2014-11-11T09:33:42-07:00 2013-12-31 990 2013-01-01 161005419 GENESEE VALLEY GROUP HEALTH ASSOCIATION INC GENE 5853276505 165 Court Street Rochester NY 14647 James Haefner Sr Vice President & Asst Treasurer 5853276505 2014-11-04 2013 2015-11-30 17:44:51Z Lifetime Health Medical Group Dorothy Coleman 165 Court St Rochester NY 14647 132695224 0 X www.lifetimehealth.org X 1972 NY Genesee Valley Group Health Association, Inc. provides primary health care for patients in Buffalo and Rochester. A variety of services are offered at each health center and most sites to include pharmacy, laboratory, radiology, internal medicine, pediatrics, family practice and specialty care. 3 0 685 0 0 0 0 0 102917253 106650355 596454 1563383 4427421 4280650 107941128 112494388 0 0 46668360 54284810 42175130 42989342 0 0 0 15329213 15020762 104172703 112294914 3768425 199474 15597210 15774712 14499163 14375634 1098047 1399078 Lifetime Health Medical Group exists to guide and support you with your health needs, to work with you to improve your health, and to care for you during illness. We will do this by: being a responsive and respectful partner in your care and addressing your health needs from your perspective, developing effective relationships with other providers to assure coordination of your care, and seeking innovative solutions to continuously improve your access to quality, evidence-based health care. 0 0 112294914 0 107450961 Health Care Delivery: Health Services (Member Months = 116,596) 0 0 0 112294914 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 78 0 1 685 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X Jim Haefner 5853276505 165 Court Street Rochester NY 14647 X Christopher C Booth Director 0.4 40 X 0 1680926 138695 Dorothy Coleman CEO, CFO and Treasurer 1.2 40 X X 0 803585 65073 Stephen Sloan Secretary 0.4 40 X X 0 739084 94888 James Haefner Assistant Treasurer 0.4 40 X 0 352141 65027 Margaret M Cassady Asst Secretary 0.4 40 X 0 289536 36931 Ann Ruflin President 40 0 X 0 451090 99277 Mark F Perry Chief Medical Officer 40 0 X 0 372957 38893 Douglas J Golding Medical Director 40 0 X 0 282292 33263 Stephen C LaSalle Sr Vice President of Finance 40 0 X 0 265832 48317 Deborah A Carlascio Vice President of Operations 40 0 X 0 200130 53341 Michael R Jordan Physician 40 0 X 334970 0 30549 Valerie Newman Physician 40 0 X 322780 0 24826 Pramila Penta Physician 40 0 X 315591 0 10904 Richard Dudrak Medical Director 40 0 X 309001 0 27803 Robert Cole Medical Director 40 0 X 298638 0 26383 David H Klein Former CEO 0 0 X 0 19881183 149311 Emil D Duda Former Treasurer 0 0 X 0 2398353 12071 1580980 27717109 955552 62 1 1 0 LeChase Construction Services LLC 300 Trolley Blvd Rochester NY 14606 Construction Mgmt/General Contractor 1580015 Eastern Niagara Radiology Associates 222 Genesee Street Buffalo NY 14203 Radiology Services 874000 Quality Systems Inc 18111 Von Karman Avenue Suite 700 Irvine CA 92612 Software Maintenance 620294 Mason Marketing Communications LLC 400 Whitney Rd Penfield NY 14526 Advertising 206651 Opus ISM LLC 2601 Scott Ave Suite 600 Fort Worth TX 76103 Software Maintenance 201110 7 0 Capitation Revenue 621110 63162261 63162261 0 0 Fee For Service Revenue 621110 43242752 43242752 0 0 Registration Fees 621110 245342 245342 0 0 0 0 0 0 106650355 1563383 1563383 0 0 0 0 0 0 0 0 0 0 192996 0 0 0 192996 0 192996 0 0 192996 0 0 24288490 20200836 4087654 0 0 4087654 0 112494388 108213738 0 4280650 54284810 54284810 1650359 1650359 33231990 33231990 1149753 1149753 4624595 4624595 2332645 2332645 150361 150361 101300 101300 4074808 4074808 312757 312757 1442060 1442060 950592 950592 2941058 2941058 180762 180762 18548 18548 293214 293214 893987 893987 693848 693848 Other Exp - Medical Supplies 2926072 2926072 0 0 Other Exp - Miscellaneous 41395 41395 0 0 112294914 112294914 0 0 233845 479279 4408801 3291044 2375445 2561964 600563 555098 13577825 9144624 3580025 4433201 725045 1890290 3673486 2563836 15597210 15774712 7671591 9702067 0 0 0 0 0 0 0 6827572 4673567 14499163 14375634 X 1098047 1399078 0 0 0 0 1098047 1399078 15597210 15774712 X 199474 0 0 0 0 101557 X 0 1 X 1 0 X Schedule A, Part I, Line 3 Genesee Valley Group Health Association, Inc. is exempt as a hospital under Internal Revenue Code Section 170(b)(1)(A)(iii); however it is not a hospital as defined by the Form 990, Section H instructions : "a hospital is a facility that is, or is required to be licensed, registered, or similarly recognized by a state as a hospital." Genesee Valley Group Health Association does not meet any of these requirements. Genesee Valley Group Health Association is licensed under Article 28 of the New York State Public Health Law to operate diagnostic and treatment centers. 