2012-11-13T17:40:11-06:00 2011-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2011-01-01 161085780 ST CAMILLUS RESIDENTIAL HEALTH CARE FACILITY STCA 3154882951 813 FAY ROAD SYRACUSE NY 132193098 MICHAEL ZINGARO 3154882951 2012-11-10 1 JOSEPH J SCHLEGEL P00301329 3154463600 2011 2016-02-24 21:20:13Z MICHAEL ZINGARO 813 FAY ROAD SYRACUSE NY 132193098 36005283 0 X WWW.ST-CAMILLUS.ORG X 1969 NY ST. CAMILLUS IS A RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO CARING FOR LIFE THROUGH A BROAD RANGE OF HEALTHCARE SERVICES. THE ORGANIZATION OPERATES A 284 BED SKILLED NURSING FACILITY WHICH INCLUDES A 20 BED UNIT DEDICATED TO TRAUMATIC BRAIN INJURY, ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM, A CERTIFIED HOME HEALTH CARE AGENCY, AND AN OUT PATIENT DIAGNOSTIC AND TREATMENT CENTER. THROUGH THESE SERVICES, ST. CAMILLUS HELPS TO ADDRESS THE LONG-TERM CARE, REHABILITATION AND HOME AND COMMUNITY BASED CARE NEEDS OF OUR COMMUNITY. 23 23 729 116 0 0 325807 384452 33093599 35260482 0 40118 488989 320231 33908395 36005283 0 0 0 0 22291920 23364751 0 0 0 12990081 13082314 35282001 36447065 -1373606 -441782 19821560 19290265 14974521 14979759 4847039 4310506 X ST. CAMILLUS IS A RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO CARING FOR LIFE THROUGH A BROAD RANGE OF HEALTHCARE SERVICES. THE ORGANIZATION OPERATES A 284 BED SKILLED NURSING FACILITY WHICH INCLUDES A 20 BED UNIT DEDICATED TO TRAUMATIC BRAIN INJURY, ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM, A CERTIFIED HOME HEALTH CARE AGENCY, AND AN OUT PATIENT DIAGNOSTIC AND TREATMENT CENTER. THROUGH THESE SERVICES, ST. CAMILLUS HELPS TO ADDRESS THE LONG-TERM CARE, REHABILITATION AND HOME AND COMMUNITY BASED CARE NEEDS OF OUR COMMUNITY. 0 0 30868171 35588169 CARE AND TREATMENT OF PATIENTS IN A RESIDENTIAL HEALTH CARE FACILITY AND AN OUTPATIENT CLINIC. 30868171 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 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 0 1 29 0 1 729 1 0 0 0 0 0 0 0 0 0 0 X 23 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MARGARET FRIGON 3154882951 813 FAY ROAD SYRACUSE NY 132193098 DOUGLAS J REICHER 1.00 X 0 0 0 REV LOUIS AIELLO 1.00 X 0 0 0 JOHN J CANNIZZARO 1.00 X X 0 0 0 PETER CAPPUCCILLI JR 1.00 X 0 0 0 JOHN F CATANZARITA 1.00 X 0 0 0 CHARLES P CONOLE 1.00 X 0 0 0 PATRICIA A CURTIN 1.00 X X 0 0 0 JEANNE E BISHOP MD 1.00 X 0 0 0 JAMES N JEROSE 1.00 X 0 0 0 RV MSGR RICHARD KOPP 1.00 X 0 0 0 WAYNE V LA FRANCE 1.00 X 0 0 0 MAUREEN DUNN MCGLYNN 1.00 X 0 0 0 PAUL MELLO 1.00 X 0 0 0 SHEILA LEMKE MD 1.00 X 0 0 0 DAVID J MOYNIHAN 1.00 X 0 0 0 BRENDA A RIGAS 1.00 X 0 0 0 JAMES D SPENCER 1.00 X X 0 0 0 RONALD WSTAHL MD 1.00 X 0 0 0 DERRICK J SUEHS 1.00 X 0 0 0 MARY GRACE VANNORTWICK 1.00 X 0 0 0 ANNE MARIE MULLIN 1.00 X 0 0 0 WILLIAM LOEHR 1.00 X 0 0 0 DANIEL J ROSS 1.00 X 0 0 0 AILEEN BALITZ 40.00 X 184393 0 864 MICHAEL ZINGARO 40.00 X 107111 0 9250 CHAD GOODMAN 40.00 X 50536 0 9030 MICHAEL SCHAFER 40.00 X 54042 0 3062 KATHY BARBER 40.00 X 87040 0 18354 CHRISTINE KEARNEY 40.00 X 93983 0 18334 HELENA GLASSFORD 40.00 X 77467 0 18132 HEATHER KEMMIS 40.00 X 83502 0 25680 MARY ELLEN KAIER 40.00 X 43444 0 6156 DAVID DUBE 40.00 X 110950 0 0 892468 0 108862 3 0 1 0 SODEXHO INC 1900 SELWYN AVENUE CHARLOTTE NC 28207 FOOD SERVICE 1436069 NURSECORE MANAGEMENT SERVICES 2201 BROOKHOLLOW ARLINGTON TX 76006 NURSING STAFF 697467 NURSEFINDERS 7421 OSWEGO ROAD LIVERPOOL NY 13090 NURSING STAFF 273599 ATLAS HEALTHCARE LINEN 