2013-11-12T15:50:16-07:00 2012-12-31 990 2012-01-01 161005419 GENESEE VALLEY GROUP HEALTH ASSOCIATION INC GENE 5855306760 165 Court Street Rochester NY 14647 Stephen LaSalle II 5855306760 2013-11-15 2012 2016-02-25 16:41:14Z Lifetime Health Medical Group Stephen LaSalle 165 Court St Rochester NY 14647 128335117 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 0 711 0 0 0 0 0 100062235 102917253 15323 596454 5813196 4427421 105890754 107941128 0 0 43267515 46668360 42786254 42175130 0 0 0 17570311 15329213 103624080 104172703 2266674 3768425 13688769 15597210 42373596 14499163 -28684827 1098047 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 104172703 0 102917253 Health Care Delivery: Health Services (Member Months = 106,853) 0 0 0 104172703 1 0 0 0 0 0 0 0 0 0 1 0 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 98 0 1 711 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Stephen LaSalle 5855306760 165 Court Street Rochester NY 14647 X David H Klein 0.4 40 X X 0 20706291 23729 Christopher C Booth 0.4 40 X 0 1621527 88666 Dorothy Coleman 0.8 40 X X 0 819932 51946 Stephen Sloan 0.4 40 X 0 682013 92267 Ann Ruflin 40 0 X 0 409285 88910 Margaret M Cassady 0.4 40 X 0 289932 35390 Mark F Perry 40 0 X 0 337651 35012 Douglas J Golding 40.0 0 X 0 265002 28859 Stephen C LaSalle 40 0 X 0 240128 36302 Deborah A Carlascio 40 0 X 0 186908 41718 Valerie Newman 40 0 X 384639 0 22239 Michael R Jordan 40 0 X 339733 0 28703 Pramila Penta 40 0 X 323355 0 10093 Maritza Baez 40 0 X 320172 0 13480 Matthew Bartels 10 30 X 140305 176561 28479 Emil D Duda 0 40 X 0 25873176 10805 James D Spencer 0 0 X 0 1628685 21180 1508204 53237091 657778 59 1 1 0 LeChase Construction Services LLC 300 Trolley Blvd Rochester NY 14606 Construction Mgmt/General Contractor 1372196 Eastern Niagara Radiology Associates 222 Genesee Street Buffalo NY 14203 Radiology Services 990553 Quality Systems Inc 18111 Von Karman Avenue Suite 700 Irvine CA 92612 Software Maintenance 386532 Mason Marketing Communications LLC 400 Whitney Rd Penfield NY 14526 Advertising 233212 Nextgen Healthcare Information 18111 Von Karman Avenue Suite 700 Irvine CA 92612 Software Maintenance 216526 10 0 Capitation Revenue 621110 65553720 65553720 0 0 Fee For Service Revenue 621110 37124559 37124559 0 0 Registration Fees 621110 238974 238974 0 0 0 0 0 0 102917253 596454 0 0 596454 0 0 0 0 0 0 0 0 167075 0 0 0 167075 0 167075 0 0 167075 0 0 24654335 20393989 4260346 0 0 4260346 0 107941128 102917253 0 5023875 0 0 0 0 0 0 46668360 46668360 0 0 0 0 0 0 0 0 34299545 34299545 0 0 966324 966324 0 0 4607284 4607284 0 0 2301977 2301977 0 0 0 0 0 103110 103110 0 0 106000 106000 0 0 0 0 0 0 0 0 0 0 0 0 3866157 3866157 0 0 694936 694936 0 0 1639027 1639027 0 0 1068912 1068912 0 0 0 0 0 0 3016809 3016809 0 0 149594 149594 0 0 0 0 0 0 15351 15351 0 0 41181 41181 0 0 0 0 0 0 1061162 1061162 0 0 764644 764644 0 0 Other Exp - Medical Supplies 2742885 2742885 0 0 Other Exp - Miscellaneous 59445 59445 0 0 104172703 104172703 0 0 369676 233845 0 0 4899967 4408801 0 0 0 2515146 2375445 489607 600563 15309680 11729655 3713740 3580025 725045 1700633 3673486 13688769 15597210 10032449 7671591 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32341147 6827572 42373596 14499163 X -28684827 1098047 0 0 0 0 -28684827 1098047 13688769 15597210 X 3768425 0 0 0 612920 25401529 X 0 1 X 1 0 X Part I - 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, Schedule 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. 