2022-11-15T13:08:46-06:00 2021-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2021-01-01 131740301 PROVIDENCE REST PROV 7189313000 3304 WATERBURY AVENUE BRONX NY 10465 ANNMARIE COVONE EXECUTIVE VP & CFO 7189313000 2022-11-14 1 ANNMARIE COVONE 999009999 GARRETT M HIGGINS P00543209 9143818900 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ARCHCARE AT PROVIDENCE REST SCOTT P LA RUE 205 LEXINGTON AVE - 2ND FLOOR NEW YORK NY 10016 32455137 0 0928 X WWW.PROVIDENCEREST.ORG X 1956 NY TO RENDER INPATIENT MEDICAL CARE TO THE AGED. 7 4 265 22 0 0 2250841 3082071 22545205 23612330 2128273 742285 312241 -50268 27236560 27386418 0 0 0 0 16985174 15609047 0 0 0 13974138 14773486 30959312 30382533 -3722752 -2996115 42104175 37979898 28880049 25723108 13224126 12256790 X IT IS OUR MISSION TO PROVIDE EXCEPTIONAL SKILLED NURSING AND REHABILITATIVE CARE IN A SAFE, PEACE-FILLED, SPIRITUALLY-CENTERED ENVIRONMENT TO THE OLDER ADULTS ENTRUSTED TO US. WE CONSIDER IT OUR PRIVILEGE TO CARE FOR EACH PERSON AS GOD'S PRECIOUS GIFT OF LIFE AND LOVE. WE FULLY COMMIT OURSELVES TO A CIRCLE OF COMMUNITY WITH OUR RESIDENTS AS THE CENTER, SURROUNDED BY STAFF, FAMILIES AND FRIENDS; THE RECOGNITION OF EACH RESIDENT AS AN AUTONOMOUS INDIVIDUAL WITH SPECIAL AND UNIQUE NEEDS, INTERESTS AND PREFERENCES; THE INVOLVEMENT OF ALL STAFF IN THE DAILY LIVES OF OUR RESIDENTS; CREATING A CARE ENVIRONMENT WHERE ALL THE MEMBERS OF OUR COMMUNITY WORK IN HARMONY TO PROVIDE A HAPPY HOME. 0 0 25590484 23609339 OUR SNF OFFERS SHORT TERM REHABILITATION, SUBACUTE SERVICES, LONG TERM CARE AND RESPITE CARE. IN ADDITION, WE HAVE A COMPREHENSIVE PALLIATIVE CARE PROGRAM AND PROVIDE IN-PATIENT HOME HOSPICE CARE. OUR SERVICES FOCUS ON THE OLDER ADULTS IN OUR COMMUNITY. WE HAVE A PERSON-CENTERED PHILOSOPHY, FOCUSING ON ALL THE NEEDS OF EACH INDIVIDUAL ENTRUSTED TO US PHYSICAL, SPIRITUAL, PSYCHOLOGICAL AND SOCIAL. WE HAD 479 ADMISSIONS TO PROVIDENCE REST IN 2021, DISCHARGED 132 RESIDENTS BACK TO THEIR HOMES. WE RENDERED 54,948 DAYS OF RESIDENT CARE AND 21 DAYS OF RESPITE CARE. PROVIDENCE REST CONTINUED TO EXTEND THE BOUNDARIES OF THE HOME TO THE COMMUNITY AT LARGE, SHARING EXPERTISE, PROGRAMS AND RESOURCES, THROUGH INTERNSHIP PROGRAMS, COMMUNITY INFORMATION PROGRAMS, HEALTH FAIR PARTICIPATION AND OTHER OUTREACH EFFORTS INCLUDING PROVIDING THE BOARD OF ELECTIONS WITH PROVIDENCE AS A NEW, HANDICAPPED ACCESSIBLE POLLING SITE. 0 2991 OUR OUTPATIENT PROGRAM PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES TO THE ADULTS OF OUR COMMUNITY, SPECIALIZING IN REHABILITATION FOR THE SENIOR POPULATION. THE PROGRAM ALSO PROVIDES CONTINUITY FOR OUR DISCHARGED SHORT-TERM REHAB CLIENTS WHO CHOOSE TO REMAIN WITH OUR THERAPISTS FOR THEIR REHABILITATION ONCE THEY RETURN HOME. WE RENDERED 91 PATIENT VISITS DURING 2021. 25590484 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 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 33 0 265 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 4 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X ANNMARIE COVONE 6466334700 205 LEXINGTON AVENUE - 2ND FLR NEW YORK NY 10016 SCOTT P LA RUE PRESIDENT & CEO 0.10 38.70 X X 0 1410218 353773 ANNMARIE COVONE EXECUTIVE VP/CFO 0.10 38.70 X X 0 876551 199201 HUGO PIZZURO BOARD MEMBER 0.10 35.00 X 0 487646 141900 JOHN DECINA CHAIRMAN 0.10 