2011-11-15T10:28:25-05:00 2010-12-31 KPMG LLP 515 Broadway 4th Floor Albany NY 122072974 990 2010-01-01 161533232 KALEIDA HEALTH KALE 7168598501 726 EXCHANGE STREET BUFFALO NY 14210 Joseph M Kessler 2011-11-14 5184274600 2010 2016-02-24 21:20:13Z JAMES KASKIE 726 Exchange Street Suite 200 BUFFALO NY 14210 1286257827 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, 3 LT CARE, AS WELL AS OUTPATIENT & PRIMARY CARE SITES. 15 12 10023 1570 3517509 86704225 33453390 1057084879 1083912619 917155 5115295 11010157 9240906 1155716416 1131722210 179570 240200 0 0 577605218 605535584 0 0 0 502544574 490988871 1080329362 1096764655 75387054 34957555 933611492 1029678448 700737788 770656008 232873704 259022440 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 three 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, Kal false false 935978325 240200 1086654223 See Attachment 1. 935978325 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 false false true true true true false false false true true true true false false true 555 0 true 10023 true true true false false false false false false false false false X 15 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 X 0 0 0 MATTHEW L BROWN 1.0 X 0 0 0 EVAN EVANS MD 1.0 X 50000 0 0 ROBERT HALONEN PhD 1.0 X MURIEL HOWARD PhD 1.0 X JAMES KASKIE 38.0 X X X 2364860 0 43482 JOYCE P KORZEN RN 1.0 X JOHN R KOELMEL 1.0 X X DAVID A MILLING MD 1.0 X HERMAN S MOGAVERO Jr MD 1.0 X DALE N SCHUMACHER MD 1.0 X FRANCISCO M VASQUEZ PhD 1.0 X 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 X 725993 0 39755 CONNIE VARI 38.0 X X 1145164 0 48815 JOSEPH KESSLER 38.0 X X 580337 0 201985 MARGARET PAROSKI MD 38.0 X X 1235509 0 0 D ERIC POGUE 38.0 X X 410041 0 118928 CHERYL KLASS 38.0 X 522679 0 43760 LAWRENCE ZIELINSKI 38.0 X 538484 0 33749 DONALD BOYD 38.0 X 461950 0 51460 CHRISTOPHER LANE 38.0 X 390338 0 46389 TAMARA OWEN 38.0 X 344324 0 47567 JAMES FOSTER MD 38.0 X 363701 0 15672 FRANCIS MEYER Jr 38.0 X 365634 0 27063 ANDRAS VARI MD 38.0 X 356501 0 27169 STEPHANIE MANN MD 38.0 X 415389 0 9350 LUCY CAMPBELL MD 38.0 X 381817 0 20253 10652721 0 775397 355 false true false UNIVERSITY PEDIATRIC ASSOCIATES 239 BRYANT STREET BUFFALO NY 14222 MEDICAL SERVICES 4063031 WNY RADIOLOGY LLC PO BOX 4029 BUFFALO NY 14240 RADIOLOGY SERVICES 3792036 UNIVERSITY NEUROLOGY INC 100 HIGH STREET BUFFALO NY 14260 MEDICAL SERVICES 3155640 SODEXHO MANAGEMENT INC PO BOXES 81049 WOBURN NY 018131049 CLEANING & LAUNDRY 3663144 ACADEMIC MEDICINE SERVICES 4498 MAIN ST SUITE 23 AMHERST NY 14226 MEDICAL SERVICES 3000393 88 10549601 17606096 5297693 10278618 33453390 SERVICE REVENUE 623990 1080471367 1080471367 MANAGEMENT FEES 561000 151967 151967 LABORATORY SERV 621500 3289285 3289285 1083912619 5268916 101182 17774 5149960 0 0 2803544 2803544 2803554 58483 2745071 154349596 32400 154484635 50982 -135039 -18582 -153621 -153621 0 0 0 VENDOR REBATES 900099 1443656 1443656 UNIVERSITY LEASE INCOME 531120 1259889 1259889 CAFETERIA 722210 1122282 1122282 2611525 1196766 1414759 6437352 1131722210 1083212971 3517509 11538340 240200 240200 0 0 0 8719679 8719679 0 457686023 416419391 41266632 0 104831251 58698549 46132702 34298631 31141189 3157442 0 1533598 768568 765030 559696 559696 253163 253163 0 0 105761996 96473480 9288516 3274853 1621999 1652854 3858633 2723116 1135517 0 0 5962639 3530821 2431818 909231 549976 359255 0 0 12258345 9811376 2446969 0 50363598 40290878 10072720 17601461 13140473 4460988 HEALTH CARE SUPPLIES 186537389 186420872 116517 BAD DEBT EXPENSE 16869876 16869876 EQUIPMENTAL RENTAL & MAINT 25918839 13021667 12897172 UTILITIES 11144923 8933168 2211755 SERVICE CONTRACTS 7941439 6206926 1734513 40239192 29115800 11123392 1096764655 935978325 160786330 0 800500 534416 118038961 96742771 103737857 135996337 21836253 21909693 8216142 9924277 1346909733 1010811558 266166517 336098175 205347461 215985857 209467801 212486922 933611492 1029678448 119211939 137940657 208745213 188175482 8152568 35624187 364628068 408915682 700737788 770656008 X 98116607 130649199 115208207 112973024 19548890 15400217 232873704 259022440 933611492 1029678448 X 34957555 -8808819 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false false false true 38595 true 214568 false false 253163 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. 