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NORTH PARK NURSING HOME INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
NORTH PARK NURSING HOME INC (EIN 22-3159644)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-15
IRS object ID
201643209349308699
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-11-15T13:29:02-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN161226221PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FUST CHARLES CHAMBERS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line15784 WIDEWATERS PARKWAYAddressLine1Txt
CitySYRACUSECityNm
State AbbreviationNYStateAbbreviationCd
ZIP13214ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN223159644EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NORTH PARK NURSING HOME INCBusinessNameLine1Txt
Business Name Line2DBA EDNA TINA WILSON LIVING CENTERBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlNORTBusinessNameControlTxt
Phone5853686290PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11555 LONG POND RDAddressLine1Txt
CityROCHESTERCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14626ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTHOMAS R CRILLYPersonNm
Person TitleCFOPersonTitleTxt
Phone5853686290PhoneNum
Signature2016-11-11SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonANGELA M FRANCOPreparerPersonNm
PTINP00589741PTIN
Phone3154463600PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerERIC BIEBER MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11555 LONG POND RDAddressLine1Txt
CityROCHESTERCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14626ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$16,358,947GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ROCHESTERREGIONAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1991FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionAS AN AFFILIATE OF THE SYSTEM AND THE CENTER OF AGING AND CONTINUING CARE SERVICES, NORTH PARK NURSING HOME, INC. (D.B.A EDNA TINA WILSON LIVING CENTER) IS DEDICATED TO PROVIDING QUALITY CARE, INDEPENDENCE AND A POSITIVE LIVING EXPERIENCE FOR PATIENTS AND RESIDENTS IN OUR FACILITY. THE MISSION IS ACHIEVED THROUGH THE CORE VALUES OF THE SYSTEM WHICH INCLUDE PEOPLE, EXCELLENCE, LEARNING AND RESULTS.ActivityOrMissionDesc
Voting Members Governing Body25VotingMembersGoverningBodyCnt
Voting Members Independent24VotingMembersIndependentCnt
Total Employee317TotalEmployeeCnt
Total Volunteers69TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$421,170PYContributionsGrantsAmt
CY Contributions Grants$348,672CYContributionsGrantsAmt
PY Program Service Revenue$16,427,715PYProgramServiceRevenueAmt
CY Program Service Revenue$15,973,462CYProgramServiceRevenueAmt
PY Investment Income$115,897PYInvestmentIncomeAmt
CY Investment Income$909CYInvestmentIncomeAmt
PY Other Revenue$119,547PYOtherRevenueAmt
CY Other Revenue$35,904CYOtherRevenueAmt
PY Total Revenue$17,084,329PYTotalRevenueAmt
CY Total Revenue$16,358,947CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$12,190,788PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$11,930,406CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,435,289PYOtherExpensesAmt
CY Other Expenses$5,327,356CYOtherExpensesAmt
PY Total Expenses$16,626,077PYTotalExpensesAmt
CY Total Expenses$17,257,762CYTotalExpensesAmt
PY Revenues Less Expenses$458,252PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$898,815CYRevenuesLessExpensesAmt
Total Assets BOY$13,731,532TotalAssetsBOYAmt
Total Assets EOY$13,669,867TotalAssetsEOYAmt
Total Liabilities BOY$8,672,475TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,454,158TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,059,057NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,215,709NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionAS AN AFFILIATE OF THE SYSTEM AND THE CENTER OF AGING AND CONTINUING CARE SERVICES, NORTH PARK NURSING HOME, INC. (D.B.A EDNA TINA WILSON LIVING CENTER) IS DEDICATED TO PROVIDING QUALITY CARE, INDEPENDENCE AND A POSITIVE LIVING EXPERIENCE FOR PATIENTS AND RESIDENTS IN OUR FACILITY. THE MISSION IS ACHIEVED THROUGH THE CORE VALUES OF THE SYSTEM WHICH INCLUDE PEOPLE, EXCELLENCE, LEARNING AND RESULTS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$10,386,362ExpenseAmt
Revenue$11,168,221RevenueAmt
Desc120-BED SKILLED NURSING FACILITY PROVIDING 43,267 PATIENT CARE DAYS. THE EDNA TINA WILSON LIVING CENTER USES AN INNOVATIVE NEIGHBORHOOD DESIGN, WITH RESIDENT ROOMS CLUSTERED AROUND THE ACTIVITY CENTER AND THE LIVING AND DINING AREAS, TO PROMOTE MORE SOCIAL AND INTERACTIVE LIVING.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$3,167,779ExpenseAmt
Revenue$3,680,408RevenueAmt
