2019-11-14T14:58:58-06:00 2018-12-31 271728945 PKF O'CONNOR DAVIES LLP 300 TICE BOULEVARD SUITE 315 WOODCLIFF LAKE NJ 07677 990 2018-01-01 320041186 VALLEY PHYSICIAN SERVICES INC VALL 2014478000 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 DR TIMOTHY WILLOX PRESIDENT 2014478000 2019-11-12 1 EDWARD G O'CONNOR P00434443 2017129800 2019-11-11 47.19.39.42 2019-11-12 11:41:01 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 19BBD1C62914FEE4179E511BAA0C0D53ABD164E1 2018 2020-03-31 21:24:44Z DR TIMOTHY WILLOX 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 98168230 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. 12 12 867 31 0 28319 0 83166226 2933230 14924941 0 0 149039 77063 3082269 98168230 0 0 0 0 38655727 54178178 0 0 0 39721960 43500399 78377687 97678577 -75295418 489653 34494591 36799073 10602399 10768560 23892192 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 85371381 14924941 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. 85371381 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 112 0 867 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 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 JEFFREY S TUCKER CHAIRMAN 0.50 0.50 X X 0 0 0 RIMA KOPELMAN MD VICE CHAIRMAN 0.50 0.50 X X 0 0 0 MARIA SCIBETTA MD VICE CHAIRMAN 0.50 0.50 X X 0 0 0 STEVEN SILVERSTEIN SECRETARY/ TREASURER 0.50 0.50 X X 0 0 0 WARREN F COOKE ESQ TRUSTEE 0.50 0.50 X 0 0 0 ARTHUR A KLEIN MD TRUSTEE 0.50 0.50 X 0 0 0 JOHN KANDRAVY ESQ TRUSTEE - THRU 5/22/18 0.50 0.50 X 0 0 0 SUNEET MITTAL MD TRUSTEE 0.50 40.00 X 0 976180 42127 THOMAS RAKOWSKI MD TRUSTEE 0.50 0.50 X 0 0 0 AUDREY MEYERS EX-OFFICIO TRUSTEE 0.50 40.00 X 0 1610026 48093 MICHELLE HASSON TRUSTEE 0.50 0.50 X 0 0 0 ELLIOTT S LICHTSTEIN MD TRUSTEE 0.50 0.50 X 0 0 0 ANDREW SNYDER MD TRUSTEE - THRU 5/22/18 0.50 0.50 X 0 0 0 BRUCE MACTAS TRUSTEE 0.50 0.50 X 0 0 0 MARC R GOLDSTEIN PRESIDENT, VALLEY MEDICAL 40.00 0.50 X 807692 0 31465 JEAN FLANAGAN CHIEF OPERATING OFFICER 40.00 0.50 X 314407 0 48642 MARYANN KEPPLE CFO 40.00 0.50 X 388967 0 9648 LAURIE C DEBENEDETTO BOARD SECRETARY 0.50 40.00 X 0 95212 17471 HAROLD MC DONALD DIRECTOR, VALLEY MEDICAL 40.00 X 199675 0 33477 BENJAMIN FURMAN DIRECTOR, ACCESS & NAVIGATION CENTER 40.00 X 151251 0 5840 CAROL PERSLEY MANAGER REGIONAL SPECIALTY 40.00 X 140904 0 15064 MARY AIOSA DIRECTOR CLINICAL SERVICES 40.00 X 138594 0 27616 LOURDES HIDALGO-GATO REGIONAL PRACTICE MANAGER 40.00 X 137757 0 32624 EDWINA ANTONIO RN 40.00 X 135842 0 19376 JOSHUA GREGOIRE MANAGER, QUALITY 40.00 X 135037 0 2763 2550126 2681418 334206 28 0 1 0 TORCON INC 214 EAST GROVE ST WESTFIELD NJ 07091 CONSTRUCTION SERVICE 1308019 OPTUM THE ADVISORY BOARD COMPANY PO BOX 8 CHICAGO IL 606894002 CONSULTING SERVICE 508988 SHI INTERNATIONAL CORP PO BOX 952121 DALLAS TX 753952121 COMPUTER SERVICE 427548 THE VALDE GROUP INC 1900 MARKET ST 8TH FLR PHILADELPHIA PA 19103 CONSULTING SERVICE 371287 MEDIX STAFFING SOLUTIONS 7839 SOLUTION CENTER CHICAGO IL 606777008 STAFFING SERVICE 294883 9 83166226 83166226 MANAGEMENT FEE REVENUE 900099 14396096 14396096 NET PATIENT SERVICE REVENUE 624100 528845 528845 14924941 OTHER INCOME 624100 77063 77063 77063 98168230 14924941 0 77063 1600821 1362396 238425 39540195 33582863 5957332 1247034 1079581 167453 8775543 7820143 955400 3014585 2706031 308554 22921 500 22421 41050 1200 39850 7283656 7283656 15858 10059 5799 1878540 614934 1263606 962900 552978 409922 12187155 11777124 410031 74496 51765 22731 46990 2559 44431 6536770 5453669 1083101 170917 170917 CLINICAL SUPPLIES 12293954 12293954 TEMPORARY HELP 658410 607052 51358 OTHER EXPENSES 392100 392100 UNIFORMS, LAUNDRY AND L 309039 309039 625643 625643 97678577 85371381 12307196 0 63699 1215760 1346742 309600 110522 107639 314177 196998 48258199 21957190 22087922 26301009 3117245 2354871 7454284 6313196 34494591 36799073 7857461 8117432 367750 630787 2377188 2020341 10602399 10768560 X 23892192 26030513 23892192 26030513 34494591 36799073 X 489653 1648668 X X 0 1 X 1 0 X 83166226 83166226 50490181 74820953 106491173 2933230 14924941 249660478 50490181 74820953 106491173 2933230 98091167 332826704 0 0 0 332826704 524 524 524 524 9241499 12162180 16624506 149039 77063 38254287 59731680 86983133 123116203 3082269 98168230 371081515 0.89690 0.86430 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: INCOME FROM VALLEY HOSPITAL - 2014 AMOUNT: $ 8,329,498. 