2018-11-13T13:34:15-06:00 2017-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL ROCHESTER NY 14534 990 2017-01-01 160962256 GOOD SHEPHERD-FAIRVIEW HOME INC GOOD 6077242477 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 ALAN RUNDE CFO 6077242477 2018-11-08 1 JENNIFER ARBORE P00893012 5853811000 4.14.157.194 2018-11-08 09:18:47 ES P 23025919B01E351967CFBA1C5A22CB7E3130E6CC 9905B8AE44F9A523E3DB1257BB3F03EEF3C060D2 2017 2019-02-21 02:37:17Z MICHAEL J KEENAN 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 11504094 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. 16 15 327 60 0 0 885193 515522 10802201 10711114 13675 -6489 221047 246784 11922116 11466931 662291 315001 0 0 6538891 6222719 0 0 0 5196001 5483968 12397183 12021688 -475067 -554757 11336670 11352244 6482506 6814230 4854164 4538014 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 4690389 315001 5797957 SKILLED NURSING FACILITY AND REHAB 3185925 3938234 ADULT CARE FACILITY 973477 1203349 INDEPENDENT LIVING 8849791 1 1 0 0 0 0 0 0 0 1 1 1 0 0 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 36 0 327 1 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 NY X X ALAN RUNDE CFO 6077242477 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 JOAN NAVARRO CHAIR 0.25 0.75 X X 0 0 0 RYAN MEAD 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 LAWRENCE HARRIS DIRECTOR 0.25 0.75 X 0 0 0 DOUGLAS JOHNSON DIRECTOR 0.25 0.75 X 0 0 0 JOAN LACEY DIRECTOR 0.25 0.75 X 0 0 0 PAUL MARRA 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 THOMAS SYLVESTER 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 319498 47484 PATRICIA MACKEY COO 8.00 32.00 X 0 151567 15057 JUDITH L SEIER CFO 8.00 32.00 X 0 132394 14292 0 603459 76833 1 0 1 0 SELECT REHABILITATION 550 FRONTAGE ROAD SUITE 2415 NORTHFIELD IL 60093 THERAPY SERVICES 774020 MEDICINE SHOPPE 4999 LOUISE DRIVE SUITE 204 MECHANICSBURG PA 17055 PHARMACY & CONSULTATION 282903 SODEXO 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 DINING SERVICES 142455 3 183589 315001 16932 515522 RESIDENTIAL SERVICE REVENUE 623000 10711114 10711114 10711114 11869 11869 18805 2022 35141 16783 -35141 -18358 -18358 GUEST MEALS 722210 74412 74412 SOLD SERVICES 623000 71560 71560 REFUNDS 900099 44415 44415 56397 56397 246784 11466931 10939540 0 11869 315001 315001 4853372 4368802 484570 124188 124188 891176 548528 342648 353983 318374 35609 31641 31641 22300 22300 1296 1296 98258 98258 317733 273472 44261 7793 2508 5285 202633 202633 777170 777170 68251 4020 64231 PURCHASED SERVICES 1381121 1376446 4675 MANAGEMENT SERVICES - R 822223 77810 744413 SUPPLIES 524744 488428 36316 FOOD 450207 427390 22817 778598 649012 129586 12021688 8849791 3171897 0 301552 294525 350625 66042 1254155 1529808 91071 89647 22328717 15446518 7531965 6882199 210779 351668 1528163 1742193 68360 396162 11336670 11352244 931468 1615488 90787 56915 4741788 4545317 718463 596510 6482506 6814230 X 3323659 2793919 1092612 1306202 437893 437893 4854164 4538014 11336670 11352244 X -554757 24577 214030 X 0 1 X 1 0 X 6962 11111 4802 34235 16932 74042 10459761 9956142 10608572 10893746 11078544 52996765 10466723 9967253 10613374 10927981 11095476 53070807 0 0 0 53070807 9963 8751 8414 8632 11869 47629 9963 8751 8414 8632 11869 47629 208371 241405 206604 221047 246784 1124211 10685057 10217409 10828392 11157660 11354129 54242647 0.97840 0.97900 0.00090 0.00090 X SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: VITAL ACCESS PROVIDER DATE: 08/01/16 AMOUNT: 315001. 1528163 214030 1742193 1128985 399178 1528163 1809691 5000 685706 1128985 1258544 5000 546122 1809691 1069871 53630 135043 1258544 0.25000 0.75000 0 0 469533 469533 10261525 6499573 3761952 7686226 6047420 1638806 3911433 2899525 1011908 6882199 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1742193 F 1742193 CONTRIBUTIONS PAYABLE 187823 DUE TO THIRD PARTY PAYERS 30967 LINE OF CREDIT 250000 RESIDENT DEPOSITS 67946 WORKERS' COMPENSATION INSURANCE LIABILITY 59774 596510 11740679 24577 214030 238607 11502072 -35141 -35141 11466931 12056829 35141 35141 12021688 0 12021688 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 214,030. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS -35,141. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 35,141. 1 CHASE MEMORIAL NURSING HOME ONE TERRACE HEIGHTS NEW BERLIN NY 13411 160977850 501(C)(3) 315001 TO IMPROVE FINANCIAL STATUS AND VIABILITY 1 0 0 0 0 0 0 0 0 0 MICHAEL KEENAN PRESIDENT & CEO 0 264994 0 54504 0 0 0 15212 0 32272 0 366982 0 0 PATRICIA MACKEY COO 0 141767 0 9800 0 0 0 8676 0 6381 0 166624 0 0 FORM 990, PART VI, SECTION B, LINE 11B REVIEW WITH THE OP'S COMMITTEE OF THE BOARD. 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 214,030. 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