414 W TAYLOR STREET SYRACUSE NY 13202 LINEN SERVICES 261016 ADECCO EMPLOYMENT AGENCY 225 GREENFIELD PARKWAY LIVERPOOL NY 13088 NURSING STAFF 240745 10 50325 334127 384452 PROGRAM SERVICE REVENU 623000 35260482 35260482 35260482 14876 14876 17786 0 17786 17786 17786 25242 0 25242 25242 25242 OTHER REVENUE 623000 132974 132974 MANAGEMENT FEE INCOME 623000 107436 107436 BEAUTY SHOP REVENUE 623000 62035 62035 302445 36005283 35588169 0 32662 1001330 1001330 17714656 15223858 2490798 3283608 2659874 623734 1365157 1164625 200532 47336 47336 40789 40789 263981 176867 87114 126009 36874 89135 88003 88003 1051983 946785 105198 119878 118669 1209 16840 6935 9905 26000 26000 1025305 922774 102531 351047 296767 54280 SUPPLIES 2776029 2625169 150860 CONTRACT LABOR 2222998 2222998 0 MANAGEMENT CONTRACT 1666541 1646243 20298 NYS ASSESSMENT 1419905 1419905 0 1839670 1399828 439842 36447065 30868171 5578894 0 12782 52880 232779 50195 7058383 7074870 529277 210902 75765 63233 277414 289704 27024566 18012938 9430502 9011628 2204658 2536853 19821560 19290265 3351086 4523068 8597024 7794854 3026411 2661837 14974521 14979759 X 4470781 4139654 376258 170852 4847039 4310506 19821560 19290265 X -441782 -94751 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 376258 -94751 110655 170852 437275 110655 127414 299086 376258 1628216 88747 1279688 437275 1561368 309288 242440 1628216 0.00000 0.00000 1.00000 0 1 1 153315 153315 19090409 11282651 7807758 1229934 1112812 117122 6345736 5617475 728261 205172 205172 9011628 MORTGAGE REFINANCING COST, NET OF AMORTIZATION 230990 PATIENT FUNDS 32304 RESERVE FOR REPLACEMENTS 864362 CASH WORKING CAPITAL ESCROW 341664 INTEREST IN NET ASSETS OF ST. CAMILLUS FOUNDATION 170852 OTHER RECEIVABLES 493542 LONG TERM RECEIVABLES 403139 2536853 PATIENTS' FUNDS 32304 ESTIMATED THIRD PARTY SETTLEMENTS 1152544 ESTIMATED WORKER'S COMPENSATION TRUST LIABILITY 573850 LINE OF CREDIT 500000 OTHER LIABILITIES 403139 2661837 36005283 36447065 -441782 -94751 -94751 -536533 36000434 -4849 -4849 36005283 0 36005283 36442216 -4849 -4849 36447065 0 36447065 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE ORGANIZATION HAS BEEN LIMITED BY DONORS OR GRANTORS TO A SPECIFIC TIME PERIOD OR PURPOSE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ST. CAMILLUS AND INTEGRITY ARE TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF DECEMBER 31, 2011, THE ORGANIZATION DOES NOT HAVE ANY SIGNIFICANT UNRECOGNIZED TAX BENEFIT OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2008 THROUGH 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF ST. CAMILLUS FOUNDATION -94,751. X X 0 0 0 0 0 0 0 0 0 AILEEN BALITZ 184393 0 0 0 0 0 432 0 432 0 185257 0 0 0 PART I, LINE 3 THE FACILITY'S SALARY RANGES ARE BASED ON AN INCORPORATION OF A STUDY PERFORMED BY AN INDEPENDENT ACCOUNTING FIRM DURING THE 1990'S, TRENDED FORWARD, AND TWO SEPARATE INDEPENDENT SURVEYS OF SALARY PACKAGES OF SIMILAR POSITIONS RECEIVED DURING 2009. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION VOTE TO ELECT TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE OPERATING DECISIONS MADE BY THE GOVERNING BODY (BOARD OF TRUSTEES) ARE DONE SO BY A MAJORITY VOTE OF THE TRUSTEES AND CAN NOT BE OVERRIDDEN. HOWEVER, ANY BY LAW CHANGES OR NEW TRUSTEE APPOINTMENTS REQUIRE A MAJORITY VOTE OF THE MEMBERS, IF PERSONALLY IN ATTENDANCE AT THE MEETING OR 100% WRITTEN APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 BEFORE THIS FORM 990 WAS FILED WITH THE