DescA LICENSED HOME CARE SERVICE AGENCY PROVIDING 163,685 HOURS OF SERVICE. THIS PROGRAM ALLOWS SENIORS TO CONTINUE LIVING SAFELY AND INDEPENDENTLY IN THEIR OWN HOMES. SERVICES ARE CUSTOMIZED FOR EACH INDIVIDUAL AND RANGE FROM MEAL DELIVERY AND ASSISTANCE WITH HOUSEHOLD TASKS TO MEDICAL CARE.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$344,976ExpenseAmt
Revenue$604,175RevenueAmt
DescAN ADULT DAYCARE CENTER PROVIDING 5,867 CLIENT DAYS. ADULT DAY SERVICES PROVIDE A CARING, SUPPORTIVE, AND THERAPEUTIC ENVIRONMENT FOR PEOPLE WHO NEED CARE OR SUPERVISION DURING DAYTIME HOURS.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$430,155ExpenseAmt
Revenue$906,143RevenueAmt
DescUNITY CARE AT HOME PROVIDES ASSISTANCE WITH UNDERSTANDING COMMUNITY RESOURCES AND OPTIONS FOR CARE. ADDITIONAL SERVICES INCLUDE DEVELOPING AND COORDINATING A SERVICE PLAN, OBTAINING INSURANCE COVERAGE, AND HELPING TO FIND THE RIGHT ASSISTED LIVING OR NURSING HOME. ALSO, THEY PROVIDE SERVICES INCLUDING HOUSEKEEPING, LAUNDRY, GROCERY SHOPPING, RUNNING ERRANDS, COMPANION CARE, ACCOMPANYING TO DOCTOR'S APPOINTMENTS, AND OTHER HELPFUL DUTIES AROUND THE HOUSE.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$430,155TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$906,143TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$14,329,272TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee317EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members25GoverningBodyVotingMembersCnt
Independent Voting Member24IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHRIS PETERSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5859220089PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 KINGS HIGHWAY SOUTHAddressLine1Txt
CityROCHESTERCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14617ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
LINDA BECKER
DIRECTOR1.001.00Yes (X)$0$0$0
ERIC BIEBER MD
CEO1.0054.00Yes (X)$26,500$1,298,481$1,085,763Yes (X)
ROBERT DOBIES
CHAIR OF THE BOARD1.001.00Yes (X)$0$0$0
MICHAEL NUCCITELLI
VICE CHAIR1.001.00Yes (X)$0$0$0
FAHEEM MASOOD
TREASURER1.001.00Yes (X)$0$0$0
DANIEL MEYERS
DIRECTOR1.001.00Yes (X)$0$0$0
THOMAS PENN MD
DIRECTOR1.001.00Yes (X)$0$0$0
JOHN RIEDMAN
DIRECTOR1.001.00Yes (X)$0$0$0
RACHAEL ADONIS
DIRECTOR1.001.00Yes (X)$0$0$0
ROBERT S SANDS
SECRETARY1.001.00Yes (X)$0$0$0
RALPH DESTEPHANO
DIRECTOR1.001.00Yes (X)$0$0$0
ROBERT HAVRILLA
DIRECTOR1.001.00Yes (X)$0$0$0
JAGAT MEHTA MD
DIRECTOR1.001.00Yes (X)$0$0$0
ELIZABETH PATTON PHD
DIRECTOR1.001.00Yes (X)$0$0$0
THOMAS RILEY
DIRECTOR1.001.00Yes (X)$0$0$0
NANCY FERRIS PHD
DIRECTOR1.001.00Yes (X)$0$0$0
JOHN GENIER MD
DIRECTOR1.001.00Yes (X)$0$0$0
TARUN KOTHARI MD
DIRECTOR1.001.00Yes (X)$0$0$0
ANNA LYNCH
DIRECTOR1.001.00Yes (X)$0$0$0
LEONARD OLIVIERI
DIRECTOR1.001.00Yes (X)$0$0$0
EFRAIN RIVERA
DIRECTOR1.001.00Yes (X)$0$0$0
LEON T SAWYKO
DIRECTOR1.001.00Yes (X)$0$0$0
JUSTIN SMITH
DIRECTOR1.001.00Yes (X)$0$0$0
KAREN M GALLINA
DIRECTOR1.001.00Yes (X)$0$0$0
JEFFREY C MAPSTONE
DIRECTOR1.001.00Yes (X)$0$0$0
THOMAS R CRILLY
CFO2.0053.00$15,236$492,642$376,725Yes (X)
ROBERT NESSELBUSH
COO1.0054.00$7,939$785,947$563,234Yes (X)
HUGH THOMAS
CAO1.0054.00$6,255$619,246$449,405Yes (X)
MARK KLYCZEK
VICE PRESIDENT, LTC10.0045.00$48,515$194,059$77,392Yes (X)
MARK CLEMENT
FORMER CEO0.000.00$0$1,591,897$4,097Yes (X)
WARREN HERN
FORMER CEO0.000.00$0$5,042,012$3,846Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$104,445TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$10,024,284TotReportableCompRltdOrgAmt
Total Other Compensation$2,560,462TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
LECHASE CONSTRUCTION LLC
205 INDIGO CREEK DRIVEROCHESTERNY14626CONSTRUCTION$1,912,721
NURSEFINDERS
PO BOX 910738DALLASTX75391TEMPORARY STAFF SERVICES$121,480
POSTLER & JAECKLE CORPORATION
615 SOUTH AVENUEROCHESTERNY14620CONSTRUCTION$107,200
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Related Organizations$334,200RelatedOrganizationsAmt
Government Grants$14,472GovernmentGrantsAmt
Total Contributions$348,672TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICAID623000$7,983,633$7,983,633
PRIVATE PAY623000$6,241,905$6,241,905
MEDICARE/HMO623000$644,425$644,425
MEDICARE623000$428,393$428,393
BLUE CROSS623000$406,837$406,837

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$268,269TotalRevenueColumnAmt
Related Or Exempt Func Income$268,269RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$15,973,462TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$909TotalRevenueColumnAmt
Exclusion$909ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescCAFETERIA INCOMEDesc
Business623000BusinessCd
Total Revenue Column$10,623TotalRevenueColumnAmt
Exclusion$10,623ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$25,281TotalRevenueColumnAmt
Exclusion$25,281ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$35,904OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,358,947TotalRevenueColumnAmt
Related Or Exempt Func Income$15,973,462RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$36,813ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$163,066TotalAmt
