2018-11-02T14:23:40-05:00 2017-12-31 161092347 MENGEL METZGER BARR & CO LLP 333 EAST WATER ST STE 200 ELMIRA NY 14901 990 2017-01-01 510191763 BETHANY NURSING HOME AND HEALTH RELATED FACILITY INC BETH 6077398711 3005 WATKINS ROAD HORSEHEADS NY 14845 THOMAS SANTOBIANCO CEO 6077398711 2018-10-22 1 KRISTA L NILES-UPDYKE P00958947 6077344183 2018-10-22 98.159.217.67 2018-10-22 10:52:38 ED P DE8F756557E6DC067C8E4F7CC1E5D7199762286C 3879453E6F550BA2EC23F67EA1C8C4C18DF08C34 2017 2019-02-21 02:37:17Z THOMAS SANTOBIANCO 3005 WATKINS ROAD HORSEHEADS NY 14845 11727939 0 X WWW.BETHANY-VILLAGE.ORG X 1975 NY TO PROVIDE REGIONAL LEADERSHIP, SERVICES, ADVOCACY, AND EDUCATION FOR QUALITY SENIOR LIVING, WHILE OPERATING A VIBRANT, LIFE-AFFIRMING RESIDENTIAL COMMUNITY THAT CELEBRATES SPIRITUAL WELL-BEING, ENHANCES INDEPENDENCE AND PROMOTES WELLNESS AS ITS RESIDENTS EVOLVE TOWARD THEIR FULL POTENTIAL. 13 13 313 27 0 0 2076 3258 11390909 11298067 176 7061 214993 419553 11608154 11727939 0 0 0 0 6353631 6648099 0 0 0 5221099 4943578 11574730 11591677 33424 136262 5776306 6399854 5218269 5705555 558037 694299 X THE MISSION OF BETHANY VILLAGE IS TO PROVIDE REGIONAL LEADERSHIP, SERVICES, ADVOCACY, AND EDUCATION FOR QUALITY SENIOR LIVING, WHILE OPERATING A VIBRANT, LIFE-AFFIRMING RESIDENTIAL COMMUNITY THAT CELEBRATES SPIRITUAL WELL-BEING, ENHANCES INDEPENDENCE AND PROMOTES WELLNESS AS ITS RESIDENTS EVOLVE TOWARD THEIR FULL POTENTIAL. 0 0 10302294 11724681 OPERATES A SKILLED NURSING FACILITY WHICH PROVIDES HEALTH CARE SERVICES TO THE ELDERLY. 10302294 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 21 0 1 313 1 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MICHAEL KISER CPA 6077398711 3005 WATKINS ROAD HORSEHEADS NY 14845 RICHARD G CARR BOARD MEMBER 1.00 X 0 0 0 RANDI HEWIT BOARD MEMBER 1.00 X 0 0 0 RC IKE BOARD MEMBER 1.00 X 0 0 0 J CAROL LINCOLN BOARD MEMBER 1.00 X 0 0 0 JOSEPH PONZI BOARD MEMBER 1.00 X 0 0 0 JASON PARMENTER BOARD MEMBER 1.00 X 0 0 0 DAVID SCHULTZ BOARD MEMBER 1.00 X 0 0 0 DAWN BURLEW BOARD MEMBER 1.00 X 0 0 0 ALISON HUNT BOARD MEMBER 1.00 X 0 0 0 DAVID HELSING BOARD MEMBER 1.00 X 0 0 0 WALTER HERBST BOARD CHAIR 2.00 X 0 0 0 JACK BENJAMIN BOARD VICE CHAIR 2.00 X 0 0 0 JAMES BATTERSBY TREASURER / SECRETARY 2.00 X 0 0 0 THOMAS SANTOBIANCO CEO 40.00 X 203162 0 28457 MICHAEL KISER CFO 40.00 X 128065 0 6396 JAMES MARK ADMINISTRATOR 40.00 X 135977 0 14695 467204 0 49548 3 0 1 0 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 606809056 MANAGES AND STAFFS PT/OT/SLP THERAPY PRO 1159181 FIRST CALL PHYSICIAN ASSISTANT SERVICES 378 BANNISTER ROAD BREESPORT NY 14816 PHYSICIAN ASSISTANT 529510 2 3258 3258 MEDICARE AND MEDICAID 623000 9465406 9465406 PRIVATE PAY 623000 1773529 1773529 ANCILLARY SERVICES 623000 59132 59132 11298067 7061 7061 SHARED SERVICES/MGMT FEE 623000 343812 343812 SUNDRY 623000 70881 70881 OFFICE RENTAL 623000 4860 4860 419553 11727939 11724681 0 0 X 516752 150672 366080 4882815 4554114 328701 74215 68218 5997 742905 695654 47251 431412 367232 64180 23183 23183 76138 41032 35106 1183719 1183719 38599 7779 30820 117425 27305 90120 177424 150936 26488 28085 16099 11986 245073 245073 381939 381939 89507 89507 CONTRACTED SERVICES 774713 649363 125350 MEDICAL SUPPLIES AND DR 478286 478286 CASH RECEIPTS ASSESSMEN 441952 441952 0 FOOD 364168 364168 523367 389246 134121 11591677 10302294 1289383 0 564274 1100 573514 1884744 1872915 579890 105074 11784630 9513386 2548028 2271244 199370 1576007 5776306 6399854 1391540 1364084 40224 62389 289528 940546 3496977 3338536 5218269 5705555 X 558037 694299 558037 694299 5776306 6399854 136262 0 X X 0 1 X 1 0 X 19230 5033 3163 1541 3258 32225 10242476 10749768 10906310 11390909 11298067 54587530 10261706 10754801 10909473 11392450 11301325 54619755 0 0 0 54619755 338 320 254 176 7061 8149 338 320 254 176 7061 8149 156961 76327 173176 215528 419553 1041545 10419005 10831448 11082903 11608154 11727939 55669449 0.98110 0.97820 0.00010 0.00000 X 0 1 X 24400 24400 7298081 5806266 