TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) JODY LOMEO...................................................................... PRES/CEO EX-OFFICIO W/VOTE	40.0 ................. 0.5	X	X	2,305,353	176,516
(2) NICHOLAS J AQUINO MD...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(3) LORRIE CLEMO PHD...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(4) GARY CROSBY...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(5) FRANK CURCI...................................................................... CHAIRMAN	1.0 ................. 0.0	X		0	0
(6) CHRISTOPHER T GREENE ESQ...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(7) DARREN J KING...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(8) WILLIAM I MAGGIO...................................................................... VICE CHAIR	1.0 ................. 0.0	X		0	0
(9) GEORGE MATTHEWS MD...................................................................... DIRECTOR/CHIEF OF SERVICE	1.0 ................. 0.0	X		160,170	31,233
(10) BRENDA MCGEE...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(11) DAVID A MILLING MD...................................................................... SECRETARY	1.0 ................. 0.0	X		0	0
(12) PAUL O'LEARY...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(13) CHRISTOPHER C ROSS...................................................................... TREASURER	1.0 ................. 0.0	X		0	0
(14) MARY LOU RUSIN EDD RN...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(15) FRANCISCO VASQUEZ PHD...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(16) ALYSON SPAULDING...................................................................... GENERAL COUNSEL	40.0 ................. 0.0		X	883,630	96,734
(17) DAVID HUGHES MD...................................................................... EVP, CMO	40.0 ................. 1.0		X	990,056	51,653

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) JONATHAN SWIATKOWSKI........................................................................ EVP, CFO	40.0 .......................0.5	X			921,023	67,190
(19) DONALD BOYD........................................................................ EVP BUSINESS DEVELOPMENT	40.0 .......................1.0	X			761,316	24,830
(20) JERRY VENABLE........................................................................ EVP, CHIEF HR OFFICER	40.0 .......................0.0	X			511,356	47,070
(21) CHRISTOPHER LANE........................................................................ SVP OPERATIONS BGMC	40.0 .......................0.0		X		649,020	31,189
(22) CHERYL KLASS........................................................................ EVP, CHIEF NURSE EXECUTIVE	40.0 .......................0.0		X		1,233,220	48,261
(23) ALLEGRA JAROS........................................................................ SVP OPERATIONS WCHOB	40.0 .......................0.0		X		546,842	27,003
(24) MICHAEL HUGHES........................................................................ SVP, PUBLIC AFFAIRS MARKETING	40.0 .......................0.0		X		527,917	38,098
(25) DARCY CRAVEN........................................................................ SVP OPERATIONS MFS, DMH	40.0 .......................0.0		X		569,277	48,413
(26) AARON HOFFMAN MD........................................................................ EMPLOYED PHYSICIAN	40.0 .......................0.0			X	708,289	46,150
(27) CHRISTOPHER MALLAVARAPU MD........................................................................ EMPLOYED PHYSICIAN	40.0 .......................0.0			X	900,992	47,248
(28) CARROLL HARMON MD........................................................................ EMPLOYED PHYSICIAN	40.0 .......................0.0			X	683,479	9,320
(29) KAVEH VALI MD........................................................................ EMPLOYED PHYSICIAN	40.0 .......................0.0			X	624,820	28,616
(30) KATHRYN BASS MD........................................................................ EMPLOYED PHYSICIAN	40.0 .......................0.0			X	585,615	34,919

(A) Name and business address	(B) Description of services	(C) Compensation
SODEXO MANAGEMENT INC, PO BOX 81049 WOBURN,MA018131049	CLEANING & LAUNDRY	3,512,715
WNY RADIOLOGY LLC, PO BOX 4029 BUFFALO,NY14240	RADIOLOGY SVCS	5,151,112
FREED MAXICK CPAS, 424 MAIN ST LIBERTY BLDG SUITE 80 BUFFALO,NY14202	CONSULTING SERVICES	1,596,695
HURON CONSULTING SERVICES, 3005 MOMENTUM PLACE CHICAGO,IL60689	CONSULTING SERVICES	1,896,466
XANITOS INC, 3809 WEST CHESTER PIKE SUITE 210 NEWTON SQUARE,PA19073	CLEANING & LAUNDRY	2,491,450
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 79

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2018 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization KALEIDA HEALTH

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization KALEIDA HEALTH		Employer identification number 16-1533232

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization KALEIDA HEALTH			Employer identification number 16-1533232
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Yes

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

200,207

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

150,315

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

350,522

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
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 HEALTHCARE ASSOCIATION OF NEW YORK STATE 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.

Return Reference

Explanation

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 HEALTHCARE ASSOCIATION OF NEW YORK STATE 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.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	27,593,062	25,527,409	29,821,659	30,738,989	30,087,437
b	Contributions ...	2,596,681	1,623,254	1,770,884	1,435,796	1,656,821
c	Net investment earnings, gains, and losses	-995,040	2,762,723	-3,706,203	-1,046,152	850,732
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	2,201,315	2,320,324	2,358,931	1,306,974	1,856,001
f	Administrative expenses ....
g	End of year balance ......	26,993,388	27,593,062	25,527,409	29,821,659	30,738,989

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

66.230 %

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

33.770 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	6,713,867		6,713,867
b	Buildings ....	819,529,600	408,462,380	411,067,220
c	Leasehold improvements
d	Equipment ....	1,088,545,618	842,996,473	245,549,145
e	Other .....	16,290,954	10,827,357	5,463,597
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				668,793,829

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DEFERRED FINANCING				9,656,989
(2) INTEREST IN NET ASSETS OF FDNS				117,555,597
(3) OTHER RECEIVABLES				65,337,891
(4) OTHER ASSETS				13,149,187
(5) ESTIMATED 3RD PARTY PAYOR REC				19,933,635
(6) INTEREST IN NET ASSETS OF UAHS				81,897,130
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				307,530,429

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
DUE TO THIRD PARTY PAYORS	9,502,339
SELF INSURANCE LIABILITY	150,058,651
OTHER LIABILITIES	3,984,444
PENSION LIABILITY	290,252,723
ASSET RETIREMENT OBLIGATIONS	8,066,172
CAPITAL LEASE OBLIGATIONS	65,713,083
LINE OF CREDIT	40,053,721
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	567,631,133
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
INTENDED USE OF ENDOWMENTS:	SCHEDULE D, PART V, QUESTION 4 THE FOLLOWING ARE THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS: 1) CAPITAL EXPANSION AND IMPROVEMENT 2) ADVANCEMENT OF MEDICAL EDUCATION AND RESEARCH AND HEALTH CARE SERVICES 3) SUPPORT PEDIATRIC HEALTH CARE SERVICES
FIN 48 FOOTNOTE:	SCHEDULE D, PART X, QUESTION 2 KALEIDA RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE-LIKELY THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
KALEIDA HEALTH

Employer identification number

16-1533232

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	Central America and the Caribbean	Investments	42,464,374
















3a	Sub-total .....		42,464,374
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)		42,464,374

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2018

Schedule F (Form 990) 2018

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2018

Schedule F (Form 990) 2018Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2018

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2018

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
SCHEDULE F, PART I, LINE 3, COLUMN F	INVESTMENT AMOUNTS REPORTED ARE DERIVED FROM KALEIDA'S BOOKS AND RECORDS WHICH ARE MAINTAINED ON AN ACCRUAL BASIS.

Schedule F (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	12,777,158	3,769,000	9,008,158	0.670 %
b	Medicaid (from Worksheet 3, column a) . . . . .	368,855,995	264,272,886	104,583,109	7.790 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	381,633,153	268,041,886	113,591,267	8.460 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	4,843,838		4,843,838	0.360 %
f	Health professions education (from Worksheet 5) . . .	52,657,979	23,764,070	28,893,909	2.150 %
g	Subsidized health services (from Worksheet 6) . . . .	34,019,103	13,078,030	20,941,073	1.560 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	91,520,920	36,842,100	54,678,820	4.070 %
k	Total. Add lines 7d and 7j .	473,154,073	304,883,986	168,270,087	12.530 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	168	46,483	124,675	124,675
8	Workforce development
9	Other
10	Total	168	46,483	124,675	124,675

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

11,993,601

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

734,608

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

186,420,460

Enter Medicare allowable costs of care relating to payments on line 5.....

175,561,703

Subtract line 6 from line 5. This is the surplus (or shortfall)........

10,858,757

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1MFSC LLC	PHYSICIAN SERVICES	67.47 %	32.53 %
2HARLEM ROAD LEASING	MRI EQUIPMENT LEASING	50 %	50 %
3AMTON IMAGING LLC	HEALTH CARE SERVICES	50 %	50 %
4SITE E LLC	REAL ESTATE LEASING CO	50.14 %	49.86 %
5SOUTHTOWNS IMAGING	IMAGING EQUIPMENT LEASING	70 %	30 %
6GL MEDICAL BILLING	MEDICAL BILLING	50 %	50 %
7SOUTHTOWNS SURG CTR	PHYSICIAN SERVICES	63.954 %	36.046 %
8
9
10
11
12
13

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?4Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)							Facility reporting group
1	BUFFALO GENERAL MEDICAL CENTER 100 HIGH STREET BUFFALO,NY14203 WWW.KALEIDAHEALTH.ORG 1401014H	X	X		X	X	A
2	OISHEI CHILDREN'S HOSPITAL 818 ELLICOTT STREET BUFFALO,NY14203 WWW.KALEIDAHEALTH.ORG 1401014H	X	X	X	X	X	A
3	MILLARD FILLMORE SUBURBAN HOSPITAL 1540 MAPLE ROAD WILLIAMSVILLE,NY14221 WWW.KALEIDAHEALTH.ORG 1401014H	X	X		X	X	A
4	DEGRAFF MEMORIAL HOSPITAL 445 TREMONT STREET NORTH TONAWANDA,NY14120 WWW.KALEIDAHEALTH.ORG 1401014H	X	X		X	X	A

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	GROUP A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	GROUP A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.KALEIDAHEALTH.ORG

The FAP application form was widely available on a website (list url):

