2022-11-15T22:46:30-06:00 2021-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2021-01-01 111633518 NORWEGIAN CHRISTIAN HOME AND HEALTH CENTER NORW 7182322322 1250 67TH STREET BROOKLYN NY 11219 MICHAEL PAGANO CFO 7182322322 2022-11-15 1 MICHAEL PAGANO 999009999 GARRETT M HIGGINS P00543209 9143818900 2022-11-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MICHAEL PAGANO 1250 67TH STREET BROOKLYN NY 11219 29282311 0 X WWW.NCHHC.ORG X 1903 NY MOTIVATED BY FAITH IN GOD, THE BELIEF THAT REDEMPTION CAN ONLY BE FOUND IN JESUS CHRIST, AND HIS LOVE EXTENDS TO ALL MAN KIND, THE NORWEGIAN CHRISTIAN HOME AND HEALTH CENTER EXISTS TO PROVIDE EXCEPTIONAL PHYSICAL, SOCIAL, AND SPIRITUAL CARE SERVICES TO ITS RESIDENTS IN A PLEASANT ENVIRONMENT WHERE HUMAN DIGNITY IS PRESERVED. 17 17 285 0 0 0 1158594 3352727 24218737 25478169 164092 141230 81052 310185 25622475 29282311 0 0 0 0 14726452 14555154 0 0 0 10703259 10835470 25429711 25390624 192764 3891687 32474567 33822234 26367685 21849460 6106882 11972774 X MOTIVATED BY FAITH IN GOD, THE BELIEF THAT REDEMPTION CAN ONLY BE FOUND IN JESUS CHRIST, AND HIS LOVE EXTENDS TO ALL MAN KIND, THE NORWEGIAN CHRISTIAN HOME AND HEALTH CENTER EXISTS TO PROVIDE EXCEPTIONAL PHYSICAL, SOCIAL, AND SPIRITUAL CARE SERVICES TO ITS RESIDENTS IN A PLEASANT ENVIRONMENT WHERE HUMAN DIGNITY IS PRESERVED. 0 0 17569981 22622721 SKILLED NURSING AND RESPITE CARE PROVIDED IN A FULL SERVICE, STATE OF THE ART 135 BED FACILITY WITH 2 RESPITE BEDS AND 24/7 MEDICAL CARE TO ATTEND TO THE COMPLETE NEEDS OF EVERY RESIDENT SUB-ACUTE CARE PROVIDES INTENSIVE RESTORATIVE REHABILITATION DESIGNED TO IMPROVE THE PHYSICAL STATE OF THE RESIDENT AN INTERDISCIPLINARY TEAM IS COMPRISED OF PHYSICIANS, NURSES, THERAPISTS, SOCIAL WORKERS AND MORE THE GOAL IS TO ATTAIN MEASURABLE PROGRESS WITH EVERY RESIDENT, AS WELL AS TO BE ABLE TO AFFECT A SAFE DISCHARGE. ALL ROOMS ARE EQUIPPED WITH SATELLITE TELEVISION, TELEPHONES, SECURITY, AND SAFETY DEVICES SERVICES INCLUDE HOUSEKEEPING, LAUNDRY SERVICE, 3 NUTRITIONAL MEALS DAILY (TAILORED TO INDIVIDUAL DIETARY NEEDS), PASTORAL CARE AND ELECTIVE GROUP ACTIVITIES IN 2021, THE HOME PROVIDED 46,286 DAYS OF SKILLED NURSING CARE AND 25 DAYS OF RESPITE CARE THERE WERE A TOTAL OF 389 ADMISSIONS AND 385 DISCHARGES DURING 2021. 4955635 6659590 ASSISTED LIVING FOR WHEN A HELPING HAND IS NEEDED PROGRAM SERVICES INCLUDE 88 BEDS IN SEMI-PRIVATE ACCOMMODATIONS PROVIDING RESIDENTS WITH UNCOMPROMISED AND ACCURATE ATTENTION RESIDENTS ENJOY DELICIOUS MEALS, AND SOCIAL PROGRAMS THAT KEEP THEIR MINDS AND BODIES ACTIVE INDEPENDENT LIVING STUDIO AND SUITES PROVIDE 28 RESIDENTS A SECURE ENVIRONMENT WHILE MAINTAINING THEIR INDEPENDENCE LUXURY APARTMENTS INCLUDE FULL FUNCTIONING