Program Services$139,527ProgramServicesAmt
Management And General$23,539ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,264,027TotalAmt
Program Services$7,496,417ProgramServicesAmt
Management And General$1,767,610ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$681,497TotalAmt
Program Services$552,013ProgramServicesAmt
Management And General$129,484ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,188,056TotalAmt
Program Services$962,325ProgramServicesAmt
Management And General$225,731ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$633,760TotalAmt
Program Services$513,346ProgramServicesAmt
Management And General$120,414ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$179,383TotalAmt
Program Services$145,300ProgramServicesAmt
Management And General$34,083ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$478,775TotalAmt
Program Services$387,808ProgramServicesAmt
Management And General$90,967ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$815TotalAmt
Program Services$660ProgramServicesAmt
Management And General$155ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$97,932TotalAmt
Program Services$79,325ProgramServicesAmt
Management And General$18,607ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$44,956TotalAmt
Program Services$36,414ProgramServicesAmt
Management And General$8,542ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$196,390TotalAmt
Program Services$159,076ProgramServicesAmt
Management And General$37,314ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$195,274TotalAmt
Program Services$158,172ProgramServicesAmt
Management And General$37,102ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$157,318TotalAmt
Program Services$126,723ProgramServicesAmt
Management And General$30,595ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$729,651TotalAmt
Program Services$591,017ProgramServicesAmt
Management And General$138,634ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$31,076TotalAmt
Program Services$25,172ProgramServicesAmt
Management And General$5,904ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$1,175,000$1,175,000
MEDICAL AND FOOD SUPPLE$854,065$691,793$162,272
NYS REVENUE ASSESSMENT$673,369$673,369
SERVICE CONTRACTS$238,875$193,489$45,386

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$274,477TotalAmt
Program Services$222,326ProgramServicesAmt
Management And General$52,151ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$17,257,762TotalAmt
Program Services$14,329,272ProgramServicesAmt
Management And General$2,928,490ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$67,814BOYAmt
EOY$549,518EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$30,229BOYAmt
EOY$35,236EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,667,403BOYAmt
EOY$2,026,654EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$11,325BOYAmt
EOY$33,761EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$7,545BOYAmt
EOY$1,045EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$21,749,803LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$10,868,751LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$8,981,902BOYAmt
EOY$10,881,052EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,965,314BOYAmt
EOY$142,601EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$13,731,532BOYAmt
EOY$13,669,867EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$757,557BOYAmt
EOY$912,504EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$206,935BOYAmt
EOY$3,415EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$30,690BOYAmt
EOY$24,371EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$5,897,000BOYAmt
EOY$5,317,000EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,780,293BOYAmt
EOY$3,196,868EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,672,475BOYAmt
EOY$9,454,158EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,059,057BOYAmt
EOY$4,215,709EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,059,057BOYAmt
EOY$4,215,709EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$13,731,532BOYAmt
EOY$13,669,867EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$898,815ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$55,467OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,132CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,136CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$421,170CurrentTaxYearMinus1YearAmt
Current Tax Year$348,672CurrentTaxYearAmt
Total$794,110TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,508,757CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,778,773CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15,030,510CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$16,427,715CurrentTaxYearMinus1YearAmt
Current Tax Year$15,973,462CurrentTaxYearAmt
