of the county as more residents have a bachelor's degree and earn over $100,000. However, the average income is still less than the New York State and U.S. averages. During 2014, there were 53,582 inpatient discharges, of which 26% were Medicaid and Medicaid Managed Care, 40% Medicare and Medicare Managed Care, and 1% were uninsured. There are six other hospitals in Erie County and four other hospitals in Niagara County serving the communities. More information can be found in the 2014-2016 Community Health Needs Assessment and Community Service Plan. The CHNA was completed in fall 2013. A copy of the CHNA can be found on our website at www.kaleidahealth.org/community/publications.asp and is attached to this return. Promotion of Community Health Kaleida Health's mission is to advance the health of the community. Kaleida Health's vision is to be the regional health care system providing exceptional quality services, with a commitment to education and research, accessible to all. The Organization's values illustrate how these goals are achieved: Accountability: We take personal responsibility for delivering results. Patient-Centered: We put patients and families first. Integrity: We demonstrate honesty in everything we do. Excellence: As a team, we pursue exceptional performance with passion. To carry out the mission, much of Kaleida Health's community benefit work is focused on the needs of low income, medically underserved populations. Kaleida Health representatives actively engage in various community health collaborations with local health departments, state health department and local not-for-profit health and human service agencies. Poverty trends, community health research and local community health needs are reviewed on a regular basis while planning services and programs. Responsive to community priorities, program development and services fill identified gaps or supplement existing programs. Most Kaleida Health community health outreach programs are offered in partnership with other community organizations or government agencies in order to leverage resources and meet the community's needs. This includes education and active participation in health events with targeted audiences. Information regarding availability of community health programs, assistance with health insurance enrollment and financial assistance for medical care received at Kaleida Health hospitals, emergency departments, outpatient clinics or long-term care facilities is disseminated to the public in the community benefit and triennial community services plan and available on the Kaleida Health website or in print form upon request. The Visiting Nursing Association of Western New York, Inc., Kaleida Health's home care affiliate, also works to promote the health of the community. This includes educating chronic care patients on self-management and personal care in areas such as rehabilitation services, nutrition education and therapy, infection control, falls risk assessment and intervention, and health education related to improved lifestyle choices for individuals and families in their homes and the community. Community-based prevention programs, such as one of the area's largest annual community influenza immunization program, also are offered through the Visiting Nursing Association. Kaleida Health Board of Directors Kaleida Health maintains control over the corporation through its self-perpetuating, 13 member governing board of directors. The board of directors, the majority of whom reside in Western New York, is comprised of community leaders from the business, industry, and healthcare sectors, including physicians who are on the medical staff. Each director serves a three-year term and