2015-06-16T14:03:42-05:00 2014-12-31 271728945 O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2014-01-01 311587828 MICHAEL MALOTZ SKILLED NURSING PAVILION MICH 9149643333 120 ODELL AVENUE YONKERS NY 107011408 MARK POHAR ADMINISTRATOR 9149643333 2015-06-16 1 GARRETT M HIGGINS P00543209 9143818900 2015-06-16 2014 2016-04-25 22:37:26Z MARK POHAR 120 ODELL AVENUE YONKERS NY 107011408 15840591 0 X WWW.RIVERSIDEHEALTH.ORG X 1998 NY RIVERSIDE HEALTH CARE SYSTEM, INC. WHICH INCLUDES ST. JOHN'S RIVERSIDE HOSPITAL (SJRH) AND MICHAEL MALOTZ SKILLED NURSING PAVILION ("PAVILION") IS DEDICATED TO PROVIDING COMPREHENSIVE MEDICAL CARE IN A COMPASSIONATE, PROFESSIONAL, RESPECTFUL AND ETHICAL MANNER TO EVERY PATIENT. BY OFFERING EXCELLENCE IN MEDICAL AND NURSING CARE, STATE-OF-THE-ART TECHNOLOGIES, CONTINUING EDUCATION AND PREVENTIVE SERVICES, WE ARE COMMITTED TO IMPROVING THE CARE WE PROVIDE AND THE QUALITY OF LIFE IN OUR COMMUNITY. WE ARE OPEN TO NEW IDEAS, DIRECTIONS AND INITIATIVES THAT MOST EFFECTIVELY RESPOND TO COMMUNITY HEALTH CARE NEEDS. 6 6 239 7 0 0 6621 210 16349225 15787389 23516 19298 51149 33694 16430511 15840591 0 0 0 0 10683483 10335686 0 0 0 6598050 7282163 17281533 17617849 -851022 -1777258 18993321 13918706 22793684 19496327 -3800363 -5577621 TO PROVIDE SKILLED NURSING AND REHABILITATION SERVICES TO GERIATRIC, SUBACUTE AND VENTILATOR DEPENDENT RESIDENTS. 0 0 16033389 15787389 SKILLED NURSING, REHABILITATION AND ANCILLARY SERVICES PROVIDED TO GERIATRIC, SUB-ACUTE AND VENTILATOR DEPENDENT RESIDENTS. PATIENT DAYS OF CARE FOR THE YEAR WAS 40,215: GERIATRIC DAYS OF 37,960 AND VENTILATOR DEPENDENT DAYS OF 2,735. THE NUMBER OF RESIDENTS SERVED IN 2014 WAS 585: 578 GERIATRIC AND 7 VENTILATOR DEPENDENT RESIDENTS. 16033389 1 0 0 1 0 0 0 0 1 0 1 0 0 1 1 1 1 0 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 14 0 239 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X SHERWIN CHUE 9149643333 120 ODELL AVENUE YONKERS NY 107011408 ALFRED M GOMEZ MD CHAIRMAN 0.30 X X 0 0 0 ANIL M JOSHI MD VICE CHAIRMAN 0.30 X X 0 0 0 KEVIN T FAY TRUSTEE 0.30 1.00 X 0 0 0 ROYDEN LETSEN TRUSTEE THRU 2014 0.30 1.00 X 0 0 0 RICHARD PETERSON TRUSTEE 0.30 X 0 0 0 DIANE SKALICKY TRUSTEE 0.30 X 0 0 0 RICHARD KOMOSINSKY TRUSTEE 0.30 1.00 X 0 0 0 MARK POHAR ADMINISTRATOR 37.50 X 218530 0 61869 SHERWIN CHUE CONTROLLER 30.00 7.50 X 196380 0 53781 SHARON CARBERRY NURSING SUPERVISOR 37.50 X 120530 0 46344 RUTH ARCIGAL DIRECTOR OF NURSING 37.50 X 106618 0 33152 DELBERT CARTER RN 37.50 X 105486 0 53041 747544 0 248187 5 0 1 0 ST JOHN'S RIVERSIDE HOSPITAL 967 N BROADWAY YONKERS NY 10701 VARIOUS SERVICES: DIETARY, LAB, LAUNDRY, 1211303 EMB PHYSICAL THERAPY PO BOX 273 HARTSDALE NY 10530 OCCUPATIONAL THERAPY 149762 MITCHELLMARTIN INC 307 W 38TH ST 1305 NEW YORK NY 10018 PHYSICAL THERAPY 109066 3 210 210 MEDICAID 