0.00 X X 0 0 0 SISTER SELINE FLORES BOARD MEMBER 0.10 1.70 X 0 0 0 JOHN GLEASON BOARD MEMBER 0.10 1.70 X 0 0 0 JOSEPH SAPORITO BOARD MEMBER 0.10 1.70 X 0 0 0 RICHARD J LOHNE EXECUTIVE DIRECTOR, THRU JUNE 2021 35.00 0.00 X 107892 0 22476 RICHARD P BISCOTTI ADMINISTRATOR 35.00 0.00 X 155881 0 67372 JULIET GORDONCILLO RN SUPERVISOR 35.00 0.00 X 130899 0 22666 YAKOV KATSNELSON DIRECTOR OF PLANT MAINTENANCE 35.00 0.00 X 106616 0 22666 501288 2774415 830054 4 0 1 0 MORRISON MANAGEMENT SPECIALIST 100 SOUTHCREST DRIVE STOCKBRIDGE GA 30281 NUTRITION MGMT SERVICES 1173110 ESSEN MEDICAL URGICARE PO BOX 788 HARTSDALE NY 10530 COVID-19 TESTING/LAB SERVICES 879616 SELECT REHABILITATION PO BOX 674102 DALLAS TX 75267 REHAB SERVICES 789653 RN EXPRESS STAFFING 71 WEST 23RD ST SUITE 1622 NEW YORK NY 10010 STAFFING SERVICES 578294 CATHOLIC HEALTH CARE SYSTEM 205 LEXINGTON AVE 2ND FLR NEW YORK NY 10012 ADMINISTRATIVE SERVICES 500000 13 107879 2739713 234479 3082071 MEDICAID REVENUE 623000 13216102 13216102 MEDICARE REVENUE 623000 6239297 6239297 PRIVATE PAY AND OTHER 623000 3236777 3236777 OTHER PATIENT REVENUE 623000 657339 657339 RENTAL INCOME FROM AFFILIATE 900099 262815 262815 23612330 237559 237559 380 0 380 380 380 5466686 4961960 504726 504726 504726 15480 107879 96186 -80706 -80706 7635 323 7312 7312 23374 10250 13124 13124 CABLE/PHONE CHARGES 900099 4655 4655 INTEREST ON PAST DUE ACCTS 900099 3526 3526 OTHER REVENUE 900099 881 881 560 560 9622 27386418 23612330 0 692017 X 374617 374617 9609797 9295431 314366 1265216 1189512 75704 3076407 2910135 166272 1283010 1199635 83375 500000 500000 81823 81823 46500 46500 2385 2385 48565 48565 5715480 4799157 916323 13570 13570 606777 481497 125280 147704 147704 1231814 1116969 114845 1477 1200 277 2931009 2931009 538050 538050 BAD DEBT EXPENSE 1209630 1209630 NY CASH RECEIPT ASSMNT 968009 968009 MEDICATIONS 283752 283752 REPAIRS & MAINTENANCE 169376 169376 277565 244802 32763 30382533 25590484 4792049 0 662451 827365 6543553 4489162 2796643 3103003 142886 147516 270700 203365 65506013 51136872 17075545 14369141 13166518 14214907 1445879 625439 42104175 37979898 4605100 3945900 18620223 17617801 267242 339054 5387484 3820353 28880049 25723108 X 13224126 12256790 13224126 12256790 42104175 37979898 X -2996115 1769534 259244 X X 0 1 X 1 0 X 354002 353407 1274456 2204677 3082071 7268613 28834800 27405705 27244362 22545205 23612330 129642402 29188802 27759112 28518818 24749882 26694401 136911015 21133 22513 19373 9070 3550 75639 0 21133 22513 19373 9070 3550 75639 136835376 348424 585284 594055 568158 237939 2333860 348424 585284 594055 568158 237939 2333860 47212 50992 53982 58937 32996 244119 29584438 28395388 29166855 25376977 26965336 139488994 0.98100 0.97960 0.01670 0.01800 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2018 AMOUNT: $ 1,386. 2019 AMOUNT: $ 4,060. 2021 AMOUNT: $ 881. CABLE / PHONE CHARGES - 2017 AMOUNT: $ 8,592. 2018 AMOUNT: $ 10,039. 2019 AMOUNT: $ 8,079. 2020 AMOUNT: $ 6,902. 2021 AMOUNT: $ 4,655. PURCHASE DISCOUNTS - 2017 AMOUNT: $ 23,067. 2018 AMOUNT: $ 29,959. 2019 AMOUNT: $ 26,929. 2020 AMOUNT: $ 6,734. INTEREST ON PAST DUE ACCOUNTS - 2017 AMOUNT: $ 934. 2018 AMOUNT: $ 7,174. 2019 AMOUNT: $ 11,102. 2020 AMOUNT: $ 12,484. 2021 AMOUNT: $ 3,526. MEDICAL RECORD ABSTRACTS - 2017 AMOUNT: $ 6,966. 