2021-11-15T16:44:09-06:00 2020-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2020-01-01 131740301 PROVIDENCE REST PROV 7189313000 3304 WATERBURY AVENUE BRONX NY 10465 SR SELINE MARY FLORES CEO 7189313000 2021-11-15 1 SR SELINE MARY FLORES 999009999 GARRETT M HIGGINS P00543209 9143818900 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SR SELINE MARY FLORES 3304 WATERBURY AVENUE BRONX NY 10465 41288296 0 0928 X WWW.PROVIDENCEREST.ORG X 1956 NY TO RENDER INPATIENT MEDICAL CARE TO THE AGED. 19 19 301 19 0 0 1274456 2250841 27220750 22545205 749675 2128273 327717 312241 29572598 27236560 0 0 0 0 18058590 16985174 27000 0 82156 14248067 13974138 32333657 30959312 -2761059 -3722752 45049358 42104175 27423710 28880049 17625648 13224126 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 26521074 22474010 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 470 ADMISSIONS TO PROVIDENCE REST IN 2020, DISCHARGED 132 RESIDENTS BACK TO THEIR HOMES. WE RENDERED 54,556 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. 6466 71195 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 2 PATIENT VISITS DURING 2020. 26527540 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 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 0 1 0 0 0 1 27 0 301 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 19 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X ANNMARIE COVONE 7189313000 3304 WATERBURY AVENUE BRONX NY 10465 SR CLAUDETTE JASZCYNSKI CSJB PRESIDENT 1.00 1.00 X X 0 0 0 CHRISTOPHER D'ANGELO VICE-CHAIR 1.00 X X 0 0 0 JOHN A DECINA CHAIRMAN 1.00 X X 0 0 0 JOSEPH SAPORITO TREASURER 1.00 X X 0 0 0 SR THERESA D'ONOFRIO CSJB SECRETARY 1.00 0.10 X X 0 0 0 SR SELINE MARY FLORES CSJB DIRECTOR/CEO 35.00 0.10 X X 0 0 0 DR ANNE M CASEY DIRECTOR 1.00 X 0 0 0 REV ERIC P CRUZ DIRECTOR 1.00 X 0 0 0 DENISE L DEMARZO DIRECTOR 1.00 X 0 0 0 SR MARY MARGARET DULSKY CSJB DIRECTOR 1.00 1.00 X 0 0 0 SR LORETTA MARIE FLORIO CSJB DIRECTOR 1.00 X 0 0 0 JACK GLEASON DIRECTOR 1.00 X 0 0 0 JOSEPH J GUARRACINO DIRECTOR 1.00 X 0 0 0 SR ELSA JERONIMO CSJB DIRECTOR 1.00 X 0 0 0 ROBERT F MARIANI JR DIRECTOR 1.00 X 0 0 0 CAMILLE MILEA DIRECTOR 1.00 X 0 0 0 FRANK S PATERNO DIRECTOR 1.00 X 0 0 0 JOSEPH SCIAME DIRECTOR 1.00 X 0 0 0 SR MICHELLE SINNONA CSJB DIRECTOR/PURCHASING DIRECTOR 35.00 X 0 0 0 RICHARD J LOHNE EXECUTIVE DIRECTOR 35.00 X 275849 0 21402 VENETIA UY MDS MANAGER 35.00 X 124056 0 32498 ERNESTO S ANTONINO DIRECTOR OF NURSING 35.00 X 167285 0 33668 JULIET GORDONCILLO RN SUPERVISOR 35.00 X 111513 0 21833 YAKOV KATSNELSON DIRECTOR OF PLANT MAINTENANCE 35.00 X 107496 0 21833 KIM A D'AMICO NURSE COORDINATOR 35.00 X 114844 0 32498 901043 0 163732 7 0 1 0 SELECT REHABILITATION PO BOX 674102 DALLAS TX 75267 REHAB SERVICES 1414565 MORRISON MANAGEMENT SPECIALIST 100 SOUTHCREST DRIVE STOCKBRIDGE GA 30281 NUTRITION MGMT SERVICES 1344094 CATHOLIC HEALTH CARE SYSTEM 205 LEXINGTON AVE 2ND FLR NEW YORK NY 10012 ADMINISTRATIVE SERVICES 418843 RN EXPRESS STAFFING 71 WEST 23RD ST SUITE 1622 NEW YORK NY 10010 STAFFING SERVICES 267468 UNITEX TEXTILE RENTAL SERVICES 401 SOUTH MAXQUESTEN PARKWAY MOUNT VERNON NY 10550 LAUNDRY