2022-11-12T14:19:35-06:00 2021-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2021-01-01 136266115 MARGARET TIETZ NURSING AND REHABILITATION CENTER MARG 7185194238 136-65 37TH AVENUE FLUSHING NY 11354 LENY TIRTASAPUTRA CFO 7185194238 2022-11-12 1 LENY TIRTASAPUTRA XXX-XX-XXXX GARRETT M HIGGINS P00543209 9143818900 2022-11-01 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X TARA BUONOCORE-RUT 136-65 37TH AVENUE FLUSHING NY 11354 90 0 X WWW.MARGARETTIETZ.ORG X 1967 NY THE ORGANIZATION PROVIDED SKILLED NURSING FACILITY SERVICES. 9 9 0 9 0 0 0 0 0 0 0 90 0 0 0 90 0 0 0 0 0 0 0 0 0 258183 9254 258183 9254 -258183 -9164 2425342 3192792 3319918 3822604 -894576 -629812 X MARGARET TIETZ NURSING AND REHABILITATION CENTER (MARGARET TIETZ) OPERATED A 200 BED SKILLED NURSING FACILITY WHICH SERVED THE DIVERSE POPULATION IN WHICH IT OPERATED. IT OFFERED THE HIGHEST QUALITY OF SERVICES AND HAD WORKED TO FULFILL ITS MISSION OF CARING FOR THE CHRONICALLY ILL AND DISABLED IN THE COMMUNITY. 0 0 A 200 BED SKILLED NURSING FACILITY THAT PROVIDED CARE FOR THE CHRONICALLY ILL AND DISABLED IN THE COMMUNITY. THE SKILLED NURSING FACILITY'S SERVICES INCLUDED LONG-TERM MEDICAL CARE AND REHABILITATION, POSTACUTE CARE SERVICES FOR TRANSITIONING FROM HOSPITAL TO HOME, AND A PARTICULAR FOCUS ON STROKE REHABILITATION AND ON CARING FOR MEN AND WOMEN STRUGGLING AGAINST THE EFFECTS OF ALZHEIMER'S DISEASE, DEMENTIA, AND OTHER DISABLING CONDITIONS OF AGING. THE CENTER CEASED OPERATIONS ON FEBRUARY 1, 2019 AFTER THE SALE OF ITS PROPERTY AND OPERATIONS. IT IS IN THE PROCESS DISSOLVING THE ORGANIZATION. 1 0 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X X LENY TIRTASAPUTRA CFO 7185194238 136-65 37TH AVENUE FLUSHING NY 11354 MICHAEL R POTACK CHAIRMAN 0.50 5.00 X X 0 0 0 HARVEY ISHOFSKY VICE CHAIRMAN 0.50 5.00 X X 0 0 0 MYRON SCHLANGER SECRETARY 0.50 5.00 X X 0 0 0 KENNETH ZUCKERBROT ASSISTANT SECRETARY 0.50 5.00 X X 0 0 0 MARK WEINSTEIN TREASURER 0.50 5.00 X X 0 0 0 RUSSELL D FISHER TRUSTEE 0.50 5.00 X 0 0 0 NEIL HEYMAN TRUSTEE 0.50 5.00 X 0 0 0 STEPHEN KANTOR DDS TRUSTEE 0.50 5.00 X 0 0 0 HOWARD KRAIN TRUSTEE 0.50 5.00 X 0 0 0 JOHNNY LEE CFO 0.25 34.75 X 0 0 0 TARA BUONOCORE-RUT PRESIDENT/CEO 0.25 34.75 X 0 616621 36089 DAVID A ROCK PRESIDENT/CEO (THRU 01/2021) 0.25 34.75 X 0 419392 3 DAVID SILVA MOJICA CHIEF HR OFFICER 0.25 34.75 X 0 287072 13838 JOHN J KEHOE VP FINANCE 0.25 34.75 X 0 234433 33395 JUSTIN WALTER VP OF PERFORMANCE IMPROVEMENT 0.25 34.75 X 0 220205 1221 CARLY HARNICK VP OF CARE DELIVERY ADMINISTRATION 0.25 34.75 X 0 206020 31407 SHAUN RUSKIN EXEC. VP, CHIEF STRATEGY OFFICER 0.25 34.75 X 0 356602 19 0 2340345 115972 0 0 1 0 0 90 90 90 0 0 90 4078 4078 4000 4000 1176 1176 9254 0 9254 0 490658 328299 208486 151979 370617 1782705 2285390 2425342 3192792 3319918 3822604 3319918 3822604 X -894576 -629812 -894576 -629812 2425342 3192792 -9164 273928 0 X X 0 0 0 X 9480 30714 496 40690 26616485 31147766 2906402 60670653 26625965 31178480 2906898 60711343 0 0 0 60711343 58400 54197 2690 90 115377 58400 54197 2690 90 115377 95386 226773 87142 409301 26779751 31459450 2996730 90 61236021 0.99140 0.99310 0.00190 0.00170 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: EMPLOYEE CAFETERIA - 2017 AMOUNT: $ 546. 