Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 4,030,637 | 4,938,734 | 4,781,115 | 5,323,000 | 6,529,084 | 25,602,570 |
| 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 | 4,030,637 | 4,938,734 | 4,781,115 | 5,323,000 | 6,529,084 | 25,602,570 |
| 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).. | 3,221,824 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 22,380,746 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 4,030,637 | 4,938,734 | 4,781,115 | 5,323,000 | 6,529,084 | 25,602,570 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,375,901 | 4,743,206 | 1,939,147 | 5,058,796 | 1,546,631 | 14,663,681 |
| 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.).. | 745,258 | 766,180 | 682,907 | 908,037 | 516,695 | 3,619,077 |
| 11 | Total support. Add lines 7 through 10 | 43,885,328 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| 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 MOST SIGNIFICANT ACTIVITIES | PART III, LINE 4A THE ORGANIZATION IS A NON-FOR-PROFIT CHARITABLE FOUNDATION SUPPORTING THE HEALTH SERVICES AND A SPECIALIZED PEDIATRIC HOSPITAL SITE THAT IS A DIVISION OF KALEIDA HEALTH, BY PROVIDING FUNDING FOR PATIENT CARE, EDUCATION AND RESEARCH. WITH SUPPORT FROM ITS' BOARD OF DIRECTORS AND MANY OTHER VOLUNTEERS, THE ORGANIZATION RAISES GIFTS IN THE FORM OF CASH, STOCKS, ESTATE GIFTS, CORPORATE GIFTS AND GRANTS FROM PRIVATE FOUNDATIONS. THE PRIMARY PROGRAMS AND ACTIVITIES OF THE ORGANIZATION INCLUDE: 1. FESTIVAL OF TREES- DUE TO COVID, THE 43RD ANNUAL BLACK-TIE GALA, THE MAIN EVENT, IN SUPPORT OF THE JOHN R. OISHEI CHILDREN'S HOSPITAL, SYMBOLIZES THE BOND BETWEEN THE HOSPITAL AND THE COMMUNITY THAT IT SERVES HAD TO BE RE-IMAGINED. THE EVENT HAS RAISED OVER $9 MILLION DOLLARS WITH THE 2020 YEAR'S PROCEEDS BEING UTILIZED TO SUPPORT PROGRAMS AND CARE DELIVERY FOR CHILDREN WITH BEHAVIORAL AND EMOTIONAL HEALTH ISSUES AND FOR KIDS LIVING WITH SPECIAL NEEDS. THE USUAL EVENTS: FASHION SHOW, DESIGNER SHOWCASE AND THE FESTIVAL GALA WERE NOT HELD DUE TO COVID. WE RE-IMAGINED THE EVENT AND WERE MINDFUL OF SAFETY AND OFFERED A NUMBER OF DIFFERENT SPONSORSHIP AND DONATION OPPORTUNITIES WITH BENEFITS REDEEMABLE THROUGHOUT THE YEAR. WE HAD OVER 64 SPONSORSHIPS WITH ALMOST HALF FORGOING THE DINING EXPERIENCE SO OCH WOULD RECEIVE THE ADDITIONAL FUNDS IN DIRECT FINANCIAL SUPPORT. MANY ADDITIONAL SUPPORTERS MADE STRAIGHT MONETARY DONATIONS. IN ADDITION, WE HAD 17 DECORATED TREES SOLD IN AN ONLINE AUCTION. NO CHILD IS EVER TURNED AWAY FROM THE OISHEI CHILDREN'S HOSPITAL WHERE EVERY FAMILY IS ENTITLED TO THE VERY BEST CARE NO MATTER THEIR ABILITY TO PAY. WE WERE GRATEFUL TO HAVE MADE OVER $250,000. 2. KISS CARES FOR KIDS RADIOTHON AIRS ANNUALLY IN MAY ON WKSE-FM RADIO AND KISS 98.5 TO BENEFIT OISHEI CHILDREN'S HOSPITAL. IN 2020, DUE TO COVID, THE EVENT WAS CANCELLED BUT WE DID DO A MAILING TO PAST SUPPORTERS IN HOPES OF RECEIVING DONATIONS. 3. KICKING FOR MIRACLES -MASTER CHONG'S TAE KWON DO SCHOOLS SPONSOR THE EVENT AND HAVE HOURS OF EXCITING DEMONSTRATIONS AND BOARD BREAKING EXCITEMENT. DUE TO COVID, IN 2020, THIS EVENT WAS CANCELLED. 4. CHIP-IN FOR CHILDREN'S HOSPITAL GOLF TOURNAMENT- PREVIOUSLY NAMED JOHN R. OISHEI CHILDREN'S HOSPITAL INVITATIONAL - PREVIOUSLY NAMED PRO-AM CHARITY GOLF TOURNAMENT - A GOLF TOURNAMENT HELD ANNUALLY IN JUNE TO RAISE FUNDS TO SUPPORT THE MISSION OF OISHEI CHILDREN'S HOSPITAL. IN 2020, DUE TO COVID WE POSTPONED THE TOURNAMENT UNTIL SEPTEMBER WHEN COVID LIFE CALMED DOWN A BIT. TOURNAMENT SPONSORS RECEIVED GOLF, MEALS AND GOLF-RELATED PRIZES IN EXCHANGE FOR THEIR CONTRIBUTION. THERE WERE 151 GOLFERS PARTICIPATING IN THE 2020 EVENT. THE EVENT NORMALLY KICKS OFF WITH A PRE-EVENT AUCTION WHICH FEATURES A TICKET AUCTION AND LIVE AUCTION FOR GUESTS BUT WAS CANCELLED THIS YEAR. WE DID HAVE AN ON-LINE AUCTION WITH 20 ITEMS AND OUR USUAL PEBBLE BEACH GOLF TRIP RAFFLE. WE MADE OVER $100,000.00. 