WWW.KALEIDAHEALTH.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.KALEIDAHEALTH.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	GROUP A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	GROUP A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B, LINE 5	GROUP A IN CONDUCTING ITS 2016-2018 COMMUNITY HEALTH NEEDS ASSESSMENT - COMMUNITY SERVICE PLAN (CHNA-CSP), KALEIDA HEALTH TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY ITS HOSPITALS LOCATED IN ERIE AND NIAGARA COUNTIES, THE PRIMARY SERVICE AREA. FOR EACH COUNTY, KALEIDA HEALTH PARTICIPATED IN COLLABORATIVE WORK GROUPS LED BY THE ERIE COUNTY DEPARTMENT OF HEALTH AND THE NIAGARA COUNTY DEPARTMENT OF HEALTH AND COMPRISED OF REPRESENTATIVES FROM OTHER HOSPITALS, ORGANIZATIONS, AGENCIES, AND SCHOOLS; AND INCLUDED INPUT FROM THE COMMUNITY INCLUDING THE MEDICALLY UNDERSERVED. FROM MARCH THROUGH AUGUST 2016, THE ERIE COUNTY WORK GROUP CONDUCTED COUNTY-WIDE ASSESSMENT ACTIVITIES INCLUDING A CONSUMER SURVEY WITH 1,839 RESPONSES AND FIVE COMMUNITY FOCUS GROUP SESSIONS. THERE WERE SEVERAL SURVEY DISTRIBUTION SITES ACROSS THE COUNTY AND OF THE 1,839 SURVEY RESPONSES, 21.3% WERE FROM RESPONDENTS INDICATING AN INCOME BELOW $35,000. KALEIDA HEALTH DISTRIBUTED THE SURVEY IN ITS PRIMARY CARE CLINICS OF WHICH A SIGNIFICANT NUMBER OF PATIENTS ARE INSURED THROUGH MEDICAID. FOCUS GROUP SESSIONS WERE HELD AT A GEOGRAPHIC CROSS-SECTION OF SITES INCLUDING THE CAZENOVIA LIBRARY, UNITED WAY, AND MERRIWEATHER LIBRARY IN BUFFALO; SPRINGVILLE FIRE HALL IN SPRINGVILLE, AND THE ERIE COUNTY FIRE TRAINING ACADEMY IN CHEEKTOWAGA. KALEIDA HEALTH PROMOTED THE MERRIWEATHER LIBRARY EVENT LOCATED ON BUFFALO'S EAST SIDE, A LOW INCOME AND MEDICALLY UNDERSERVED COMMUNITY, THROUGH A PROMOTIONAL EMAIL TO THE MEMBERS OF THE NEAR EAST SIDE AND WEST SIDE TASK FORCE. KALEIDA HEALTH PROVIDED LINKS TO THE CONSUMER SURVEY AND PROMOTED THE FOCUS GROUP SESSIONS ON ITS PUBLIC WEBSITE, EMPLOYEE WEBSITE, AND ON FACEBOOK. IN ADDITION TO THE REVIEW OF DATA FROM THE NYS PREVENTION AGENDA DASHBOARD AND OTHER RELIABLE SOURCES, THESE ACTIVITIES HELPED TO PRIORITIZE THE HEALTH CARE NEEDS OF THE COUNTY AND THE RESULTING IMPLEMENTATION STRATEGIES; AND ARE INCLUDED IN KALEIDA HEALTH'S 2016-2018 CHNA-CSP AND ALIGNED WITH THE ERIE COUNTY DEPARTMENT OF HEALTH, COMMUNITY HEALTH IMPROVEMENT PLAN. FROM MARCH THROUGH AUGUST 2016, THE NIAGARA COUNTY WORK GROUP CONDUCTED COUNTY-WIDE ASSESSMENT ACTIVITIES INCLUDING A CONSUMER SURVEY WITH 2,111 RESPONSES AND NINE COMMUNITY FOCUS GROUP SESSIONS. THERE WERE SEVERAL SURVEY DISTRIBUTION SITES AND OF THE 1,655 SURVEY RESPONDENTS WHO ANSWERED THE QUESTION ON ANNUAL HOUSEHOLD INCOME, 26.7% HAD AN INCOME OF LESS THAN $35,000. KALEIDA HEALTH'S DEGRAFF MEMORIAL HOSPITAL DISTRIBUTED THE SURVEY IN HOSPITAL WAITING AREAS, FRONT DESK, SWITCHBOARD, PHYSICIAN OFFICES, OB/GYN CLINICS, AND THE DEGRAFF MCLAUGHLIN CENTER FOR SENIOR WELLNESS. COMMUNITY FOCUS GROUP SESSIONS WERE HELD AT A GEOGRAPHIC CROSS-SECTION OF SITES INCLUDING THOSE LOCATED IN MEDICALLY UNDERSERVED COMMUNITIES. SITES INCLUDED THE NEIGHBORHOOD HEALTH CENTER AND BETHANY BAPTIST CHURCH IN NIAGARA FALLS, WOODLANDS SENIOR VILLAGE AND DEGRAFF COMMUNITY CENTER IN NORTH TONAWANDA; HARTLAND BIBLE CHURCH IN GASPORT; OLCOTT UNITED METHODIST CHURCH AND NEWFANE FOOD PANTRY IN NEWFANE; EASTERN NIAGARA HOSPITAL IN LOCKPORT; AND MOUNT ST. MARY'S HOSPITAL IN LEWISTON. A COUNTY-WIDE FOCUS GROUP SESSION WAS ALSO HELD TO GET INPUT FROM SEVERAL COMMUNITY-BASED HEALTH, MENTAL HEALTH, AND SOCIAL SERVICE ORGANIZATIONS ACROSS THE COUNTY. KALEIDA HEALTH PROVIDED LINKS TO THE CONSUMER SURVEY AND PROMOTED THE FOCUS GROUP SESSIONS ON ITS PUBLIC WEBSITE, EMPLOYEE WEBSITE, AND ON FACEBOOK. IN ADDITION TO THE REVIEW OF DATA FROM THE NYS PREVENTION AGENDA DASHBOARD AND OTHER RELIABLE SOURCES, THESE ACTIVITIES HELPED TO PRIORITIZE THE HEALTH CARE NEEDS OF THE COUNTY AND THE RESULTING IMPLEMENTATION STRATEGIES INCLUDED IN KALEIDA HEALTH'S CHNA-CSP AND ALIGNED WITH THE NIAGARA COUNTY DEPARTMENT OF HEALTH, COMMUNITY HEALTH IMPROVEMENT PLAN. THE KALEIDA HEALTH 2016-2018 CHNA-CSP IS AVAILABLE TO THE PUBLIC IN THE COMMUNITY HEALTH SECTION OF THE KALEIDA HEALTH WEBSITE AT WWW.KALEIDAHEALTH.ORG AND SPECIFICALLY AT HTTP://KALEIDAHEALTH.ORG/COMMUNITY/PUBLICATIONS.ASP. A PAPER VERSION IS AVAILABLE UPON REQUEST AT NO CHARGE. WRITTEN COMMENTS ON THE CHNA-CSP ARE INVITED FROM THE PUBLIC THROUGH A LINK ENTITLED "COMMENT ON PLAN" LOCATED NEXT TO THE DOCUMENT THROUGH THE ABOVE LINK. THIS INFORMATION IS DOCUMENTED IN THE CHNA-CSP IN THE DISSEMINATION TO THE PUBLIC SECTION. NO COMMENTS ON THE CHNA-CSP WERE RECEIVED IN 2018.
PART V, SECTION B, LINE 6A	GROUP A KALEIDA HEALTH'S FOUR HOSPITALS ARE INCLUDED IN ITS 2016-2018 CHNA-CSP: BUFFALO GENERAL MEDICAL CENTER, MILLARD FILLMORE SUBURBAN HOSPITAL, AND OISHEI CHILDREN'S HOSPITAL, ALL LOCATED IN ERIE COUNTY, AND DEGRAFF MEMORIAL HOSPITAL LOCATED IN NIAGARA COUNTY. (IN NOVEMBER 2017, WOMEN & CHILDREN'S HOSPITAL OF BUFFALO CLOSED AND REOPENED IN A NEW FACILITY AS OISHEI CHILDREN'S HOSPITAL.) IN ERIE COUNTY, KALEIDA HEALTH COLLABORATED ON THE CHNA-CSP PROCESS THROUGH A PARTNERSHIP LED BY THE ERIE COUNTY DEPARTMENT OF HEALTH AND INCLUDED UNRELATED HOSPITAL FACILITIES OF THE CATHOLIC HEALTH SYSTEM. IN NIAGARA COUNTY, KALEIDA HEALTH COLLABORATED ON THE CHNA-CSP PROCESS THROUGH A PARTNERSHIP LED BY THE NIAGARA COUNTY DEPARTMENT OF HEALTH, AND INCLUDED THE FOLLOWING UNRELATED HOSPITAL FACILITIES: NIAGARA FALLS MEMORIAL MEDICAL CENTER, MOUNT ST MARY HOSPITAL, AND EASTERN NIAGARA HOSPITAL SYSTEM.
PART V, SECTION B, LINE 6B	GROUP A IN ERIE COUNTY, KALEIDA HEALTH COLLABORATED ON THE 2016-2018 CHNA-CSP PROCESS WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES: ERIE COUNTY DEPARTMENT OF HEALTH, UNITED WAY OF BUFFALO AND ERIE COUNTY, P2 COLLABORATIVE OF WNY, BUFFALO STATE COLLEGE, UB SCHOOL OF PUBLIC HEALTH, UB FAMILY MEDICINE PRIMARY CARE RESEARCH CENTER, DAEMEN COLLEGE, AND D'YOUVILLE COLLEGE. IN NIAGARA COUNTY, KALEIDA HEALTH COLLABORATED ON THE 2016-2018 CHNA-CSP PROCESS WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES: NIAGARA COUNTY DEPARTMENT OF HEALTH, NIAGARA COUNTY DEPARTMENT OF MENTAL HEALTH, AND THE P2 COLLABORATIVE OF WNY. PART V, SECTION B, LINES 7 AND 10 WWW.KALEIDAHEALTH.ORG/COMMUNITY/PUBLICATIONS.ASP
PART V, SECTION B, LINE 11	GROUP A WITH HOSPITALS LOCATED IN BOTH ERIE AND NIAGARA COUNTIES, KALEIDA HEALTH WORKED COLLABORATIVELY WITH WORK GROUPS LED BY THE ERIE COUNTY DEPARTMENT OF HEALTH AND THE NIAGARA COUNTY DEPARTMENT OF HEALTH TO REVIEW HEALTH CARE DATA, DISSEMINATE CONSUMER SURVEYS AND CONDUCT FOCUS GROUP SESSIONS TO PRIORITIZE SIGNIFICANT HEALTH NEEDS AND IMPLEMENTATION STRATEGIES FOR EACH COUNTY. THE STRATEGIES FURTHER ALIGN WITH THE PRIORITY AREAS OF THE NEW YORK STATE PREVENTION AGENDA. KALEIDA HEALTH INCLUDED THESE COLLABORATIVE PRIORITY AREAS IN ITS 2016-2018 CHNA-CSP. HEALTH CARE NEEDS ADDRESSED IN KALEIDA HEALTH'S 2016-2018 CHNA-CSP: IN ERIE COUNTY AND NIAGARA COUNTY, CARDIOVASCULAR DISEASE IS THE NUMBER ONE CAUSE OF DEATH (2014, NYS VIRAL STATISTICS), AND THERE IS A HIGH INCIDENCE OF RISK FACTORS AMONG RESIDENTS INCLUDING HIGH BLOOD PRESSURE, DIABETES, OBESITY, AND SMOKING. OUTREACH THROUGH PUBLIC EDUCATION EVENTS HOSTED BY KALEIDA HEALTH HOSPITALS HAVE BEEN HELD IN COLLABORATION WITH NUMEROUS ORGANIZATIONS INCLUDING THOSE REPRESENTING THE MEDICALLY UNDERSERVED. IN 2018, KALEIDA HEALTH PROVIDED 22 CHRONIC DISEASE EDUCATION AND SCREENING TO 3,837 INDIVIDUALS. ADDITIONALY, 17 STROKE EDUCATION OFFERINGS WERE PROVIDED REACHING AN ESTIMATED 3,000 INDIVIDUALS. A STRIKE OUT STROKE EVENT WAS HELD IN JULY 2018 IN COORDINATION WITH THE BUFFALO BISON'S BASEBALL TEAM WITH INFORMATION PROVIDED ON STROKE PREVENTION AND RECOGNITION OF SIGNS/SYMPTOMS AND TREATMENT TO AN ESTIMATED 8,000 ATTENDEES. ADDITIONALLY, CARDIOVASCULAR EDUCATION AND SCREENING TARGETING LOW INCOME WOMEN IS ADDRESSED IN THE CLINICAL SETTING THROUGH A PROGRAM FOR PATIENTS OF KALEIDA HEALTH'S OB-GYN CENTERS, WHERE AN ESTIMATED 73% OF PATIENT VISITS ARE REIMBURSED THROUGH MEDICAID. THIS STRATEGY ALIGNS WITH THE NYS PREVENTION AGENDA PRIORITY TO PREVENT CHRONIC DISEASE AND TO INCREASE ACCESS TO HIGH QUALITY CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT IN CLINICAL AND COMMUNITY SETTINGS. IN 2018, 497 CLINIC PATIENTS PRESENTING FOR THEIR ANNUAL GYNECOLOGICAL APPOINTMENT WERE SCREENED FOR CARDIOVASCULAR DISEASE AND PROVIDED EDUCATION ON THE DISEASE AND ITS RISK FACTORS. THE HEALTH BENEFITS OF BREASTFEEDING FOR BOTH INFANT AND MOTHER ARE WELL DOCUMENTED AND THE NEW YORK STATE PREVENTION AGENDA SUPPORTS THE PROMOTION OF BREASTFEEDING TO INCREASE THE PROPORTION OF NEW YORK STATE BABIES WHO ARE BREASTFED. IN ERIE COUNTY, THE PERCENT OF INFANTS FED ANY BREAST MILK IN A DELIVERY HOSPITAL WAS 72.1% AND EXCLUSIVELY FED BREAST MILK WAS 51.1% (2012-2014, NYS VITAL STATISTICS). KALEIDA HEALTH IS WORKING TO INCREASE BREASTFEEDING RATES AT ITS DELIVERY HOSPITALS THROUGH EVIDENCE-BASED PROMOTION AND EDUCATION INITIATIVES. IN 2018, AT OISHEI CHILDREN'S HOSPITAL, THE BREASTFEEDING INITIATION RATE WAS 71.9% AND THE EXCLUSIVE RATES WAS 37% AND AT MILLARD FILLMORE SUBURBAN HOSPITAL, THE INITIATION RATE WAS 85.1% AND THE EXCLUSIVE RATE WAS 57.1%. THE NEEDS OF THE MEDICALLY UNDERSERVED ARE ADDRESSED GIVEN THAT 68.85% OF INPATIENT DISCHARGES, ED VISITS AND OUTPATIENT VISITS AT OISHEI CHILDREN'S HOSPITAL AND 11.8% AT MILLARD FILLMORE SUBURBAN HOSPITAL ARE REIMBURSED BY MEDICAID. HIGH RATES OF POOR MENTAL HEALTH, DRUG ADDICTION, AND BINGE DRINKING IN NIAGARA COUNTY; IN ADDITION TO A SUICIDE DEATH RATE OF 16% VS THE NEW YORK STATE RATE OF 7.9% (2012-2014, NYS PREVENTION AGENDA DASHBOARD) INDICATE A DIRE NEED TO ADDRESS MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES IN THE COUNTY. ACCESS TO ADEQUATE MENTAL HEALTH CARE AND RESOURCES IS AN ADDED CHALLENGE. IN RESPONSE, KALEIDA HEALTH'S DEGRAFF MEMORIAL HOSPITAL PROMOTES BOTH PROVIDER AND PUBLIC AWARENESS AND KNOWLEDGE OF MENTAL HEALTH CONDITIONS AND SUBSTANCE ABUSE; AND THE AVAILABLE RESOURCES. THIS PROJECT ADDRESSES THE NEEDS OF THE MENTAL HEALTH POPULATION AS A MEDICALLY UNDERSERVED DISPARITY POPULATION. IT ALSO ALIGNS WITH THE NYS PREVENTION AGENDA PRIORITY TO PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE. THE CHILDREN'S PSYCHIATRY CLINIC OF KALEIDA HEALTH'S OISHEI CHILDREN'S HOSPITAL IN NEIGHBORING ERIE COUNTY, PROVIDES AN ADDED RESOURCE FOR PEDIATRIC MENTAL HEALTH SERVICES FOR NIAGARA COUNTY RESIDENTS AND ALL OF WESTERN NEW YORK. THE RISING OPIOID ADDICTION PROBLEM IS AN EMERGING AREA OF CONCERN IN BOTH ERIE AND NIAGARA COUNTIES. THE ERIE COUNTY DEPARTMENT OF HEALTH INCLUDED IT IN ITS COMMUNITY HEALTH IMPROVEMENT PLAN AND IN THE 2016-2018 CHNA-CSP, KALEIDA HEALTH STATED ITS COMMITMENT TO WORKING WITH ITS ERIE COUNTY PARTNERS TO ADDRESS THE PROBLEM. IN 2016, THROUGH A PARTNERSHIP WITH THE ERIE COUNTY DEPARTMENT OF HEALTH, KALEIDA HEALTH HOSPITALS INCLUDING BUFFALO GENERAL MEDICAL CENTER, MILLARD FILLMORE SUBURBAN HOSPITAL, DEGRAFF MEMORIAL HOSPITAL, AND OISHEI CHILDREN'S HOSPITAL EMERGENCY DEPARTMENTS BEGAN TO DISPENSE THE NARCAN OPIOID OVERDOSE KITS TO PATIENTS AND CAREGIVERS FOR PATIENTS WITH AN OPIOID OVERDOSE OR IS AT RISK FOR AN OPIOID OVERDOSE. THE COUNTY SUPPLIED THE KITS AND EMERGENCY DEPARTMENT PHYSICIANS PROVIDED THE PATIENT/CAREGIVER EDUCATION ON THE USE OF NARCAN. IN 2018, AN ADDICTION CLINIC NETWORK OF 20 WNY CLINIC LOCATIONS WAS ESTABLISHED AT ALL KALEIDA HEALTH HOSPITAL EMERGENCY DEPARTMENTS. STAFF ARE ABLE TO CALL A CENTRAL REFERRAL NUMBER TO REFER PATIENTS, WHO ARE PRESENTING WITH AN OPIOID OVERDOSE OR EXPERIENCING OPIATE WITHDRAWAL SYMPTOMS, TO THE CLINIC OF THEIR CHOOSING FOR FOLLOW-UP CARE WITHIN 48 HOURS. THE NIAGARA COUNTY DEPARTMENT OF HEALTH IS ADDRESSING THE OPIOID PROBLEM AS IT ADDRESSES MENTAL HEALTH AND SUBSTANCE ABUSE IN ITS COMMUNITY HEALTH IMPROVEMENT PLAN. KALEIDA HEALTH IS A PARTNER IN THIS NIAGARA COUNTY PRIORITY AREA THROUGH ITS DEGRAFF MEMORIAL HOSPITAL AS IDENTIFIED ABOVE AND IN THE WORK PLAN SECTION OF KALEIDA HEALTH'S 2016-2018 CHNA-CSP. KALEIDA HEALTH WILL CONTINUE TO PARTNER WITH THE COUNTIES AND OTHERS TO ADDRESS THIS SIGNIFICANT HEALTH CARE PROBLEM. Health Care Needs Not Addressed in Kaleida Health 2016-2018 CHNA-CSP: FALLS PREVENTION AMONG NIAGARA COUNTY'S SENIOR POPULATION WAS ADDRESSED THROUGH IMPLEMENTATION STRATEGIES INCLUDED IN KALEIDA HEALTH'S LAST CHNA CONDUCTED IN 2013. THE STEP UP TO STOP FALLS PROGRAM WAS HIGHLY SUCCESSFUL AND ACHIEVED POSITIVE, SUSTAINABLE OUTCOMES. HOWEVER, THE NIAGARA COUNTY COLLABORATIVE WORK GROUP DECIDED TO PRIORITIZE OTHER COMMUNITY HEALTH NEEDS FOR 2016-2018. WHILE CANCER IS IDENTIFIED AS THE NUMBER TWO CAUSE OF DEATH IN ERIE AND NIAGARA COUNTIES AND IS A PUBLIC HEALTH CONCERN, IT IS NOT ADDRESSED AS A FOCUS AREA IN THE COUNTY COMMUNITY HEALTH IMPROVEMENT PLANS OR IN KALEIDA HEALTH'S CHNA-CSP FOR 2016-2018; AS THE COUNTY WORK GROUPS DECIDED TO PRIORITIZE OTHER AREAS OF CONCERN. HOWEVER, CANCER IS ADDRESSED BY KALEIDA HEALTH AND SEVERAL HOSPITAL AND COMMUNITY BASED PREVENTION, EDUCATION, AND TREATMENT INITIATIVES THROUGHOUT THE REGION. KALEIDA HEALTH PROVIDES ONCOLOGY SERVICES THROUGH ITS MILLARD FILLMORE SUBURBAN HOSPITAL AND THE HOSPITAL ALSO HAS A CANCER REHABILITATION PROGRAM FOR CANCER SURVIVORS. IN 2015, KALEIDA HEALTH ACQUIRED CANCER CARE OF WESTERN NEW YORK, AN ONCOLOGY TREATMENT PRACTICE. IN 2018, KALEIDA HEALTH HELD TWO MEN'S PROSTATE CANCER OUTREACH AND SCREENING EVENTS TARGETING BUFFALO'S AFRICAN AMERICAN AND HISPANIC POPULATIONS IN COLLABORATION WITH WNY UROLOGY AND CANCER CARE OF WNY. IN 2018, KALEIDA HEALTH PARTNERED WITH SEVEN OTHER HEALTH CARE PROVIDERS TO LAUNCH GREAT LAKES HEALTH CANCER CARE. THIS COLLABORATIVE INITIATIVE IS A COMPREHENSIVE AND INTEGRATED APPROACH TO CANCER CARE FOR DIAGNOSIS AND TREATMENT, AND INCLUDES RESEARCH TO FIND CURES FOR CANCER. WESTERN NEW YORK IS ALSO HOME TO ROSWELL PARK CANCER INSTITUTE WHICH HOLDS THE NATIONAL CANCER INSTITUTE DESIGNATION AS A COMPREHENSIVE CANCER CENTER AND HAS A PROVEN MULTIDISCIPLINARY APPROACH. ITS RESEARCH PROGRAMS ARE MAKING GREAT STRIDES IN THE CARE AND TREATMENT OF CANCER, BENEFITING THE RESIDENTS OF WESTERN NEW YORK AND BEYOND.
PART V, SECTION B, LINE 16J	GROUP A INFORMATION THAT EXPLAINS HOW QUALIFIED PATIENTS CAN ACCESS FINANCIAL ASSISTANCE THROUGH THE HOSPITAL IS INCLUDED ON BILLS AND STATEMENTS TO PATIENTS. APPLICATION MATERIALS INCLUDE A NOTICE TO THE PATIENTS THAT ONCE THEY SUBMIT A COMPLETED APPLICATION AND DOCUMENTATION, THEY MAY DISREGARD ANY BILLS UNTIL THE HOSPITAL HAS RENDERED A WRITTEN DECISION ON THE APPLICATION. THE HOSPITAL MAY NOT FORWARD ACCOUNTS TO COLLECTION WHILE AN APPLICATION IS PENDING.

