2018-11-14T17:11:07-06:00 2017-12-31 161131146 BONADIO & CO LLP 171 SULLYS TRAIL SUITE 201 PITTSFORD NY 14534 990 2017-01-01 161502303 THE MEADOWS AT WESTFALL INC MEAD 5854427960 5901 LAC DE VILLE BLVD ROCHESTER NY 14618 CARRIE FULLER-SPENCER CHIEF FINANCIAL OFFICER 5854427960 2018-11-14 1 KELLEY DEMONTE P01382609 5853811000 4.14.157.194 2018-11-14 09:46:32 ES P 193F6AE1718A57C948D864191F84258781228FD9 193F6AE1718A57C948D864191F84258781228FD9 2017 2019-02-21 02:37:17Z THE HIGHLANDS AT BRIGHTON STEVEN GOLDSTEIN 5901 LAC DE VILLE BLVD ROCHESTER NY 14618 15977057 0 X N/A X 1995 NY TO PROVIDE A CARING, COMPASSIONATE AND QUALITY-FOCUSED LIVING ENVIRONMENT IN A 145 BED SKILLED-NURSING FACILITY. 8 6 389 0 0 0 182 359 15597745 15917080 379 3828 31064 55790 15629370 15977057 0 0 0 0 11310787 12376933 0 0 0 5488616 6807912 16799403 19184845 -1170033 -3207788 19397370 18806013 21970841 22987272 -2573471 -4181259 TO PROVIDE A CARING, COMPASSIONATE AND QUALITY-FOCUSED LIVING ENVIRONMENT IN A 145 BED SKILLED-NURSING FACILITY. 0 0 16246187 15917080 OPERATE A 145 BED SKILLED-NURSING FACILITY AT 97% OCCUPANCY. 16246187 1 0 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 389 1 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JUDY SEIER 5854427960 5901 LAC DE VILLE BLVD ROCHESTER NY 14618 X MICHAEL P RIORDAN BOARD CHAIR 1.00 X X 0 0 0 ELIZABETH GARRETT BOARD MEMBER 1.00 X 0 0 0 WILLIAM J HALL MD BOARD MEMBER 1.00 60.00 X 0 236811 31335 ROBERT LATELLA BOARD MEMBER 1.00 X 0 0 0 ROBBIE MAGEE BOARD MEMBER 1.00 X 0 0 0 GERALD VAN STRYDONK BOARD MEMBER 1.00 X 0 0 0 JANES MORRE BOARD MEMBER 1.00 X 0 0 0 ROBERT MCCANN MD BOARD MEMBER 1.00 60.00 X 0 585766 62140 STEVEN GOLDENSTEIN PRESIDENT 1.00 66.00 X 0 1366233 503360 CARRIE FULLER-SPENCER CHIEF FINANCIAL OFFICER (AS OF 12/5/17) 1.00 59.00 X 0 240002 44897 ADAM ANOLIK CHIEF FINANCIAL OFFICER (TIL 12/5/17) 1.00 59.00 X 0 523899 82468 WALTER WINIARCZYK ADMINISTRATOR 40.00 X 173467 0 0 LEONARD SHUTE FORMER OFFICER 1.00 59.00 X 0 221220 33235 173467 3173931 757435 1 1 1 0 MEDICAL STAFFING NETWORK 235 EAST AVE ROCHESTER NY 14604 TEMP STAFF 595397 US FOOD SERVICE 125 GARDENVILLE PARKWAY WEST BUFFALO NY 14224 FOOD 383692 HIGHLAND HOSPITAL DEPARTMENT OF MEDICINE 1000 SOUTH AVE ROCHESTER NY 14620 PHYSICIAN SERVICES 379584 AID TO HOSPITALS 45 MCKEE RD ROCHESTER NY 14611 LINEN SERVICE 206484 CROSBY-BROWNLIE INC 100 NASSAU ST ROCHESTER NY 14605 CAPITAL CONSTRUCTION 143764 6 359 359 RESIDENT SERVICE REVENUE 900099 15917080 15917080 15917080 3828 3828 39250 0 39250 39250 39250 MISCELLANEOUS 900099 16540 16540 16540 15977057 15917080 0 59618 9831034 9166994 664040 86272 80445 5827 1707553 1592341 115212 752074 701275 50799 89672 89672 16900 16900 568810 513013 55797 10258 7636 2622 187137 187137 914322 822890 91432 51503 46453 5050 PROFESSIONAL SERVICES 1597775 1545649 52126 MEDICAL SUPPLIES 1030972 1030972 BAD DEBTS 939780 939780 NON MEDICAL SUPPLIES 867235 527271 339964 533548 211248 322300 19184845 16246187 2938658 0 1093893 1366578 4010723 3604162 11726 59603 18304909 5545543 13176213 12759366 1104815 1016304 19397370 18806013 344538 627209 5946429 5303577 15679874 17056486 21970841 22987272 X -2573471 -4181259 -2573471 -4181259 19397370 18806013 -3207788 1600000 X X 0 1 X 1 0 X 5120 838 1374 379 359 8070 13712862 14511283 15254014 15597745 15917080 74992984 13717982 14512121 15255388 15598124 15917439 75001054 0 0 0 75001054 21557 17868 23034 16879 43078 122416 21557 17868 23034 16879 43078 122416 9614 