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ObjectId: 201813199349309001 - Submission: 2018-11-15
TIN: 16-1533232
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.
Attach to Form 990.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
17
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
,
NY
14210
16-1570311
DORMANT
NY
0
0
KH
(2)
KALEIDA IPA LLC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
16-1570380
DORMANT
NY
0
0
KH
(3)
KALEIDA WNYI LLC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
45-3189404
HEALTH CARE
NY
-15,380
2,644,416
KH
(4)
KALEIDA SERVICES LLC
2100 WEHRLE DRIVE
WILLIAMSVILLE
,
NY
14221
47-2284036
ADULT DAYCARE
NY
136,033
419,217
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?
Yes
No
(1)
MILLARD FILLMORE AMBULATORY SURGER CTR
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
16-1307129
SUPPORT ORG
NY
501(C)(3)
12A
KH
Yes
(2)
VNA HOME CARE SERVICES
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
16-1491203
HOME HLTHCARE
NY
501(C)(3)
10
KH
Yes
(3)
VNA OF WESTERN NEW YORK
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
16-0743214
HOME HLTHCARE
NY
501(C)(3)
10
KH
Yes
(4)
VISK INC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
22-2738425
SUPPORT ORG
NY
501(C)(3)
10
KH
Yes
(5)
KALEIDA HEALTH FOUNDATION
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
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
,
NY
14210
16-1332044
FUNDRAISING
NY
501(C)(3)
7
KH
Yes
(7)
CHILDREN'S HEALTH HOME OF WNY INC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
81-4086046
PED HOME HLTH
NY
501(C)(3)
10
KH
Yes
(8)
UPPER ALLEGHENY HEALTH SYSTEM INC
515 MAIN STREET
OLEAN
,
NY
14760
27-1255425
SUPPORT ORG
NY
501(C)(3)
12A
KH
Yes
(9)
BRADFORD REGIONAL MEDICAL CENTER
116 INTERSTATE PARKWAY
BRADFORD
,
PA
16701
25-0965270
HOSPITAL
PA
501(c)(3)
3
UAHS
Yes
(10)
OLEAN GENERAL HOSPITAL
515 MAIN STREET
OLEAN
,
NY
14760
16-0743102
HOSPITAL
NY
501(C)(3)
3
UAHS
Yes
(11)
BRADFORD REGIONAL MED SVCS
116 INTERSTATE PARKWAY
BRADFORD
,
PA
16701
23-2875157
PHYS. GROUP
PA
501(C)(3)
3
BRMC
Yes
(12)
HEALTH SYSTEM PHYSICIAN PC
130 SOUTH UNION STREET
OLEAN
,
NY
14760
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) 2017
Page 2
Schedule R (Form 990) 2017
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
Yes
No
Yes
No
(1)
HARLEM ROAD LEASING LLC
3435 MAIN STREET
BUFFALO
,
NY
14214
20-5588135
EQUIPMENT LEASING
NY
KALEIDA HEALTH
UNRELATED
107,784
114,480
No
Yes
50.000 %
(2)
AMTON IMAGING LLC
199 PARK CLUB LANE SUITE 300
WILLIAMSVILLE
,
NY
14221
26-2925470
HEALTH CARE
NY
KALEIDA WNYI
RELATED
390,940
692,602
No
Yes
50.000 %
(3)
SITE E LLC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
27-2124795
REAL ESTATE MGMT
NY
KPI
EXCLUDED
113,242
1,755,913
No
No
50.148 %
(4)
MSFC LLC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
26-1582864
HEALTH CARE
NY
KALEIDA HEALTH
EXCLUDED
-152,618
1,766,921
No
No
63.464 %
(5)
SOUTHTOWNS IMAGING LLC
5959 BIG TREE ROAD SUITE 105
ORCHARD PARK
,
NY
14127
47-1123230
EQUIPMENT LEASING
NY
KALEIDA WNYI
UNRELATED
144,409
2,253,893
No
Yes
70.000 %
(6)
COLLABORATIVE CARE VENTURES LLC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
47-2365690
HEALTH CARE
NY
KALEIDA HEALTH
EXCLUDED
No
No
50.000 %
(7)
GREAT LAKES MEDICAL BILLING SVCS LLC
199 PARK CLUB LANE SUITE 300
WILLIAMSVILLE
,
NY
14221
46-1668448
MEDICAL BILLING
NY
KALEIDA WNYI
UNRELATED
-550,729
0
No
No
50.000 %
(8)
ALTUS MANAGEMENT LLC
840 AERO DRIVE SUITE 150
CHEEKTOWAGA
,
NY
14225
90-0149133
GROUP PURCHASING
NY
KALEIDA HEALTH
EXCLUDED
168,076
1,882,216
No
No
51.194 %
(9)
SOUTHTOWNS SURGERY CENTER LLC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
46-4742028
HEALTH CARE
NY
KALEIDA HEALTH
EXCLUDED
-1,558,130
3,537,208
No
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?