Schedule H (Form 990) 2018

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?23
Name and address		Type of Facility (describe)
1	HIGHPOINTE ON MICHIGAN 1031 MICHIGAN AVE BUFFALO,NY14203	INPATIENT SKILLED NURSING FACILITY
2	DEGRAFF SKILLED NURSING FACILITY 445 TREMONT STREET NORTH TONAWANDA,NY14120	INPATIENT SKILLED NURSING FACILITY
3	MILLARD FILLMORE SURGERY CENTER 215 KLEIN ROAD WILLIAMSVILLE,NY14221	AMBULATORY SURGERY CENTER FACILITY
4	NIAGARA STREET PEDIATRICS 564 NIAGARA STREET BUFFALO,NY14201	MEDICAL SERVICES - PRIMARY CARE, PRENATAL OUTPATIENT
5	MAPLE WEST MEDICAL COMPLEX 705 MAPLE ROAD AMHERST,NY14221	MEDICAL SERVICES - PRIMARY CARE, OTHER SPECIALTIES
6	NORTH BUFFALO MEDICAL PARK 900 HERTEL AVE BUFFALO,NY14207	MEDICAL SERVICES - PRIMARY CARE, RADIOLOGY OUTPATIENT, OUTPATIENT THERAPY SERVICES
7	KALEIDA HEALTH FAMILY PLANNING CENTER 1313 MAIN STREET BUFFALO,NY14209	OUTPATIENT FAMILY PLANNING
8	NIAGARA STREET PEDIATRICS 1050 NIAGARA STREET BUFFALO,NY14213	HOSPITAL BASED OUTPATIENT PRIMARY CARE SERVICES
9	TOWNE GARDEN PEDIATRICS 461 WILLIAM STREET BUFFALO,NY14204	HOSPITAL BASED OUTPATIENT PRIMARY CARE SERVICES
10	SOUTHTOWNS SURGERY CENTER 5959 BIG TREE ROAD SUITE 100 ORCHARD PARK,NY14217	AMBULATORY SURGERY CENTER PRIMARY CARE SERVICES
11	KENSINGTON OBGYN 462 GRIDER STREET BUFFALO,NY14215	HOSPITAL BASED OUTPATIENT PRIMARY CARE SERVICES
12	WCHOB MCKINLEY OBGYN 3860 MCKINLEY PARKWAY HAMBURG,NY14219	MEDICAL SERVICES - PRIMARY CARE, PRENATAL OUTPATIENT
13	WCHOB CHILD PROTECTION CENTER 556 FRANKLIN STREET BUFFALO,NY14202	MEDICAL SERVICES - PRIMARY CARE
14	STANLEY MAKOWSKI SBHC 1095 JEFFERSON AVE BUFFALO,NY14214	SCHOOL BASED PRIMARY CARE SERVICES
15	HILLERY PARK #27 SBHC 72 PAWNEE PARKWAY BUFFALO,NY14210	SCHOOL BASED PRIMARY CARE SERVICES
16	WESTMINSTER #68 SBHC 24 WESTMINSTER AVE BUFFALO,NY14215	SCHOOL BASED PRIMARY CARE SERVICES
17	DR LYDIA WRIGHT #89 SBHC 106 APPENHEIMER STREET BUFFALO,NY14214	SCHOOL BASED PRIMARY CARE SERVICES
18	BUILD ACADEMY #91 SBHC 340 FOUGERON STREET BUFFALO,NY14211	SCHOOL BASED PRIMARY CARE SERVICES
19	BUFFALO SCHOOL OF TECHNOLOGY SBHC 414 SOUTH DIVISION STREET BUFFALO,NY14204	SCHOOL BASED PRIMARY CARE SERVICES
20	HERMAN BADILLO #76 SBHC 315 CAROLINE STREET BUFFALO,NY14201	SCHOOL BASED PRIMARY CARE SERVICES
21	THE CHILDREN'S PSYCHIATRY CLINIC 1404 SWEET HOME ROAD AMHERST,NY14228	CERTIFIED MENTAL HEALTH SVCS O/P
22	COMMUNITY MENTAL HEALTH CENTER 1028 MAIN STREET BUFFALO,NY14203	HOSPITAL BASED OUTPATIENT BEHAVIORAL HEALTH SERVICES
23	ENDOSCOPY CENTER OF NIAGARA 6933 ELAINE DRIVE NIAGARA FALLS,NY14304	AMBULATORY SURGERY - SINGLE SPECIALTY - GASTROENTEROLOGY

