2014-11-14T10:33:00-06:00 2013-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2013-01-01 272021133 EXTRAORDINARY HOME CARE EXTR 7182818777 29-01 216TH STREET BAYSIDE NY 11360 EDWIN F SIMPSER MD PRESIDENT AND CEO 7182818777 2014-11-04 1 ISRAEL TANNENBAUM P01589203 2128674000 2013 2015-11-30 17:44:51Z ST MARY'S HOME CARE EDWIN F SIMPSER MD 29-01 216TH STREET BAYSIDE NY 11360 26172598 0 X WWW.STMARYSKIDS.ORG X 2010 NY A CERTIFIED HOME HEALTH AGENCY (CHHA) PROVIDING HOME-BASED THERAPY AND RELATED SERVICES TO CHILDREN AND YOUNG ADULTS WITH SPECIAL NEEDS. 4 1 122 1 0 0 0 280078 18980600 25888538 45 3982 0 0 18980645 26172598 0 0 0 0 8345603 13648804 0 0 0 13889936 20535315 22235539 34184119 -3254894 -8011521 5188610 5286840 7781912 15891663 -2593302 -10604823 X A CERTIFIED HOME HEALTH AGENCY (CHHA) PROVIDING HOME-BASED THERAPY AND RELATED SERVICES TO CHILDREN AND YOUNG ADULTS WITH SPECIAL NEEDS. 0 0 29557456 25888538 HOME HEALTH CARE SERVICES (SEE SCHEDULE O)ST. MARY'S HOME CARE WAS ESTABLISHED IN 2010 TO EXPAND UPON A LONG-STANDING COMMITMENT TO PROVIDING CARE FOR CHILDREN WITH SPECIAL NEEDS IN A CARE DELIVERY SETTING WHERE CHILDREN CAN HEAL AND THRIVE. ST. MARY'S PIONEERED THE FIRST HOME CARE PROGRAM FOR CHILDREN IN NEW YORK MORE THAN 25 YEARS AGO, AND REMAINS THE LARGEST AND MOST COMPREHENSIVE PROVIDER OF SERVICES TO CHILDREN WITH SPECIAL HEALTHCARE NEEDS. THE CHILDREN SERVED BY ST. MARY'S HOME CARE ARE OFTEN MEDICALLY FRAGILE, AND THEY ARE CHILDREN WHO WOULD OTHERWISE REQUIRE HOSPITALIZATION OR INSTITUTIONAL CARE. THEIR DIAGNOSES RUN THE GAMUT OF CHILDHOOD SEVERE ILLNESSES INCLUDING COMPLICATIONS OF PREMATURITY, GENETIC DISORDERS, NEURO-DEVELOPMENTAL DISORDERS, NEURO-MUSCULAR DISORDERS, TRAUMATIC BRAIN INJURY, AIDS, CANCER, RESPIRATORY DISORDERS, AND VENTILATOR DEPENDENCE.SERVICES PROVIDED BY ST. MARY'S HOME CARE INCLUDE COMBINATIONS OF PROFESSIONAL HEALTHCARE SERVICES AND LIFE ASSISTANCE SERVICES THAT ARE TAILORED TO MEET THE NEEDS OF BOTH PATIENTS AND THEIR FAMILIES. SERVICES MAY INCLUDE NURSING CARE, REHABILITATION THERAPIES, PERSONAL CARE ASSISTANCE, HOME HEALTH AIDE CARE, WOUND CARE, MEDICATION MANAGEMENT, PAIN MANAGEMENT, DISEASE EDUCATION AND MANAGEMENT, COMPLEMENTARY CARE, ARRANGING FOR EQUIPMENT, HOME MODIFICATIONS, AND COORDINATION OF CARE. 29557456 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 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 37 0 122 1 0 0 0 0 0 0 0 0 0 0 X 4 1 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X EDWIN F SIMPSER MD 7182818777 5 DAKOTA DRIVE SUITE 200 NEW HYDE PARK NY 11042 STEPHEN BRENT WELLS CHAIRMAN 1.50 9.00 X X 0 0 0 JEFFREY K FRERICHS PRESIDENT & CEO (THROUGH 9/18/13) 1.00 42.50 X X 0 478239 23074 CAROLINE D GREENE SECRETARY/TREASURER 1.00 42.50 X X 0 297185 24391 EDWIN F SIMPSER MD PRESIDENT & CEO/CMO (FROM 9/19/13) 1.00 42.50 X X 0 435454 31429 MICHAEL P PASTERNACK ASSISTANT SECRETARY 1.00 6.00 X 0 0 0 HOPE M ILICETO CAO 11.00 26.50 X 0 340528 38370 ELVIRA FARDELLA-ROVETO PROGRAM DIRECTOR 37.50 X 153202 0 8137 JAQUELINE MADDIE HHA SUPERVISOR 37.50 X 103499 0 22508 GHARNOT PETITFRERE RN CARE COORDINATOR 37.50 X 105121 0 10101 361822 1551406 158010 3 0 1 0 