is not an employee, independent contractor, or family member of Kaleida Health. State in Which the Organization Files a Community Benefit Report New York State true WNY HEALTHENET LLC 2568 WALDEN AVE SUNY BUFFALO CHEEKTOWAGA NY 14225 043726634 N/A 200000 CONTRIBUTION WNY CLINICAL INFO EXCHANGE 2568 WALDEN AVE CHEEKTOWAGA NY 14225 364594483 501(C)(3) 60000 SPONSORSHIP CONTRIBUTION UB FOUNDATION 3435 MAIN STREET SUITE 107 BUFFALO NY 14231 160865182 501(C)(3) 33750 SPONSORSHIP SPONSORSHIP UPSTATE NY TRANSPLANT SERVICES INC 110 BROADWAY STREET BUFFALO NY 14203 161172463 501(C)(3) 12500 SPONSORSHIP SPONSORSHIP MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVE WHITE PLAINS NY 10605 131846366 501(C)(3) 7300 Uncompensated Care SPONSORSHIP CHAMBER OF COMMERCE OF THE TONAWANDAS INC 15 WEBSTER STREET SUITE 107 NORTH TONAWANDA NY 14120 160371125 501(C)(3) 5315 CONTRIBUTION SPONSORSHIP 5 1 FORM 990, SCHEDULE I: PART I, LINE 2 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS: KALEIDA HEALTH MAKES CONTRIBUTIONS TO ORGANIZATONS IN WESTERN NEW YORK THAT ALSO HAVE HEALTH CARE RELATED ACTIVITIES. ALL CONTRIBUTIONS MUST BE APPROVED BY THE GOVERNING BODY BEFORE MONEY IS DISTRIBUTED. X true true X X X X X X true true false false false false false false false JAMES KASKIE FORMER CEO EX-OFFICIO W/ VOTE 211023 0 0 0 1417764 0 22662 0 2173 0 1653622 0 482848 0 JODY LOMEO PRES/CEO EX-OFFICIO W/VOTE 771444 0 0 0 0 0 221993 0 6706 0 1000143 0 0 0 ROBERT NOLAN FORMER GENERAL COUNSEL 264165 0 0 0 56275 0 46820 0 9083 0 376343 0 48775 0 ALYSON SPAULDING GENERAL COUNSEL 207564 0 0 0 0 0 24671 0 13399 0 245634 0 0 0 MARGARET PAROSKI FORMER EVP, CMO 75483 0 0 0 688069 0 0 0 0 0 763552 0 150522 0 DAVID HUGHES MD EVP, CMO 563730 0 0 0 0 0 161604 0 804 0 726138 0 0 0 TONI BOOKER EVP, HUMAN RESOURCES OFFICER 343944 0 0 0 287942 0 32014 0 6058 0 669958 0 280442 0 JOSEPH KESSLER FORMER EVP, CFO 214463 0 0 0 361044 0 26121 0 6826 0 608454 0 179642 0 JONATHAN SWIATKOWSKI EVP, CFO 384006 0 0 0 0 0 99308 0 13518 0 496832 0 0 0 JAMAL GHANI EVP, COO 169381 0 0 0 0 0 45086 0 62 0 214529 0 0 0 DONALD BOYD SVP BUSINESS DEVELOPMENT 459395 0 0 0 90633 0 58759 0 13724 0 622511 0 83133 0 CHRISTOPHER LANE SVP OPERATIONS MFS, DMH 348117 0 0 0 10000 0 52026 0 13592 0 423735 0 0 0 CHERYL KLASS SVP OPERATIONS BGMC 543203 0 0 0 7500 0 408281 0 6309 0 965293 0 0 0 ALLEGRA JAROS SVP OPERATIONS WCHOB 318583 0 0 0 3000 0 54027 0 13508 0 389118 0 0 0 CONNIE VARI FORMER EVP, COO 0 0 0 0 184272 0 0 0 3228 0 187500 0 0 0 AARON HOFFMAN MD EMPLOYED PHYSICIAN 1190210 0 0 0 0 0 31272 0 14112 0 1235594 0 0 0 CHRISTOPHER MALLAVARAPU MD EMPLOYED PHYSICIAN 943474 0 0 0 0 0 29035 0 12846 0 985355 0 0 0 JOHN BUTSCH MD EMPLOYED PHYSICIAN 702237 0 0 0 0 0 2473 0 13872 0 718582 0 0 0 CARROLL HARMON MD EMPLOYED PHYSICIAN 630415 0 0 0 0 0 0 0 1087 0 631502 0 0 0 KAVEH VALI MD EMPLOYED PHYSICIAN 619764 0 0 0 0 0 30921 0 1021 0 651706 0 0 0 MICHAEL HUGHES SVP, PUBLIC AFFAIRS MARKETING 236935 0 0 0 0 0 59297 0 526 0 296758 0 0 0 HEALTH OR SOCIAL CLUB DUES SCHEDULE J, PART I, LINE 1A AS PART OF THEIR COMPENSATION PACKAGE, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE ENTITLED TO CHOOSE AS AN EXECUTIVE PERK THE BENEFIT OF BUSINESS RELATED SOCIAL DUES OR INITIATION FEES. SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A THE FOLLOWING FORMER EMPLOYEES LISTED ON FORM 990, PART VII, SECTION A RECEIVED SEVERANCE PAYMENTS DURING 2014: JAMES KASKIE, FORMER CEO, $917,416 MARGARET PAROSKI, FORMER CMO, $509,755 CONNIE VARI, FORMER COO, $184,272 JOSEPH KESSLER, FORMER CFO, $173,902 EXECUTIVE DEFERRED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B DURING THE YEAR, THE FOLLOWING OFFICERS AND KEY EMPLOYEES LISTED ON FORM 990, PART