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, FINANCIAL ASSISTANCE - LINE 3C	KALEIDA HEALTH HAS 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 PROVIDED FINANCIAL ASSISTANCE CONTACT INFORMATION DURING INTAKE AND REGISTRATION. THE APPLICANT FOR FREE OR REDUCED PRICE CARE WORKS DIRECTLY WITH A MEMBER OF THE FINANCIAL COUNSELING OR CHARITY CARE TEAM FOR FINANCIAL SCREENING AND ENROLLMENT IN A GOVERNMENT-FUNDED PROGRAM, IF ELIGIBLE. 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 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
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 II	KALEIDA HEALTH'S COMMUNITY HEALTH SERVICES SUPPORTS A COMPREHENSIVE PROGRAM OF COMMUNITY HEALTH IMPROVEMENT ADVOCACY. OUTREACH IS CONDUCTED IN MULTIPLE WESTERN NEW YORK COMMUNITIES TARGETING VARIED POPULATIONS OF ALL AGES AND ETHNICITIES, INCLUDING THE MEDICALLY UNDERSERVED. PROGRAMS AND EVENTS PROMOTE THE REDUCTION OF HEALTH DISPARITIES, ACCESS TO CARE, AND PROMOTE OVERALL COMMUNITY HEALTH AND WELLNESS; AND INCLUDE HEALTH EDUCATION AND SCREENING, SPEAKERS ON HEALTH-RELATED TOPICS, AND COMMUNITY REFERRALS. TOPICS RANGE FROM HEALTH INSURANCE ENROLLMENT TO DIABETES, STROKE, HEART DISEASE, MATERNAL AND CHILD HEALTH, AND HEALTH CAREER EXPLORATION. In 2018, Kaleida Health partnered with several organizations and participated in 174 events to reach 46,483 individuals with community service programming. All of the outreach programs are free and reach cross section of cultures, ethnicities, languages, religions and all genders including LBGQ community. Kaleida Health participates in multiple events in various communities across Western New York, including Buffalo, a city with a poverty rate of 30.9% and several census tracts federally designated as Medically Underserved Areas. The following Kaleida Health health and wellness programs were provided in Buffalo: - NEAR EAST SIDE AND WEST SIDE TASK FORCE - PASSPORT TO WELLNESS, AN OUTREACH/WELLNESS/MEDICAL SCREENING PROGRAM AT LOCAL TOPS GROCERY MARKETS TARGETING MOSTLY LATINO AND AFRICAN AMERICAN COMMUNITIES; AND THE BROADWAY MARKET ON BUFFALO'S EAST SIDE, DIVERSE COMMUNITY WHERE OVER 30 LANGUAGES ARE SPOKEN. - BUFFALO EAST HIGH SCHOOL - SPEAKER SERIES WITH KALEIDA HEALTH EMPLOYEES SHARING KNOWLEDGE ABOUT THEIR CAREERS WITH HIGH SCHOOL STUDENTS WHO ARE PREPARING FOR COLLEGE AND CAREERS AS CERTIFIED NURSING ASSISTANTS. EAST HIGH SCHOOL IS LOCATED IN AN AFRICAN AMERICAN COMMUNITY IN THE 14211 ZIP CODE WITH RATES OF HEALTH DISPARITIES, UNEMPLOYMENT, UNDEREMPLOYMENT AND IS KNOWN AS A FOOD DESERT. - BUFFALO PUBLIC LIBRARY -LOCATED IN DOWNTOWN BUFFALO, TWO COMMUNITY WELLNESS EVENTS, SPONSORED BY HISPANIC HERITAGE COUNSEL AND THE LIBRARY. -TRUE BETHEL BAPTIST CHURCH, ST JOHN BAPTIST CHURCH, FRIENDSHIP BAPTIST CHURCH, LINWOOD GOD OF CHRIST, GREATER EMMANUEL CHURCH OF CHRIST, SHILOH BAPTIST CHURCH, LINCOLN METHODIST CHURCH, TRINITY BAPTIST CHURCH, MIRACLE MISSIONS FULL GOSPEL, ST LUKE'S AME CHURCH - FAMILY WELLNESS PROGRAMS TARGETING MEMBERS OF CONGREGATION ALONG WITH THE SURROUNDING UNDERSERVED COMMUNITY. - JUNETEENTH FESTIVAL - HEALTH AND WELLNESS EDUCATION PROVIDED UNDER THE HEALTH PAVILION. THIS FESTIVAL, LOCATED ON BUFFALO'S EAST SIDE ATTRACTS THOUSANDS OF PEOPLE OF ALL AGES, RACES, RELIGIONS, ETHNICITIES AND GENDERS. -PRIDE VILLAGE- FOLLOWING BUFFALO'S PRIDE PARADE, HUNDREDS VISIT PRIDE VILLAGE, HOME TO APPROXIMATELY 50 PLUS ORGANIZATIONS PROVIDING SERVICES FOR THE LGBTQ COMMUNITY. KALEIDA HEALTH WAS AMONG THE ORGANIZATIONS PROVIDING HEALTH AND WELLNESS EDUCATION. -KOMEN WALK-THE BUFFALO KOMEN WALK IS OPEN TO SURVIVORS OF BREAST CANCER, EVERYONE INTERESTED IN FINDING A CURE FOR BREAST CANCER. KALEIDA HEALTH WAS AMONG THE ORGANIZATIONS PROVIDING HEALTH AND WELLNESS EDUCATION. - IN 2018, KALEIDA HEALTH CONDUCTED TWO MEN'S PROSTATE CANCER OUTREACH AND SCREENING EVENTS TARGETING BUFFALO'S AFRICAN AMERICAN AND HISPANIC POPULATION AT RICH PRODUCTS AND TRUE BETHEL BAPTIST CHURCH. KALEIDA HEALTH COLLABORATED WITH WNY UROLOGY AND CANCER CARE OF WNY; AND WITH COMMUNITY AND FAITH BASED ORGANIZATIONS TO PROMOTE THE EVENTS INCLUDING BUFFALO MUNICIPAL HOUSING AUTHORITY, BUFFALO BRANCH NAACP, BUFFALO UNITED FRONT, INC., HISPANIC HERITAGE COUNCIL OF WNY, HISPANIC PASTORS ASSOCIATION OF WNY, AREA FRATERNITIES, MASONIC GROUPS AND BUFFALO PEACEMAKERS. THE PROGRAMS ARE SUPPORTING KALEIDA HEALTH'S PLEDGE TO HELP TO DECREASE PSA CANCER. IN ADDITION, KALEIDA HELD ONE MEDICAL LECTURE ON THE IMPORTANCE OF COLORECTAL SCREENING. COLON CANCER RATES ARE HIGHER IN URBAN COMMUNITIES OF COLOR. THIS DATA IS SUPPORTED BY THE AMERICA CANCER SOCIETY (ACS), THE CENTER FOR DISEASE CONTROL AND PREVENTION (CDC) AND THE NATIONAL COLORECTAL CANCER ROUNDTABLE (AN ORGANIZATION CO-FOUNDED BY ACS AND CDC). COLORECTAL CANCER IS ONE OF THE MOST COMMON CANCERS IN BOTH MEN AND WOMEN AND IS ONE OF THE MOST PREVENTABLE AND TREATABLE WHEN DETECTED EARLY. PROSTATE CANCER IS NUMBER ONE KILLER AND PREVENTABLE DISEASE OF AFRICAN AMERICAN MEN. - WUFO 1080 AM / POWER 96.5 FM - AIRING EVERY 2ND AND 4TH MONDAY, THE GREAT LAKES HEALTH RADIO PROGRAM, HOSTED BY KALEIDA HEALTH, INTERVIEWS GUESTS FROM KALEIDA HEALTH FOR 1/2 HOUR ON A VARIETY OF HEALTH AND WELLNESS TOPICS. THE WUFO LISTENERSHIP PREDOMINATELY URBAN, ALL AGES, RACES, SEXUAL ORIENTATIONS AND ETHNIC GROUPS IN WNY. - A NUMBER OF BLOCK CLUBS, PUBLIC SCHOOLS AND NOT-FOR PROFIT ORGANIZATIONS ALSO PARTNER WITH KALEIDA HEALTH TO PROVIDE HEALTH AND WELLNESS OUTREACH AND EDUCATION AT MULTIPLE LOCATIONS. -COLLABORATING WITH THE BUFFALO BILLS AND THE BELLE CENTER, A COMMUNITY CENTER SERVES LATINO COMMUNITY, SEVERAL DEPARTMENTS FROM KALEIDA HEALTH OFFERED WELNESS SERVICES TO CHILDREN AND FAMILIES. -KALEIDA HEALTH PARTNERED WITH FOUR SENIOR CITIZEN WELLNESS PROGRAMS AND LUNCHEONS AT THE FOLLOWING LOCATIONS: WILLIAM EMSLIE YMCA, SHILLER PARK COMMUNITY CENTER, CANISIUS COLLEGE AND ST JOHN TOWER. -KALEIDA HEALTH WORKED ALONG WITH SEVERAL PEACE MAKER ORGANIZATIONS BY PROVIDING OUTREACH AND LITERATURE.
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 A RATIO OF COSTS TO CHARGES (RCC). KALEIDA HEALTH ADJUSTS BAD DEBT EXPENSE PRIOR TO THE APPLICATION OF AN RCC SO THAT THE REPORTED BAD DEBT EXPENSE AT COST, ON PART III, LINE 2 OF IRS FORM 990, SCHEDULE H REFLECTS THE TRUE COST OF THE BAD DEBTS. THE ORGANIZATION HAS A CHARITY CARE POLICY, AND ANY WRITE-OFFS AS A RESULT OF THIS POLICY ARE RECORDED AS CHARITY CARE ALLOWANCES AND ARE A REDUCTION OF THE NET PATIENT REVENUE. INDIVIDUALS WHO MAY QUALIFY FOR CHARITY CARE ASSISTANCE UNDER THE POLICY, BUT DO NOT VOLUNTEER TO COMPLETE THE APPLICATION PROCESS WOULD NOT BE GRANTED CHARITY CARE ASSISTANCE. KALEIDA USES A PRESUMPTIVE CHARITY CARE PROCESS, WHICH HAS DETERMINED THAT 25% OF SELF-PAY BAD DEBT EXPENSE IN 2018 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 $734,608. WE ESTIMATED THIS AMOUNT BY USING THE 2018 CALCULATED PRESUMPTIVE ELIGIBILITY PERCENTAGE ON BAD DEBT WRITE-OFF AMOUNTS OVER $500 (24.5%), AND APPLIED THIS PERCENTAGE TO THOSE BAD DEBT WRITE-OFF AMOUNTS UNDER $500, TO DETERMINE THE BAD DEBT WRITE-OFFS THAT WOULD BE ELIGIBLE, IF THEY WERE SCORED USING THE PRESUMPTIVE ELIGIBILITY PROCESS. BAD DEBT IS NOT INCLUDED AS A COMMUNITY BENEFIT.
Part III, LINE 4 (PAGE 9 OF ATTACHED AUDITED FINANCIAL STATEMENTS)	KALEIDA PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE KALEIDA DOES NOT ANTICIPATE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. KALEIDA GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED BY COMMERCIAL AND GOVERNMENT INSURANCE PLANS. ADDITIONS TO THE ESTIMATED ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE BY MEANS OF THE PROVISION OF BAD DEBTS. THE PROVISION FOR BAD DEBTS PRIMARILY RELATES TO PATIENTS WITHOUT INSURANCE AND TO THOSE THAT ARE EITHER UNDERINSURED OR WITHOUT THE NECESSARY RESOURCES TO PAY COINSURANCE AND DEDUCTIBLE BALANCES. 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 DEBT COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS.
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 2018 CMS MEDICARE COST REPORT TO DETERMINE THE AMOUNTS REPORTED ON THESE LINES.