79899854 14188339 2153889 23654903 72587179 23068508 71865683 3656737 18691074 79899854 28374857 4858154 -5863675 4300728 23068608 0.25030 0.74970 false true true 8712769 8712769 317001729 296148859 20852870 1008604995 706357472 302247523 12590240 8305227 4285013 336098175 VAR PUBL TRADED SECURITIES 105527492 F BRANDES INTERNATIONAL EQUITY 17976120 F INTECH RISK-MANAGED L CAP FUND 7177099 F FEDERAL ST ASSOC OFFSHORE FUND 6584840 F ARDEN ENDOWMENT ADVISORS CL G 6372605 F MCM CF GLOBAL ALPHA I FUND 8677613 F WTC CTF RESEAR VALUE PUR 4/06 6974648 F BENCHMARK PLUS INST PART L CAP 7076874 F WTC CIF OPPORTUNISTIC FUND 10030641 F CHARITABLE TEMPORARY INVEST FD 7 F KALEIDA MIT COMMON FUND LP 213535 F COMMON CAP VENTURE PTNRS VI 261618 F COMMON FND CAP PRIVATE EQ P V 392230 F KALEIDA MIT REALITY LP 868419 F KALEIDA SI REALITY LP 1360650 F DWS GLOBAL COMMODITIES 9979839 F ROBECO GLOBAL EMERGING MARKETS 7789343 F AQR GLOBAL RISK 6999094 F PANAGORA RISK PARITY TOTAL RET 6388377 F AAM HIGH YIELD TOTAL RET FUND 5334813 F 215985857 DEFERRED FINANCING 12909723 EQUITY IN UNCONSOLIDATED AFFIL 117137445 OTHER RECEIVABLES 16348261 OTHER ASSETS 11139832 INSURANCE RECOVERIES REC. 7808908 LONG TERM GRANT FROM HEAL NY 47142753 212486922 0 DUE TO THIRD PARTY PAYORS 25970991 SELF INSURANCE LIABILITY 154188753 LINE OF CREDIT 10000000 OTHER LIABILITIES 6389973 PENSION LIABILITY 176506508 ASSET RETIREMENT OBLIGATIONS 10684572 CAPITAL LEASE OBLIGATIONS 13479261 CONSTRUCTIONS PAYABLE 11695624 408915682 1131722210 1096764655 34957555 17070392 -20468843 -3398451 31559104 1123120438 17070392 -836318 16234074 1106886364 24835846 24835846 1131722210 1091561334 896255 896255 1090665079 6099576 6099576 1096764655 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 SCH. D, PART XI, LINE 8 RECONCILIATION OF CHANGE IN NET ASSETS FROM EARNINGS TO AUDITED FINANCIAL STATEMENTS - LESS: MINORITY INTEREST IN SUB <836,318> LESS: CONTRIBUTIONS FOR CAPITAL ACQUIS <11,354,327> LESS: RESTRICTED CONTRIBUTIONS <14,188,339> LESS: RESTRICTED INVESTMENT INCOME <189,435> PLUS: NET ASSETS RELEASED FROM RESTRICTION 6,099,576 TOTAL: <20,468,843> SCH D, PART XII, LINE 2D OTHER REVENUE INCLUDED ON BOOKS BUT NOT ON RETURN: MINORITY INTEREST IN SUBSIDIARY <836,318> SCH D, PART XII, LINE 4B OTHER REVENUE ON RETURN BUT NOT ON BOOKS: RESTRICTED CONTRIBUTIONS 14,188,339 RESTRICTED INVESTMENT INCOME 189,435 CONTRIBUTIONS FOR CAPITAL ACQUISITIONS 11,354,327 ASSETS RELEASED FROM RESTRICTIONS <896,255> TOTAL: 24,835,846 SCH D, PART XIII, LINE 2C OTHER EXPENSES ON BOOKS BUT NOT ON RETURN - NET REALIZED LOSS ON SALE OF INVESTMENTS: 896,255 SCH D, PART XIII, LINE 4B OTHER EXPENSES ON RETURN, NOT ON BOOKS: NET ASSETS RELEASED FROM RESTRICTION FOR OPERATIONS: 6,099,576 true true X true X true X true true true false true true 14834463 2982619 11851844 0.01080 261065556 190518284 70547272 0.06430 275900019 193500903 82399116 0.07510 5737822 5737822 0.00520 50123254 21471250 28652004 0.02610 40200314 13757212 26443102 0.02410 114915 114915 0.00010 96176305 35228462 60947843 0.05550 372076324 228729365 143346959 0.13060 true 11284147 862614 177579298 169660750 7918548 true true MFSC LLC PHYSICIAN SERVICES 0.50162 0.49838 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. 0.50100 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 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 X X X X X X X true X false false 28 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 JS Mattina Health Center