1491815 4177044 3518345 658699 285105 188775 96330 2271244 DUE FROM MEDICAID 153726 DUE FROM AFFILIATED ENTITY 1002525 RESTRICTED CASH - RESIDENT DEPOSITS 50745 RESTRICTED CASH - PROJECT FUNDS 369011 1576007 DUE TO THIRD PARTIES 113335 CAP LEASE OBLIG WITH AFFILIATE 3102173 DUE TO AFFILIATED ENTITIES 123028 3338536 X 11727939 0 11727939 0 11727939 11591677 0 11591677 0 11591677 PART IV, LINE 2B: RESIDENT DEPOSITS REPRESENT CASH HELD ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT LIVING ALLOWANCES RECEIVED FROM THE STATE OF NEW YORK, AS WELL AS OTHER RESIDENT FUNDS DEPOSITED WITH THE FACILITY FOR SAFE KEEPING. PART X, LINE 2: THE FACILITY IS A NON-PROFIT ORGANIZATION EXEMPT FROM FEDERAL AND STATE INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE REGULATIONS. THE FACILITY HAS FILED FOR AND RECEIVED INCOME TAX EXEMPTIONS IN THE VARIOUS JURISDICTIONS WHERE THEY ARE REQUIRED TO DO SO. THE FACILITY FILES FORM 990 TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND IN NEW YORK STATE. WITH FEW EXCEPTIONS, AS OF DECEMBER 31, 2017, THE FACILITY IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE DECEMBER 31, 2014. THE TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2014 THROUGH DECEMBER 31, 2017 ARE STILL SUBJECT TO POTENTIAL AUDIT BY THE IRS AND THE TAXING AUTHORITIES IN NEW YORK STATE. MANAGEMENT OF THE FACILITY BELIEVES IT HAS NO MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, IT HAS NOT RECOGNIZED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. 0 0 0 0 0 0 0 0 0 THOMAS SANTOBIANCO CEO 203162 0 0 0 0 0 0 0 28457 0 231619 0 0 0 MICHAEL KISER CFO 128065 0 0 0 0 0 0 0 6396 0 134461 0 0 0 JAMES MARK ADMINISTRATOR 135977 0 0 0 0 0 0 0 14695 0 150672 0 0 0 PART I, LINE 1B THE GOVERNING BOARD REVIEWS AND APPROVES ALL WAGE AND SALARY INCREASES THROUGH THE BUDGET PROCESS FOR THE CEO AND CFO. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE MEETS WITH A DESIGNATED BOARD MEMBER WHO HAS BEEN ASSIGNED BY THE OTHER BOARD MEMBERS TO REVIEW THE FORM 990. THE FORM 990 IS PRESENTED TO THE DESIGNATED BOARD MEMBER AND THE FULL EXTENT OF THE FORM AND ITS PREPARATION IS EXPLAINED AT THAT TIME. THE DESIGNATED BOARD EMMBER THEN REVIEWS AND APPROVES THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS WRITTEN CONFLICT OF INTEREST POLICY AT QUARTERLY MEETINGS AND QUALITY ASSURANCE AUDITS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWS AND APPROVES ALL WAGE AND SALARY INCREASES THROUGH THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIANS AND THERAPISTS: PROGRAM SERVICE EXPENSES 1,183,719. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,183,719. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BETHANY RETIREMENT HOME INC 3005 WATKINS ROAD HORSEHEADS NY 14845 160988865 HOUSING ELDERLY NY 501(C)(3) LINE 10 N/A 0 ORCHARD HOMES AT BETHANY VILLAGE INC 3005 WATKINS ROAD HORSEHEADS NY 14845 202019814 HOUSING ELDERLY NY 501(C)(3) LINE 10 N/A 0 BETHANY SENIOR CITIZENS' HOUSING INC 3005 WATKINS ROAD HORSEHEADS NY 14845 222238087 HOUSING ELDERLY NY 501(C)(3) LINE 10 N/A 0 BETHANY VILLAGE PRIMARY CARE NETWORK INC 2977 WESTINGHOUSE ROAD HORSEHEADS NY 14845 814217677 HEALTH CLINIC NY 501(C)(3) LINE 10 BETHANY NURSING HOME AND HEALTH RELATED FACILITIES INC 0 BETHANY VILLAGE DEVELOPMENT CORPORATION 3005 WATKINS ROAD HORSEHEADS NY 14845 813458789 PROPERTY INVESTMENTS NY BETHANY NURSING HOME AND HEALTH RELATED FACILITY INC C 1.00000 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 BETHANY VILLAGE PRIMARY CARE NETWORK INC D 150000 LOAN AMOUNT BETHANY SENIOR CITIZEN'S HOUSING INC L 106242 MANAGEMENT AGREEMENT (CONTRACT) BETHANY VILLAGE PRIMARY CARE NETWORK INC L 237570 MANAGEMENT AGREEMENT BETHANY RETIREMENT HOME INC Q 1149538 SHARED SERVICE ALLOCATION ORCHARD HOMES AT BETHANY VILLAGE INC Q 103518 SHARED SERVICE ALLOCATION BETHANY RETIREMENT HOME INC K 232254 DIRECT FINANCE LEASE AGREEMENT BETHANY RETIREMENT HOME INC E 694082 LOAN AMOUNT ORCHARD HOMES AT BETHANY VILLAGE INC S 195000 REVIEW OF TRANSFERS