2023-08-04T12:24:45-07:00 2022-12-31 990 2022-01-01 160743225 SCHOFIELD RESIDENCE INC SCHO 7168741566 3333 Elmwood Avenue Kenmore NY 14217 Nicholas Scarpine Controller 7168741566 2023-08-04 1 1 11 1 AAL2 2022 2023-04-26 12:10:37Z Schofield Residence Christopher Koenig 3333 Elmwood Avenue Kenmore NY 14217 16096331 0 X www.schofieldcare.org X 1915 NY To provide the highest level of professional health care and supportive services to the frail elderly and disabled individuals in the community. We offer individual choice by providing a variety of services that are offered in both residential and community settings, including long term care in our residential health care facility, a certified home health agency, and an adult day health care program. 7 7 351 0 0 0 2011284 1828406 12138795 13624024 704482 121264 562683 522637 15417244 16096331 0 0 0 0 8227373 8660548 0 0 0 6300165 7491126 14527538 16151674 889706 -55343 15562030 16134573 2892855 3749626 12669175 12384947 To provide the highest level of professional health care and supportive services to the frail elderly and disabled individuals in the community. We offer individual choice by providing a variety of services that are offered in both residential and community settings, including long term care in our residential health care facility, a certified home health agency, and an adult day program. 0 0 8248402 0 10091715 The general purpose of the facility is to operate a nursing home for elderly men and women with full medical care and supervision. 1349961 0 1223138 The facility operates a certified home care program which provides health care services to patients in the community. 2579788 0 2309171 The facility operates an adult day health care program which provides medical and therapeutic services to registrants on an outpatient basis. 0 0 0 12178151 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 15 0 1 351 1 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 NY X Steven Chizuk 7168741566 3333 Elmwood Avenue Kenmore NY 14217 Olivia Rozycki SNF Administrator 40 0 X 135110 0 12600 Steve Chizuk CFO 16 4 X 125615 0 0 Jodie Steffans Director of Nursing 37.5 0 X 113852 0 3415 Melinda Hollie Director of Patient Services 37.5 0 X 101709 0 11099 Misty Willis RN Unit Coordinator 37.5 0 X 104543 0 7467 Randy Gerlach President 36 4 X 65723 0 10000 James Campbell Chairman 3 2 X X 0 0 0 Christopher Kempton Treasurer 3 2 X X 0 0 0 Sharon McGuan Secretary 3 2 X X 0 0 0 Lawrence DiGiulio Director 3 2 X 0 0 0 Paul Hettich Director 3 2 X 0 0 0 Rebecca Korosi Director 3 2 X 0 0 0 Saralin Tiedeman Director 3 2 X 0 0 0 Patricia Watson Secretary 3 2 X X 0 0 0 Darlene Maclay Director 3 2 X 0 0 0 James Phillips MS Chairman 3 2 X X 0 0 0 Christopher Koenig CEO 14 2 X 0 0 0 646552 0 44581 5 0 0 0 Diversified Rehab Services Inc 2565 Elmwood Avenue Kenmore NY 14217 Therapies 807366 Favorite Healthcare Staffing 3719 Union Road Buffalo NY 14225 CNA and LPN Staffing Agency 296548 Regional Care Network 1 Radisson Plaza Suite 906 New Rochelle NY 10801 CNA and LPN Staffing Agency 240746 Shiftmed 7925 Jones Branch Drive Suite 1100 McClean VA 22102 CNA and LPN Staffing Agency 214672 PCA Technology Group Inc 303 Cayuga Rd Ste 100 Buffalo NY 14225 Technology Services 181432 7 0 0 0 18625 1809781 0 0 1828406 Skilled Nursing Facility 623000 10091715 10091715 0 0 Adult Day Health Care Program 621990 2309171 2309171 0 0 Certified Home Health Agency 621610 1223138 1223138 0 0 0 0 0 0 13624024 121264 0 0 121264 0 0 0 0 0 0 0 0 0 0 0 0 0 Shared Services Revenue 561000 472471 472471 0 0 50166 0 0 50166 522637 16096331 14096495 0 171430 X 125615 0 125615 0 6731045 5690635 1040410 172086 150080 22006 1129692 937220 192472 502110 424580 77530 0 611321 289155 322166 89843 89843 36050 36050 2098331 2098331 79925 79925 929667 833717 95950 315041 108820 206221 503675 503675 19208 18806 402 6106 1405 4701 3193 3193 273653 273653 1372248 1372248 Adult Day Transportation 110173 110173 0 0 NYS Cash Assessment and Licenses 576271 576271 0 0 466421 435283 31138 0 16151674 12178151 3973523 0 1787917 347333 1921020 1821664 0 0 1427268 1626238 0 0 0 0 1239811 1477728 182302 188540 623485 809948 11722797 9864496 1771447 1858301 6416098 6250417 0 0 6015 0 186667 186667 0 1567737 15562030 16134573 2677659 1228874 0 0 0 0 0 0 25365 26366 0 0 0 0 0 0 189831 2494386 2892855 3749626 X 11633728 11565941 1035447 819006 12669175 12384947 15562030 16134573 -55343 -228885 0 0 0 0 X 0 1 X 1 0 X 73450 7537 2908069 2011284 1830512 6830852 18593318 17146969 12854857 15417244 16096331 80108719 18666768 17154506 15762926 17428528 17926843 86939571 86939571 -178631 159954 146822 704640 121264 954049 -178631 159954 146822 704640 121264 954049 52739 38561 265874 127768 48060 533002 18540876 17353021 16175622 18260936 18096167 88426622 0.98318 0.98233 0.01079 0.01199 X Schedule A, Part III, Line 12 Miscellaneous supply sales and rebates RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1035443 2106 -175084 0 43459 0 819006 991071 6831 158909 0 121368 0 1035443 858951 90199 95491 0 53570 0 991071 756657 7537 148714 0 53957 0 858951 