Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
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.") .. | 2,922,358 | 9,316,779 | 1,712,413 | 1,518,029 | 2,588,181 | 18,057,760 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 2,922,358 | 9,316,779 | 1,712,413 | 1,518,029 | 2,588,181 | 18,057,760 |
| 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).. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 18,057,760 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,922,358 | 9,316,779 | 1,712,413 | 1,518,029 | 2,588,181 | 18,057,760 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,383,342 | 792,875 | 2,187,925 | 1,596,366 | 2,244,753 | 8,205,261 |
| 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.).. | 270,867 | 346,272 | 464,534 | 464,047 | 575,415 | 2,121,135 |
| 11 | Total support. Add lines 7 through 10 | 28,384,156 | |||||
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.) | ||||||
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.).. | ||||||
| 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 | ||||
| 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..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART I TO SOLICIT, MAINTAIN, AND ENHANCE THE VALUE OF PUBLIC CONTRIBUTIONS TO PROVIDE FINANCIAL SUPPORT TO KALEIDA HEALTH IN THEIR MISSION TO ADVANCE THE HEALTH OF OUR COMMUNITY. |
| ORGANIZATION'S MOST SIGNIFICANT ACTIVITIES | FORM 990, PART III, LINE 4A THE ORGANIZATION IS A NOT-FOR-PROFIT CHARITABLE FOUNDATION SUPPORTING THE FOLLOWING DIVISIONS UNDER KALEIDA HEALTH, A RELATED TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM: BUFFALO GENERAL MEDICAL CENTER DEGRAFF MEMORIAL HOSPITAL MILLARD FILLMORE SUBURBAN HOSPITAL GATES VASCULAR INSTITUTE HIGHPOINTE ON MICHIGAN DEGRAFF SNF THE ORGANIZATION ALSO SUPPORTS THE VISITING NURSES ASSOCIATION OF WNY, AN AFFILIATE HOME HEALTH CARE AGENCY. WITH SUPPORT FROM ITS BOARD OF DIRECTORS AND THE MANY VOLUNTEERS, THE ORGANIATION RAISES GIFTS IN THE FORM OF CASH, STOCKS, ESTATE GIFTS, CORPORATE GIFTS AND GRANTS FROM PRIVATE FOUNDATIONS. BY FOSTERING CHARITABLE RELATIONSHIPS AND INCREASING PHILANTHROPY, THE ORGANIZATION SUPPORTS KALEIDA HEALTH IN ITS MISSION TO ADVANCE THE HEALTH OF OUR COMMUNITY EVERY DAY THROUGH EXCEPTIONAL CARE, EDUCATION AND RESEARCH. THE PRIMARY PROGRAMS AND ACTIVITIES OF THE ORGANIZATION INCLUDE: 1. KALEIDA BALL - AN ANNUAL DINNER THAT IS A PREMIER FUNDRAISER FOR KALEIDA HEALTH AND ITS AFFILIATES. THE FOUNDATION SOLICITS PATRONS AND ATTENDEES IN ADVANCE OF THE EVENT AS WELL AS CONDUCT OVERALL ACTIVITIES DURING THE EVENT INCLUDING DINNER AND ENTERTAINMENT. THE HIGHLIGHT OF THE EVENING INCLUDES THE PRESENTATION OF THE SPIRIT AWARD WHICH RECOGNIZES LOCAL INDIVIDUALS FOR THEIR SIGNIFICANT AND SPIRITED SUPPORT OF KALEIDA HEALTH AND FOR THEIR DEDICATION TO IMPROVE THE HEALTH OF THE WESTERN NEW YORK COMMUNITY. THEY ALSO PRESENT THE EMPLOYEE OF THE YEAR AWARD. THE 2018 EVENT WAS ATTENDED BY OVER 1,100 PEOPLE. 2. KALEIDA CLASSIC - AN ANNUAL GOLF TOURNAMENT TO RAISE FUNDS TO SUPPORT THE FOUNDATION AND KALEIDA HEALTH. THE FOUNDATION SOLICITS PATRONS AND PARTICIPANTS IN ADVANCE OF THE TOURNAMENT AS WELL AS CONDUCT OVERALL ACTIVITIES DURING THE EVENT. MORE THAN 250 GOLFERS TEED OFF DURING THE 2018 EVENT. 3. Meat Raffle Held the first ever Meat Raffle to support the Cardiac Care Center at Buffalo General Medical Center, Over 330 guests attended this energetic event and raised over $9,000. 4. Tee Off for Tots An annual golf tournament to raise funds for the Pediatric Unit at HighPointe on Michigan, Kaleidas skilled nursing facility. The Tots committee solicits sponsors and participants in advance of the tournament as well as conducts overall activities during the event. In 2018, the event was sold out with 144 golfers. A SIGNIFICANT PORTION OF THE OPERATING ACTIVITY REFLECTED BY THE ORGANIZATION OCCURS WITHIN THE SPECIAL PURPOSE FUNDS. IN MANY CASES USE OF THESE FUNDS IS EITHER PERMANENTLY OR TEMPORARILY RESTRICTED BY THE DONOR. SEE SCHEDULE D, PART V FOR FURTHER DETAIL REGARDING THESE FUNDS. |
