2022-11-14T18:08:49-06:00 2021-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2021-01-01 141370000 HOOSICK FALLS HEALTH CENTER INC HOOS 5186864371 21 DANFORTH STREET HOOSICK FALLS NY 12090 STEPHEN MAJETICH TREASURER & CFO 5186864371 2022-11-14 1 STEPHEN MAJETICH 999009999 GARRETT M HIGGINS P00543209 9143818900 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z CENTER FOR NURSING AND REHABILITATION AT HOOSICK FALLS GREGORY LAURIN 21 DANFORTH STREET HOOSICK FALLS NY 12090 6084654 0 X WWW.NURSINGANDREHAB.ORG X 1914 NY THE CENTERS MISSION IS TO PROVIDE REHABILITATION AND LONG-TERM CARE SERVICES TO THOSE IN NEED. WE STRIVE TO PROVIDE RESIDENT CENTERED CARE IN OUR 82 BED SKILLED NURSING FACILITY SO THAT EACH RESIDENT HAS THE OPPORTUNITY TO REACH THEIR MAXIMUM POTENTIAL. 7 6 188 7 0 0 837264 167834 6209239 5906621 778 298 79337 9901 7126618 6084654 0 0 0 0 5324352 4984277 0 0 0 2887752 3178823 8212104 8163100 -1085486 -2078446 5281403 4877210 6413159 8082508 -1131756 -3205298 WE ARE AN 82 BED SKILLED NURSING HOME FACILITY PROVIDING 24 HR/7 DAYS A WEEK HEALTH CARE TO THOSE IN NEED IN A HOME LIKE ATMOSPHERE. 0 0 6938736 0 5906621 HOOSICK FALLS HEALTH CENTER FOCUSES ON DEVELOPING, MANAGING, AND OPERATING NURSING HOME CARE IN THE HOOSICK FALLS, NEW YORK AREA AND PROVIDING SERVICES TO THE COMMUNITY. THE ORGANIZATION SPECIALIZES IN LONG-TERM CARE AND REHABILITATION SERVICES, AND PROVIDES GREAT NURSING CARE, GOOD FOOD AND FRIENDLY AND HELPFUL PEOPLE, AND A SUPPORTING AND CARING ENVIRONMENT. THE HOOSICK FALLS HEALTH CENTER HAS 82 SKILLED NURSING BEDS. DURING THE YEAR, THE TOTAL PATIENT/RESIDENT DAYS WERE 21,621. 6938736 1 1 0 1 0 0 0 0 1 0 1 0 0 0 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 1 0 0 0 1 10 0 188 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X X STEPHEN MAJETICH 8024474587 21 DANFORTH STREET HOOSICK FALLS NY 12090 STEPHEN D MAJETICH TREASURER & CFO 1.00 46.15 X X 0 529249 89533 GREGORY LAURIN PRESIDENT 2.00 0.00 X X 0 0 0 WILLIAM KOESTER VICE PRESIDENT 1.00 0.00 X X 0 0 0 JOYCE DAVIS SECRETARY 1.00 0.25 X X 0 0 0 PATTY RYAN DIRECTOR 1.00 0.00 X 0 0 0 BILL COTTRELL DIRECTOR 1.00 0.00 X 0 0 0 KEN FACIN DIRECTOR 1.00 0.00 X 0 0 0 SUZANNE ANAIR ADMINISTRATOR 40.00 40.00 X 117994 99843 32582 117994 629092 122115 1 0 1 0 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 STAFFING AGENCY 305043 QUEST DIAGNOSTICS PO BOX 829864 PITTSBURGH PA 19182 COVID-19 TESTING SERVICES 211610 2 23290 121749 22795 167834 MEDICAID REVENUE 623000 3754795 3754795 PRIVATE PATIENT REVENU 623000 1216693 1216693 MEDICARE REVENUE 623000 935133 935133 5906621 298 298 6600 0 6600 6600 6600 OTHER INCOME 900099 2060 2060 RECOVERY OF BAD DEBT 900099 1241 1241 3301 6084654 5906621 0 10199 X 135940 124506 11434 3971274 3634845 336429 92135 84276 7859 354488 324270 30218 430440 393748 36692 9675 9675 131282 131282 2959 2959 1225994 849206 376788 2066 2066 502711 396240 106471 78908 180 78728 197332 186683 10649 11994 2101 9893 457309 457309 73207 73207 NY CASH RECEIPT ASSMT. 