2012-11-14T14:50:23-06:00 2011-12-31 KPMG LLP 515 Broadway 4th Floor Albany NY 122072974 990 2011-01-01 161533232 KALEIDA HEALTH % JON SWIATKOWSKI KALE 7168598501 726 EXCHANGE STREET BUFFALO NY 14210 Joseph M Kessler 2012-11-14 true 5184274600 2011 2016-02-24 21:20:13Z JAMES KASKIE 726 Exchange Street Suite 200 BUFFALO NY 14210 1342053977 false X WWW.KALEIDAHEALTH.ORG X 1998 NY KALEIDA HEALTH IS THE LARGEST HEALTHCARE PROVIDER IN WNY, SERVING THE AREA'S 8 COUNTIES WITH COMPREHENSIVE SERVICES & PROGRAMS PROVIDED AT 5 ACUTE CARE, 2 LT CARE, AS WELL AS OUTPATIENT & PRIMARY CARE SITES. 14 12 9966 1062 3471041 -56623 33453390 18385104 1083912619 1077197344 5115295 15876877 9240906 7627938 1131722210 1119087263 240200 392500 0 0 605535584 627869038 0 0 0 490988871 503822481 1096764655 1132084019 34957555 -12996756 1029678448 1073480481 770656008 938525536 259022440 134954945 KALEIDA HEALTH IS A VOLUNTARY, NOT-FOR-PROFIT; NEW YORK STATE DEPARTMENT OF HEALTH ARTICLE 28 LICENSED HOSPITAL-BASED HEALTHCARE DELIVERY SYSTEM SERVING THE COMMUNITIES OF WESTERN NEW YORK STATE AT VARIOUS LEVELS AND WITH FACILITIES IN MULTIPLE LOCATIONS THROUGHOUT THE REGION. KALEIDA HEALTH IS A PRODUCT OF THE 1998 MERGER OF BUFFALO GENERAL HOSPITAL (BUFFALO GENERAL), MILLARD FILLMORE GATES CIRCLE HOSPITAL (MILLARD GATES), 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 FIVE 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 BONDED TOGETHER INTO ONE FRAMEWORK FOR LEADERSHIP, GOVERNANCE, SHARED SERVICES, FINANCIAL INFRASTRUCTURE AND INFORMATION TECHNOLOGY PLATFORMS. COLLECTIVELY, KALEI false false 954291507 392500 1080007475 See Attachment 1. 954291507 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 489 0 true 9966 true true true false false false false false false false false false X 14 12 false true false false false false false true true false false true true true true true true true true true false NY X X JON SWIATKOWSKI 7168598501 726 EXCHANGE STREET BUFFALO NY 14210 ROBERT M ZAK 1.0 X 0 0 0 MATTHEW L BROWN 1.0 X 0 0 0 EVAN EVANS MD 1.0 X 50385 0 0 ROBERT J HALONEN PhD 1.0 X 0 0 0 DARREN J KING 1.0 X 0 0 0 JAMES KASKIE 38.0 X X 1507356 0 48599 JOHN R KOELMEL 1.0 X 0 0 0 DAVID A MILLING MD 1.0 X 0 0 0 HERMAN S MOGAVERO Jr MD 1.0 X 0 0 0 DALE N SCHUMACHER 1.0 X 0 0 0 FRANCISCO M VASQUEZ PhD 1.0 X 0 0 0 AMY L CLIFTON 1.0 X 0 0 0 KATHLEEN GRIMM MD 1.0 X 0 0 0 CHRISTOPHER T GREENE ESQ 1.0 X 0 0 0 ROBERT NOLAN 38.0 X 519340 0 27143 CONNIE VARI 38.0 X 837087 0 76378 JOSEPH KESSLER 38.0 X 610837 0 225190 MARGARET PAROSKI MD 38.0 X 658864 0 0 D ERIC POGUE 38.0 X 293942 0 24654 TONI BOOKER 38.0 X 318027 0 79208 CHERYL KLASS 38.0 X 533146 0 101687 LAWRENCE ZIELINSKI 38.0 X 515382 0 61511 DONALD BOYD 38.0 X 480716 0 65496 CHRISTOPHER LANE 38.0 X 389902 0 57051 TAMARA OWEN 38.0 X 370039 0 70334 ANTHONY ZITO 38.0 X 285887 0 47608 JAMES FOSTER MD 38.0 X 398678 0 39423 STEPHANIE MANN MD 38.0 X 337373 0 13009 LUCY CAMPBELL MD 38.0 X 430232 0 56179 VINCENT CALLANAN MD 38.0 X 415875 0 42684 KIEN LE MD 38.0 X 344628 0 19212 ANDRAS VARI MD 38.0 X 319237 0 57489 9616933 0 1112855 387 true true false DELOITTE CONSULTING 250 EAST FIFTH ST PO BOX 5340 CINCINNATI OH 452739626 CONSULTING 1943676 WNY RADIOLOGY LLC PO BOX 4029 BUFFALO NY 14240 RADIOLOGY SERVICES 4262443 NUANCE COMMUNICATIONS INC PO BOX 7247-6924 PHILADELPHIA PA 191706924 DICTATION SERVICES 2225004 SODEXHO MANAGEMENT INC PO BOXES 81049 WOBURN NY 018131049 CLEANING & LAUNDRY 3934764 VIRTUAL RADIOLOGY PO BOX 4029 BUFFALO NY 14240 RADIOLOGY SERVICES 1373272 62 1440819 10909787 6034498 1550460 18385104 SERVICE REVENUE 623990 1073931308 1073931308 MANAGEMENT FEES 561000 144175 144175 LABORATORY SERV 621500 3121861 3121861 1077197344 5299981 -214904 102119 5412766 0 0 2452507 2452507 2452507 58483 2394024 233504672 38938 222951714 15000 10552958 23938 10576896 10576896 0 0 0 VENDOR REBATES 900099 1716704 1716704 UNIVERSITY LEASE INCOME 531120 706584 706584 CAFETERIA 722210 19 19 2752124 1308331 44403 1399390 5175431 1119087263 1076741439 3471041 20489679 392500 392500 0 0 0 7320524 7320524 0 465805687 426379255 39426432 27965913 27965913 91160564 63629940 27530624 35616350 32136412 3479938 0 2459903 1219912 1239991 505000 505000 275458 275458 0 0 108615768 93701120 14914648 2668246 1168241 1500005 3319021 2269298 1049723 0 0 6656969 3463879 3193090 886421 573125 313296 0 0 10227620 8175244 2052376 0 56640799 45312639 11328160 21846661 16592881 5253780 HEALTH CARE SUPPLIES 186446356 186290843 155513 BAD DEBT EXPENSE 16735993 16735993 EQUIPMENT RENTAL & MAINT 26012721 11677670 14335051 UTILITIES 10191963 8172285 2019678 50333582 36400270 13933312 1132084019 954291507 