2020-11-12T16:13:34-06:00 2019-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2019-01-01 237098164 ST ANN'S NURSING HOME COMPANY INC STAN 5856976000 1500 PORTLAND AVENUE ROCHESTER NY 14621 DENNIS KANT SENIOR VICE PRESIDENT & CFO 5856976307 2020-11-09 1 JENNIFER ARBORE P00893012 5853811000 4.14.157.197 2020-11-09 16:21:15 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 829852D3FE1B4BD6D88CB1F1483A018BA4D8437D 2019 2021-01-29 14:40:06Z THE HERITAGE DENNIS KANT 1500 PORTLAND AVENUE ROCHESTER NY 14621 16154966 0 X WWW.STANNSCOMMUNITY.COM X 1971 NY PROMOTE INDEPENDENCE, PHYSICAL & SPIRITUAL WELL-BEING OF OLDER ADULTS IN A SKILLED NURSING FACILITY. 23 19 0 25 0 0 12089 5824 11313492 11291228 502916 1133213 20156 14323 11848653 12444588 104544 142152 0 0 4557751 4588694 0 0 0 5545125 5659259 10207420 10390105 1641233 2054483 34391608 37368799 15724977 16136074 18666631 21232725 X SINCE OUR FOUNDING IN 1874, OUR MISSION HAS BEEN TO PROMOTE THE HIGHEST LEVELS OF INDEPENDENCE, PHYSICAL AND SPIRITUAL WELL-BEING OF OLDER ADULTS IN THE CATHOLIC TRADITION OF EXCELLENCE IN CARE AND SERVICES. TO FULFILL THIS MISSION, ST. ANN'S COMMUNITY OFFERS A CONTINUUM OF SERVICES FOR SENIORS IN THE GREATER ROCHESTER AREA. ST. ANN'S COMMUNITY OTHERWISE KNOWN AS ST. ANN'S OF GREATER ROCHESTER, INC. DELIVERS THESE SERVICES THROUGH THESE AFFILIATED ORGANIZATIONS: ST. ANN'S HOME FOR THE AGED, ST. ANN'S NURSING HOME COMPANY, INC., CHAPEL OAKS, INC., ST. ANN'S FOUNDATION, INC. AND ST. ANN'S SENIOR HOUSING, INC.ST. ANN'S NURSING HOME COMPANY, INC. (THE HERITAGE) IS A NONPROFIT CORPORATION THAT OPERATES ST. ANN'S CARE CENTER AT CHERRY RIDGE, A 72-BED RESIDENTIAL HEALTH CARE FACILITY, PROVIDING INPATIENT POST-ACUTE REHABILITATION CARE AND PALLIATIVE CARE. 0 0 8995720 142152 11291228 ST. ANN'S NURSING HOME COMPANY, INC. (THE HERITAGE) IS A LICENSED SKILLED NURSING FACILITY THAT CURRENTLY OPERATES AS ST. ANN'S CARE CENTER AT CHERRY RIDGE. IT IS A 72-BED LICENSED FACILITY WITH 72 SKILLED NURSING BEDS. DURING 2019, THERE WERE 25,860 DAYS OF CARE FOR SKILLED NURSING. 8995720 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 12 0 0 0 0 0 0 0 0 0 0 0 0 X 23 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X DENNIS KANT SENIOR VICE PRESIDENT & CFO 5856976000 1500 PORTLAND AVENUE ROCHESTER NY 14621 DAN ADAMS DIRECTOR 1.00 X 0 0 0 EDMOND AKUBUIRO DIRECTOR 1.00 X 0 0 0 MICHELLE ASHBY DIRECTOR 1.00 X 0 0 0 CRAIG BURTON DIRECTOR 1.00 X 0 0 0 THOMAS COMBS DIRECTOR 1.00 X 0 0 0 MARK CRONIN DIRECTOR 1.00 X 0 0 0 KENT GARDNER CHAIR 1.00 X X 0 0 0 JOHN HAYES SECRETARY 1.00 X X 0 0 0 CARMEN INDIANO DIRECTOR 1.00 X 0 0 0 JAMES LEO TREASURER 1.00 X X 0 0 0 CANDICE LUCAS DIRECTOR 1.00 X 0 0 0 ANNA LYNCH DIRECTOR 1.00 X 0 0 0 SR MARLENE PAPE DIRECTOR 1.00 X 0 0 0 MICHAEL PINCH DIRECTOR 1.00 X 0 0 0 PATRICIA RISSONE DIRECTOR 1.00 X 0 0 0 MARURICIO RIVEROS DIRECTOR 1.00 X 0 0 0 CHERYL RYAN