280555 280555 REPAIRS AND MAINTENANCE 147113 147099 14 PHARMACEUTICALS 55525 55525 STAFF DEVELOPMENT 2193 2193 8163100 6938736 1224364 0 357515 333746 70087 83795 558885 524634 8398 31295 26557 11577997 7814662 4123084 3763335 132139 145143 5281403 4877210 1136536 1637980 70087 83795 946 0 5205590 6360733 6413159 8082508 X -1205158 -3283604 73402 78306 -1131756 -3205298 5281403 4877210 X -2078446 4904 X 0 1 X 0 0 X 25520 2811091 1314630 837264 167834 5156339 6326025 5894979 6589604 6209239 5906621 30926468 6351545 8706070 7904234 7046503 6074455 36082807 0 0 0 36082807 11434 8248 6916 7378 6898 40874 11434 8248 6916 7378 6898 40874 141900 55762 52759 72737 3301 326459 6504879 8770080 7963909 7126618 6084654 36450140 0.98990 0.98980 0.00110 0.00130 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: RECOVERY OF BAD DEBT EXPENSE - 2020 AMOUNT: $ 70,268. 2021 AMOUNT: $ 1,241. OTHER INCOME - 2017 AMOUNT: $ 11,170. 2018 AMOUNT: $ 55,762. 2019 AMOUNT: $ 52,759. 2020 AMOUNT: $ 2,469. 2021 AMOUNT: $ 2,060. LOAN FORGIVENESS - 2017 AMOUNT: $ 130,730. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2959 2959 0 PART II-B, LINE 1: AMOUNTS REPORTED ON LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES, PAID BY THE ORGANIZATION TO TRADE OR PROFESSIONAL ASSOCIATIONS, ATTRIBUTABLE TO LOBBYING ACTIVITIES. 0 1 X 60499 60499 3433077 2131124 1301953 7493011 5146820 2346191 591410 536718 54692 3763335 DUE TO THIRD PARTY PAYORS 249786 DUE TO FOUNDATION 29273 ESTIMATED INSURANCE LIABILITIES 113104 DUE TO AFFILIATES 5968570 6360733 X 6094309 9655 9655 6084654 0 6084654 8170524 7424 7424 8163100 0 8163100 PART IV, LINE 2B: RESIDENTS' FUNDS ARE HELD BY THE HEALTH CENTER ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT ALLOWANCES RECEIVED BY RESIDENTS AS WELL AS OTHER RESIDENTS' FUNDS DEPOSITED WITH THE HEALTH CENTER FOR SAFEKEEPING. THESE FUNDS ARE DISBURSED BY THE HEALTH CENTER AT THE REQUEST OF, OR ON BEHALF OF, RESIDENTS FOR THEIR PERSONAL USE. PART X, LINE 2: THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE ATTRIBUTED TO AFFILIATE 4,751. CHANGE IN VALUE OF BENEFICIAL INTEREST IN TRUST 4,904. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES ATTRIBUTED TO AFFILIATE 7,424. 0 1 0 0 0 0 0 0 0 STEPHEN D MAJETICH TREASURER & CFO 0 329910 0 115525 0 83814 0 50817 0 38716 0 618782 0 34127 SUZANNE ANAIR ADMINISTRATOR 111770 99678 6000 0 224 165 3610 3046 14336 11590 135940 114479 0 0 PART I, LINE 4B STEPHEN D. MAJETICH, PARTICIPATED IN NONQUALIFIED DEFERRED COMPENSATION PLAN DESCRIBED 457(F) SPONSORED BY A RELATED TAX-EXEMPT ENTITY, SOUTHWESTERN VERMONT MEDICAL CENTER. DURING THE YEAR, $45,000 WAS CONTRIBUTED TO THE PLAN. ADDITIONALLY, HE RECEIVED A DISTRIBUTION FROM THE PLAN IN THE AMOUNT OF $34,127. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CENTER IS SVHC - HOOSICK FALLS LLC, A SINGLE MEMBER LLC OF SOUTHWESTERN VERMONT HEALTH CARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE POWER TO APPOINT, FIX THE NUMBER OF, AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE POWER TO: (1) APPROVE, INTERPRET AND CHANGE THE STATEMENT OF MISSION AND PHILOSOPHY ADOPTED BY THE CORPORATION AND TO REQUIRE THAT THE CORPORATION OPERATE IN CONFORMANCE WITH ITS MISSION AND PHILOSOPHY; (2) APPROVE AND AMEND THE BYLAWS AND CERTIFICATE OF INCORPORATION OF THE CORPORATION; (3) APPROVE ANY PLAN OF MERGER, CONSOLIDATION, DISSOLUTION OR REORGANIZATION OF THE CORPORATION OR ANY SALE, LEASE OR OTHER DISPOSITION OF ALL OF SUBSTANTIALLY ALL OF THEIR ASSETS; (4) ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND/OR THE ADMINISTRATOR OF THE NURSING HOME IF OTHER THAN THE CEO; (5) TO APPROVE THE DEBT OF THE CORPORATION, IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE CORPORATION, EXCEPT FOR DEBT NECESSARY TO FINANCE THE COST OF COMPLIANCE WITH OPERATIONAL OR PHYSICAL PLAN STANDARDS REQUIRED BY LAW; (6) TO APPROVE THE SALE, ACQUISITION, LEASE, TRANSFER, MORTGAGE, PLEDGE OR OTHER ALIENATION OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE BOARD OF MANAGERS OF THE MEMBER; (7) TO APPROVE THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION TO ENSURE THAT SUCH BUDGETS CONFORM TO THE MISSION AND PHILOSOPHY OF THE CORPORATION; (8) TO APPROVE SETTLEMENTS OF LITIGATION WHEN SUCH SETTLEMENTS EXCEED APPLICABLE INSURANCE COVERAGE OR THE AMOUNT OF ANY APPLICABLE SELF-INSURANCE FUND; (9) TO APPROVE ANY CORPORATE REORGANIZATION OF THE CORPORATION AND THE DEVELOPMENT OR DISSOLUTION OF ANY SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; (10) TO APPROVE THE STRATEGIC PLAN OF THE CORPORATION, PROVIDED THAT SUCH RIGHT OF APPROVAL SHALL NOT PERMIT THE CORPORATION TO EXERCISE ANY OF THE GOVERNANCE AUTHORITY UNDER APPLICABLE REGULATIONS UNLESS THE CORPORATION HAS RECEIVED ESTABLISHMENT APPROVAL FROM THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL; (11) TO APPROVE ANY APPLICATION TO THE NEW YORK STATE DEPARTMENT OF HEALTH BY THE CORPORATION FOR A CERTIFICATE OF NEED; (12) TO APPROVE ANY FINAL SETTLEMENT BY THE CORPORATION RELATED TO MEDICAID OR ANY OTHER PAYOR AUDITS; AND (13) TO APPROVE ANY RATE APPEALS TO BE INITIATED BY THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD FOR APPROVAL. ONCE THE BOARD HAS APPROVED THE RETURN IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH EMPLOYEE AND BOARD MEMBER HAS A RESPONSIBILITY AT ALL TIMES TO PROMOTE THE BEST INTERESTS OF THE CENTER FOR NURSING AND REHABILITATION AT HOOSICK FALLS. A CONFLICT OF INTEREST OCCURS WHEN AN EMPLOYEE'S JUDGMENT IN ACTING FOR THE FACILITY IS ADVERSELY AFFECTED. EXAMPLES OF CONFLICTS OF INTEREST INCLUDE BUT ARE NOT LIMITED TO: - ACCEPTING GRATUITIES FROM OTHER COMPANIES OR INDIVIDUALS WHO DO BUSINESS WITH THIS FACILITY OR SEEK TO DO BUSINESS WITH IT. - RENDERING SERVICES TO COMPETITORS. - USING, FACILITATING, CONVEYING, OR PERMITTING OTHERS TO USE FACILITY DOCUMENTS, EQUIPMENT, CONFIDENTIAL INFORMATION OR TRADE SECRETS. - BENEFITING PERSONALLY FROM ANY PURCHASES OR SALES BY THIS FACILITY. - ENGAGING IN OTHER EMPLOYMENT TO THE DETRIMENT OF THE EMPLOYEE'S