0 488386 488386 0 4087426 3924858 162568 0 2418221 766152 1652069 0 6583792 4453614 2130178 0 0 0 0 4433201 0 Investment in Limited Liability Company 1890290 F 1890290 Reg 164 Trust 1700989 Due From Affiliates 862847 2563836 Post Retirement Benefits 1472789 Current Debt 1964318 Long Term Debt 1236460 4673567 X 131616929 0 0 0 19122541 19122541 112494388 0 0 0 112494388 131417455 0 0 0 19122541 19122541 112294914 0 0 0 112294914 Schedule D, Part X, Line 2 Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 740, Income Taxes provides that a tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits. Income tax positions must meet a more likely than not recognition threshold at the effective date to be recognized upon the adoption of this interpretation and in subsequent periods. This topic also provides guidance on measurement, derecognition, classification, interest and penalties, accounting in interim periods, disclosure and transition. Schedule D, Part XI, Line 2d Pharmacy Elimination $1,356,224; Bad Debt Allowance $<277,929>; Pharmacy Cost of Goods Sold $<20,200,836> Schedule D, Part XII, Line 2d Pharmacy Elimination $1,356,224; Bad Debt Allowance $<277,929>; Pharmacy Cost of Goods Sold $<20,200,836> 1 1 1 1 0 0 0 0 0 Christopher C Booth Director 0 816107 0 859862 0 4957 0 118567 0 20128 0 1819621 0 0 Dorothy Coleman CEO, CFO and Treasurer 0 504338 0 291619 0 7628 0 44871 0 20202 0 868658 0 0 Stephen Sloan Secretary 0 428530 0 294728 0 15826 0 73830 0 21058 0 833972 0 James Haefner Assistant Treasurer 0 206764 0 51551 0 93826 0 45140 0 19887 0 417168 0 0 Margaret M Cassady Asst Secretary 0 246344 0 41431 0 1761 0 27444 0 9487 0 326467 0 0 Ann Ruflin President 0 321277 0 127609 0 2204 0 79546 0 19731 0 550367 19731 Mark F Perry Chief Medical Officer 0 261361 0 110987 0 609 0 20197 0 18696 0 411850 0 0 Douglas J Golding Medical Director 0 232810 0 48229 0 1253 0 15082 0 18181 0 315555 0 0 Stephen C LaSalle Sr Vice President of Finance 0 191368 0 72974 0 1490 0 27087 0 21230 0 314149 0 0 Deborah A Carlascio Vice President of Operations 0 162072 0 36487 0 1571 0 33917 0 19424 0 253471 0 0 Michael R Jordan Physician 143605 0 184172 0 7193 0 7650 0 22899 0 365519 0 0 0 Valerie Newman Physician 232105 0 88321 0 2354 0 5335 0 19491 0 347606 0 0 0 Pramila Penta Physician 257450 0 54959 0 3182 0 3598 0 7306 0 326495 0 0 0 Richard Dudrak Medical Director 297720 0 10000 0 1281 0 7650 0 20153 0 336804 0 0 0 Robert Cole Medical Director 250621 0 46625 0 1392 0 7650 0 18733 0 325021 0 0 0 David H Klein Former CEO 0 0 0 3094311 0 16786872 0 139415 0 9896 0 20030494 0 584918 Emil D Duda Former Treasurer 0 0 0 0 0 2398353 0 128124 0 12071 0 2538548 0 861651 Schedule J, Part I, Line 3 The CEO, CFO and Treasurer of the filing organization is also the CFO of a related (parent) organization. The CEO, CFO and Treasurer receives her compensation from the related organization. The CEO, CFO and Treasurer's compensation is determined in accordance with a Board of Directors approved executive compensation philosophy. The Executive Compensation process includes an evaluation of market comparable organizations, using an external consultant, and the process is approved by the Board of Directors of the related organization. The filing organization relies upon the related (parent) organization's process used to establish compensation. Schedule J, Part I, Line 4 a) One individual, D Klein, from Part VII, Section A, Line 1a, received a severence payment in 2013 in the amount of $9,779,978. b) The following persons from Part VII, Section A,Line 1a participated in supplemental nonqualified retirement plans of a related organization: D Klein, E Duda, C Booth, S Sloan, M Cassady, A Ruflin, M Perry, D