300 Niagara Street Buffalo NY 14201

Hospital based outpatient primary care services Amherst General

4955 North Bailey Avenue Suite 207 Amherst NY 14226

Hospital based outpatient diagnostic services North Buffalo Medical Park

900 Hertel Avenue Buffalo NY 14207

hospital based outpatient primary care services Deaconess Family Planning Center

1011 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 WCHOB Hodge Pediatrics

125 Hodge Street Buffalo NY 14222

Hospital based outpatient 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 14086

Hospital Based outpatient behavorial health services Dr M L King SBHC

487 High Street Buffalo NY 14211

school based primary care services Hillery Park SBHC

72 Pawnee Parkway Buffalo NY 14210

School based primary care services South Park High SBHC

150 Southside Parkway Buffalo NY 14220

School based primary care services Buffalo Elem School of Technology

414 S Division Street Buffalo NY 14204

School based primary care services Futures Academy SBHC

295 Carlton Street Buffalo NY 14204

School Based primary care services Bennett High SBHC

2885 Main Street Buffalo NY 14214

School based primary care services Herman Badillo SBHC

315 Carolina Street Buffalo NY 14201

School based primary care services Westminster Community SBHC

24 Westminster Avenue Buffalo NY 14215

School based primary care services Stanley Makowski SBHC

1095 Jefferson Avenue Buffalo NY 14214

School based primary care services Dr Lydia Wright SBHC

106 Appenheimer Street Buffalo NY 14214

school based primary care services BUILD Academy SBHC

340 Fougeron Street Buffalo NY 14211

School based primary care services Grover Cleveland High SBHC

110 Fourteenth Street Buffalo NY 14213

School based primary care services WCHOB Early Childhood Direction Center

3131 Sheridan Avenue Amherst 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 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 reduce price care is contacted by a facilitated enroller for financial screening and enrollment in a government-funded program, if eligible. PART I, LINE 6 Kaleida Health's 2010 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. Costs attributable to a physician clinic: There are no costs attributable to a physician clinic included in Subsidized Health Services. Bad debt expense included on Form 990, but subtracted for purposes of calculating the percentage of total expense: Total Bad Debt expense subtracted from total expenses in the determination of calculating the percentage of Total Expense is $17,526,163. 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 recruit 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 to staff our hospitals. 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 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 credit scored and based on this score, and charity care may be awarded. Kaleida Health, in implementing the presumptive eligibility process, determined that 38% of self-pay bad debt expense in 2010 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 $822,614. We estimated this amount by using the 2010 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. PART III, LINE 4 Charity Care and Bad Debt Expense "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 quality 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." 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 benefits 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. Rationale for including any portion of bad debt as community benefit (if any): 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 2010 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 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, THAN THE PATIENT IS NOTIFIED OF THE LEVEL OF CHARITY CARE AWARDED. IF 100% CHARITY CARE AWARDED, THEN NO BILL IS SENT TO THE PATIENT. IF LESS THAN 100% CHARITY CARE IS AWARDED, THAN THE PATIENT WILL RECEIVE A BILL PURSUANT TO THE PRIVATE PAY COLLECTION POLICY. Part V, Line 13g FINANCIAL AID INFORMATION INCLUDED ON BILLS 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. HOSPITAL MAY NOT FORWARD ACCOUNTS TO COLLECTION WHILE AN 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 use 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 quality 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 Kaleida serves the eight counties of Western New York State, with primary service areas in Erie and Niagara Counties. The service area has a combined population of approximately 1.5 million people. The eight county service areas includes: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Orleans, Niagara and Wyoming Counties. The region is diverse in character, ranging form rural