623000 8259181 8259181 MEDICARE 623000 4553487 4553487 COMMERCIAL INSURANCE 623000 1814167 1814167 PRIVATE PAY 623000 1160554 1160554 15787389 19298 19298 EMPLOYEE PARKING 812930 17796 17796 REBATE 900099 13180 13180 VENDING MACHINES 900099 1836 1836 882 882 33694 15840591 15787389 0 52992 X 499241 499241 6938256 6778189 160067 939657 921009 18648 1152555 1104123 48432 805977 731011 74966 121605 121605 49500 49500 2424 2424 1959882 1433218 526664 167 167 393454 375848 17606 47542 47542 1035432 1012098 23334 1444 876 568 104956 101646 3310 766562 742388 24174 267454 253533 13921 BAD DEBT EXPENSE 845820 845820 MEDICAL SUPPLIES 812567 812567 NYS CASH ASSESSMENT 703008 703008 REPAIRS AND MAINTENANCE 118732 118732 51614 51614 17617849 16033389 1584460 0 69644 612621 37795 37985 2948195 2856344 10560 10339 81445 231443 20791220 14363869 7133756 6427351 8711926 3742623 18993321 13918706 1531430 1404464 219864 144501 11585886 11209115 9456504 6738247 22793684 19496327 X -3800363 -5577621 -3800363 -5577621 18993321 13918706 -1777258 0 X X 0 1 X 1 1 1 X 7109 50565 3537 6621 210 68042 13592296 14916272 15330802 16349225 15787389 75975984 13599405 14966837 15334339 16355846 15787599 76044026 1325 4420 950 3150 9845 0 1325 4420 950 3150 9845 76034181 45935 41336 29148 23516 19298 159233 45935 41336 29148 23516 19298 159233 35473 28250 35112 51149 33694 183678 13680813 15036423 15398599 16430511 15840591 76386937 0.99540 0.99470 0.00210 0.00280 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: VENDING MACHINES INCOME - 2010 AMOUNT: $ 2,551. 2013 AMOUNT: $ 1,937. 2014 AMOUNT: $ 1,836. CASH DISCOUNT - 2010 AMOUNT: $ 242. MEDICAL ABSTRACTION FEES - 2010 AMOUNT: $ 4,716. 2013 AMOUNT: $ 7. REFUNDS AND REBATES - 2010 AMOUNT: $ 6,015. 2011 AMOUNT: $ 8,089. 2012 AMOUNT: $ 3,863. 2013 AMOUNT: $ 9,179. 2014 AMOUNT: $ 13,180. SOLD SERVICES - 2010 AMOUNT: $ 9,000. EMPLOYEE PARKING FEES - 2010 AMOUNT: $ 12,949. 2011 AMOUNT: $ 19,195. 2012 AMOUNT: $ 19,700. 2013 AMOUNT: $ 19,097. 2014 AMOUNT: $ 17,796. OTHER - 2011 AMOUNT: $ 966. 2012 AMOUNT: $ 11,549. 2013 AMOUNT: $ 1,967. 2014 AMOUNT: $ 882. TELEPHONE/TELEVISION INCOME - 2013 AMOUNT: $ 18,962. 0 0 0 0 0 0 0 0 1 2424 2424 0 PART II-B, LINE 1: COSTS ARE INCURRED AS PART OF DUES PAID TO NURSING HOME INDUSTRY ORGANIZATIONS AND UNIONS (1199). 0 1 X 10 10 18021786 12231447 5790339 2769424 2132422 637002 6427351 DUE FROM THIRD PARTY PAYORS 406918 ASSETS LIMITED AS TO USE - CASH AND CASH EQUIVALENTS 2568204 RESIDENT FUNDS 144501 INSURANCE RECOVERY RECEIVABLE 623000 3742623 DUE TO THIRD PARTY PAYORS 696916 DUE TO ST. JOHN'S RIVERSIDE HOSPITAL 5418331 PROFESSIONAL LIABILITIES 623000 6738247 X 15840591 0 15840591 0 15840591 17617849 0 17617849 0 17617849 PART IV, LINE 2B: RESIDENTS' FUNDS ARE HELD BY THE PAVILION ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT ALLOWANCES RECEIVED BY RESIDENTS AS WELL AS OTHER RESIDENTS' FUNDS DEPOSITED WITH THE PAVILION FOR SAFEKEEPING. THESE FUNDS ARE DISBURSED BY THE PAVILION AT THE REQUEST OF, OR ON BEHALF OF RESIDENTS FOR THEIR PERSONAL USE. PART X, LINE 2: THE PAVILION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE PAVILION HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE PAVILION IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2011. X X 0 0 0 0 0 0 0 1 0 MARK POHAR ADMINISTRATOR 218530 0 0 0 0 0 34983 0 26886 0 280399 0 0 0 SHERWIN CHUE CONTROLLER 196380 0 0 0 0 0 25619 0 28162 0 250161 0 0 0 SHARON CARBERRY NURSING SUPERVISOR 120530 0 0 0 0 0 20851 0 25493 0 166874 0 0 0 DELBERT CARTER RN 105486 0 0 0 0 0 16643 0 36398 0 158527 0 0 0 PART I, LINE 7 ANNUAL MEMBERSHIP DUES ARE PAID TO SEVERAL PROFESSIONAL ASSOCIATIONS AND ORGANIZATIONS ON BEHALF OF MARK POHAR AND SHERWIN CHUE. FORM 990, PART VI, SECTION A, LINE 6 RIVERSIDE HEALTH CARE SYSTEM, INC. IS THE SOLE MEMBER OF THE PAVILION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE PAVILION HAS THE POWER TO ELECT AND REMOVE THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B RESERVED POWERS OF MEMBER THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER, AND NO ATTEMPTED EXERCISE OF ANY SUCH POWERS BY ANYONE OTHER THAN THE MEMBER SHALL BE VALID OR OF ANY FORCE OR EFFECT WHATSOEVER: (A) POWER TO ELECT AND REMOVE THE BOARD OF TRUSTEES (B) POWER TO AMEND THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE CORPORATION (C) POWER TO ACQUIRE, ALIENATE, CONVEY OR MORTGAGE THE REAL PROPERTY, ENDOWMENT FUNDS OR OTHER PERMANENT ASSETS OF THE CORPORATION (D) POWER TO DISPOSE OF ALL OR SUBSTANTIALLY ALL OF THE PHYSICAL ASSETS OF THE CORPORATION PROVIDED THAT THE BOARD OF TRUSTEES SHALL HAVE THE RIGHT TO APPROVE CERTIFICATE OF NEED APPLICATIONS FILED BY OR ON BEHALF OF THE CORPORATION AND THE RELATED USE OF ASSETS. (E) POWER TO AUTHORIZE THE ESTABLISHMENT OF SUBSIDIARY AND SPONSORED CORPORATIONS AND TO APPROVE THE INITIAL CERTIFICATE OF INCORPORATION AND BYLAWS OF SUCH ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE IRS FORM 990 IS PREPARED BY THE CONTROLLER OF MICHAEL MALOTZ SKILLED NURSING PAVILION AND REVIEWED BY THE CHIEF FINANCIAL OFFICER OF RIVERSIDE HEALTH CARE SYSTEM, INC. THE OUTSIDE ACCOUNTING FIRM THEN REVIEWS THE DRAFT FORM 990 BEFORE A COPY IS PROVIDED TO THE BOARD. THE DRAFT WAS PROVIDED BY EMAIL TO ALL BOARD TRUSTEES BEFORE ITS BOARD MEETING. THE IRS FORM 990 WAS REVIEWED AND DISCUSSED IN DETAIL AT THE MEETING PRIOR TO FILING THE FORM WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENTS ARE SENT BY ST. JOHN'S RIVERSIDE HOSPITAL'S DIRECTOR OF PERFORMANCE IMPROVEMENT (COMPLIANCE OFFICER) TO ALL DEPARTMENT HEADS, KEY EMPLOYEES AND BOARD TRUSTEES ANNUALLY AT THE END OF THE FISCAL YEAR, WITH THE