2020-11-12T10:29:08-06:00 2019-12-31 161131146 BONADIO & CO LLP 6 WEMBLEY CT ALBANY NY 12205 990 2019-01-01 237310663 GOOD SAMARITAN LUTHERAN HEALTH CARE CENTER INC GOOD 5184398116 700 WHITE PLAINS RD STE 377 NO SCARSDALE NY 10583 LARAINE FELLEGARA CEO 5184398116 2020-11-05 1 KENNETH MCGIVNEY P01324731 5184644080 2020-10-30 4.26.26.190 2020-11-05 11:46:39 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4E509B2D1465824EB5436EDE64E0391D8FED92E2 2019 2021-01-29 14:40:06Z LARAINE FELLEGARA 125 ROCKEFELLER ROAD DELMAR NY 12054 8575832 0 X WWW.TLCN.ORG X 1973 NY SKILLED NURSING FACILTY 5 5 210 5 0 0 450 165 9592235 8435339 0 0 148529 140328 9741214 8575832 0 0 0 0 7805106 6901421 0 0 0 4348036 3401650 12153142 10303071 -2411928 -1727239 4958778 4571709 10827776 13315020 -5868998 -8743311 X A MINISTRY OF HEALING, HOSPITALITY AND COMMUNITY THROUGH PARTNERSHIPS IN CARING. 0 0 7777344 8435339 A 120 BED SKILLED NURSING FACILITY. THE NURSING DEPARTMENT PROVIDES SKILLED NURSING CARE ON A DAILY BASIS PER NYS DOH GUIDELINES. RESIDENTS ARE ADMITTED ON A VOLUNTARY BASIS. SERVICES INCLUDE, ASSISTANCE AND/OR SUPERVISION, WHEN REQUIRED, WITH ACTIVITIES OF DAILY LIVING, RECREATIONAL AND MOTIVATIONAL ACTIVITIES, AS WELL AS DIAGNOSTIC SERVICES, MEDICATION MONITORING, AND USE OF GENERAL HOUSEHOLD MEDICINE CABINET SUPPLIES. THE FACILITY HAD 36,057 DAYS IN 2019. 785006 DIETARY SERVICES - PROVIDES THREE MEALS PER DAY, 365 DAYS PER YEAR. MEALS SERVED TO INDIVIDUALS WITH SPECIAL DIETARY NEEDS ARE SUPERVISED BY A CONSULTING AND REGISTERED DIETICIAN. TOTAL MEALS SERVED IN 2019 WERE 118,000. 500573 PLANT OPERATIONS. THE PLANT OPERATIONS DEPARTMENT PROVIDES MAINTENANCE, HOUSEKEEPING, GROUNDS, LAUNDRY, AND TRANSPORTATION SERVICES 365 DAYS PER YEAR. THIS DEPARTMENT ENSURES A CLEAN, HEALTHY, SHELTERED ENVIRONMENT AND PROPERLY OUTFITTED FACILITY PER NYS DOH GUIDELINES. THIS DEPARTMENT PROVIDES FRESH BED LINEN, CHANGED AT LEAST TWICE WEEKLY, AS WELL AS LAUNDRY SERVICES FOR HOSPITAL GOWNS OR PAJAMAS AS REQUIRED BY THE CLINICAL CONDITION OF THE RESIDENT OR OTHER, IF ELECTED, PERSONAL CLOTHING ITEMS. TOTAL SERVICE DAYS PROVIDED IN 2019 EQUALED 365. 140328 MANAGEMENT FEE INCOME 140328 9062923 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 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 0 0 0 1 16 0 210 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X LARAINE FELLEGARA 9143656365 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 LARAINE FELLEGARA CEO 2.00 34.00 X X 0 393176 20877 REV DEREK LECAKES CHAIR 1.00 X X 0 0 0 REV DANIEL COHN BOARD MEMBER 1.00 X 0 0 0 WILLIAM TEATOR BOARD MEMBER 1.00 X 0 0 0 THOMAS ROEMKE SECRETARY 1.00 X X 0 0 0 KAREN WOODCOCK ADMINISTRATOR 35.00 X 0 54115 1130 SHARON SIEGEL CFO 5.00 30.00 X 0 130983 75 THERESA NICHOLSON CFO 5.00 30.00 X 0 47005 58 BRUCE ZARETT ADMINISTRATOR 35.00 X 0 75635 0 0 700914 22140 0 0 1 0 GINSBERG INSTITUTIONAL FOODS 29 GINSBERG LANE HUDSON NY 12534 FOOD SERVICE 240751 MCKESSON MEDICAL-SURGICAL 9954 MARYLAND DRIVE SUITE 4000 RICHMOND VA 23233 MEDICAL 193490 2 165 165 REGULAR INPATIENT CARE 623000 8277327 8277327 RATE ADJUSTMENT 623000 158012 158012 8435339 MANAGEMENT FEES 561000 134152 134152 OTHER INCOME 623000 6176 6176 140328 8575832 8575667 0 0 5073269 4797246 276023 1828152 1828152 682687 164628 518059 17603 17603 5929 5929 208795 205259 3536 15176 15103 73 199 199 215513 215513 120342 120342 MEDICAL & DIETARY SUPPL 829387 794915 34472 BAD DEBT EXPENSE 695850 