areas and small towns of the southeastern counties, to the denser areas of Erie and Niagara counties. Kaleida Health (Kaleida) is headquartered in the City of Buffalo, (Erie County) New York. There are several federally designated Medically Underserved Areas, Medically Underserved Populations, and Health Professional Shortage Areas in Kaleida's service area. Demographic Information, Erie County, NY: Erie County is the largest metropolitan county in upstate New York. According to the U.S. Census 2010 estimates, the population of Erie County including the City of Buffalo is 919,040. Buffalo serves as the County seat. Buffalo has a population of 276,059. The City of Buffalo is the largest city in the region and the second largest city in New York State. Buffalo is ranked as the third poorest city in the nation. Erie County is home to 3 cities, 16 villages, 25 towns, and two Native American Indian reservations. Erie County is largely a metropolitan urban County with the majority of the population living within the cities and surrounding communities. There is a significant rural population that resides outside the first and second ring suburban areas. 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 an approximately 3.3% decrease in population between the years 2000 and 2010. According to the 2009 U.S. Census, 5.4% of the Erie County population are under the age of five, 21.5% are under age 18, and 15.8% are age 65 and over. Compared to New York 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, 26.3% of residents are under age 18, which is higher than both New York State (24.7%) and the USA (24.3%). The percent of persons age 65 and over residing in the City of Buffalo is lower than in Erie County as a whole and equal to the New York State percentage of 13.4%. In Erie County, 51.8% of the population is female and 48.2% male. This distribution is similar to the New York State distribution, however the national distribution is closer to 50%. In the City of Buffalo there is a high percentage of females (53%) and lower percentage of males (47%). According to the 2010 US Census, 82.18% of the Erie County population is non-Hispanic Whites, 13% non-Hispanic African-Americans, 3.27% Hispanic, 0.6% Native Americans, and 1.46% Asian/Pacific Islanders. As per the 2005-2009 American Community Survey, the City of Buffalo is characterized by a much higher percentage of African Americans (39.8%), and Hispanics (8.3%). The West Side of 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 Arab community, many of whom do not speak English as their first language. Nearly 9% of the Erie County population speaks a language other than English in their homes. The median household income in Erie County is $46,739. The median earnings for male full-time workers is $38,703. The median earnings for female full-time workers is $26,510. For all families in Erie County, 9.20% are below the federal poverty level. For families with children under 18 years of age, 17.30% 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. 13.7% percent of families in Erie County have a female head of household with no husband present and 30.4% of these families are below the poverty level. For those families with children under 18 years of age, 42.5% are below the poverty level and 53.4% of these families with children under age 5 are below the poverty level. Erie County's per capita income in 2009 was $26,256. In the City of Buffalo where poverty is more prevalent, the median household hold income is $24,536, which is more than $20,000 less than the County as a whole; and the per capita income in Buffalo is $14,991, almost $11,000 less than the County. The median household income nationally in 2009 is $50,221, and $54,554 for New York State. In Erie County, 13.9% of all residents live below the federal poverty level, which is very similar to the percent for New York State. In the City of Buffalo, 26.6% of residents are living below the federal poverty level. According to the New York State Department of Health, at the end of 2008, 6.1% of Erie County residents did not have health insurance and 8.1% of Erie County residents were unemployed in 2009. Erie County has a higher high school graduation rate (87.9%) than New York State (84.2%), however the City of Buffalo's high school graduation rate is lower (74.6%). Similarly, the City of Buffalo's college graduation rate (18.3%) is significantly lower than Erie County (28.5%) and New York State (31.8%). (2010 US Census) Demographic Information, Niagara County New York: 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 reveal that 88.5% of residents are Caucasian, 6.9% are African-American, 1.1% are