SERVICES 169742 7 25000 1488689 737152 2250841 MEDICAID REVENUE 623000 11143483 11143483 MEDICARE REVENUE 623000 5818068 5818068 PRIVATE PAY AND OTHER 623000 4454916 4454916 OTHER PATIENT REVENUE 623000 1128738 1128738 22545205 310025 310025 258133 0 258133 258133 258133 15865155 14046907 1818248 1818248 1818248 27358 4829 22529 22529 INTEREST ON PAST DUE ACCTS 900099 12484 12484 CABLE/PHONE CHARGES 900099 6902 6902 PURCHASE DISCOUNTS 900099 6734 6734 5459 5459 31579 27236560 22545205 0 2440514 X 317155 317155 10770441 10323883 446558 1415456 1326040 89416 2925876 2761095 164781 1556246 1457936 98310 500000 500000 282363 282363 88125 88125 6021 6021 58900 58900 5546355 4393938 1152417 15170 15170 631942 469090 80696 82156 175768 175768 1360730 1274095 86635 437 417 20 3021378 3021378 473531 473531 NY CASH RECEIPT ASSMNT 956000 956000 BAD DEBT EXPENSE 287401 287401 MEDICATIONS 254553 254553 REPAIRS & MAINTENANCE 152799 152799 162665 136316 26349 30959312 26527540 4349616 82156 1202690 662451 5931247 6543553 3321273 2796643 71632 142886 380470 270700 65281408 48205863 19945905 17075545 12076996 13166518 2119145 1445879 45049358 42104175 3573820 4605100 822153 0 19587042 18620223 158127 267242 3282568 5387484 27423710 28880049 X 17625648 13224126 17625648 13224126 45049358 42104175 X -3722752 -475170 -203600 X X 0 1 X 1 0 X 300200 354002 353407 1274456 2204677 4486742 31677208 28834800 27405705 27244362 22545205 137707280 31977408 29188802 27759112 28518818 24749882 142194022 18572 21133 22513 19373 9070 90661 0 18572 21133 22513 19373 9070 90661 142103361 519383 348424 585284 594055 568158 2615304 519383 348424 585284 594055 568158 2615304 9747 9747 36094 47212 50992 53982 58937 247217 32542632 29584438 28395388 29166855 25376977 145066290 0.97960 0.98210 0.01800 0.01550 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2018 AMOUNT: $ 1,386. 2019 AMOUNT: $ 4,060. CABLE / PHONE CHARGES - 2016 AMOUNT: $ 8,378. 2017 AMOUNT: $ 8,592. 2018 AMOUNT: $ 10,039. 2019 AMOUNT: $ 8,079. 2020 AMOUNT: $ 6,902. PURCHASE DISCOUNTS - 2016 AMOUNT: $ 22,157. 2017 AMOUNT: $ 23,067. 2018 AMOUNT: $ 29,959. 2019 AMOUNT: $ 26,929. 2020 AMOUNT: $ 6,734. INTEREST ON PAST DUE ACCOUNTS - 2016 AMOUNT: $ 3,965. 2017 AMOUNT: $ 934. 2018 AMOUNT: $ 7,174. 2019 AMOUNT: $ 11,102. 2020 AMOUNT: $ 12,484. MEDICAL RECORD ABSTRACTS - 2016 AMOUNT: $ 1,594. 2017 AMOUNT: $ 6,966. 2018 AMOUNT: $ 2,434. 2019 AMOUNT: $ 3,612. 2020 AMOUNT: $ 2,213. 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. COFFEE SHOP - 2020 AMOUNT: $ 20,321. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6021 6021 0 PART II-B, LINE 1: COSTS ARE INCURRED AS PART OF DUES PAID TO NURSING HOME INDUSTRY ORGANIZATIONS. 0 1 X 2525290 2525290 58326055 44545787 13780268 52275 52275 0 4377788 3607801 769987 17075545 DUE TO THIRD PARTY PAYORS 745984 ACCRUED PENSION OBLIGATION 1285420 PROFESSIONAL LIABILITIES 831000 DUE TO RELATED PARTY 2980 PAYCHECK PROTECTION PROGRAM LOAN 2522100 5387484 X 26291598 -475170 4829 -470341 26761939 58900 415721 474621 27236560 30489520 4829 4829 30484691 58900 415721 474621 30959312 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, 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B 4,829. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24 287,401. RECLASS OF FUNDRAISING EXPENSE TO PART IX 82,156. RECLASS FFCRA CREDIT TO PART VIII, LINE 13 46,164. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B 4,829. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24 287,401. RECLASS OF FUNDRAISING EXPENSE TO PART IX 82,156. RECLASS FFCRA CREDIT TO PART VIII, LINE 13 46,164. 0 0 0 0 0 0 0 1 0 RICHARD J LOHNE EXECUTIVE DIRECTOR 250449 0 25400 0 0 0 0 0 21402 0 297251 0 0 0 ERNESTO S ANTONINO DIRECTOR OF NURSING 161885 0 5400 0 0 0 0 0 33668 0 200953 0 0 0 VENETIA UY MDS MANAGER 123656 0 400 0 0 0 10450 0 22048 0 156554 0 0 0 PART I, LINE 7 RICHARD J. LOHNE, ERNESTO S. ANTONINO, KIM A. D'AMICO, AND VENETIA UY BONUS IS BASED ON THEIR PERFORMANCE AND IS DETERMINED AND APPROVED BY THE GOVERNANCE AND COMPENSATION COMMITTEE OF THE BOARD. THE TAXABLE BONUSES WERE REPORTED IN BOX 5 OF THEIR 2020 W-2. 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 12660000 42107501 165250 42106567 2009 0 0 1 1 B 3732203 22821500 3908329 400862 18512309 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. CATHOLIC HEALTH CARE SYSTEM WAS PAID $500,000 IN 2020 FOR THESE SERVICES. SCOTT LA RUE, BOARD MEMBER, IS AN EMPLOYEE OF CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. IN 2020, HE RECEIVED A W-2 IN THE AMOUNT OF $1,406,730, RETIREMENT AND OTHER DEFERRED COMPENSATION, AND NON-TAXABLE BENEFITS OF $343,704. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION SHALL BE THE PROVINCIAL OF THE SPONSOR ("THE PROVINCIAL"), THE PROVINCIAL COUNCIL OF THE SPONSOR, AND THE PROVINCIAL TREASURER OF THE SPONSOR. EACH MEMBER OF THE CORPORATION MUST BE A MEMBER IN GOOD STANDING OF THE CONGREGATION OF SISTERS OF ST. JOHN THE BAPTIST (THE SPONSOR). FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE CORPORATION SHALL HAVE THE SOLE AND EXCLUSIVE AUTHORITY FOR THE ELECTION AND REMOVAL WITH OR WITHOUT CAUSE OF THE BOARD OF DIRECTORS OR ANY INDIVIDUAL DIRECTOR OF THE CORPORATION. THE BOARD OF DIRECTORS SHALL HAVE THE AUTHORITY TO REMOVE A DIRECTOR FOR CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS OF THE CORPORATION SHALL HAVE THE SOLE AND EXCLUSIVE AUTHORITY WITH REGARD TO THE FOLLOWING ACTIONS: (A) AMENDMENT OR REVISION OF THE NAME OR MISSION OF THE CORPORATION (B) ELECTION AND REMOVAL WITH OR WITHOUT CAUSE OF THE BOARD OF DIRECTORS OR ANY INDIVIDUAL DIRECTOR OF THE CORPORATION. THE BOARD OF DIRECTORS SHALL HAVE THE AUTHORITY TO REMOVE A DIRECTOR FOR CAUSE. (C) AMENDMENT OF THE CERTIFICATE OF INCORPORATION OF THE CORPORATION (D) ADOPTION, AMENDMENT AND REPEAL OF THE BY-LAWS OF THE CORPORATION (E) APPROVAL OF A STRATEGIC PLAN FOR THE OPERATIONS AND PROGRAMS OF THE CORPORATION AND APPROVAL OF ANY ACTIVITY OUTSIDE THE SCOPE OF SUCH STRATEGIC PLAN IN CONSULTATION WITH THE BOARD OF DIRECTORS OF THE CORPORATION (F) APPROVAL OF ANY CHANGES TO THE ANNUAL OPERATING AND / OR CAPITAL BUDGETS PROPOSED BY THE BOARD OF DIRECTORS TO THE EXTENT THAT THE SAME ARE INCONSISTENT WITH THE MISSION AND PHILOSOPHY OF THE CORPORATION. (G) APPROVAL, AUTHORIZATION