2021-11-10T13:50:21-06:00 2020-12-31 161131146 BONADIO & CO LLP 432 NORTH FRANKLIN STREET SYRACUSE NY 13204 990 2020-01-01 161085780 ST CAMILLUS RESIDENTIAL HEALTH CARE FACILITY STCA 3154882951 813 FAY ROAD SYRACUSE NY 132193098 MICHAEL ZINGARO VICE PRESIDENT - FINANCE 3154882951 2021-10-27 1 MICHAEL ZINGARO XXX-XX-XXXX MICHELLE MUNDY P01982856 3154227109 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z AILEEN BALITZ 813 FAY ROAD SYRACUSE NY 132193098 30325197 0 X WWW.ST-CAMILLUS.ORG X 1967 NY ST. CAMILLUS IS A RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO CARING FOR LIFE THROUGH A BROAD RANGE OF HEALTHCARE SERVICES. THE ORGANIZATION OPERATES A 284 BED SKILLED NURSING FACILITY WHICH INCLUDES A 20 BED UNIT DEDICATED TO TRAUMATIC BRAIN INJURY, ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM, A SOCIAL ADULT DAY CARE PROGRAM AND A CERTIFIED HOME HEALTH AGENCY. THROUGH THESE SERVICES, ST. CAMILLUS HELPS TO ADDRESS THE LONG-TERM CARE, REHABILITATION AND HOME AND COMMUNITY BASED CARE NEEDS OF OUR COMMUNITY. 23 23 602 75 0 0 1191129 3518830 33417165 26131125 12787 13055 673298 660316 35294379 30323326 0 0 0 0 23162736 21967167 0 0 0 12063814 11219891 35226550 33187058 67829 -2863732 17904181 19641010 13571113 18171673 4333068 1469337 X ST. CAMILLUS IS A RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO CARING FOR LIFE THROUGH A BROAD RANGE OF HEALTHCARE SERVICES. THE ORGANIZATION OPERATES A 284 BED SKILLED NURSING FACILITY WHICH INCLUDES A 20 BED UNIT DEDICATED TO TRAUMATIC BRAIN INJURY, ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM, A SOCIAL ADULT DAY CARE PROGRAM AND A CERTIFIED HOME HEALTH AGENCY. THROUGH THESE SERVICES, ST. CAMILLUS HELPS TO ADDRESS THE LONG-TERM CARE, REHABILITATION AND HOME AND COMMUNITY BASED CARE NEEDS OF OUR COMMUNITY. 0 0 26348895 26131125 CARE AND TREATMENT OF PATIENTS IN A RESIDENTIAL HEALTH CARE FACILITY, OUTPATIENT ADULT DAY PROGRAMS, IN PATIENTS' HOMES. 26348895 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 39 0 602 1 0 0 0 0 0 0 0 0 0 0 0 X 23 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MARIA WEIR 3154882951 813 FAY ROAD SYRACUSE NY 132193098 PETER CAPPUCCILLI JR TRUSTEE 1.00 1.00 X 0 0 0 JOHN F CATANZARITA TRUSTEE 1.00 1.00 X 0 0 0 CHARLES P CONOLE MEMBER/TRUSTEE 1.00 1.00 X 0 0 0 DR JEANNE E BISHOP TRUSTEE 1.00 1.00 X 0 0 0 REV MSGR RICHARD KOPP MEMBER/TRUSTEE 1.00 1.00 X 0 0 0 WAYNE V LA FRANCE TRUSTEE 1.00 1.00 X 0 0 0 PAUL MELLO SECRETARY 1.00 1.00 X X 0 0 0 DR SHEILA M LEMKE TRUSTEE 1.00 1.00 X 0 0 0 STEPHEN C DALEY TRUSTEE 1.00 1.00 X 0 0 0 BRENDA A RIGAS TRUSTEE 1.00 1.00 X 0 0 0 JAMES D SPENCER CHAIR 1.00 1.00 X X 0 0 0 DERRICK J SUEHS TRUSTEE 1.00 1.00 X 0 0 0 MARY GRACE VANNORTWICK VICE CHAIR 1.00 1.00 X X 0 0 0 JOHN MAESTRI TRUSTEE 1.00 1.00 X 0 0 0 DOUGLAS J REICHER TRUSTEE 1.00 1.00 X 0 0 0 SCOTT MCCLURG TRUSTEE 1.00 1.00 X 0 0 0 JOANN WALLACE TRUSTEE 1.00 1.00 X 0 0 0 WANDA HINES-MCGRIFF TRUSTEE 1.00 1.00 X 0 0 0 GEORGE W CHAPMAN TRUSTEE 1.00 