KITCHENS, WALK IN CLOSETS, CABLE AND INTERNET ACCESS PUBLIC AREAS INCLUDE A BRIGHT ATRIUM WITH A FIREPLACE, OUTDOOR GARDEN WITH POND AND GAZEBO, AS WELL AS A COMFORTABLE ENVIRONMENT TO RELAX IN 2021, THE HOME PROVIDED 24,348 DAYS OF ASSISTED LIVING AND INDEPENDENT LIVING CARE. 22525616 1 1 0 1 0 0 0 0 1 0 1 1 0 1 1 1 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 1 0 0 0 1 0 0 285 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X STEVEN COHEN 7182322322 1250 67TH STREET BROOKLYN NY 11219 GEORGE JENSEN CHAIRMAN 2.00 1.00 X X 0 0 0 ARLENE RUTUELO VICE CHAIRMAN 2.00 1.00 X X 0 0 0 RALPH AAVIK TREASURER 2.00 0.00 X X 0 0 0 ARTHUR J GOYENA ASST. TREASURER 2.00 0.00 X X 0 0 0 ARNOLD OFTEDAL SECRETARY 1.00 0.00 X X 0 0 0 PAUL CASSONE ASST SECRETARY 1.00 0.00 X 0 0 0 LORI AAVIK MEMBER 1.00 0.00 X 0 0 0 REBECCA E DANIEL MEMBER 1.00 0.00 X 0 0 0 GORDON A JENSEN MEMBER 1.00 0.00 X 0 0 0 EDWARD JOHANNESEN MEMBER 1.00 0.00 X 0 0 0 ERIC V JOHNSON MEMBER 1.00 0.00 X 0 0 0 REV PAULH KNUDSEN MEMBER 1.00 0.00 X 0 0 0 EARNEST K RAGIN MEMBER 1.00 0.00 X 0 0 0 STANLEY RAMSAL MEMBER 1.00 0.00 X 0 0 0 RICHARD C THOMPSON JR MEMBER 1.00 0.00 X 0 0 0 SAMANTHA WONG MEMBER 1.00 0.00 X 0 0 0 ANTHONY RESTAINO NON VOTING MEMBER 1.00 0.00 X 0 0 0 TORRY BERNTSEN MEMBER THRU 1.00 0.00 X 0 0 0 ELEANOR BENSEN MEMBER THRU 1.00 0.00 X 0 0 0 ANTHONY RESTAINO EXECUTIVE DIRECTOR 37.50 1.00 X 216609 0 38079 STEVEN J COHEN CFO 37.50 0.00 X 197318 0 12388 MELANIA COLAMARIA MDS COORDINATOR 37.50 0.00 X 116040 0 7458 LISA DE CARLO MDS ASSESSOR 37.50 0.00 X 107292 0 7575 JANE GABBIDON DIR. OF NURSING 37.50 0.00 X 154674 0 23313 VALBONA ISMAILANJI NURSING SUPERVISOR 37.50 0.00 X 103799 0 7266 STEVE KENNEDY DIR. OF HR 37.50 0.00 X 116819 0 18691 1012551 0 114770 7 0 1 0 PREFERRED THERAPY SERVICES 850 SILAS DEANE HIGHWAY WETHERSFIELD CT 06109 THERAPY SERVICES 1555394 PROMED STAFFING RESOURCES PO BOX 610028 DALLAS TX 75261 NURSING AGENCY STAFFING 628697 PROCARE LTC PHARMACY 111 EXECUTIVE BOULEVARD FARMINGDALE NY 11735 PHARMACEUTICAL SERVICES 340591 WINFILED SECURITY 57 WEST 38TH STREET NEW YORK NY 10018 SECURITY 310290 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 10528 AUDITING AND CONSULTING 175178 5 3241302 111425 3352727 MEDICARE 623000 10016174 10016174 MEDICAID 623000 9595441 9595441 PRIVATE PAY REVENUE 623000 3039317 3039317 OTHER NET PATIENT REVENUE 623000 2827237 2827237 25478169 141230 141230 MORTGAGE INS REFUND 900099 168172 168172 HERITAGE HALL REV 900099 57416 57416 MISC INCOME 900099 50115 50115 34482 34482 310185 29282311 25478169 0 451415 X 10960113 9628393 1331720 597668 524987 72681 1869883 1642492 227391 1127490 990379 137111 21447 21447 88563 88563 4980 4980 3364592 3307922 56670 361311 60643 