2020-11-05T07:27:12-06:00 2019-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2019-01-01 161085780 ST CAMILLUS RESIDENTIAL HEALTH CARE FACILITY STCA 3154882951 813 FAY ROAD SYRACUSE NY 132193098 MICHAEL ZINGARO VICE PRESIDENT - FINANCE 3154882951 2020-11-02 1 MARY ELLEN LUKER P00207995 3154463600 2020-11-02 72.228.95.151 2020-11-02 11:33:05 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DBC1BC8B0C1E0EE34BAC0D1569A4ADC0DA1D7718 2019 2021-01-29 14:40:06Z MICHAEL ZINGARO 813 FAY ROAD SYRACUSE NY 132193098 35332092 0 X WWW.ST-CAMILLUS.ORG X 1967 NY ST. CAMILLUS IS A RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO CARING FOR LIFE THROUGH A BROAD RANGE OF HEALTHCARE SERVICES. THE ORGANIZATION OPERATES A 284 BED SKILLED NURSING FACILITY WHICH INCLUDES A 20 BED UNIT DEDICATED TO TRAUMATIC BRAIN INJURY, ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM, A SOCIAL ADULT DAY CARE PROGRAM AND A CERTIFIED HOME HEALTH AGENCY. THROUGH THESE SERVICES, ST. CAMILLUS HELPS TO ADDRESS THE LONG-TERM CARE, REHABILITATION AND HOME AND COMMUNITY BASED CARE NEEDS OF OUR COMMUNITY. 23 23 681 81 0 0 889419 1191129 34535084 33417165 11630 12787 452532 673298 35888665 35294379 0 0 0 0 23995163 23162736 0 0 1249 13193670 12063814 37188833 35226550 -1300168 67829 18369010 17904181 14103771 13571113 4265239 4333068 X ST. CAMILLUS IS A RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO CARING FOR LIFE THROUGH A BROAD RANGE OF HEALTHCARE SERVICES. THE ORGANIZATION OPERATES A 284 BED SKILLED NURSING FACILITY WHICH INCLUDES A 20 BED UNIT DEDICATED TO TRAUMATIC BRAIN INJURY, ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM, A SOCIAL ADULT DAY CARE PROGRAM AND A CERTIFIED HOME HEALTH AGENCY. THROUGH THESE SERVICES, ST. CAMILLUS HELPS TO ADDRESS THE LONG-TERM CARE, REHABILITATION AND HOME AND COMMUNITY BASED CARE NEEDS OF OUR COMMUNITY. 0 0 28627740 34073939 CARE AND TREATMENT OF PATIENTS IN A RESIDENTIAL HEALTH CARE FACILITY, OUTPATIENT ADULT DAY PROGRAMS, IN PATIENTS' HOMES. 28627740 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 681 1 0 0 0 0 0 0 0 0 0 0 0 0 X 23 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MARIA WEIR 3154882951 813 FAY ROAD SYRACUSE NY 132193098 PETER CAPPUCCILLI JR TRUSTEE 1.00 X 0 0 0 JOHN F CATANZARITA TRUSTEE 1.00 X 0 0 0 CHARLES P CONOLE MEMBER/TRUSTEE 1.00 X 0 0 0 JEANNE E BISHOP MD TRUSTEE 1.00 X 0 0 0 JAMES N JEROSE TRUSTEE 1.00 X 0 0 0 RV MSGR RICHARD KOPP MEMBER/TRUSTEE 1.00 X 0 0 0 WAYNE V LA FRANCE TRUSTEE 1.00 X 0 0 0 PAUL MELLO SECRETARY 1.00 X X 0 0 0 SHEILA LEMKE MD TRUSTEE 1.00 X 0 0 0 STEPHEN DALEY TRUSTEE 1.00 X 0 0 0 BRENDA A RIGAS TRUSTEE 1.00 X 0 0 0 JAMES D SPENCER CHAIR/TRUSTEE/MEMBER 1.00 X X 0 0 0 DERRICK J SUEHS TRUSTEE 1.00 X 0 0 0 MARY GRACE VANNORTWICK VICE CHAIR/TRUSTEE 1.00 X X 0 0 0 JOHN MAESTRI TRUSTEE 1.00 X 0 0 0 SCOTT MCCLURG TRUSTEE 1.00 X 0 0 0 DOUGLAS J REICHER TRUSTEE 1.00 X 0 0 0 JOANN WALLACE TRUSTEE 1.00 X 0 0 0 WANDA HINES-MCGRIFF TRUSTEE 1.00 X 0 0 0 ROBERT KRENITSKY TRUSTEE 1.00 X 0 0 0 GEORGE CHAPMAN TRUSTEE 1.00 X 0 0 0 NANCY DAOUST TRUSTEE 1.00 X 0 