2017-11-13T13:08:00-06:00 2016-12-31 474526160 EFPR GROUP CPAS PLLC 280 KENNETH DRIVE ROCHESTER NY 14623 990 2016-01-01 160962256 GOOD SHEPHERD-FAIRVIEW HOME INC GOOD 6077242477 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 JUDITH SEIER CFO 6077242477 2017-11-09 1 WILLIAM FRIEDMAN P00060112 5854278900 2017-11-09 64.88.174.3 2017-11-09 09:50:41 ES P BE935AE4703465E2E97F1EA689C26804D8B216D1 5B9A64A0F8A969FC6577C41733DAD495BCBC4276 2016 2017-02-10 21:41:12Z MICHAEL KEENAN 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 11923548 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. 18 17 338 63 0 0 997949 885193 10297422 10802201 -35095 13675 206604 221047 11466880 11922116 0 662291 0 0 6208022 6538891 0 0 0 5073462 5196001 11281484 12397183 185396 -475067 10267263 11336670 5339755 6482506 4927508 4854164 X 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 5835327 662291 6834414 SKILLED NURSING FACILITY AND REHAB. 1317654 1543255 LICENSED ASSISTED LIVING PROGRAM 1882363 2204650 ADULT CARE FACILITY 376473 440929 APARTMENTS, BEAUTY, CAFE, PHYSICAL THERAPY AND OCCUPATIONAL THERAPY 376473 440929 9411817 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 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 44 0 1 338 1 0 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X JUDITH SEIER 6077242477 80 FAIRVIEW AVENUE BINGHAMTON NY 13904 R MARK PATTERSON DIRECTOR 1.00 X X 0 0 0 JOANN NAVARRO CHAIR 1.00 X X 0 0 0 LINDA GLAJCH SECRETARY 1.00 X X 0 0 0 JILL ANDREWS DIRECTOR 1.00 X 0 0 0 DOUGLAS JOHNSON DIRECTOR 1.00 X 0 0 0 JOAN LACEY VICE CHAIR 1.00 X X 0 0 0 PATTI REUTHER DIRECTOR 1.00 X 0 0 0 PAUL MOLLO TREASURER 1.00 X X 0 0 0 OLIVER RILEY JR DIRECTOR 1.00 X 0 0 0 ELLEN RURY DIRECTOR 1.00 X 0 0 0 JEFFREY SMITH DIRECTOR 1.00 X 0 0 0 THOMAS SYLVESTER DIRECTOR 1.00 X 0 0 0 KENNETH TOMKO DIRECTOR 1.00 X 0 0 0 MICHAEL KEENAN PRESIDENT & CEO 16.00 24.00 X X 0 317991 42573 KATHY BUNNELL DIRECTOR 1.00 X 0 0 0 LARRY HARRIS DIRECTOR 1.00 X 0 0 0 RYAN MEAD DIRECTOR 1.00 X 0 0 0 PAUL MARRA DIRECTOR 1.00 X 0 0 0 KATHY SWEZEY EXECUTIVE DIRECTOR 40.00 X 122545 0 19704 JUDITH SEIER CFO 18.00 22.00 X 0 121348 12522 PATRICIA MACKEY COO 18.00 22.00 X 0 139532 14955 122545 578871 89754 1 0 1 0 SELECT REHABILITATION 550 FRONTAGE ROAD SUITE 2415 NORTHFIELD IL 60093 THERAPY SERVICES 833499 SODEXO 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 DINING SERVICES 516294 MEDICINE SHOPPE 4999 LOUISE DR SUITE 204 MECHANICSBURG PA 17055 PHARMACY & CONSULTATION 272562 YORK'S LANDSCAPING SERVICE 3065 PENNSYLVANIA AVE APALACHINI NY 13732 CONSTRUCTION 201705 WILLIAM H LANE 113 COURT STREET BINGHAMTON NY 13901 CONSTRUCTION 138807 5 188667 687291 9235 885193 RESIDENTIAL SERVICE REVENUE 623000 10802201 10802201 10802201 8632 8632 6071 404 1432 0 4639 404 5043 5043 SOLD SERVICES 623000 57996 57996 GIFT SHOP 453220 47505 47505 BEAUTY SHOP 812900 38715 38715 76831 76831 221047 11922116 11023248 0 13675 662291 662291 4930033 4447872 482161 140919 140919 1105605 744067 361538 362334 328680 33654 941571 99831 841740 18162 18162 34015 32719 1296 83224 83224 330983 311385 19598 7970 4102 3868 