PART III, SECTION C, LINE 9B	ONCE PATIENT LIABILITY HAS BEEN DETERMINED FOLLOWING PROCESSING OF APPLICATIONS FOR GOVERNMENT ASSISTANCE, CHARITY CARE, AND/OR INSURANCE CARRIER REMITTANCE, THE PATIENT STATEMENT IS MAILED FOR PAYMENT RECOVERY. KALEIDA HEALTH HAS A PRE-COLLECTION PROCESS FOR ACCOUNTS WITH A POSITIVE PATIENT BALANCE GREATER THAN $4.99 AND A FIRST BILL DATE OLDER THAN 60 DAYS, BUT NOT PREVIOUSLY PAID IN FULL BY THE PATIENT (EXCLUDING ACCOUNTS FOR PATIENTS THAT HAVE SUBMITTED A COMPLETED APPLICATION FOR CHARITY CARE, MEDICAID, OR CHILD HEALTH PLUS, AND AN ELIGIBILITY DETERMINATION IS PENDING). UPON A PATIENT EXPRESSING FINANCIAL CONCERN, THE PATIENT WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE (CHARITY CARE). ONCE THE PATIENT SUBMITS THE COMPLETED APPLICATION, THE ACCOUNT IS PLACED ON HOLD AND ALL COLLECTION ACTIVITIES ARE SUSPENDED UNTIL AN ELIGIBILITY DETERMINATION IS MADE. IF THE PATIENT IS ELIGIBLE FOR CHARITY CARE, THEN THE PATIENT IS NOTIFIED OF THE LEVEL OF CHARITY CARE AWARDED. IF 100% CHARITY CARE IS AWARDED, THEN NO BILL IS SENT TO THE PATIENT. IF LESS THAN 100% CHARITY CARE IS AWARDED, THEN THE PATIENT WILL RECEIVE A BILL PURSUANT TO THE PRIVATE PAY COLLECTION POLICY. COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS KALEIDA HEALTH ASSESSES THE NEEDS OF THE COMMUNITY THROUGH A COMMUNITY HEALTH NEEDS ASSESSMENT-COMMUNITY SERVICE PLAN (CHNA-CSP) WITH ITS MOST RECENT PLAN COMPLETED IN 2016. THE 2016-2018 CHNA-CSP IS AVAILABLE TO THE PUBLIC ON THE KALEIDA HEALTH WEBSITE AT WWW.KALEIDAHEALTH.ORG/COMMUNITY/PUBLICATIONS.ASP AND A PRINTED COPY IS AVAILABLE UPON REQUEST AT NO CHARGE. WRITTEN COMMENTS ON THE 2016-2018 CHNA-CSP ARE INVITED FROM THE PUBLIC THROUGH A LINK ENTITLED "COMMENT ON PLAN," LOCATED NEXT TO THE DOCUMENT THROUGH THE ABOVE LINK. IN ADDITION TO THE 2016-2018 CHNA-CSP (AS REPORTED IN PART V, SECTION B), KALEIDA HEALTH STAFF ENGAGE IN OTHER METHODS TO ASSESS THE NEEDS OF THE COMMUNITY. POVERTY TRENDS, COMMUNITY HEALTH RESEARCH, AND LOCAL COMMUNITY HEALTH NEEDS ARE REVIEWED ON A REGULAR BASIS WHILE PLANNING SERVICES AND PROGRAMS. RESPONSIVE TO COMMUNITY PRIORITIES, PROGRAM DEVELOPMENT AND SERVICES FILL IDENTIFIED GAPS OR SUPPLEMENT EXSITING PROGRAMS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE KALEIDA HEALTH INFORMS INDIVIDUALS OF FINANCIAL ASSISTANCE MADE AVAILABLE 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 AS WELL AS APPLICATION IS ALSO MADE AVAILABLE THROUGH KALEIDA HEALTH'S WEBSITE. KALEIDA HEALTH OFFERS ASSISTANCE TO INDIVIDUALS IN OUR COMMUNITY FOR ACCESSING AFFORDABLE HEALTH CARE, INCLUDING: NEW YORK STATE OF HEALTH, HEALTH PLAN MARKETPLACE: ASSISTS WITH NAVIGATING, EDUCATING AND ENROLLMENT IN THE NY STATE OF HEALTH OFFERINGS. DEDICATED AND STATE-TRAINED STAFF IS AVAILABLE TO ASSIST INDIVIDUALS IN PERSON OR VIA THE PHONE. KALEIDA HEALTH OFFERS IN-PERSON APPOINTMENTS AT (4) FOUR DIFFERENT SITE LOCATIONS. FACILITATED ENROLLMENT: ASSISTS ELIGIBLE INDIVIDUALS WITH HEALTH INSURANCE ENROLLMENT BY OFFERING EDUCATION AND APPLICATION ASSISTANCE FOR MEDICAID, CHILD HEALTH PLUS, ESSENTIAL PLANS, STATE AID PROGRAM FOR CHILDREN WITH SPECIAL NEEDS AND ALL QUALIFIED HEALTH PLANS MADE AVAILABLE THROUGH THE NEW YORK STATE OF HEALTH, HEALTH PLAN MARKETPLACE. A DEDICATED TELEPHONE NUMBER IS AVAILABLE AND INFORMATION IS PUBLISHED IN BROCHURES AT KALEIDA SITES AND AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. FINANCIAL ASSISTANCE PROGRAM: AS DESCRIBED ABOVE, THE KALEIDA FINANCIAL ASSISTANCE PROGRAM, IF ELIGIBLE, PROVIDES FREE OR REDUCED-PRICES FOR PATIENTS TREATED AT KALEIDA HEALTH HOSPITALS OR LONG-TERM CARE FACILITIES. DISCOUNTS ARE AWARDED BASED UPON INCOME AND ASSET VERIFICATION. PRESUMPTIVE ELIGIBILITY: KALEIDA HEALTH HAS SHOWN A WILLINGNESS TO EXTEND FINANCIAL ASSISTANCE TO NEEDY PATIENTS WITH OUTSTANDING BILLS WHO HAVE NOT COMPLETED THE CHARITY APPLICATION PROCESS. THIS IS ACHIEVED THROUGH AN AUTOMATED PARO SCORING PROCESS USING PUBLIC RECORDS, REGIONAL COST OF LIVING, ESTIMATED HOUSEHOLD INCOME THRESHOLDS, AND COMMUNITY DEMOGRAPHICS TO DERIVE AN ESTIMATED FINANCIAL POSITION FOR EACH PATIENT. THOSE PATIENTS SCREENED THROUGH THIS AUTOMATED PROCESS AND DEEMED ELIGIBLE ARE ADJUSTED OFF TO CHARITY CARE IN LIEU OF BAD DEBT. COMMUNITY INFORMATION KALEIDA HEALTH SERVES WESTERN NEW YORK'S EIGHT COUNTIES OF ALLEGANY, CATTARAUGUS, CHAUTAUQUA, ERIE, GENESEE, NIAGARA, ORLEANS, AND WYOMING. THE POPULATION FOR THE REGION IS APPROXIMATELY 1.5 MILLION WITH ERIE COUNTY AND NIAGARA COUNTY COMPRISING AN ESTIMATED 1.1 MILLION OF THIS TOTAL. THREE KALEIDA HEALTH HOSPITALS INCLUDING BUFFALO GENERAL MEDICAL CENTER, MILLARD FILLMORE SUBURBAN HOSPITAL, AND OISHEI CHILDREN'S HOSPITAL ARE LOCATED IN ERIE COUNTY, THE HOSPITALS' PRIMARY SERVICE AREA. DEGRAFF MEMORIAL HOSPITAL IS LOCATED IN NIAGARA COUNTY, ITS PRIMARY SERVICE AREA. DEGRAFF ALSO SERVES A NUMBER OF ERIE COUNTY RESIDENTS GIVEN ITS LOCATION IS LESS THAN ONE MILE FROM THE ERIE COUNTY BORDER. EACH HOSPITAL'S PRIMARY SERVICE AREA IS DEFINED AS THE COUNTY WITH THE HIGHEST PERCENTAGE OF ALL WNY COUNTIES FOR 2015 INPATIENT DISCHARGES, EMERGENCY DEPARTMENT VISITS, AND OUTPATIENT VISITS AS IDENTIFIED IN THE 2016-2018 CHNA-CSP. ERIE COUNTY ERIE COUNTY IS LOCATED IN THE WESTERN PORTION OF NEW YORK STATE BORDERING LAKE ERIE, AND ALSO LIES ON THE INTERNATIONAL BORDER BETWEEN THE UNITED STATES AND CANADA. THE FOLLOWING DEMOGRAPHIC STATISTICS FOR ERIE COUNTY ARE FROM MEDSTAT MARKET EXPERT, 2016 AND THE US CENSUS: QUICK FACTS, 2014 AMERICAN COMMUNITY SURVEY, AND 2015 POPULATION ESTIMATES AS INDICATED IN KALEIDA HEALTH'S 2016-2018 CHNA-CSP. THE COUNTY'S TOTAL POPULATION IS 930,801 AND IS COMPRISED OF URBAN, SUBURBAN, AND RURAL CITIES, TOWNS, AND VILLAGES. ERIE COUNTY'S MEDIAN HOUSEHOLD INCOME IS $51,050, ITS POVERTY RATE IS 15.2%, AND 17.4% OF ITS POPULATION IS OVER 65 YEARS. ITS LARGEST CITY AND COUNTY SEAT IS BUFFALO WITH A POPULATION OF 277,181. tHE 2014 AMERICAN COMMUNITY SURVEY RANKED BUFFALO AS THE FOURTH POOREST CITY IN THE NATION. THE CITY HAS A 30.9% POVERTY RATE (INCOME BELOW THE FEDERAL POVERTY LEVEL PER US CENSUS) AND 38.6% OF HOUSEHOLDS HAVE AN AVERAGE INCOME LESS THAN $25,000. BUFFALO ALSO HAS A HIGH MINORTY POPULATION WITH 35.7% OF ITS RESIDENTS BEING BLACK NON-HISPANIC AND 11.7% HISPANIC AS COMPARED TO 13% BLACK NON-HISPANIC AND 5.3% HISPANIC FOR ALL OF ERIE COUNTY. PERSONS UNDER 65 WITHOUT HEALTH INSURANCE COMPRISE 6.9% OF ERIE COUNTY'S POPULATION AND 10.7% OF BUFFALO'S POPULATION. BUFFALO GENERAL MEDICAL CENTER AND OISHEI CHILDREN'S HOSPITAL ARE LOCATED IN THE CITY OF BUFFALO AND SERVE A HIGH PERCENTAGE OF BUFFALO'S POOR AND UNDERSERVED POPULATION. MOST CENSUS TRACTS IN BUFFALO ARE FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS. THE TOWN OF AMHERST IS ONE OF THE COUNTY'S LARGEST SUBURBS WITH A POPULATION OF 139,363 AND IS HOME TO MILLARD FILLMORE SUBURBAN HOSPITAL. IN CONTRAST TO BUFFALO, THE TOWN OF AMHERST HAS A POVERTY RATE OF 9.4% AND 33.9% OF HOUSEHOLDS HAVE AN AVERAGE INCOME OVER $100,000. AMHERST'S POPULATION IS 80.7% WHITE NON-HISPANIC. THE TOWN ALSO HAS 8.8% ASIAN-PACIFIC ISLANDER POPULATION, COMPARABLE TO THE NYS RATE OF 8.6% WHILE THE ERIE COUNTY RATE IS 3.1%. THE TOWN HAS A SIGNIFICANT SENIOR POPULATION WITH 19.4% OF RESIDENTS 65 YEARS AND OVER, AND MILLARD FILLMORE SUBURBAN HOSPITAL SERVES A HIGH PERCENTAGE OF THE TOWN'S AGING POPULATION. NIAGARA COUNTY NIAGARA COUNTY IS LOCATED IN THE WESTERN PORTION OF NEW YORK STATE, JUST NORTH OF BUFFALO (ERIE COUNTY) AND ADJACENT TO LAKE ONTARIO ON ITS NORTHERN BORDER AND THE NIAGARA RIVER AND CANADA ON ITS WESTERN BORDER. THE FOLLOWING DEMOGRAPHIC STATISTICS FOR NIARAGA COUNTY ARE FROM MEDSTAT MARKET EXPERT AND THE US CENSUS: QUICK FACTS, 2014 AMERICAN COMMUNITY SURVEY, AND 2015 POPULATION ESTIMATES AS INDICATED IN KALEIDA HEALTH'S 2016-2018 CHNA-CSP. THE COUNTY'S TOTAL POPULATION IS 212,170 AND IS COMPRISED OF URBAN, SUBURBAN, AND RURAL CITIES, TOWNS, AND VILLAGES. NIAGARA COUNTY'S MEDIAN HOUSEHOLD INCOME IS $49,091, ITS POVERTY RATE IS 13.4% (INCOME BELOW THE FEDERAL POVERTY LEVEL PER US CENSUS), AND 18.2% OF ITS POPULATION IS OVER 65 YEARS. ITS CITIES INCLUDE NIAGARA FALLS, POPULATION 63,520; NORTH TONAWANDA, POPULATION 45,253; AND ITS COUNTY SEAT OF LOCKPORT, POPULATION 58,397. THESE CITIES INCLUDE A HIGH PROPORTION OF THE COUNTY'S LOW INCOME AND UNDERSERVED POPULATION. 17.2% OF NIAGARA FALLS RESIDENTS ARE BLACK NON-HISPANIC AND THE CITY HAS A 25.3% POVERTY RATE. ADDITIONALLY, NIAGARA FALLS IS FEDERALLY DESIGNATED AS AN AREA WITH A MEDICALLY UNDERSERVED POPULATION. THE POVERTY RATE FOR NORTH TONAWANDA IS 10.6% AND 18.9% FOR LOCKPORT. FURTHERMORE,