0 0 JILL GALLAGHER TRUSTEE 1.00 X 0 0 0 CATHERINE GREEN-HARRIS TRUSTEE 1.00 X 0 0 0 BARBARA DRAPOLA TRUSTEE 1.00 X 0 0 0 JENNIFER WATKINS TRUSTEE 1.00 X 0 0 0 AILEEN BALITZ PRESIDENT 36.00 4.00 X 203022 0 300 MICHAEL ZINGARO VP FINANCE 36.00 4.00 X 137934 0 6516 MICHAEL SCHAFER VP - NURSING 40.00 X 149838 0 6516 KATHRYN BARBER VP - QUALITY MANAGEMENT 36.00 4.00 X 108023 0 10345 HEATHER KEMMIS VP - HOME CARE 24.00 16.00 X 95481 0 15840 JOYCE DENNINGTON VP - HUMAN RESOURCES 32.00 8.00 X 10548 0 0 CARIN PREDMORE VP- HUMAN RESOURCES 32.00 8.00 X 108915 0 300 DR ALBERT TRIPODI MEDICAL DIRECTOR 40.00 X 144973 0 0 SARAH FIASCHETTI DIRECTOR OF NURSING 40.00 X 111960 0 11069 DONNA GILLETTE NURSE PRACTITIONER 40.00 X 100793 0 15743 MARIA WEIR DIRECTOR OF FINANCE 40.00 X 102400 0 287 1273887 0 66916 9 0 1 0 SODEXO INC PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICE 1362182 NURSE CONNECTION STAFFING INC 1 COMPUTER DRIVE SOUTH ALBANY NY 12205 NURSING STAFF 660431 ADECCO EMPLOYMENT SERVICES 225 GREENFIELD PARKWAY LIVERPOOL NY 13088 NURSING STAFF 612990 MCKESSON HBOC 6555 STATE HWY 161 IRVING TX 75039 SUPPLIES 587688 CLINICAL STAFFING RESOURCES PO BOX 4776 DEPT 100 HOUSTON TX 77210 NURSING STAFF 395380 16 75804 1115325 1191129 PROGRAM SERVICE REVENUE 623000 33417165 33417165 33417165 12787 12787 43684 0 43684 43684 43684 9748 75804 37713 -27965 -27965 OTHER REVENUE 623000 337307 337307 FUND DEVELOPMENT REVENUE 623000 168351 168351 MANAGEMENT FEE INCOME 623000 107436 107436 44485 43680 805 657579 35294379 34073939 0 29311 853578 853578 18233880 15019076 3214804 2689553 2116290 573263 1385725 1148959 236766 37991 37991 25624 25624 1617881 1514863 103018 145040 97177 47863 141815 36093 105722 6274 6274 673488 606139 67349 74215 71509 2706 11821 2390 9431 85002 85002 1025867 923280 102587 378100 253302 124798 CONTRACT LABOR 2914099 2914099 SUPPLIES 2058419 1959749 98670 NYS ASSESSMENT 1290379 1290379 EQUIPMENT & MAINTENANCE 597697 317494 280203 980102 356941 621912 1249 35226550 28627740 6597561 1249 1218169 670291 6587140 6684423 83071 124584 71015 65364 227287 175188 31165209 25011166 6700118 6154043 3482210 4030288 18369010 17904181 6232122 6646887 328542 99212 4371386 5909021 3171721 915993 14103771 13571113 X 4188856 4270541 76383 62527 4265239 4333068 18369010 17904181 67829 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 76383 17267 31123 62527 70879 53609 48105 76383 83226 38060 50407 70879 137990 12478 67242 83226 52712 98428 13150 137990 1.00000 0 0 153315 153315 22222112 17016256 5205856 1341859 1249742 92117 7428797 6745168 683629 19126 19126 6154043 PATIENT FUNDS 70233 RESERVE FOR REPLACEMENTS 1474004 OTHER RECEIVABLES 1540904 LONG TERM RECEIVABLES 200738 DONOR RESTRICTED FUNDS 129183 GRANT RESTRICTED FUNDS 62389 CURRENT PORTION OF ASSETS LIMITED AS TO USE 371141 DUE FROM MEDICAID 181696 4030288 PATIENTS' FUNDS 70233 ESTIMATED THIRD PARTY SETTLEMENTS 373536 OTHER LIABILITIES 200738 CURRENT PORTION OF GRANT FUNDS HELD FOR OTHERS 271486 915993 X PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE ORGANIZATION HAS BEEN