Yes
No
(1)
KALEIDA PROPERTIES INC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
22-2738483
PROP MGMT SVCS
NY
KALEIDA HEALTH
C Corp
223,659
18,393,409
100.000 %
Yes
(2)
WESTLINK CORPORATION
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
16-1354421
MED & DIAGN SVCS
NY
KALEIDA HEALTH
C Corp
-312
100,640
100.000 %
Yes
(3)
KALEIDA HEALTHNOW INC
257 WEST GENESEE STREET
BUFFALO
,
NY
14202
46-2164089
HEALTH CARE
NY
KALEIDA HEALTH
C Corp
4,883
3,645,060
0 %
No
(4)
GREAT LAKES INTEGRATED NETWORK INC
726 EXCHANGE STREET SUITE 200
BUFFALO
,
NY
14210
82-3184375
HEALTH CARE
NY
KALEIDA HEALTH
C Corp
100.000 %
Yes
Schedule R (Form 990) 2017
Page 3
Schedule R (Form 990) 2017
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
No
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
.....................
1a
Yes
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
Yes
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
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)
VNA HOME CARE SERVICES
q
1,053,079
ACTUAL COST
(2)
VNA HOME CARE SERVICES
e
88,072
ACTUAL COST
(3)
VNA OF WESTERN NEW YORK
q
16,599,202
ACTUAL COST
(4)
VNA OF WESTERN NEW YORK
d
439,283
ACTUAL COST
(5)
MFSC LLC
j
520,700
ACTUAL COST
(6)
MFSC LLC
q
87,972
ACTUAL COST
(7)
MFSC LLC
d
50,376
ACTUAL COST
(8)
KALEIDA PROPERTIES INC
q
112,926
ACTUAL COST
(9)
KALEIDA PROPERTIES INC
d
4,809,213
ACTUAL COST
(10)
SITE E LLC
k
233,450
ACTUAL COST
(11)
WCHOB FOUNDATION
c
2,553,175
ACTUAL COST
(12)
WCHOB FOUNDATION
s
15,385,756
ACTUAL COST
(13)
WCHOB FOUNDATION
d
9,894,580
ACTUAL COST
(14)
KALEIDA HEALTH FOUNDATION
c
3,727,546
ACTUAL COST
(15)
KALEIDA HEALTH FOUNDATION
s
2,067,518
ACTUAL COST
(16)
KALEIDA HEALTH FOUNDATION
d
707,574
ACTUAL COST
(17)
SOUTHTOWNS IMAGING LLC
d
727,437
ACTUAL COST
(18)
VNA OF WESTERN NEW YORK
o
277,559
ACTUAL COST
(19)
VNA OF WESTERN NEW YORK
l
358,004
ACTUAL COST
(20)
MFSC LLC
l
132,000
ACTUAL COST
(21)
VISK
d
300,200
ACTUAL COST
(22)
SOUTHTOWNS IMAGING LLC
j
251,434
ACTUAL COST
(23)
SOUTHTOWNS IMAGING LLC
q
123,931
ACTUAL COST
(24)
SOUTHTOWNS SURGERY CENTER LLC
l
519,836
ACTUAL COST
(25)
SOUTHTOWNS SURGERY CENTER LLC
j
797,072
ACTUAL COST
(26)
SOUTHTOWNS SURGERY CENTER LLC
q
52,878
ACTUAL COST
(27)
SOUTHTOWNS SURGERY CENTER LLC
d
1,668,217
ACTUAL COST
(28)
COLLABORATIVE CARE VENTURES LLC
q
170,063
ACTUAL COST
(29)
COLLABORATIVE CARE VENTURES LLC
d
1,221,167
ACTUAL COST
(30)
CHILDREN'S HOME HEALTH OF WNY INC
q
118,384
ACTUAL COST
(31)
CHILDREN'S HOME HEALTH OF WNY INC
d
150,682
ACTUAL COST
(32)
MILLARD FILLMORE AMBULATORY SURGERY CENTER
c
486,700
ACTUAL COST
(33)
OLEAN GENERAL HOSPITAL
A
1,256,000
ACTUAL COST
Schedule R (Form 990) 2017
Page 4
Schedule R (Form 990) 2017
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(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?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2017
Page 5
Schedule R (Form 990) 2017
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) 2017
Additional Data
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