Total$74,719,217TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,521,889CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,789,909CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15,030,510CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$16,848,885CurrentTaxYearMinus1YearAmt
Current Tax Year$16,322,134CurrentTaxYearAmt
Total$75,513,327TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$75,513,327PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$64,931CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$58,065CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$41,366CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$22,974CurrentTaxYearMinus1YearAmt
Current Tax Year$909CurrentTaxYearAmt
Total$188,245TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$64,931CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$58,065CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$41,366CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$22,974CurrentTaxYearMinus1YearAmt
Current Tax Year$909CurrentTaxYearAmt
Total$188,245TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$76,976CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$142,431CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$157,369CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$119,547CurrentTaxYearMinus1YearAmt
Current Tax Year$35,904CurrentTaxYearAmt
Total$532,227TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,663,796CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,990,405CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15,229,245CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$16,991,406CurrentTaxYearMinus1YearAmt
Current Tax Year$16,358,947CurrentTaxYearAmt
Total$76,233,799TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99050PublicSupportCY509Pct
Public Support PY5090.98900PublicSupportPY509Pct
Investment Income CY0.00250InvestmentIncomeCYPct
Investment Income PY0.00310InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Beginning Balance$30,690BeginningBalanceAmt
Ending Balance$30,690EndingBalanceAmt
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$41,502BeginningYearBalanceAmt
End Year Balance$41,502EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$46,511BeginningYearBalanceAmt
Contributions$410,369ContributionsAmt
Grants Or Scholarships$415,378GrantsOrScholarshipsAmt
End Year Balance$41,502EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$34,414BeginningYearBalanceAmt
Contributions$26,485ContributionsAmt
Grants Or Scholarships$14,388GrantsOrScholarshipsAmt
End Year Balance$46,511EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$33,821BeginningYearBalanceAmt
Contributions$18,000ContributionsAmt
Grants Or Scholarships$17,407GrantsOrScholarshipsAmt
End Year Balance$34,414EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$26,216BeginningYearBalanceAmt
Contributions$12,985ContributionsAmt
Grants Or Scholarships$5,380GrantsOrScholarshipsAmt
End Year Balance$33,821EndYearBalanceAmt
FieldValueIRS element (for citing)
Term Endowment Balance EOY1.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$485,000OtherCostOrOtherBasisAmt
Book Value$485,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,155,962OtherCostOrOtherBasisAmt
Depreciation$8,382,415DepreciationAmt
Book Value$8,773,547BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$133,026OtherCostOrOtherBasisAmt
Depreciation$67,997DepreciationAmt
Book Value$65,029BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$593,707OtherCostOrOtherBasisAmt
Depreciation$349,370DepreciationAmt
Book Value$244,337BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,382,108OtherCostOrOtherBasisAmt
Depreciation$2,068,969DepreciationAmt
Book Value$1,313,139BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$10,881,052TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
ACCRUED PENSION LIABILITY$1,756,314
SWAP VALUATION LIABILITY$61,337
REFUND DUE CUSTOMERS-$510
DUE TO UNITY HOSPITAL$980,135
DUE TO THIRD PARTY$399,592
FieldValueIRS element (for citing)
Total Liability$3,196,868TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$16,358,947TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$16,358,947RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$16,358,947TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$17,257,762TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$17,257,762ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$17,257,762TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:RESIDENTS HAVE AUTHORIZED NORTH PARK NURSING HOME TO MANAGE THEIR PERSONAL FINANCES. THE FACILITY HOLDS, SAFEGUARDS, MANAGES, AND ACCOUNTS FOR PERSONAL FUNDS OF THE RESIDENTS DEPOSITED WITH THE FACILITY. INDIVIDUAL RESIDENT FUNDS ARE DEPOSITED IN AN INTEREST-BEARING ACCOUNT AND EACH RESIDENT HAS AN INTERNAL ACCOUNTING OF THE BALANCE OF THEIR FUND. EACH RESIDENT IS PROVIDED ON A MONTHLY BASIS AN ACCOUNTING OF THEIR FUND BALANCE.