VII, SECTION A PARTICIPATED IN THE EXECUTIVE DEFERRED RETIREMENT PLAN: JODY LOMEO, JAMAL GHANI, JONATHAN SWIATKOWSKI, TONI BOOKER, DAVID HUGHES, MD, DONALD BOYD, MICHAEL HUGHES, CHERYL KLASS, JAMES KASKIE, JOSEPH KESSLER, MARGARET PAROSKI, ROBERT NOLAN AND CONNIE VARI. EMPLOYER AND EMPLOYEE CONTRIBUTIONS DURING THE YEAR TO THIS PLAN HAVE BEEN REPORTED, AS REQUIRED, ON SCHEDULE J, PART II COLUMNS (B) (III) AND (C). DURING 2014, THE FOLLOWING DIRECTORS RECEIVED PAYMENTS UNDER AN EXECUTIVE DEFERRED RETIREMENT PLAN: JAMES KASKIE $482,848 TONI BOOKER $280,442 JOSEPH KESSLER $179,642 MARGARET PAROSKI $150,522 DONALD BOYD $83,133 ROBERT NOLAN $48,775 A DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 64983Q429 2006-09-21 81810000 RENOVATIONS TO FACILITIES false false false A 12715000 0 86266214 46572838 5074244 0 1213231 1836365 2067415 69802989 0 0 2008 false false true true A false false true true false 0 false false false false A false false false true false false 0 true MBIA INC true true true A true Supplemental Information SCHEDULE K, PART IV, ARBITRAGE, LINE 2C (A) ISSUER NAME: DORMITORY AUTHORITY - STATE OF NEW YORK DATE THE REBATE COMPUTATION WAS PERFORMED, 08/31/2011. PART II, LINE 3 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. PART II, LINE 3 THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. PART IV, COUMN A, LINE 5C CONSTRUCTION FUND - 2.5 YEARS, RESERVE FUND - 4.4 YEARS. DR DAVID HUGHES SEE PART V SEE PART V X 26982367 26982367 false true true 26982367 GREATER NY HOSPITAL ASSOCIATION SEE PART V 121660 SEE PART V false JOCELYN BELISLE SEE PART V 32040 SEE PART V false DAVID VARI SEE PART V 63590 SEE PART V false SUSAN EVANS SEE PART V 75160 SEE PART V false LOANS TO INTERESTED PERSONS SCHEDULE L, PART II DR. DAVID HUGHES COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DR. DAVID HUGHES, AN INTERESTED PERSON TO KALEIDA HEALTH, IS THE CURRENT OWNER OF GENERAL PHYSICIANS, P.C. (GPPC). COLUMN C - PURPOSE OF THE LOAN: DURING 2014, KALEIDA HEALTH LOANED GENERAL PHYSICIANS, P.C. MONEY TO ASSIST IN PAYING THE COSTS OF ACQUIRING AND EMPLOYING PHYSICIANS AND STAFF AS WELL AS ONGOING OPERATING COSTS OF THE PRACTICE AND WILL BE REPAID TO KALEIDA ONCE GPPC HAS RE-ESTABLISHED ITS PATIENT BASE AND HAS THE ABILITY TO REPAY. BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV GREATER NEW YORK HOSPITAL ASSOCIATION, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: THE FORMER PRESIDENT/CEO OF THE FILING ORGANIZATION (KALEIDA HEALTH), JAMES KASKIE, WAS ALSO SERVING AS A BOARD MEMBER OF THE GREATER NEW YORK HOSPITAL ASSOCIATION AT THE TIME OF THE TRANSACTION. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2014, THE ORGANIZATION PAID THE INTERESTED PERSON (GREATER NEW YORK HOSPITAL ASSOCIATION) PARTICIPATION DUES RELATED TO A SUPPLY INITIATIVE PROGRAM. JOCELYN BELISLE, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: JOCELYN BELISLE IS A FAMILY MEMBER OF A FORMER OFFICER OF THE ORGANIZATION, CONNIE VARI, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2014, THE ORGANIZATION PAID THE INTERESTED PERSON (JOCELYN BELISLE) IN THE NORMAL COURSE OF BUSINESS TO FURNISH SERVICES AS A PERFORMACE IMPROVEMENT PROJECT COORDINATOR. DAVID VARI, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DAVID VARI IS A FAMILY MEMBER OF A FORMER OFFICER OF THE ORGANIZATION, CONNIE VARI, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2014, THE ORGANIZATION PAID THE INTERESTED PERSON (DAVID VARI) IN THE NORMAL COURSE OF BUSINESS FOR PERFORMANCE OF SERVICES AS A SENIOR HUMAN RESOURCES GENERALIST. SUSAN EVANS, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SUSAN EVANS IS A FAMILY MEMBER OF A CURRENT BOARD MEMBER OF THE ORGANIZATION, EVAN