Native American, and 0.8% Asian/Pacific Islander. The median household income for Niagara County is $42,580. Approximately 14% (13.9%) of county residents lives in poverty and 9% of families and 33.8% of female headed households with no spouse had incomes below the federal poverty level. According to the New York State Department of Health, nearly 9% of people in Niagara County had no health insurance at the end of 2008. English is the primary language for 94.1% of Niagara County residents and the second language spoken is Spanish. There is also a small population of recent immigrants from Russia that resides in North Tonawanda, many of whom speak very little English. Niagara Falls is the largest city in Niagara County with 51,712 residents. The population of the City of Niagara Falls is 76.2% Caucasian, 18.7% African-American, 1.6% Native American, 2.4% Hispanic, and 0.7% Asian/Pacific Islander. There are 27,299 females and 24,413 males residing in Niagara Falls. The median income in Niagara Falls is $31,336. According to Business First, the unemployment rate in Niagara Falls in January 2011 was one of the highest in the Western New York region at nearly 11.1%. 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 live below the federal poverty level. In addition, 33.8% of female headed households had income below the federal poverty level. In Niagara Falls, 83.7% of adults graduated from high school, 12.4% earned college degrees, however 18% did not complete high school. North Tonawanda is the second largest city in Niagara County, with a total population of 31,362. There are 14,593 males and 15,869 females residing in North Tonawanda. The majority of residents (97.6%) are Caucasian, 0.7% African-American and 1% are Asian/Pacific Islanders. The median income in North Tonawanda is $46,457. According to Business First, the unemployment rate in 2009 was 8.9%. An 8.3% poverty level was identified, including 5.8% of families residing in North Tonawanda and 24.2% of female headed households with no spouse. 89.6% of adults graduated from high school and 20.7% hold a college degree. Twelve percent (12%) of North Tonawanda residents dropped out of high school. (Niagara County Department of Health Community Health Assessment) PROMOTION OF COMMUNITY HEALTH Kaleida Health's mission is "to advance the health of the community." Our vision is to be the "regional health care system providing exceptional quality services, with a commitment to education and research, accessible to all". Our values clearly state who we are and how we perform our work: 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. Promoting community health is how we carry out the mission of Kaleida Health: "to advance the health of our community." Much of our community benefit work is focused on the needs of low income, medically underserved populations. Poverty trends, community health research and local community health needs assessments are reviewed on a regular basis while planning services and programs. Kaleida Health representatives are actively engaged in various community health collaborations with the local health departments, state health department, and local not-for-profit health and human service agencies. We are responsive to community priorities and develop programs and services that fill a gap or supplement an existing program. Most Kaleida Health community health outreach programs are offered in partnership with other community organizations or governmental agencies, in order to leverage resources to meet community 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 departments or long-term care facilities is disseminated to the public in electronic (website) form in the annual Community Benefit Report and triennual Community Services Plan. Print form of these documents are available upon request. The Visiting Nursing Association of Western New York, Inc. is the Kaleida Health home care affiliate. The Visiting Nursing Association of Western New York promotes the health of the community by 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 are offered through the Visiting Nursing Association, such as the annual community influenza immunization program. The Visiting Nursing Association of Western New York offers one of the largest annual influenza immunization programs in the region. KALEIDA HEALTH BOARD OF DIRECTORS Kaleida Health maintains community control over the corporation through its Board of Directors, comprised of community and faith leaders, and leaders in business and industry, healthcare, and physicians representing the medical staff of Kaleida Health. The majority of the members of the Board of Directors reside in