PART V, LINE 4:ENDOWMENT FUNDS HELD FOR INTENDED USE BY NORTH PARK NURSING HOME, INC. ARE IN THE POSSESSION OF THE UNITY HEALTH SYSTEM FOUNDATION. WHEN THE TERMS OF THE ENDOWMENT ARE MET, THE FOUNDATION GRANTS THE FUNDS OVER TO NORTH PARK NURSING HOME, INC.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ERIC BIEBER MD
CEO$17,961$880,081$8,034$393,666$505$24,734$21,406$1,048,910$309$15,138$48,215$2,362,529$6,034$295,666
THOMAS R CRILLY
CFO$12,341$399,040$2,544$82,256$351$11,346$11,183$361,584$119$3,839$26,538$858,065$2,544$82,256
ROBERT NESSELBUSH
COO$6,661$659,425$1,278$126,522$0$0$5,565$550,947$67$6,655$13,571$1,343,549$1,278$126,522
HUGH THOMAS
CAO$5,237$518,464$1,018$100,782$0$0$4,422$437,799$72$7,112$10,749$1,064,157$1,018$100,782
MARK KLYCZEK
VICE PRESIDENT, LTC$45,715$182,859$2,800$11,200$0$0$14,063$56,250$1,416$5,663$63,994$255,972$0$0
MARK CLEMENT
FORMER CEO$0$0$0$0$0$1,591,897$0$0$0$4,097$0$1,595,994$0$1,591,897
WARREN HERN
FORMER CEO$0$0$0$0$0$5,042,012$0$0$0$3,846$0$5,045,858$0$5,042,012

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS INCLUDING: - ERIC BIEBER, M.D. (PRESIDENT & CEO) - THOMAS CRILLY (CFO) - MARK CLEMENT (CEO UNTIL 11/30/14) - WARREN HERN (CEO UNTIL 11/30/14) - HUGH THOMAS (CAO) - ROBERT NESSELBUSH (COO) USED THE FOLLOWING TO ESTABLISH THEIR COMPENSATION AND BENEFITS: - COMPENSATION COMMITTEE, - INDEPENDENT COMPENSATION CONSULTANT, - FORM 990 OF OTHER ORGANIZATIONS, - COMPENSATION SURVEYS AND STUDIES; - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ON AN ANNUAL BASIS, THE ORGANIZATION USES AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE SALARIES FOR ALL EXECUTIVES TO ENSURE SUCH SALARIES ARE CONSISTENT WITH MARKET SALARIES PAID TO SIMILARLY SITUATED EXECUTIVES. IN ADDITION, A COMPENSATION COMMITTEE REVIEWS THIS INFORMATION ANNUALLY AND IT IS THEN APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. FINALLY, EXECUTIVES RECEIVE A WRITTEN LETTER OUTLINING THE SPECIFICS OF THE COMPENSATION AGREEMENT AND THEIR EXPECTED PERFORMANCE.
PART I, LINES 4A-BSUPPLEMENTAL EXECUTIVE RETIREMENT PLANS PROVIDE BENEFITS TO CERTAIN KEY EXECUTIVE EMPLOYEES OF NORTH PARK NURSING HOME, INC. D/B/A EDNA TINA WILSON. THE ORGANIZATION MAINTAINS A SECTION 457(F) PLAN WHICH WOULD BE CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2015, WARREN HERN RECEIVED A DISTRIBUTION. IN 2014 AND PRIOR YEARS, THE TOTAL COMPENSATION OF THE FORMER CEO'S WAS DISCLOSED AS A COMBINATION OF CASH PAID BY THE ORGANIZATION AND DEFERRED COMPENSATION. THE CASH PAYMENTS TO THE FORMER CEO'S SHOWN ON THE 2015 TAX RETURNS REPRESENTS PAYMENTS OF COMPENSATION WHICH WAS RECOGNIZED IN PREVIOUS TAX RETURNS. THERE WAS NO INCREMENTAL EXPENSE RECOGNIZED BY THE ORGANIZATION IN 2015 FOR PAYMENTS MADE TO THE FORMER CEO'S. OFFICERS CAN SELECT ADDITIONAL BENEFITS PURSUANT TO A NON-QUALIFIED 457(F) PLAN. THIS BENEFIT IS A CAPITAL ACCUMULATION FUND AND IS OFFERED TO VICE PRESIDENTS THROUGH AN EXTERNAL INVESTMENT COMPANY. EACH VP IS GIVEN A CONTRIBUTION AMOUNTING TO 5% OF THEIR SALARY AND THEY CAN INVEST THE FUNDS IN 3 DIFFERENT OPTIONS. THE OPTIONS ARE LIFE INSURANCE FOR SELF, LIFE INSURANCE FOR SPOUSE OR CAPITAL ACCUMULATION.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonANNA LYNCHPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionBOARD SECRETARYRelationshipDescriptionTxt
Transaction$230,370TransactionAmt