1.00 X 0 0 0 NANCY DAOUST TRUSTEE 1.00 1.00 X 0 0 0 CATHERINE GREEN-HARRIS TRUSTEE 1.00 1.00 X 0 0 0 BARBARA H DRAPOLA TRUSTEE 1.00 1.00 X 0 0 0 JENNIFER A WATKINS TRUSTEE 1.00 1.00 X 0 0 0 AILEEN BALITZ PRESIDENT 36.00 4.00 X 207937 0 1634 MICHAEL ZINGARO VP FINANCE 36.00 4.00 X 143000 0 8581 MICHAEL SCHAFER VP-NURSING 40.00 X 154522 0 8058 KATHRYN BARBER VP-QUALITY MANAGEMENT 36.00 4.00 X 108507 0 11514 HEATHER KEMMIS VP-HOME CARE 24.00 16.00 X 105865 0 22852 CARIN PREDMORE VP-HUMAN RESOURCES 32.00 8.00 X 129468 0 780 DR ALBERT TRIPODI MEDICAL DIRECTOR 40.00 X 151377 0 350 DONNA GILLETTE NURSE PRACTITIONER 40.00 X 107331 0 23375 MARIA WEIR DIRECTOR OF FINANCE 40.00 X 108381 0 630 OMONIGHO OGBONNA CNA 40.00 X 106854 0 1839 ANN VENTURINI DIRECTOR OF ADMISSIONS AND CONTRACT 38.00 2.00 X 101566 0 1126 1424808 0 80739 11 0 1 0 SODEXO INC PO BOX 360170 PITTSBURG PA 15251 FOOD SERVICE 1434510 NURSE CONNECTION STAFFING 1 COMPUTER DRIVE SOUTH ALBANY NY 12205 NURSING STAFF 801549 ADECCO EMPLOYMENT SERVICES 225 GREENFIELD PARKWAY LIVERPOOL NY 13088 NURSING STAFF 640505 CLINICAL STAFFING RESOURCES PO BOX 4776 DEPT 100 HOUSTON TX 77210 NURSING STAFF 439469 NURSECORE MGMT SERVICES LLC PO BOX 650823 DEPT 41753 DALLAS TX 75265 NURSING STAFF 280944 8 36106 3080819 401905 3518830 PROGRAM SERVICE REVENUE 623000 26131125 26131125 26131125 13055 13055 48683 0 48683 48683 48683 150 36106 1871 -1721 -1721 OTHER REVENUE 900099 505918 505918 MANAGEMENT FEE INCOME 623000 107436 107436 613354 30323326 26744479 0 60017 1424808 1424808 16673641 13689938 2983703 2565675 1940715 624960 1303043 1047280 255763 36558 36558 47295 47295 1545398 1442452 102946 157936 157936 140647 30316 110331 479306 431375 47931 75182 74762 420 3200 343 2857 217958 178940 39018 1056009 950408 105601 413437 288715 124722 CONTRACT LABOR 2707459 2707459 SUPPLIES 2016355 1933576 82779 NYS ASSESSMENT 1111647 1111647 OTHER EXPENSES 784694 254976 529718 426810 265993 160817 33187058 26348895 6838163 0 670291 4782484 6684423 5286814 124584 4846 65364 240304 175188 228121 31614356 26067175 6154043 5547181 4030288 3551260 17904181 19641010 6646887 5558580 99212 5909021 9921620 915993 2691473 13571113 18171673 X 4270541 1345919 62527 123418 4333068 1469337 17904181 19641010 -2863732 0 X X 0 1 X 1 1 1 X SCHEDULE A LINE 3 ST. CAMILLUS RESIDENTIAL HEALTH CARE FACILITY IS A NURSING HOME WHICH HAS AS ITS MAIN PURPOSE THE PROVISION OF HEALTHCARE SERVICES, IT APPROPRIATELY NOTED ON FORM 1023 THAT IT IS A HOSPITAL. THE STATE OF NEW YORK DOES NOT REQUIRE NURSING HOMES TO BE LICENSED AS A HOSPITAL. AS A NURSING HOME, ST. CAMILLUS RESIDENTIAL HEALTH CARE FACILITY HAS AS ITS PRINCIPAL PURPOSE THE PROVISION OF HEALTH CARE. ACCORDINGLY, IT WAS (I) PROPERLY IDENTIFIED AS A "HOSPITAL" ON FORM 1023; (II) PROPERLY IDENTIFIED AS A "HOSPITAL" ON FORM 990 SCHEDULE A; AND (III) SHOULD NOT BE DESIGNATED AS A "HOSPITAL/HOSPITAL FACILITY" ON FORM 990 SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 62527 98757 37866 