DIRECTOR 1.00 X 0 0 0 RONALD SALLUZZO BOARD CHAIR ELECT 1.00 X X 0 0 0 DEB SCHAUSEIL DIRECTOR 1.00 X 0 0 0 REV ROBERT SCHRADER DIRECTOR 1.00 X 0 0 0 SAMANTHA SINGHAL DIRECTOR 1.00 X 0 0 0 JOSEPH STANKAITIS IMMEDIATE PAST CHAIR 1.00 X X 0 0 0 MICHAEL MCRAE PRESIDENT/CEO 6.00 34.00 X X 0 494916 31256 DENNIS KANT SVP/CFO 3.00 37.00 X 0 275546 30439 KIM PETRONE MEDICAL DIRECTOR 4.00 36.00 X 0 381640 30877 SUSAN MURTY VP ADMINISTRATOR 6.00 34.00 X 0 238531 31222 JARVIS SANCHEZ-RIVERA ASSOCIATE MEDICAL DIRECTOR 4.00 36.00 X 0 259416 31003 JOHN JURIK ASSOCIATE MEDICAL DIRECTOR 4.00 36.00 X 0 245475 27875 ROBERT BOURG VP OF ORGANIZATIONAL TRAINING AND DEVELOPMENT 4.00 36.00 X 0 234972 12391 EILEEN RYAN-MARUKE VP OF MARKETING AND COMMUNITY RELATIONS 2.00 38.00 X 0 187532 28049 MICHAEL LARCHE CHIEF INFORMATION OFFICER 4.00 36.00 X 0 205529 10983 0 2523557 234095 0 0 1 0 USI INSURANCE SERVICES 100 SUMMIT LAKE DRIVE SUITE 400 VALHALLA NY 10595 INSURANCE SERVICES 166884 1 5824 5824 NET RESIDENT SERVICE REVENUE 623000 11291228 11291228 11291228 450069 450069 742 0 742 742 742 4393522 3710378 683144 683144 683144 MISCELLANEOUS 900099 13581 13581 13581 12444588 11291228 0 1147536 142152 142152 3798842 3609484 189358 507284 425632 81652 282568 237086 45482 14900 14900 105224 89299 15925 23419 23419 57961 47967 9994 95397 21665 73732 119562 119562 9937 6340 3597 498614 498614 2249598 1329803 919795 1325562 1325562 124348 124348 NYS ASSESSMENT 717558 717558 OTHER EXPENSES 167935 152302 15633 MEDICAL SUPPLIES 116499 116499 LICENSES, FEES & DUES 18022 18022 14723 13825 898 10390105 8995720 1394385 0 2115388 1016561 265212 15550 834522 606645 27879 32637 19974920 9716217 11533887 10258703 15700702 14716194 3914018 10722509 34391608 37368799 869628 680876 14350305 15297174 310266 194778 158024 15724977 16136074 X 18459200 20974495 207431 258230 18666631 21232725 34391608 37368799 X 2054483 1073445 -29849 -531985 X X 0 1 X 1 0 X 4852 8157 8635 12089 5824 39557 7890610 10766888 10643268 11313492 11291228 51905486 7895462 10775045 10651903 11325581 11297052 51945043 0 0 0 51945043 300308 315893 458528 416094 1490823 300308 315893 458528 416094 1490823 16909 34771 19304 13581 84565 8195770 11107847 11145202 11760979 11310633 53520431 0.97060 0.96400 0.02790 0.03470 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9461406 3783592 5677814 9400169 4915803 4484366 1113345 1016822 96523 10258703 BENEFICIAL INTEREST IN REMAINDER TRUSTS 226554 DEBT SERVICE RESERVE FUND 956154 DUE FROM AFFILIATES 1351426 DUE FROM RELATED PARTIES 8123016 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS, MEDICAID 33683 INTEREST IN NET ASSETS OF FOUNDATION 31676 10722509 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 158024 158024 13188608 1073446 -299577 773869 12414739 29849 29849 12444588 10247953 -142152 -142152 10390105 0 10390105 PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENT -350,376. CHANGE IN VALUE OF BENEFICIAL INTEREST IN REMAINDER TRUSTS 50,799. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONTRIBUTION TO RELATED PARTY -142,152. 0 ST ANN'S OF GREATER ROCHESTER 1500 PORTLAND AVENUE ROCHESTER NY 14621 161494042 142152 N/A PROVIDE FINANCIAL SUPPORT 1 0 PART I, LINE 2: THE ORGANIZATION PROVIDES PERIODIC REPORTS DETAILING THE USE OF THE GRANT FUNDS TO THE BOARD OF DIRECTORS. X X X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 MICHAEL MCRAE PRESIDENT/CEO 0 387395 0 106209 0 1312 0 11938 0 19318 0 526172 0 0 DENNIS KANT SVP/CFO 0 229068 0 44117 0 2361 0 12517 0 17922 0 305985 0 0 KIM PETRONE MEDICAL DIRECTOR 0 299281 0 80856 0 1503 0 12670 0 18207 0 412517 0 0 SUSAN MURTY VP ADMINISTRATOR 0 199642 0 38433 0 456 0 11904 0 19318 0 269753 0 0 JARVIS SANCHEZ-RIVERA ASSOCIATE MEDICAL DIRECTOR 0 236454 0 22454 0 508 0 11685 0 19318 0 290419 0 0 JOHN JURIK ASSOCIATE MEDICAL DIRECTOR 0 229325 0 9857 0 6293 0 11608 0 16267 0 273350 0 0 ROBERT BOURG VP OF ORGANIZATIONAL TRAINING AND DE 0 196464 0 37823 0 685 0 10883 0 1508 0 247363 0 0 EILEEN RYAN-MARUKE VP OF MARKETING AND COMMUNITY RELATI 0 158491 0 28085 0 956 0 8767 0 19282 0 215581 0 0 MICHAEL LARCHE CHIEF INFORMATION OFFICER 0 182315 0 21444 0 1770 0 9475 0 1508 0 216512 0 0 PART I, LINE 1A ST. ANN'S COMMUNITY PROVIDED THE FOLLOWING BENEFITS FOR THE PRESIDENT/CEO: PERSONAL CAR ALLOWANCE OF $3,278; INSURANCE OF $1,228; AND MOVING EXPENSES OF $18,840. ALL OF THESE ITEMS WERE CONSIDERED TAXABLE BENEFITS FOR THE PRESIDENT/CEO AND WERE INCLUDED AS WAGE COMPENSATION ON ON THE FORM W-2. ST. ANN'S COMMUNITY PROVIDED THE FOLLOWING BENEFITS FOR THE VP OF SENIOR HOUSING OPERATIONS AND DEVELOPMENT: REIMBURSEMENT OF LOCAL HOTEL STAYS OF $136. THIS WAS CONSIDERED A TAXABLE BENEFIT FOR THE VP OF SENIOR HOUSING OPERATIONS AND DEVELOPMENT AND WAS INCLUDED AS WAGE COMPENSATION ON THE FORM W-2. PART I, LINE 7 80 % IS TIED TO KEY ORGANIZATIONAL GOALS. 20% IS TIED TO INDIVIDUAL PERFORMANCE VS. ORGANIZATIONAL GOALS. A MONROE COUNTY INDUSTRIAL DEV CORP 510188852 61075TUH9 2019-12-31 15666763 TO REFUND REV BOND, SERIES 2014 0 0 1 A 15666763 956154 14510555 200054 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 A 0 ANNA LYNCH BOARD MEMBER OF ST. ANN'S COMMUNITY 127101 ANNA LYNCH IS A CURRENT BOARD MEMBER AND MANAGING PARTNER OF UNDERBERG & KESSLER LLP. ST. ANN'S ENGAGES UNDERBERG & KESSLER FOR LEGAL SERVICES. 0 MICHELLE ASHBY BOARD MEMBER OF ST. ANN'S COMMUNITY 121876 MICHELLE ASHBY IS A CURRENT BOARD MEMBER AND PRESIDENT/CEO OF TIPPING POINT MEDIA. ST. ANN'S ENGAGES TIPPING POINT MEDIA FOR MARKETING CONSULTING. 0 MAURICIO RIVEROS BOARD MEMBER OF ST. ANN'S COMMUNITY 5934976 MAURICIO RIVEROS IS A CURRENT BOARD MEMBER AND PRESIDENT/CEO OF THE PIKE GROUP, WHO OWNS LECESSE CONSTRUCTION. ST. ANN'S ENGAGES LECESSE CONSTRUCTION FOR CONSTRUCTION PROJECTS. 