2015-11-13T09:49:18-06:00 2014-12-31 420714325 RSM US LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2014-01-01 112164674 RUTLAND NURSING HOME INC RUTL 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 JOHN SCHMITT CFO 7186045532 2015-11-13 1 STEVEN LAPSKER P00850484 2123721000 2014 2016-04-25 22:37:26Z LINDA BRADY MD 585 SCHENECTADY AVENUE BROOKLYN NY 11203 64344428 0 X WWW.KINGSBROOK.ORG X 1971 NY OUR MISSION IS TO PARTNER WITH OUR CULTURALLY DIVERSE COMMUNITIES TO PROVIDE A CONTINUUM OF OUTSTANDING HEALTH CARE SERVICES TO INDIVIDUALS AND FAMILIES THROUGH A CARING AND TRUSTWORTHY STAFF. 7 6 0 71 0 0 1848788 482975 77036654 63756790 139563 104663 0 0 79025005 64344428 0 0 0 0 49209914 50052449 0 0 0 31976166 31793382 81186080 81845831 -2161075 -17501403 25044939 20905092 75259616 88621172 -50214677 -67716080 X OUR MISSION IS TO PARTNER WITH OUR CULTURALLY DIVERSE COMMUNITIES TO PROVIDE A CONTINUUM OF OUTSTANDING HEALTH CARE SERVICES TO INDIVIDUALS AND FAMILIES THROUGH A CARING AND TRUSTWORTHY STAFF. 0 0 70434761 63756790 RUTLAND NURSING HOME, LOCATED ON THE CAMPUS OF KINGSBROOK JEWISH MEDICAL CENTER, IS A 466-BED, LONG AND SHORT-TERM CARE FACILITY OFFERING SKILLED NURSING, PHYSICAL REHABILITATION, COMPREHENSIVE WOUND CARE, A SPECIALTY UNIT FOR VENTILATOR DEPENDENT RESIDENTS AND AN ARRAY OF OTHER SUB-ACUTE SERVICES. ALL THE RESOURCES OF THE MEDICAL CENTER, INCLUDING GENERAL MEDICAL AND SUB-SPECIALTIES, SURGICAL, ORTHOPEDIC, PSYCHIATRIC AND DENTAL SERVICES, AND THE EMERGENCY ROOM, ARE IMMEDIATELY AVAILABLE TO THE RESIDENTS. NURSING HOME RESIDENTS ARE EASILY TRANSFERRED TO THE ACUTE SERVICES OF THE HOSPITAL IF MEDICAL NECESSITY REQUIRES, AND SUBSEQUENTLY RETURNED TO THE NURSING HOME. RUTLAND NURSING HOME HAS A DEDICATED 32-BED PEDIATRIC LONG-TERM CARE UNIT FOR CHILDREN WITH SEVERE DEVELOPMENTAL AND METABOLIC DISORDERS. THE UNIT IS STAFFED WITH NURSES AND PEDIATRICIANS 24 HOURS A DAY, SEVEN DAYS A WEEK. MEDICAL CARE IN THE RUTLAND NURSING HOME IS COORDINATED BY PHYSICIANS EXPERIENCED AND DEDICATED TO PEDIATRICS AND GERIATRICS. ENCOURAGING THE RESIDENTS TO MAXIMIZE THEIR ABILITY TO LEAD ACTIVE AND FULFILLING LIVES, LICENSED NURSES AND THERAPISTS DELIVER STATE OF THE ART PHYSICAL, OCCUPATIONAL, RECREATIONAL AND SPEECH THERAPIES. TO ENSURE COMPREHENSIVE CARE, DIETICIANS AND SOCIAL WORKERS AUGMENT THE TREATMENT TEAM. 70434761 1 1 0 0 0 0 0 0 1 0 1 0 0 0 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 19 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 NY X JOHN SCHMITT 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 X EDWARD LIEBERSTEIN BOARD CHAIR 2.00 2.00 X X 0 0 0 SEEMA GOLDSTEIN VICE CHAIR & SECRETARY 1.50 2.00 X X 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 12.00 36.50 X X 0 888644 67642 HENNA WHITE BOARD DIRECTOR 3.00 5.50 X 0 0 0 ROBERT REISS TREASURER 1.50 2.00 X 0 0 0 VALERIE BYNOE-KASDEN ESQ BOARD DIRECTOR 1.00 1.00 X 0 