2023-11-14T11:55:17-06:00 2022-12-31 135565207 KPMG LLP 515 BROADWAY 4TH FLOOR ALBANY NY 122072974 990 2022-01-01 161307129 MILLARD FILLMORE AMBULATORY SURGERY CENTER C/O KALEIDA HEALTH MILL 7168598501 726 EXCHANGE STREET 200 BUFFALO NY 14210 HUGH CHISHOLM CFO 7168598501 2023-11-13 1 HUGH CHISHOLM 999009999 0 STEPHANIE LONCZAK P01880207 5184274600 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DONALD BOYD 100 HIGH STREET BUFFALO NY 14203 539156 0 X WWW.KALEIDAHEALTH.ORG X 1989 NY HOLDING TITLE TO PROPERTY, COLLECTING INCOME THEREFROM, AND TURNING OVER THE ENTIRE AMOUNT THEREOF TO ITS SOLE CORPORATE MEMBER, KALEIDA HEALTH. 0 0 0 0 0 0 0 0 539156 539156 0 0 0 0 539156 539156 539156 539156 0 0 0 0 0 0 0 51346 51351 590502 590507 -51346 -51351 311654 260307 14567 14571 297087 245736 HOLDING TITLE TO PROPERTY, COLLECTING INCOME THEREFROM, AND TURNING OVER THE ENTIRE AMOUNT THEREOF TO ITS SOLE CORPORATE MEMBER, KALEIDA HEALTH. 0 0 590507 539156 539156 COLLECTING RENTAL INCOME FROM THE LEASE OF THE AMBULATORY SURGERY CENTER BUILDING AND TURNING OVER THE ENTIRE AMOUNT THEREOF TO ITS SOLE CORPORATE MEMBER, KALEIDA HEALTH. 590507 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 NY X HUGH CHISHOLM 7168598836 726 LARKIN STREET FLOOR 2 BUFFALO NY 14210 X NONE NONE 0.00 X 0 0 0 0 0 0 0 0 0 0 0 RENTAL INCOME FROM AMB 531120 539156 539156 539156 539156 539156 0 0 539156 539156 51346 51346 OTHER EXPENSES 5 5 590507 590507 0 0 3198534 2938227 311654 260307 311654 260307 14567 14571 14567 14571 X 297087 245736 297087 245736 311654 260307 -51351 0 X 0 1 X 1 0 X X 1 KALEIDA HEALTH 161533232 3 0 539156 0 1 539156 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION B, LINE 1 THE ENTITY NO LONGER RETAINS A GOVERNING BODY. THE ORGANIZATION'S ONLY SUPPORTED ORGANIZATION, KALEIDA HEALTH MAINTAINS THE OPERATIONS OF THE FILING ORGANIZATION. KALEIDA HEALTH'S BOARD OF DIRECTORS ARE RESPONSIBLE FOR ALL DECISIONS RELATED TO MILLARD FILLMORE AMBULATORY SURGERY CENTER. 3196326 2936019 260307 2208 2208 0 260307 X PART X, LINE 2: FIN 48 FOOTNOTE 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. 1 KALEIDA HEALTH (KH) 726 EXCHANGE STREET BUFFALO NY 14210 161533232 501(C)(3) 539156 0 N/A N/A SUPPORT HEALTHCARE PROVIDER KH 1 PART I, LINE 2: DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING USE OF GRANTS: AS DESCRIBED IN THE FILING ORGANIZATION'S MISSION ON FORM 990, PART I, LINE 1, MILLARD FILLMORE AMBULATORY SURGERY CENTER'S (MFASC) PRIMARY PURPOSE IS TO HOLD TITLE TO PROPERTY COLLECTING INCOME AND THEN TURN OVER THE ENTIRE AMOUNT THEREOF TO ITS CORPORATE MEMBER, KALEIDA HEALTH. MFASC DOES NOT MAKE GRANT PAYMENTS TO ANY OTHER ORGANIZATION OTHER THAN KALEIDA HEALTH, THE DESIGNATED SUPPORTED ORGANIZATION (FORM 990, SCHEDULE A, PART I, LINE 12G). THE GRANT PAYMENT IN THE AMOUNT OF $539,156 MADE IN 2022 EQUATES TO THE GROSS RENTAL INCOME ASSOCIATED WITH THE PROPERTY FOR WHICH MFASC HOLDS TITLE. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION'S MEMBER & MEMBER'S RIGHTS 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. FORM 990, PART VI, SECTION A, LINE 7A THE ENTITY NO LONGER RETAINS A GOVERNING BODY AND KALEIDA HEALTH, AS THE SOLE CORPORATE MEMBER, MAINTAINS THE OPERATIONS OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B KALEIDA HEALTH'S BOARD OF DIRECTORS ARE RESPONSIBLE FOR ALL DECISIONS RELATED TO MILLARD FILLMORE AMBULATORY SURGERY CENTER. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS FOR FORM 990 MANAGEMENT FOR KALEIDA HEALTH, THE ORGANIZATION'S SOLE CORPORATE MEMBER, IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, KPMG, REVIEWS THE FORM 990. THE FINANCIAL REVIEW IS BASED ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE RELEVANT TIME PERIOD. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY THE FILING ORGANIZATION IS A MEMBER OF THE HEALTH CARE ORGANIZATIONAL STRUCTURE OF KALEIDA HEALTH, AS SUCH THE CONFLICT OF INTEREST POLICY APPLICABLE TO KALEIDA HEALTH'S BOARD OF DIRECTORS AND KEY EMPLOYEES WOULD ALSO BE APPLICABLE TO THE FILING ORGANIZATION. KALEIDA HEALTH, THE ORGANIZATION'S SOLE CORPORATE MEMBER, MONITORS ITS CONFLICT OF INTEREST POLICY AS FOLLOWS: UPON EMPLOYMENT AND ANNUALLY THEREAFTER EACH KEY EMPLOYEE AND OFFICER OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, PROVIDING SUFFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THE ORGANIZATION CAN (1) DETERMINE WHETHER ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST MAY EXIST, AND (2) MONITOR WORK OR SERVICE ASSIGNMENTS TO AVOID PLACING THE KEY EMPLOYEE, OFFICER OR DIRECTOR IN A POSITION WHERE THERE MAY BE A POTENTIAL, ACTUAL, OR EVEN APPEARANCE, OF A CONFLICT OF INTEREST OR A QUESTION OF OBJECTIVITY. THE COMPLETED CONFLICT OF INTEREST FORMS FOR DIRECTORS ARE RETURNED TO THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 ACCESS TO ORGANIZATIONAL DOCUMENTS 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 ORGANIZATION'S SOLE CORPORATE MEMBER) AT 726 EXCHANGE STREET, SUITE 200, BUFFALO, NY 14210. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. KALEIDA HEALTH 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161533232 HOSPITAL NY 501(C)(3) 3 N/A 0 VNA HOME CARE SERVICES 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161491203 HOME HLTHCARE NY 501(C)(3) 10 KH 0 VNA OF WESTERN NEW YORK 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 160743214 HOME HLTHCARE NY 501(C)(3) 10 KH 0 VISK 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 222738425 SUPPORT ORG NY 501(C)(3) 10 KH 0 KALEIDA HEALTH FOUNDATION 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161579143 FUNDRAISING NY 501(C)(3) 7 KH 0 WOMEN & CHILDRENS HOSP OF BUFFALO FDN 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 161332044 FUNDRAISING NY 501(C)(3) 7 KH 0 CHILDREN'S HEALTH HOME OF WNY INC 726 EXCHANGE STREET SUITE 200 BUFFALO NY 14210 814086046 PED HOME HLTH NY 501(C)(3) 10 KH 0 UPPER ALLEGHENY HEALTH SYSTEM INC 515 MAIN STREET OLEAN NY 14760 271255425 SUPPORT ORG NY 501(C)(3) 12A KH 0 OLEAN GENERAL HOSPITAL 515 MAIN STREET OLEAN NY 14760 160743102 HOSPITAL NY 501(C)(3) 3 UAHS 0 BRADFORD REGIONAL MED SVCS 116 INTERSTATE PARKWAY BRADFORD PA 16701 232875157 PHYS. GROUP PA 501(C)(3) 3 BRMC 0 HEALTH SYSTEM PHYSICIAN PC 130 SOUTH UNION STREET OLEAN NY 14760 463404317 PHYS. 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