2018 AMOUNT: $ 327. MEDICAL RECORDS - 2017 AMOUNT: $ 17,937. 2018 AMOUNT: $ 4,361. 2019 AMOUNT: $ 1,874. PURCHASE DISCOUNTS - 2017 AMOUNT: $ 1,733. 2018 AMOUNT: $ 119,902. MISCELLANEOUS - 2017 AMOUNT: $ 13,600. 2019 AMOUNT: $ 81,276. SHOP INCOME - 2017 AMOUNT: $ 1,418. 2018 AMOUNT: $ 760. REBATES AND REFUNDS - 2017 AMOUNT: $ 60,152. 2018 AMOUNT: $ 101,423. 2019 AMOUNT: $ 3,992. 0 INSURANCE RECOVERY RECEIVABLE 2154305 DUE FROM RELATED PARTIES 131085 2285390 DUE TO RELATED PARTIES 1668299 PROFESSIONAL AND SIMILAR LIABILITIES 2154305 3822604 1 0 0 0 0 0 0 0 0 TARA BUONOCORE-RUT PRESIDENT/CEO 0 615481 0 0 0 1140 0 3791 0 32298 0 652710 0 0 DAVID A ROCK PRESIDENT/CEO (THRU 01/2021) 0 80221 0 0 0 339171 0 0 0 3 0 419395 0 0 SHAUN RUSKIN EXEC. VP, CHIEF STRATEGY OFFICER 0 355769 0 0 0 833 0 0 0 19 0 356621 0 0 DAVID SILVA MOJICA CHIEF HR OFFICER 0 286112 0 0 0 960 0 4331 0 9507 0 300910 0 0 JOHN J KEHOE VP FINANCE 0 232066 0 0 0 2367 0 6995 0 26400 0 267828 0 0 CARLY HARNICK VP OF CARE DELIVERY ADMINISTRATION 0 205394 0 0 0 626 0 3250 0 28157 0 237427 0 0 JUSTIN WALTER VP OF PERFORMANCE IMPROVEMENT 0 219546 0 0 0 659 0 508 0 713 0 221426 0 0 PART I, LINE 3 THE SALARIES FOR THE EXECUTIVES ARE DETERMINED BY THE PARENT COMPANY, CENTERLIGHT HEALTH SYSTEM, INC. THE METHODS UTILIZED INCLUDE: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANTS, COMPARING TO THE FORM 990'S OF OTHER ORGANIZATIONS, COMPENSATION SURVEYS OR STUDIES, AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE BOARD. PART I, LINE 4A THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE IN HIS 2021 W-2 FROM THE REPORTING ORGANIZATION AND RELATED PARTIES TOTALING: DAVID ROCK, PRESIDENT/CEO - $337,500 FORM 990, PART VI, SECTION A, LINE 3 THE ENTITY PURCHASED MANAGEMENT SERVICES FROM AN UNRELATED ADVISORY SERVICES COMPANY, GRANT THORNTON, LLP. SERVICES INCLUDED DELEGATED CFO RESPONSIBILITIES. MANAGEMENT FEES TOTALING $1,486,332 WERE PAID DURING 2021 TO THIS COMPANY BY A RELATED ORGANIZATION, CENTERLIGHT HEALTH SYSTEM, INC. JOHNNY LEE, WHO IS LISTED ON PART VII, WAS COMPENSATED BY THE MANAGEMENT COMPANY. FORM 990, PART VI, SECTION A, LINE 6 CENTERLIGHT HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF MARGARET TIETZ NURSING AND REHABILITATION CENTER. FORM 990, PART VI, SECTION A, LINE 7A CENTERLIGHT HEALTH SYSTEM, INC. MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF THE MEMBER SHALL BE REQUIRED FOR ALL ACTIONS OF THE CORPORATION FOR WHICH MEMBER APPROVAL IS REQUIRED UNDER THE NOT-FOR-PROFIT CORPORATION LAW OF THE STATE OF NEW YORK. WITHOUT LIMITING THE FOREGOING OR ANY OTHER PROVISION OF THESE BYLAWS, THE APPROVAL OF THE MEMBER SHALL BE REQUIRED FOR THE CORPORATION TO: (A) EFFECT A MERGER, CONSOLIDATION, REORGANIZATION, OR SALE OR OTHER DISPOSITION OF THE CORPORATION OR ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; (B) EFFECT ANY DISSOLUTION, LIQUIDATION OR OTHER WINDING UP OF THE CORPORATION OR THE CESSATION OF ALL OR A SUBSTANTIAL PART OF THE BUSINESS OF THE CORPORATION; (C) AMEND THE CORPORATION'S CERTIFICATE OF LNCORPORATION OR BY-LAWS; (D) EFFECT A MATERIAL CHANGE IN THE CORPORATION'S BUSINESS; (E) INCREASE THE NUMBER OF DIRECTORS OR CHANGE THE TERM OF THE DIRECTORS ON THE CORPORATION'S BOARD OF DIRECTORS; (F) CREATE ANY MORTGAGE, PLEDGE OR