2018 AMOUNT: $ 2,434. 2019 AMOUNT: $ 3,612. 2020 AMOUNT: $ 2,213. 2021 AMOUNT: $ 560. MISCELLANEOUS - 2017 AMOUNT: $ 4,000. GIFT SHOP - 2017 AMOUNT: $ 3,653. REBATES - 2019 AMOUNT: $ 200. 2020 AMOUNT: $ 3,246. BEAUTY PARLOR - 2020 AMOUNT: $ 7,037. 2021 AMOUNT: $ 8,072. COFFEE SHOP - 2020 AMOUNT: $ 20,321. 2021 AMOUNT: $ 15,302. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2385 2385 0 PART II-B, LINE 1: AMOUNTS REPORTED ON LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES PAID BY THE ORGANIZATION TO PROFESSIONAL ASSOCIATIONS AND SIMILAR ORGANIZATIONS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 0 1 X 2525290 2525290 58326055 47300440 11025615 4602393 3784157 818236 52275 52275 0 14369141 DUE TO THIRD PARTY PAYORS 111331 ACCRUED PENSION OBLIGATION 1174534 PROFESSIONAL LIABILITIES 206000 DUE TO RELATED PARTY 2328488 3820353 X 27902698 1769534 10250 1779784 26122914 48565 1214939 1263504 27386418 29129278 10250 10250 29119028 48565 1214939 1263504 30382532 PART IV, LINE 2B: RESIDENTS' FUNDS ARE HELD BY THE HOME ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT ALLOWANCES RECEIVED BY RESIDENTS AS WELL AS OTHER RESIDENTS' FUNDS DEPOSITED WITH THE HOME FOR SAFEKEEPING. THESE FUNDS ARE DISBURSED BY THE HOME AT THE REQUEST OF, OR ON BEHALF OF, RESIDENTS FOR THEIR PERSONAL USE. PART X, LINE 2: THE HOME RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE HOME HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE HOME IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B 10,250. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24 1,209,630. RECLASS FFCRA CREDIT TO PART VIII, LINE 13 5,309. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B 10,250. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24 1,209,630. RECLASS FFCRA CREDIT TO PART VIII, LINE 13 5,309. GOLF EVENT 123359 107879 15480 32855 63331 123359 107879 15480 32855 63331 96186 -80706 0 1 0 0 0 0 0 0 0 SCOTT P LA RUE PRESIDENT & CEO 0 988763 0 281992 0 139463 0 330725 0 23048 0 1763991 0 291706 ANNMARIE COVONE EXECUTIVE VP/CFO 0 668383 0 131713 0 76455 0 165931 0 33270 0 1075752 0 131713 HUGO PIZZURO BOARD MEMBER 0 390714 0 75873 0 21059 0 108416 0 33484 0 629546 0 75873 RICHARD P BISCOTTI ADMINISTRATOR 155881 0 0 0 0 0 53865 0 13507 0 223253 0 0 0 JULIET GORDONCILLO RN SUPERVISOR 130899 0 0 0 0 0 10767 0 11899 0 153565 0 0 0 PART I, LINE 3 CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT ITS EXECUTIVE COMPENSATION IS REASONABLE. TOWARD THAT END, THE BOARD OF TRUSTEES HAS A COMPENSATION COMMITTEE OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN ANY PROPOSED COMPENSATION ARRANGEMENT. THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT WHO CONDUCTED INDEPENDENT RESEARCH AND UTILIZED A WIDE RANGE OF INDUSTRY DATA TO DEVELOP COMPARABILITY OR BENCHMARKING DATA FOR APPROPRIATE LEVELS OF COMPENSATION FOR TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES. THE CONSULTANT PROJECTED THE DATA FOR THE FOLLOWING THREE YEARS FOR EACH SALARY LEVEL. THE COMPENSATION COMMITTEE, TAKING THE CONSULTANT'S RECOMMENDATIONS UNDER ADVISEMENT, HELD A MEETING AT WHICH CONTEMPORANEOUS MINUTES WERE KEPT AND AT THAT MEETING DETERMINED TO MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN CONSIDERED AND APPROVED THE RECOMMENDATIONS OF THE COMPENSATION COMMITTEE, WHICH APPROVAL