WORK FOR THE FACILITY. ANNUALLY, ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM REPORTING ANY POTENTIAL CONFLICT OF INTERESTS. IF ONE BELIEVES A CONFLICT OF INTEREST EXISTS THE INDIVIDUAL MUST CONSULT THEIR SUPERVISOR, DEPARTMENT MANAGER, OR ADMINISTRATOR IN WHICH THE DETERMINATION OF WHETHER A CONFLICT EXISTS WILL BE MADE AND REVIEWED. ENGAGEMENT IN ANY BUSINESS PRACTICES THAT COMPROMISE THE FACILITY IN ANY WAY MAY RESULT IN THE IMMEDIATE TERMINATION OF ANY AND ALL EMPLOYEES INVOLVED IN SUCH ACTIVITY, AND MAY BE GROUNDS FOR LEGAL ACTION AGAINST THOSE EMPLOYEES. 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 POSTED 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 AT 21 DANFORTH STREET, HOOSICK FALLS, NY 12090 OR BY CALLING THE ORGANIZATION DIRECTLY AT 518-686-4371. FORM 990, PART IX, LINE 11G PHYSICIAN & NURSING PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 543,835. MANAGEMENT AND GENERAL EXPENSES 376,788. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 920,623. COVID TESTING: PROGRAM SERVICE EXPENSES 174,089. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,089. CONSULTANTS: PROGRAM SERVICE EXPENSES 36,203. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,203. CONTINUING EDUCATION SERVICES: PROGRAM SERVICE EXPENSES 1,362. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,362. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 93,717. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,717. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUST 4,904. HOOSICK FALLS HEALTH CENTER FOUNDATION INC 21 DANFORTH STREET HOOSICK FALLS NY 12090 223186959 SUPPORT THE OPERATIONS OF THE HOOSICK FALLS HEALTH CENTER, INC. NY 501(C)(3) LINE 7 HOOSICK FALLS HEALTH CENTER INC 1 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 030179435 HOSPITAL VT 501(C)(3) LINE 3 N/A 0 SOUTHWESTERN VT HEALTH CARE FOUNDATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 453362785 FUNDRAISING VT 501(C)(3) LINE 12A, I SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 SOUTHWESTERN VERMONT MEDICAL CENTER 100 HOSPITAL DRIVE BENNINGTON VT 05201 222563241 HOSPITAL VT 501(C)(3) LINE 3 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 MOUNT ANTHONY HOUSING CORPORATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 030279740 NURSING HOME VT 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 TWIN RIVERS MEDICAL PC 2 SUNRISE DRIVE HOOSICK FALLS NY 12090 473028931 HEALTHCARE NY 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 NORTHERN BERKSHIRE MEDICAL PC 375 MAIN STREET WILLIAMSTOWN MA 01267 814023607 HEALTHCARE MA 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 SOUTHWESTERN VERMONT HEALTH CARE AUXILIARY 100 HOSPITAL DRIVE BENNINGTON VT 05201 222563243 TO SERVE AND ASSIST SOUTHWESTERN VERMONT HEALTH CARE CORPORATION VT 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 SOUTHWESTERN VT HEALTH CARE ENTERPRISES 100 HOSPITCAL DRIVE BENNINGTON VT 05201 030314501 HEALTHCARE VT N/A C 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0