123418 76383 17267 31123 62527 70879 53609 48105 76383 83226 38060 50407 70879 137990 12478 67242 83226 1.00000 0 0 153315 153315 22350187 17779528 4570659 1341859 1269648 72211 7766513 7017999 748514 2482 2482 5547181 PATIENTS FUNDS 62929 RESERVE FOR REPLACEMENTS 1003668 OTHER RECEIVABLES 1549195 LONG TERM RECEIVABLES 398000 DONOR RESTRICTED FUNDS 166837 GRANT RESTRICTED FUNDS 92956 CURRENT PORTION OF ASSETS LIMITED AS TO USE 440 DUE FROM MEDICAID 277235 3551260 PATIENTS FUND 62929 OTHER LIABILITIES 398000 ESTIMATED THIRD PARTY PAYOR SETTLMENTS 1208984 MEDICARE ADVANCE PAYMENT 1021560 2691473 PART V, LINE 4: DONOR RESTRICTED ENDOWMENT FUNDS ARE THOSE WHOSE USE BY THE ORGANIZATION HAS BEEN LIMITED BY DONORS OR GRANTORS TO A SPECIFIC TIME PERIOD OR PURPOSE. PART X, LINE 2: ST. CAMILLUS ND INTEGRITY ARE TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. X X X X X X X 0 NY ANNUAL APPEAL 17950 18050 -100 426 LIGHT THE WAY 6555 6555 149 1 11751 11501 250 1296 36256 36106 150 1871 1871 -1721 X X 0 0 0 0 0 0 0 0 0 AILEEN BALITZ PRESIDENT 207937 0 0 0 0 0 0 0 1634 0 209571 0 0 0 MICHAEL SCHAFER VP-NURSING 154522 0 0 0 0 0 0 0 8058 0 162580 0 0 0 DR ALBERT TRIPODI MEDICAL DIRECTOR 151377 0 0 0 0 0 0 0 350 0 151727 0 0 0 MICHAEL ZINGARO VP FINANCE 143000 0 0 0 0 0 0 0 8581 0 151581 0 0 0 PART I, LINE 3: THE FACILITY'S SALARY RANGES ARE BASED ON AN INCORPORATION OF A STUDY PERFORMED BY AN INDEPENDENT ACCOUNTING FIRM DURING THE 1990'S, TRENDED FORWARD, AND TWO SEPARATE INDEPENDENT SURVEYS OF SALARY PACKAGES OF SIMILAR POSITIONS RECEIVED DURING 2009. ON AN ONGOING BASIS, THE VP OF HUMAN RESOURCES CONTACTS THEIR COUNTERPARTS IN THE AREA TO CHECK THEIR RATES AND BENEFITS. LEADING AGE NY CONDUCTS PERIODIC COMPENSATION SURVEYS THAT THE ORGANIZATION REVIEWS TO GAUGE CURRENT SALARY STRUCTURE WITHIN THE INDUSTRY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION VOTE TO ELECT TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE OPERATING DECISIONS MADE BY THE GOVERNING BODY (BOARD OF TRUSTEES) ARE DONE SO BY A MAJORITY VOTE OF THE TRUSTEES AND CAN NOT BE OVERRIDDEN. HOWEVER, ANY BY LAW CHANGES OR NEW TRUSTEE APPOINTMENTS REQUIRE A MAJORITY VOTE OF THE MEMBERS, IF PERSONALLY IN ATTENDANCE, OR BY PROXY, AT THE MEETING OR 100% WRITTEN APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B BEFORE THIS FORM 990 WAS FILED WITH THE IRS, ALL OF THE FOLLOWING REVIEWS TOOK PLACE: THE FORM 990 WAS REVIEWED BY THE CONTROLLER, VP OF FINANCE, AND CORPORATE COMPLIANCE OFFICER, IN CONSULTATION WITH ADMINISTRATIVE STAFF MEMBERS, EXECUTIVE MANAGEMENT, AND ADVISORS TO THE ORGANIZATION. THE FORM 990 WAS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES AND WAS MADE AVAILABLE TO ALL CURRENT VOTING MEMBERS OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES WRITTEN DISCLOSURES BY ALL TRUSTEES, OFFICERS, KEY EMPLOYEES, AND OTHER MANAGEMENT OR SUPERVISORY EMPLOYEES WHO ARE IN A POSITON TO INFLUENCE DECISION MAKING FOR THE ORGANIZATION. SUCH INDIVIDUALS