177792512 0 0 0 0 0 534416 475006 96742771 77494154 0 0 135996337 133854817 0 0 0 0 0 0 21909693 19127555 9924277 10999998 1528394248 1065438554 336098175 462955694 0 0 215985857 183086445 0 0 0 0 212486922 185486812 1029678448 1073480481 137940657 140360464 0 0 0 0 188175482 177398754 0 0 0 0 35624187 106426054 0 0 408915682 514340264 770656008 938525536 X 130649199 31887201 112973024 87667527 15400217 15400217 259022440 134954945 1029678448 1073480481 X -12996756 -111070739 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false false false true 35458 true 240000 false false 275458 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 AND THE PORTION OF DUES PAID TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 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. 72587179 5877436 28660 31497652 46995623 79899854 14188339 2153889 23654903 72587179 23068508 71865683 3656737 18691074 79899854 28374857 4858154 -5863675 4300728 23068608 0.38550 0.61450 false true true 8697769 8697769 392080504 310186841 81893663 1114931833 746559434 368372399 12684142 8692279 3991863 462955694 VAR PUBL TRADED SECURITIES 84453285 F BRANDES INTERNATIONAL EQUITY 6780537 F INTECH RISK-MANAGED L CAP FUND 4091012 F FEDERAL ST ASSOC OFFSHORE FUND 599940 F MCM CF GLOBAL ALPHA I FUND 3611220 F WTC CTF RESEAR VALUE PUR 4/06 4196015 F BENCHMARK PLUS INST PART L CAP 6288408 F WTC CIF OPPORTUNISTIC FUND 8206871 F CHARITABLE TEMPORARY INVEST FD 9 F KALEIDA MIT COMMON FUND LP 154709 F COMMON CAP VENTURE PTNRS VI 313296 F COMMON FND CAP PRIVATE EQ P V 324088 F KALEIDA MIT REALITY LP 777599 F KALEIDA SI REALITY LP 1383067 F DWS GLOBAL COMMODITIES 8001830 F ROBECO GLOBAL EMERGING MARKETS 5342611 F AQR GLOBAL RISK 5807283 F PANAGORA RISK PARITY TOTAL RET 7676940 F AAM HIGH YIELD TOTAL RET FUND 4704078 F PICTET LOCAL EMERGING 8244468 F ABERDEEN EMERGING MARKETS 2997058 F PERMAL FIXED INCOME HOLDING 4807899 F CRESTLINE OFFSHORE FUND 5197782 F PUTNAM TOTAL RETURN FUND 7615367 F AQR GLOBAL RISK PREM OFFSHORE 1511073 F ARDEN ENDOWMENT ADVISORS CL G 0 F 183086445 DEFERRED FINANCING 12193502 EQUITY IN UNCONSOLIDATED AFFIL 117662711 OTHER RECEIVABLES 12724695 OTHER ASSETS 14521374 INSURANCE RECOVERIES REC. 9077792 LONG TERM GRANT FROM HEAL NY 19306738 185486812 0 DUE TO THIRD PARTY PAYORS 21910117 SELF INSURANCE LIABILITY 161174158 LINE OF CREDIT 10000000 OTHER LIABILITIES 22022932 PENSION LIABILITY 264766842 ASSET RETIREMENT OBLIGATIONS 13030337 CAPITAL LEASE OBLIGATIONS 8146233 CONSTRUCTIONS PAYABLE 13289645 514340264 1119087263 1132084019 -12996756 -11418642 -7923670 -19342312 -32339068 1107792402 -702686 -702686 1108495088 10592175 10592175 1119087263 1140131470 11418642 11418642 1128712828 3371191 3371191 1132084019 FIN 48 FOOTNOTE SCHEDULE D, PART X, QUESTION 2 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT REPORT ANY LIABILITY OR HAVE ANY FOOTNOTE REPORTING THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48. INTENDED USE OF ENDOWMENT FUNDS 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 RECONCILIATION OF CHANGE IN NET ASSETS FROM 990 TO AUDITED FINANCIAL STMTS SCH. D, PART XI, LINE 8 LESS: MINORITY INTEREST IN SUB <702,686> LESS: CONTRIBUTIONS FOR CAPITAL ACQUIS <3,443,169> LESS: RESTRICTED CONTRIBUTIONS <5,877,436> LESS: RESTRICTED INVESTMENT INCOME <1,271,570> PLUS: NET ASSETS RELEASED FROM RESTRICTION 3,371,191 --------- TOTAL: <7,923,670> OTHER REVENUE INCLUDED ON BOOKS BUT NOT ON RETURN: SCH D, PART XII, LINE 2D MINORITY INTEREST IN SUBSIDIARY <702,686> OTHER REVENUE ON RETURN BUT NOT ON BOOKS SCH D, PART XII, LINE 4B CONTRIBUTIONS FOR CAPITAL ACQUISITIONS 3,443,169 RESTRICTED CONTRIBUTIONS 5,877,436 RESTRICTED INVESTMENT INCOME 1,271,570 ------------ TOTAL : 10,592,175 OTHER EXPENSES INCLUDED ON BOOKS BUT NOT ON RETURN SCH D, PART XIII, LINE 2D UNREALIZED LOSSES ON INVESTMENTS 11,418,642 OTHER EXPENSES ON RETURN BUT NOT ON BOOKS: SCHEDULE D, PART XIII, LINE 4B NET ASSETS RELEASED FROM RESTRICTIONS 3,371,191 true true X true X true X true true true false true true 17683287 3157700 14525587 0.01300 285376934 209231604 76145330 0.06830 303060221 212389304 90670917 0.08130 4888236 4888236 0.00440 44411529 21089778 23321751 0.02090 34823901 11788237 23035664 0.02070 84123666 32878015 51350856 0.04610 387183887 245267319 142021773 0.12740 true 11130866 811440 173929114 170383025 3546089 X true true MFSC LLC PHYSICIAN SERVICES 0.51000 0.49000 COMMUNITY MEDICAL PC PHYSICIAN SERVICES 1.00000 GENERAL PHYSICIANS P 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 0.01107 SITE E LLC REAL ESTATE LEASING CO. 0.50225 NORTHTOWNS VENTURE L HEALTH CARE SERVICES 0.50000 5 1 BUFFALO GENERAL HOSPITAL