OTHER SECURITY INTEREST IN ALL SUBSTANTIALLY ALL OF THE ASSETS OR PROPERTY OF THE CORPORATION OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; (G) MAKE ANY GUARANTEE OR BECOME A SPONSOR, OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; OR (H) MAKE ANY CHANGE THAT WOULD RESULT IN THE TRANSFER OF ULTIMATE VOTING CONTROL OF THE CORPORATION TO ANOTHER PERSON OR ENTITY OTHER THAN THE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE RETURNS ARE BASED ON THE CERTIFIED FINANCIAL STATEMENTS, AS WELL AS INFORMATION PROVIDED IN RESPONSE TO A DETAILED QUESTIONNAIRE WITH ADDITIONAL INFORMATION NOT INCLUDED IN THE FINANCIAL STATEMENTS INCLUDING COMPENSATION AND BENEFITS FOR SENIOR MANAGEMENT, PROCEDURES FOR ESTABLISHING SUCH COMPENSATION, AND GOVERNANCE POLICIES AND PROCEDURES (CONFLICTS OF INTEREST, RECORD RETENTION AND DESTRUCTION, WHISTLEBLOWER). DRAFTS OF THE COMPLETED RETURNS ARE REVIEWED BY THE CFO AND THE CORPORATE VP OF FINANCE. ANY COMMENTS ARISING FROM OUR REVIEW ARE DISCUSSED AND IF REQUIRED, CHANGES ARE MADE TO THE DRAFT. THAT DRAFT WILL BE SUBMITTED TO THE AUDIT COMMITTEE FOR ITS REVIEW AND APPROVAL. ONCE THE AUDIT COMMITTEE HAS COMPLETED ITS REVIEW COPIES OF THE RETURNS WILL BE PROVIDED TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT: NEW BOARD MEMBERS AND EMPLOYEES ARE GIVEN A COPY OF THE RESPECTIVE POLICIES. EACH YEAR ALL EMPLOYEES ARE REMINDED AT THE ANNUAL CORPORATE COMPLIANCE PROGRAM TRAINING OF THE POLICY AND OF THE SANCTIONS ASSOCIATED WITH NON-COMPLIANCE. ANNUALLY, DIRECTORS OF THE BOARD AND ARE ASKED TO REVIEW THE POLICY AND TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS THAT MAY HAVE OCCURRED SINCE THE LAST DISCLOSURE. THE AUDIT COMMITTEE OF THE BOARD REVIEWS THE BOARD AND SENIOR MANAGEMENT DISCLOSURES. PROCEDURES FOR MANAGING IDENTIFIED CONFLICTS: BEFORE THE BOARD OF DIRECTORS TAKES ACTION TO REVIEW OR APPROVE A CONTRACT, TRANSACTION OR COMPENSATION ARRANGEMENT INVOLVING AN ACTUAL CONFLICT OF INTEREST, THE DIRECTOR, OFFICER, OR EMPLOYEE WHO HAS THE POTENTIAL/ACTUAL CONFLICT OF INTEREST AND WHO IS IN ATTENDANCE AT THE MEETING MUST DISCLOSE ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE BOARD OR DESIGNEE (IF APPROPRIATE) WILL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE AND REPORT TO THE BOARD OF DIRECTORS ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. BASED ON THE INFORMATION FURNISHED BY THE DISINTERESTED PERSON OR COMMITTEE, THE BOARD OF DIRECTORS WILL MAKE A DETERMINATION OF WHETHER THE ORGANIZATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR MORE REASONABLE ARRANGEMENTS FROM AN ENTITY OR PERSON THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST IS NOT REASONABLY ATTAINABLE UNDER THE CIRCUMSTANCES, THE BOARD OF DIRECTORS WILL DETERMINE, BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS, WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATIONS' BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION. A DIRECTOR WHO HAS A CONFLICT OF INTEREST MAY NOT VOTE ON THE TRANSACTION OR ARRANGEMENT AND MAY NOT BE PRESENT IN THE MEETING ROOM WHEN THE VOTE IS TAKEN, UNLESS THE VOTE IS BY SECRET BALLOT. THE DIRECTORS' INELIGIBILITY TO VOTE SHALL BE REFLECTED IN THE MINUTES OF THE MEETING. THE AUDIT COMMITTEE, WHICH SHALL BE COMPOSED