0 0 VICTOR AYALA PHD BOARD DIRECTOR 2.00 3.00 X 0 0 0 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 12.00 36.50 X 0 364468 67642 MICHAEL MCDERMOTT THRU 52014 ASS'T SECRETARY & GENERAL COUNSEL 12.00 36.50 X 0 107005 27578 HAROLD MCDONALD THRU 42014 SVP 12.00 35.00 X 0 155140 941 MICHELLE EDWARDS ADMINISTRATOR 40.00 X 0 207030 55505 JOVILIA ATIENZA NURSE 40.00 X 0 127155 24946 FRITZIE PASCAL NURSE 40.00 X 0 125783 25082 JACQUELINE LAGUERRE NURSE 40.00 X 0 121858 25966 ESTER ILLASTRON NURSE 40.00 X 0 120387 24163 JEAN LACKAN NURSING COORDINATOR 40.00 X 0 119545 34303 0 2337015 353768 0 0 1 0 EXCLUSIVE AMBULETTE SVC INC PO BOX 476 LAWRENCE NY 11559 PATIENT TRANSPORTATION 338225 ROBIN BUS CO INC 2302 NEPTUNE AVENUE BROOKLYN NY 11224 PATIENT TRANSPORTATION 194345 2 482975 482975 NET PATIENT SERVICE REVENUE 623000 62181065 62181065 MEDICARE DRUG BILLING 524114 1575725 1575725 63756790 104663 104663 64344428 63756790 0 104663 254532 223988 30544 35353068 31110700 4242368 3442617 3029503 413114 8277949 7284595 993354 2724283 2397369 326914 1863115 1429009 434106 -23764 -23764 7958125 6085655 1872470 2262216 1735120 527096 2144922 1645155 499767 76689 58820 17869 630993 483972 147021 399347 306299 93048 MEDICAL & PHARMACEUTICA 4426736 4426736 NY STATE ASSESSMENT 3796738 2912098 884640 MAINT & REPAIRS 3638962 2791084 847878 BAD DEBT EXP 2499996 2499996 2119307 2014662 104645 81845831 70434761 11411070 0 4412440 3016705 254669 252000 9227755 8418991 43260067 34149646 8291185 9110421 678016 106975 2180874 0 25044939 20905092 1070689 864540 254670 252000 1479802 0 72454455 87504632 75259616 88621172 X -50214677 -67716080 -50214677 -67716080 25044939 20905092 -17501403 0 X 0 1 X 1 0 X 557793 1641893 1848788 482975 4531449 71238182 73386587 68198959 77036654 63756790 353617172 71238182 73944380 69840852 78885442 64239765 358148621 0 0 0 358148621 145757 142789 142919 139563 104663 675691 145757 142789 142919 139563 104663 675691 71383939 74087169 69983771 79025005 64344428 358824312 0.99810 0.99800 0.00190 0.00200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 825000 825000 35487625 28521562 6966063 6947442 5628084 1319358 9110421 DUE TO KINGSBROOK JEWISH MEDICAL CENTER 65772932 ESTIMATED THIRD PARTY SETTLEMENTS 21637385 FIN 47 LIABILITY 94315 87504632 X PART IV, LINE 2B: AS PER NYS DOH REGULATIONS, THE NURSING HOME IS REQUIRED TO ESTABLISH AN IN-HOUSE PATIENT BANKING ACCOUNT FOR THE RESIDENTS TO USE WHILE THEY ARE LIVING AT THE NURSING HOME. THESE FUNDS ARE KEPT IN A SEPARATE CUSTODIAL ACCOUNT AT STERLING BANK. PART X, LINE 2: THE COMPANY IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"). ADDITIONALLY, THE COMPANY, AS A NONPROFIT ENTITY, IS SUBJECT TO UNRELATED BUSINESS INCOME TAX ("UBIT"), IF APPLICABLE. FOR THE TAX YEARS ENDED DECEMBER 31, 2014 AND 2013, THE COMPANY DID NOT OWE ANY UBIT. MANAGEMENT EVALUATED THE COMPANY'S TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT THE COMPANY HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ACCOUNTING STANDARDS CODIFICATION ("ASC") 740, ACCOUNTING FOR INCOME TAXES. GENERALLY, THE COMPANY IS SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS ENDED DECEMBER 31, 2011 AND THEREAFTER. PER THE REQUIREMENT TO ASSESS FOR TAX UNCERTAINTY, MANAGEMENT HAS DETERMINED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED. 0 0 0 0 0 0 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 0 800153 0 0 0 88491 0 24700 0 42942 0 956286 0 0 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 0 341434 0 0 0 23034 0 24700 0 42942 0 432110 0 0 HAROLD MCDONALD THRU 42014 SVP 0 153453 0 0 0 1687 0 0 0 941 0 156081 0 0 MICHELLE EDWARDS ADMINISTRATOR 0 205343 0 0 0 1687 0 20268 0 35237 0 262535 0 0 JOVILIA ATIENZA NURSE 0 127155 0 0 0 0 0 9100 0 15846 0 152101 0 0 FRITZIE PASCAL NURSE 0 125783 0 0 0 0 0 9100 0 15982 0 150865 0 0 JEAN LACKAN NURSING COORDINATOR 0 119545 0 0 0 0 0 12840 0 21463 0 153848 0 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE ORGANIZATION: KINGSBROOK HEALTHCARE SYSTEM ("KHS") IS THE SOLE MEMBER OF RUTLAND NURSING HOME INC. FORM 990, PART VI, SECTION A, LINE 7A ELECTION & DECISIONS OF THE GOVERNING BODY: KHS IS THE SOLE MEMBER OF RUTLAND NURSING HOME, INC., AND IT HAS RESERVED POWERS THAT ARE DELINEATED IN THE BYLAWS OF RUTLAND NURSING HOME INC. FORM 990, PART VI, SECTION A, LINE 7B ELECTION & DECISIONS OF THE GOVERNING BODY: KHS IS THE SOLE MEMBER OF RUTLAND NURSING HOME, INC., AND IT HAS RESERVED POWERS THAT ARE DELINEATED IN THE BYLAWS OF RUTLAND NURSING HOME INC. FORM 990, PART VI, SECTION B, LINE 11 REVIEW PROCESS FOR FORM 990: THE CFO HAS CONDUCTED A DETAILED REVIEW OF THE 990 WITH THE HOSPITAL'S TAX ACCOUNTANT AND ALL APPROPRIATE CHANGES HAVE BEEN MADE. THE 990 IS THEN REVIEWED WITH THE CEO FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS. THE 990 IS THEN REVIEWED WITH THE AUDIT CHAIR AND THEN PRESENTED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS. ONCE COMPLETED AND FILED, FORM 990 IS MADE AVAILABLE TO THE FULL BOARD BY THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12 CONFLICT OF INTEREST POLICY: RUTLAND NURSING HOME, INC FOLLOWS KINGSBROOK JEWISH MEDICAL CENTER'S CONFLICT OT INTEREST POLICY. AT KINGSBROOK JEWISH MEDICAL CENTER, ALL CONFLICTS OF INTEREST ARE REVIEWED BY THE COMPLIANCE OFFICER. ANY POTENTIAL CONFLICTS INVOLVING BOARD MEMBERS ARE REFERRED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW AND/OR ACTION, AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION POLICY AND REVIEW PROCESS: RUTLAND NURSING HOME, INC. DID NOT PAY COMPENSATION DIRECTLY FOR ITS EMPLOYEES. THE COMPENSATION AND BENEFITS ARE PAID THROUGH KINGSBROOK JEWISH MEDICAL CENTER'S PAYROLL SYSTEM AND ARE RECORDED ON THE FORM 941 FILED BY KINGSBROOK JEWISH MEDICAL CENTER UNDER THE EMPLOYER INDENTIFICATION NUMBER 11-1631759. THE