WAS RECORDED IN THE MINUTES OF THE MEETING OF THE BOARD OF TRUSTEES. IN 2021, THE CONSULTANT UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE OF TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES FOLLOWING THE METHOD DESCRIBED ABOVE. IN ADDITION, THE ORGANIZATION UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE FOR ALL OTHER POSITIONS (NON-UNION). PART I, LINE 4B SCOTT P. LA RUE AND ANNMARIE COVONE ALSO PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE DISTRIBUTED $139,463 TO SCOTT AND $63,705 TO ANNMARIE IN THEIR 2021 W-2S. A DORMITORY AUTHORITY OF THE STATE OF NEW YORK (DASNY) 146000293 64983QQN2 2005-09-29 42107501 CAPITAL IMPROVEMENTS PROJECTS 1 0 0 B DORMITORY AUTHORITY OF THE STATE OF NEW YORK (DASNY) 146000293 000000000 2016-12-29 22821500 REFINANCING ISSUE 0 0 0 A 13975000 42107501 137846 41969655 2009 0 0 1 1 B 4766044 22821500 3921062 400862 18499576 2016 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 1 A 0 B 1 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT AGREEMENT FOR CERTAIN ADMINISTRATIVE AND CONSULTING SERVICES WITH CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. CATHOLIC HEALTH CARE SYSTEM SHALL PROVIDE HUMAN RESOURCES, IT SERVICES, FINANCE SERVICES, LEGAL SERVICES, COMPLIANCE, AND SUPPLY CHAIN MANAGEMENT TO THE ORGANIZATION. ANNMARIE COVONE AND SCOTT LA RUE (OFFICERS OF THE FILING ORGANIZATION) WERE PAID BY CATHOLIC HEALTH CARE SYSTEM. THEIR 2021 COMPENSATION IS REPORTED IN PART VII, SECTION A AND SCHEDULE J, PART II. CATHOLIC HEALTH CARE SYSTEM WAS PAID $500,000 FOR SERVICES PROVIDED IN 2021. FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE JANUARY 1, 2021, THE FORMER SOLE MEMBER OF PROVIDENCE REST, THE SISTERS OF ST. JOHN THE BAPTIST ENTERED INTO A MEMBER SUBSTITUTION AGREEMENT WITH THE CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. CATHOLIC HEALTH CARE SYSTEM ASSUMED THE MEMBERSHIP ROLE OF PROVIDENCE REST WITH ALL OF THE RIGHTS HELD BY THE PRIOR MEMBER. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE "MEMBER" IS CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES, APPOINT THE CHAIRMAN OF THE BOARD, AMEND THE BY-LAWS AND CERTIFICATE OF INCORPORATION AND APPROVE SUBSTANTIAL TRANSACTIONS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RIGHT TO AMEND THE BY-LAWS AND CERTIFICATE OF INCORPORATION AND APPROVE SUBSTANTIAL TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 11B PROVIDENCE REST 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 MEMBERS OF THE ORGANIZATION FOR ANY COMMENTS. ANY COMMENTS ARE THEN GROUPED, SUMMARIZED AND PROVIDED TO THE OUTSIDE ACCOUNTANTS. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED FOR FILING. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE OFFICER OBTAINS DISCLOSURE FROM EACH BOARD MEMBER PRIOR TO A DIRECTOR'S FIRST ATTENDANCE AT A BOARD MEETING AND FROM ALL BOARD MEMBERS AT LEAST EVERY TWO YEARS. BOARD MEMBERS ARE IN-SERVICED ANNUALLY ON THE POLICIES AND PROCEDURES OF THE CORPORATE COMPLIANCE PROGRAM. EMPLOYEES ARE IN-SERVICED ON THE POLICY AND CORPORATE COMPLIANCE PROGRAM DURING ORIENTATION AND ANNUALLY DURING THE MONTH OF JULY. THEY ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST TO THE ADMINISTRATOR AND TO AVOID PARTICIPATING IN ANY DECISIONS OR DELIBERATIONS RELATED TO AN INSTITUTIONAL OR BUSINESS