TransactionANNA LYNCH, THE SECRETARY OF THE BOARD FOR RGHS IS A PARTNER OF THE LAW FIRM UNDERBERG AND KESSLER. THE LAW FIRM PROVIDED LEGAL SERVICES TO THE ORGANIZATION AND ITS AFFILIATES IN THE AMOUNT OF $230,370.TransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1EACH BOARD HAS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD PLUS THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND SUCH OTHER DIRECTORS AS THE CHAIR MAY NOMINATE FROM TIME TO TIME FOR APPOINTMENT BY A MAJORITY VOTE OF THE ENTIRE BOARD. BETWEEN MEETINGS OF THE BOARD, AND TO THE EXTENT PERMITTED BY LAW, THE EXECUTIVE COMMITTEE SHALL POSSESS THE POWERS OF THE BOARD WITH RESPECT TO MANAGING AND CONDUCTING THE AFFAIRS OF THE CORPORATION, EXCEPT AS OTHERWISE PROVIDED BY LAW OR WITHIN CERTAIN BY-LAWS.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION IS A MEMBERSHIP (NOT A STOCK) CORPORATION UNDER NEW YORK STATE LAW. THE ORGANIZATION'S SOLE CORPORATE MEMBER IS RU SYSTEM, INC. D/B/A ROCHESTER REGIONAL HEALTH, A RELATED NOT-FOR-PROFIT ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7BRU SYSTEM, INC. D/B/A ROCHESTER REGIONAL HEALTH, AS THE SOLE CORPORATE MEMBER, ALSO HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY, INCLUDING AMENDMENT OF BYLAWS AND CHARTERS, REMOVAL OF MEMBERS OF THE GOVERNING BODY, AND THE DECISION TO DISSOLVE THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11PRIOR TO FILING, A COPY OF THE FORM 990 IS PROVIDED TO, AND REVIEWED WITH, ALL MEMBERS OF THE AUDIT AND COMPLIANCE COMMITTEE. THIS REVIEW IS PERFORMED IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND OTHER RELEVANT INFORMATION FOR THE APPROPRIATE TIME PERIOD.
FORM 990, PART VI, SECTION B, LINE 12CUPON EMPLOYMENT, ALL EMPLOYEES RECEIVE THE ETHICAL STANDARD OF CONDUCT BOOKLET FOR WHICH THEY SIGN A RECEIPT OF ACKNOWLEDGEMENT. CONFLICT OF INTEREST IS DEFINED, AS IS MANAGEMENT OF A CONFLICT OF INTEREST. EMPLOYEES ARE REQUIRED TO DISCLOSE AND SEEK RESOLUTION TO ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST BEFORE TAKING A POTENTIALLY IMPROPER ACTION AND THEREAFTER, ANNUALLY, EACH KEY EMPLOYEE AND OFFICER OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM, PROVIDING MANAGEMENT WITH SUFFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THAT MANAGEMENT CAN (1) DETERMINE WHETHER ANY ACTUAL OR PERCEIVED CONFLICT OF INTEREST EXISTS, AND (2) MONITOR WORK ASSIGNMENTS TO AVOID PLACING THE KEY EMPLOYEE OR OFFICER IN A POSITION WHERE THERE MAY BE A QUESTION AS TO HIS/HER OBJECTIVITY AS WELL AS TO AVOID ANY APPEARANCE OF IMPROPRIETY. THROUGHOUT THE YEAR, KEY EMPLOYEES AND OFFICERS OF THE ORGANIZATION ARE ALSO REQUIRED TO NOTIFY MANAGEMENT PROMPTLY IF ANY CHANGE TO THEIR DISCLOSURES OCCURS. BOARD MEMBERS LEAVE THE ROOM DURING DISCUSSIONS AND ABSTAIN FROM VOTING WHEN THEY HAVE A CONFLICT OF INTEREST. IN ADDITION, EACH MEMBER OF THE BOARD OF DIRECTORS MUST ALSO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, WHICH MUST BE SUBMITTED TO THE GENERAL COUNSEL.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION'S OFFICER AND KEY EMPLOYEE COMPENSATION ARRANGEMENTS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF ROCHESTER REGIONAL HEALTH, A RELATED NOT-FOR-PROFIT ORGANIZATION. INFORMATION REVIEWED FOR THE OFFICER/KEY EMPLOYEE INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX EXEMPT ORGANIZATIONS IN THE WESTERN/CENTRAL NY COMMUNITY AS WELL AS COMPENSATION FOR THESE POSITIONS (AS DISCLOSED ON FORM 990) WITH OTHER ORGANIZATIONS IN THE HEALTH CARE INDUSTRY THAT ARE OF SIMILAR SIZE, DEMOGRAPHICS AND GEOGRAPHY. REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY THE COMPENSATION COMMITTEE IS DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ADMINISTRATIVE OFFICES OF THE AFFILIATED HEALTH SYSTEM AT 100 KINGS HIGHWAY SOUTH, ROCHESTER, NY 14617 AND ADMINISTRATIVE OFFICES OF THE FILING ORGANIZATION. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED.
