2017-05-12T14:19:21-05:00 2016-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2016-01-01 200670083 CEDARBROOK VILLAGE INCORPORATED CEDA 3157973114 2050 TILDEN AVE NEW HARTFORD NY 134133630 CHRISTA SERAFIN CEO 3157973114 2017-05-11 1 ANGELA M FRANCO P00589741 3154463600 2017-05-09 24.39.85.114 2017-05-11 16:35:13 ED P F2DA1F6750C88AB2A9B4F1EE63F15EFB0D07AC5D 315614A2A569D91B0F4A84342C1D145A8997199D 2016 2021-01-29 14:40:06Z CHRISTA SERAFIN 2050 TILDEN AVE NEW HARTFORD NY 134133630 2140664 0 X WWW.SITRIN.COM X 2004 NY SENIOR ENRICHED HOUSING AND ASSISTED LIVING PROGRAM. 7 6 77 0 0 0 50 9902 2031065 2109859 742 3879 19732 16925 2051589 2140565 0 0 0 0 1047245 1077519 0 0 0 954450 958026 2001695 2035545 49894 105020 7361525 7295269 3058949 2817198 4302576 4478071 CEDARBROOK IS A LICENSED ASSISTED LIVING PROVIDER REGULATED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. CEDARBROOK IS AFFILIATED WITH SITRIN HEALTH CARE CENTER. 0 0 1860373 2126784 CEDARBROOK PROVIDES VARIOUS LEVELS OF CARE TO INDIVIDUALS 62 YEARS OF AGE AND OLDER SO THAT THEY MAY LIVE INDEPENDENTLY WITH SUPPORT SERVICES AVAILABLE AS THEIR NEEDS CHANGE.IN 2016, CEDARBROOK'S TOTAL RESIDENT DAYS WERE 18,828 WITH A TOTAL OF 70 SENIORS SERVED. 1860373 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 77 1 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CHRISTA SERAFIN 3157973114 2050 TILDEN AVE NEW HARTFORD NY 13413 MICHAEL DAMSKY DIRECTOR 0.50 1.50 X 0 0 0 MARSHA SILVERMAN SECRETARY 2.00 6.00 X X 0 0 0 EDWARD KOWALSKY DIRECTOR 0.50 6.50 X 0 0 0 MICHAEL COMINSKY TREASURER 2.00 8.00 X X 0 0 0 DR SUSAN BLATT VICE CHAIRPERSON 2.00 18.50 X X 0 60000 0 NEIL COHEN DIRECTOR 0.50 0.00 X 0 0 0 MICHAEL SILVERMAN CHAIRMAN 2.00 9.00 X X 0 0 0 MARK SMITH DIRECTOR 0.50 1.50 X 0 0 0 ADELE SOSSEN DIRECTOR 0.50 1.00 X 0 0 0 RICHARD WILSON VP OF STRATEGIC PLANNI 1.00 37.50 X 0 118021 1840 CHRISTA SERAFIN CHIEF EXECUTIVE OFFICER 1.00 37.50 X 0 226593 12000 BRENDA COBANE VP OF ASSISTED LIVING 32.50 5.00 X 98708 0 15065 98708 404614 28905 0 0 1 0 0 9557 345 9902 RESIDENT SERVICES 623311 2061179 2061179 SHARED SERVICES 561000 26286 26286 APPLICATION REVENUE 623311 8750 8750 GUEST MEALS 623311 8129 8129 GARAGE RENTAL 623311 2850 2850 2665 2665 2109859 3978 3978 99 -99 -99 -99 CABLE REVENUE 623311 15315 15315 MISCELLANEOUS 623311 1297 1297 FORFEITED SECURITY DEP 623311 313 313 16925 2140565 2126784 0 3879 113708 113708 775212 743911 31301 11446 7778 3668 117358 115558 1800 59795 50038 9757 77169 77169 1261 1261 8962 8962 9577 9577 7975 7975 235036 235036 7449 5602 1847 416336 416336 FOOD/BEVERAGE EXPENSE 124808 124808 REPAIRS & MAINTENANCE E 18106 18106 HOUSEKEEPING & LAUNDRY 10448 10448 DURABLE/DISPOSABLE DIET 7550 7550 33349 29220 4129 2035545 1860373 175172 0 147689 397419 544847 663623 23826 29379 219832 248485 6465 8361 6253 6306 9065811 3141426 6302226 5924385 110387 17311 7361525 7295269 125298 130574 2615000 2452950 318651 233674 3058949 2817198 X 4302576 4478071 4302576 4478071 7361525 7295269 X 105020 2973 67502 X X 0 1 X 1 0 X 1155 50 9902 11107 1833633 1930112 2035849 2031065 2109859 9940518 1833633 1930112 2037004 2031115 2119761 9951625 0 0 0 9951625 994 764 680 742 3978 7158 994 764 680 742 3978 7158 25182 18136 21891 19732 16925 101866 1859809 1949012 2059575 2051589 2140664 10060649 0.98920 0.98850 0.00070 0.00040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12660 12660 8320185 2654807 5665378 713048 483312 229736 19918 3307 16611 5924385 CASH HELD IN