Schedule H (Form 990) 2018

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
KALEIDA HEALTH

Employer identification number
16-1533232

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)	(h) Purpose of grant or assistance
(1) UNIVERSITY ORTHOPEDIC SERVICE 5500 MAIN STREET SUITE 107 BUFFALO,NY14221	16-1406947	N/A	50,000	FMV	CONTRIBUTION CONTRIBUTION CONTRIBUTION SPONSORSHIP SPONSORSHIP SPONSORSHIP SPONSORSHIP SPONSORSHIP
(2) JACOBS INSTITUTION INC 875 ELLICOTT ST 5TH FL BUFFALO,NY14203	26-3085485	501(c)(3)	200,000	FMV	SPONSORSHIP CONTRIBUTION
(3) WNY HEALTHENET 2745 GEORGE URBAN BLVD SUITE 202 DEPEW,NY14043	04-3726634	N/A	80,000	FMV	CONTRIBUTION SPONSORSHIP SPONSORSHIP SPONSORSHIP
(4) AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS,TX75231	13-5613797	501(C)(3)	15,000	FMV	SPONSORSHIP SPONSORSHIP SPONSORSHIP SPONSORSHIP
(5) BUFFALO CENTER FOR ARTS 1221 MAIN STREET BUFFALO,NY14203	45-5213027	501(c)(3)	12,500	FMV	SPONSORSHIP SPONSORSHIP SPONSORSHIP
(6) MERCY FLIGHT 100 AMHERST VILLA ROAD BUFFALO,NY14225	22-2560963	501(c)(3)	40,000	FMV	SPONSORSHIP SPONSORSHIP SPONSORSHIP
(7) HABITAT FOR HUMANITY 1675 SOUTH PARK AVE BUFFALO,NY14220	22-2746890	501(C)(3)	40,000	FMV	SPONSORSHIP SPONSORSHIP SPONSORSHIP
(8) UB FOUNDATION 916 KIMBALL TOWER BUFFALO,NY14214	16-1372532	501(c)(3)	32,000	FMV	SPONSORSHIP SPONSORSHIP SPONSORSHIP
(9) UPSTATE NY TRANSPLANT INC 110 BROADWAY BUFFALO,NY14203	16-1172453	501(c)(3)	25,000	FMV	SPONSORSHIP SPONSORSHIP SPONSORSHIP
(10) MAKE A WISH FOUNDATION OF WNY 1000 SYLVAN PARKWAY AMHERST,NY14228	11-2645641	501(C)(3)	11,000	FMV	SPONSORSHIP
(11) AMHERST POLICE FOUNDATION 1955 WEHRLE DRIVE WILLIAMSVILLE,NY14221	16-1612376	501(C)(3)	10,000	FMV	SPONSORSHIP
(12) ARTPARK & COMPANY 450 SOUTH FOURTH ST LEWISTON,NY14092	23-7086200	501(C)(3)	8,500	FMV	SPONSORSHIP
(13) THE HOSPICE FOUNDATION 225 COMO PARK BLVD BUFFALO,NY14227	22-3137812	501(C)(3)	7,500	FMV	SPONSORSHIP
(14) AMERICAN CANCER SOCIETY 101 JJ AUDUBON PKWY AMHERST,NY14228	16-0743902	501(C)(3)	7,500	FMV	SPONSORSHIP
(15) BUFFALO RENNAISSANCE FOUNDATION PO BOX 322 BUFFALO,NY14205	13-3204330	501(c)(3)	6,500	FMV	SPONSORSHIP
(16) BROOKS MEMORIAL HOSPITAL 529 CENTRAL AVENUE DUNKIRK,NY14048	16-0743301	501(C)(3)	5,500	FMV	SPONSORSHIP

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
FORM 990, SCHEDULE I:	PART I, LINE 2 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS: KALEIDA HEALTH MAKES CONTRIBUTIONS TO ORGANIZATONS IN WESTERN NEW YORK THAT ALSO HAVE HEALTH CARE RELATED ACTIVITIES. ALL CONTRIBUTIONS MUST BE APPROVED BY THE GOVERNING BODY BEFORE MONEY IS DISTRIBUTED.

Schedule I (Form 990) 2018

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2018

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JODY LOMEO PRES/CEO EX-OFFICIO W/VOTE	(i) (ii)	1,051,275 -------------	452,002 -------------	802,076 -------------	157,276 ------------- 0	19,240 ------------- 0	2,481,869 ------------- 0	508,843 ------------- 0
2ALYSON SPAULDING GENERAL COUNSEL	(i) (ii)	410,596 -------------	99,512 -------------	373,522 -------------	80,406 ------------- 0	16,328 ------------- 0	980,364 ------------- 0	235,851 ------------- 0
3DAVID HUGHES MD EVP, CMO	(i) (ii)	515,214 -------------	172,900 -------------	301,942 -------------	35,192 ------------- 0	16,461 ------------- 0	1,041,709 ------------- 0	213,333 ------------- 0
4JONATHAN SWIATKOWSKI EVP, CFO	(i) (ii)	551,846 -------------	117,390 -------------	251,787 -------------	50,677 ------------- 0	16,513 ------------- 0	988,213 ------------- 0	141,805 ------------- 0
5DONALD BOYD EVP BUSINESS DEVELOPMENT	(i) (ii)	494,146 -------------	142,500 -------------	124,670 -------------	8,395 ------------- 0	16,435 ------------- 0	786,146 ------------- 0	0 ------------- 0
6CHRISTOPHER LANE SVP OPERATIONS BGMC	(i) (ii)	507,214 -------------	115,200 -------------	26,606 -------------	14,739 ------------- 0	16,450 ------------- 0	680,209 ------------- 0	0 ------------- 0
7CHERYL KLASS EVP, CHIEF NURSE EXECUTIVE	(i) (ii)	549,282 -------------	156,750 -------------	527,188 -------------	40,757 ------------- 0	7,504 ------------- 0	1,281,481 ------------- 0	0 ------------- 0
8ALLEGRA JAROS SVP OPERATIONS WCHOB	(i) (ii)	424,146 -------------	96,750 -------------	25,946 -------------	10,661 ------------- 0	16,342 ------------- 0	573,845 ------------- 0	0 ------------- 0
9MICHAEL HUGHES SVP, PUBLIC AFFAIRS MARKETING	(i) (ii)	328,932 -------------	67,500 -------------	131,485 -------------	37,390 ------------- 0	708 ------------- 0	566,015 ------------- 0	62,430 ------------- 0
10DARCY CRAVEN SVP OPERATIONS MFS, DMH	(i) (ii)	442,214 -------------	100,575 -------------	26,488 -------------	32,048 ------------- 0	16,365 ------------- 0	617,690 ------------- 0	0 ------------- 0
11AARON HOFFMAN MD EMPLOYED PHYSICIAN	(i) (ii)	707,386 -------------	-------------	903 -------------	29,649 ------------- 0	16,501 ------------- 0	754,439 ------------- 0	0 ------------- 0
12CHRISTOPHER MALLAVARAPU MD EMPLOYED PHYSICIAN	(i) (ii)	898,283 -------------	-------------	2,709 -------------	30,714 ------------- 0	16,534 ------------- 0	948,240 ------------- 0	0 ------------- 0
13CARROLL HARMON MD EMPLOYED PHYSICIAN	(i) (ii)	678,846 -------------	-------------	4,633 -------------	8,170 ------------- 0	1,150 ------------- 0	692,799 ------------- 0	0 ------------- 0
14KAVEH VALI MD EMPLOYED PHYSICIAN	(i) (ii)	624,325 -------------	-------------	495 -------------	27,633 ------------- 0	983 ------------- 0	653,436 ------------- 0	0 ------------- 0
15JERRY VENABLE EVP, CHIEF HR OFFICER	(i) (ii)	478,584 -------------	-------------	32,772 -------------	30,787 ------------- 0	16,283 ------------- 0	558,426 ------------- 0	0 ------------- 0
16KATHRYN BASS MD EMPLOYED PHYSICIAN	(i) (ii)	582,901 -------------	-------------	2,714 -------------	33,847 ------------- 0	1,072 ------------- 0	620,534 ------------- 0	0 ------------- 0
17GEORGE MATTHEWS MD DIRECTOR/CHIEF OF SERVICE	(i) (ii)	160,170 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	31,233 ------------- 0	191,403 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
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.
EXECUTIVE DEFERRED RETIREMENT PLAN	SCHEDULE J, PART I, LINE 4B DURING THE YEAR, CERTAIN OFFICERS AND KEY EMPLOYEES LISTED ON FORM 990, PART VII, SECTION A PARTICIPATED IN AN EXECUTIVE DEFERRED RETIREMENT PLAN. AS REQUIRED, KALEIDA HAS REPORTED DISTRIBUTIONS MADE UNDER THIS PLAN TO THE PLAN PARTICIPANTS ON SCHEDULE J, PART II, COLUMN (B)(III). ALL DISTRIBUTIONS MADE ARE CALCULATED USING A COMBINATION OF INDIVIDUALIZED DEMOGRAPHIC INPUTS INCLUDING BOTH HISTORICAL COMPENSATION AS WELL AS THE INDIVIDUALS AGE. ADDITIONALLY, DEFERRED RETIREMENT BENEFITS NOT YET PAID HAVE BEEN REPORTED ON SCHEDULE J, PART II, COLUMN (C). THE FOLLOWING OFFICERS AND KEY EMPLOYEES ACHIEVED CERTAIN VESTING MILESTONES DURING 2018 AND AS SUCH RECEIVED DISTRIBUTIONS (SHOWN BELOW) UNDER THE TERMS OF AN EXECUTIVE DEFERRED RETIREMENT PLAN. A PORTION OF THESE DISTRIBUTIONS FOR EACH OF THESE INDIVIDUALS HAVE BEEN PREVIOUSLY REPORTED ON SCHEDULE J, COLUMN(C) IN PRIOR YEAR IRS FORM 990S, WHICH ARE REPORTED IN COLUMN (F) ON THE 2018 SCHEDULE J. DAVID HUGHES, MD $268,833 MICHAEL HUGHES $98,703 JODY LOMEO $755,604 ALYSON SPAULDING $341,005 JONATHAN SWIATKOWSKI $218,721
COMPENSATION FROM UNRELATED ORGANIZATIONS:	DR. GEORGE MATTHEWS, A CURRENT BOARD MEMBER, IS COMPENSATED FOR HIS SERVICES AS CHIEF OF SERVICE FOR KALEIDA HEALTH.

Schedule J (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
KALEIDA HEALTH

Employer identification number
16-1533232

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	DORMITORY AUTHORITY - STATE OF NEW YORK (SCH 1)	14-6000293		09-30-2016	7,650,258	LEASE OF EQUIPMENT		X		X		X
B	DORMITORY AUTHORITY - STATE OF NEW YORK (SCH 2)	14-6000293		09-30-2016	7,349,742	LEASE OF EQUIPMENT		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,240,541		2,152,528
2 Amount of bonds legally defeased ..............	0		0
3 Total proceeds of issue ..................	7,650,258		7,349,742
4 Gross proceeds in reserve funds .............	0		0
5 Capitalized interest from proceeds .............	0		0
6 Proceeds in refunding escrows ...............	0		0
7 Issuance costs from proceeds ...............	104,266		0
8 Credit enhancement from proceeds .............	0		0
9 Working capital expenditures from proceeds .............	0		0
10 Capital expenditures from proceeds .............	7,348,433		6,748,676
11 Other spent proceeds .............	0		0
12 Other unspent proceeds .............	197,559		601,066
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X
16 Has the final allocation of proceeds been made? ..........		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X
b Exception to rebate? ........		X		X
c No rebate due? .........		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........	0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........	0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
SCHEDULE K, PART III, LINE 9, PART IV, LINE 7 AND PART V	KALEIDA HEALTH DOES NOT CURRENTLY HAVE WRITTEN POLICIES AND PROCEDURES IN PLACE BUT MANAGEMENT REGULARLY REVIEWS POST-ISSUANCE COMPLIANCE OBLIGATIONS TO ENSURE THERE ARE NO VIOLATIONS OF FEDERAL TAX REQUIREMENTS. KALEIDA HEALTH IS CURRENTLY IN THE PROCESS OF ADOPTING WRITTEN POLICIES AND PROCEDURES.

Schedule K (Form 990) 2018

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) TOPS MARKETS LLC	SEE PART V	218,772	SEE PART V		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS	SCHEDULE L, PART IV TOPS MARKETS LLC: FRANK CURCI IS THE CHAIRMAN OF THE BOARD AND A GREATER THAN 35% OWNER OF TOPS MARKETS LLC, WHICH HAD A PHARMACY DISPENSING CONTRACT WITH THE ORGANIZATION DURING THE YEAR.