100 HIGH STREET BUFFALO NY 14203

X X X X 2 Women & Children's Hospital of Buffalo

219 Bryant Street Buffalo NY 14222

X X X X X 3 Millard Fillmore Suburban Hospital

1540 Maple Road Williamsville NY 14221

X X X 4 Millard Fillmore Gates Circle Hospital

3 Gates Circle Buffalo NY 14209

X X X X 5 Degraff Memorial Hospital

445 Tremont Avenue North Tonawanda NY 14120

X X X BUFFALO GENERAL HOSPITAL 1 true true 200. true 400. true X X X X X X true true X X true X X X true X X X X X X X true X false false Women & Children's Hospital of Buffalo 2 true true 200. true 400. true X X X X X X true true X X true X X X true X X X X X X X true X false false Millard Fillmore Suburban Hospital 3 true true 200. true 400. true X X X X X X true true X X true X X X true X X X X X X X true X false false Millard Fillmore Gates Circle Hospital 4 true true 200. true 400. true X X X X X X true true X X true X X X true X X X X X X X true X false false Degraff Memorial Hospital 5 true true 200. true 400. true X X X X X X true true X X true X X X true X X X X X X X true X false false 30 Deaconess Skilled Nursing Facility

1001 Humboldt Parkway Buffalo NY 14208

Inpatient Skilled Nursing Facility Center for Laboratory Medicine

115 Flint Road Amherst NY 14226

Hospital based lab services MFSC LLC Ambulatory Surgery Center

215 Klein Road Williamsville NY 14221

Freestanding surgery Center Community Mental Health Center

1010 Main Street Buffalo NY 14203

Hospital based outpatient behavorial health services WCHOB Women's Health Center

239 Bryant Street Buffalo NY 14222

Hospital based outpatient primary care services Amherst General

4955 North Bailey Avenue Suite 207 Amherst NY 14226

Hospital based outpatient diagonstic services Pediatric Dental Center

515 Abbott Road Buffalo NY 14220

Hospital based outpatient primary care services North Buffalo Medical Park

900 Hertel Avenue Buffalo NY 14207

hospital based outpatient Primary care services Deaconess Family Planning Center

1001 Humboldt Parkway Buffalo NY 14208

Family planning services WCHOB Specialty Clinics

140 Hodge Street Buffalo NY 14222

Hospital based outpatient primary care services Buffalo Therapy Services

115 Flint Road Amherst NY 14226

Hospital based outpatient therapy services DeGraff Memorial Hospital Wellness Cntr