EVANS, MD, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2014, THE ORGANIZATION PAID THE INTERESTED PERSON (SUSAN EVANS) IN THE NORMAL COURSE OF BUSINESS FOR PERFORMANCE OF SERVICES AS A UTILIZATION REVIEW COORDINATOR. X VARIOUS MEDICAL EQUIPMENT 5 3027072 REPLACEMENT COST false true false ORGANIZATION'S MISSION KALEIDA HEALTH IS THE LARGEST HEALTHCARE PROVIDER IN WNY, SERVING THE AREA'S 8 COUNTIES WITH COMPREHENSIVE SERVICES & PROGRAMS PROVIDED AT 4 ACUTE CARE, 2 LT CARE, AS WELL AS OUTPATIENT & PRIMARY CARE SITES. DELEGATION OF CMO DUTIES FORM 990, PART VI, SECTION A, QUESTION 3 DURING 2014, THE ORGANIZATION CONTRACTED WITH UNIVERSITY NEUROLOGY FOR THE SERVICES OF MARGARET PAROSKI IN HER CAPACITY AS CHIEF MEDICAL OFFICER (CMO) OF THE ORGANIZATION. PART OF HER ROLE AS CMO WAS CONTROL OVER CERTAIN MANAGEMENT DUTIES WITH RESPECT TO EMPLOYED PHYSICIANS THAT CUSTOMARILY ARE PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS OR KEY EMPLOYEES. REVIEW PROCESS FOR FORM 990 Form 990, Part VI, Section B, Line 11B ORGANIZATION'S MANAGEMENT (A TEAM COMPRISED OF REPRESENTATIVES OF THE FINANCE, HUMAN RESOURCES, AND LEGAL DEPARTMENTS) IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, KPMG, REVIEW THE FORM 990. THE FINANCIAL REVIEW IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS FOR THE RELEVANT TIME PERIOD. BEFORE THE FORM 990 IS FILED WITH THE IRS THE FINANCE COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS THE FORM 990 AND PROVIDES A COPY OF THE SAME TO THE ORGANIZATION'S FULL BOARD OF DIRECTORS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C UPON EMPLOYMENT AND ANNUALLY THEREAFTER EACH KEY EMPLOYEE AND OFFICER OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, PROVIDING SUFFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THE ORGANIZATION CAN (1) DETERMINE WHETHER ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST MAY EXIST, AND (2) MONITOR WORK OR SERVICE ASSIGNMENTS TO AVOID PLACING THE KEY EMPLOYEE, OFFICER OR DIRECTOR IN A POSITION WHERE THERE MAY BE A POTENTIAL, ACTUAL, OR EVEN APPEARANCE, OF A CONFLICT OF INTEREST OR A QUESTION OF OBJECTIVITY. THE COMPLETED CONFLICTS OF INTEREST AND DISCLOSURE FORMS FOR DIRECTORS ARE RETURNED TO THE ORGANIZATION. COMPENSATION APPROVAL PROCESS FORM 990,PART VI, SECTION B, QUESTION 15A AND B ON A REGULAR BASIS, THE ORGANIZATION PROVIDES DOCUMENTATION TO THE COMPENSATION COMMITTEE OF THE BOARD WITH RESPECT TO THE COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES FOR REVIEW AND APPROVAL. SUCH INFORMATION INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX-EXEMPT ORGANIZATIONS IN THE WESTERN NEW YORK COMMUNITY AS WELL AS COMPENSATION FOR THESE POSITIONS (AS DISCLOSED ON FORM 990) WITH OTHER ORGANIZATIONS IN THE HEALTH CARE INDUSTRY THAT ARE OF SIMILAR SIZE, DEMOGRAPHICS AND GEOGRAPHY. REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY THE OFFICERS/EXECUTIVE COMMITTEE IS DOCUMENTED. ACCESS TO ORGANIZATIONAL DOCUMENTS FORM 990, PART VI, SECTION C, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS OFFICE AT 726 EXCHANGE STREET, SUITE 200, BUFFALO, NY 14210. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. Form 990, Part XI OTHER CHANGES IN NET ASSETS OR FUND BALANCES MINORITY INTEREST IN SUBSIDIARY (522,322) DECREASE IN PENSION LIABILITY (93,718,060) TRANSFER FROM KALEIDA FOUNDATIONS 48,000 OTHER TRANSFERS, NET 517,139 CHANGE IN VALUE OF FOUNDATIONS 39,628,904 ------------ TOTAL (54,046,339) FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:XXX-XX-XXXX KALEIDA MCO LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161570311 DORMANT NY KH KALEIDA IPA LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161570380 DORMANT NY KH KALEIDA WNYI LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 