Schedule L (Form 990 or 990-EZ) 2018

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( VARIOUS MEDICAL EQUIPMENT )	X	3	4,125,332	REPLACEMENT COST
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2018)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation

Schedule M (Form 990) (2018)

Additional Data

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Return Reference	Explanation
REVIEW PROCESS FOR FORM 990	Form 990, Part VI, Line 11b ORGANIZATION'S MANAGEMENT, 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 ORGANZATION 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 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, QUESTIONS 15A & 15B 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 IS COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT AND 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 COMPENSATION COMMITTEE IS DOCUMENTED.
ACCESS TO ORGANIZATIONAL DOCUMENTS	Form 990, Part VI, SECTION C, Line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS OFFICE AT 726 EXCHANGE STREET, SUITE 200, BUFFALO, NY 14210. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED.
FORM 990, PART XI	OTHER CHANGES IN NET ASSETS OR FUND BALANCES MINORITY INTEREST IN SUBSIDIARY 11,907,341 DECREASE IN PENSION LIABILITY 24,673,321 TRANSFER FROM KALEIDA FOUNDATIONS 1,775,000 OTHER TRANSFERS NET 4,125,332 CHANGE IN VALUE OF FOUNDATIONS (20,809,708) CHANGE IN VALUE OF UAHS (4,638,012) ------------ TOTAL 17,033,274
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN AND PURCHASED SVCS TOTAL FEES:XXX-XX-XXXX

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

KALEIDA HEALTH

Employer identification number

16-1533232

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) KALEIDA MCO LLC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-1570311	DORMANT	NY	0	0	KH
(2) KALEIDA IPA LLC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-1570380	DORMANT	NY	0	0	KH
(3) KALEIDA WNYI LLC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 45-3189404	HEALTH CARE	NY	-742,503	584,430	KH
(4) KALEIDA SERVICES LLC 2100 WEHRLE DRIVE WILLIAMSVILLE,NY14221 47-2284036	ADULT DAYCARE	NY	94,172	427,401	KH

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)MILLARD FILLMORE AMBULATORY SURGER CTR 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-1307129	SUPPORT ORG	NY	501(C)(3)	12A	KH	Yes
(2)VNA HOME CARE SERVICES 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-1491203	HOME HLTHCARE	NY	501(C)(3)	10	KH	Yes
(3)VNA OF WESTERN NEW YORK 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-0743214	HOME HLTHCARE	NY	501(C)(3)	10	KH	Yes
(4)VISK 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 22-2738425	SUPPORT ORG	NY	501(C)(3)	10	KH	Yes
(5)KALEIDA HEALTH FOUNDATION 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-1579143	FUNDRAISING	NY	501(C)(3)	7	KH	Yes
(6)THE WOMEN & CHILDREN'S HOSP OF BFLO FDN 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-1332044	FUNDRAISING	NY	501(C)(3)	7	KH	Yes
(7)CHILDREN'S HEALTH HOME OF WNY INC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 81-4086046	PED HOME HLTH	NY	501(C)(3)	10	KH	Yes
(8)UPPER ALLEGHENY HEALTH SYSTEM INC 515 MAIN STREET OLEAN,NY14760 27-1255425	SUPPORT ORG	NY	501(C)(3)	12A	KH	Yes
(9)BRADFORD REGIONAL MEDICAL CENTER 116 INTERSTATE PARKWAY BRADFORD,PA16701 25-0965270	HOSPITAL	PA	501(C)(3)	3	UAHS	Yes
(10)OLEAN GENERAL HOSPITAL 515 MAIN STREET OLEAN,NY14760 16-0743102	HOSPITAL	NY	501(C)(3)	3	BRMC	Yes
(11)BRADFORD REGIONAL MED SVCS 116 INTERSTATE PARKWAY BRADFORD,PA16701 23-2875157	PHYS. GROUP	NY	501(C)(3)	3	BRMC	Yes
(12)HEALTH SYSTEM PHYSICIAN PC 130 SOUTH UNION STREET OLEAN,NY14760 46-4304317	PHYS. GROUP	NY	501(C)(3)	10	OGH	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) HARLEM ROAD LEASING LLC 3435 MAIN STREET BUFFALO,NY14214 20-5588135	EQUIPMENT LEASING	NY	KALEIDA HEALTH	UNRELATED	104,176	118,656		No	0	Yes		50.000 %
(2) AMTON IMAGING LLC 199 PARK CLUB LANE SUITE 300 WILLIAMSVILLE,NY14221 26-2925470	HEALTH CARE	NY	KALEIDA WNYI	RELATED	-688,586	-1,104,246		No	0	Yes		50.000 %
(3) SITE E LLC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 27-2124795	REAL ESTATE MGMT	NY	KPI	EXCLUDED	113,106	1,751,769		No			No	50.148 %
(4) MSFC LLC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 26-1582864	HEALTH CARE	NY	KALEIDA HEALTH	EXCLUDED	-437,689	1,983,624		No	0		No	63.464 %
(5) SOUTHTOWNS IMAGING LLC 5959 BIG TREE ROAD SUITE 105 ORCHARD PARK,NY14127 47-1123230	EQUIPMENT LEASING	NY	KALEIDA WNYI	UNRELATED	-48,341	1,854,546		No	0	Yes		70.000 %
(6) COLLABORATIVE CARE VENTURES LLC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 47-2365690	HEALTH CARE	NY	KALEIDA HEALTH	EXCLUDED	1,376,007	8,325,622		No	0		No	60.000 %
(7) GREAT LAKES MEDICAL BILLING SVCS LLC 199 PARK CLUB LANE SUITE 300 WILLIAMSVILLE,NY14221 46-1668448	MEDICAL BILLING	NY	KALEIDA WNYI	EXCLUDED	-5,576	-165,870		No	0		No	50.000 %
(8) ALTUS MANAGEMENT LLC 840 AERO DRIVE SUITE 150 CHEEKTOWAGA,NY14225 90-0149133	GROUP PURCHASING	NY	KALEIDA HEALTH	EXCLUDED	168,076	1,882,216		No	0		No	59.194 %
(9) SOUTHTOWNS SURGERY CENTER LLC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 46-4742028	HEALTH CARE	NY	KALEIDA HEALTH	EXCLUDED	-766,145	4,125,102		No	0	Yes		63.171 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) KALEIDA PROPERTIES INC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 22-2738483	PROP MGMT SVCS	NY	KALEIDA HEALTH	C Corp	486,810	14,712,161	100.000 %	Yes
(2) WESTLINK CORPORATION 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 16-1354421	MED & DIAGN SVCS	NY	KALEIDA HEALTH	C Corp	-211	100,456	100.000 %	Yes
(3) KHBC Inc 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 46-2164089	HEALTH CARE	NY	KALEIDA HEALTH	C Corp	-4,310,215	763,724	50.000 %		No
(4) GREAT LAKES INTEGRATED NETWORK INC 726 EXCHANGE STREET SUITE 200 BUFFALO,NY14210 82-3184375	HEALTH CARE	NY	KALEIDA HEALTH	C Corp	-1,668	4,448,250	50.000 %		No

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) MILLARD FILLMORE AMBULATORY SURGERY CENTER	c	502,321	ACTUAL COST
(2) VNA HOME CARE SERVICES	O	22,264	ACTUAL COST
(3) VNA HOME CARE SERVICES	q	2,424,845	ACTUAL COST
(4) VNA HOME CARE SERVICES	e	122,675	ACTUAL COST
(5) VNA OF WESTERN NEW YORK	o	322,941	ACTUAL COST
(6) VNA OF WESTERN NEW YORK	l	358,004	ACTUAL COST
(7) VNA OF WESTERN NEW YORK	q	16,471,556	ACTUAL COST
(8) VNA OF WESTERN NEW YORK	d	3,465	ACTUAL COST
(9) MSFC LLC	q	34,178	ACTUAL COST
(10) MFSC LLC	j	536,321	ACTUAL COST
(11) MFSC LLC	d	56,503	ACTUAL COST
(12) MFSC LLC	l	132,000	ACTUAL COST
(13) KALEIDA PROPERTIES INC	q	99,609	ACTUAL COST
(14) KALEIDA PROPERTIES INC	d	4,908,822	ACTUAL COST
(15) SITE E LLC	k	233,450	ACTUAL COST
(16) VISK (FORMERLY GHC)	q	250	actual cost
(17) VISK (formerly GHC)	d	300,450	ACTUAL COST
(18) WOMEN AND CHILDREN'S HOSPITAL FOUNDATION	c	577,257	ACTUAL COST
(19) WOMEN AND CHILDREN'S HOSPITAL FOUNDATION	s	8,236,233	ACTUAL COST
(20) WOMEN AND CHILDREN'S HOSPITAL FOUNDATION	d	1,510,242	ACTUAL COST
(21) KALEIDA HEALTH FOUNDATION	c	3,130,650	ACTUAL COST
(22) KALEIDA HEALTH FOUNDATION	s	2,770,548	ACTUAL COST
(23) KALEIDA HEALTH FOUNDATION	d	455,887	ACTUAL COST
(24) NORTHTOWNS VENTURE LLC	D	684	ACTUAL COST
(25) SOUTHTOWNS IMAGING LLC	d	1,068,643	ACTUAL COST
(26) SOUTHTOWNS IMAGING LLC	j	274,699	ACTUAL COST
(27) SOUTHTOWNS IMAGING LLC	q	116,508	ACTUAL COST
(28) SOUTHTOWNS SURGERY CENTER LLC	l	809,929	ACTUAL COST
(29) SOUTHTOWNS SURGERY CENTER LLC	R	30,959	ACTUAL COST
(30) SOUTHTOWNS SURGERY CENTER LLC	j	802,500	ACTUAL COST
(31) SOUTHTOWNS SURGERY CENTER LLC	d	3,249,711	ACTUAL COST
(32) COLLABORATIVE CARE VENTURES LLC	q	914,380	ACTUAL COST
(33) COLLABORATIVE CARE VENTURES LLC	d	2,135,548	ACTUAL COST
(34) CHILDREN'S HOME HEALTH OF WNY INC	O	25,955	ACTUAL COST
(35) CHILDREN'S HOME HEALTH OF WNY INC	q	80,789	ACTUAL COST
(36) CHILDREN'S HOME HEALTH OF WNY INC	d	257,427	ACTUAL COST
(37) OLEAN GENERAL HOSPITAL	l	1,261,478	ACTUAL COST
(38) UAHS	o	423,902	ACTUAL COST
(39) UAHS	q	5,154,927	ACTUAL COST
(40) UAHS	d	4,731,025	ACTUAL COST
(41) HEALTH SYSTEM PHYSICIANS PC	Q	17,633	ACTUAL COST
(42) HEALTH SYSTEM PHYSICIANS PC	o	267,668	ACTUAL COST
(43) HEALTH SYSTEM PHYSICIANS PC	d	285,301	ACTUAL COST
(44) BRADFORD REGIONAL MEDICAL SERVICES PC	q	71,106	ACTUAL COST
(45) BRADFORD REGIONAL MEDICAL SERVICES PC	d	71,106	ACTUAL COST
(46) GREAT LAKES INTEGRATED NETWORK INC	d	4,620,999	ACTUAL COST

Schedule R (Form 990) 2018

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: KALEIDA HEALTH PROVIDES HEALTHCARE SERVICES FOR THE EIGHT COUNTIES OF WNY AT FOUR ACUTE CARE, TWO LT CARE, AND OTHER OUTPATIENT AND PRIMARY CARE SITES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	9,525
6	Total number of volunteers (estimate if necessary) .............	6	1,434
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	7,554,852
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	1,386,368

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	43,232,834	20,329,042
9	Program service revenue (Part VIII, line 2g) .........	1,262,832,279	1,329,383,884
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,657,323	-2,087,622
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	18,473,068	16,307,589
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,331,195,504	1,363,932,893
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	448,949	612,375
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	697,358,570	722,374,625
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	572,965,029	620,737,477
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,270,772,548	1,343,724,477
19	Revenue less expenses. Subtract line 18 from line 12.......	60,422,956	20,208,416
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,417,694,523	1,433,260,601
21	Total liabilities (Part X, line 26).............	1,109,884,345	1,102,863,164
22	Net assets or fund balances. Subtract line 21 from line 20.....	307,810,178	330,397,437