2015 AMOUNT: $ 11,347,905. 2016 AMOUNT: $ 16,143,605. 2017 AMOUNT: $ 130,326. OTHER INCOME - 2014 AMOUNT: $ 912,001. 2015 AMOUNT: $ 814,275. 2016 AMOUNT: $ 480,901. 2017 AMOUNT: $ 18,713. 2018 AMOUNT: $ 77,063. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 24694316 11253244 13441072 20608183 10703946 9904237 2955700 2955700 26301009 SECURITY DEPOSITS 269302 ASSETS HELD BY RELATED ORGANIZATION 6043894 6313196 DUE TO AFFILIATES 182106 ESTIMATED THIRD-PARTY PAYER SETTLEMENT 1838235 2020341 X 225895497 127727267 127727267 98168230 0 98168230 236533522 138854945 138854945 97678577 0 97678577 PART X, LINE 2: VMG RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. 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 2015 TAX YEAR. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE ATTRIBUTABLE TO OTHER ENTITIES 127,727,267. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES ATTRIBUTABLE TO OTHER ENTITIES 138,854,945. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 SUNEET MITTAL MD TRUSTEE 0 922558 0 51000 0 2622 0 9625 0 32502 0 1018307 0 0 AUDREY MEYERS EX-OFFICIO TRUSTEE 0 1050913 0 488048 0 71065 0 26125 0 21968 0 1658119 0 0 MARC R GOLDSTEIN PRESIDENT, VALLEY MEDICAL 441337 0 145529 0 220826 0 9625 0 21840 0 839157 0 0 0 JEAN FLANAGAN CHIEF OPERATING OFFICER 237610 0 38115 0 38682 0 20678 0 27964 0 363049 0 0 0 MARYANN KEPPLE CFO 276697 0 57510 0 54760 0 8575 0 1073 0 398615 0 0 0 HAROLD MC DONALD DIRECTOR, VALLEY MEDICAL 182510 0 15724 0 1441 0 6034 0 27443 0 233152 0 0 0 BENJAMIN FURMAN DIRECTOR, ACCESS & NAVIGATION CENTER 151000 0 0 0 251 0 840 0 5000 0 157091 0 0 0 CAROL PERSLEY MANAGER REGIONAL SPECIALTY 130536 0 8651 0 1717 0 4967 0 10097 0 155968 0 0 0 MARY AIOSA DIRECTOR CLINICAL SERVICES 125005 0 11877 0 1712 0 5066 0 22550 0 166210 0 0 0 LOURDES HIDALGO-GATO REGIONAL PRACTICE MANAGER 127426 0 8621 0 1710 0 4950 0 27674 0 170381 0 0 0 EDWINA ANTONIO RN 135442 0 400 0 0 0 9293 0 10083 0 155218 0 0 0 PART I, LINE 1A THE FOLLOWING PEOPLE RECEIVED TAX GROSS-UPS: MARC GOLDSTEIN JEAN FLANAGAN MARYANN KEPPLE PART I, LINE 7 THE FOLLOWING EMPLOYEES RECEIVED A BOARD DISCRETIONARY BONUS IN THEIR 2018 W-2 FROM THE ORGANIZATION: 1. MARC R. GOLDSTEIN, $145,529 2. JEAN FLANAGAN, $38,115 3. MARYANN KEPPLE, $57,510 4. HAROLD MCDONALD, $15,724 5. CAROL PERSLEY, $8,651 6. MARY AIOSA, $11,877 7. LOURDES HIDALGO-GATO, $ 8,621 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 FROM 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: INVESTMENT IN ACO 998,963. CHANGE IN ASSETS HELD AT VALLEY HOSPITAL FOUNDATION 646,172. TRANSFER OF ASSETS FROM VALLEY MEDICAL SERVICES , INC. 3,533. FORM 990, PART XI, LINE 2C THE AUDIT COMMITTEE IS RESPONSIBLE FOR SELECTING AN INDEPENDENT ACCOUNTANT AND FOR OVERSIGNT OF THE AUDIT. 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 MEDICAL SERVICES INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 223260998 PROVIDES MANAGEMENT AND VARIED CONSULTING SERVICES NJ 501(C)(3) LINE 10 THE VALLEY HOSPITAL INC 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 VALLEY HEALTH MEDICAL GROUP OF NJPC 15 ESSEX ROAD PARAMUS NJ 07652 223475166 OPERATES URGENT/PRIMARY CARE CLINICS NJ VALLEY HEALTH SYSTEM INC C 0 VALLEY HEALTH MEDICAL GROUP 15 ESSEX ROAD PARAMUS NJ 07652 223475233 OPERATES URGENT/PRIMARY CARE CLINICS NJ VALLEY HEALTH SYSTEM INC C 0 VHS INSURANCE COMPANY LTD 010 MAIN STREET CAYMAN ISLANDS CJ 980408200 PROVIDES PROFESSIONAL, MEDICAL AND COMMERCIAL GENERAL LIABILITY INSURANCE CJ THE VALLEY HOSPITAL INC C 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1