2016-11-07T16:09:01-06:00 2015-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2015-01-01 112150953 LUTHERAN AUGUSTANA CENTER FOR EXTENDED CARE AND REHABILITATION INC LUTH 7186306000 5434 SECOND AVENUE BROOKLYN NY 11220 JEANNE LEE VICE PRESIDENT 7186306000 2016-10-13 1 ERIC GOLDFARB P01277125 2128674000 2015 2017-02-10 21:41:12Z JEANNE LEE 5434 SECOND AVENUE BROOKLYN NY 11220 31878995 0 X WWW.LUTHERANAUGUSTANACENTER.COM X 1968 NY TO PROVIDE SKILLED NURSING HOME CARE FOR THE ELDERLY AND DISABLED, RESTORATIVE REHABILITATION AND SUB ACUTE CARE AND VENTILATOR DEPENDANT CARE IN A 240-BED NURSING HOME FACILITY. 12 11 413 12 0 0 15561 642285 28780792 30905724 31744 27988 304783 302998 29132880 31878995 7000 7000 0 0 20524040 23263485 0 0 0 9315179 9130931 29846219 32401416 -713339 -522421 30971543 62997282 29205772 29954689 1765771 33042593 SEE SCHEDULE OTO FULFILL ITS MISSION, LUTHERAN AUGUSTANA CENTER FOR EXTENDED CARE AND REHABILITATION PLEDGES TO: - SERVE THE DIVERSE NEEDS OF OUR PATIENTS, THEIR FAMILIES AND THE COMMUNITY AT LARGE. -SUPPORT INDIVIDUALS IN REALIZING THEIR MAXIMUM POTENTIAL AND INDEPENDENCE WHILE ENRICHING THEIR LIVES WITH DIGNITY AND HONOR. 0 0 28468007 7000 30905724 IN 2015, LUTHERAN AUGUSTANA CENTER CONVERTED 12 OF ITS 240 SKILLED NURSING BEDS TO LICENSED VENTILATOR DEPENDENT BEDS. ALSO, AUGUSTANA CONTINUED TO INCREASE THE CAPACITY OF ITS SHORT TERM RESTORATIVE REHABILITATION AND MEDICALLY COMPLEX SUBACUTE CARE PROGRAMS. AUGUSTANA CONTINUES TO FOCUS ON INITIATIVES TO IMPROVE THE QUALITY OF CARE FOR ITS PATIENTS THROUGH THE PROGRESSIVE WOUND CARE PREVENTION AND TREATMENT PROGRAM, APPROPRIATE USAGE OF ANTIPSYCHOTIC MEDICATIONS, AND PALLIATIVE CARE AND HOSPICE PROGRAMS. THE CENTER PROVIDED 82,666 DAYS OF SKILLED NURSING CARE FOR THE YEAR ENDED DECEMBER 31, 2015. 28468007 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 413 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MICHAEL PAGANO 7186306014 5434 2ND AVENUE BROOKLYN NY 11220 REV DAVID H ROMMEREIM CHAIRPERSON 1.00 1.00 X X 0 0 0 PETER CLAVIN VICE CHAIRPERSON 1.00 X X 0 0 0 WENDY Z GOLDSTEIN VICE CHAIRPERSON OF OPERAT 1.00 35.00 X X 0 1278102 756807 BRENDA A GRANDELL SECRETARY 1.00 1.00 X X 0 0 0 HOWARD SMITH JR TREASURER 1.00 X X 0 0 0 ROBERT KASSENBROCK BOARD MEMBER 1.00 X 0 0 0 DONALD ENG ESQ BOARD MEMBER 1.00 X 0 0 0 FLORENCE SULLIVAN ESQ BOARD MEMBER 1.00 X 0 0 0 CRISTAL RIVERA BOARD MEMBER 1.00 X 0 0 0 LAWERENCE DIGIOVANNA ESQ BOARD MEMBER 1.00 X 0 0 0 REV KHADER EL'YATEEM BOARD MEMBER 1.00 X 0 0 0 CHESTER LEE BOARD MEMBER 1.00 X 0 0 0 JEANNE LEE VICE PRESIDENT 35.00 1.00 X 467497 0 41300 MICHAEL PAGANO SVP - FINANCE/CFO 35.00 1.00 X 248913 0 40371 ELENA N LOPEZ ASSOCIATE ADMINISTRATOR 35.00 X 214203 0 13566 MARGARET ALADE DIRECTOR OF NURSING 35.00 X 184147 0 18860 JOSE LABARCA DIRECTOR OF HUMAN RESOURCES 35.00 X 186535 0 11076 SUSAN VILLANUEVA MENDOZA MDS COORDINATOR 35.00 X 127879 0 32956 ELIZABETH BRILL DIRECTOR OF CHHA 8.00 27.00 X 30583 111545 13109 1459757 1389647 928045 24 0 1 0 LUTHERAN MEDICAL CENTER 150 55TH STREET BROOKLYN NY 11220 MANAGEMENT COMPANY 261434 