LIMITED BY DONORS OR GRANTORS TO A SPECIFIC TIME PERIOD OR PURPOSE. PART X, LINE 2: ST. CAMILLUS AND INTEGRITY ARE TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF DECEMBER 31, 2019, THE ORGANIZATION DOES NOT HAVE ANY SIGNIFICANT UNRECOGNIZED TAX BENEFIT OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2016 THROUGH 2019. X X X X X X X 0 NY ANNUAL DINNER 31450 31450 21534 AUXILLARY FASHION SHOW 13628 10444 3184 5377 4 40474 33910 6564 10802 85552 75804 9748 37713 37713 -27965 X X 0 0 0 0 0 0 0 0 0 AILEEN BALITZ PRESIDENT 203022 0 0 0 0 0 0 0 300 0 203322 0 0 0 MICHAEL SCHAFER VP - NURSING 149838 0 0 0 0 0 0 0 6516 0 156354 0 0 0 PART I, LINE 3 THE FACILITY'S SALARY RANGES ARE BASED ON AN INCORPORATION OF A STUDY PERFORMED BY AN INDEPENDENT ACCOUNTING FIRM DURING THE 1990'S, TRENDED FORWARD, AND TWO SEPARATE INDEPENDENT SURVEYS OF SALARY PACKAGES OF SIMILAR POSITIONS RECEIVED DURING 2009. ON AN ONGOING BASIS, THE VP OF HUMAN RESOURCES CONTACTS THEIR COUNTERPARTS IN THE AREA TO CHECK THEIR RATES AND BENEFITS. LEADING AGE NY CONDUCTS PERIODIC COMPENSATION SURVEYS THAT THE ORGANIZATION REVIEWS TO GAUGE CURRENT SALARY STRUCTURE WITHIN THE INDUSTRY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION VOTE TO ELECT TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE OPERATING DECISIONS MADE BY THE GOVERNING BODY (BOARD OF TRUSTEES) ARE DONE SO BY A MAJORITY VOTE OF THE TRUSTEES AND CAN NOT BE OVERRIDDEN. HOWEVER, ANY BY LAW CHANGES OR NEW TRUSTEE APPOINTMENTS REQUIRE A MAJORITY VOTE OF THE MEMBERS, IF PERSONALLY IN ATTENDANCE, OR BY PROXY, AT THE MEETING OR 100% WRITTEN APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B BEFORE THIS FORM 990 WAS FILED WITH THE IRS, ALL OF THE FOLLOWING REVIEWS TOOK PLACE: THE FORM 990 WAS REVIEWED BY THE CONTROLLER, CHIEF FINANCIAL OFFICER, AND CORPORATE COMPLIANCE OFFICER, IN CONSULTATION WITH ADMINISTRATIVE STAFF MEMBERS, EXECUTIVE MANAGEMENT, AND ADVISORS TO THE ORGANIZATION. THE FORM 990 WAS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES AND WAS MADE AVAILABLE TO ALL CURRENT VOTING MEMBERS OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES WRITTEN DISCLOSURES BY ALL TRUSTEES, OFFICERS, KEY EMPLOYEES, AND OTHER MANAGEMENT OR SUPERVISORY EMPLOYEES WHO ARE IN A POSITION TO INFLUENCE DECISION MAKING FOR THE ORGANIZATION. SUCH INDIVIDUALS ARE REQUIRED TO DISCLOSE ACTUAL AND POTENTIAL CONFLICTS OF INTEREST UPON INITIAL AFFILIATION WITH THE ORGANIZATION, ON AN ANNUAL BASIS, AND WHENEVER REPORTABLE INTERESTS ARISE. THE COMPLIANCE OFFICER, IN COLLABORATION WITH THE CHAIR OF THE AUDIT COMMITTEE, IN CONSULTATION WITH THE PRESIDENT, REVIEWS WRITTEN DISCLOSURES, OBTAINS FURTHER INFORMATION AS NEEDED, AND EVALUATES ACTUAL AND POTENTIAL CONFLICTS. AS WARRANTED, THE PRESIDENT, THE CHAIR OF THE AUDIT COMMITTEE, AND/OR BOARD CHAIRMAN IMPLEMENTS MEASURES TO ENSURE THAT DECISIONS RELATING TO THE ORGANIZATION ARE MADE SOLELY ON THE BASIS OF THE BEST INTERESTS OF THE ORGANIZATION AND IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PURPOSES. ANY TRUSTEE WHO HAS A DUALITY OF