2020-11-16T09:38:10-06:00 2019-12-31 271728945 PKF O'CONNOR DAVIES LLP 300 TICE BOULEVARD SUITE 315 WOODCLIFF LAKE NJ 07677 990 2019-01-01 320041186 VALLEY PHYSICIAN SERVICES INC VALL 2014478000 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 JAMES BUTLER PRESIDENT 2014478000 2020-11-10 1 EDWARD G O'CONNOR P00434443 2017129800 2020-11-10 47.19.39.42 2020-11-10 09:10:12 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F2FB08A8147ED42291C73DE8B4A1AFBF9D3B6C53 2019 2021-01-29 14:40:06Z JAMES BUTLER 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 105504698 0 X WWW.VALLEYHEALTH.COM X 2002 NJ ON 1/1/17, VALLEY PHYSICIAN SERVICES, INC. ASSIGNED THEIR NEW JERSEY PHYSICIAN CONTRACTS TO VALLEY PHYSICIAN SERVICES, P.C. WHICH IS ONE OF THE CAPTIVE CORPORATIONS OF VALLEY PHYSICIAN SERVICES, INC. WHOSE SOLE MEMBER IS THE VALLEY HOSPITAL, INC. EFFECTIVE WITH THE ASSIGNMENT OF THESE CONTRACTS, VALLEY PHYSICIAN SERVICES, INC. BECAME A MANAGEMENT SERVICES CORPORATION PROVIDING SERVICES TO THE PROFESSIONAL CORPORATIONS. 17 15 915 32 0 0 83166226 103278008 14924941 2212620 0 0 77063 14070 98168230 105504698 0 336444 0 0 54178178 55261963 0 0 0 43500399 49986285 97678577 105584692 489653 -79994 36799073 105683909 10768560 79653396 26030513 26030513 TO PROVIDE MANAGEMENT SERVICES TO THE FOLLOWING PROFESSIONAL CORPORATIONS: VALLEY PHYSICIAN SERVICES, P.C., VALLEY MEDICAL SERVICES, P.C. , AND VALLEY PHYSICIAN SERVICES, NY, P.C. 0 0 82145598 336444 2212620 ON 1/1/17, VALLEY PHYSICIAN SERVICES, INC. ASSIGNED THEIR NEW JERSEY PHYSICIAN CONTRACTS TO VALLEY PHYSICIAN SERVICES, P.C. WHICH IS ONE OF THE CAPTIVE CORPORATIONS OF VALLEY PHYSICIAN SERVICES, INC. WHOSE SOLE MEMBER IS THE VALLEY HOSPITAL, INC. EFFECTIVE WITH THE ASSIGNMENT OF THESE CONTRACTS, VALLEY PHYSICIAN SERVICES, INC. BECAME A MANAGEMENT SERVICES CORPORATION PROVIDING SERVICES TO THE PROFESSIONAL CORPORATIONS VALLEY PHYSICIAN SERVICES, P.C., VALLEY MEDICAL SERVICES, P.C. AND VALLEY MEDICAL SERVICES NY, P.C. 82145598 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 106 0 915 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 15 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 NJ X MARIETTA STONE 2012916391 15 ESSEX ROAD PARAMUS NJ 07652 AUDREY MEYERS EX-OFFICIO TRUSTEE 0.50 40.00 X 0 1710491 43337 SUNEET MITTAL MD TRUSTEE 0.50 40.00 X 0 1119843 42849 MARC R GOLDSTEIN PRES. VALLEY MEDICAL THRU 8/15/19 40.00 X 939119 0 25207 TIMOTHY WILLOX VP, VALLEY MEDICAL 40.00 X 422354 0 13021 JEAN FLANAGAN CHIEF OPERATING OFFICER 40.00 X 331222 0 37825 JOSEPH JEROME DIRECTOR OF FINANCE, VMG 40.00 X 210347 0 16242 MARYANN KEPPLE CFO, THRU 03/29/19 40.00 X 187998 0 3137 MARY AIOSA DIRECTOR CLINICAL SERVICES 40.00 X 142836 0 28143 EDWINA ANTONIO RN 40.00 X 148500 0 17780 CAROL PERSLEY MANAGER REGIONAL SPECIALTY 40.00 X 143797 0 15375 JOSHUA