COMPENSATION OF EXECUTIVE OFFICERS IS REVIEWED ANNUALLY BY KINGSBROOK JEWISH MEDICAL CENTER (KJMC). FOLLOWING BELOW PROCESS: CONSISTENT WITH BEST PRACTICES IN GOVERNANCE AND FIDUCIARY OVERSIGHT OF TAX EXEMPT FUNDS, KINGSBROOK JEWISH MEDICAL CENTER (KJMC) HAS INSTITUTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. THE COMPENSATION COMMITTEE IS AUTHORIZED BY THE BOARD TO DEVELOP AND RECOMMEND FOR BOARD APPROVAL THE COMPENSATION OF THE PRESIDENT AND CEO AND MEMBERS OF SENIOR MANAGEMENT (SENIOR VICE PRESIDENTS, VICE PRESIDENTS AND ASSISTANT VICE PRESIDENTS). ONLY INDEPENDENT MEMBERS OF THE BOARD SHALL PARTICIPATE IN COMPENSATION DELIBERATIONS AND DECISIONS (I.E., EMPLOYEES, MEMBERS OF THE MEDICAL STAFF AND CONSULTANTS ARE NOT DEEMED INDEPENDENT FOR THESE PURPOSES). ALL EXECUTIVE COMPENSATION DECISIONS ARE BASED ON COMPETITIVE MARKET DATA, ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE RESULTS, AND ALIGNMENT WITH KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY. THE BOARD'S COMPENSATION COMMITTEE REVIEWS AND APPROVES ALL EXECUTIVE COMPENSATION TO ENDURE LEGAL AND REGULATORY COMPLIANCE AND ADHERENCE TO GOVERNANCE BEST PRACTICES AND PROPER FIDUCIARY OVERSIGHT AS STEWARDS OF TAX EXEMPT ASSETS. THE EXECUTIVE COMPENSATION PHILOSOPHY STATES ITS INTENT IS TO MAINTAIN A COMPETITIVE EXECUTIVE COMPENSATION PROGRAM IN ORDER TO ATTRACT, RETAIN AND MOTIVATE QUALIFIED EMPLOYEES TO SUPPORT THE MISSION AND BUSINESS GOALS OF KJMC. THE COMPENSATION COMMITTEE RETAINS OUTSIDE LEGAL COUNSEL WHO REVIEWS COMPLIANCE WITH TAX AND REGULATORY REQUIREMENTS AS WELL AS THE SERVICES OF AN INDEPENDENT QUALIFIED COMPENSATION CONSULTANT WHO COMPILES AND ANALYZES PUBLISHED SURVEY - DATA FOR BASE SALARIES AND TOTAL COMPENSATION PROVIDED BY TAX EXEMPT HOSPITALS AND MEDICAL CENTERS SIMILAR TO KJMC IN SIZE, OPERATIONS AND LOCATION. THE COMMITTEE'S REVIEW OF COMPENSATION OCCURS ANNUALLY SUCH THAT EXECUTIVE COMPENSATION AND BENEFITS CONTINUE TO BE COMPETITIVE AND REASONABLE BY FOLLOWING THE PRECEDING GOVERNANCE AND FIDUCIARY PRACTICES, THE COMMITTEE QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS REGULATIONS OF THE INTERNAL REVENUE CODE SUCH THAT THE TOTAL COMPENSATION PROVIDED TO THE EXECUTIVES IS COMPARED TO WHAT IS "ORDINARILY PAID FOR LIKE SERVICES BY LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES," AS DEFINED IN THE INTERMEDIATE SANCTIONS REGULATIONS. BASE PAY FOR EACH EXECUTIVE IS BASED ON FACTORS INCLUDING MARKET DATA, TENURE, EXPERIENCE, AND INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. EXECUTIVE BASE PAY IS REVIEWED AND SET ANNUALLY BY THE INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE OF THE INDEPENDENT DIRECTORS OF KINGSBROOK JEWISH MEDICAL CENTER (KJMC), BASED ON THE EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. AS DESCRIBED IN KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER, KJMC SUPPORTS PERFORMANCE BASED COMPENSATION AND