Golding, S LaSalle, and D Coleman. Payments totaling $861,651 were made during 2013 to E Duda and $584,918 to D Klein, from these nonqualified plans. c) The following persons from Part VII, Section A Line 1a participated in an equity-based compensation arrangement of a related organization: D Klein and E Duda. $292,360 in payments were made during 2013 to these individuals. Schedule J, Part I, Line 5 Physicians are eligible for an incentive if the filing organization exceeds its budgeted performance. Schedule J, Part II Line 16(ii), column B(iii) - The amount of $16,786,872 reported for David Klein primarily consists of three items: (1) a payment from a deferred compensation plan that totaled $6,412,147 and represents compensation earned by Mr. Klein over his career that he voluntarily deferred and the earnings on those deferrals; (2) the amount of $9,779,978 which was paid to Mr. Klein pursuant to an Executive Severance Agreement entered into by Mr. Klein and approved by the Board of Directors of the related (parent) organization; and (3) the amount of $584,918 which was paid to Mr. Klein pursuant to a Supplemental Excess Retirement Plan maintained by the related (parent) company. The remainder is for other accrued credits as of his date of termination. Line 17(ii), column B(iii) - The amount of $2,270,229 reported for Emil Duda primarily consists of two items: (a) a payment from a deferred compensation plan that totaled $1,516,526 and represents compensation earned by Mr. Duda over his career that he voluntarily deferred and the earnings on those deferrals; and (2) the amount of $861,651 which was paid to Mr. Duda pursuant to Supplemental Excess Retirement Plans maintained by the related (parent) company. Excellus Health Plan Parent 81790944 Revenue from Parent 0 Excellus Health Plan Parent 1530677 Rental of Space 0 Excellus Health Plan Parent 8620239 Mgmt Fees & Purchased Services 0 Schedule L, Part IV The filing organization has various business transactions with Excellus Health Plan whose CEO, CFO, Secretary, Assistant Secretary and Assistant Treasurer are also officers of the filing organization. Form 990, Part VI, Section A, Line 2 The following current GVGHA board members have business relationships among each other as they are also current officers of Excellus Health Plan: Christopher Booth, Dorothy Coleman, Stephen Sloan, Margaret Cassady and James Haefner. Form 990, Part VI, Section A, Line 4 Article VII Officers, Section 1 - Removed Chairman and added Chief Executive Officer, President and Chief Financial Officer. Form 990, Part VI, Section A, Line 6 The organization's sole member is Excellus Health Plan, Inc. Form 990, Part VI, Section A, Line 7a Excellus Health Plan, Inc. may elect one or more members of the organization's governing body. This formal election (or reconfirmation of existing members of the governing body) occurs at the Excellus annual meeting in March, but can also occur (on an as needed basis) at any of its regularly scheduled meetings throughout the year. Form 990, Part VI, Section A, Line 7b The sale of all or substantially all assets of the organization would require the approval of the member (Excellus Health Plan, Inc.). Form 990, Part VI, Section B, Line 11b The completed IRS Form 990 was provided to the organization's Board of Directors prior to filing allowing the opportunity for review. Responses were provided to questions raised by the governing body and any comments were analyzed and incorporated as applicable. Form 990, Part VI, Section B, Line 12c The organization's Conflict of Interest Policy is regularly and consistently enforced via a robust annual process. Annually, all employees who hold a position at the Director level or above complete the Conflict of Interest Questionnaire. New or newly promoted employees at the Director level complete the questionnarie at the time of employment or promotion. The Corporate Director of Ethical Compliance is responsible for the annual distribution, tracking, review and reporting of the Conflict of Interest or potential Conflict of Interest Questionnaires for employees of the Corporation. Corporate legal counsel reviews all Conflict of Interest or potential Conflicts of Interest