GREGOIRE MANAGER, QUALITY 40.00 X 142605 0 10415 LAURIE C DEBENEDETTO BOARD SECRETARY 0.50 40.00 X 0 98437 15921 VINCENT FORLENZA CHAIRMAN 0.50 X X 0 0 0 FRANK J SHEEHY VICE CHAIRMAN 0.50 0.50 X X 0 0 0 RIMA KOPELMAN MD VICE CHAIRMAN, THRU 6/30/19 0.50 X X 0 0 0 MARIA SCIBETTA MD VICE CHAIRMAN, THRU 6/30/19 0.50 X X 0 0 0 STEVEN SILVERSTEIN SECRETARY/ TREASURER, THRU 6/30/19 0.50 X X 0 0 0 EDWARD B SELF MD TREAS. THRU 6/30/19, TRUSTEE 0.50 X X 0 0 0 JOSEPH MARION TREASURER 0.50 X X 0 0 0 ANN LIMBERG SECRETARY 0.50 X X 0 0 0 WARREN F COOKE ESQ TRUSTEE, THRU 6/30/19 0.50 X 0 0 0 THOMAS RAKOWSKI MD TRUSTEE, THRU 6/30/19 0.50 X 0 0 0 ELLIOTT S LICHTSTEIN MD TRUSTEE, THRU 6/30/19 0.50 X 0 0 0 BRUCE MACTAS TRUSTEE 0.50 4.00 X 0 0 0 SCOTT SCHROEDER TRUSTEE 0.50 0.50 X 0 0 0 JUDY BASELICE TRUSTEE 0.50 X 0 0 0 MICHELLE HASSON TRUSTEE 0.50 X 0 0 0 KEVIN LOBO TRUSTEE 0.50 X 0 0 0 STEVEN SILVERSTEIN TRUSTEE 0.50 X 0 0 0 PATRICIA VERDUIN TRUSTEE 0.50 X 0 0 0 WAYNE WALD ESQ TRUSTEE 0.50 X 0 0 0 BARNETT RUKIN TRUSTEE, THRU 12/18/19 0.50 X 0 0 0 DUANE SACHS TRUSTEE 0.50 X 0 0 0 DENIS SALAMONE TRUSTEE 0.50 X 0 0 0 JEFFREY TUCKER TRUSTEE 0.50 X 0 0 0 2668778 2928771 269252 32 0 1 0 MERRITT HAWKINS & ASSOCIATES 12400 HIGH BLUFF DR SAN DIEGO CA 92130 STAFFING SERVICE 509574 SHI INTERNATIONAL CORP PO BOX 952121 DALLAS TX 753952121 COMPUTER SERVICE 363934 OPTUM THE ADVISORY BOARD COMPANY PO BOX 8 CHICAGO IL 606894002 CONSULTING SERVICE 273736 PRESS GANEY ASSOCIATES INC PO BOX 88335 MILWAUKEE WI 532880335 CONSULTING SERVICE 256311 SOERRIES CODING & BILLING INSTITUTE INC 1412 SW EAGLES PKY GRAIN VALLEY MO 64029 EDUCATIONAL SERVICES 156100 27 103278008 103278008 MANAGEMENT FEE REVENUE 900099 1167401 1167401 NET PATIENT SERVICE REVENUE 624100 1045219 1045219 2212620 OTHER INCOME 624100 14070 14070 14070 105504698 2212620 0 14070 336444 336444 2186472 1701750 484722 39966265 31075045 8891220 1267513 1068093 199420 8472622 6620888 1851734 3369091 2844654 524437 4285 4285 68250 21950 46300 10136360 900589 9235771 10481 9598 883 1730504 1534408 196096 747327 544786 202541 14258965 13590168 668797 42807 31925 10882 41954 6729 35225 7041016 6128557 912459 243916 243916 CLINICAL SUPPLIES 14438102 14438102 TEMPORARY HELP 393668 393668 UNIFORMS, LAUNDRY AND L 334039 330302 3737 LICENSES AND DUES 133745 91409 42336 360866 228332 132534 105584692 82145598 23439094 0 1215760 813499 309600 78224 107639 80317 196998 249107 54980386 28156028 26301009 26824358 2354871 1519989 6313196 76118415 36799073 105683909 8117432 6015520 630787 2020341 73637876 10768560 79653396 X 26030513 26030513 26030513 26030513 36799073 105683909 X -79994 79994 X X 0 1 X 1 0 X 83166226 103278008 186444234 74820953 106491173 2933230 14924941 2212620 201382917 74820953 106491173 2933230 98091167 105490628 387827151 0 0 0 387827151 524 524 524 524 12162180 16624506 149039 77063 14070 29026858 86983133 123116203 3082269 98168230 105504698 416854533 0.93040 0.89690 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: INCOME FROM VALLEY HOSPITAL - 2015 AMOUNT: $ 11,347,905. 