CLEAN TEX SERVICES INC 1420 EAST LINDEN AVENUE LINDEN NJ 07036 LAUNDRY SERVICE 220689 LOEB & TROPER LLP 655 THIRD AVENUE NEW YORK NY 10017 ACCOUNTING AND CONSULTING 192521 CLIFTON BUDD & DEMARIA LLP 350 FIFTH AVENUE ROOM 6110 NEW YORK NY 10118 LEGAL SERVICES 180471 MEDICAL SOLUTIONS GROUP INC 100 BROADHOLLOW ROAD SUITE 105 FARMINGDALE NY 11735 RN RESPIRATORY SERVICES 172766 5 637314 4971 642285 PATIENT SERVICE REVENUE 623000 30905724 30905724 30905724 27988 27988 PARKING GARAGE 812930 263804 263804 REBATES 900099 25735 25735 MEDICAL RECORDS FEES 900099 6530 6530 6929 6929 302998 31878995 30905724 0 330986 7000 7000 798081 798081 16086111 14715285 1370826 1233873 1153144 80729 3806898 3735944 70954 1338522 1221162 117360 175850 175850 230315 230315 96970 96970 3246 3246 1437295 1102725 334570 3886 3886 2500978 1992830 508148 1609520 1572950 36570 6265 976 5289 1567540 1523579 43961 472117 415463 56654 ASSESMENT FEES 1026949 1026949 32401416 28468007 3933409 0 35270 1905512 3518688 1933061 6265089 7041506 667455 585404 44009415 1000674 12507787 43008741 1143000 7977254 7380058 30971543 62997282 5722996 7437740 209076 202043 22747289 22068241 526411 246665 29205772 29954689 X 1565229 32853821 200542 188772 1765771 33042593 30971543 62997282 X -522421 -11770 31811013 X X 0 1 X 1 1 1 X 36836 48707 24114 15561 4971 130189 34323230 34269688 32967866 28780792 30905724 161247300 34360066 34318395 32991980 28796353 30910695 161377489 0 0 0 161377489 27220 38807 34882 31744 27988 160641 27220 38807 34882 31744 27988 160641 316368 1219400 297945 304783 302998 2441494 34703654 35576602 33324807 29132880 31241681 163979624 0.98410 0.98440 0.00100 0.00100 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: PARKING REBATES MEDICAL RECORDS FEES VENDING EMPLOYEE MEALS TELEPHONE GAIN ON MORTGAGE REFINANCING RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3246 3246 0 PART II-B, LINE 1: PORTION OF MEMBERSHIP DUES ASSOCIATED WITH LOBBYING ACTIVITIES 0 1 X 23352000 23352000 19377599 710260 18667339 9954 1938 8016 1269862 288476 981386 43008741 ESCROW DEPOSITS 6322302 BENEFICIAL INTEREST IN PERPETUAL TRUST 143040 DUE FROM THIRD PARTY 914716 7380058 DUE TO THIRD PARTIES 246665 246665 X 31813569 -11770 -11770 31825339 53656 53656 31878995 32347760 0 32347760 53656 53656 32401416 PART IV, LINE 2B: LUTHERAN AUGUSTANA CENTER FOR EXTENDED CARE AND REHABILITATION, INC. ACTS AS A CUSTODIAN FOR PATIENTS' PERSONAL FUNDS. PART X, LINE 2: LUTHERAN AUGUSTANA CENTER FOR EXTENDED CARE AND REHABILITATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2012 AND SUBSEQUENT REMAIN SUBJECT TO REVIEW BY TAXING AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: PARKING GARAGE EXPENSES 53,656. PART XII, LINE 4B - OTHER ADJUSTMENTS: PARKING GARAGE EXPENSES 53,656. 