JENNIE B RICHMOND CHAFFEE NURSING HOME CO: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
JENNIE B RICHMOND CHAFFEE NURSING HOME CO (EIN 23-7259920)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-15
IRS object ID
202123199349317237
Schema version
2020v4.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-15T14:19:41-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN454051133PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FREED MAXICK CPAS PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1424 MAIN STREET SUITE 800AddressLine1Txt
CityBUFFALOCityNm
State AbbreviationNYStateAbbreviationCd
ZIP142023508ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN237259920EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JENNIE B RICHMOND CHAFFEE NURSING HOMEBusinessNameLine1Txt
Business Name Line2COMPANY INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlJENNBusinessNameControlTxt
Phone7165922871PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1222 EAST MAIN STREETAddressLine1Txt
CitySPRINGVILLECityNm
State AbbreviationNYStateAbbreviationCd
ZIP14141ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTERESA DONOHUEPersonNm
Person TitleCFOPersonTitleTxt
Phone7165922871PhoneNum
Signature2021-11-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTERESAPersonFirstNm
Person LastDONOHUEPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARY MADONIAPreparerPersonNm
PTINP00405803PTIN
Phone7168472651PhoneNum
Preparation2021-11-11PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTERESA DONOHUEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1222 EAST MAIN STREETAddressLine1Txt
CitySPRINGVILLECityNm
State AbbreviationNYStateAbbreviationCd
ZIP14141ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$7,642,753GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressBERTRANDCHAFFEE.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1974FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionTO PROVIDE LONG-TERM CARE AND REHABILITATIVE SERVICES TO THE RESIDENTS OF SPRINGVILLE AND THE SURROUNDING REGION TO ENHANCE THE HEALTH STATUS OF RESIDENTS AND RESPOND TO COMMUNITY HEALTH NEEDS.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee143TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$200PYContributionsGrantsAmt
CY Contributions Grants$756,472CYContributionsGrantsAmt
PY Program Service Revenue$6,832,103PYProgramServiceRevenueAmt
CY Program Service Revenue$6,886,117CYProgramServiceRevenueAmt
PY Investment Income$571PYInvestmentIncomeAmt
CY Investment Income$164CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$6,832,874PYTotalRevenueAmt
CY Total Revenue$7,642,753CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,776,006PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,150,175CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,805,868PYOtherExpensesAmt
CY Other Expenses$3,109,064CYOtherExpensesAmt
PY Total Expenses$6,581,874PYTotalExpensesAmt
CY Total Expenses$7,259,239CYTotalExpensesAmt
PY Revenues Less Expenses$251,000PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$383,514CYRevenuesLessExpensesAmt
Total Assets BOY$3,201,904TotalAssetsBOYAmt
Total Assets EOY$3,801,568TotalAssetsEOYAmt
Total Liabilities BOY$725,754TotalLiabilitiesBOYAmt
Total Liabilities EOY$941,904TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,476,150NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,859,664NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE LONG-TERM CARE AND REHABILITATIVE SERVICES TO THE RESIDENTS OF SPRINGVILLE AND THE SURROUNDING REGION TO ENHANCE THE HEALTH STATUS OF RESIDENTS AND RESPOND TO COMMUNITY HEALTH NEEDS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$5,912,946ExpenseAmt
Revenue$6,886,117RevenueAmt
DescPROFESSIONAL CARE OF PATIENTS - FACILITY PROVIDED 80 NURSING BEDS, NURSING SERVICES, AND OTHER RELATED SERVICES AND SUPPLIES.Desc
Total Program Service Expenses$5,912,946TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document9IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee143EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonTERESA DONOHUEPersonNm
Phone7165922871PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1JB RICHMOND CHAFFEE NURSING HOMEAddressLine1Txt
CitySPRINGVILLECityNm
State AbbreviationNYStateAbbreviationCd
ZIP14141ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
MICHAEL BOZA
BOARD MEMBER2.002.00Yes (X)$0$0$0
GARY EPPOLITO
BOARD MEMBER/PRESIDENT3.003.00Yes (X)$0$0$0Yes (X)
STAN HANDZLIK
BOARD MEMBER2.002.00Yes (X)$0$0$0
ROBBIN HANSEN
BOARD MEMBER VICE PRESIDENT2.002.00Yes (X)$0$0$0Yes (X)
CLAUDIA MILLER
BOARD MEMBER2.002.00Yes (X)$0$0$0
KAREN STANFORD
BOARD MEMBER/SECRETARY2.002.00Yes (X)$0$0$0Yes (X)
PETER SWALES
BOARD MEMBER2.002.00Yes (X)$0$0$0
MARK ALIANELLO
BOARD MEMBER/TREASURER2.002.00Yes (X)$0$0$0Yes (X)
ROBERT ROGGIE
BOARD MEMBER2.002.00Yes (X)$0$0$0
JOHANNA HEALY
BOARD MEMBER3.003.00Yes (X)$0$0$0
NILS GUNNERSEN
CEO10.0030.00$0$236,299$0Yes (X)
TERESA DONOHUE
CFO10.0030.00$0$113,693$21,457Yes (X)
CAROLE FRANCIS
ADMINISTRATOR (PARTIAL YEA40.00$7,703$0$13Yes (X)