453189404 HEALTH CARE NY KH MILLARD FILLMORE AMBULATORY SURGER CTR 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161307129 SUPPORT ORG NY 501(C)(3) 11A KH true VNA HOME CARE SERVICES 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161491203 HOME HLTH CAR NY 501(C)(3) 9 KH true VNA OF WESTERN NEW YORK 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 160743214 HOME HLTH CAR NY 501(C)(3) 9 KH true VISK 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 222738425 DORMANT NY 501(C)(3) 9 KH true KALEIDA HEALTH FOUNDATION 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161579143 FUNDRAISING NY 501(C)(3) 7 KH true THE WOMEN & CHILDREN'S HOSP OF BFLO FDN 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161332044 FUNDRAISING NY 501(C)(3) 7 KH true HARLEM ROAD LEASING LLC 3435 MAIN STREET BUFFALO NY 14214 205588135 EQUIPMENT LEASING NY KALEIDA HEALTH UNRELATED 150146 78612 false true 0.50000 AMTON IMAGING LLC 199 PARK CLUB LANE SUITE 300 WILLIAMSVILLE NY 14221 262925470 HEALTH CARE NY KALEIDA WNYI RELATED -488629 239997 false true 0.50000 PARK CLUB LANE LLC 199 PARK CLUB LANE SUITE 300 WILLIAMSVILLE NY 14221 271516155 HEALTH CARE NY KALEIDA WNYI EXCLUDED false true 0.30000 SITE E LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 272124795 REAL ESTATE MGMT NY KPI EXCLUDED 114085 1651810 false false 0.50169 MSFC LLC 100 HIGH STREET BUFFALO NY 14203 261582864 HEALTH CARE NY KALEIDA HEALTH EXCLUDED 543284 1760285 false false 0.54290 SOUTHTOWNS IMAGING LLC 5959 BIG TREE ROAD SUITE 105 ORCHARD PARK NY 14127 471123230 EQUIPMENT LEASING NY KALEIDA WNYI EXCLUDED false true 0.70000 COLLABORATIVE CARE VENTURES LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 472365690 Health Care NY KALEIDA HEALTH Excluded 11090000 false true 0.60000 KALEIDA PROPERTIES INC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 222738483 PROP MGMT SVCS NY KALEIDA HEALTH C Corp 1.00000 false WESTLINK CORPORATION 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161354421 MED & DIAGN SVCS NY KALEIDA HEALTH C Corp -283 101392 1.00000 false KALEIDA HEALTHNOW INC 257 WEST GENESEE STREET BUFFALO NY 14202 462164089 HEALTH CARE NY KALEIDA HEALTH C Corp 3200 960964 0.50000 false false true true true true false false false false true true false false false true true true false true VNA HOME CARE SERVICES q 1097253 VNA HOME CARE SERVICES d 208654 VNA OF WESTERN NEW YORK q 5645652 VNA OF WESTERN NEW YORK d 1195083 MFSC LLC j 608514 MFSC LLC p 642308 MFSC LLC e 175494 KALEIDA PROPERTIES INC q 186283 KALEIDA PROPERTIES INC d 4423496 SITE E LLC k 233450 WCHOB FOUNDATION c 930710 WCHOB FOUNDATION s 4646188 WCHOB FOUNDATION d 454449 KALEIDA HEALTH FOUNDATION c 1949708 KALEIDA HEALTH FOUNDATION s 1030097 KALEIDA HEALTH FOUNDATION d 857353 SOUTHTOWNS IMAGING LLC b 614395 TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R, PART V, TRANSACTION TYPE C THERE IS A VARIANCE BETWEEN THE AMOUNT REFLECTED ON PART VIII, LINE 1D (AND SCHEDULE B) - GIFTS, GRANTS AND CONTRIBUTIONS FROM THE FOLLOWING RELATED ORGANIZATIONS AND THE AMOUNT INCLUDED ON SCHEDULE R, PART V AS A RESULT OF THE VARIANCE IN TIMING OF THE RECORDING OF THE TRANSFER BETWEEN THE TWO ORGANIZATIONS. KALEIDA HEALTH FOUNDATION RECORDED GRANTS PAID TO THE FILING ORGANIZATION IN THE AMOUNT OF $1,949,708 (SEE SCHEDULE R, PART V) VERSUS THE $1,794,548 RECORDED BY THE FILING ORGANIZATION AS GRANTS RECEIVED (SEE PART VIII, LINE 1D AND SCHEDULE B). THE WOMEN & CHILDREN'S HOSPITAL OF BUFFALO FOUNDATION RECORDED GRANTS PAID TO THE FILING ORGANIZATION IN THE AMOUNT OF $930,710 (SEE SCHEDULE R, PART V) VERSUS THE $767,301 RECORDED BY THE FILING ORGANIZATION AS GRANTS RECEIVED (SEE PART VIII, LINE 1D AND SCHEDULE B).