823064 79548 18650 0 164605 0 756657 0.9484 0.0516 0 1 0 0 250147 250147 0 1860328 1549540 310788 0 92200 56762 35438 0 9041396 7946364 1095032 0 478726 311830 166896 1858301 ADHCP Property Lease - Right of Use Asset 1567737 1567737 0 Professional Liability Reserve 888893 ADHCP Lease Liability 1588723 Due to/From Medicaid 16770 2494386 X Schedule D, Part IV, Line 2b Resident funds held in trust. Schedule D, Part V, Line 4 Schofield Residence holds funds donated to the organization with the donor restriction that the principal gift remains permanently intact and only the investment income from those gifts be used for the unrestricted purposes. Schofield Residence also holds funds donated to the organization with the donor restriction that the funds be held until they can be utilized for the certain capital projects or programs to enhance the quality of resident care at the skilled nursing facility. Schedule D, Part X, Line 2 Schofield Residence is a not-for-profit corporation and is exempt from income taxes as an organization qualified under Section 501 (c) (3) of the Internal Revenue Code. Schofield Residence has also been classified by the Internal Revenue Service as an entity that is not a private foundation. Form 990, Part VI, Section B, Line 11b The process used by Schofield Residence to review the form 990 is as follows: - The 990 is prepared by the Finance Department - The form 990 draft is reviewed by the organization's independent auditors who then propose changes - The final Form 990 is then reviewed by the Finance Committee of the Board of Directors - A copy of the Form 990 is provided to all board members prior to filing. Form 990, Part VI, Section B, Line 12c Schofield Residence regularly and consistently monitors and enforces compliance of its written conflict of interest policy through Corporate Compliance policies and procedures. All employees, agents, and members of the Board of Directors are required to abide by the organization's conflict of interest policy. The Corporate Compliance manual identifies specific situations, as examples, to assist in identifying situations that would represent conflicts of interest. All employees are required to report any potential conflict of interest concerns to management. All potential conflict of interest situations are then brought to the attention of the Corporate Compliance Committee, which reviews the specifics of the situation, and determines if any risks exist and what actions would be appropriate. The Board of Directors, on an annual basis, must sign a statement which affirms that they have reviewed and understand the By-Laws article regarding conflict of interest and agree to comply with the policy. All potential and actual conflict of interest situations that involve a Board Member are brought to the attention of the Board of Directors at the governing board meeting. After presentation of the information, the director involved will leave the meeting and the Board of Directors will then discuss and vote on the risks involved and what actions would be appropriate. Form 990, Part VI, Section B, Line 15 The process for determining compensation for the President consist of the Board of Directors delegating to the Personnel/Pension Committee the responsibility to review the compensation package for the President, and using comparability data in establishing appropriate compensation. The compensation of other officers and key employees of the organization is established by the President. Form 990, Part VI, Section C, Line 19 The governing document of Schofield Residence, which is made available to the public, is the organization's original and amended Certificate of Incorporation of the Corporation which is filed with the New York State Secretary of State. The 990 is available to the public via the Administration Office upon request. Form 990, Part IX, Line 11g Contracted staff for therapy services, CNA and LPN nursing services, contracted services for labs, dental, and other medical services. Schofield Home Health Care Services Inc 3333 Elmwood Avenue Kenmore NY 14217 223204613 Licensed Home Health Care Agency NY 501 (c) (3) 9 Schofield Residence Inc 1 Schofield Foundation Inc 3333 Elmwood Avenue Kenmore NY 14217 161190702 Support for related organiztions NY 501 (c) (3) 11 Schofield Residence Inc 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 Schofield Home Health Care Services Inc l 362662 Expense Allocations Schofield Home Health Care Services Inc m 16375 Servive agreement for LPN and aide services Schofield Home Health Care Services Inc o 132458 Time study for payroll allocations Schofield Foundation Inc l 57967 Expense Allocation Schofield Home Health Care Services Inc q 366493 Amount paid in 2022 for expenses allocated to SHHCS The organization has suffered from turnover and short staffing in the finance and administrative departments. As a result, the deadline for the automatic six month extension was missed by a few days. This report is still being filed well before the November due date that would be in place if the automatic extension was granted.