Western New York and are neither employees, independent contractors, nor family members thereof. Each Director serves a three-year term. Open medical staff As conferred by the Board of Directors, medical staff membership is offered to professionally competent physicians, dentists, podiatrists and other specified individuals, who continuously meet the qualifications, standards and requirements outlined in the Bylaws, Rules and Regulations, Policies of the Medical Staff and Kaleida Health, consistent with the needs of Kaleida Health's patients. Staff membership or particular clinical privileges shall not be denied on the basis of age, sex, sexual orientation, race, color, creed, national origin, a disability unrelated to the ability to fulfill patient care and medical staff responsibilities or any other criterion unrelated to the efficient delivery of quality patient care, to professional qualifications or to the needs of the community, or to the purposes, needs, and capabilities of Kaleida Health. Every member of the Medical Staff assists the hospitals in fulfilling our mission and responsibility to provide emergency and uncompensated care for those in need. Use of surplus funds: Surplus funds are used to further the mission of Kaleida Health, such as reinvesting in community benefit programs and making improvements in facilities, patient care, medical, nursing and allied health training and education in support of the health needs of the community. STATE FILING OF community benefit report: NEW YORK true AMERICAN HEART ASSOCIATION 20 NORTHPOINTE PKWY SUITE 130 AMHERST NY 14228 135613797 501(C)(3) 30000 LUNCH SPONSORSHIP BUFFALO URBAN LEAGUE INC 15 EAST GENESEE STREET BUFFALO NY 14203 160743940 501(C)(3) 10000 GALA SPONSOR ECMC LIFELINE FOUNDATION 462 GRIDER STREET BUFFALO NY 14215 223283946 501(C)(3) 15000 GOLF TOURNAMENT SPONSOR NIAGARA FALLS MEMORIAL MEDICAL CENTER 621 TENTH STREET NIAGARA FALLS NY 14302 160743094 501(C)(3) 6000 GOLF TOURNAMENT SPONSORSHIP UB FOUNDATION 3435 MAIN STREET BUFFALO NY 14231 160865182 501(C)(3) 77500 ABS PROGRAM WNY CLINICAL INFO EXCHANGE 2568 WALDEN AVE SUITE 107 CHEEKTOWAGA NY 14225 364594483 501(C)(3) 101700 CONTRIBUTION 5 1 Schedule I, Part 1, question 2 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 false true false false false true false false false JAMES KASKIE 906574 0 1091850 0 366436 0 31230 0 47204 0 2443294 0 0 ROBERT NOLAN 343936 0 256922 0 125135 0 27503 0 17225 0 770721 0 0 CONNIE VARI 528238 0 382184 0 234742 0 43551 0 12661 0 1201376 0 0 JOSEPH KESSLER 470756 0 101081 0 8500 0 189733 0 18731 0 788801 0 0 MARGARET PAROSKI MD 413846 0 97840 0 723823 0 0 0 1235509 0 698823 0 D ERIC POGUE 319161 0 82380 0 8500 0 113664 0 9864 0 533569 0 0 JAMES FOSTER MD 326268 0 37433 0 0 15672 0 588 0 379961 0 0 FRANCIS MEYER Jr 295509 0 70125 0 0 27063 0 4163 0 396860 0 0 ANDRAS VARI MD 278876 0 77625 0 0 21905 0 8110 0 386516 0 0 STEPHANIE MANN MD 415389 0 0 0 4086 0 5972 0 425447 0 0 LUCY CAMPBELL MD 381817 0 0 0 20253 0 650 0 402720 0 0 CHERYL KLASS 401054 0 118125 0 3500 0 31508 0 17894 0 572081 0 0 LAWRENCE ZIELINSKI 330600 0 71250 0 136634 0 21497 0 16998 0 576979 0 0 DONALD BOYD 322580 0 87600 0 51770 0 39208 0 16949 0 518107 0 0 CHRISTOPHER LANE 299525 0 87313 0 3500 0 34137 0 16598 0 441073 0 0 TAMARA OWEN 281449 0 59375 0 3500 0 42303 0 9135 0 395762 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. HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, SCHEDULE J-2, PART I THE FOLLOWING INDIVIDUALS LISTED ON SCHEDULE J-2, PART I, COLUMN A EACH DEVOTED 4 HOURS IN TOTAL TO RELATED ORGANIZATIONS: CONNIE VARI, JOSEPH KESSLER, LAWRENCE ZIELINSKI. 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 AND D. ERIC POGUE. 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 2010, THE FOLLOWING OFFICERS RECEIVED PAYMENTS UNDER AN EXECUTIVE DEFERRED RETIREMENT PLAN: CONNIE VARI $226,242 LARRY ZIELINSKI $116,634 JAMES KASKIE $329,397 ROBERT NOLAN $116,635 DONALD BOYD $43,270 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 2009, CERTAIN FINANCIAL OPERATING TARGETS WHICH WERE SET BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, INCLUDING TOTAL NET 0PERATLNG MARGIN WERE MET AND EXCEEDED RESULTING IN COMPENSATION UNDER THIS ARRANGEMENT PAID TO OFFICERS AND KEY EMPLOYEES DURING 2010 Dormitory Authority - State of New York 146000293 64983TQT3 2004-05-20 97405000 REFINANCE BUF GENERAL HOSP MOR 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 21405000 97405000 30724942 1867994 88672006 1987 true false true true 4740000 86265656 24518390 5074243 1213231 1836365 2067415 69802989 2008 false false true true 9398845 16894022 83005 16811017 2007 false false true