695850 CASH RECEIPT ASSESSMENT 521970 521970 OTHER 68199 21998 46201 20000 20000 10303071 9062923 1240148 0 486107 318794 929900 696946 77682 85072 3465089 3470897 4958778 4571709 1633866 1843937 2628998 2536243 6564912 8934840 10827776 13315020 X -5868998 -8743311 -5868998 -8743311 4958778 4571709 X -1727239 -1147074 X X 0 1 X 0 0 X 1175 4524 1005 450 165 7319 10173204 9717168 9863335 9592235 8435339 47781281 10174379 9721692 9864340 9592685 8435504 47788600 0 0 0 47788600 204647 154452 154606 148529 140328 802562 10379026 9876144 10018946 9741214 8575832 48591162 0.98350 0.98270 0.00000 X 0 ASSETS HELD FOR SALE 3470897 3470897 DUE TO THE LUTHERAN CARE NETWORK, INC. 6815182 PAYABLE TO THIRD PARTY 166670 LIABILITIES HELD FOR SALE 296618 NOTE PAYABLE TO AFFILIATED COMPANIES 500000 POSTPETITION ACCOUNTS PAYABLE 93520 POSTPETITION ACCRUED EXPENSES 466736 POSTPETITION DUE TO AFFILIATED COMPANIES 171114 PREPETITION NOTE PAYABLE TO AFFILIATED COMPANIES 425000 8934840 8575832 0 8575832 0 8575832 10303071 0 10303071 0 10303071 0 0 0 0 0 0 0 0 0 LARAINE FELLEGARA CEO 0 393176 0 0 0 0 0 0 0 20877 0 414053 0 0 PART IV, LINE 31 REORGANIZATION UNDER BANKRUPTCY PROCEEDINGS IN DECEMBER 2019, THE COMPANY FILED PETITIONS FOR RELIEF UNDER CHAPTER 11 OF THE FEDERAL BANKRUPTCY LAWS IN THE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF NEW YORK. THIS GENERALLY DELAYS PAYMENT OF LIABILITIES INCURRED PRIOR TO FILING THOSE PETITIONS WHILE THE COMPANY DEVELOPS A PLAN OF REORGANIZATION THAT IS SATISFACTORY TO ITS CREDITORS AND ALLOWS IT TO CONTINUE AS A GOING CONCERN. THE CARRYING AMOUNTS OF ASSETS AND LIABILITIES ARE UNAFFECTED BY THE PROCEEDINGS, BUT LIABILITIES ARE PRESENTED ACCORDING TO THE STATUS OF THE CREDITORS. UNDER CHAPTER 11, CERTAIN CLAIMS AGAINST THE COMPANY IN EXISTENCE BEFORE THE FILING OF THE PETITIONS OF RELIEF UNDER THE FEDERAL BANKRUPTCY LAWS ARE STAYED WHILE THE COMPANY CONTINUES BUSINESS OPERATIONS AS DEBTOR-IN-POSSESSION. THESE CLAIMS ARE REFLECTED IN THE DECEMBER 31, 2019 STATEMENT OF FINANCIAL POSITION AS LIABILITIES SUBJECT TO COMPROMISE. ADDITIONAL CLAIMS (LIABILITIES SUBJECT TO COMPROMISE) MAY ARISE AFTER THE FILING DATE RESULTING FROM REJECTION OF EXECUTORY CONTRACTS, INCLUDING LEASES, AND FROM THE DETERMINATION OF THE COURT (OR AGREED TO BY PARTIES IN INTEREST) OF ALLOWED CLAIMS FOR CONTINGENCIES AND OTHER DISPUTED AMOUNTS. CLAIMS SECURED AGAINST THE COMPANY'S ASSETS (SECURED CLAIMS) ARE ALSO STAYED, ALTHOUGH THE HOLDERS OF SUCH CLAIMS HAVE THE RIGHT TO MOVE THE COURT FOR RELIEF FROM THE STAY. SECURED CLAIMS ARE SECURED PRIMARILY BY LIENS ON THE COMPANY'S PROPERTY AND EQUIPMENT. THE COMPANY RECEIVED APPROVAL FROM THE BANKRUPTCY COURT TO PAY OR OTHERWISE HONOR CERTAIN OF ITS PREPETITION OBLIGATIONS, INCLUDING EMPLOYEE WAGES, UTILITIES, AND INSURANCES. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S SOLE MEMBER, THE LUTHERAN CARE NETWORK, INC. PROVIDES CERTAIN MANAGEMENT FUNCTIONS, INCLUDING THE CEO AND CFO FUNCTIONS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER - THE LUTHERAN CARE NETWORK, INC. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS ARE ELECTED BY THE SOLE MEMBER AS PER THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B AS PER THE ORGANIZATION'S BYLAWS, THE VOTE OF THE MEMBERSHIP IS REQUIRED FOR THE FOLLOWING ACTIONS: 1) THE AMENDMENT OF THE BYLAWS, 2) INCURRING DEBT IN EXCESS OF $100,000, 3) INITIATION OF ANY ACTIVITIES REQUIRING A CERTIFICATE OF NEED, AND 4) ESTABLISHING A SUBSIDIARY OR OTHERWISE AFFILIATING WITH ANY OTHER ENTITY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE AUDIT COMMITTEE CHAIR OR AT LEAST ONE MEMBER OF THE AUDIT COMMITTEE. ONCE APPROVED, A COPY IS GIVEN TO EACH BOARD MEMBER BEFORE SIGNING AND FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AT BEGINNING OF EMPLOYMENT, MANAGEMENT LEVEL EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST AND OUTSIDE ACTIVITIES FORM. THE ORGANIZATION ENFORCES THIS POLICY BY ASSESSING AND MONITORING SITUATIONS IN WHICH ANY POTENTIAL CONFLICT OF INTEREST ARISES. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION OF CEO AND EXECUTIVE STAFF IS AT THE DISCRETION OF THE BOARD OF DIRECTORS UNDER ADVISEMENT OF AN INDEPENDENT THIRD PARTY COMPENSATION FIRM. A CONSULTANT FIRM IS USED THAT PROVIDES STRATEGIC HUMAN RESOURCES SOLUTIONS TO CORPORATE AND NON PROFIT EMPLOYERS AND WAS SELECTED FROM SEVERAL VENDORS. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC OTHER THAN THOSE REQUIRED BY LAW. THOSE DOCUMENTS THAT ARE REQUIRED TO BE AVAILABLE TO THE PUBLIC ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: REORGANIZATION ITEMS - PROFESSIONAL FEES -1,147,074. FORM 990, PART XI, LINE 2C: NO CHANGE IN THE PROCESS FROM PRIOR YEARS. COBURG VILLAGE 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 113211085 INDEPENDENT LIVING SENIOR HOUSING NY 501(C)(3) LINE 11 0 WARTBURG NURSING HOME 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 237087284 INACTIVE NY 501(C)(3) LINE 11 0 KENWOOD MANOR INC 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 141368178 LICENSED ADULT HOME FACILITY NY 501(C)(3) LINE 11 0 GOOD SAMARITAN SENIOR HOUSING DEVELOPMENT FUND COMPANY INC 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 141727655 LOW INCOME HOUSING NY 501(C)(3) LINE 11 0 LUTHERAN CENTER AT POUGHKEEPSIE 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 223408456 SKILLED NURSING CARE AND HEALTH SERVICES TO THE ELDERLY NY 501(C)(3) LINE 11 0 LUTHERAN HOUSING DEVELOPMENT CORPORATION AT CONCORD VILLAGE 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 030436196 RESIDENTIAL APARTMENT BUILDING FOR THE ELDERLY NY 501(C)(3) LINE 11 0 LUTHERAN HOUSING DEVOLOPMENT CORPORATION OF LONG ISLAND 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 112574183 RESIDENTIAL APARTMENT BUILDING FOR THE ELDERLY NY 501(C)(3) LINE 11 0 LUTHERAN HOUSING DEVOPMENT CORPORATION OF PAWLING 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 113269257 RESIDENTIAL APARTMENT BUILDING FOR THE ELDERLY NY 501(C)(3) LINE 11 0 WARTBURG HOUSING DEVELOPMENT FUND CORPORATION 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 113051052 TO PROVIDE HOUSING FOR LOW INCOME AND INDIGENT PEOPLE NY 501(C)(3) LINE 11 0 THE LUTHERAN CARE NETWORK FOUNDATION INC 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 112645255 TO DEVELOP AND SUPPORT NOT FOR PROFIT HEALTH CARE ENTITIES NY 501(C)(3) LINE 7 0 WARTBURG LUTHERAN HOME FOR THE AGING INC 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 111631836 MANAGE LOW INCOME HOUSING COMPANIES NY 501(C)(3) LINE 11 0 THE LUTHERAN CARE NETWORK INC 700 WHITE PLAINS ROAD SUITE 377 SCARSDALE NY 10583 112896230 PROVIDE MGMT, DEVP & FUNDRAISING SERVICES RELATED TO 501(C)(3) NY 501(C)(3) LINE 11 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 THE LUTHERAN CARE NETWORK INC E 6986296 KENWOOD MANOR INC L 112455 THE LUTHERAN CARE NETWORK INC M 425000 KENWOOD MANOR INC (GUARANTEE) E 4023408