SOLELY OF DISINTERESTED DIRECTORS, SHALL ENSURE THAT THESE PROCEDURES ARE COMPLIED WITH, AND RECOMMEND REMOVAL OF THOSE THAT FAIL TO COMPLY WITH THE POLICY. MONITORING: CONTINUOUSLY, THROUGHOUT THE COURSE OF THE YEAR, ALL EMPLOYEES AND DIRECTORS ARE REMINDED OF THE CONFLICTS OF INTEREST POLICIES THROUGH CASES AND CONSEQUENCES DISCUSSIONS OF NON-COMPLIANCE. THIS IS DONE VIA E-MAIL, AT DIRECTORS MEETINGS, AND DURING STEERING COMMITTEE MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS AVAILABLE ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CENTERLIGHT HEALTH SYSTEM INC 136-65 37TH AVENUE FLUSHING NY 11354 133323765 TO SUPPORT HEALTHCARE SERVICES NY 501(C)(3) LINE 12B, II N/A 0 CENTERLIGHT HEALTHCARE INC 136-65 37TH AVENUE FLUSHING NY 11354 133600807 MANAGED CARE NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 PARK HOUSING DEVELOPMENT FUND COMPANY INC 136-65 37TH AVENUE FLUSHING NY 11354 133566484 HOUSING FOR THE ELDERLY NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 BEST CHOICE HOME HEALTH CARE INC 136-65 37TH AVENUE FLUSHING NY 11354 133889937 HOME CARE NY 501(C)(3) LINE 12B, II CENTERLIGHT HEALTH SYSTEM INC 0 MVP HOUSING DEVELOPMENT FUND COMPANY INC 136-65 37TH AVENUE FLUSHING NY 11354 133760575 HOUSING FOR THE ELDERLY NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 SCHNURMACHER CRN 136-65 37TH AVENUE FLUSHING NY 11354 133482590 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 BETH ABRAHAM SERVICES 136-65 37TH AVENUE FLUSHING NY 11354 131739920 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 CENTER FOR NURSING AND REHABILITATION INC 136-65 37TH AVENUE FLUSHING NY 11354 112289702 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 BETH ABRAHAM - CNR FOUNDATION INC 136-65 37TH AVENUE FLUSHING NY 11354 113284763 FUNDRAISING NY 501(C)(3) LINE 7 CENTERLIGHT HEALTH SYSTEM INC 0 CENTERLIGHT HEALTHCARE DIAGNOSTIC AND TREATMENT CENTER INC 136-65 37TH AVENUE FLUSHING NY 11354 133631727 DIAGNOSTIC TREATMENT CENTER NY 501(C)(3) LINE 12A, I CENTERLIGHT HEALTHCARE INC 0 CL HEALTHCARE INC 136-65 37TH AVENUE FLUSHING NY 11354 460833951 HOME CARE NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 CENTERLIGHT CERTIFIED HOME HEALTH AGENCY 136-65 37TH AVENUE FLUSHING NY 11354 461840894 HOME CARE NY 501(C)(3) LINE 10 CENTERLIGHT HEALTH SYSTEM INC 0 SCHEUER GARDENS LP 136-65 37TH AVENUE FLUSHING NY 11354 900894600 AFFORDABLE HOUSING NY SCHEUER GARDENS GP INC RELATED 0 0 SCHEUER PLAZA LP 136-65 37TH AVENUE FLUSHING NY 11354 320390482 AFFORDABLE HOUSING NY SCHEUER PLAZA GP INC RELATED 0 0 BETH ABRAHAM MANAGEMENT SOLUTIONS 136-65 37TH AVENUE FLUSHING NY 11354 134128549 TO MANAGE NURSING FACILITIES UNDER RECEIVERSHIP NY BETH ABRAHAM HEALTH SERVICES C 0 SCHEUER GARDENS GP INC 136-65 37TH AVENUE FLUSHING NY 11354 461126473 REAL ESTATE NY N/A C 0 SCHEUER PLAZA GP INC 136-65 37TH AVENUE FLUSHING NY 11354 461126614 REAL ESTATE NY N/A C 0 TBM HOUSING DEVELOPMENT FUND COMPANY INC 136-65 37TH AVENUE FLUSHING NY 11354 133227442 HOUSING FOR THE ELDERLY NY CENTERLIGHT HEALTH SYSTEM INC C 0 BETH ABRAHAM HOUSING DEVELOPMENT FUND COMPANY INC 136-65 37TH AVENUE FLUSHING NY 11354 133067236 HOUSING FOR THE ELDERLY NY CENTERLIGHT HEALTH SYSTEM INC C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0