415 Tremont Street North Tonawanda NY 14120

Hospital based outpatient therapy services WCHOB Hodge Pediatrics

125 Hodge Street Buffalo NY 14222

Hospital based outpatient primary care services Stanley Makowski SBHC

1095 Jefferson Avenue Buffalo NY 14214

School based primary care services Towne Garden Pediatrics

461 William Street Buffalo NY 14204

Hospital based outpatient primary care services Sterling Medical Park

200 Sterling Drive Orchard Park NY 14127

Hospital Based outpatient primary care services Lancaster Addictions Clinic

11 West Main Street Lancaster NY 14127

Hospital based outpatient behavorial health services Dr M L King SBHC

487 High Street Buffalo NY 14211

School based primary care services Buffalo Elem School of Technology

414 S Division Street Buffalo NY 14204

School based primary care services Herman Badillo SBHC

315 Carolina Street Buffalo NY 14201

School based primary care services Bennett High SBHC

2885 Main Street Buffalo NY 14214

School Based primary care services BUILD Academy SBHC

340 Fougeron Street Buffalo NY 14211

School based primary care services Hillery Park SBHC

72 Pawnee Parkway Buffalo NY 14210

School based primary care services Dr Lydia Wright SBHC

106 Appenheimer Street Buffalo NY 14214

School based primary care services Westminster Community SBHC

24 Westminster Avenue Buffalo NY 14215

School based primary care services WCHOB Preschool Programs

1653 Kensington Avenue Buffalo NY 14215

Hospital based outpatient primary care services South Park High SBHC

150 Southside Parkway Buffalo NY 14220

School based primary care services Futures Academy SBHC

295 Carlton Street Buffalo NY 14204

School based primary care services Grover Cleveland High SBHC

110 Fourteeth Street Amherst NY 14213

school based primary care services WCHOB Early Childhood Direction Center

3131 Sheridan Avenue Buffalo NY 14226

School based 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 published annually by the U.S. Department of Health and Human Services. Individuals are notified during admissions 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 reduce price care is contacted by a facilitated enroller for financial screening and enrollment in a government-funded program, if eligible, while in the hospital if inpatient or shortly after their visit. PART I, LINE 6 Kaleida Health's 2011 Community Benefit Report is a separate report prepared by the organization. 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 I, Line 7G There are no costs attributable to a physician clinic included in Subsidized Health Services. Part I, Line 7, Column (F) Total Bad Debt expense subtracted from total expenses in the determination of calculating the percentage of Total Expense is $16,735,993. Part II, Community Building Activities Kaleida Health is actively engaged in protecting our community through emergency preparedness. Kaleida Health has taken the lead with community and international partners to increase the Western New York region's level of readiness for any crisis that may occur, including organizing and conducting internal and external emergency drills. Community partners include local law enforcement and fire departments, the United States Postal Service, Erie County Department of Health, Niagara County Department of Health, Erie County Hazmat Organization, local universities and the International Joint Commission [for Emergency Response] involving Erie County, Niagara County and the Niagara Province of Ontario, Canada, among other organizations. Kaleida Health's Emergency Management Department provides leadership training and programmatic services for other healthcare organizations throughout the region. The Department assisted with creation of a Regional Mutual-Aid Agreement between 26 healthcare organizations in Western New York. The Mutual-Aid Agreement makes it possible for the healthcare organizations to share resources with one another during a disaster. Kaleida Health's emergency management activities promote the health of the communities we serve by ensuring that citizens, businesses and non-profit organizations are well prepared for all hazards. Kaleida Health conducts physician workforce planning and actively recruits physicians to medical shortage/underserved areas. A medical staff development plan is established based on community need in our service area. Community need is based on the total number of physicians providing medial services to the area, not only those physicians that staff our hospitals. Part III, Line 4 Charity Care and Bad Debt Expense Footnote 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 collection 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 under third-party arrangements. Additions to the estimated allowance for doubtful accounts are made by means of the provision for 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. Costing Methodology Used in Determining the Amounts Reported on Lines 2 and 3 of Part III and the Rationale for Including a Portion of Bad Debt Amounts as Community Benefit 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 New Patient Revenue. Individuals who may quality for Charity Care assistance under the policy, but do not volunteer to complete the application process would not be granted Charity Care assistance. Beginning on April 1, 2010, Kaleida Health implemented a presumptive eligibility process, whereby, each charity care applicant is scored and based on this score, charity care may be awarded. Kaleida Health, in implementing the presumptive eligibility process, determined that 27% of self-pay bad debt expense in 2011 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 $811,440. We estimated this amount by using the 2011 calculated presumptive eligibility percentage on bad debt write-off's amounts over $500 (27%), and applied this percentage to those bad debt write-off's amounts under $500, to determine the bad debt write-off's that would have been eligible, if they were scored using the presumptive eligibility process. Bad debt is not included as community benefit. 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 2011 CMS Medicare Cost Report to determine the amounts reported on these lines. Part III, Line 9A Only after 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, Family Health Plus or Child Health Plus, and an eligibility determination is pending). Part III, Line 9B When the financial assistance policies and options are reviewed with the patient or 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. Part V, Section B All of the Hospital Facilities of Kaleida Health share the same financial assistance policies. As such, the additional information provided for Part V, Section B, lines 11h, 13g, 15e, 16e, 17e, 19D, and 21 applies each of the hospital facilities listed. Part V, Line 11H Method used to determine the amount that reasonably could be attributable to patients who would likely qualify for financial assistance under the financial assistance policy, if sufficient information had been available to make a determination of their eligibility: Kaleida recognizes that, as a benefit to the Communities that they serve, that some patients are unable to or unwilling to ask for financial assistance due to barriers to applying for assistance such as educational level and literacy, documentation limitations, fear of application processes and general apathy. Kaleida is willing to extend benefit