12025 13410 14564 16540 66153 13749153 14542014 15291832 15629567 15977057 75189623 0.99750 0.99810 0.00160 0.00120 X 899333 899333 16032052 4704897 11327155 1373524 840646 532878 12759366 RESIDENT ACCOUNTS 43525 OTHER NON-CURRENT ASSETS 757620 DUE FROM RELATED PARTIES - LONG TERM 11406 ASSETS HELD BY TRUSTEE UNDER LEASE AGREEMENT 144000 DUE FROM RELATED PARTIES - SHORT TERM 33753 THIRD PARTY PAYOR RECEIVABLE 26000 1016304 RESIDENT ACCOUNTS 43525 ACCRUED WORKERS COMPENSATION - SHORT TERM 175884 ACCRUED PAYROLL/EMPLOYEE BENEFITS 821572 DUE TO UNIVERSITY OF ROCHESTER - LONG TERM 5160906 DUE TO RELATED PARTIES - LONG TERM 8021734 ACCRUED WORKERS COMPENSATION - LONG TERM 2040736 DUE TO RELATED PARTIES - SHORT TERM 792129 17056486 15977057 0 15977057 0 15977057 19184845 0 19184845 0 19184845 0 1 0 0 0 0 0 0 0 WILLIAM J HALL MD BOARD MEMBER 0 236811 0 0 0 0 0 22815 0 8520 0 268146 0 0 ROBERT MCCANN MD BOARD MEMBER 0 585050 0 0 0 716 0 37158 0 24982 0 647906 0 0 STEVEN GOLDENSTEIN PRESIDENT 0 1089334 0 0 0 276899 0 485358 0 18002 0 1869593 0 0 CARRIE FULLER-SPENCER CHIEF FINANCIAL OFFICER (AS OF 12/5/ 0 240002 0 0 0 0 0 23613 0 21284 0 284899 0 0 ADAM ANOLIK CHIEF FINANCIAL OFFICER (TIL 12/5/17 0 522918 0 0 0 981 0 60683 0 21785 0 606367 0 0 WALTER WINIARCZYK ADMINISTRATOR 173467 0 0 0 0 0 0 0 0 0 173467 0 0 0 LEONARD SHUTE FORMER OFFICER 0 188376 0 0 0 32844 0 19658 0 13577 0 254455 0 0 PART I, LINE 3 AS PROVIDED IN THE FORM 990 SCHEDULE J INSTRUCTIONS, SINCE THE ORGANIZATION RELIES ON A RELATED ORGANIZATION WHICH USES ONE OR MORE OF THE METHODS DESCRIBED IN LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIALS COMPENSATION, THE QUESTION HAS BEEN LEFT UNANSWERED. REFER TO SCHEDULE O, DESCRIPTION OF COMPENSATION REVIEW AND APPROVAL PROCESS. PART I, LINE 4B BOX 4(B) HAS BEEN CHECKED YES, SINCE CERTAIN OFFICERS OF MAW PARTICIPATE IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PROVIDED BY THE UNIVERSITY OF ROCHESTER, A RELATED IRC SECTION 501(C)(3) ORGANIZATION. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED EMPLOYER-PAID AMOUNTS THAT ARE INCLUDED IN DEFERRED COMPENSATION AS FOLLOWS: STEVEN GOLDSTEIN SERP $159,400 ROBERT MCCANN, MD SERP $11,200 ADAM ANOLIK SERP $30,000 STEVEN GOLDSTEIN 457(F) $300,000 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE MEADOWS AT WESTFALL, INC ("MAW") IS STRONG PARTNERS HEALTH SYSTEM, INC ("SPHS"). SPHS, ACTING THROUGH ITS BOARD OF DIRECTORS,HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF MAW, AND CERTAIN DECISIONS OF THE MAW BOARD ARE SUBJECT TO THE APPROVAL OF THE SPHS BOARD. SUCH DECISIONS INCLUDE APPOINTMENT OF THE MAW PRESIDENT AND CEO, AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS,APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION,APPROVAL OF CAPITAL AND OPERATING BUDGETS, STRATEGIC PLANS AND INCURRENCE OF CERTAIN DEBT. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE MEADOWS AT WESTFALL, INC ("MAW") IS STRONG PARTNERS HEALTH SYSTEM, INC ("SPHS"). SPHS, ACTING THROUGH ITS BOARD OF DIRECTORS,HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF MAW, AND CERTAIN DECISIONS OF THE MAW BOARD ARE SUBJECT TO THE APPROVAL OF THE SPHS BOARD. SUCH DECISIONS INCLUDE APPOINTMENT OF THE MAW PRESIDENT AND CEO, AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS,APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION,APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION,APPROVAL OF CAPITAL AND OPERATING BUDGETS, STRATEGIC PLANS AND INCURRENCE OF CERTAIN DEBT. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE MEADOWS AT WESTFALL, INC ("MAW") IS STRONG PARTNERS HEALTH SYSTEM, INC ("SPHS"). SPHS, ACTING THROUGH ITS BOARD OF DIRECTORS,HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF MAW, AND CERTAIN DECISIONS OF THE MAW BOARD ARE SUBJECT TO THE APPROVAL OF THE SPHS BOARD. SUCH DECISIONS INCLUDE APPOINTMENT OF THE MAW PRESIDENT AND CEO, AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS,APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISSOLUTION,APPROVAL OF CAPITAL AND OPERATING BUDGETS, STRATEGIC PLANS AND INCURRENCE OF CERTAIN DEBT. FORM 990, PART VI, SECTION B, LINE 11B MAW'S FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTANT AND PROVIDED TO SENIOR MANAGEMENT FOR REVIEW PRIOR TO FILING. THE FORM 990 WAS PROVIDED TO MAW'S BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, COMMITTEE MEMBERS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE A CONFLICT OF INTEREST: (A) PRIOR TO VOTING ON OR OTHERWISE DISCHARGING THEIR DUTIES WITH RESPECT TO ANY MATTER INVOLVING THE CONFLICT WHICH COMES BEFORE THE BOARD OR ANY COMMITTEE; (B) PRIOR TO ENTERING INTO ANY CONTRACT OR TRANSACTION INVOLVING THE CONFLICT; (C) AS SOON AS POSSIBLE AFTER THE DIRECTOR, COMMITTEE MEMBER OR OFFICER LEARNS OF THE CONFLICT; AND (D) ON AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE FORM IS DISTRIBUTED ANNUALLY AND REQUIRES DISCLOSURE OF ALL CONFLICTS OF INTEREST, INCLUDING SPECIFIC INFORMATION CONCERNING THE TERMS OF ANY CONTRACT OR TRANSACTION WITH MAW THAT INVOLVES A POTENTIAL CONFLICT OF INTEREST FOR THE INDIVIDUAL. THE FORMS ARE REVIEWED BY THE BOARD CHAIR AND LEGAL COUNSEL, AND CONFLICTS DISCLOSED ON THE FORMS OR ON AN AD HOC BASIS ARE REVIEWED BY A BOARD COMMITTEE. THE COMMITTEE CONSIDERS THE MATERIAL FACTS CONCERNING ANY PROPOSED CONTRACT OR TRANSACTION, INCLUDING THE PROCESS BY WHICH THE DECISION WAS MADE TO APPROVE OR RECOMMEND ENTERING INTO THE ARRANGEMENT ON THE TERMS PROPOSED, AND APPROVES SUCH CONTRACTS OR TRANSACTIONS ONLY IF THE TERMS ARE FAIR AND REASONABLE TO MAW AND THE ARRANGEMENTS ARE CONSISTENT WITH THE BEST INTEREST OF MAW. FORM 990, PART VI, SECTION B, LINE 15 WRITTEN SELF-EVALUATIONS AND PERFORMANCE EVALUATIONS FOR MAW OFFICERS AND THE ADMINISTRATOR ANNUALLY ARE REVIEWED BY THE COMMITTEE ON COMPLIANCE AND COMPENSATION OF THE UNIVERSITY OF ROCHESTER MEDICAL CENTER BOARD. THE COMMITTEE HAS AVAILABLE EVALUATIONS FROM THE CEO OF URMC HEALTH SYSTEM FOR THE OFFICERS, AND FROM MAW'S CEO FOR THE ADMINISTRATOR. THE COMMITTEE REVIEWS AND APPROVES TOTAL COMPENSATION FOR OFFICERS AND THE ADMINISTRATOR AND CONSIDERS, IN ADDITION TO THE EVALUATIONS, THE SCOPE OF THE INDIVIDUAL'S JOB RESPONSIBILITIES, PREVIOUS COMPENSATION AND COMPARABLE COMPENSATION PAID TO PEOPLE WITH SIMILAR RESPONSIBILITIES AT COMPARABLE INSTITUTIONS. THE COMPARABLE INFORMATION IS PROVIDED BY AN INDEPENDENT CONSULTANT AND IS BASED ON LOCAL, REGIONAL AND NATIONAL COMPENSATION SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 MAW'S FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. MAW'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE NOT ROUTINELY MADE AVAILABLE TO THE PUBLIC. FORM 990 PART VII - SUPPORTING STATEMENTS CERTAIN OFFICERS OF THE MEADOWS AT WESTFALL, INC. ALSO DEVOTE SIGNIFICANT TIME EACH WEEK TO OTHER RELATED ORGANIZATIONS. FORM 990, PART XII, LINE 2C: NO CHANGES IN OVERSIGHT PROCESS OR SELECTION PROCESS. 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