TRANSACTION IN WHICH A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS. AN EMPLOYEE WHO FAILS TO DISCLOSE A CONFLICT MAY BE DISCIPLINED AND/OR DISCHARGED. IN ADDITION, UNDER THE CORPORATE COMPLIANCE PROGRAM ANYONE CAN REPORT A SUSPECTED VIOLATION OF THE CONFLICT OF INTEREST POLICY. THE COMPLIANCE OFFICER AND/OR COMPLIANCE COMMITTEE WILL INVESTIGATE THE ALLEGATION TO DETERMINE ITS VALIDITY. THE COMPLIANCE OFFICER CONDUCTS A COMPREHENSIVE INVESTIGATION INCLUDING INTERVIEWS WITH APPROPRIATE STAFF, VENDORS, REVIEW OF DOCUMENTS, CONSULTATION WITH LEGAL COUNSEL IF NECESSARY. THE COMPLIANCE OFFICER KEEPS THE ADMINISTRATOR AND CHAIRMAN OF THE BOARD APPRISED OF THE PROGRESS OF THE INVESTIGATION. AT THE CONCLUSION OF THE INVESTIGATION A REPORT IS PREPARED FOR THE ADMINISTRATOR. IF THE INVESTIGATION REVEALED A VIOLATION HAD OCCURRED THE OFFICER WILL RECOMMEND CORRECTIVE ACTION. APPROPRIATE ACTION MAY INCLUDE DISCIPLINARY ACTION, DISMISSAL (BOARD MEMBER), COMMUNICATIONS TO EMPLOYEES, STAFF, CONTRACTORS AND BOARD MEMBERS. AUDITS ARE CONDUCTED DURING THE YEAR TO ENSURE EMPLOYEES, CONSULTANTS AND CONTRACTORS ARE ADHERING TO THE POLICY. THIS INCLUDES A REVIEW OF EACH NEW CONTRACTOR AND/OR VENDOR PRIOR TO BUSINESS BEING CONDUCTED. FORM 990, PART VI, SECTION B, LINE 15B THE CORPORATION UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT ITS EXECUTIVE COMPENSATION IS REASONABLE AND COMPETITIVE. TOWARD THAT END, THE BOARD OF TRUSTEES HAS A COMPENSATION COMMITTEE OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN ANY PROPOSED COMPENSATION ARRANGEMENT. THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT WHO CONDUCTED INDEPENDENT RESEARCH AND UTILIZED A WIDE RANGE OF INDUSTRY DATA TO DEVELOP COMPARABILITY OR BENCHMARKING DATA FOR APPROPRIATE LEVELS OF COMPENSATION FOR TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES. IN ADDITION, THE CONSULTANT CREATED A COMPENSATION STRUCTURE FOR ALL OTHER POSITIONS (NON-UNION). THIS STRUCTURE IS REVIEWED EVERY THREE YEARS. THE CONSULTANT REVIEWS EXECUTIVE COMPENSATION ANNUALLY AND REVIEWS THESE RESULTS WITH THE COMPENSATION COMMITTEE. THE CONSULTANT PROJECTED THE DATA FOR THE FOLLOWING THREE YEARS FOR EACH SALARY LEVEL. THE COMPENSATION COMMITTEE, TAKING THE CONSULTANT'S RECOMMENDATIONS UNDER ADVISEMENT, HELD A MEETING AT WHICH CONTEMPORANEOUS MINUTES WERE KEPT AND AT THAT MEETING DETERMINED TO MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN CONSIDERED AND APPROVED THE RECOMMENDATIONS OF THE COMPENSATION COMMITTEE, WHICH APPROVAL WAS RECORDED IN THE MINUTES OF THE MEETING OF THE BOARD OF TRUSTEES. IN 2021, THE CONSULTANT UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE OF TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES FOLLOWING THE METHOD DESCRIBED ABOVE. IN ADDITION, THE ORGANIZATION UPDATED ITS REVIEW OF THE COMPENSATION STRUCTURE FOR ALL OTHER POSITIONS (NON-UNION). FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. THE ORGANIZATION'S FORM 990 IS ALSO AVAILABLE ON GUIDESTAR AND OTHER SIMILAR WEBSITES. FORM 990, PART VI, SECTION C, LINE 19 PROVIDENCE REST MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINACIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. THE ORGANIZATION ALSO FILES AN ANNUAL COST REPORT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH WHICH CONTAINS FINANCIAL STATEMENTS AND RELATED NOTE DISCLOSURES, WHICH IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G BILLING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 144,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 144,000. CONSULTING: PROGRAM SERVICE EXPENSES 42,030. MANAGEMENT AND GENERAL EXPENSES 726,393. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 768,423. DASNY FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,119. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,119. EMPLOYMENT AGENCY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 34,811. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,811. ENGINEERING: PROGRAM SERVICE EXPENSES 245,238. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 245,238. FOOD SERVICES: PROGRAM SERVICE EXPENSES 1,353,543. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,353,543. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 207,099. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 207,099. PHYSICAL THERAPISTS: PROGRAM SERVICE EXPENSES 2,850. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,850. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 84,375. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,375. LABORATORY/RADIOLOGY: PROGRAM SERVICE EXPENSES 165,245. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,245. RN, LPN, CAN: PROGRAM SERVICE EXPENSES 1,223,630. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,223,630. SECURITY: PROGRAM SERVICE EXPENSES 169,138. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 169,138. THERAPISTS & NON PHYS.: PROGRAM SERVICE EXPENSES 1,100,657. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,100,657. PASTORAL CARE: PROGRAM SERVICE EXPENSES 205,352. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 205,352. FORM 990, PART XI, LINE 9: EFFECT OF PENSION LIABILITY ADJUSTMENT 207,955. EQUITY TRANSFER FROM CATHOLIC HEALTH CARE SYSTEM 51,289. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTING FIRM. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BENEFICE ADVANTAGE INC 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 134201050 DORMANT/PROVIDE ADMIN., BENEFITS COORDINATING AND OTHER SERVICES TO ARCHCARE NY 501(C)(3) LINE 1 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CALVARY FUND INC 1740 EASTCHESTER ROAD BRONX NY 10461 133259649 SUPPORT CALVARY HOSPITAL NY 501(C)(3) LINE 12A, I CALVARY HOLDING COMPANY INC 0 CALVARY HOLDING COMPANY 1740 EASTCHESTER ROAD BRONX NY 10461 061531426 SUPPORT THE CALVARY HOSPITAL AND ITS AFFILIATED ORGANIZATIONS NY 501(C)(3) LINE 12A, I CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CALVARY HOSPITAL 1740 EASTCHESTER ROAD BRONX NY 10461 131740274 OPERATE A TAX EXEMPT HOSPITAL NY 501(C)(3) LINE 3 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CARMEL RICHMOND NURSING HOME INC 88 OLD TOWN ROAD STATEN ISLAND NY 103044299 132720248 OPERATE SKILLED NURSING & REHABILITATION FACILITY NY 501(C)(3) LINE 10 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CATHOLIC HEALTH CARE FOUNDATION OF THE ARCHDIOCESE OF NY 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 134054158 PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) LINE 7 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 205 LEXINGTON AVE - 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