ARE REQUIRED TO DISCLOSE ACTUAL AND POTENTIAL CONFLICTS OF INTEREST UPON INITIAL APPLICATION WITH THE ORGANIZATION, ON AN ANNUAL BASIS, AND WHENEVER REPORTABLE INTERESTS ARISE. THE COMPLIANCE OFFICER, IN COLLABORATION WITH THE CHAIR OF THE AUDIT COMMITTEE, IN CONSULTATION WITH THE PRESIDENT, REVIEWS WRITTEN DISCLOSURES, OBTAINS FURTHER INFORMATION AS NEEDED, AND EVALUATES ACTUAL AND POTENTIAL CONFLICTS. AS WARRANTED, THE PRESIDENT, THE CHAIR OF THE AUDIT COMMITTEE, AND/OR BOARD CHAIRMAN IMPLEMENTS MEASURES TO ENSURE THAT DECISIONS RELATING TO THE ORGANIZATIONS ARE MADE SOLELY ON THE BASIS OF THE BEST INTERESTS OF THE ORGANIZATION AND IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PURPOSES. ANY TRUSTEE WHO HAS A DUALITY OF INTEREST OR A POTENTIAL CONFLICT OF INTEREST AS TO A MATTER COMING BEFORE THE BOARD IS PROHIBITED FROM VOTING OR USING PERSONAL INFLUENCE AS TO BOARD ACTION ON SUCH MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE FACILITY'S SALARY RANGES ARE BASED ON AN INCORPORATION OF A STUDY PERFORMED BY AN INDEPENDENT ACCOUNTING FIRM DURING THE 1900'S AND TRENDED FORWARD AND TWO SEPARATE INDEPENDENT SURVEYS OF SALARY PACKAGES OF SIMILAR POSITIONS RECEIVED DURING 2009. ON AN ONGOING BASIS, THE VP OF HUMAN RESOURCES CONTACTS THEIR COUNTERPARTS IN THE AREA TO CHECK THEIR RATES AND BENEFITS. LEADING AGE NY CONDUCTS PERIODIC COMPENSATION SURVEYS THAT THE ORGANIZATION REVIEWS TO GAUGE CURRENT SALARY STRUCTURE WITHIN THE INDUSTRY. AT THE TIME OF HIRE THE FACILITY'S CEO REVEIWS THE SALARY REQUIREMENTS FOR KEY EMPLOYEES IN RELATION TO CURRENY MARKET CONDITIONS AND SALARY PAYSCALES PREVIOUSLY APPROVED BY THE EXECUIVE COMMITTEE TO DETERMINE COMPENSATION. ANY SALARY RECOMMENDATIONS PROPOSED THAT ARE NOT COMMENSURATE WITH PREVIOUSLY APPROVED PAYSCALES REQUIRE CONSULTATION WITH AND AGREEEMENT FROM THE BOARD CHAIRPERSON. ANNUALLY, OR WHEN CIRCUMSTANCES WARRANT, THE CEO PRESENTS TO THE EXECUTIVE COMMITTEE FOR THEIR REVIEW AND APPROVAL ANY RECOMMENDATIONS FOR COMPENSATION OF KEY EMPLOYEES BASED ON PERFORMANCE EVALUATIONS. FORM 990, PART VI, SECTION C, LINE 18 THE FACILITY MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PART XII, LINE 2C ST. CAMILLUS HAS AN AUDIT COMMITTEE AND A FINANCE COMMITTEE, BOTH, COMPRISED OF TRUSTEES. THE AUDIT COMMITTEE, IN CONJUNCTION WITH THE FINANCE COMMITTEE MEETS TWICE ANNUALLY, THE FIRST MEETING TO REVIEW THE ANTICIPATED AUDIT PROCESS AND TO DISCUSS ANY POTENTIAL MATTERS REQUIRING DISCLOSURE OR A CHANGE FROM PRIOR YEAR TREATMENT, ETC; THE SECOND MEETING TO REVIEW THE FINAL FINANCIAL STATEMENTS AND ANY FINDINGS. INTEGRITY HOME CARE SERVICES INC 813 FAY ROAD SYRACUSE NY 13219 161500579 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 ST CAMILLUS RESIDENTAL HEALTH CARE FACILITY 1 1 1 0 1 1 0 0 0 0 1 0 1 0 1 1 1 1 0 0 INTEGRITY HOME CARE SERVICES INC A 7200 FMV INTEGRITY HOME CARE SERVICES INC J 6662 FMV INTEGRITY HOME CARE SERVICES INC P 214788 FMV INTEGRITY HOME CARE SERVICES INC Q 169083 FMV