THEREFORE HAS IMPLEMENTED AN ANNUAL INCENTIVE PAY PROGRAM (EXECUTIVE MANAGEMENT ANNUAL INCENTIVE PLAN) FOR THE EXECUTIVES, WHICH IS CURRENTLY SUSPENDED, AND A LONG-TERM INCENTIVE PAY PROGRAM (ANNUALIZED STRATEGIC PERFORMANCE INCENTIVE) FOR THE PRESIDENT AND CEO. THE ANNUAL AND LONG-TERM INCENTIVE PAY PROGRAMS ARE DESIGNED TO SUPPORT THE ATTAINMENT OF ANNUAL AND STRATEGIC PERFORMANCE OBJECTIVES AND REFLECT A COMBINATION OF FORMULAIC WEIGHTINGS PROVIDING FOR THRESHOLD, TARGET AND MAXIMUM BONUS LEVELS AND DISCRETIONARY JUDGMENT AS DETERMINED BY THE COMPENSATION COMMITTEE. THE PERFORMANCE MEASURES ARE SET PRIOR TO THE BEGINNING OF EACH PLAN YEAR AND PLAN PAYMENTS ARE DETERMINED BASED ON AUDITED FINANCIAL RESULTS AND OTHER MEASURES. THE PROCESS USED FOR DETERMINING THE COMPENSATION OF THE CEO ALSO APPLIES TO MEMBERS OF THE EXECUTIVE STAFF, DEPARTMENT CHAIRS AND OTHER HIGHLY COMPENSATED STAFF EXCEPT THAT THE PRESIDENT AND CEO MAKES COMPENSATION RECOMMENDATIONS TO THE COMPENSATION SUBCOMMITTEE FOR THOSE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION: UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS. FORM 990, PART VI, LINE 13 WHISTLEBLOWER POLICY: KINGSBROOK JEWISH MEDICAL CENTER HAS A WRITTEN WHISTLEBLOWER POLICY WHICH APPLIES TO THE ACTIVITIES OF RUTLAND NURSING HOME INC. FORM 990, PART VI, LINE 14 DOCUMENT RETENTION POLICY: KINGSBROOK JEWISH MEDICAL CENTER'S DOCUMENT RETENTION AND DESTRUCTION POLICY APPLIES TO ALL BOOKS AND RECORDS HELD BY RUTLAND NURSING HOME INC. FORM 990, PART VII, LINE 2 RUTLAND NURSING HOME, INC. DOES NOT DIRECTLY PAY ITS EMPLOYEES. THE COMPENSATION AND BENEFITS ARE ALLOCATED FROM KINGSBROOK JEWISH MEDICAL CENTER. THE COMPENSATION AND BENEFITS ARE RECORDED ON FORM 941 FILED BY KINGSBROOK JEWISH MEDICAL CENTER UNDER EMPLOYER IDENTIFICATION NUMBER 11-1631759. KINGSBROOK JEWISH MEDICAL CENTER (KJMC) 585 SCHENECTADY AVENUE BROOKLYN NY 11203 111631759 HOSPITAL NY 501(C)(3) LINE 3 KHS 0 KINGSBROOK JEWISH MEDICAL CENTER AUXILIARIES 585 SCHENECTADY AVENUE BROOKLYN NY 11203 113016121 SUPPORT ORG NY 501(C)(3) LINE 11A, I KJMC 0 KINGSBROOK HEALTHCARE SYSTEM INC (KHS) 585 SCHENECTADY AVENUE BROOKLYN NY 11203 030464734 SUPPORT ORG NY 501(C)(3) LINE 11A, I N/A 0 KINGSBROOK HEALTHCARE FOUNDATION INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 112845058 SUPPORT ORG NY 501(C)(3) LINE 11A, I KHS 0 KSI INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327654 INACTIVE NY N/A C 0 SINGULAB INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327669 INACTIVE DE N/A C 0 ATM NURSE REGISTRY 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327649 INACTIVE NY N/A 0 KINGSBROOK LTACH INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 800712226 INACTIVE NY N/A C 0 KINGSBROOK MEDICAL ASSOCIATES PC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 452351859 BILLING & COLLECTION NY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0