ALLYSA OLSEN
ADMINISTRATOR (PARTIAL YEA40.00$91,358$0$13,063Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$99,061TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$349,992TotReportableCompRltdOrgAmt
Total Other Compensation$34,533TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1OMNICARE INCBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1DEPT 781668 PO BOX 78000AddressLine1Txt
CityDETROITCityNm
State AbbreviationMIStateAbbreviationCd
ZIP48278ZIPCd
FieldValueIRS element (for citing)
ServicesPHARMACYServicesDesc
Compensation$148,267CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$753,000GovernmentGrantsAmt
All Other Contributions$3,472AllOtherContributionsAmt
Total Contributions$756,472TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PROGRAM SERVICES623000$6,320,172$6,320,172
GRANT REVENUE623000$565,945$565,945
FieldValueIRS element (for citing)
Total Program Service Revenue$6,886,117TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$164TotalRevenueColumnAmt
Exclusion$164ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,642,753TotalRevenueColumnAmt
Related Or Exempt Func Income$6,886,117RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$164ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$99,061TotalAmt
Management And General$99,061ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,200,673TotalAmt
Program Services$2,900,543ProgramServicesAmt
Management And General$300,130ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$82,333TotalAmt
Program Services$76,816ProgramServicesAmt
Management And General$5,517ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$496,833TotalAmt
Program Services$463,545ProgramServicesAmt
Management And General$33,288ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$271,275TotalAmt
Program Services$253,099ProgramServicesAmt
Management And General$18,176ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$35,860TotalAmt
Management And General$35,860ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$193,389TotalAmt
Program Services$80,041ProgramServicesAmt
Management And General$113,348ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$2,325TotalAmt
Program Services$2,325ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$738,102TotalAmt
Program Services$343,819ProgramServicesAmt
Management And General$394,283ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$94,618TotalAmt
Program Services$94,618ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,413TotalAmt
Program Services$4,556ProgramServicesAmt
Management And General$857ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$98,010TotalAmt
Program Services$93,109ProgramServicesAmt
Management And General$4,901ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$32,888TotalAmt
Management And General$32,888ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SHARED SERVICES$1,321,621$1,062,301$259,320
NYS ASSESSMENT FEE$394,790$394,790
CONTRACTED SERVICES$84,634$84,634
MISCELLANEOUS$54,832$35,511$19,321

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$52,582TotalAmt
Program Services$23,239ProgramServicesAmt
Management And General$29,343ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$7,259,239TotalAmt
Program Services$5,912,946ProgramServicesAmt
Management And General$1,346,293ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,347,401BOYAmt
EOY$2,685,712EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$893,177BOYAmt
EOY$577,348EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$12,778BOYAmt
EOY$4,044EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,595,742LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,193,602LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$344,929BOYAmt
EOY$402,140EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$603,619BOYAmt
EOY$132,324EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,201,904BOYAmt
EOY$3,801,568EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$396,381BOYAmt
EOY$559,780EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$9,599BOYAmt
EOY$11,667EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$319,774BOYAmt
EOY$370,457EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$725,754BOYAmt
EOY$941,904EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,476,150BOYAmt
EOY$2,859,664EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,476,150BOYAmt
EOY$2,859,664EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,201,904BOYAmt
EOY$3,801,568EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$383,514ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,601CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,935CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$895CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$200CurrentTaxYearMinus1YearAmt
Current Tax Year$3,472CurrentTaxYearAmt
Total$8,103TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,101,670CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,153,738CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,246,937CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,832,103CurrentTaxYearMinus1YearAmt
