2012-08-13T08:30:43-05:00 2011-12-31 264298079 EFP ROTENBERG LLP 280 KENNETH DRIVE ROCHESTER NY 14623 990 2011-01-01 270035416 FOUNDERS PAVILION INC FOUN 6076542400 205 EAST FIRST STREET CORNING NY 14830 GAIL MURRAY 6076542400 2012-08-10 1 DARLA WHEATON P00060135 5854278900 2011 2016-02-24 21:20:13Z GAIL MURRAY 205 EAST FIRST STREET CORNING NY 14830 11580465 0 X WWW.FOUNDERSPAVILION.ORG X 1970 NY TO DEDICATE OUR RESOURCES TO MEETING THE PHYSICAL AND EMOTIONAL NEEDS OF OUR RESIDENTS, WITH THE UNSHAKABLE BELIEF THAT THEY ARE THE PRIMARY REASON FOR OUR FACILITY'S EXISTENCE. 7 5 219 10 0 0 273666 2474840 9145311 9102609 1116 3016 0 0 9420093 11580465 0 0 0 0 6769516 6436690 0 0 0 2971760 3394644 9741276 9831334 -321183 1749131 3143265 4876211 1529048 1512863 1614217 3363348 TO DEDICATE OUR RESOURCES TO MEETING THE PHYSICAL AND EMOTIONAL NEEDS OF OUR RESIDENTS, WITH THE UNSHAKABLE BELIEF THAT THEY ARE THE PRIMARY REASON FOR OUR FACILITY'S EXISTENCE. 0 0 8160007 9105625 A RESIDENTIAL HEALTH CARE FACILITY WHICH PROVIDES THE PHYSICAL AND EMOTIONAL NEEDS FOR ITS RESIDENTS. 8160007 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 9 0 1 219 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X GAIL MURRAY 6076542400 205 EAST FIRST STREET CORNING NY 14830 CHARLES CORRAO 6.00 X 0 0 0 TONY TRIPENY 10.00 X 0 0 0 FRANCIS AVAGLIANO 2.00 X 0 0 0 ERICA DARMSTADT 4.00 X 0 0 0 DIANE PIERRI 4.00 X 0 0 0 GAIL MURRAY 40.00 X 53865 0 14206 BETH BEECHER 40.00 X 50595 0 13694 104460 0 27900 0 0 0 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR SUITE 300 BENSALEM PA 19020 DIETARY & HOUSEKEEPING 809027 REHAB RESOURCES 159 WEST FIRST ST OSWEGO NY 13126 PHYSICAL, OCCUPATION, SPEECH THERAPY 427301 2 2474840 2400000 2474840 MEDICAID 623000 7455742 7455742 PRIVATE INSURANCE 623000 1646867 1646867 9102609 3016 3016 11580465 9105625 0 0 132360 132360 4580677 3888663 692014 177176 151299 25877 834266 711355 122911 712211 591135 121076 11182 9281 1901 117706 97696 20010 37861 31425 6436 1599161 1327304 271857 22486 18663 3823 308955 256433 52522 149594 124163 25431 8493 7049 1444 31859 26443 5416 90657 75245 15412 82366 68364 14002 DRUG EXPENSE 211955 175923 36032 BAD DEBT 193553 160649 32904 FOOD AND CATERING 150351 124791 25560 REPAIRS AND MAINT 136790 113536 23254 241675 200590 41085 9831334 8160007 1671327 0 763532 207606 316548 203780 1492995 1527106 9791 12342 2711862 193531 119828 2518331 93102 85700 347469 321346 3143265 4876211 477045 731145 25397 48517 55367 1003486 700954 1529048 1512863 X 1172864 2925052 367918 364861 73435 73435 1614217 3363348 3143265 4876211 1749131 0 X 0 1 1 X 0 X 52169 273666 74840 400675 9000293 9145311 9102609 27248213 9052462 9418977 9177449 27648888 0 0 0 27648888 1004 1116 3016 5136 1004 1116 3016 5136 9053466 9420093 9180465 27654024 0.99980 0.99990 0.00020 0.00010 X SCHEDULE A, PART IV, LIST OF UNUSUAL GRANTS: BUILDING AND LAND DATE: 01/01/11 AMOUNT: 2400000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 200000 200000 2216842 63561 2153281 295020 129970 165050 2518331 DUE FROM THIRD-PARTY PAYORS 265979 RESIDENT FUNDS HELD IN TRUST 55367 321346 DUE TO THIRD-PARTY PAYORS 700954 700954 11580465 9831334 1749131 1749131 11580465 0 11580465 0 11580465 9831334 0 9831334 0 9831334 PART IV, LINE 2B: THE FACILITY HOLDS CUSTODY OVER THE RESIDENT'S FUNDS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: INCOME TAXES - THE FACILITY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE FACILITY'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. IN ACCORDANCE WITH ASC 740-10-50, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE FACILITY 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 FACILITY IS CURRENTLY OPERATING IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS HAS BEEN INCLUDED IN THE FACILITY'S FINANCIAL STATEMENTS. THE EXEMPT FACILITY'S INFORMATIONAL RETURNS ARE SUBJECTED TO AUDIT BY VARIOUS TAXING AUTHORITIES AND ITS OPEN AUDIT PERIODS ARE 2009 THROUGH 2011. X 1 2400000 100% OF ASSESSED VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS REVIEWS THE 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE FACILITY ROUTINELY REVIEWS ANY EXISTING RELATIONSHIPS AND THE STAFF'S RELATIONSHIPS WITH OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIONS, AND PAYERS. FORM 990, PART VI, SECTION B, LINE 15 THE ADMINISTRATOR'S SALARY OF THE FACILITY IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE ADMINISTRATOR REVIEWS AND APPROVES THE REST OF THE STAFF'S SALARY. FORM 990, PART VI, SECTION C, LINE 19 THE FACILITY'S FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.