AND/OR INDUCEMENT OF ANY SALE, ASSIGNMENT, TRANSFER, EXCHANGE, ENCUMBRANCE, MORTGAGE, INSURANCE OR GUARANTY OF ANY INDEBTEDNESS, OR CREATION OF ANY OTHER LIENS ON ANY ASSETS OF THE CORPORATION OUTSIDE THE ORDINARY COURSE OF BUSINESS OR IN EXCESS OF THE THRESHOLDS ESTABLISHED FROM TIME TO TIME FOR ALIENATION OF ECCLESIASTICAL GOODS IN ACCORDANCE WITH CANON LAW OF THE ROMAN CATHOLIC CHURCH (H) APPROVAL, AUTHORIZATION AND/OR INDUCEMENT OF THE DISSOLUTION, LIQUIDATION, MERGER OR CONSOLIDATION OF THE CORPORATION. (I) THE APPOINTMENT AND DISMISSAL OF THE ADMINISTRATOR/CEO OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS INCLUDES THE FOLLOWING: 1) ONCE THE FORM 990 IS COMPLETED AND READY TO BE FILED IT WILL BE ELECTRONICALLY SENT TO MANAGEMENT FOR REVIEW. 2) ONCE APPROVED BY MANAGEMENT, IT IS EMAILED TO THE BOARD OF DIRECTORS. ANY QUESTIONS OR CONCERNS WILL BE DIRECTED TO MANAGEMENT. 3) NO LATER THAN THREE (3) DAYS PRIOR TO THE FILING DATE, THE BOARD WILL MEET TO DOCUMENT AND FORMALIZE THEIR PARTICIPATION IN THE REVIEW PROCESS. ONCE THE FORM 990 HAS BEEN APPROVED BY THE BOARD, IT WILL BE FILED WITH THE INTERNAL REVENUE SERVICE. 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 15A THE GOVERNANCE AND COMPENSATION COMMITTEE OF THE BOARD WILL OBTAIN RESEARCH AND INFORMATION TO MAKE A RECOMMENDATION TO THE FULL BOARD FOR THE COMPENSATION (SALARY AND BENEFITS) OF THE EXECUTIVE OFFICERS OF PROVIDENCE REST BASED ON A REVIEW OF COMPARABILITY DATA. THE HUMAN RESOURCES DIRECTOR WILL ASSIST THE BOARD IN OBTAINING SUCH INFORMATION. THIS INCLUDES SECURING DATA THAT DOCUMENTS COMPENSATION LEVELS AND BENEFITS FOR SIMILARLY QUALIFIED INDIVIDUALS IN COMPARABLE POSITIONS AT SIMILAR ORGANIZATIONS. THIS DATA MAY INCLUDE THE FOLLOWING: 1. SALARY AND BENEFIT COMPENSATION STUDIES BY INDEPENDENT SOURCES; 2. WRITTEN JOB OFFERS FOR POSITIONS AT SIMILAR ORGANIZATIONS; 3. DOCUMENTED TELEPHONE CALLS ABOUT SIMILAR POSITIONS AT BOTH NONPROFIT AND FOR-PROFIT ORGANIZATIONS; AND 4. INFORMATION OBTAINED FROM THE IRS FORM 990 FILINGS OF SIMILAR ORGANIZATIONS. TO APPROVE THE COMPENSATION FOR THE CEO, ADMINISTRATOR AND OTHER HIGHLY COMPENSATED EMPLOYEES, THE BOARD DOCUMENTS HOW IT MADE ITS DECISIONS, INCLUDING THE DATA ON WHICH IT RELIED, IN MINUTES OF THE MEETING DURING WHICH THE COMPENSATION WAS APPROVED. DOCUMENTATION INCLUDES: 1. A DESCRIPTION OF THE PACKAGE AND THE DATE IT WAS APPROVED; 2. THE MEMBERS OF THE BOARD WHO WERE PRESENT DURING THE DISCUSSION ABOUT COMPENSATION AND BENEFITS; AND THE RESULTS OF THE VOTE; 3. A DESCRIPTION OF THE COMPARABILITY DATA RELIED UPON AND HOW THE DATA WAS OBTAINED; AND 4. ANY ACTIONS TAKEN (SUCH AS ABSTAINING FROM DISCUSSION AND VOTE) WITH RESPECT TO CONSIDERATION OF THE COMPENSATION BY ANYONE WHO IS OTHERWISE A MEMBER OF THE BOARD BUT WHO HAD A CONFLICT OF INTEREST WITH RESPECT TO THE DECISION ON THE COMPENSATION AND BENEFITS. 