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 1,208,549,787 including grants of $ 612,375 ) (Revenue $ 1,331,981,873 )
	KALEIDA HEALTH IS A VOLUNTARY, NOT-FOR-PROFIT; NEW YORK STATE DEPARTMENT OF HEALTH ARTICLE 28 LICENSED HOSPITAL-BASED HEALTHCARE DELIVERY SYSTEM SERVICING THE COMMUNITIES OF WESTERN NEW YORK STATE AT VARIOUS LEVELS AND WITH FACILITIES IN MULTIPLE LOCATIONS THROUGHOUT THE REGION. KALEIDA HEALTH INCLUDES THE BUFFALO GENERAL MEDICAL CENTER (BUFFALO GENERAL), MILLARD FILLMORE SUBURBAN HOSPITAL (MILLARD SUBURBAN), OISHEI CHILDREN'S HOSPITAL (FORMERLY THE WOMEN & CHILDREN'S HOSPITAL OF BUFFALO), AND DEGRAFF MEMORIAL HOSPITAL (DEGRAFF). THE ABOVE OPERATE UNDER ONE TAX IDENTIFICATION NUMBER. IN ADDITION TO THE FOUR KALEIDA HEALTH (KALEIDA) HOSPITALS, KALEIDA OPERATES UPPER ALLEGHENY HEALTH SYSTEM, A SUBSIDIARY HEALTH SYSTEM WITH TWO HOSPITAL FACILITIES, TWO SKILLED NURSING FACILITIES, AND NUMEROUS OUTPATIENT CLINICS. UPPER ALLEGHENY HEALTH SYSTEM FILES A SEPARATE IRS FORM 990 AND THEREFORE IS NOT INCLUDED WITHIN THIS FILING. OUR FAMILY OF HEALTH CARE ORGANIZATIONS IS BLENDED TOGETHER INTO ONE FRAMEWORK FOR LEADERSHIP, GOVERNANCE, SHARED SERVICES, FINANCIAL INFRASTRUCTURE AND INFORMATION TECHNOLOGY PLATFORMS. COLLECTIVELY, KALEIDA HEALTH'S MARKET SHARE IS 32.8% IN WESTERN NEW YORK, 40.7% IN ERIE COUNTY AND 31.31% IN NIAGARA COUNTY. ANNUALLY ONE MILLION COMBINED INPATIENT, EMERGENCY DEPARTMENT AND OUTPATIENT VISITS OCCUR AT THE HEALTH CARE FACILITIES IN THE KALEIDA HEALTH SYSTEM, WHICH EMPLOYS APPROXIMATELY 9,400 STAFF AND HAVE APPROXIMATELY 2,400 MEDICAL STAFF MEMBERS. DURING 2018, THERE WERE 56,441 INPATIENT DISCHARGES, OF WHICH 26% WERE MEDICAID AND MEDICAID MANAGED CARE, 1% SELF PAY, AND 31% WERE OTHER. KALEIDA HEALTH'S MISSION IS TO ADVANCE THE HEALTH OF OUR COMMUNITY. OUR VISION IS TO PROVIDE COMPASSIONATE, HIGH-VALUE, QUALITY CARE, IMPROVING HEALTH IN WESTERN NEW YORK AND BEYOND, EDUCATING FUTURE HEALTH CARE LEADERS AND DISCOVERING INNOVATIVE WAYS TO ADVANCE MEDICINE. OUR VALUES CLEARLY STATE WHO WE ARE AND HOW WE PERFORM OUR WORK: CENTERED: REMAIN CENTERED AROUND THE PATIENT AND FAMILY. ACCOUNTABLE: BE ACCOUNTABLE TO PATIENTS AND EACH OTHER. RESPECT: SHOW RESPECT AND INTEGRITY. EXCELLENCE: PROVIDE EXCELLENCE IN ALL WE DO. KALEIDA HEALTH'S PROGRAMS AND AFFILIATES ARE LICENSED BY THE STATE OF NEW YORK DEPARTMENT OF HEALTH AND ACCREDITED BY DNV. KALEIDA IS CERTIFIED BY THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR PARTICIPATION IN MEDICARE AND MEDICAID. THE ACCREDITATION COUNSEL FOR GRADUATE MEDICAL EDUCATION APPROVES ALL RESIDENCY PROGRAMS FOR PHYSICIANS, AND THE AMERICAN DENTAL ASSOCIATION APPROVES ITS DENTAL AND ORAL SURGERY PROGRAMS. KALEIDA IS ALSO A MEMBER OF THE COUNCIL OF TEACHING HOSPITALS, THE AMERICAN DENTAL ASSOCIATION, THE AMERICAN MEDICAL ASSOCIATION AND THE GREATER NEW YORK HOSPITAL ASSOCIATION. OPERATION OF EMERGENCY ROOMS: KALEIDA HEALTH OPERATES FOUR EMERGENCY ROOMS, ONE IN EACH OF THE ACUTE CARE HOSPITALS, GENERATING A TOTAL OF 168,794 PATIENT VISITS DURING 2018. THE EMERGENCY DEPARTMENTS, WHICH OPERATE 24 HOURS A DAY, SEVEN DAYS EACH WEEK, ARE OPEN TO ANYONE, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. BOARD OF DIRECTORS AND COMMUNITY GUIDANCE: 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 DIRECTORS RESIDE IN WESTERN NEW YORK AND 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 AND OPERATIONS OF KALEIDA HEALTH, SUCH AS REINVESTING IN COMMUNITY BENEFIT PROGRAMS, AND MAKING IMPROVEMENTS IN FACILITIES, PATIENT CARE, MEDICAL, NURSING AND ALLIED HEALTH TRAINING, EDUCATION AND RESEARCH IN SUPPORT OF THE HEALTH NEEDS OF THE COMMUNITY. COMMUNITY BENEFIT PROGRAMS AND SERVICES: KALEIDA HEALTH OFFERS NUMEROUS COMMUNITY BENEFIT PROGRAMS AND SERVICES IN RESPONSE TO THE COMMUNITY'S NEEDS, BY IMPROVING ACCESS TO CARE, IMPROVE PUBLIC HEALTH, ADVANCE KNOWLEDGE AND RELIEVE GOVERNMENT PROGRAMS. THESE PROGRAMS ARE CONDUCTED IN COMMUNITY-BASED SETTINGS SUCH AS SCHOOLS, CHURCHES, COMMUNITY CENTERS, SENIOR CENTERS AND PROGRAMS ARE ALSO OFFERED AT KALEIDA'S HOSPITAL CAMPUSES AND FACILITIES. COMMUNITY BENEFIT PROGRAMS AND SERVICES INCLUDE HEALTH FAIRS, HEALTH SCREENINGS, HEALTH EDUCATION LECTURES AND WORKSHOPS FOR COMMUNITY GROUPS AND THE GENERAL PUBLIC, SCHOOL HEALTH EDUCATION PROGRAMS, AND CONSUMER HEALTH INFORMATION IN THE KALEIDA HEALTH LIBRARIES. KALEIDA ALSO OFFERS A NUMBER OF SUBSIDIZED HEALTH SERVICES SUCH AS OUTPATIENT CLINICS, LONG-TERM CARE SERVICES, WOMEN'S HEALTH CENTERS, DIALYSIS SERVICES, BEHAVIORAL HEALTH SERVICES, SCHOOL-BASED HEALTH CENTERS, EARLY CHILDHOOD PROGRAM, EARLY INTERVENTION SERVICES, FAMILY PLANNING SERVICES, WESTERN NEW YORK CLINICAL INFORMATION EXCHANGE AND HEALTH-E-LINK AND DIAGNOSTIC, THERAPEUTIC AND REHABILITATION SERVICES FOR CHILDREN WITH SPECIAL NEEDS. KALEIDA'S HOSPITALS SERVE AS A MAJOR TEACHING AFFILIATE OF THE STATE UNIVERSITY OF NEW YORK AT BUFFALO'S SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES AND DENTAL MEDICINE, WITH TRAINING TO 400 MEDICAL AND DENTAL RESIDENTS EACH YEAR. KALEIDA IS INVOLVED IN AND SPONSORS RESEARCH PROJECTS, AND WE PROVIDE LOAN FORGIVENESS FOR PHYSICIANS TO ESTABLISH OR JOIN EXISTING PRACTICES THAT SERVE THE UNDERSERVED COMMUNITIES OF BUFFALO AND WESTERN NEW YORK. KALEIDA OFFERS CLINICAL TRAINING FACILITIES AND SUPPORT FOR NURSING AND A NUMBER OF ALLIED HEALTH PROFESSIONAL TRAINING PROGRAMS AT LOCAL COLLEGES AND UNIVERSITIES, AND OTHER PROFESSIONAL DEVELOPMENT/CONTINUING EDUCATION TRAINING PROGRAMS FOR COLLEAGUES FROM HEALTH CARE ORGANIZATIONS ACROSS THE REGION.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses1,208,549,787

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	13,562,375	0	854,443

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	6,899,942
e	Government grants (contributions)		1e	12,995,797

f	All other contributions, gifts, grants, and similar amounts not included above		1f	433,303

g	Noncash contributions included in lines 1a - 1f:$ 4,125,332
h Total. Add lines 1a-1f.......		20,329,042

		Business Code
2a	NET PATIENT SERVICE REVENUE	623990	1,322,113,493	1,322,113,493
b	MANAGEMENT FEES	561000	72,900		72,900
c	LAB SERVICES	621500	7,197,491		7,197,491
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		1,329,383,884

3 Investment income (including dividends, interest, and othersimilar amounts) ......			12,018,931		-94,789	12,113,720
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		1,771,646
b	Less: rental expenses
c	Rental income or (loss)	0	1,771,646
d	Net rental income or (loss)......			1,771,646		155,507	1,616,139
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	125,046	210,476,763
b	Less: cost or other basis and sales expenses		224,708,362
c	Gain or (loss)	125,046	-14,231,599
d	Net gain or (loss).....			-14,106,553			-14,106,553
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	REBATE REVENUE		900099	6,994,577			6,994,577
b	UNIVERSITY LEASE INCOME		531120	173,020	173,020
c	MANAGEMENT CONSULTING FEES		541610	1,623,426	1,623,426
d	All other revenue ....			5,744,920	801,543	223,743	4,719,634
e	Total. Add lines 11a–11d ......			14,535,943
12	Total revenue. See Instructions......			1,363,932,893	1,324,711,482	7,554,852	11,337,517

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	612,375	612,375
2	Grants and other assistance to domestic individuals. See Part IV, line 22	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	9,899,009		9,899,009
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	87,614		87,614
7	Other salaries and wages	526,782,703	499,470,339	27,312,364
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	43,945,615	39,049,982	4,895,633
9	Other employee benefits .......	102,006,776	94,536,723	7,470,053
10	Payroll taxes ...........	39,652,908	36,861,437	2,791,471
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	2,802,212	1,377,498	1,424,714
c	Accounting ...........	496,484	39,440	457,044
d	Lobbying ...........	350,522		350,522
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	155,650,507	140,459,471	15,191,036
12	Advertising and promotion ....	2,772,895	2,298,920	473,975
13	Office expenses .......	2,047,255	1,592,387	454,868
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	20,859,522	6,355,600	14,503,922
17	Travel ............	1,231,882	946,722	285,160
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	17,139,021	13,711,217	3,427,804
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	63,767,974	46,166,800	17,601,174
23	Insurance ...	14,013,785	10,455,972	3,557,813
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	HEALTH CARE SUPPLIES	253,589,329	253,530,224	59,105
b	EQUIPMENT RENTAL & MAINTENANCE	32,555,193	11,669,477	20,885,716
c	UTILITIES	7,902,017	5,677,161	2,224,856
d	DUES AND SUBSCRIPTIONS	1,574,918	411,466	1,163,452
e	All other expenses	43,983,961	43,326,576	657,385
25	Total functional expenses. Add lines 1 through 24e	1,343,724,477	1,208,549,787	135,174,690	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			6,667,646	1	23,249,584
2	Savings and temporary cash investments .........			9,948,594	2	14,411,282
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			191,386,814	4	226,821,972
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			32,400,450	8	35,985,553
9	Prepaid expenses and deferred charges ......			16,205,756	9	9,813,625
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,931,080,039
b	Less: accumulated depreciation	10b	1,262,286,210	649,022,691	10c	668,793,829
11	Investments—publicly traded securities .			115,857,645	11	103,249,212
12	Investments—other securities. See Part IV, line 11 .....			52,537,898	12	43,405,115
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			343,667,029	15	307,530,429
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,417,694,523	16	1,433,260,601

17	Accounts payable and accrued expenses .....	170,923,760	17	187,001,957
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	11,858,725	20	9,804,851
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	357,857,785	23	338,425,223
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	569,244,075	25	567,631,133
26	Total liabilities. Add lines 17 through 25..	1,109,884,345	26	1,102,863,164

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	161,296,327	27	203,277,286
28	Temporarily restricted net assets ...........	101,550,807	28	81,623,883
29	Permanently restricted net assets	44,963,044	29	45,496,268
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	307,810,178	33	330,397,437
34	Total liabilities and net assets/fund balances ........	1,417,694,523	34	1,433,260,601

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No