to those patients that face these barriers based on the best information that can be gathered about the guarantor. Kaleida intends to process patient accounts for presumptive charity scoring at the completion of the revenue cycle and after eligibility efforts for alternative funding or public assistance have been exhausted. The PARO model utilizes public record data and returns information that is utilized to determine characteristics for the consumer. PARO is designed to identify patients likely to qualify for financial assistance based on a predictive model and other financial and asset estimates for the patient derived from public record sources. In the absence of additional information from the patient, this rule set is applied to all patients exiting the revenue to determine which patients would have likely qualified for financial assistance. Based on the analysis of historical data from Kaleida, PARO derived the following rules to define guarantor eligibility for presumptive charity: 1) PARO Score - The PARO charity score is a predictive model that defines the likely socio-economic conditions for the patient. This score is based on public record data for the consumer. AND 2) Estimated Federal Poverty Level - This is an estimate of the ratio of the patient household against the Federal Poverty Level as defined by HHS. This is derived from estimated household size and estimated household income. This ratio for Kaleida was adjusted to represent local cost of living and historical approvals. AND 3) The 3rd party data which is gathered must not indicate that the patient is a homeowner or probable homeowner. Although the traditional charity policy may not consider homeownership as an excluding factor to charity qualification, the application of presumptive charity typically excludes homeownership status for approval in the absence of additional information from the patient. All three factors must be met in order for the patient to qualify for presumptive charity. If a patient does not qualify under these rules, the patient may engage in the traditional charity policy in order to be considered for charity care. Part V, Line 13G Financial Aid Information Included on Bill and Statements Information that explains how qualified patients can access financial assistance through the hospital are included on bills and statements to patients. Application materials include a notice to 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 and application is pending. Part V, Line 15E Upon verification of employment wages will be garnished. Part V, Line 16E Upon verification of employment, the agency will garnish wages on Kaleida Health's behalf. Part V, Line 17E Notification through Kaleida Health website and brochures. Part V, Line 19D The amounts billed are calculated using the Medicare rate, Medicaid rate or highest volume commercial payor rate. Part V, Line 21 Uninsured patients who are eligible for a our charity care program will be offered our self-pay rate in accordance with Public Health Law section 2807-K(9-a). The patient will be responsible for the established rate or total charges (whichever is less) minus the charity care award. If 100% charity care is awarded, then no bill is sent to the patient. Community Health Needs Assessment Process Kaleida Health assesses the health of the communities we serve through a variety of means, including but not limited to consideration of the following community health needs assessments: * Kaleida Health: Community and Provider Health Care Assessment (January 2008): Kaleida sponsored and published a population-based, cross- sectional house-to-house community health needs assessment of 2,000 heads of households in medically underserved City of Buffalo neighborhoods. Of these households, 1,658 community residents participated in the survey. The purpose was to gather data from community residents on health care, provide information on how health care may be improved to best serve the community's needs, and identify what works well and what does not in the local health care environment for these residents, from their perspective. Additional data was gathered from community-based primary care providers to identify opportunities for collaboration on disease prevention for patients under their care. * Erie County Department of Health's Community Health Assessment (March 2010): Includes demographic and health status information for the population, including disease prevalence, incidence, health resources and service utilization, profiles of community resources, behavioral risk factors, unmet need for services, local health priorities, and opportunities for action in Erie County. * Niagara County Department of Health's Community Health Assessment (September 2009): Includes demographics, description of populations at risk, disease prevalence, incidence, access to care, problems and issues in the community, local health priorities, accomplishments and opportunities for action in Niagara County. * Project CODA: Creating Options for Dignified Aging in Erie and Niagara Counties (June 2009): A locally driven elderly-centered strategy based upon in-depth research on the demographics and specific needs and wants of elders, caregivers and service providers. The assessment provides an overview of the existing long-term care system in Erie and Niagara counties, forecasts the future of long-term care, and identifies models to project future economic and demographic trends, likely shifts in public policies and projections of future changes in consumer preferences and demand for aging services. * Western New York Health Care Safety-Net Assessment (February 2008): An assessment of access, consumer experience and health information technology. The assessment offers a description of the primary care safety-net in the region, assesses access and the safety-net's overall capacity and strength, assesses consumer's experience with their primary care, and determines the information technology capacity of the primary care safety net. * Reaching for Excellence: Community Vision and Voices for WNY Health Care (July 2009): A community health assessment that incorporates the perspective of the community and users of the health care system in current health care strategy development. More than 1700 Western New Yorkers were engaged in a series of community conversations about what consumers want for the future of health care in the region. The conversations resulted in 5 health care priorities, reflecting the top concerns of the region across race, ethnicity, age, income and geography. Secondary level quantitative data include local surveys, U.S. census, U.S. Department of Health and Human Services' Community Health Status Indicators Report for NY (including Erie and Niagara Counties), among other assessments. Kaleida's team uses data from community health assessments, such as those above, to shape strategy for prioritizing its efforts and identifying areas of focus for the community benefit interventions. Many of the interventions adopted by Kaleida Health focus on populations with Disproportionate Unmet Health Needs (DUHN), including the elderly, low-income individuals and families, children and youth, and persons with special needs. The goals selected for each intervention are in support of local collaborative planning efforts when possible, and engage the breadth of Kaleida's community benefit programs. 