Current Tax Year$7,639,117CurrentTaxYearAmt
Total$32,973,565TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,103,271CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,155,673CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,247,832CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,832,303CurrentTaxYearMinus1YearAmt
Current Tax Year$7,642,589CurrentTaxYearAmt
Total$32,981,668TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$32,981,668PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$645CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$293CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$714CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$571CurrentTaxYearMinus1YearAmt
Current Tax Year$164CurrentTaxYearAmt
Total$2,387TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$645CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$293CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$714CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$571CurrentTaxYearMinus1YearAmt
Current Tax Year$164CurrentTaxYearAmt
Total$2,387TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,103,916CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,155,966CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,248,546CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,832,874CurrentTaxYearMinus1YearAmt
Current Tax Year$7,642,753CurrentTaxYearAmt
Total$32,984,055TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99990PublicSupportCY509Pct
Public Support PY5090.99990PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$16,000OtherCostOrOtherBasisAmt
Book Value$16,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,707,136OtherCostOrOtherBasisAmt
Depreciation$2,448,469DepreciationAmt
Book Value$258,667BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,744,194OtherCostOrOtherBasisAmt
Depreciation$1,616,721DepreciationAmt
Book Value$127,473BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$128,412OtherCostOrOtherBasisAmt
Depreciation$128,412DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$402,140TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ACCRUED PENSION COSTS$60,000
DUE TO 3RD PARTIES$310,457
FieldValueIRS element (for citing)
Total Liability$370,457TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:THE HOME ACTS AS CUSTODIAN FOR RESIDENT PERSONAL FUNDS.
PART X, LINE 2:THE HOSPITAL AND HOME ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND, ACCORDINGLY, ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL AND HOME ACCOUNT FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH U.S. GAAP, WHICH REQUIRES THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS THAT THE HOSPITAL AND HOME HAVE TAKEN OR EXPECTS TO TAKE ON THEIR TAX RETURNS. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE ACCOMPANYING FINANCIAL STATEMENTS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonNILS GUNNERSENPersonNm
TitleCEOTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$236,299CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$236,299TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN OUTSIDE, INDEPENDENT ACCOUNTING FIRM. THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS THE 990 PRIOR TO FILING THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST QUESTIONNAIRE FORMS ARE COMPLETED BY DIRECTORS AND MANAGERS ANNUALLY. THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND ADDRESSED AS NEEDED.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION FORMED AN INDEPENDENT SEARCH COMMITTEE THAT WAS INVOLVED IN NEGOTIATING THE CONTRACT OF THE CURRENT CEO. OTHER OFFICER AND KEY EMPLOYEE SALARIES ARE REVIEWED BY THE BOARD OF DIRECTORS AND SALARIES ARE COMPARED TO PEERS IN THE SURROUNDING AREA TO DETERMINE AN APPROPRIATE PAY SCALE.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION PROVIDES COPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C: AUDIT OVERSIGHTTHE AUDIT OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART IV, LINE 34: RELATED PARTIESTHE BERTRAND CHAFFEE HOSPITAL FOUNDATION, INC. (THE FOUNDATION) WAS ORGANIZED TO RECEIVE AND ADMINISTER FUNDS AND BEQUESTS TO BENEFIT THE COMMUNITY. WHILE THE FOUNDATION MAY, AT TIMES, MAKE DONATIONS TO JENNIE B. RICHMOND CHAFFEE NURSING HOME COMPANY ("JBR") OR BERTRAND CHAFFEE HOSPITAL ("BCH"), THERE IS NO OBLIGATION TO DO SO. THE FOUNDATION WAS NOT ORGANIZED SOLELY TO BENEFIT EITHER OF THESE ENTITIES. THE RELATIONSHIP BETWEEN THE FOUNDATION, JBR AND BCH DOES NOT MEET ANY "RELATED PARTY OR "CONTROL" DEFINITIONS STATED IN THE FORM 990 INSTRUCTIONS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1BERTRAND CHAFFEE HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1224 EAST MAIN STREETAddressLine1Txt
CitySPRINGVILLECityNm
State AbbreviationNYStateAbbreviationCd
ZIP14141ZIPCd
FieldValueIRS element (for citing)
EIN160743921EIN
Primary ActivitiesHOSPITAL/HEALTH CAREPrimaryActivitiesTxt
Legal Domicile StateNYLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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