true false false false false true 0.00000 0.00000 0.00000 true false false true false true true false false false false true true false false false true BAYERISCHE LANDESBAN 11.5 true true true false false false true MBIA INC true true false false false false false false false Part II, Line 3 The total proceeds do not agree to the issue price in Part I, Column (e) due to investment earnings Part IV, Column A, Line 4b Bayerische Landesbank Part IV, Column B, Line 4c Construction Fund - 2.5 years, Reserve Fund - 4.4 years BUFFALO NIAGARA MEDICAL CAMPUS SEE PART V 118581 SEE PART V false GREATER NEW YORK HOSPITAL ASSOCIATI SEE PART V 15000 SEE PART V false JOCELYN VARI SEE PART V 77374 SEE PART V false DAVID VARI SEE PART V 44970 SEE PART V false BONNIE PLEUTHNER SEE PART V 72578 SEE PART V false SUSAN EVANS SEE PART V 71398 SEE PART V false Dr ANDRAS VARI SEE PART V 356501 SEE PART V false GENERAL PHYSICIANS PC SEE PART V 3557367 SEE PART V false Damon and Morey LLP See Part V 1128006 See Part V false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV BUFFALO NIAGARA MEDICAL CAMPUS, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION: THE PAST BOARD CHAIRMAN OF THE FILING ORGANIZATION (KALEIDA HEALTH), EDWARD F. WALSH, JR., WAS ALSO SERVING AS A BOARD MEMBER OF THE BUFFALO NIAGARA MEDICAL CAMPUS AT THE TIME OF THE TRANSACTION. COLUMN D - DESCRIPTION OF THE TRANSACTION; DURING 2010, THE ORGANIZATION PAID THE INTERESTED PERSON (BUFFALO NIAGARA MEDICAL CAMPUS) PARTICIPATION DUES AND FOR SERVICES 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 2010, 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 2010, 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 2010, 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 2010, 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 CURRENT OFFICER OF THE ORGANIZATION, EVAN EVANS, MD, WHO RECEIVED COMPENSATION FROM THE ORGANIZATION IN EXCESS OF $10,000. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2010, 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 2010, THE ORGANIZATION PAID THE INTERESTED PERSON (DR. ANDRAS VARI) IN THE NORMAL COURSE OF BUSINESS FOR PERFORMANCE OF PHYSICIAN SERVICES. 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 TRANSACTION: During 2010, Kaleida Health loaned General Physicians P.C. money to re-activate the physician practice that has been dormant since 2002. The loan was made to assist General Physicians P.C. to pay for 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. DAMON AND MOREY, LLP, COLUMN B - RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DAMON AND MOREY, LLP IS AN ENTITY IN WHICH A CURRENT BOARD MEMBER OF THE ORGANIZATION, CHRISTOPHER GREENE, ESQ, ALSO HAS A PARTNERSHIP INTEREST AT THE TIME OF THE TRANSACTION. COLUMN D - DESCRIPTION OF THE TRANSACTION: DURING 2010, THE ORGANIZATION PAID THE INTERESTED PERSON (DAMON AND MOREY, LLP) IN THE NORMAL COURSE OF BUSINESS. X Various Medical equipment 14 10278618 Replacement cost false true false DELEGATION OF CMO DUTIES FORM 990, PART VI, SECTION A, LINE 3 DURING 2010, 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 OR DIRECTOR IN A POSITION WHERE THERE MAY BE A POTENTIAL, ACTUAL, OR EVEN APPEARANCE, OF A CONFLICT OF INTEREST OR A QUESTION 0F 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 0RGANIZATION 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 organizations' 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 GAIN ON INVESTMENTS, UNRESTRICTED: 17,070,392 MINORITY INTEREST IN SUB: <836,318> UNREALIZED GAIN IN INV. AFFILIATES: 2,133,436 INCREASE IN PENSION LIABILITY: <32,528,878> OTHER TRANSFERS, NET: <978,666> UNREALIZED GAINS, TEMP. RESTRICTED: 148,075 UNREALIZED GAINS, PERM. RESTRICTED: 1,343,919 CHANGE IN VALUE OF FOUNDATIONS: 4,839,231 TOTAL: <8,808,809> SUPPLEMENTAL DISCLOSURE REGARDING TAX EXEMPT BONDS SCHEDULE K - PARTS I, II AND IV PART I, LINE B, COLUMN F - DESCRIPTION OF PURPOSE OF 2006 TAX EXEMPT BOND ISSUE FROM DORMITORY AUTHORITY OF THE STATE OF NEW YORK: RENOVATE AND EXPAND PATIENT CARE AREAS AT MILLARD FILLMORE SUBURBAN AND TO RENOVATE AND EXPAND THE CARDIAC PROCEDURE LABORATORIES AT BUFFALO GENERAL HOSPITAL AND MILLARD FILLMORE GATES HOSPITAL. PART II, LINE 5, COLUMN B - DETAIL OF ISSUANCE COSTS FROM PROCEEDS FROM 2006 ISSUE FROM DORMITORY AUTHORITY OF THE STATE OF NEW YORK: ISSUANCE COSTS - $1,213,231 AND CREDIT ENHANCEMENT FEE - $1,836,365 PART IV, LINE 4B - NAME OF PROVIDER FOR GUARANTEED INSURANCE CONTRACTS: COLUMN A - 2004 ISSUE FROM DORMITORY AUTHORITY OF THE STATE OF NEW YORK: BAYERISCHE LANDESBANK COLUMN B - 2006 ISSUE FROM DORMITORY AUTHORITY OF THE STATE OF NEW YORK: CONSTRUCTION FUND - MBIA, INC. RESERVE