and makes recommendations. Form 990, Part VI, Section B, Line 15 Key employee compensation is established in conjunction with the Board of Directors by having Human Resources engage independent compensation consultants that provide compensation surveys and information of comparable organizations, as well as market standards and best practices, to make informed compensation decisions on a prospective basis.Line 15b)Key employee compensation is established in conjunction with the Board of Directors by having Human Resources engage independent compensation consultants that provide compensation surveys and information of comparable organizations, as well as market standards and best practices, to make informed compensation decisions on a prospective basis. Form 990, Part VI, Section C, Line 18 Form 990 is available online via Guidestar.org. Form 990, Part VI, Section C, Line 19 Governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part VII, Section A, Line 1a Column B - Some of the trustees and offices that devote time to the filing organization do so on an allocated basis as supported by a management fee agreement with a related organization. Such trustees and officers receive their compensation from a related organization. In some cases these trustees and officers devote all of their time to the filing organization, and in others the related organization is where the majority of their time is devoted. Form 990, Part XI, Line 9 Amortization of Net Gain/Loss - Defined Benefit Plans Genesee Region Home Care Assoc Inc 165 Court Street Rochester NY 14647 160844109 Home Health Services NY 501(c)(3) 509(a)(2) Excellus Health Plan 1 Genesee Region Home Care of Ontario County Inc 165 Court Street Rochester NY 14647 223257719 Home Health Services NY 501(c)(3) 509(a)(2) Excellus Health Plan 1 Lifetime Healthcare Inc 165 Court Street Rochester NY 14647 161514675 Holding Co NY N/A C 0 Excellus Health Plan Inc 165 Court Street Rochester NY 14647 150329043 Health Insurer NY N/A C Beacon Network Services Inc 165 Court Street Rochester NY 14647 141830065 Inactive NY N/A C Excellus Acquisition Inc 165 Court Street Rochester NY 14647 141830065 Holding Co NY N/A C MedAmerica Inc 165 Court Street Rochester NY 14647 161581817 Holding Co NY N/A C Excellus Ventures Inc 165 Court Street Rochester NY 14647 161550984 Holding Co NY N/A C Upstate Professional Liability Corp 165 Court Street Rochester NY 14647 141783968 Inactive NY N/A C North Star Home Health Management Inc 165 Court Street Rochester NY 14647 161548051 Holding Co NY N/A C MedAmerica Insurance Company of NY 165 Court Street Rochester NY 14647 161310986 Long Term Care Ins NY N/A C MedAmerica Insurance Company 165 Court Street Rochester NY 14647 340977231 Long Term Care Ins PA N/A C MedAmerica Insurance Company of FL 165 Court Street Rochester NY 14647 141993330 Long Term Care Ins FL N/A C EBS-RMSCO Inc 165 Court Street Rochester NY 14647 161171765 Third Party Administrator NY N/A C 344 South Warren Street Corp 165 Court Street Rochester NY 14647 010718849 Real Estate Holding Co NY N/A C Sibley Nursing Personnel Service Inc 165 Court Street Rochester NY 14647 161447472 Home Health Service NY N/A C Support Services Alliance Inc 165 Court Street Rochester NY 14647 133033862 Benefit Plan Administrator NY N/A C Excellus Insurance Agency Inc 165 Court Street Rochester NY 14647 161588653 Insurancy Agency NY N/A C EBS-RMSCO Insurance Agency Inc 165 Court Street Rochester NY 14647 161611043 Insurance Agency NY N/A C MIG Assurance Ltd 165 Court Street Rochester NY 14647 980210843 Long Term Care Insurance CJ N/A C Charles A Walker Corporation 165 Court Street Rochester NY 14647 150483335 Broker NY N/A C Human Care Consortium I Inc 165 Court Street Rochester NY 14647 454039701 Inactive NY N/A C Human Care Consortium II Inc 165 Court Street Rochester NY 14647 454039630 Inactive NY N/A C Lifetime Healthcare Companies Workers' Compensation Trust 165 Court Street Rochester NY 14647 161483185 Grantor Trust NY N/A T 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 Excellus Health Plan Inc l 81790944 Arms length transaction Excellus Health Plan Inc k 1530677 Arms length transaction Excellus Health Plan Inc m 8620239 Arms length transaction