2019-11-14T14:28:26-06:00 2018-12-31 161131146 BONADIO & CO LLP 6 WEMBLEY CT ALBANY NY 12205 990 2018-01-01 237310663 GOOD SAMARITAN LUTHERAN HEALTH CARE CENTER INC GOOD 5184398116 700 WHITE PLAINS RD STE 377 NO 377 SCARSDALE NY 10583 LARAINE FELLEGARA CEO 5184398116 2019-11-14 1 KENNETH MCGIVNEY P01324731 5184644080 24.103.149.254 2019-11-14 11:17:58 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 86E6F92F558D743C159114FDCA77A2339B094F2C 2018 2020-03-31 21:24:44Z LARAINE FELLEGARA 125 ROCKEFELLER ROAD DELMAR NY 12054 9741214 0 X WWW.TLCN.ORG X 1973 NY SKILLED NURSING FACILTY 7 5 245 10 0 1262 1005 450 9863335 9592235 0 0 154606 148529 10018946 9741214 0 0 0 0 7511183 7805106 0 0 0 4359082 4348036 11870265 12153142 -1851319 -2411928 5670041 4958778 9127111 10827776 -3457070 -5868998 X A MINISTRY OF HEALING, HOSPITALITY AND COMMUNITY THROUGH PARTNERSHIPS IN CARING. 0 0 9189177 9592235 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 39,654 DAYS IN 2018. 861656 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 2018 WERE 118,962. 712018 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 2018 EQUALED 365. 148529 MANAGEMENT FEE INCOME 148529 10762851 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 15 0 1 245 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 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 JOHN MESLOH BOARD CHAIR 1.00 X X 0 0 0 LARAINE FELLEGARA CEO (EFF. 2/2018) 2.00 34.00 X X 0 395811 29355 REV DEREK LECAKES BOARD MEMBER 1.00 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 BOARD MEMBER 1.00 X 0 0 0 FRANK TRIPODI DIRECTOR/CEO THRU 2/2018 2.00 34.00 X X 0 121694 5488 KAREN WOODCOCK ADMINISTRATOR 35.00 X 0 105242 5061 SHARON SIEGEL CFO 5.00 30.00 X 0 153267 100 0 776014 40004 0 0 1 0 RAINBOW CARE & CONSULTING 417A KENWOOD AVE DELMAR NY 12054 CONSULTING SERVICES AND CARE PRODUCTS 150613 CIGNA HEALTH AND LIFE INSURANCE COMPANY 900 COTTAGE GROVE ROAD BLOOMFIELD CT 06002 MEDICAL SUPPLIES 150450 OMNICARE INC PO BOX 78000 DETROIT MI 48278 PHARMACY 114734 CDPHP 500 PATROON CREEK BLVD ALBANY NY 12206 HEALTHCARE EXPENSES 104479 DRISCOLL FOODS 105 QUIST RD AMSTERDAM NY 12010 FOOD SERVICES 101761 5 450 450 REGULAR INPATIENT CARE 623000 9564095 9564095 RATE ADJUSTMENT 623000 28140 28140 9592235 MANAGEMENT FEES 561000 134152 134152 OTHER INCOME 623000 14377 14377 148529 9741214 9740764 0 0 5636690 5348248 288442 2168416 2168416 995537 372908 622629 114680 116089 -1409 12057 12057 324160 319400 4760 16822 15489 1333 998 298 700 199375 199375 105893 105893 MEDICAL & DIETARY SUPPL 1049572 1003209 46363 BAD DEBT EXPENSE 844275 844275 CASH RECEIPT ASSESSMENT 554596 554596 OTHER 91065 19923 71142 39006 39006 12153142 10762851 1390291 0 528339 486107 1397769 929900 45786 77682 3698147 3465089 5670041 4958778 1116210 1633866 255052 2781536 2628998 4974313 6564912 9127111 10827776 X -3457070 -5868998 -3457070 -5868998 5670041 4958778 -2411928 0 X X 0 1 X 0 0 X 2935 1175 4524 1005 450 10089 10316634 10173204 9717168 9863335 9592235 49662576 10319569 10174379 9721692 9864340 9592685 49672665 0 0 0 49672665 214652 204647 154452 154606 148529 876886 10534221 10379026 9876144 10018946 9741214 50549551 0.98270 0.97930 0.00000 X 0 ASSETS HELD FOR SALE 3465089 3465089 DUE TO THE LUTHERAN CARE NETWORK, INC. 5947023 PAYABLE TO THIRD PARTY 331883 LIABILITIES HELD FOR SALE 286006 6564912 9741214 0 9741214 0 9741214 12153142 0 12153142 0 12153142 0 0 0 0 0 0 0 0 0 LARAINE FELLEGARA CEO (EFF. 2/2018) 0 395811 0 0 0 0 0 0 0 29355 0 425166 0 0 SHARON SIEGEL CFO 0 153267 0 0 0 0 0 0 0 100 0 153367 0 0 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 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 5947023 KENWOOD MANOR INC L 112455 THE LUTHERAN CARE NETWORK INC M 425000 KENWOOD MANOR INC (GUARANTEE) E 4415136