FORM 990, PART XI, LINE 9:FMV ADJUSTMENT ON DERIVATIVE INSTRUMENTS -19,224. PENSION ACTUARIAL VALUATION 74,691.
FORM 990, PART XII, LINE 2C:THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (33 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
THE ROCHESTER GENERAL HOSPITAL
1425 PORTLAND AVENUEROCHESTERNY14621160743134HOSPITALNY501(C)(3)LINE 3N/AYes (1)
GRHS FOUNDATION INC
100 KINGS HIGHWAY SOUTHROCHESTERNY14617223378111R/E INV MGMTNY501(C)(3)LINE 11B, IIYes (1)RU SYSTEM INC
THE ROCHESTER GENERAL HOSPITAL FOUNDATION
100 KINGS HIGHWAY SOUTHROCHESTERNY14617222229425FUNDRAISINGNY501(C)(3)LINE 11B, IIYes (1)RU SYSTEM INC
NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION
DRIVING PARK AVENUENEWARKNY14513222963015FUNDRAISINGNY501(C)(3)LINE 11B, IIYes (1)NWCH
NEWARK WAYNE COMMUNITY HOSPITAL
DRIVING PARK AVENUENEWARKNY14513150584188HOSPITALNY501(C)(3)LINE 3Yes (1)RU SYSTEM INC
CONTINUING CARE NETWORK INC (CCN)
100 KINGS HIGHWAY SOUTHROCHESTERNY14617222963016SUPPORT RGHNY501(C)(3)LINE 11B, IIYes (1)RU SYSTEM INC
ROCHESTER GENERAL HUDSON HOUSING
2066 HUDSON AVENUEROCHESTERNY14621223210351LOW INC HOUSINGNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
VIA HEALTH HOME CARE I
100 KINGS HIGHWAY SOUTHROCHESTERNY14617161504370HOME HEALTHNY501(C)(3)LINE 9Yes (1)CCN
VIA HEALTH HOMECARE II
100 KINGS HIGHWAY SOUTHROCHESTERNY14617161538727HOME HEALTHNY501(C)(3)LINE 9Yes (1)CCN
INDEPENDENT LIVING FOR SENIORS DBA ELDERONE
2066 HUDSON AVENUEROCHESTERNY14617161491059ADULT DAY HCNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
RGHS WORKERS' COMPENSATION TRUST
1425 PORTLAND AVENUEROCHESTERNY14621166429300SEE PART VIINY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
WESTERN NEW YORK MEDICAL PRACTICE PC
1425 PORTLAND AVENUEROCHESTERNY14621611654232PHYS PRACNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
THE UNITY HOSPITAL OF ROCHESTER
1555 LONG POND RDROCHESTERNY14626237221763HOSPITALNY501(C)(3)LINE 3Yes (1)RU SYSTEM INC
ROCHESTER GENERAL LONG TERM CARE
1550 EMPIRE BLVDWEBSTERNY14580223187140NH & REHABNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
PARK RIDGE NURSING HOME INC DBA PARK RIDGE LIVING CENTER
1555 LONG POND RDROCHESTERNY14626160978184LONG TERM CARE FACILITYNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
UNITY HEALTH SYSTEM FOUNDATION
1555 LONG POND RDROCHESTERNY14626119627400FOUNDATIONNY501(C)(3)LINE 7Yes (1)RU SYSTEM INC
PRCD INC
1555 LONG POND RDROCHESTERNY14626161311581SUBSTANCE ABUSE TREATMENT & REHAB.NY501(C)(3)LINE 7Yes (1)RU SYSTEM INC
PARK RIDGE CHILD CARE CENTER INC
1555 LONG POND RDROCHESTERNY14626222918126CHILD DAY CARE SERVICESNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
PARK RIDGE HOUSING DEVELOPMENT FUND CO DBA RIDGE COMMONS
1555 LONG POND RDROCHESTERNY14626222608311LOW INCOME HOUSING PROJECT FOR ELDERLYNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
PARK RIDGE HOUSING INC
1555 LONG POND RDROCHESTERNY14626222570457SENIOR APARTMENT COMPLEXNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
PARKWAY COMMONS HOUSING DEVELOPMENT DBA RESCH COMMONS
1555 LONG POND RDROCHESTERNY14626223130818LOW INCOME HOUSING FOR ELDERLY/HANDICAPPEDNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
STBERNARD'S HDFC INC