| ORGANIZATION'S MEMBER AND MEMBER RIGHTS | FORM 990, PART VI, SECTION A, QUESTIONS 6, 7A, & 7B THE ORGANIZATION IS A MEMBERSHIP (NOT A STOCK) CORPORATION UNDER NEW YORK STATE LAW. THE ORGANIZATION'S SOLE CORPORATE MEMBER IS KALEIDA HEALTH, A RELATED NOT-FOR-PROFIT ORGANIZATION. PART VI, SECTION A, QUESTION 7A - IN ACCORDANCE WITH THE TERMS AND REQUIRMENTS OF ITS GOVERNING DOCUMENTS (IE BYLAWS), ON AN ANNUAL BASIS THE ORGANIZATION'S CURRENT BOARD MEMBERS RECOMMEND THE LIST OF CANDIDATES FOR MEMBERSHIP TO THE GOVERNING BODY FOR THE SUBSEQUENT TERM TO THE KALEIDA HEALTH BOARD OF DIRECTORS. THE KALEIDA HEALTH BOARD OF DIRECTORS APPROVE AND ELECT THESE CANDIDATES TO SERVE AS THE ORGANIZATION'S BOARD OF DIRECTORS. PART VI, SECTION A, QUESTION 7B - KALEIDA HEALTH, AS THE SOLE CORPORATE MEMBER, ALSO HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY INCLUDING THE AMENDMENT OF BYLAWS AND CHARTERS, REMOVAL OF MEMBERS OF THE GOVERNING BODY, AND THE DECISION TO DISSOLVE THE ORGANIZATION. |
| REVIEW PROCESS FOR FORM 990 | FORM 990, PART VI, SECTION B, QUESTION 11A THE ORGANIZATION'S MANAGEMENT, IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, KPMG LLP, REVIEWS THE FORM 990. THE FINANCIAL REVIEW IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS FOR THE RELEVANT TIME PERIOD. BEFORE THE 990 IS FILED WITH THE IRS, THE EXECUTIVE 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, QUESTION 12C UPON EMPLOYMENT AND ANNUALLY THEREAFTER EACH KEY EMPLOYEE AND OFFICER OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, PROVIDING SUFFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THE ORGANIZATION CAN (1) DETERMINE WHETHER ANY POTENTIAL OR ACTUAL CONFLICTS OF INTERESTS MAY EXIST, AND (2) MONITOR WORK OR SERVICE ASSIGNMENTS TO AVOID PLACING A KEY EMPLOYEE, OFFICER OR DIRECTOR IN A POSITION WHERE THERE MAY BE AN APPEARANCE, POTENTIAL OR ACTUAL, OF A CONFLICT OF INTEREST OR A QUESTION OF OBJECTIVITY. THE COMPLETED CONFLICT OF INTEREST FORMS 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 OF KALEIDA HEALTH WITH RESPECT TO THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEE FOR REVIEW AND APPROVAL. SUCH INFORMATION INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX EXEMPT ORGANIZATIONS IN THE WESTERN NEW YORK COMMUNITY AS WELL AS COMPENSATION FOR THIS POSITION WITHIN OTHER FOUNDATIONS THAT ARE SIMILAR IN SIZE, DEMOGRAPHICS, AND GEOGRAPHY. |
| ACCESS TO ORGANIZATIONAL DOCUMENTS | FORM 990, PART VI, SECTION C, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS OFFICE AT 726 EXCHANGE STREET, SUITE 200, BUFFALO, NY 14210. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. |
| UNRELATED BUSINESS INCOME | KALEIDA HEALTH, INC., THE ENTITY'S PARENT, MAINTAINS A MASTER INVESTMENT ACCOUNT THAT HOLDS ALL OF ITS SEPARATE SUBSIDIARY INVESTMENTS. KALEIDA HEALTH, INC. REPORTS ANY UNRELATED BUSINESS INCOME RESULTING FROM INVESTMENTS IN LIMITED PARTNERSHIPS HELD FOR THE BENEFIT OF KALEIDA HEALTH FOUNDATION ON ITS 990-T. |
| Software ID: | |
| Software Version: |