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: * Facilitated Enrollment: Assists eligible individuals with health insurance enrollment by offering education and application assistance for Medicaid, Child Health Plus, Family Health Plus, Prenatal Care Assistance Program, and State Aid for Children with Special Needs. 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. Individuals who do not qualify for Medicaid, Child Health Plus, Family Health Plus, Prenatal Care Assistance Program, and/or State Aid for Children with Special Needs are considered for financial assistance (charity care). Community Information Headquartered in the City of Buffalo, Erie County, New York, Kaleida Health serves a region diverse in character. The eight counties of Western New York State, including Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Orleans, Niagara and Wyoming, range from rural areas and small towns to denser metropolitan cities. Within the primary service area of Erie and Niagara counties, there is a combined population of approximately 1.5 million people. There are also several federally designated Medically Underserved Areas, Medically Underserved Populations, and Health Professional Shortage Areas in the service area. Demographic Information - Erie County Erie County is the largest metropolitan county in upstate New York. It is home to three cities, 16 villages, 25 towns, and two Native American Indian reservations. While the majority of the population lives within the cities and surrounding communities, there is a significant rural population that resides outside the first and second ring suburban areas. According to the 2010 U.S. Census, the population of Erie County, including the City of Buffalo, is 919,040. The City of Buffalo is the largest city in the region and the second largest city in New York State. Buffalo, which serves as the County seat, has a population of 261,310 and is ranked the third poorest city in the nation. The population of Erie County has been declining over the past decade. In the year 2000, the population of Erie County was 950,265. This represents a decrease of more than 3% population between the years 2000 and 2010. According to the 2010 U.S. Census, 5.3% of the Erie County population are under the age of 5, 21.3% are under age 18, and 15.8% are age 65 and over. Compared to state and national age distributions, Erie County has a slightly lower percentage of young people and a higher percentage of people age 65 and older. However, the City of Buffalo population distribution is quite different from Erie County. In Buffalo, 23.6% of residents are under age 18 and 11.4% are age 65 and over. In Erie County, 51.8% of the population is female and 48.2% male. This distribution is similar to that of New York State. In the City of Buffalo there is a high percentage of females at 52.1% and lower percentage of males, 47.9%. According to the 2010 U.S. Census, 81.1% of the Erie County population is non-Hispanic Whites, 13.9% non-Hispanic African-Americans, 4.7% Hispanic, 0.7% Native Americans, and 2.7% Asian/Pacific Islanders. As per the 2005 - 2009 American Community Survey, the City of Buffalo has a much higher percentage of African Americans (39.8%) and Hispanics (8.3%) than the county. In the 2010 U.S. Census, the percentage of Hispanics increased so that the population is broken down as 50.4% Whites, 38.6% African-American, 10.5% Hispanic, 0.8% Native Americans, and 3.2% Asian/Pacific Islanders. Buffalo is home to a large immigrant and refugee population where there are 28 ethnicities and a minimum of 31 languages and dialects spoken. Lackawanna, New York, located just south of the City of Buffalo, is home to a large Arabian community, many of whom do not speak English as their first language. That corresponds with the fact that 13.7% of homes in the City of Buffalo and over 9% of the Erie County population speak a language other than English. The median household income in Erie County is $46,816, and the per capita income in 2010 was $26,378. The median earnings for male full-time workers is $46,807. The median earnings for female full-time workers is $36,858. For all families in Erie County, 10.4% are below the federal poverty level. For families with children under 18 years of age, 18.8% are below the federal poverty level. The likelihood of families living below the poverty level is compounded for female headed families that do not have a husband present. Of the 13.7% percent of families in Erie County that have a female head of household with no husband present, 29.3% are below the poverty level. For those families with children under 18 years of age, 41.8% are below the poverty level and 59.8% of these families with children under age 5 are below the poverty level. In the City of Buffalo, according to the 2010 U.S. Census, where poverty is more prevalent, the median household income is $28,490, which is almost $20,000 less than the County as a whole; and the per capita income in Buffalo is $19,117. In comparison, the median household income nationally is $50,221, and $55,603 for New York State. In Erie County, 14% of all residents live below the federal poverty level, which is very similar to New York State. In the City of Buffalo, 29.6% of residents are living below the federal poverty level. In addition, 7.6% of Erie County residents and 10.7% of Buffalo residents do not have health insurance. Of those residents who do have coverage, 34.3% and 48% respectively have public coverage, according to the 2010 U.S. Census. Demographic Information - Niagara County Niagara County is located just north of Erie County. Niagara County consists of 26 cities, towns and villages along with the Tuscarora Indian Reservation, which is located approximately in the middle of the county. The City of Niagara Falls is the most populated city in Niagara County, followed by North Tonawanda. According to the 2010 U.S. Census, Niagara County has a total population of 216,469, which has been declining in recent years. Niagara County demographics show the distribution of residents to be 88.9% White, 7% African-American, 1.1% Native American, and 0.9% Asian/Pacific Islander. The median household income for Niagara County is $43,991. English is the primary language for almost 94% of Niagara County residents. Niagara Falls is the largest city in Niagara County with 50,193 residents. The population of the City of Niagara Falls is 70.5% White, 21.6% African-American, 1.9% Native American, 3% Hispanic, and 01.2% Asian/Pacific Islander. The median income in Niagara Falls is $45,101. Families in the city who have children under 18 total 25.1%. There are also 19.8% of female headed households where with no husband, and of those 11.7% have children. As for education, of those over 25 years of age, 86.4% of adults graduated from high school and 13.8% earned college degrees; however, 13.7% did not complete high school. According to "Business First," the unemployment rate in Niagara Falls in January 2011 was 11.1%, one of the highest in Western New York. The poverty rates in Niagara Falls from 2005 - 2007 indicated that an overall 20.9% of residents live in poverty. Within this group, 27.7% of related children under age 18 and 33.8% of female headed households live below the federal poverty level. North Tonawanda is the second largest city in Niagara County with a total population of 31,568. The population is 96.5% Caucasian, 0.8% African-American, 