2019-11-07T15:33:49-06:00 2018-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2018-01-01 160962256 GOOD SHEPHERD-FAIRVIEW HOME INC GOOD 6077242477 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 JAMES KONISZEWSKI CFO 6077242477 2019-11-07 1 JENNIFER ARBORE P00893012 5853811000 4.14.157.194 2019-11-07 10:20:02 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 97CA22C36712BE9F192A465FEB7411582D68DDD7 2018 2020-03-31 21:24:44Z MICHAEL J KEENAN 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 12095573 0 X WWW.GSFHOME.COM X 1969 NY THE GOOD SHEPHERD-FAIRVIEW HOME, INC. OPERATES A MULTI-LEVEL RETIREMENT COMMUNITY. ITS PURPOSE IS TO PROVIDE SUITABLE HOUSING AND HEALTH CARE FOR THE ELDERLY. 15 14 317 33 0 10351 515522 490592 10711114 11201540 -6489 23249 246784 374047 11466931 12089428 315001 87708 0 0 6222719 6239391 0 0 0 5483968 5565405 12021688 11892504 -554757 196924 11352244 10169149 6814230 5530330 4538014 4638819 THE GOOD SHEPHERD-FAIRVIEW HOME, INC. OPERATES A MULTI-LEVEL RETIREMENT COMMUNITY. ITS PURPOSE IS TO PROVIDE SUITABLE HOUSING AND HEALTH CARE FOR THE ELDERLY. 0 0 4490629 87708 5910607 SKILLED NURSING FACILITY AND REHAB 3257907 4288088 ADULT CARE FACILITY 1056618 1390731 INDEPENDENT LIVING 8805154 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 30 0 1 317 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 NY X X JAMES KONISZEWSKI CFO 6077242477 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 SUE FREED DIRECTOR 0.25 0.75 X 0 0 0 JOANN NAVARRO DIRECTOR 0.25 0.75 X 0 0 0 KATHLEEN BUNNELL VICE CHAIR 0.25 0.75 X X 0 0 0 PAUL MOLLO TREASURER 0.25 0.75 X X 0 0 0 LINDA GLAJCH SECRETARY 0.25 0.75 X X 0 0 0 JILL ANDREWS DIRECTOR 0.25 0.75 X 0 0 0 ROGER HALBERT DIRECTOR 0.25 0.75 X 0 0 0 JACK ROQUE DIRECTOR 0.25 0.75 X 0 0 0 JOAN LACEY CHAIR 0.25 0.75 X X 0 0 0 JEFF SMITH DIRECTOR 0.25 0.75 X 0 0 0 R MARK PATTERSON DIRECTOR 0.25 0.75 X 0 0 0 PATTI REUTHER DIRECTOR 0.25 0.75 X 0 0 0 OLIVER RILEY JR DIRECTOR 0.25 0.75 X 0 0 0 KENNETH TOMKO DIRECTOR 0.25 0.75 X 0 0 0 MICHAEL KEENAN PRESIDENT & CEO 8.00 32.00 X X 0 327995 61970 JUDITH SEIER JAN THRU MAR CFO 8.00 32.00 X 0 44704 3530 ALAN RUNDE OCT THRU DEC CFO 8.00 32.00 X 0 42309 114 PATRICIA MACKEY COO 8.00 32.00 X 0 178091 36230 KATHY SWEZEY EXECUTIVE DIRECTOR 40.00 0.00 X 136085 0 27524 136085 593099 129368 1 0 1 0 SELECT REHABILITATION 550 FRONTAGE ROAD SUITE 2415 NORTHFIELD IL 60093 THERAPY SERVICES 769767 MEDICINE SHOPPE 4999 LOUISE DRIVE SUITE 204 MECHANICSBURG PA 17055 PHARMACY & CONSULTATION 249695 SODEXO 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 DINING SERVICES 108898 3 372000 101211 17381 490592 RESIDENTIAL SERVICE REVENUE 623000 11201540 11201540 11201540 9410 9410 19984 1812 4333 18172 -4333 13839 13839 REFUNDS 900099 115689 115689 SOLD SERVICES 623000 88926 88926 GUEST MEALS 722210 71169 71169 98263 98263 374047 12089428 11589426 0 9410 87708 87708 4934733 4521115 413618 141084 141084 800164 499818 300346 363410 332139 31271 55897 55897 27250 27250 2440 1144 1296 92742 92742 387291 326038 61253 5962 4656 1306 222864 222864 768180 768180 65478 3440 62038 PURCHASED SERVICES 1405338 1312696 92642 MANAGEMENT SERVICES - R 779184 90541 688643 FOOD 478729 456617 22112 SUPPLIES 401471 372113 29358 872579 797129 75450 11892504 8805154 3087350 0 294525 43423 66042 1529808 1108700 89647 97421 22432249 16177590 6882199 6254659 351668 302335 1742193 1677393 396162 685218 11352244 10169149 1615488 639144 56915 49777 4545317 4383039 596510 458370 6814230 5530330 X 2793919 2959312 1306202 1241614 437893 437893 4538014 4638819 11352244 10169149 X 196924 -31319 -64800 X 0 1 X 1 0 X 11111 4802 34235 16932 402884 469964 9956142 10608572 10893746 11078544 11201540 53738544 9967253 10613374 10927981 11095476 11604424 54208508 0 0 0 54208508 8751 8414 8632 11869 50860 88526 8751 8414 8632 11869 50860 88526 241405 206604 221047 246784 332597 1248437 10217409 10828392 11157660 11354129 11987881 55545471 0.97590 0.97840 0.00160 0.00090 X SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: VITAL ACCESS PROVIDER DATE: 01/01/18 AMOUNT: 87708. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1742193 -64800 1677393 1528163 214030 1742193 1128985 399178 1528163 1809691 5000 685706 1128985 1258544 5000 546122 1809691 0.26000 0.74000 0 0 469533 469533 10281520 6841307 3440213 7725930 6237031 1488899 3955266 3099252 856014 6254659 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1677393 F 1677393 APARTMENT ESCROW 65522 DUE FROM AFFILIATES 607030 RESIDENT FUNDS 12666 685218 CONTRIBUTIONS PAYABLE 84029 DUE TO THIRD PARTY PAYERS 14693 LINE OF CREDIT 250000 RESIDENT DEPOSITS 78188 WORKERS' COMPENSATION INSURANCE LIABILITY 31460 458370 11997642 -31319 -64800 -96119 12093761 -4333 -4333 12089428 11896837 4333 4333 11892504 0 11892504 PART V, LINE 4: TO SUPPORT THE HOME'S ACTIVITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGES IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION -64,800. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS -4,333. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 4,333. 1 CHASE MEMORIAL NURSING HOME ONE TERRACE HEIGHTS NEW BERLIN NY 13411 160977850 501(C)(3) 87708 TO IMPROVE FINANCIAL STATUS AND VIABILITY 1 0 0 0 0 0 0 0 0 0 MICHAEL KEENAN PRESIDENT & CEO 0 273491 0 54504 0 0 0 33994 0 27976 0 389965 0 0 PATRICIA MACKEY COO 0 165112 0 12979 0 0 0 28676 0 7554 0 214321 0 0 KATHY SWEZEY EXECUTIVE DIRECTOR 136085 0 0 0 0 0 15951 0 11573 0 163609 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B REVIEWED BY OPERATIONS COMMITTEE OF FGS, INC. D/B/A GOOD SHEPHERD COMMUNITIES FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST DISCLOSURES ARE UPDATED ANNUALLY WITH MEMBERS. ANY CONFLICT IS REVIEWED WITH THE EXECUTIVE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION IS DETERMINED BY THE BOD EXECUTIVE COMMITTEE WITH COO PROVIDING MARKET SURVEY DATA. AN OUTSIDE CONSULTANT WAS HIRED TO REVIEW COMPENSATION AND FOUND IT TO BE COMPETITIVE. CEO IS UNDER MULTIPLE YEAR WRITTEN CONTRACT. CEO DETERMINES COMPENSATION OF ALL SENIOR MANAGEMENT POSITIONS WITH MARKET SURVEY DATA PROVIDED BY COO. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS AVAILABLE BY REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, ETC. ARE AVAILABLE BY REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION -64,800. FORM 990, PART XII, LINE 2(C): NO CHANGE FROM PRIOR YEAR. GOOD SHEPHERD-FAIRVIEW FOUNDATION INC 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 133386383 TO PROVIDE FINANCIAL SUPPORT FOR AFFILIATED COMPANIES NY 501(C)(3) LINE 7 FGS DBA GOOD SHEPHERD COMMUNITIES 0 GOOD SHEPHERD VILLAGE AT ENDWELL INC 32 VILLAGE DRIVE ENDWELL NY 13760 205580506 TO PROVIDE A CONTINUING CARE RETIREMENT COMMUNITY FOR THE ELDERY NY 501(C)(3) LINE 10 FGS DBA GOOD SHEPHERD COMMUNITIES 0 FGS DBA GOOD SHEPHERD COMMUNITIES 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 161256975 TO PROVIDE SUITABLE HOUSING TO THE ELDERLY NY 501(C)(3) LINE 12C, III-FI N/A 0 CHASE MEMORIAL NURSING HOME COMPANY INC ONE TERRACE HEIGHTS NEW BERLIN NY 13411 160977850 LONG TERM HEALTH CARE FOR ELDERLY NY 501(C)(3) LINE 10 FGS DBA GOOD SHEPHERD COMMUNITIES 0 CHASE HOUSING CORPORATION ONE TERRACE HEIGHTS NEW BERLIN NY 13411 161080510 HOUSING COMPLEX FOR THE ELDERLY AND HANDICAPPED NY 501(C)(3) LINE 10 FGS DBA GOOD SHEPHERD COMMUNITIES 0 CHASE MEMORIAL COMMUNITY CENTER INC ONE TERRACE HEIGHTS NEW BERLIN NY 13411 150539044 SUPPORT OF HEALTH CARE/ELDERLY SERVICES NY 501(C)(3) LINE 10 FGS DBA GOOD SHEPHERD COMMUNITIES 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0