12122 12122 731585 731585 82914 5940 76974 PURCHASED SERVICES 1384409 1378232 6177 FOOD 503635 472943 30692 SUPPLIES 502509 431782 70727 NYS ASSESSMENT 215605 215605 347297 276368 70929 12397183 9411817 2985366 0 138590 301552 350625 1167533 1254155 114780 91071 22319857 14787892 7412753 7531965 179403 210779 1128985 1528163 125219 68360 10267263 11336670 944608 931468 64398 90787 4086730 4741788 244019 718463 5339755 6482506 X 3795944 3323659 699671 1092612 431893 437893 4927508 4854164 10267263 11336670 X -475067 2545 399178 X X 0 1 X 1 0 X 14797 6962 11111 4802 34235 71907 9288608 10459761 9956142 10608572 10893746 51206829 9303405 10466723 9967253 10613374 10927981 51278736 0 0 0 51278736 11461 9963 8751 8414 8632 47221 11461 9963 8751 8414 8632 47221 176123 208371 241405 206604 221047 1053550 9490989 10685057 10217409 10828392 11157660 52379507 0.97900 0.98020 0.00090 0.00090 X SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: VITAL ACCESS PROVIDER DATE: 08/01/16 AMOUNT: 662291. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 431893 6000 437893 426893 5000 431893 421868 5025 426893 368238 53630 421868 362238 6000 368238 1.00000 0 0 456317 456317 10355671 6245195 4110476 7637469 5834988 1802481 3870400 2707709 1162691 7531965 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1528163 F 1528163 CONTRIBUTIONS PAYABLE 374039 DUE TO RELATD PARTIES 32876 DUE TO THIRD PARTY PAYERS 1954 LINE OF CREDIT 150000 RESIDENT DEPOSITS 68360 WORKERS' COMPENSATION INSURANCE LIABILITY 91234 718463 X 12318916 2545 399178 401723 11917193 4923 4923 11922116 12392260 0 12392260 4923 4923 12397183 PART V, LINE 4: TO SUPPORT THE HOME'S ACTIVITIES. PART X, LINE 2: THE HOME IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE HOME'S TAX-EXEMPT PURPOSE MAY BE SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. IN ACCORDANCE WITH ASC 740-10-50, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE HOME RECOGNIZES THE TAX BENEFITS FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES. MANAGEMENT BELIEVES THAT THE HOME IS CURRENTLY OPERATING IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS HAS BEEN INCLUDED ON THE HOME'S FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGES IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 399,178. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE PER ASU 2011-07 4,923. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE PER ASU 2011-07 4,923. 1 CHASE MEMORIAL NURSING HOME ONE TERRACE HEIGHTS NEW BERLIN NY 13411 160977850 501(C)(3) 662291 TO IMPROVE FINANCIAL STATUS AND VIABILITY 1 0 0 0 0 0 0 1 1 0 0 MICHAEL KEENAN PRESIDENT & CEO 0 265587 0 52404 0 0 0 0 0 42573 0 360564 0 0 PATRICIA MACKEY COO 0 139532 0 0 0 0 0 0 0 14955 0 154487 0 0 PART I, LINE 3 THE ORGANIZATION IS A SUBSIDIARY OF FGS, INC. AND HAS RELIED ON FGS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO. PART I, LINE 6 MICHAEL KEENAN RECEIVED BONUSES PER HIS CONTRACT. 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 IS USED AS WELL. 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 399,178. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0