0.4% Native American, 1.7% Hispanic, and 0.7% Asian/Pacific Islander. The median income in North Tonawanda is $44,345. Organization and affiliates role in promoting 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: Patient-Centered: We put patients and families first. Excellence: As a team, we pursue exceptional performance with passion. Accountability: We take personal responsibility for delivering results. Integrity: We demonstrate honesty in everything we do. To carry out the mission, Kaleida Health promotes community health. Much of the 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 assessments 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. Information regarding the 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 annual Community Benefit Report and triennial Community Services Plan. These documents are available on the Kaleida Health website and in print form, which is available 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 community control over the corporation through its self-perpetuating, 14 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 faith, business and 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 ECMC LIFELINE FOUNDATION 462 GRIDER STREET BUFFALO NY 14215 223283946 501(C)(3) 15000 GOLF TOURNAMENT SPONSOR UB FOUNDATION 3435 MAIN STREET BUFFALO NY 14231 160865182 501(C)(3) 7500 ABS PROGRAM WNY CLINICAL INFO EXCHANGE 2568 WALDEN AVE SUITE 107 CHEEKTOWAGA NY 14225 364594483 501(C)(3) 120000 CONTRIBUTION Community Foundation for Greater Buffalo 726 Exchange St 525 Buffalo NY 14210 222743917 501(C)(3) 250000 Uncompensated Care 4 0 FORM 990, SCHEDULE I DESCRIPTON OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS KALEIDA HEALTH MAKES CONTRIBUTIONS TO ORGANIZATIONS IN WESTERN NEW YORK THAT ALSO HAVE HEALTH CARE RELATED ACTIVITIES. ALL CONTRIBUTIONS MUST BE APPROVED BY THE GOVERNING BODY BEFORE THE MONEY IS DISTRIBUTED. X true true X X X X X X true true false false false true false false false ANDRAS VARI MD 279362 0 39875 0 0 0 52274 0 5669 0 377180 0 0 0 JAMES KASKIE 911755 0 180000 0 415601 0 36438 0 15550 0 1559344 0 367856 0 ROBERT NOLAN 344136 0 51000 0 124204 0 14982 0 12808 0 547130 0 115704 0 CONNIE VARI 530985 0 54592 0 251510 0 71163 0 6084 0 914334 0 243010 0 JOSEPH KESSLER 474087 0 128250 0 8500 0 213029 0 12970 0 836836 0 0 0 MARGARET PAROSKI MD 420000 0 63000 0 175864 0 0 0 0 0 658864 0 150864 0 D ERIC POGUE 216142 0 69300 0 8500 0 22046 0 3036 0 319024 0 0 0 TONI BOOKER 251202 0 54325 0 12500 0 73993 0 5683 0 397703 0 0 0 JAMES FOSTER MD 326004 0 72674 0 0 0 39423 0 647 0 438748 0 0 0 STEPHANIE MANN MD 337373 0 0 0 0 0 9097 0 4559 0 351029 0 0 0 LUCY CAMPBELL MD 430232 0 0 0 0 0 50964 0 5908 0 487104 0 0 0 VINCENT CALLANAN MD 415875 0 0 0 0 0 30523 0 12881 0 459279 0 0 0 KIEN LE MD 344628 0 0 0 0 0 7051 0 12818 0 364497 0 0 0 CHERYL KLASS 402646 0 127000 0 3500 0 89526 0 12880 0 635552 0 0 0 LAWRENCE ZIELINSKI 262798 0 30525 0 222059 0 50364 0 11750 0 577496 0 127835 0 DONALD BOYD 332061 0 78000 0 70655 0 53335 0 12790 0 546841 0 62155 0 CHRISTOPHER LANE 300152 0 86250 0 3500 0 44890 0 12760 0 447552 0 0 0 TAMARA OWEN 297789 0 68750 0 3500 0 65119 0 5809 0 440967 0 0 0 ANTHONY ZITO 248012 0 34375 0 3500 0 35447 0 12700 0 334034 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 FORMER PRESIDENT OF BGH, LAWRENCE ZIELINSKI, RECEIVED SEVERANCE PAYMENTS DURING THE YEAR IN THE AMOUNT OF $74,224. 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: ROBERT NOLAN, CONNIE VARI, JOSEPH KESSLER, JAMES KASKIE, LARRY ZIELINSKI, DONALD BOYD, MARGARET PAROSKI, CHERYL KLASS, AND TONI BOOKER. 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 2011, THE FOLLOWING OFFICERS RECEIVED PAYMENTS UNDER AN EXECUTIVE DEFERRED RETIREMENT PLAN: CONNIE VARI $243,010 LARRY ZIELINSKI $127,835 JAMES KASKIE $367,856 ROBERT NOLAN $115,704 DONALD BOYD $62,155 MARGARET PAROSKI $150,864 COMPENSATION ARRANGEMENT CONTINGENT ON NET EARNINGS OF THE ORGANIZATION SCHEDULE J, PART I, QUESTION 6A THE ORGANIZATION PLACES A CERTAIN PORTION OF AN EXECUTIVES TOTAL AVAILABLE COMPENSATION AT RISK ANNUALLY AND A PROPORTION OF THAT AT-RISK AMOUNT IS DEPENDENT UPON THE CONSOLIDATED HEALTH SYSTEM ATTAINING CERTAIN OPERATING PERFORMANCE TARGETS BOTH FINANCIAL AND NON-FINANCIAL. DURING 2010, CERTAIN FINANCIAL OPERATING TARGETS WHICH WERE SET BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, INCLUDING TOTAL NET OPERATING MARGIN WERE MET AND EXCEEDED RESULTING IN COMPENSATION UNDER THIS ARRAGEMENT PAID TO OFFICERS AND KEY EMPLOYEES DURING 2011. DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 64983TQT3 2004-05-20 97405000 REFINANC BUFF GENERAL HOSP MORT false false false DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 64983Q429 2006-09-21 81810000 RENOVATIONS TO FACILITIES false false false DORMITORY AUTHORITY - STATE OF NEW YORK 146000293 2006-09-28 16485005 EQUIPMENT PURCHASE false false false 25375000 0 97590469 29697680 0 0 1867994 0 0 0 88857475 0 1987 true false true true 6660000 0 86265171 23707318 5074243 0 1213231 1836365 2067415 69802989 0 0 2008 false false true true 11877177 0 16894022 0 0 0 83005 0 0 16811017 0 0 2007 false false true true false false false false 0.00000 0.00000 0.00000 true false false true true false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true false false false 0 true BAYERISCHE LANDESBAN 11.5 true true true false false false 0 true MBIA INC 0. true true false false false false 0 false 0 false false PART II, LINE 3 0 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (e) DUE TO INVESTMENT EARNINGS THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4 PART IV, COLUMN B,LINE 4C 0 CONSTRUCTION FUND - 2.5 YEARS, RESERVE FUND - 4.4 YEARS. Dr Andras Vari See Part V X 6857367 6857367 false true true 6857367 DELAWARE SURGICAL GROUP PC SEE PART V 58494 SEE PART V false GREATER NEW YORK HOSPITAL ASSOCIATI SEE PART V 34225 SEE PART V false JOCELYN VARI SEE PART V 71565 SEE PART V false DAVID VARI SEE PART V 44085 SEE PART V false BONNIE PLEUTHNER SEE PART V 76488 SEE PART V false SUSAN EVANS SEE PART V 68338 SEE PART V false Dr ANDRAS VARI SEE PART V 319237 SEE PART V false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV DELAWARE SURGICAL GROUP, PC, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DELAWARE SURGICAL GROUP, PC IS AN ENTITY IN WHICH A CURRENT BOARD MEMBER OF THE ORGANIZATION, EVAN EVANS, MD, ALSO HAS A PARTNERSHIP INTEREST AT THE TIME OF THE TRANSACTION. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2011, THE ORGANIZATION PAID THE INTERESTED PERSON (DELAWARE SURGICAL GROUP, PC) IN THE NORMAL COURSE OF BUSINESS. GREATER NEW YORK HOSPITAL ASSOCATION, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: THE CURRENT PRESIDENT/CEO OF THE FILING ORGANIZATION (KALEIDA HEALTH), JAMES KASKIE, WAS ALSO SERVING AS A BOARD MEMBER OF THE GREATER NEW YORK HOSPITAL ASSOCATION AT THE TIME OF THE TRANSACTION. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2011, THE ORGANIZATION PAID THE INTERESTED PERSON (GREATER NEW YORK HOSPITAL ASSOCIATION) PARTICIPATION DUES. JOCELYN VARI, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: JOCELYN VARI IS A FAMILY MEMBER OF A CURRENT OFFICER OF THE ORGANIZATION, CONNIE VARI, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2011, THE ORGANIZATION PAID THE INTERESTED PERSON (JOCELYN VARI) IN THE NORMAL COURSE OF BUSINESS TO FURNISH SERVICES AS PERFORMANCE IMPROVEMENT PROJECT COORDINATOR. DAVID VARI, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DAVID VARI IS A FAMILY MEMBER OF A CURRENT OFFICER OF THE ORGANIZATION, CONNIE VARI, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2011, THE ORGANIZATION PAID THE INTERESTED PERSON (DAVID VARI) IN THE NORMAL COURSE OF BUSINESS FOR PERFORMANCE OF SERVICES AS AN EMPLOYEE RELATIONS SPECIALIST. BONNIE PLEUTHNER, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BONNIE PLEUTHNER IS A FAMILY MEMBER OF A CURRENT OFFICER OF THE ORGANIZATION, CONNIE VARI, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2011, THE ORGANIZATION PAID THE INTERESTED PERSON (BONNIE PLEUTHNER) IN THE NORMAL COURSE OF BUSINESS FOR PERFORMANCE OF SERVICES AS A REGISTERED NURSE. SUSAN EVANS, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SUSAN EVANS IS A FAMILY MEMBER OF A 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 2011, THE ORGANIZATION PAID THE INTERESTED PERSON (SUSAN EVANS) IN THE NORMAL COURSE OF BUSINESS FOR PERFORMANCE OF SERVICES AS A DISCHARGE PLANNER. DR. ANDRAS VARI, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DR. ANDRAS VARI IS THE HUSBAND OF A CURRENT OFFICER OF THE ORGANIZATION, CONNIE VARI, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2011, THE ORGANIZATION PAID THE INTERESTED PERSON (DR. ANDRAS VARI) IN THE NORMAL COURSE OF BUSINESS FOR PERFORMANCE OF PHYSICIAN SERVICES. LOANS TO INTERESTED PERSONS SCHEDULE L, PART II GENERAL PHYSICIANS, P.C. (GPPC) COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DR. ANDRAS VARI, AN INTERESTED PERSON TO KALEIDA HEALTH, IS 100% OWNER OF GPPC. COLUMN D - DESCRIPTION OF THE MORE TRANSACTION: DURING 2011, KALEIDA HEALTH LOANED GENERAL PHYSICIANS P.C. MONEY TO FUND FURTHER OPERATING INITIATIVES OF THE PHYSICIAN PRACTICES. THE LOAN WAS MADE TO ASSIST GENERAL PHYSICIANS P.C. TO PAY FOR COSTS OF ACQUIRING PRACTICES 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. X Various Medical equipment 10 1550460 Replacement cost false true false DELEGATION OF CMO DUTIES FORM 990, PART VI, SECTION A, LINE 3 DURING 2011, 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 IS 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, QUESTION 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 OF 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. PROCEDURE TO EVALUATE JOINT VENTURE ARRANGEMENT FORM 990, PART VI, SECTION B, QUESTION 16B THE ORGANIZATION HAS NOT ADOPTED A FORMAL WRITTEN POLICY OR PROCEDURE REQUIRING THE ORGANIZATION TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS. HOWEVER, THE NORMAL DUE DILIGENCE PROCESS UNDERTAKEN IN CONJUNCTION WITH THE ORGANIZATION'S EXTERNAL LEGAL COUNSEL, ACCOUNTANTS AND OTHER BUSINESS ADVISORS DOES INCLUDE A REVIEW TO DETERMINE THE FOLLOWING: 1) THE IMPACT OF THE ARRANGEMENT UNDER APPLICABLE FEDERAL AND STATE LAW 2) WHETHER THE ARRANGEMENT WILL JEOPARDIZE THE ORGANIZATION'S EXEMPT STATUS AS A SECTION 501 (C) (3) CHARITABLE ORGANIZATION - HOSPITAL 3) WHETHER THE ARRANGEMENT WILL RESULT IN ANY UNRELATED BUSINESS TAXABLE INCOME 4) THE IMPACT OF THE ARRANGEMENT ON ANY EXISTING CONTRACTUAL AGREEMENTS OR OTHER BUSINESS RELATIONSHIPS AND 5) WHETHER THE ARRANGEMENT WILL RESULT IN ANY CONFLICTS OF INTEREST. IF THERE ARE CONCERNS WITH RESPECT TO ANY OF THE ABOVE MATTERS, THE ORGANIZATION WILL TAKE APPROPRIATE STEPS BEFORE THE JOINT VENTURE IS PURSUED, TO ENSURE THAT THE ARRANGEMENT WILL BE IN COMPLIANCE WITH APPLICABLE FEDERAL AND STATE LAWS AND TO SAFEGUARD THE ORGANIZATION'S TAX-EXEMPT STATUS. THE ORGANIZATION IS IN THE PROCESS OF FORMALIZING THE WRITTEN POLICY. 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. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990,PART XI, LINE 5 UNREALIZED LOSS ON INVESTMENTS (11,418,642) MINORITY INTEREST IN SUB. (702,686) UNREALIZED LOSS IN INV. AFFILIATES (5,954,542) INCREASE IN PENSION LIABILITY (92,290,908) TRANSFER FROM KALEIDA FOUNDATIONS 182,000 UNREALIZED LOSSES, TEMPORARILY RESTRICTED (137,414) UNREALIZED LOSSES, PERM. RESTRICTED (1,273,812) CHANGE IN VALUE OF FOUNDATIONS 525,265 ------------- TOTAL (111,070,739) ------------- KALEIDA HEALTH 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 WNY I LLC 726 EXCHANGE STREET BUFFALO NY 14210 453189404 HEALTH CARE NY -104754 202555 KH High St Medical Develop Associates LLC 350 Essjay Road Suite 101 WILLIAMSVILLE NY 14221 161422533 MEDICAL NY 22652 1184441 GHC MILLARD FILLMORE AMBULATORY SURGERY CTR 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161307129 SUPPORT ORG NY 501(C)(3) 11A KH true WATERFRONT HEALTH CARE CENTER 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161396236 HEALTH CARE NY 501(C)(3) 9 NA false 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 GENERAL HOME CARE (GHC) 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 222738425 DORMANT NY 501(C)(3) 9 KH true KALEIDA HEALTH FOUNDATION 726 EXCHANGE STREET BUFFALO NY 14210 161579143 FUNDRAISING NY 501(C)(3) 7 KH true THE WOMEN & CHILDREN'S HOSP OF BFLO FDN 726 EXCHANGE STREET BUFFALO NY 14210 161332044 FUNDRAISING NY 501(C)(3) 7 KH true MFSC LLC 100 HIGH STREET BUFFALO NY 14203 261582864 HEALTH CARE NY KH EXCLUDED 919417 1799911 false false 0.53301 HARLEM ROAD LEASING LLC 3435 MAIN STREET BUFFALO NY 14214 205588135 EQUIPMENT LEASING NY KH UNRELATED 102119 154173 false 102119 true 0.50000 AMTON IMAGING LLC PO BOX 1368 WILLIAMSVILLE NY 14231 262925470 HEALTH CARE NY KALEIDAWNYI LLC RELATED -170004 119670 false true 0.40000 PARK CLUB LANE LLC 2828 SHERIDAN DRIVE TONAWANDA NY 14150 271516155 HEALTH CARE NY KALEIDAWNYI LLC EXCLUDED 65250 82885 false true 0.30000 SITE E LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 272124795 REAL ESTATE MGMT NY KPI EXCLUDED 116020 1675000 false false 0.50225 KALEIDA PROPERTIES INC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 222738483 PROP MGMT SERVICE NY KH C Corp 619440 11540500 1.00000 WESTLINK CORPORATION 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161354421 MED & DIAG SERV NY KH C Corp -217 102006 1.00000 false false true true true false false false true true false false false true true true false true MILLARD FILLMORE AMBULATORY SURGICAL CENTER E 55821 MILLARD FILLMORE AMBULATORY SURGICAL CENTER C 402888 WATERFRONT HEALTH CARE CENTER P 217509 VNA OF WESTERN NEW YORK N 56094 VNA HOME CARE SERVICES P 889352 VNA HOME CARE SERVICES D 100638 VNA OF WESTERN NEW YORK P 374845 VNA OF WESTERN NEW YORK E 433899 MFSC LLC D 51060 MFSC LLC I 570257 KALEIDA PROPERTIES P 204421 KALEIDA PROPERTIES D 3575259 KALEIDA HEALTH FOUNDATION C 2486092 KALEIDA HEALTH FOUNDATION R 1153529 KALEIDA HEALTH FOUNDATION E 83500 WOMENS AND CHILDRENS HOSPITAL OF BUFFALO FDN R 1224054 WOMENS AND CHILDRENS HOSPITAL OF BUFFALO FDN D 492642 WOMENS AND CHILDRENS HOSPITAL OF BUFFALO FDN C 989102 SITE E LLC J 233450 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 $2,486,092 (SEE SCHEDULE R, PART V) VERSUS THE $576,458 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 $989,102 (SEE SCHEDULE R, PART V) VERSUS THE $864,361 RECORDED BY THE FILING ORGANIZATION AS GRANTS RECEIVED (SEE PART VIII, LINE 1D AND SCHEDULE B). RELATED TAX EXEMPT ORGANIZATIONS SCHEDULE R, PART II, NUMBER (2) ON AUGUST 15, 2011, WATERFRONT HEALTH CARE CENTER ENTERED INTO A VOLUNTARY RECEIVERSHIP AGREEMENT WITH A THIRD PARTY OPERATOR AND THE NEW YORK STATE DEPARTMENT OF HEALTH. SINCE THAT DATE THE CENTER HAS BEEN UNDER THE DIRECT CONTROL AND OPERATION OF THE THIRD PARTY OPERATOR AND NOT KALEIDA HEALTH.