5. WRITTEN PERFORMANCE REVIEWS OF EXECUTIVES. THE CHAIRMAN OF THE BOARD'S GOVERNANCE AND COMPENSATION COMMITTEE, WHO IS A VOLUNTEER AND NOT COMPENSATED BY PROVIDENCE REST, WILL OPERATE INDEPENDENTLY WITHOUT UNDUE INFLUENCE FROM THE CHIEF EXECUTIVE OFFICER OR ADMINISTRATOR. NO MEMBER OF THE GOVERNANCE AND COMPENSATION COMMITTEE WILL BE A STAFF MEMBER, THE RELATIVE OF A STAFF MEMBER, OR HAVE ANY RELATIONSHIP WITH STAFF THAT COULD PRESENT A CONFLICT OF INTEREST. THE ADMINISTRATOR AND CEO'S SALARIES WERE REVIEWED/RECALIBRATED IN MARCH 2018 IN ACCORDANCE WITH THE POLICY WHEN WE CHANGED MANAGEMENT STRUCTURE. COMPENSATION PAID TO THE CEO AND DIRECTOR OF PURCHASING: PLEASE NOTE THAT BOTH THE CEO AND DIRECTOR OF PURCHASING AS RELIGIOUS MEMBERS OF THE CONGREGATION OF SISTERS OF ST. JOHN THE BAPTIST HAVE TAKEN A VOW OF POVERTY AND ARE PROVIDED WITH ZERO (0) COMPENSATION FROM THE HOME. ALL COMPENSATION THAT WOULD HAVE BEEN PAID TO THE CEO, DIRECTOR OF PURCHASING OR ANY OTHER SISTER WORKING WITHIN THE HOME ON BEHALF OF SERVICES PROVIDED TO THE HOME IS INSTEAD PAID TO THE SISTERS OF ST. JOHN THE BAPTIST, INC. (THE ORDER), RATHER THAN THE INDIVIDUALS. FOR 2020, THE HOME PAID THE ORDER AN AMOUNT OF $290,253 FOR SERVICES THE CEO AND DIRECTOR OF PURCHASING PROVIDED TO THE HOME. TOTAL PAYMENTS IN 2020 TO THE ORDER FROM THE HOME FOR SERVICES PROVIDED BY ALL THE SISTERS WORKING WITHIN THE HOME AMOUNTED TO $543,359 FOR SALARIES, $171,749 FOR PENSION, AND $117,130 FOR BENEFITS. 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 25,780. MANAGEMENT AND GENERAL EXPENSES 963,973. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 989,753. DASNY FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,731. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,731. EMPLOYMENT AGENCY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 32,713. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,713. ENGINEERING: PROGRAM SERVICE EXPENSES 258,769. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 258,769. FOOD SERVICES: PROGRAM SERVICE EXPENSES 1,325,492. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,325,492. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 200,452. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 200,452. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 103,125. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 103,125. LABORATORY/RADIOLOGY: PROGRAM SERVICE EXPENSES 92,745. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,745. RN, LPN, CAN: PROGRAM SERVICE EXPENSES 578,547. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 578,547. SECURITY: PROGRAM SERVICE EXPENSES 19,081. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,081. THERAPISTS & NON PHYS.: PROGRAM SERVICE EXPENSES 1,543,665. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,543,665. PASTORAL CARE: PROGRAM SERVICE EXPENSES 246,282. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 246,282. FORM 990, PART XI, LINE 9: EFFECT OF PENSION LIABILITY ADJUSTMENT -203,600. 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. SISTERS OF ST JOHN THE BAPTIST INC 3308 CAMPBELL DRIVE BRONX NY 10465 136131396 RELIGIOUS INSTITUTION NY 501(C)3 LINE 1 N/A 0 PROVIDENCE REST CHILD DAY CARE CENTER INC 3310 CAMPBELL AVENUE BRONX NY 10465 133614259 CHILD DAY CARE SERVICES NY 501(C)3 LINE 10 SISTERS OF ST JOHN THE BAPTIST INC 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0