300668 283559 283559 1230956 1230956 6663 398 6265 41159 41159 2748709 2463128 285581 MEDICAL SUPPLIES 1070938 1070938 FOOD EXPENSE 790578 790578 NYS CASH RECEIPT ASSMNT 751760 751760 OTHER DIRECT EXPENSES 70255 21883 48372 25390624 22525616 2865008 0 4683651 5866284 2530974 2295601 270453 239781 40735103 30848572 11207312 9886531 3737064 4718001 10045113 10816036 32474567 33822234 3537339 3634188 12569890 11309144 658611 761788 9601845 6144340 26367685 21849460 X 5370062 11178125 736820 794649 6106882 11972774 32474567 33822234 X 3891687 1974205 X X 0 1 X 1 0 X 381294 335413 49224 1158594 3352723 5277248 23143738 23437848 24652023 24218737 25478169 120930515 23525032 23773261 24701247 25377331 28830892 126207763 0 0 0 126207763 26343 33068 115137 164092 141230 479870 26343 33068 115137 164092 141230 479870 146942 136763 114175 81052 310185 789117 23698317 23943092 24930559 25622475 29282307 127476750 0.99000 0.99150 0.00380 0.00320 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: GIFT SHOP INCOME - 2017 AMOUNT: $ 102,782. 2018 AMOUNT: $ 2,050. 2019 AMOUNT: $ 2,100. 2020 AMOUNT: $ 900. 2021 AMOUNT: $ 2,500. EQUAL FUNDS - 2017 AMOUNT: $ 32,087. MISCELLANEOUS INCOME - 2017 AMOUNT: $ 12,073. 2018 AMOUNT: $ 18,221. 2019 AMOUNT: $ 17,170. 2020 AMOUNT: $ 12,073. 2021 AMOUNT: $ 50,115. REBATES - 2018 AMOUNT: $ 5,427. 2019 AMOUNT: $ 3,357. 2020 AMOUNT: $ 17,681. 2021 AMOUNT: $ 21,122. CAFETERIA INCOME - 2018 AMOUNT: $ 111,065. 2019 AMOUNT: $ 91,548. 2020 AMOUNT: $ 50,398. 2021 AMOUNT: $ 57,416. MORTGAGE INS REFUND - 2021 AMOUNT: $ 168,172. BAD DEBT RECOVERY - 2021 AMOUNT: $ 10,860. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4980 4980 0 PART II-B, LINE 1: IN ACCORDANCE WITH SECTION 6033(E) OF THE INTERNAL REVENUE CODE A PORTION OF THE DUES ARE ATTRIBUTABLE TO LOBBY ACTIVITIES. 0 1 X 736820 57829 794649 677337 59483 736820 584321 93016 677337 664091 -79770 584321 591228 72863 664091 1.00000 1 0 937041 937041 36060855 27881863 8178992 3496690 2836592 660098 240517 130117 110400 9886531 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 794649 F INTEREST IN NORWEGIAN CHRISTIAN HOME FOUNDATION 3923352 F 4718001 RESTRICTED CASH-RESIDENTS' FUNDS 761789 ASSETS LIMITED TO USE 7473836 INSURANCE RECOVERY RECEIVABLE 2454000 DUE FROM FOUNDATION 126411 10816036 ACCRUED PENSION COST 2628307 PROFESSIONAL AND SIMILAR LIABILITIES 2678000 DUE TO THIRD-PARTY PAYORS 838033 6144340 X 29282311 0 29282311 0 29282311 25390624 0 25390624 0 25390624 PART IV, LINE 2B: RESIDENT'S FUNDS ARE HELD BY THE HOME ON BEHALF OF THE RESIDENTS SUCH FUNDS REPRESENT LIVING ALLOWANCES RECEIVED BY RESIDENTS AS WELL AS OTHER FUNDS DEPOSITED WITH THE HOME FOR SAFEKEEPING THE FUNDS ARE DISBURSED AT THE REQUEST OF, OR ON