2020-11-16T16:05:41-06:00 2019-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2019-01-01 131740301 PROVIDENCE REST PROV 7189313000 3304 WATERBURY AVENUE BRONX NY 10465 SR SELINE MARY FLORES CEO 7189313000 2020-11-16 1 GARRETT M HIGGINS P00543209 9143818900 2020-11-16 24.190.81.120 2020-11-16 16:05:36 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9616F4B14A694591D1E716C270910E6FA5556DA3 2019 2021-01-29 14:40:06Z SR SELINE MARY FLORES 3304 WATERBURY AVENUE BRONX NY 10465 36840906 0 0928 X WWW.PROVIDENCEREST.ORG X 1956 NY TO RENDER INPATIENT MEDICAL CARE TO THE AGED. 19 19 349 36 0 0 353407 1274456 27405705 27220750 688570 749675 330641 327717 28778323 29572598 0 0 0 0 16638745 18058590 34000 27000 91113 13654190 14248067 30326935 32333657 -1548612 -2761059 45339805 45049358 26315215 27423710 19024590 17625648 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 28409310 27163067 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 438 ADMISSIONS TO PROVIDENCE REST IN 2019, DISCHARGED 218 RESIDENTS BACK TO THEIR HOMES. WE RENDERED 69,372 DAYS OF RESIDENT CARE AND 96 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. 40538 57683 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 21 PATIENT VISITS DURING 2019. 28449848 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 349 1 0 0 0 0 0 1 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 DOMINIC DAMBROSIO ADMINISTRATOR THRU AUG. 2019 35.00 X 131089 0 18587 VENETIA UY MDS MANAGER 35.00 X 117202 0 21762 JULIO ROSARIO DIRECTOR OF ADMISSIONS 35.00 X 101829 0 31867 JULIET GORDONCILLO RN SUPERVISOR 35.00 X 102441 0 11399 YAKOV KATSNELSON DIRECTOR OF PLANT MAINTENANCE 35.00 X 101801 0 11353 COLLEEN D MARTIN RN SUPERVISOR 35.00 X 100740 0 0 RICHARD LOHNE DIRECTOR 35.00 X 56538 0 7102 SR CLAUDETTE JASZCYNSKI CSJB PRESIDENT 1.00 X X 0 0 0 MR CHRISTOPHER D'ANGELO VICE-CHAIR 1.00 X X 0 0 0 MR JOHN A DECINA CHAIRMAN 1.00 X X 0 0 0 MR JOSEPH SAPORITO TREASURER 1.00 X X 0 0 0 SR THERESA D'ONOFRIO CSJB SECRETARY 1.00 1.00 X X 0 0 0 SR SELINE MARY FLORES DIRECTOR/CEO 35.00 1.00 X X 0 0 0 DR ANNE M CASEY DIRECTOR 1.00 X 0 0 0 MR JACK GLEASON DIRECTOR 1.00 X 0 0 0 MR JOSEPH SCIAME DIRECTOR 1.00 X 0 0 0 MRS CAMILLE MILEA DIRECTOR 1.00 X 0 0 0 MRS DENISE L DEMARZO DIRECTOR 1.00 X 0 0 0 SR MARY MARGARET DULSKY DIRECTOR 1.00 1.00 X 0 0 0 SR ELSA JERONIMO CSJB DIRECTOR 1.00 1.00 X 0 0 0 SR LORETTA MARIE FLORIO CSJB DIRECTOR 1.00 X 0 0 0 MR JOSEPH GUARRACINO DIRECTOR 1.00 X 0 0 0 MR ROBERT F MARIANI JR DIRECTOR 1.00 X 0 0 0 ERIC P CRUZ DIRECTOR 1.00 X 0 0 0 FRANK PATERNO DIRECTOR 1.00 X 0 0 0 SR MICHELLE SINNONA CSJB DIRECTOR/PURCHASING DIRECTOR 35.00 1.00 X 0 0 0 MR SCOTT LA RUE DIRECTOR THRU JANUARY 2019 1.00 X 0 0 0 711640 0 102070 6 0 0 0 SELECT REHABILITATION PO BOX 674102 DALLAS TX 75267 REHAB SERVICES 2077906 MORRISON MANAGEMENT SPECIALIST 100 SOUTHCREST DRIVE STOCKBRIDGE GA 30281 NUTRITION MGMT SERVICES 1142242 CATHOLIC HEALTH CARE SYSTEM 205 LEXINGTON AVE 2ND FLR NEW YORK NY 10012 ADMINISTRATIVE SERVICES 458333 PARISH PROPERTY MANAGEMENT 11 SEVENTH STREET PELHAM NY 10803 PROPERTY MANAGEMENT SERVICES 417807 UNITEX TEXTILE RENTAL SERVICES 401 SOUTH MAXQUESTEN PARKWAY MOUNT VERNON NY 10550 LAUNDRY SERVICES 202587 10 134135 1140321 1274456 MEDICAID REVENUE 623000 14573947 14573947 