EXPECTATION THAT THEY BE RETURNED TO THE COMPLIANCE OFFICER IN JANUARY OF THE FOLLOWING YEAR. WHEN RETURNED, THE STATEMENTS ARE REVIEWED BY THE COMPLIANCE OFFICER. ALL INFORMATION IS KEPT CONFIDENTIAL AND STATEMENTS ARE MAINTAINED IN THE COMPLIANCE OFFICE. THE COMPLIANCE OFFICER WILL CONSULT WITH OUTSIDE COUNSEL AS NECESSARY CONCERNING ANY POTENTIAL PROBLEMS OR POSSIBLE CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER WILL REPORT ANY CONFLICTS OF INTEREST OR POSSIBLE CONFLICTS OF INTEREST TO THE THE BOARD OF TRUSTEES FOR REVIEW. THE INDIVIDUAL WITH THE CONFLICT WILL BE EXCUSED FROM VOTING ON THE MATTER IN WHICH A DECISION IS MADE ON HOW TO PROCEED WITH THE POTENTIAL CONFLICT. ANY DECISION MADE BY THE BOARD IS DOCUMENTED IN THE MINUTES TO THAT MEETING. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION CONTRACTS WITH AN INDEPENDENT THIRD PARTY TO BRING THE COMPENSATION LEVELS TO A COMPETITIVE LEVEL IN THE MARKET AREA. A REQUEST FOR PROPOSAL FOR AN EXECUTIVE COMPENSATION SURVEY IS INITIATED BY HUMAN RESOURCES TO FIND A VENDOR WHO COULD PROVIDE A COMPREHENSIVE REVIEW AND COMPARISON OF THE SALARY AND BENEFITS RIVERSIDE HEALTH CARE SYSTEMS INC. AND ITS AFFILIATES SHOULD BE PROVIDING ITS EXECUTIVES WHILE MEETING ALL LEGAL AND ANTI-TRUST REQUIREMENTS. THIS SURVEY IS TO IDENTIFY THE BASE COMPENSATION, INCENTIVE COMPENSATION AND NON-CASH COMPENSATION FOR LIKE POSITIONS IN THE COMPETING WESTCHESTER COUNTY, NEW YORK AREA. THE AREAS THAT WOULD BE EVALUATED INCLUDE: NURSING HOME ADMINISTRATOR, AND CONTROLLER. THE REQUEST FOR PROPOSAL GETS SENT TO EIGHT COMPANIES WITH A KNOWN TRACK RECORD IN COMPENSATION CONSULTING. EACH OF THE VENDORS RESPONDS WITH THE DETAILED ANALYSIS THAT THEY WILL PROVIDE AND THE COST ASSOCIATED WITH THE PROCESS. BASED ON THE TIMEFRAME AND THE COST, A VENDOR IS CHOSEN TO PERFORM THE EXECUTIVE COMPENSATION SURVEY. A PROPOSAL IS PRESENTED TO INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES PERSONNEL AND COMPENSATION COMMITTEE FOR APPROVAL. THE PERSONNEL AND COMPENSATION COMMITTEE CONTEMPORANEOUSLY DOCUMENTS ITS FINDINGS IN ITS MINUTES. INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES MAKE THE DECISION ON APPROVING THE SALARY CHANGES. AN EXECUTIVE COMPENSATION REVIEW TOOK PLACE IN SPRING 2013; THERE WERE NO SALARY INCREASES AWARDED IN 2014. FORM 990, PART VI, SECTION C, LINE 18 THE PAVILLION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. THE PAVILION'S FORM 990 IS ALSO AVAILABLE ON GUIDESTAR'S WEBSITE, AND OTHER SIMILAR TYPES OF WEBSITES. FORM 990, PART VI, SECTION C, LINE 19 THE MICHAEL MALOTZ SKILLED NURSING PAVILION (PAVILION) MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. THE PAVILION ALSO FILES AN ANNUAL COST REPORT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH WHICH CONTAINS FINANCIAL STATEMENTS AND RELATED NOTE DISCLOSURES, WHICH IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 17,585. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,585. LAUNDRY: PROGRAM SERVICE EXPENSES 139,847. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 139,847. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 412,554. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 412,554. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 108,488. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,488. ADMINISTRATIVE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 509,079. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 509,079. CORPORATE HEALTHCARE SERVICES: PROGRAM SERVICE EXPENSES 40,260. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,260. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 286,387. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 286,387. OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 352,930. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 352,930. SPEECH THERAPY: PROGRAM SERVICE EXPENSES 40,582. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,582. AUDIOLOGY CONSULTANTS: PROGRAM SERVICE EXPENSES 17,150. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,150. PHARMACY CONSULTANTS: PROGRAM SERVICE EXPENSES 25,920. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,920. QUALITY ASSURANCE CONSULTANTS: PROGRAM SERVICE EXPENSES 9,100. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,100. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTING FIRM. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ST JOHN'S RIVERSIDE HOSPITAL 967 NORTH BROADWAY YONKERS NY 10701 131740126 HOSPITAL NY 501(C)(3) LINE 3 RIVERSIDE HEALTH CARE SYSTEM INC 0 RIVERSIDE HEALTH CARE SYSTEM INC 967 NORTH BROADWAY YONKERS NY 10701 133237215 HOSPITAL NY 501(C)(3) LINE 7 N/A 0 VALENTINE LANE FAMILY PRACTICE 120 ODELL AVENUE YONKERS NY 10701 133520368 CLINIC FOR ST. JOHN'S RIVERSIDE HOSPITAL NY 501(C)(3) LINE 3 RIVERSIDE HEALTH CARE SYSTEM INC 0 RIVERSIDE HEALTH CARE FOUNDATION 128 ASHFORD AVENUE DOBBS FERRY NY 10522 133971735 FUNDRAISING NY 501(C)(3) LINE 11D, III-O ST JOHN'S RIVERSIDE HOSPITAL 0 SJR MEDICAL PC 967 NORTH BROADWAY YONKERS NY 10701 134185781 MEDICAL SERVICES NY ST JOHNS RIVERSIDE HOSPITAL C 0 RIVER MANAGEMENT INC 967 NORTH BROADWAY YONKERS NY 10701 133474004 MANAGEMENT NY RIVERSIDE HEALTH CARE SYSTEM C 0 RIVERSIDE HEALTH CARE SYSTEM BERMUDA 967 NORTH BROADWAY YONKERS NY 10701 133237215 INSURANCE BD RIVERSIDE HEALTH CARE SYSTEM C 0 RIVERSIDE MANAGEMENT SERVICES ORGANIZATION 967 NORTH BROADWAY YONKERS NY 10701 133846601 MANAGEMENT NY RIVERSIDE HEALTH CARE SYSTEM C 0 SMITHERS FUND FOR ALCOHOLISM PREVENTATION 967 NORTH BROADWAY YONKERS NY 10701 273308526 ALCOHOL RECOVERY NY RIVERSIDE HEALTH CARE SYSTEM C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0