BEHALF OF RESIDENT'S FOR THEIR PERSONAL USE. PART V, LINE 4: THE KONRAD W FREDERIKSEN CHARITABLE TRUST WAS ESTABLISHED DECEMBER 23, 1958, CONSISTING OF 4,668 UNITS OF THE MASSACHUSETTS LIFE FUND. THE TRUST AGREEMENT STATES THAT NET INCOME FROM THE FUND IS TO BE PAID QUARTERLY TO THE HOME. IN 2008, THE HOME RECORDED ITS BENEFICIAL INTEREST IN THE VERA J. CLARK TRUST. THE TRUST AGREEMENT STATES THAT THE NET INCOME FROM THE TRUST IS TO BE PAID QUARTERLY TO THE HOME AND SEVERAL OTHER CHARITABLE ORGANIZATIONS. PART X, LINE 2: THE HOME RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY WHEN THE TAX 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. X X X X 0 0 0 0 0 0 0 0 0 ANTHONY RESTAINO EXECUTIVE DIRECTOR 216609 0 0 0 0 0 15163 0 22916 0 254688 0 0 0 STEVEN J COHEN CFO 197318 0 0 0 0 0 12388 0 0 0 209706 0 0 0 JANE GABBIDON DIR. OF NURSING 154674 0 0 0 0 0 11784 0 11529 0 177987 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 RALPH AAVIK AND LORI AAVIK HAVE A FAMILY RELATIONSHIP. TORRY BERNTSEN AND GEORGE A JENSEN HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B NORWEGIAN CHRISTIAN HOME AND HEALTH CENTER 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 IT IS ELECTRONICALLY SENT TO MANAGEMENT FOR REVIEW, AND THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE HOME HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT PROTECTS THE INTEREST OF THE HOME WITH ANY TRANSACTIONS THAT MIGHT BENEFIT THE PRIVATE INTEREST OF A DIRECTOR, OFFICER, OR KEY EMPLOYEE OF THE CORPORATION. ANNUALLY INDIVDUALS MUST DISCLOSE ANY POTENTIAL CONFLICTS. IF A CONFLICT WERE TO OCCUR, ALL RELATED PARTIES WITH A FINANCIAL INTEREST MUST NOT BE PRESENT FOR DELIBERATIONS AND VOTING ON THE TRANSACTION OR ARRANGEMENT IN WHICH HE OR SHE HAS A FINANCIAL INTEREST. NO DIRECTOR OR OFFICER SHALL VOTE, ACT, OR ATTEMPT TO INFLUENCE IMPROPERLY THE DELIBERATIONS ON ANY MATTER IN WHICH HE OR SHE HAS BEEN DETERMINED BY THE BOARD TO HAVE A FINANCIAL INTEREST. ANY ATTEMPT TO VOTE, ACT, OR IMPROPERLY INFLUENCE DELIBERATIONS BY A RELATED PARTY ON ANY MATTER WITH WHICH SUCH PERSON HAS A FINANCIAL INTEREST MAY BE GROUNDS FOR REMOVAL FROM THE BOARD OR TERMINATION FROM THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE EXECUTIVE DIRECTOR / ADMINISTRATOR IS DECIDED BY THE BOARD OF DIRECTORS WHICH INCLUDES AN ANNUAL REVIEW AND APPROVAL BY THE BOARD THE BOARD UTILIZES DATA AND / OR BENCHMARKS RELATED TO COMPARABLE COMPENSATION FOR SIMILAR QUALIFIED PERSONAL IN COMPARABLE POSITIONS IN SIMILAR FACILITIES HIS / HER COMPENSATION IS VOTED ON DURING A BOARD MEETING AND DOCUMENTED IN THE BOARD MINUTES. THE SALARIES OF KEY EMPLOYEES AND SENIOR MANAGEMENT STAFF ARE DECIDED DURING THE HIRING PROCESS BY THE EXECUTIVE