MEDICARE REVENUE 623000 7013123 7013123 PRIVATE PAY AND OTHER 623000 4669814 4669814 OTHER PATIENT REVENUE 623000 583736 583736 UNIVERSAL SETTLEMENT INCOME 623000 380130 380130 27220750 340415 340415 253640 0 253640 253640 253640 7594469 7185209 409260 409260 409260 17456 134135 53889 -36433 -36433 14126 608 13518 13518 71612 28602 43010 43010 PURCHASE DISCOUNTS 900099 26929 26929 INTEREST ON PAST DUE ACCTS 900099 11102 11102 CABLE/PHONE CHARGES 900099 8079 8079 7872 7872 53982 29572598 27220750 0 1077392 X 197401 197401 11534337 11131847 402490 1470674 1398535 72139 3357853 3217573 140280 1498325 1424830 73495 500000 500000 111022 111022 56252 56252 7093 7093 27000 27000 141768 141768 5316370 4825494 490876 28561 28561 662205 492368 105724 64113 184241 184241 1429238 642005 787233 16484 7667 8817 3014927 3014927 455231 455231 NYS CASH ASSESSMENTS 1277478 1277478 MEDICATIONS 334287 334287 BAD DEBT EXPENSE 273899 273899 MEDICAL SUPPLIES 192512 186894 5618 246499 222044 24455 32333657 28449848 3792696 91113 1720744 1202690 6774346 5931247 3189918 3321273 46171 71632 222155 380470 65130389 45184484 22157945 19945905 9935684 12076996 1292842 2119145 45339805 45049358 2709267 3573820 822153 20523022 19587042 204699 158127 2878227 3282568 26315215 27423710 X 19024590 17625648 19024590 17625648 45339805 45049358 X -2761059 1604873 -242756 X X 0 1 X 1 0 X 1964391 300200 354002 353407 1274456 4246456 30405073 31677208 28834800 27405705 27244362 145567148 32369464 31977408 29188802 27759112 28518818 149813604 21101 18572 21133 22513 19373 102692 0 21101 18572 21133 22513 19373 102692 149710912 321563 519383 348424 585284 594055 2368709 321563 519383 348424 585284 594055 2368709 6722 9747 16469 54285 36094 47212 50992 53982 242565 32752034 32542632 29584438 28395388 29166855 152441347 0.98210 0.98390 0.01550 0.01390 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2015 AMOUNT: $ 32,148. 2018 AMOUNT: $ 1,386. 2019 AMOUNT: $ 4,060. CABLE / PHONE CHARGES - 2015 AMOUNT: $ 8,020. 2016 AMOUNT: $ 8,378. 2017 AMOUNT: $ 8,592. 2018 AMOUNT: $ 10,039. 2019 AMOUNT: $ 8,079. PURCHASE DISCOUNTS - 2015 AMOUNT: $ 11,098. 2016 AMOUNT: $ 22,157. 2017 AMOUNT: $ 23,067. 2018 AMOUNT: $ 29,959. 2019 AMOUNT: $ 26,929. INTEREST ON PAST DUE ACCOUNTS - 2015 AMOUNT: $ 1,251. 2016 AMOUNT: $ 3,965. 2017 AMOUNT: $ 934. 2018 AMOUNT: $ 7,174. 2019 AMOUNT: $ 11,102. MEDICAL RECORD ABSTRACTS - 2015 AMOUNT: $ 1,768. 2016 AMOUNT: $ 1,594. 2017 AMOUNT: $ 6,966. 2018 AMOUNT: $ 2,434. 2019 AMOUNT: $ 3,612. MISCELLANEOUS - 2017 AMOUNT: $ 4,000. GIFT SHOP - 2017 AMOUNT: $ 3,653. REBATES - 2019 AMOUNT: $ 200. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7093 7093 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 41694961 16631094 52275 52275 0 4226769 3437248 789521 19945905 DUE TO THIRD PARTY PAYORS 1308004 ACCRUED PENSION OBLIGATION 980074 PROFESSIONAL LIABILITIES 993000 DUE TO RELATED PARTY 1490 3282568 X 30699293 1604873 28602 1633475 29065818 141768 365012 506780 29572598 31855479 28602 28602 31826877 141768 365012 506780 32333657 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, 2016. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B: 28,602. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24: 273,899. FUNDRAISING EXPENSE RECLASS REPORTED ON PART IX: 91,113. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B: 28,602. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24: 273,899. FUNDRAISING EXPENSE RECLASS REPORTED ON PART IX: 91,113. X X X X X X X 1 KEELYN MULVEY 51 FOREST AVE 140 OLD GREENWICH CT 06870 FUNDRAISING CONSULTANT 0 91602 27000 64602 91602 27000 64602 NY GALA 91602 84291 7311 16758 2200 8301 GOLF OUTING 59989 49844 10145 25985 645 151591 134135 17456 42743 2200 8946 53889 -36433 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 2016-12-29 22821500 REFINANCING ISSUE 0 0 0 A 11410000 42107501 934 42106567 2009 0 0 1 1 B 2731965 22821500 3891951 400862 16436219 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 2019 FOR THESE SERVICES. SCOTT LA RUE, BOARD MEMBER, IS AN EMPLOYEE OF CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. IN 2019, HE RECEIVED A W-2 IN THE AMOUNT OF $1,246,121, RETIREMENT AND OTHER DEFERRED COMPENSATION, AND NON-TAXABLE BENEFITS OF $338,444. 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) NO LATER THAN TWO (2) WEEKS PRIOR TO THE FILING DATE IT WILL BE 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 2019, THE HOME PAID THE ORDER AN AMOUNT OF $273,084 FOR SERVICES THE CEO AND DIRECTOR OF PURCHASING PROVIDED TO THE HOME. TOTAL PAYMENTS IN 2019 TO THE ORDER FROM THE HOME FOR SERVICES PROVIDED BY ALL THE SISTERS WORKING WITHIN THE HOME AMOUNTED TO $525,539 FOR SALARIES, $176,233 FOR PENSION, AND $99,750 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 31,763. MANAGEMENT AND GENERAL EXPENSES 308,690. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 340,453. DASNY FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,321. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,321. EMPLOYMENT AGENCY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 25,865. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,865. ENGINEERING: PROGRAM SERVICE EXPENSES 203,113. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 203,113. FOOD SERVICES: PROGRAM SERVICE EXPENSES 1,435,827. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,435,827. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 267,151. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 267,151. PHYSICAL THERAPISTS: PROGRAM SERVICE EXPENSES 12,741. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,741. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 93,750. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,750. LABORATORY/RADIOLOGY: PROGRAM SERVICE EXPENSES 86,960. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,960. RESPIRATORY THERAPIST: PROGRAM SERVICE EXPENSES 361. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 361. RN, LPN, CAN: PROGRAM SERVICE EXPENSES 499,642. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 499,642. SECURITY: PROGRAM SERVICE EXPENSES 14,037. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,037. THERAPISTS & NON PHYS.: PROGRAM SERVICE EXPENSES 1,929,387. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,929,387. PASTORAL CARE: PROGRAM SERVICE EXPENSES 250,762. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 250,762. FORM 990, PART XI, LINE 9: EFFECT OF PENSION LIABILITY ADJUSTMENT -242,756. 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 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0