2017-07-25T11:57:24-07:00 2016-12-31 990 2016-01-01 222291346 GENESEE VALLEY PRESBYTERIAN NURSING CENTER GENE 5854611991 254 Alexander Street Rochester NY 14607 James DeVoe President 5854611991 2017-07-25 63.138.62.194 2016 2021-01-29 14:40:06Z Kirkhaven James E DeVoe 254 Alexander Street Rochester NY 14607 13305521 0 X www.Kirkhaven.com X 1980 NY Organization is a 147 licensed-bed skilled nursing home, which provides long-term and short-term skilled nursing and rehabilitative care to seniors including a high percentage of indigent and minority seniors. All income received is used in the provision of care and support services. 11 11 300 10 0 0 136768 293021 13048682 12935472 328 537 73287 76491 13259065 13305521 0 0 0 0 8059286 8562524 0 0 0 4616005 4776267 12675291 13338791 583774 -33270 11475613 11772109 11737041 12074334 -261428 -302225 X Nursing home that provides skilled long-term care, rehabilitative and Alzheimers/Dementia care for seniors in a manner that embraces a philosophy of person-centered care, quality of care and faith-based mission. 0 1 12202789 0 13305521 Nursing home that provides skilled long-term care, rehabilitation and Alzheimers/Dementia care for seniors in a manner that embraces a philosophy of person-centeredcare, quality of care and faith-based mission. 0 0 0 12202789 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 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 0 0 0 1 9 0 1 300 1 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NY X Kirkhaven 5854611991 254 Alexander Street Rochester NY 14607 Ann Marie Cook Director 0.5 0.25 X 0 0 0 Tom D'Antonio Director/Officer 0.5 0.25 X X 0 0 0 Erane Allen Director/Officer 0.5 0.25 X X 0 0 0 Alan Goodfellow Director/Officer 0.5 0.25 X X 0 0 0 Deborah Beardslee Director 0.5 0.25 X 0 0 0 John Ward Director 0.5 0.25 X 0 0 0 Carlo Jannotti Director 0.5 0.25 X 0 0 0 Jann Packard Director 0.5 0.25 X 0 0 0 Gordon Webster Director 0.5 0.25 X 0 0 0 James E DeVoe President/CEO 10 30 X X X 54000 145440 47179 Anne DePoint Executive Director/Administrator 40 0 X X 112755 0 22551 166755 145440 69730 1 0 1 0 0 0 0 0 128681 164340 0 0 293021 Skiled Nursing Home Services 623110 12935472 12935472 0 0 0 0 0 0 12935472 537 0 0 537 0 0 0 0 0 0 0 0 32936 0 0 0 32936 0 32936 0 0 32936 0 0 0 Staff Cafeteria & Vending 722210 30336 0 0 30336 Telephone & newspaper 812900 4410 0 0 4410 Parking Fees 812930 8430 0 0 8430 379 0 0 379 43555 13305521 12935472 0 77028 185287 124504 60783 0 6559735 6349298 210437 490050 475348 14702 824791 800047 24744 502661 487581 15080 7029 7029 19515 19515 1044676 937860 106816 1346 1346 39538 3045 36493 78418 78418 548730 493857 54873 12253 9167 3086 9968 9968 578456 520610 57846 107389 107389 Supplies 927169 919248 7921 0 NYS Cash Receipts Assessment 647641 647641 0 0 Purchased Services/Repairs & Maintenance 324434 219459 104975 0 Advanced Training NYS Grant Expenditures 120043 120043 0 0 309662 15317 294345 0 13338791 12202789 1136002 0 40876 1280 1475402 953791 0 0 1274269 2056782 0 0 0 0 107223 98689 16474351 10911386 5728298 5562965 2849545 3098602 11475613 11772109 905881 994195 30992 78246 5208006 4822984 5592162 6178909 11737041 12074334 X -2482895 -3130157 1262662 1865118 958805 962814 -261428 -302225 11475613 11772109 X -33270 0 0 0 0 -7527 X 1 X 1 X 1 0 X 82033 140827 263942 136768 293021 916591 11810738 11595747 11795793 13048682 12935472 61186432 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11892771 11736574 12059735 13185450 13228493 62103023 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 62103023 1767 1113 974 328 4182 0 0 0 0 537 537 1767 1113 974 328 537 4719 0 0 0 0 0 0 74248 78279 76760 73287 76491 379065 11968786 11815966 12137469 13259065 13305521 62486807 0.99386 0.99387 0.00008 0.00010 X Schedule A, Part III, Line 12 Staff cafeteria, vending, guest meals, telephone, newspapers, etc. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 958807 4007 0 0 0 0 962814 957657 1150 0 0 0 0 958807 956411 1244 61729 0 61727 0 957657 955117 1294 157986 0 157986 0 956411 954101 1016 120662 0 120662 0 955117 0 1 0 0 1 1 0 438016 438016 0 13507561 9121372 4386189 0 0 0 0 0 2206458 1606929 599529 0 322316 183085 139231 5562965 Deferred Compensation Asset 181846 Beneficial Interest in Foundation 2827932 Residents Deposits held in trust 88824 3098602 0 Due to 3rd parties 655700 Pension Liability 4750823 Workers Compensation Liability 501716 Deferred Compensation Liability 181846 Resident Deposits held in trust 88824 6178909 13305521 0 0 0 0 0 13305521 0 0 0 13305521 13338791 0 0 0 0 0 13338791 0 0 0 13338791 Schedule D, Part V, Line 4 Endowment funds are to be held in perpetuity with the income to be recognized and transferred to temporarily restricted funds within the Foundation and transferred to Kirkhaven annually based on the board approved Total Return & Spend policy for use in subsiding the organization's mission and operation. X X X X X 0 1 0 0 0 0 0 1 0 James E DeVoe President/CEO 54000 128483 0 16957 0 0 0 21000 6000 26179 60000 192619 40000 191698 Anne DePoint Executive Director/Administrator 112755 0 0 0 0 0 0 0 22551 0 135306 0 0 0 Schedule J, Part I, Line 4 President/CEO is the sole participant in a 457(f) deferred compensation plan that is funded by the Seniorsfirst Foundation in the amount of $21,000 per year. Schedule J, Part I, Line 7 President/CEO was paid a bonus for specif goal performance results as per the Executive Bonus Program and approved by the Executive Committee and Board. Form 990, Part III, Line 3 Effective 7/1/16, the organization contracted with a related organization (CMSWNY) that serves as a Management Services Organization that provides certain back office administrative & financial services for Kirkhaven and two other senior care organizations on a shared cost joint-venture basis. Form 990, Part VI, Section A, Line 6 The organization is a membership corporation with Presbyterian Homes & Services of Genessee Valley (dba Seniorsfirst) the sole member. Form 990, Part VI, Section A, Line 7a The board of directors for the Member constitute the board of directors of the organization (mirror board). Form 990, Part VI, Section A, Line 7b The organization's bylaws identify certain reserved powers that require approval by the Member. Form 990, Part VI, Section B, Line 11b The 990 is reviewed by the Audit Committee of the board on behalf of the organization's board. A copy of the 990 is available to all directors of the governing board. Form 990, Part VI, Section B, Line 12c Board members and key employees must complete and update conflict of interest forms annually and as needed. At all board meetings and committee meetings, a call for disclosure of any conflicts of interest related to the approved agenda is required and documented in the minutes. The Governance Committee of the parent board monitors and enforces compliance as needed. Form 990, Part VI, Section B, Line 15 The executive Committee of the Parent board reviews, determines and approves (with full board approval) the CEO compensation. Periodic survey and comparable compensation data is used to ascertain reasonableness and competitiveness of compensation. In 2014 the board entered into an Employment Contract with the CEO through 12/31/16. The HR Committee upon approval of the board, reviews and approves compensation pay scales and annual increase range for all other staff. Form 990, Part VI, Section C, Line 19 Information is available to the public upon request to administration. Form 990, Part XI, Line 9 Change in unrestricted net assets related to pension plan ($-647,262); Change in beneficial Interest in Foundation ($602,456) and Change in Restricted Net Assets ($4,009) Prebyterian Homes & Services of Genesee Valley dba Seniorsfirst 254 Alexander Street Rochester NY 14607 161592416 Parent Organization NY 501(C)(3) 11d N/A 0 Seniorsfirst Foundation Inc 254 Alexander Street Rochester NY 14607 161378080 Supporting Organization NY 501(c)(3) 11d PHSGV Seniorsfirst 0 Community Management Services of Western New York 254 Alexander Street Rochester NY 14607 811859699 Supporting Organization NY 501(c)(3) 11d N/A 0 1 0 1 0 1 0 0 0 0 1 0 0 1 1 1 1 1 0 0 Community Management Services of Western New York a-iv 8400 Actual income received Seniorsfirst Foundation Inc c 128681 Actual income received Seniorsfirst Foundation Inc e 750000 Actual line of credit guarantee Community Management Services of Western New York j 8400 Actual income recieved Seniorsfirst Foundation Inc m 15910 Actual cost Seniorsfirst Foundation Inc o 62447 Allocation of cost based on time estimate allocation percentage Community Management Services of Western New York p 37502 Actual cost incurred Seniorsfirst Foundation Inc q 15910 Actual cost incurred More time was needed to receive the audited financial statements due to a change in audit firms. Extension for filing was requested and approved.