DIRECTOR / ADMINISTRATOR AND DIRECTOR OF HUMAN RESOURCES JOINTLY, WHICH INCLUDES A REVIEW OF COMPARABLE COMPENSATION FOR SIMILAR QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILAR FACILITIES. AFTER INITIAL HIRE, NOMINAL SALARY INCREASES MAY BE GRANTED TAKING INTO ACCOUNT COST OF LIVING INCREASES AND THE FACILITY'S FINANCIAL SITUATION PERIODIC SALARY REVIEWS OF KEY EMPLOYEES AND TOP MANAGEMENT MAY ALSO BE CONDUCTED TAKING INTO ACCOUNT EMPLOYEES PERFORMANCE AND ANY ADDITIONAL RESPONSIBILITIES ASSIGNED INCLUDING A REVIEW OF COMPARABLE COMPENSATION FOR SIMILAR QUALIFIED PERSONS IN COMPARABLE POSITIONS IN SIMILAR FACILITIES THE BOARD AUTHORIZES THE EXECUTIVE DIRECTOR / ADMINISTRATOR TO INCREASE ALL ELIGIBLE NON-UNION SALARIES BY AN APPROVED PERCENTAGE, EACH INDIVIDUAL EMPLOYEE'S SALARY INCREASE IS DETERMINED BY THE EXECUTIVE DIRECTOR / ADMINISTRATOR THE BOARD OF DIRECTOR'S DID APPROVE A SALARY INCREASE FOR NON-UNION EMPLOYEES IN 2019. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST THE ORGANIZATION FILES AN ANNUAL COST REPORT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH WHICH CONTAINS THE FINANCIAL STATEMENTS AND RELATED NOTE DISCLOSURES THE COST REPORT IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G THERARPY: PROGRAM SERVICE EXPENSES 1,638,963. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,638,963. NURSES: PROGRAM SERVICE EXPENSES 665,587. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 665,587. PURCHASED SEVICES: PROGRAM SERVICE EXPENSES 368,477. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 368,477. SECURITY: PROGRAM SERVICE EXPENSES 350,712. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 350,712. LAUNDRY: PROGRAM SERVICE EXPENSES 155,068. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 155,068. CONSULTANTS: PROGRAM SERVICE EXPENSES 67,672. MANAGEMENT AND GENERAL EXPENSES 20,914. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 88,586. LAB SERVICE: PROGRAM SERVICE EXPENSES 43,317. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,317. PAYROLL PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 35,756. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,756. RADIOLOGY: PROGRAM SERVICE EXPENSES 18,126. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,126. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF NORWEGIAN CHRISTIAN HOME FOUNDATION 923,108. CHANGE IN VALUE OF BENEFICIAL INTEREST IN TRUSTS 58,019. PENSION LIABILITY ADJUSTMENT 993,078. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. NORWEGIAN CHRISTIAN HOME FOUNDATION 1250 67TH STREET BROOKLYN NY 11219 743219871 FUNDRAISING NY 501(C)(3) LINE 12A, I NORWEGIAN CHRISTIAN HOME AND HEALTH CENTER 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0