5. BEAUTIFUL WOMEN- THIS EVENT WAS CANCELED DUE TO COVID AND IT WILL NO LONGER BE HELD DUE TO TONY WALKER'S BRICK AND MORTAR FACILITY CLOSING. 6. ERIC WOOD'S FLIGHTS & BITES EVENT- IN 2017 BUFFALO BILLS PLAYER, ERIC WOOD, BROUGHT "THE ERIC WOOD FUND" TO THE CHILDREN'S HOSPITAL OF BUFFALO FOUNDATION. THE ERIC WOOD FUND INTRODUCES YOU TO A HOSPITAL-BASED PROGRAM PROVIDING A NETWORK OF SUPPORT TO CHRONICALLY ILL CHILDREN AND THEIR FAMILIES-STONE'S BUDDIES AT OISHEI CHILDREN'S HOSPITAL. IN 2020 AN ONLINE VIRTUAL EVENT WAS HELD BY A 3RD PARTY VENDOR AND THE PROCEEDS WERE DONATED TO THE ERIC WOOD FUND. 7. 100 HOLES OF GOLF FOR CHILDREN'S HOSPITAL- IN THE BEGINNING OF SEPTEMBER WE HELD OUR FIRST 100 HOLES OF GOLF EVENT AT CRAG BURN GOLF CLUB. WE HAD 12 GOLFERS WILLING TO PLAY 100 HOLES OF GOLF IN A DAY AND RAISE MONEY FOR OISHEI CHILDREN'S HOSPITAL. ON A PEER TO PEER FUNDRAISING PLATFORM, EACH GOLFER HAD THEIR OWN PAGE AND COLLECTED DONATIONS WHICH WAS SHARED ON SOCIAL MEDIA TO COLLECT ADDITIONAL DONATIONS. WE INVITED ADDITIONAL PAST/PRESENT/NEW DONORS AS OUR GUESTS TO PLAY A ROUND OF GOLF THROUGHOUT THE DAY WHICH GENERATED ADDITIONAL FUNDS. OVER $78,000.00 WAS RAISED. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION IS A MEMBER (NOT A STOCK) CORPORATION UNDER THE NEW YORK STATE LAW. THE ORGANIZATION'S SOLE CORPORATION MEMBER IS KALEIDA HEALTH, A RELATED NOT-FOR-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | IN ACCORDANCE WITH THE TERMS AND REQUIREMENTS 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 BOARD OF DIRECTORS. THE KALEIDA BOARD OF DIRECTORS APPROVE AND ELECT THESE CANDIDATES TO SERVE AS THE ORGANIZATION'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 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. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S MANAGEMENT, IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, KPMG LLP, REVIEW 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. |
| FORM 990, PART VI, SECTION B, LINE 12C | UPON EMPLOYMENT AND ANUALLY THEREAFTER EACH KEY EMPLOYEE, OFFICER, OR DIRECTOR OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, PROVIDING SUFFICENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THE ORGANIZATION CAN (1) DETERMINE WHETHER ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST MAY EXIST, AND (2) MONITOR WORK OR SERVICE ASSIGNMENTS TO AVOID PLACING THE KEY EMPLOYEE, OFFICER OR DIRECTOR IN A POSITION WHERE THERE MAY BE AN APPEARANCE, POTENTIAL OR ACTUAL, OF A CONFLICT OF INTEREST OR A QUESTION OF OBJECTIVITY. THE COMPLETED CONFLICT OF INTEREST FORMS AND DISCLOSURE FORMS ARE RETURNED TO THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | ON A REGULAR BASIS, THE ORGANIZATION PROVIDES DOCUMENTATION TO THE COMPENSATION COMMITTEE OF THE BOARD OF KALEIDA HEALTH (THE FILING ORGANIZATION'S SOLE CORPORATE MEMBER) 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 WITH OTHER FOUNDATIONS THAT ARE OF SIMILAR SIZE, DEMOGRAPHICS AND GEOGRAPHY. |
| 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 THE OFFICES OF KALEIDA HEALTH (THE FILING ORGANIZATION'S SOLE CORPORATE MEMBER) AT 726 EXCHANGE STREET, SUITE 200, BUFFALO, NY 14120. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. |
| Software ID: | |
| Software Version: |