2016 AMOUNT: $ 16,143,605. 2017 AMOUNT: $ 130,326. OTHER INCOME - 2015 AMOUNT: $ 814,275. 2016 AMOUNT: $ 480,901. 2017 AMOUNT: $ 18,713. 2018 AMOUNT: $ 77,063. 2019 AMOUNT: $ 14,070. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32293506 16700392 15593114 22151733 11455636 10696097 535147 535147 26824358 SECURITY DEPOSITS 282077 ASSETS HELD BY RELATED ORGANIZATION 4851537 ROU ASSET - REAL ESTATE 70984801 76118415 DUE TO AFFILIATES 287088 ESTIMATED THIRD-PARTY PAYER SETTLEMENT 1390920 LEASE LIABILITY 71959868 73637876 X 170314829 64812685 64812685 105502144 2554 2554 105504698 249080129 143495437 143495437 105584692 0 105584692 PART X, LINE 2: THE COMPANY RECOGNIZES THE BENEFIT FROM INCOME TAX POSITIONS TAKEN IN ITS INCOME TAX RETURNS ONLY WHEN THOSE POSITIONS ARE BELIEVED TO BE MORE LIKELY THAN NOT TO BE SUSTAINED UPON REVIEW BY THE TAX AUTHORITIES. VMG PROVIDES VALUATION ALLOWANCES FOR NET DEFERRED TAX ASSETS WHEN THE REALIZATION OF THE DEFERRED TAX ASSET IS UNCERTAIN. MANAGEMENT HAS DETERMINED THAT VMG HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE ENTITIES INCLUDED IN VMG ARE NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO THE 2016 TAX YEAR. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE ATTRIBUTABLE TO OTHER ENTITIES 64,812,685. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT RECOVERY INCLUDED IN REVENUE 2,554. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES ATTRIBUTABLE TO OTHER ENTITIES 143,492,883. BAD DEBT RECOVERY NETTED AGAINST EXPENSES 2,554. 0 VALLEY PHYSICIAN SERVICES PC 15 ESSEX ROAD PARAMUS NJ 07652 465285330 501(C)(3) 318156 STRATEGIC FUNDING VALLEY PHYSICIAN SERVICES NY PC 15 ESSEX ROAD PARAMUS NJ 07652 453125678 501(C)(3) 17588 STRATEGIC FUNDING 2 1 0 1 0 0 0 0 0 1 0 AUDREY MEYERS EX-OFFICIO TRUSTEE 0 1066752 0 551670 0 92069 0 20825 0 22512 0 1753828 0 0 SUNEET MITTAL MD TRUSTEE 0 979155 0 138066 0 2622 0 9800 0 33049 0 1162692 0 0 MARC R GOLDSTEIN PRES. VALLEY MEDICAL THRU 8/15/19 383002 0 134650 0 421467 0 9800 0 15407 0 964326 0 325606 0 TIMOTHY WILLOX VP, VALLEY MEDICAL 347331 0 20000 0 55023 0 0 0 13021 0 435375 0 0 0 JEAN FLANAGAN CHIEF OPERATING OFFICER 251345 0 37250 0 42627 0 9019 0 28806 0 369047 0 0 0 JOSEPH JEROME DIRECTOR OF FINANCE, VMG 183026 0 25000 0 2321 0 0 0 16242 0 226589 0 0 0 MARYANN KEPPLE CFO, THRU 03/29/19 132937 0 53816 0 1245 0 2827 0 310 0 191135 0 0 0 MARY AIOSA DIRECTOR CLINICAL SERVICES 128563 0 12500 0 1773 0 5228 0 22915 0 170979 0 0 0 EDWINA ANTONIO RN 144730 0 3770 0 0 0 7520 0 10260 0 166280 0 0 0 CAROL PERSLEY MANAGER REGIONAL SPECIALTY 133550 0 8478 0 1769 0 5076 0 