FUND - MBIA, INC. PART IV, LINE 4C - TERM OF GUARANTEED INSURANCE CONTRACT FOR 2006 ISSUE FROM DORMITORY AUTHORITY OF THE STATE OF NEW YORK: CONSTRUCTION FUND - 2.5 YEARS RESERVE FUND - 4.4 YEARS KALEIDA HEALTH MCO LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161570311 DORMANT NY 0 0 KH KALEIDA IPA LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161570380 DORMANT NY 0 0 KH KALEIDA WNY I LLC 726 EXCHANGE STREET BUFFALO NY 14210 HEALTH CARE NY -144167 1531140 KH MILLARD FILLMORE AMBULATORY SURGERY CTR 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161307129 SUPPORT ORG NY 501(C)(3) 11A KH WATERFRONT HEALTH CARE CENTER 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161396236 HEALTH CARE NY 501(C)(3) 9 KH VNA HOME CARE SERVICES 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161491203 HOME HLTH CAR NY 501(C)(3) 9 KH VNA OF WESTERN NEW YORK 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 160743214 HOME HLTH CAR NY 501(C)(3) 9 KH GENERAL HOME CARE (GHC) 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 222738425 DORMANT NY 501(C)(3) 9 KH KALEIDA HEALTH FOUNDATION 726 EXCHANGE STREET BUFFALO NY 14210 161579143 FUNDRAISING NY 501(C)(3) 7 KH THE WOMEN & CHILDREN'S HOSP OF BFLO FDN 726 EXCHANGE STREET BUFFALO NY 14210 161332044 FUNDRAISING NY 501(C)(3) 7 KH MFSC LLC 100 HIGH STREET BUFFALO NY 14203 261582864 HEALTH CARE NY KH EXCLUDED 895084 1824462 false false 0.50951 HARLEM ROAD LEASING LLC 3435 MAIN STREET BUFFALO NY 14214 205588135 EQUIPMENT LEASING NY KH UNRELATED 17774 118358 false 17774 true 0.50000 AMTON IMAGING LLC PO BOX 1368 WILLIAMSVILLE NY 14231 262925470 HEALTH CARE NY KALEIDAWNYI LLC RELATED -136702 1296514 false true 0.40000 PARK CLUB LANE LLC 2828 SHERIDAN DRIVE TONAWANDA NY 14150 271516155 HEALTH CARE NY KALEIDAWNYI LLC EXCLUDED -7465 234626 false true 0.30000 HIGH ST MEDICAL DEVELOP ASSOCIATES LLC 350 ESSJAY ROAD SUITE 101 WILLIAMSVILLE NY 14221 161422533 HEALTH CARE NY GHC EXCLUDED 32779 759683 false false 0.59051 SITE E LLC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 272124795 REAL ESTATE MGMT NY KPI EXCLUDED 94884 1660000 false false 0.51607 Prime Link LLC 726 Exchange Street Suite 200 Buffalo NY 14210 161499404 Dormant NY NA Excluded 0 0 false false 0.12500 Health Link LLC 100 High Street Buffalo NY 14203 161510524 Dormant NY NA Excluded 0 0 false false 0.14290 Westlink IPA LLC 726 Exchange Street Suite 200 Buffalo NY 14210 161538764 Health Services NY NA Excluded 0 4358 false false 0.20000 KALEIDA PROPERTIES INC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 222738483 PROP MGMT SERVICE NY KH C Corp 742781 11146327 1.00000 WESTLINK CORPORATION 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161354421 MED & DIAG SERV NY KH C Corp -344 102167 1.00000 false false true true true false false false true false false false false true true true false true MILLARD FILLMORE AMBULATORY SURGICAL CENTER e 55861 MILLARD FILLMORE AMBULATORY SURGICAL CENTER c 388566 WATERFRONT HEALTH CARE CENTER p 2497073 WATERFRONT HEALTH CARE CENTER d 4211691 VNA HOME CARE SERVICES p 741422 VNA HOME CARE SERVICES d 211044 VNA OF WESTERN NEW YORK p 782059 VNA OF WESTERN NEW YORK d 153653 MFSC LLC o 551602 MFSC LLC i 555332 KALEIDA PROPERTIES n 55701 KALEIDA PROPERTIES p 177596 KALEIDA PROPERTIES d 3428579 KALEIDA HEALTH FOUNDATION c 8179628 KALEIDA HEALTH FOUNDATION r 1068627 KALEIDA HEALTH FOUNDATION D 1093272 Womens and Childrens Hospital of Buffalo FDN r 308199 Womens and Childrens Hospital of Buffalo fdn d 56327 Womens and Childrens Hospital of Buffalo fdn c 1881496 Site E LLC j 190149 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 $8,179,628 (see Schedule R, Part V) versus the $8,247,672 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 $1,881,496 (see Schedule R, Part V) versus the $1,913,363 recorded by the filing organization as grants received (see Part VIII, Line 1D and Schedule B). DESCRIPTION OF NYS DOH HEAL GRANT IN 2009, THE NEW YORK STATE DEPARTMENT OF HEALTH AWARDED KALEIDA HEALTH A $65 MILLION GRANT TO BE UTILIZED TOWARDS THE CLOSURE OF MILLARD FILLMORE GATES CIRCLE HOSPITAL AND THE RELOCATION OF ESSENTIAL SERVICES TO A NEWLY CREATED COMPREHENSIVE HEART AND VASCULAR INSTITUTE IN A BUILDING ADJACENT TO BUFFALO GENERAL HOSPITAL (ONE OF THE HOSPITALS INCLUDED IN THIS FILING ORGANIZATION'S HEALTH SYSTEM). DURING 2009 AND 2010 NEW YORK STATE REMITTED APPROXIMATELY $28 MILLION OF THIS GRANT TO KALEIDA HEALTH BASED ON EXPENSES THE FILING ORGANIZATION HAS INCURRED TO DATE ON THIS PROJECT. IN 2010 THE NEW YORK STATE DEPARTMENT OF HEALTH AWARDED KALEIDA HEALTH A $12.4 MILLION GRANT TO SUPPORT THE CONSTRUCTION OF A NEW SKILLED NURSING FACILITY.