0 FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATION FOR THE REPORT IS PREPARED BY ST ANN'S STAFF, PROVIDED AND REVIEWED BY THE BONADIO GROUP. FINAL REPORTS ARE REVIEWED BY THE ST. ANN'S FINANCE TEAM, INCLUDING THE DIRECTOR OF FINANCE AND CFO, AND PROVIDED TO CEO AND BOARD MEMBERS PRIOR TO REVIEW AT THE BOARD MEETING. COPIES OF THE REPORTS ARE DISTRIBUTED AT A SUBSEQUENT BOARD MEETING AT WHICH TIME THE REPORTS ARE APPROVED. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS (INCLUDING THE PRESIDENT AND CEO) ARE REQUIRED TO ANNUALLY COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE FORMS ARE THEN REVIEWED BY THE VP OF ORGANIZATIONAL DEVELOPMENT AND ANY POTENTIAL CONFLICTS ARE DEALT WITH AS NEEDED INCLUDING ABSTAINING FROM VOTING ON MATTERS RELATED TO SUCH CONFLICTS. ANY PERSON COVERED BY THE POLICY SHALL NOT KNOWINGLY USE HIS OR HER POSITION FOR PERSONAL GAIN, TO COMPROMISE ST. ANN'S INTERESTS, OR TO ALLOW A CONFLICT TO ARISE BETWEEN ST. ANN'S INTEREST AND HIS OR HER PERSONAL INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR AN INDEPENDENT WAGE STUDY IS CONDUCTED BY A CONSULTANT. DIRECTORS AND ABOVE, EXCEPT CEO, ARE REVIEWED BY VP OR HR AND CEO WITH ADJUSTMENTS MADE TO MAINTAIN COMPETITIVENESS. CEO DATA IS REVIEWED BY A COMMITTEE INCLUDING THE BOARD CHAIR, PAST BOARD CHAIR AND HR BOARD CHAIR. ADJUSTMENTS MADE AS NEEDED TO MAINTAIN MARKET COMPETITIVENESS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENT -350,376. CHANGE IN VALUE OF BENEFICIAL INTEREST IN REMAINDER TRUSTS 50,799. NON CASH CONTRIBUTION TO RELATED PARTY 0. LOSS ON EXTINGUISHMENT OF DEBT -128,858. PENSION LIABILITY ADJUSTMENT -103,550. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR. FORM 990, PART V, LINE 2A: ALL INDIVIDUALS WORKING AT ST. ANN'S NURSING HOME COMPANY, INC. D/B/A THE HERITAGE ("THE HERITAGE") ARE EMPLOYEES OF ST. ANN'S HOME FOR THE AGED ("SAH") AND ARE REPORTED ON ITS FORM 941 UNDER EIN 16-0743146. THE SALARY AND BENEFITS EXPENSES REPORTED ON FORM 990, PART IX ARE THE HERITAGE'S ALLOCATED PAYROLL COSTS BASED ON TIME SPENT BY THE SHARED EMPLOYEES. SAH IS AN AFFILIATED TAX-EXEMPT ORGANIZATION. CHAPEL OAKS INC 1500 PORTLAND AVENUE ROCHESTER NY 14621 161489340 HEALTH CARE NY 501(C)(3) LINE 10 ST ANN'S OF GREATER ROCHESTER INC 0 ST ANN'S HOME FOR THE AGED 1500 PORTLAND AVENUE ROCHESTER NY 14621 160743146 HEALTH CARE NY 501(C)(3) LINE 10 ST ANN'S OF GREATER ROCHESTER INC 0 ST ANN'S FOUNDATION INC 1500 PORTLAND AVENUE ROCHESTER NY 14621 161379536 HEALTH CARE NY 501(C)(3) LINE 12A, I ST ANN'S OF GREATER ROCHESTER INC 0 ST ANN'S SENIOR HOUSING INC DBA CHERRY RIDGE 1500 PORTLAND AVENUE ROCHESTER NY 14621 760705854 HEALTH CARE NY 501(C)(3) LINE 10 ST ANN'S OF GREATER ROCHESTER INC 0 ST ANN'S OF GREATER ROCHESTER INC 1500 PORTLAND AVENUE ROCHESTER NY 14621 161494042 HEALTH CARE NY 501(C)(3) LINE 12B, II N/A 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1