INTEREST OR A POTENTIAL CONFLICT OF INTEREST AS TO A MATTER COMING BEFORE THE BOARD IS PROHIBITED FROM VOTING OR USING PERSONAL INFLUENCE AS TO BOARD ACTION ON SUCH MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE FACILITY'S SALARY RANGES ARE BASED ON AN INCORPORATION OF A STUDY PERFORMED BY AN INDEPENDENT ACCOUNTING FIRM DURING THE 1990'S AND TRENDED FORWARD AND TWO SEPARATE INDEPENDENT SURVEYS OF SALARY PACKAGES OF SIMILAR POSITIONS RECEIVED DURING 2009. ON AN ONGOING BASIS, THE VP OF HUMAN RESOURCES CONTACTS THEIR COUNTERPARTS IN THE AREA TO CHECK THEIR RATES AND BENEFITS. LEADING AGE NY CONDUCTS PERIODIC COMPENSATION SURVEYS THAT THE ORGANIZATION REVIEWS TO GAUGE CURRENT SALARY STRUCTURE WITHIN THE INDUSTRY. AT THE TIME OF HIRE THE FACILITY'S CEO REVIEWS THE SALARY REQUIREMENTS FOR KEY EMPLOYEES IN RELATION TO CURRENT MARKET CONDITIONS AND SALARY PAYSCALES PREVIOUSLY APPROVED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION. ANY SALARY RECOMMENDATIONS PROPOSED THAT ARE NOT COMMENSURATE WITH PREVIOUSLY APPROVED PAYSCALES REQUIRE CONSULTATION WITH AND AGREEMENT FROM THE BOARD CHAIRPERSON. ANNUALLY, OR WHEN CIRCUMSTANCES WARRANT, THE CEO PRESENTS TO THE EXECUTIVE COMMITTEE FOR THEIR REVIEW AND APPROVAL ANY RECOMMENDATIONS FOR COMPENSATION OF KEY EMPLOYEES BASED ON PERFORMANCE EVALUATIONS. FORM 990, PART VI, SECTION C, LINE 18 THE FACILITY MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C ST. CAMILLUS HAS AN AUDIT COMMITTEE AND A FINANCE COMMITTEE, BOTH COMPRISED OF TRUSTEES. THE AUDIT COMMITTEE, IN CONJUNCTION WITH THE FINANCE COMMITTEE MEETS TWICE ANNUALLY, THE FIRST MEETING TO REVIEW THE ANTICIPATED AUDIT PROCESS AND TO DISCUSS ANY POTENTIAL MATTERS REQUIRING DISCLOSURE OR A CHANGE FROM PRIOR YEAR TREATMENT, ETC; THE SECOND MEETING TO REVIEW THE FINAL FINANCIAL STATEMENTS AND ANY FINDINGS. IN ADDITION TO THE JOINT MEETINGS WITH THE AUDIT COMMITTEE, THE FINANCE COMMITTEE MET AN ADDITIONAL 6 TIMES DURING THE YEAR. THERE WERE NO CHANGES TO THE PROCESS DURING 2019. SCHEDULE A LINE 3 ST. CAMILLUS RESIDENTIAL HEALTH CARE FACILITY IS A NURSING HOME WHICH HAS AS ITS MAIN PURPOSE THE PROVISION OF HEALTHCARE SERVICES, IT APPROPRIATELY NOTED ON FORM 1023 THAT IT IS A HOSPITAL. THE STATE OF NEW YORK DOES NOT REQUIRE NURSING HOMES TO BE LICENSED AS A HOSPITAL. AS A NURSING HOME, ST. CAMILLUS RESIDENTIAL HEALTH CARE FACILITY HAS AS ITS PRINCIPAL PURPOSE THE PROVISION OF HEALTH CARE. ACCORDINGLY, IT WAS (I) PROPERLY IDENTIFIED AS A "HOSPITAL" ON FORM 1023; (II) PROPERLY IDENTIFIED AS A "HOSPITAL" ON FORM 990 SCHEDULE A; AND (III) SHOULD NOT BE DESIGNATED AS A "HOSPITAL/HOSPITAL FACILITY" ON FORM 990 SCHEDULE H. INTEGRITY HOME CARE SERVICES INC 813 FAY ROAD SYRACUSE NY 13219 161500579 HOME HEALTH SERVICES NY 501 (C) (3) 10 ST CAMILLUS RESIDENTAL HEALTH CARE FACILITY 1 1 1 0 1 1 0 0 0 0 1 0 1 0 1 1 1 1 0 0 INTEGRITY HOME CARE SERVICES INC A 7200 FMV INTEGRITY HOME CARE SERVICES INC B 13014 FMV INTEGRITY HOME CARE SERVICES INC J 6662 FMV INTEGRITY HOME CARE SERVICES INC P 667653 FMV INTEGRITY HOME CARE SERVICES INC Q 580000 FMV