2017-11-15T17:11:19-06:00 2016-12-31 271728945 PKF O'CONNOR DAVIES LLP 300 TICE BOULEVARD SUITE 315 WOODCLIFF LAKE NJ 07677 990 2016-01-01 320041186 VALLEY PHYSICIAN SERVICES INC VALL 2014478000 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 MARC GOLDSTEIN PRESIDENT 2014478000 2017-11-15 1 EDWARD G O'CONNOR P00434443 2017129800 2017-11-15 65.51.112.58 2017-11-15 13:39:59 ES P 8F3E04F861F0216E32497907D09A877E57DED22A 8F3E04F861F0216E32497907D09A877E57DED22A 2016 2017-02-10 21:41:12Z MARC GOLDSTEIN 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 123116203 0 X WWW.VALLEYHEALTH.COM X 2002 NJ VALLEY PHYSICIAN SERVICES, INC. WAS FORMED TO PROVIDE MEDICAL CARE AND TO CARRY OUT THE PURPOSES OF THE VALLEY HEALTH SYSTEM, INC. 13 7 1067 21 0 0 0 0 74820953 106491173 0 524 12162180 16624506 86983133 123116203 0 0 0 0 107946488 143504100 0 0 0 31434299 43475275 139380787 186979375 -52397654 -63863172 36548166 44862590 21940759 30610334 14607407 14252256 TO PROVIDE MEDICAL CARE TO PATIENTS AND TO FACILITATE THE MEDICAL NEEDS OF THE PATIENTS OF THE VALLEY HEALTH SYSTEM, INC. 0 0 166689505 106491173 VALLEY PHYSICIAN SERVICES PROVIDES MEDICAL PATIENT CARE, GENERAL/OTHER AND PEDIATRIC PULMONARY CARE, PRIMARY CARE SERVICES, MEDICAL SPECIALTY SERVICES, CARDIOLOGY, CHILD PSYCHOLOGY, IMAGING, ONCOLOGY SERVICES AND WOMEN'S SERVICES. THE THREE(3) LARGEST PROGRAM SERVICES FOR 2016 WERE URGENT CARE, INTERNAL MEDICINE, AND CARDIOLOGY. THE TOTAL NUMBER OF PATIENTS SEEN IN 2016 WAS 252,412. 166689505 1 0 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 1 125 0 1067 1 0 0 0 0 0 0 0 0 0 0 X 13 7 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 ROBERT E FINK CHAIRMAN 0.50 1.00 X X 0 0 0 JEFFREY S TUCKER VICE CHAIRMAN 0.50 0.50 X X 0 0 0 MARIA SCIBETTA MD VICE CHAIRMAN 32.00 0.50 X X 213838 0 6522 STEVEN SILVERSTEIN SECRETARY/ TREASURER 0.50 0.50 X X 0 0 0 TOM POLEN TRUSTEE, THRU 9/27/16 0.50 0.50 X 0 0 0 WARREN F COOKE ESQ TRUSTEE 0.50 1.00 X 0 0 0 JOHN KANDRAVY ESQ TRUSTEE 0.50 1.00 X 0 0 0 SUNEET MITTAL MD TRUSTEE 0.50 40.00 X 0 803650 40195 THOMAS RAKOWSKI MD TRUSTEE 40.00 0.50 X 755164 0 32972 AUDREY MEYERS EX-OFFICIO TRUSTEE 0.50 40.00 X 0 1527405 46326 RIMA KOPELMAN MD TRUSTEE 34.00 0.50 X 250011 0 11049 MICHELLE HASSON TRUSTEE 0.50 0.50 X 0 0 0 ELLIOTT S LICHTSTEIN MD TRUSTEE 40.00 0.50 X 498790 0 0 ANDREW SNYDER MD TRUSTEE 0.50 0.50 X 0 0 0 MARC R GOLDSTEIN PRESIDENT, VALLEY MEDICAL GROUP 40.00 0.50 X 665232 0 30145 JEAN FLANAGAN CHIEF OPERATING OFFICER 40.00 0.50 X 231035 0 47027 MARYANN KEPPLE CFO 40.00 0.50 X 308775 0 10348 LAURIE C DEBENEDETTO BOARD SECRETARY 40.00 0.50 X 91216 0 16835 MARC MELAMED CHIEF MEDICAL OFFICER 40.00 0.50 X 525773 0 32872 ROBERT KORST MEDICAL DIRECTOR 40.00 X 1084636 0 54241 ALEX ZAPOLANSKI PHYSICIAN 40.00 X 1451961 0 32322 ANUSAK YIENGPRUKSAWAN PHYSICIAN 40.00 X 906427 0 17983 THOMAS AHLBORN CHAIR, SURGICAL SERVICES 40.00 X 1499890 0 31618 MICHAEL RAHMIN PHYSICIAN 40.00 X 999750 0 30404 9482498 2331055 440859 269 0 1 0 THE ADVISORY BOARD PO BOX 79461 BALTIMORE MD 212790461 CONSULTING SERVICES 1020688 LAWRENCE SELTZER MD 215 