10299 0 159172 0 0 0 JOSHUA GREGOIRE MANAGER, QUALITY 133721 0 8615 0 269 0 5165 0 5250 0 153020 0 0 0 PART I, LINE 4B MARC GOLDSTEIN RECEIVED A $325,606 DISTRIBUTION FROM A 457(F) PLAN. PART I, LINE 7 THE FOLLOWING EMPLOYEES RECEIVED A BOARD DISCRETIONARY BONUS IN THEIR 2019 W-2 FROM THE ORGANIZATION: 1. MARC R. GOLDSTEIN, $134,650 2. TIMOTHY WILLOX, $20,000 3. JEAN FLANAGAN, $37,250 4. JOSEPH JEROME, $25,000 5. MARYANN KEPPLE, $53,816 6. MARY AIOSA, $12,500 7. EDWINA ANTONIO, $3,770 8. CAROL PERSLEY, $8,478 9. JOSHUA GREGOIRE, $8,615 FORM 990, PART VI, SECTION A, LINE 4 ON 5/21/2019, VALLEY PHYSICIAN SERVICES, INC. (AS PART OF VALLEY MEDICAL GROUP) UPDATED AND ADOPTED NEW BYLAWS AND LEGAL DOCUMENTS TO IMPLEMENT FORMALLY THE BOARD'S INTEGRATION INTO A PARALLEL BOARD OF THE VALLEY HEALTH SYSTEM'S ("VHS") BOARD. THIS CHANGE TOOK EFFECT JULY 1, 2019. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A MEMBERSHIP CORPORATION. THE SOLE MEMBER OF THE ORGANIZATION SHALL BE THE PARENT, THE VALLEY HOSPITAL,INC. FORM 990, PART VI, SECTION A, LINE 7A THE PARENT BOARD SHALL HAVE THE RIGHT TO APPROVE THE SLATE OF NOMINEES FOR TRUSTEES AND/OR TO DETERMINE AND SUBMIT A SUBSTITUTE SLATE OF NOMINEES PURSUANT TO THE PROVISIONS OF SECTION 3.3 OF THE BY-LAWS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING GOVERNANCE DECISIONS ARE RESERVED AND/OR SUBJECT TO APPROVAL OF THE PARENT BOARD: 1) STRATEGIC ACTIONS 2) MAJOR CORPORATE DECISIONS 3) ANY SINGLE EXPENDITURE GREATER THAN FIVE PERCENT OF THE ANNUAL OPERATING BUDGET 4) SELECTION OF AUDITORS 5) APPOINTMENT AND REMOVAL OF THE CHIEF PHYSICIAN EXECUTIVE/CMO AND THE PRESIDENT OF THE GROUP 6) MAJOR CORPORATE DECISIONS REGARDING THE INCURRENCE OF DEBT IN EXCESS OF FIVE PERCENT OF THE OPERATING BUDGET FORM 990, PART VI, SECTION B, LINE 11B VPS 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 IS PREPARED, IT IS SUBMITTED TO THE DIRECTOR OF FINANCE AND FINANCE COMMITTEE FOR REVIEW. ANY COMMENTS ARE SUMMARIZED AND PROVIDED TO DIRECTOR OF FINANCE. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED BY THE FINANCE COMMITTEE FOR FILING WITH THE INTERNAL REVENUE SERVICE. BEFORE FILING, THE FORM 990 IS MADE AVAILABLE FOR THE BOARD'S REVIEW, BY HARD COPY AND OR ELECTRONIC COPY. FORM 990, PART VI, SECTION B, LINE 12C VALLEY PHYSICIAN SERVICES, INC. HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL OF THE MEMBERS OF MANAGEMENT AND BOARD MEMBERS. ANNUALLY, THE BOARD MANDATES THAT ALL MEMBERS OF MANAGEMENT AND THE GOVERNING BODY SIGN A CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST THAT MAY EXIST. LEGAL REVIEWS AND DETERMINES IF CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST EXISTS THE ORGANIZATION WILL NOTIFY MEMBERS OF MANAGEMENT OR THE GOVERNING BODY AND INVESTIGATE THE CONFLICT. IF IT IS DETERMINED THAT AN ACTUAL CONFLICT OF INTEREST