420927 0 420927 4034169 0 3931392 102777 2138229 0 602111 1536118 8716355 0 7196152 1520203 0 0 0 0 3580025 Reg 164 Trust 1700817 Due From Affiliates 1972669 3673486 0 Post Retirement Benefits 1600303 Current Debt 1971527 Long Term Debt 3255742 6827572 X 126247174 0 0 0 18306046 18306046 107941128 0 0 0 107941128 122478749 0 0 0 18306046 18306046 104172703 0 0 0 104172703 SchD_P10_S00_L02 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. SchD_P11_S00_L02d Schedule D, Part XI, Line 2d Pharmacy Elimination $2,129,393; Bad Debt Allowance $<45,050>; Pharmacy Cost of Goods Sold $<20,393,989>; Other Adjustments $3,600 SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Pharmacy Elimination $2,129,393; Bad Debt Allowance $<45,050>; Pharmacy Cost of Goods Sold $<20,393,989>; Other Adjustments $3,600 1 1 1 1 0 0 0 0 0 David H Klein 0 1068774 0 2092480 0 17545037 0 14169 0 9560 0 20730020 0 0 Emil D Duda 0 17163 0 1837018 0 24018995 0 0 0 10805 0 25883981 0 0 Christopher C Booth 0 730138 0 886548 0 4841 0 70458 0 18208 0 1710193 0 0 Dorothy Coleman 0 492154 0 248410 0 79368 0 31935 0 20011 0 871878 0 0 Stephen Sloan 0 403565 0 273947 0 4501 0 72955 0 19312 0 774280 0 0 Ann Ruflin 0 311980 0 93064 0 4241 0 70419 0 18491 0 498195 0 0 Margaret M Cassady 0 239208 0 49001 0 1723 0 25812 0 9578 0 325322 0 0 Mark F Perry 0 256122 0 80941 0 588 0 17149 0 17863 0 372663 0 0 Douglas J Golding 0 226515 0 35162 0 3325 0 12096 0 16763 0 293861 0 0 Stephen C LaSalle 0 183372 0 53219 0 3537 0 16405 0 19897 0 276430 0 0 Deborah A Carlascio 0 158760 0 26610 0 1538 0 23121 0 18597 0 228626 0 0 Valerie Newman 233005 0 146702 0 4932 0 5160 0 17079 0 406878 0 0 0 Michael R Jordan 141971 0 187773 0 9989 0 7500 0 21203 0 368436 0 0 0 Pramila Penta 254925 0 65769 0 2661 0 3452 0 6641 0 333448 0 0 0 Maritza Baez 211021 0 103982 0 5169 0 6876 0 6604 0 333652 0 0 0 Matthew Bartels 65908 143768 69949 31982 4448 811 3108 9385 237 15749 143650 201695 0 0 James D Spencer 0 58257 0 98080 0 1472348 0 7038 0 14142 0 1649865 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The CEO of the filing organization is also the CEO of a related (parent) organization. The CEO receives his compensation from the related organization. The CEO's compensation is determined in accordance with a Board of Directors approved executive compensation philosophy. The Executive Compensation process includes an evaluation of market comparables, 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. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Line 4a - One individual, J Spencer, from Part VII, Section A, Line 1a, received a severance payment in 2012 in the amount of $133,158: . Line 4b -The following persons from Part VII, Section A, Line 1a participated in a supplemental nonqualified retirement plan of a related organization: D Klein, E Duda, C Booth, S Sloan, M Cassady, A Ruflin, J Spencer, M Perry, D Golding and D Coleman. $457,762 in payments were made during 2012 to E Duda. Line 4c - 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. $732,920 in payments were made during 2012 to these individuals. SchJ_P01_S00_L05 Schedule J, Part I, Line 5 Physicians are eligible for an incentive if the filing organization exceeds its budgeted performance. SchJ_P02_S00_L00 Schedule J, Part II Line 1(ii), column B(iii) - The amount of $17,545,037 reported for David Klein includes a total of $16,918,124 of imputed income which was not actually received by Mr. Klein in 2012. The imputed income for Mr. Klein includes the entire amount of the present value of the non-qualified retirement plan benefits that will be paid to Mr. Klein over his lifetime as an annuity. This benefit was earned by Mr. Klein based upon his length of service and compensation according to provisions of the retirement plan. Mr. Klein did not actually received any portion of this benefit in 2012. As required by IRC Section 3121 regulations, the entire value of the lifetime benefit is recognized in 2012 and applicable FICA and FUTA taxes are paid. Line 2(ii), column B(iii) - The amount of $23,561,233 reported for Emil Duda primarily consists of three items: (1) a