HARRISON AVE WESTFIELD NJ 07090 MEDICAL PROVIDER 698550 SHI INTERNATIONAL CORP PO BOX 952121 DALLAS TX 753952121 IT CONSULTING AND EQUIPMENT 540963 TORCON INC 214 EAST GROVE ST WESTFIELD NJ 07091 MEDICAL SUPPLIES AND SERVICES 357597 SULLIVAN COTTER & ASSOCIATES INC 62272 COLLECTIONS CENTER DR CHICAGO IL 606930622 LEGAL CONSULTING 176804 13 PATIENT SERVICE REVENUE 624100 106491173 106491173 106491173 524 524 INCOME FROM VALLEY HOSPITAL 624100 16143605 16143605 OTHER INCOME 624100 480901 480901 16624506 123116203 106491173 0 16625030 3228814 2932620 296194 122850701 111581057 11269644 2709527 2460970 248557 8210016 7456874 753142 6505042 5908305 596737 32666 32666 44075 44075 8865695 8808308 57387 167135 167135 1804484 685264 1119220 831817 131629 700188 9348471 9348471 124070 124070 60765 60765 5209827 4271892 937935 2147123 2147123 CLINICAL SUPPLIES 8295767 8295767 BAD DEBT EXPENSE 2661225 2661225 OUTSIDE SERVICE & CONTR 1061459 1061459 TEMPORARY HELP 1045063 1045063 1775633 1775633 186979375 166689505 20289870 0 1356533 3438368 34310 120544 10598313 12048836 119079 475544 346751 28596582 11878187 15225452 16718395 584912 0 4041416 3850715 4231686 8219902 36548166 44862590 20471615 28352536 1469144 2257798 21940759 30610334 X 14607407 14252256 14607407 14252256 36548166 44862590 X -63863172 63508021 X X 0 1 X 1 0 X 16612425 43646815 50490181 74820953 106491173 292061547 16612425 43646815 50490181 74820953 106491173 292061547 0 0 0 292061547 524 524 524 524 63052 5535103 9241499 12162180 16624506 43626340 16675477 49181918 59731680 86983133 123116203 335688411 0.87000 0.87780 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME FROM VMG - 2013 AMOUNT: $ 1,260,000. INCOME FROM VALLEY HOSPITAL - 2013 AMOUNT: $ 4,275,103. 2014 AMOUNT: $ 8,329,498. 2015 AMOUNT: $ 11,347,905. 2016 AMOUNT: $ 16,143,605. OTHER INCOME - 2012 AMOUNT: $ 63,052. 2014 AMOUNT: $ 912,001. 2015 AMOUNT: $ 814,275. 2016 AMOUNT: $ 480,901. 13370302 6327415 7042887 14038235 5550772 8487463 1188045 1188045 16718395 SECURITY DEPOSITS 263850 ASSETS HELD BY RELATED ORGANIZATION 7956052 8219902 DUE TO AFFILIATES 126485 ESTIMATED THIRD-PARTY PAYER SETTLEMENT 2131313 2257798 X 183531504 63076526 63076526 120454978 2661225 2661225 123116203 197098061 12779911 12779911 184318150 2661225 2661225 186979375 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 2013 TAX YEAR. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE ATTRIBUTABLE TO OTHER ENTITIES 11,906,111. STRATEGIC FUNDING FROM VALLEY HOSPITAL 51,170,415. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSES REPORTED ON PART IX 2,661,225. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES ATTRIBUTABLE TO OTHER ENTITIES 12,779,911. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSES REPORTED ON PART IX 2,661,225. X X X X X 0 1 0 0 0 0 0 1 0 MARIA SCIBETTA MD VICE CHAIRMAN 183007 0 30831 0 0 0 6522 0 0 0 220360 0 0 0 SUNEET MITTAL MD TRUSTEE 0 732291 0 69693 0 1666 0 8962 0 31233 0 843845 0 0 THOMAS RAKOWSKI MD TRUSTEE 740686 0 0 0 14478 0 9275 0 23697 0 788136 0 0 0 AUDREY MEYERS EX-OFFICIO TRUSTEE 0 991656 0 458156 0 77593 0 25135 0 21191 0 1573731 0 0 RIMA KOPELMAN MD TRUSTEE 200011 0 50000 0 0 0 820 0 10229 0 261060 0 0 0 ELLIOTT S LICHTSTEIN MD TRUSTEE 436312 0 10000 0 52478 0 0 0 0 0 498790 0 0 0 MARC R GOLDSTEIN PRESIDENT, VALLEY MEDICAL GROUP 415506 0 165624 0 84102 0 9275 0 20870 0 695377 0 0 0 JEAN FLANAGAN CHIEF OPERATING OFFICER 196300 0 33759 0 976 0 20015 0 27012 0 278062 0 0 0 MARYANN KEPPLE CFO 256015 0 50368 0 2392 0 9275 0 1073 0 319123 0 0 0 MARC MELAMED CHIEF MEDICAL OFFICER 514565 0 3684 0 7524 0 9275 0 23597 0 558645 0 0 0 ROBERT KORST MEDICAL DIRECTOR 990514 0 91500 0 2622 0 19875 0 34366 0 1138877 0 0 0 ALEX ZAPOLANSKI PHYSICIAN 1437483 0 0 0 14478 0 9275 0 23047 0 1484283 0 0 0 ANUSAK YIENGPRUKSAWAN PHYSICIAN 898903 0 0 0 7524 0 9275 0 8708 0 924410 0 0 0 THOMAS AHLBORN CHAIR, SURGICAL SERVICES 1492366 0 0 0 7524 0 9275 0 22343 0 1531508 0 0 0 MICHAEL RAHMIN PHYSICIAN 814628 0 182500 0 2622 0 0 0 30404 0 1030154 0 0 0 PART I, LINE 7 BONUS IS BASED ON PERFORMANCE AND IS DETERMINED BY THE BOARD OF TRUSTEES OR PHYSICIAN CONTRACTS. BONUS IS TAXABLE AND INCLUDED EACH OF THE RECIPIENT'S FORM W-2. BONUS CAN ALSO BE DEFERRED TO 457(F) PLAN AND 401(K) PLAN AND THUS IS NOT TAXABLE IN THE CURRENT YEAR. 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'S SUBMITTED TO CFO FOR REVIEW. ANY COMMENTS ARE SUMMARIZED AND PROVIDED TO CFO. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED 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 ANNUALLY. 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 AND CONFLICT OF INTEREST POLICY 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: STRATEGIC FUNDING FROM VALLEY HOSPITAL 51,170,415. INCOME FROM INVESTMENT IN ACO 1,818,503. CHANGE IN PRIOR YEAR ALLOWANCE AND REIMBURSEMENT ESTIMATES -4,787. CAPITAL STRATEGIC FUNDING FROM VALLEY HOSPITAL 6,301,548. CHANGE IN ASSETS HELD AT VALLEY HOSPITAL FOUNDATION 5,268,533. TRANSFERS TO VALLEY HOSPITAL -1,046,191. FORM 990, PART XI, LINE 2C THE PROCESS FOR SELECTING AN INDEPENDENT ACCOUNTANT AND ESTABLISHING A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM PRIOR YEARS. 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 TO ITS MEMBERS NJ 501(C)(3) LINE 7 N/A 0 VALLEY MEDICAL SERVICES 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 223260998 PROVIDE THE VALLEY HOSPITAL WITH EMPLOYED PHYSICIANS AND MEDICAL 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 SOLICIT, RECEIVE AND APPLY CONTRIBUTIONS FOR THE BENEFIT OF THE HOSPITAL NJ 501(C)(3) LINE 7 VALLEY HEALTH SYSTEM INC 0 VALLEY MEDICAL SERVICES PC 15 ESSEX ROAD PARAMUS NJ 07652 465297054 MEDICAL CARE NJ 501(C)(3) LINE 10 VALLEY HEALTH SYSTEM INC 0 VALLEY PHYSICIANS SERVICES PC 15 ESSEX ROAD PARAMUS NJ 07652 465285330 MEDICAL CARE NJ 501(C)(3) LINE 10 VALLEY HEALTH SYSTEM INC 0 VALLEY HEALTH MEDICAL GROUP OF NJPC 15 ESSEX ROAD PARAMUS NJ 07652 223475166 OPERATES URGENT/PRIMARY CARE CLINICS NJ N/A 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 VALLEY PHYSICIAN SERVICE NY PC 15 ESSEX ROAD PARAMUS NJ 07652 453125678 OPERATES URGENT/PRIMARY CARE CLINICS NY N/A 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1