EXISTS, THE MEMBERS OF MANAGEMENT OR THE GOVERNING BODY WILL BE NOTIFIED IMMEDIATELY AND WILL NOT BE ALLOWED TO VOTE OR BE PART OF ANY DECISIONS ABOUT SUCH TRANSACTIONS. THIS PROCESS IS DOCUMENTED IN THE MINUTES OF THE BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 15 VPS HAS ESTABLISHED A POLICY FOR COMPENSATION OF ITS OFFICERS AND TOP MANAGEMENT. THE POLICY MANDATES THAT COMPENSATION FOR ITS OFFICERS AND TOP MANAGEMENT, BE ANNUALLY REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES FREE OF ANY MEMBERS WITH CONFLICTS OF INTEREST RELATED THERETO. THE COMMITTEE DETERMINES THAT THE EXECUTIVES ARE BEING PAID AN APPROPRIATE LEVEL OF COMPENSATION BY USING COMPARATIVE DATA FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION DECISION ON THE AMOUNT OF COMPENSATION PAID AND TERM IS ADEQUATELY DOCUMENTED IN A CONTEMPORANEOUSLY WRITTEN FORMAT. THIS PROCESS WAS LAST UNDERTAKEN IN 2016. FORM 990, PART VI, SECTION C, LINE 19 VPS MAKES ITS FORM 990, FINANCIAL STATEMENTS, FORM 1023, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS AVAILABLE UPON WRITTEN REQUEST AT 223 NORTH VAN DIEN AVE, RIDGEWOOD, NJ 07450 OR BY CALLING THE ORGANIZATION DIRECTLY AT 201-447-8000. FORM 990, PART XI, LINE 9: CHANGE IN ASSETS HELD BY FOUNDATION 79,994. FORM 990, PART XI, LINE 2C THE AUDIT COMMITTEE IS RESPONSIBLE FOR SELECTING AN INDEPENDENT ACCOUNTANT AND FOR OVERSIGNT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE VALLEY HOSPITAL INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 221487307 PROVIDE HEALTHCARE PROGRAMS AND SERVICES TO ALL NJ 501(C)(3) LINE 3 VALLEY HEALTH SYSTEM INC 0 VALLEY HEALTH SYSTEM INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 222922016 PROVIDE MANAGEMENT AND PLANNING SERVICES FOR ITS MEMBERS NJ 501(C)(3) LINE 3 N/A 0 VALLEY HOME CARE INC 15 ESSEX ROAD PARAMUS NJ 07652 223208480 PROVIDE HOME CARE AND HOSPICE SERVICES TO RESIDENTS OF NORTHERN NJ NJ 501(C)(3) LINE 10 VALLEY HEALTH SYSTEM INC 0 THE VALLEY HOSPITAL FOUNDATION INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 222324554 SOLICITS, RECEIVES AND APPLIES CONTRIBUTIONS FOR THE BENEFIT OF THE HOSPITAL NJ 501(C)(3) LINE 7 VALLEY HEALTH SYSTEM INC 0 VALLEY PHYSICIAN SERVICE NY PC 15 ESSEX ROAD PARAMUS NJ 07450 453125678 OPERATES URGENT/PRIMARY CARE CLINICS NY 501(C)(3) LINE 10 VALLEY PHYSICIAN SERVICES INC 0 VHS INSURANCE COMPANY LTD 010 MAIN STREET CAYMAN ISLANDS CJ 980408200 PROVIDES PROFESSIONAL, MEDICAL AND COMMERCIAL GENERAL LIABILITY INSURANCE CJ VALLEY HEALTH SYSTEM INC C 0 VALLEY HEALTH MEDICAL GROUP INC 15 ESSEX ROAD PARAMUS NJ 07652 223475235 OPERATES URGENT/PRIMARY CARE CLINICS NJ VALLEY HEALTH SYSTEM INC C 0 VALLEY HEALTH MEDICAL GROUP NJPC 15 ESSEX ROAD PARAMUS NJ 07652 223475166 OPERATES URGENT/PRIMARY CARE CLINICS NJ N/A C 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1