1 NYU LUTHERAN MEDICAL CENTER 150 55TH STREET BROOKLYN NY 11220 111839567 501(C)(3) 7000 SUPPORT THE ORGANIZATION'S TAX-EXEMPT HEALTHCARE MISSION 1 0 PART I, LINE 2: ALL TRANSACTIONS, INCLUDING GRANT FUNDS, ARE CLOSELY MONITORED BY MANAGEMENT. THESE GRANTS ARE GIVEN TO MEMBERS OF THE SAME HEALTH SYSTEM, AND ALL FINANCIAL INFORMATION IS SHARED AND REVIEWED. X X X X 0 0 0 0 0 0 0 1 0 WENDY Z GOLDSTEIN VICE CHAIRPERSON OF OPERAT 0 1235097 0 0 0 43005 0 728319 0 28488 0 2034909 0 0 JEANNE LEE VICE PRESIDENT 395751 0 60000 0 11746 0 15900 0 25400 0 508797 0 0 0 MICHAEL PAGANO SVP - FINANCE/CFO 238996 0 0 0 9917 0 14194 0 26177 0 289284 0 0 0 ELENA N LOPEZ ASSOCIATE ADMINISTRATOR 211767 0 0 0 2436 0 12728 0 838 0 227769 0 0 0 MARGARET ALADE DIRECTOR OF NURSING 182370 0 0 0 1777 0 11036 0 7824 0 203007 0 0 0 JOSE LABARCA DIRECTOR OF HUMAN RESOURCES 186426 0 0 0 109 0 5999 0 5077 0 197611 0 0 0 SUSAN VILLANUEVA MENDOZA MDS COORDINATOR 127099 0 0 0 780 0 7804 0 25152 0 160835 0 0 0 ELIZABETH BRILL DIRECTOR OF CHHA 30583 110899 0 0 0 646 2264 10573 0 272 32847 122390 0 0 PART I, LINE 7 JEANNE LEE RECEIVED A BONUS OF $60,000 IN 2015. THE BONUS WAS DETERMINED BY THE BOARD OF DIRECTORS AND WAS BASED ON REACHING CERTAIN MILESTONES. FORM 990, PART VI, SECTION A, LINE 4 AS OF APRIL, 2015, LUTHERAN AUGUSTANA CENTER'S SOLE MEMBER CHANGED FROM NYU LUTHERAN MEDICAL CENTER TO NYU LANGONE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 6 AS OF APRIL, 2015, LUTHERAN AUGUSTANA CENTER'S SOLE MEMBER CHANGED FROM NYU LUTHERAN MEDICAL CENTER TO NYU LANGONE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A AS OF APRIL 1, 2015, LUTHERAN AUGUSTAN CENTER'S SOLE MEMBER CHANGED FROM NYU LUTHERAN MEDICAL CENTER TO NYU LANGONE HEALTH SYSTEM. NYU LANGONE HEALTH SYSTEM APPOINTS THE BOARD MEMBERS OF LUTHERAN AUGUSTANA CENTER. FORM 990, PART VI, SECTION A, LINE 7B AS OF APRIL, 2015, LUTHERAN AUGUSTAN CENTER'S SOLE MEMBER CHANGED FROM NYU LUTHERAN MEDICAL CENTER TO NYU LANGONE HEALTH SYSTEM. GOVERNANCE DECISIONS OF LUTHERAN AUGUSTANA CENTER ARE SUBJECT TO APPROVAL BY NYU LANGONE HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 11 DESCRIPTION OF THE PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW THE FORM 990: 1. THE ORGANIZATION'S FINANCE DEPARTMENT GATHERS THE SUPPORTING INFORMATION BASED ON THE FISCAL YEAR'S FINANCIAL ACTIVITY AND PRIOR YEAR REPORTING. 2. THE SUPPORTING INFORMATION IS PROVIDED TO THE ORGANIZATION'S EXTERNAL TAX ADVISOR FOR REVIEW AND COMMENT. 3. THE EXTERNAL TAX ADVISOR PREPARE A DRAFT RETURN WHICH IS THEN REVIEWED BY THE ORGANIZATION'S FINANCE DEPARTMENT THE NYU LANGONE HEALTH SYSTEM'S VICE PRESIDENT OF FINANCE AND CHIEF FINANCIAL OFFICER FOR COMPLETENESS AND ACCURACY. THIS IS AN ITERATIVE PROCESS WHICH MAY INVOLVE MORE THAN ONE REVIEW BY THE ORGANIZATION'S EXTERNAL TAX ADVISOR. 4. THE REVIEWED DRAFT IS PRESENTED TO THE NYU LANGONE HEALTH SYSTEM BOARD OF TRUSTEES' AUDIT COMMITTEE, AS WELL AS CERTAIN OTHER OFFICERS FOR REVIEW. 5. ONCE APPROVED BY THE AUDIT COMMITTEE, THE FORM 990 IS MADE AVAILABLE TO THE FULL BOARD AND THEN IT IS FORWARDED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C LUTHERAN AUGUSTANA CENTER REQUIRES ALL MEMBERS OF THE BOARD OF DIRECTORS AND OFFICERS TO COMPLETE AN ANNUAL CONFLICT OF INTEREST AND RELATED MATTERS DISCLOSURE STATEMENT ON AN ANNUAL BASIS. THIS DISCLOSURE STATEMENT IS MONITORED AND REVIEWED BY AUGUSTANA'S PRESIDENT. THIS DISCLOSURE STATEMENT WAS COMPLETED BY ALL MEMBERS OF THE BOARD OF DIRECTORS, AND OFFICERS, IN 2015. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING THE DISCLOSURE STATEMENTS AND, IF ANY SUSPECTED CONFLICTS ARE IDENTIFIED, REFERRING THE MATTER TO THE PRESIDENT TO DETERMINE WHETHER FURTHER INQUIRY IS REQUIRED. IF REQUIRED, THE MATTER IS REFERRED TO GENERAL COUNSEL FOR RESOLUTION. IF THERE IS A CONFLICT THE PRESIDENT WILL TAKE THE APPROPRIATE ACTION. AT NO TIME DURING THE PROCESS WILL THE PERSON WITH A CONFLICT OR POSSIBLE CONFLICT PARTICIPATE IN THE PROCEEDINGS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES OF LUTHERAN MEDICAL CENTER ENGAGES SULLIVAN COTTER AND ASSOCIATES, INC. TO PROVIDE LUTHERAN MEDICAL CENTER'S BOARD OF TRUSTEES WITH A REPORT THAT CONTAINS: A) A MARKET ANALYSIS OF THE TOTAL COMPENSATION LEVELS OF SENIOR EXECUTIVES IN RELATION TO THEIR PEERS IN THE MARKET PLACE, B) A REVIEW OF CURRENT COMPENSATION AND BENEFIT PLAN DESIGNS TO ENSURE THEIR COMPETITIVENESS TO THE MARKET PLACE, AND C) TO ENSURE COMPLIANCE WITH ANY STATE OR FEDERAL REGULATIONS. THE BOARD RELIES UPON THE DATA AND RECOMMENDATIONS PROVIDED BY SULLIVAN COTTER TO DETERMINE THE COMPENSATION LEVEL OF THE CEO. FOR OTHER KEY POSITIONS, THE COST OF LIVING ADJUSTMENTS IS THE SAME PERCENTAGE AS THOSE RECEIVED BY THE NON UNION STAFF BASED ON THE CURRENT BUDGET. THE BOARD CONDUCTS THIS PROCESS ANNUALLY. THIS PROCESS WAS LAST CONDUCTED IN 2015. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: PUSHDOWN ACCOUNTING ADJUSTMENT 31,811,013. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART XI, LINE 9 NYU LUTHERAN MEDICAL CENTER ENTERED INTO AN AFFILIATION AGREEMENT WITH NYU HOSPITALS CENTER. AS A RESULT, CERTAIN ASSETS OF LUTHERAN AUGUSTANA CENTER WERE ADJUSTED TO REFLECT THEIR FAIR MARKET VALUES AS OF APRIL 1, 2015. NEW YORK UNIVERSITY 726 BROADWAY NEW YORK NY 10003 135562308 UNIVERSITY NY 501(C)(3) LINE 2 N/A 0 NYU HOSPITALS CENTER 550 FIRST AVENUE NEW YORK NY 10016 133971298 HOSPITAL NY 501(C)(3) LINE 3 NYU LANGONE HEALTH SYSTEM 1 NYU LANGONE HEALTH SYSTEM 550 FIRST AVENUE NEW YORK NY 10016 472613531 SUPPORT ORG. 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NY 501(C)(3) LINE 11A, I NYU LUTHERAN MEDICAL CENTER 1 LMC PHYSICIAN SERVICES PC 150 55TH STREET BROOKLYN NY 11220 113192423 PHYSICIANS SERVICES NY 501(C)(3) LINE 11C, III-FI NYU LUTHERAN MEDICAL CENTER 1 SHORE ROAD RADIOLOGY ASSOCIATES PC 150 55TH STREET BROOKLYN NY 11220 112665457 HEALTHCARE NY 501(C)(3) LINE 11C, III-FI NYU LUTHERAN MEDICAL CENTER 1 LUTHERAN CHHA INC DBA LUTHERAN CARE AT HOME 5407 2ND AVENUE BROOKLYN NY 11220 462559181 HOME HEALTH AIDE AGENCY NY 501(C)(3) LINE 9 NYU LUTHERAN MEDICAL CENTER 1 SOUTHWEST BROOKLYN DENTAL PRACTICE PLLC 150 55TH STREET BROOKLYN NY 11220 472932907 DENTAL SERVICES NY 501(C)(3) LINE 9 NYU LUTHERAN MEDICAL CENTER 0 CCC 550 INSURANCE SCC 550 FIRST AVENUE NEW YORK NY 10016 PROF LIAB COVERAGE BB NYU HOSPITALS CENTER C 1.00000 0 INTERNATIONAL ART FUND C/O NYU 726 BROADWAY NEW YORK NY 10003 HOLDS STOCK IN LA PIETRA CORP. 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