payment from a deferred compensation plan which totalled $14,463,092 which represents compensation earned by Mr. Duda over his career which he voluntarily deferred and the earnings on these deferrals; (2) the amount of $7,862,887 which was paid to Mr. Duda pursuant to an Executive Severance Agreement entered into by Mr. Duda and approved by the Board of Directors of the related organization; (3) the amount of $1,000,000 which was paid to Mr. Duda pursuant to a retention agrement between Mr. Duda and the related organization to ensure the continued services of Mr. Duda through the period ending December 31, 2011. The remainder is for other accrued credits as of his date of termination. Excellus Health Plan Inc Parent 104416927 Revenue from Parent 0 Excellus Health Plan Inc Parent 1539010 Rental of Space 0 Excellus Health Plan Inc Parent 5866336 Mgmt Fees & Purchased Services 0 SchL_P01_S00_L01 Schedule L, Part I, Line 1 The filing organization has various business transactions with Excellus Health Plan Inc whose CEO is also an officer of filing organization. SchL_P01_S00_L02 Schedule L, Part I, Line 2 The filing organization has various business transactions with Excellus Health Plan Inc whose CEO is also an officer of filing organization. SchL_P01_S00_L03 Schedule L, Part I, Line 3 The filing organization has various business transactions with Excellus Health Plan Inc whose CEO is also an officer of filing organization. F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 The following GVGHA board members are currently or formerly officers of Excellus Health Plan: David Klein, Emil Duda, Christopher Booth, Dorothy Coleman, and Stephen Sloan. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The organization's sole member is Excellus Health Plan, Inc. F990_P06_S0A_L07a 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. F990_P06_S0A_L07b 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.). F990_P06_S0B_L11b 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. F990_P06_S0B_L12c 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 questionnaire 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 Conflicts of Interest or potential Conflicts of Interest and makes recommendations. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Line 15a) 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. F990_P06_S0C_L18 Form 990, Part VI, Section C, Line 18 Form 990 is available online via Guidestar.org. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The governing documents, Conflict of Interest Policy, and financial statements are not made available to the public. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Column B - Some of the trustees and officers 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. F990_P07_S0A_L01b Form 990, Part VII, Section A, Line 1b David Klein is an officer of several entities, some of which are listed in Schedule R. Genesee Valley Group Healt Association Inc is charged for 1% of his salary. F990_P11_S00_L09 Form 990, Part XI, Line 9 Amortization of Net Gain/Loss - Defined Benefit Plans $109,737; Charitable receipt - $25,291,792 Univera Community Health Inc 165 Court Street Rochester NY 14647 161500379 Health Insurer NY 501(c)(3) 509(a)(2) Excellus Health Plan Inc 1 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 Univera IPA LLC 165 Court Street Rochester NY 14647 454058523 Independent Practice Association NY N/A 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 0 0 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 Excellus Health Plan Inc l 79125135 Arms-length transaction Excellus Health Plan Inc c 25291792 Cash value Excellus Health Plan Inc k 1539010 Arms length transaction Excellus Health Plan Inc m 5866336 Arms length transaction Univera Community Health Inc l 1897097 Arms length transaction