IRS, ALL OF THE FOLLOWING REVIEWS TOOK PLACE: THE PREPARED FORM 990 WAS REVIEWED BY THE CONTROLLER, CHIEF FINANCIAL OFFICER, AND CORPORATE COMPLIANCE OFFICER, IN CONSULTATION WITH ADMINISTRATIVE STAFF MEMBERS, EXECUTIVE MANAGEMENT, AND ADVISORS TO THE ORGANIZATION. THE PREPARED FORM 990 WAS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES. UPON RECOMMENDATION BY THE FINANCE COMMITTEE, THE PREPARED FORM 990 WAS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES, ACTING ON BEHALF OF THE ENTIRE BOARD, FOR FINAL APPROVAL. COMPLETED FORM 990 WAS MADE AVAILABLE TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES WRITTEN DISCLOSURES BY ALL TRUSTEES, OFFICERS, KEY EMPLOYEES, AND OTHER MANAGEMENT OR SUPERVISORY EMPLOYEES WHO ARE IN A POSITION TO INFLUENCE DECISION MAKING FOR THE ORGANIZATION. SUCH INDIVIDUALS ARE REQUIRED TO DISCLOSE ACTUAL AND POTENTIAL CONFLICTS OF INTEREST UPON INITIAL AFFILIATION WITH THE ORGANIZATION, ON AN ANNUAL BASIS, AND WHENEVER REPORTABLE INTERESTS ARISE. THE COMPLIANCE OFFICER, IN COLLABORATION WITH THE PRESIDENT AND/OR THE BOARD CHAIRMAN, REVIEWS WRITTEN DISCLOSURES, OBTAINS FURTHER INFORMATION AS NEEDED, AND EVALUATES ACTUAL AND POTENTIAL CONFLICTS. AS WARRANTED, THE PRESIDENT AND/OR BOARD CHAIRMAN IMPLEMENTS MEASURES TO ENSURE THAT DECISIONS RELATING TO THE ORGANIZATION ARE MADE SOLELY ON THE BASIS OF THE BEST INTERESTS OF THE ORGANIZATION AND IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PURPOSES. ANY TRUSTEE WHO HAS A DUALITY OF INTEREST OR A POTENTIAL CONFLICT OF INTEREST AS TO A MATTER COMING BEFORE THE BOARD IS PROHIBITED FROM VOTING OR USING PERSONAL INFLUENCE AS TO BOARD ACTION ON SUCH MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE FACILITY'S SALARY RANGES ARE BASED ON AN INCORPORATION OF A STUDY PERFORMED BY AN INDEPENDENT ACCOUNTING FIRM DURING THE 1990'S AND TRENDED FORWARD AND TWO SEPARATE INDEPENDENT SURVEYS OF SALARY PACKAGES OF SIMILAR POSITIONS RECEIVED DURING 2009. AT THE TIME OF HIRE THE FACILITY'S CEO REVIEWS THE SALARY REQUIREMENTS FOR KEY EMPLOYEES IN RELATION TO CURRENT MARKET CONDITIONS AND SALARY PAYSCALES PREVIOUSLY APPROVED BY THE EXECUTIVE COMMITTEE TO DETERMINE COMPENSATION. ANY SALARY RECOMMENDATIONS PROPOSED THAT ARE NOT COMMENSURATE WITH PREVIOUSLY APPROVED PAYSCALES REQUIRE CONSULTATION WITH AND AGREEMENT FROM THE BOARD CHAIRPERSON. ANNUALLY, OR WHEN CIRCUMSTANCES WARRANT, THE CEO PRESENTS TO THE EXECUTIVE COMMITTEE FOR THEIR REVIEW AND APPROVAL HER RECOMMENDATIONS FOR COMPENSATION OF KEY EMPLOYEES BASED ON PERFORMANCE EVALUATIONS. FORM 990, PART VI, SECTION C, LINE 18 THE FACILITY MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN INTEREST IN NET ASSETS OF ST. CAMILLUS FOUNDATION -94,751. TOTAL TO FORM 990, PART XI, LINE 5: -94,751. FORM 990, PART XII, LINE 2C THE FACILITY HAS AN AUDIT COMMITTEE MADE UP OF TRUSTEES. THE AUDIT COMMITTEE MEETS TWICE ANNUALLY; THE FIRST MEETING TO REVIEW THE DRAFT FINANCIAL STATEMENTS AND PRELIMINARY FINDINGS; THE SECOND MEETING TO REVIEW THE FINAL FINANCIAL STATEMENTS AND FINDINGS.THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM THE PRIOR YEAR. ST CAMILLUS FOUNDATION 813 FAY ROAD SYRACUSE NY 13219 222429858 PROVIDE FINANCIAL SUPPORT NY 501 (C) (3) 9 ST CAMILLUS RESIDENTAL HEALTH CARE FACILITY 0 INTEGRITY HOME CARE SERVICES INC 813 FAY ROAD SYRACUSE NY 13219 161500579 HOME HEALTH SERVICES NY 501 (C) (3) 9 ST CAMILLUS RESIDENTAL HEALTH CARE FACILITY 0 1 0 1 1 0 0 0 0 1 0 1 0 0 0 0 1 0 0