1555 LONG POND RDROCHESTERNY14626161492955LOW INCOME HOUSING PROJECTNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
UNITY AGING SERVICES INC
1555 LONG POND RDROCHESTERNY14626841684195MANAGEMENT AND DEVELOPMENT CONY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
UNITY HOUSING DEVELOPMENT FUND CORP DBA MOORE PARK
1555 LONG POND RDROCHESTERNY14626300068596RECEIPT AND DISBURSEMENTS OF SUBSIDIESNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
WOODLAND VILLAGE INC
1555 LONG POND RDROCHESTERNY14626161588242SENIOR APARTMENT COMPLEXNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
UNITY AMBULATORY SURGERY CENTER INC
1555 LONG POND RDROCHESTERNY14626383871383OUTPATIENT SURGERYNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
UNITY HEALTH SYSTEM INC
1555 LONG POND ROADROCHESTERNY14626222572873SYSTEM SUPPORTNY501(C)(3)LINE 11B, IIYes (1)RU SYSTEM INC
RU SYSTEM INC DBA ROCHESTER REGIONAL HEALTH SYSTEM
100 KINGS HIGHWAY SOUTHROCHESTERNY14617471234999SYSTEM PARENTNY501(C)(3)LINE 11B, IIN/AYes (1)
ROCHESTER GENERAL HEALTH SYSTEM
100 KINGS HIGHWAY SOUTHROCHESTERNY14617222551509SYSTEM SUPPORTNY501(C)(3)LINE 11B, IIYes (1)RU SYSTEM INC
UNITED MEMORIAL MEDICAL CENTER
127 NORTH STREETBOTAVIANY14020160743029HOSPITALNY501(C)(3)LINE 3Yes (1)RU SYSTEM INC
HENRY FOSTER ASSOCIATES DBA CORPORATE CARE OF FINGER LAKES
4 COULTER ROADCLIFTON SPRINGSNY14432161282294EMPLOYEE ASSISTANCE PROGRAMSNY501(C)(3)LINE 9Yes (1)CSH
BEHAVIORAL HEALTH NETWORK INC
490 EAST RIDGE ROADROCHESTERNY14621166069131MENTAL HEALTHNY501(C)(3)LINE 9Yes (1)RU SYSTEM INC
CLIFTON SPRINGS HOSPITAL & CLINIC
2 COULTER ROADCLIFTON SPRINGSNY14432160743966HOSPITALNY501(C)(3)LINE 3Yes (1)RU SYSTEM INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPctDirect Controlling NADirectControllingNACd
NW ASSOCIATES LP
PO BOX 111 DRIVING PARK AVENUENEWARKNY14513141674119R/E LEASINGNYNWCHRELATED000.52570
PARMA SENIOR HOUSING
1555 LONG POND RDROCHESTERNY14626432082116HILTON PROJNY00N/A
UNITY SENIOR HOUSING ASSOCIATES LP
1555 LONG POND RDROCHESTERNY14626061709927MOORE PKNY00N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACdAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
GRACO RISK RETENTION GROUP INC
1425 PORTLAND AVENUEROCHESTERNY14621710933967INSURANCESCRGHC1.000000
NWA INC
DRIVING PARK AVENUENEWARKNY14513141667339R/E LEASINGNYNWCHC1.000000
GREATER ROCHESTER INDEPENDENT PRACTICE ASSOCIATION INC
100 KINGS HWY S SUITE 2500ROCHESTERNY14617161507171INDEPENDENT PRACTICE ASSOCIATIONNYC0.500000N/A
ROCHESTER GENERAL HEALTH SYSTEM DIALYSIS INC
1425 PORTLAND AVENUEROCHESTERNY14621383912199DIALYSISNYRGHSC1.000000
ACM MEDICAL LABORATORY INC
160 ELMGROVE PARKROCHESTERNY14624161059691CLINICAL LABNYPRH INCC0
PRH INC
1555 LONG POND ROADROCHESTERNY14626161329632MEDICAL LABNYRU SYSTEM INCC0
PARMA SENIOR HOUSING LLC
1555 LONG POND ROADROCHESTERNY14626810671687SENIOR HOUSINGNYRU SYSTEM INCC0
UNITY SENIOR HOUSING CORP
1555 LONG POND ROADROCHESTERNY14624061709925SENIOR HOUSINGNYRU SYSTEM INCC0
GREATER ROCHESTER ASSURANCE COMPANY LTD
INSURANCEC1.000000N/AGEORGE TOWNGRAND CAYMANCJCJ
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
UNITY HEALTH SYSTEM FOUNDATION
C$334,200FMV
ROCHESTER REGIONAL HEALTH SYSTEM
P$165,447FMV
THE UNITY HOSPITAL OF ROCHESTER
P$2,500,041FMV
ROCHESTER GENERAL HOSPITAL
P$679,964FMV