TRUST FOR RESIDENTS 17311 SECURITY DEPOSITS FROM RESIDENTS 116861 INTEREST RATE SWAP LIABILITY 99502 233674 X 2211040 2973 67502 70475 2140565 0 2140565 2035545 0 2035545 0 2035545 PART X, LINE 2: CEDARBROOK IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF DECEMBER 31, 2016 AND 2015, CEDARBROOK DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2013 THROUGH 2016. CEDARBROOK DOES NOT ANTICIPATE ANY UNRECOGNIZED TAX BENEFITS TO CHANGE IN THE NEXT TWELVE MONTHS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FV OF INTEREST RATE SWAP 67,502. X 1 1 X X 0 0 0 0 0 0 0 0 0 CHRISTA SERAFIN CHIEF EXECUTIVE OFFICER 0 226593 0 0 0 0 0 0 0 0 0 226593 0 0 A ONEIDA COUNTY INDUSTRIAL DEVELOPMENT AGENCY 090210781 682465CD9 2007-06-28 3000000 TO CONSTRUCT ENRICHED HOUSING ASSISTED LIVING APARTMENTS 0 0 0 A 3105333 169177 93146 23031 2819979 2009 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 1 FIRST NIAGARA BANK 10.000000000000 0 0 0 0 0 A 0 PART I LINE A, PART II LINE 3 THE DIFFERENCE BETWEEN PART I'S LISTED ISSUE PRICE OF $3,000,000 AND PART II'S, LINE 3, TOTAL PROCEEDS OF ISSUE, IS THE RESULT OF INVESTMENT EARNINGS ON THE PROCEEDS DURING THE CONSTRUCTION PHASE OF THE PROJECT. ALL EARNINGS WERE SPENT ON THE PROJECT AS SHOWN IN PART II, LINES 5-12. FORM 990, PART VI, SECTION A, LINE 6 THE CHARLES T. SITRIN NETWORK OF HOMES & SERVICES, INC. IS THE SOLE MEMBER OF CEDARBROOK VILLAGE INCORPORATED. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER, THE CHARLES T. SITRIN NETWORK OF HOMES & SERVICES, INC. APPOINTS THE BOARD OF DIRECTORS OF CEDARBROOK VILLAGE INCORPORATED. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD MEMBERS REVIEWED THE 990 AT THE MAY 2017 BOARD MEETING PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS ARE REQUIRED TO UPDATE AND RE-SIGN THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS COLLECTIVELY REVIEWS AND APPROVES THE CEO'S SALARY AND BENEFITS. COMPARATIVE DATA FROM OTHER LIKE ORGANIZATIONS IS USED. THIS MEETING IS DOCUMENTED THROUGH EXECUTIVE SESSION MINUTES OF THE BOARD MEETING. FORM 990, PART VI, SECTION C, LINE 19 ALL OF THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC. COPIES WILL BE PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 67,502. FORM 990, PAGE 7, PART VII THE FOLLOWING OFFICER IS ALSO AN OFFICER OF RELATED ENTITY, CHARLES T. SITRIN HEALTH CARE CENTER, INC. -CHRISTA SERAFIN CHARLES T SITRIN HEALTH CARE CENTER INC 2050 TILDEN AVE NEW HARTFORD NY 13413 223100745 SKILLED NURSING/OUTPATIENT REHAB FACILITY NY 501(C)3 LINE 10 CHARLES T SITRIN NETWORK OF HOMES & SERVICES INC 0 CHARLES T SITRIN NETWORK OF HOMES & SERVICES INC 2050 TILDEN AVE NEW HARTFORD NY 13413 150543936 SOLE MEMBER OF OTHER CORPORATIONS NY 501(C)3 LINE 7 N/A 0 GEORGIAN COURT ESTATES SENIOR HOUSING CORP 2050 TILDEN AVE NEW HARTFORD NY 13413 204288247 SENIOR HOUSING NY 501(C)3 LINE 10 CHARLES T SITRIN NETWORK OF HOMES & SERVICES INC 0 GAN KAVOD INC PO BOX 634 NEW HARTFORD NY 13413 223032483 INTERMEDIATE CARE FACILITY & INDIVIDUALIZED RESIDENTIAL ALTERNATIVE NY 501(C)3 LINE 10 CHARLES T SITRIN NETWORK OF HOMES & SERVICES INC 0 SITRIN CHILD DAY CARE FACILITY INC 3 KAVOD ROAD NEW HARTFORD NY 13413 161484534 CHILD DAY CARE CENTER NY 501(C)3 LINE 10 CHARLES T SITRIN NETWORK OF HOMES & SERVICES INC 0 SITRIN FOUNDATION INC 2050 TILDEN AVE NEW HARTFORD NY 13413 300098393 FOUNDATION NY 501(C)3 LINE 12A, I CHARLES T SITRIN NETWORK OF HOMES & SERVICES INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0