ACCENT CARE OF NEW YORK INC PO BOX 416181 BOSTON MA 02241 HOME HEALTH AIDES 419204 ABLE HEALTHCARE SERVICES INC 1240 BROADCAST PLAZA MERRICK NY 11566 HOME HEALTH AIDES 377273 SPECIAL TOUCH HOMECARE SERVICES 2091 CONEY ISLAND AVENUE BROOKLYN NY 11223 HOME HEALTH AIDES 362014 UNLIMITED CARE INC 333 WESTCHESTER AVENUE WEST BUILDI WHITE PLAINS NY 10604 HOME HEALTH AIDES 281633 PERSONAL TOUCH 57 W 57TH ST STE 1414 NEW YORK NY 10019 HOME HEALTH AIDES 261544 10 280078 280078 HOME HEALTH CARE SERVICES 621610 25888538 25888538 25888538 3982 3982 26172598 25888538 0 3982 X 11494043 9266481 2227562 266782 159641 107141 1400033 755567 644466 487946 349703 138243 285259 285259 105996 105996 18905 18905 14833569 14548216 285353 134434 50695 83739 401149 41863 359286 68486 68486 543175 341903 201272 158150 120838 37312 3624 3624 941 882 59 262269 202309 59960 BAD DEBT 3532000 3532000 NYS ASSESSMENT 79094 79094 108264 108264 34184119 29557456 4626663 0 42937 2543 4233130 4340602 910000 946238 5188610 5286840 3137030 4534854 4644882 11356809 7781912 15891663 X -2593302 -10604823 -2593302 -10604823 5188610 5286840 -8011521 0 X X 0 1 X 1 0 X 280078 280078 270 5235822 18980600 25888538 50105230 270 5235822 18980600 26168616 50385308 0 0 0 50385308 1045 967 45 3982 6039 1045 967 45 3982 6039 1315 5236789 18980645 26172598 50391347 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 18905 0 0 18905 0 PART II-B, LINE 1: ST. MARY'S HOME CARE ENGAGED A LAW FIRM TO LOBBY ON ITS BEHALF REGARDING BUDGET, REGULATORY AND LEGISLATIVE ISSUES. 0 DUE FROM ST. MARY'S COMMUNITY CARE PROFESSIONALS, CORP. 946238 946238 DUE TO ST. MARY'S HOSPITAL FOR CHILDREN, INC. 4270157 DUE TO SMH ADMINISTRATIVE SERVICES, INC 6807646 CASH OVERDRAFT 279006 11356809 X 22640598 -3532000 -3532000 26172598 0 26172598 30652119 0 30652119 3532000 3532000 34184119 PART X, LINE 2: ST. MARY'S HOME CARE HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2010 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT -3,532,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 3,532,000. 1 1 0 0 0 0 0 0 0 JEFFREY K FRERICHS PRESIDENT & CEO (THROUGH 9/18/13) 0 358705 0 0 0 119534 0 11648 0 11426 0 501313 0 0 CAROLINE D GREENE SECRETARY/TREASURER 0 290000 0 0 0 7185 0 9625 0 14766 0 321576 0 0 EDWIN F SIMPSER MD PRESIDENT & CEO/CMO (FROM 9/19/13) 0 400000 0 0 0 35454 0 16575 0 14854 0 466883 0 0 HOPE M ILICETO CAO 0 340000 0 0 0 528 0 23566 0 14804 0 378898 0 0 ELVIRA FARDELLA-ROVETO PROGRAM DIRECTOR 153000 0 0 0 202 0 6885 0 1252 0 161339 0 0 0 PART I, LINE 3 COMPENSATION OF THE CEO IS REVIEWED AND APPROVED BY THE COMMITTEE OF THE BOARD OF ST. MARY'S HEALTHCARE SYSTEM FOR CHILDREN, INC., THE SOLE CORPORATE MEMBER OF EXTRAORDINARY HOME CARE D/B/A ST. MARY'S HOME CARE. THE METHODS UTILIZED INCLUDE A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, COMPARING TO THE FORM 990'S OF OTHER ORGANIZATIONS, AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE BOARD. PART I, LINES 4A-B SERP: EDWIN F. SIMPSER - $29,847 SEVERANCE: JEFFREY K. FRERICHS - $103,846 FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES ARE HANDLED BY ADMINISTRATIVE PERSONNEL WHO ARE EMPLOYED BY A RELATED ENTITY, SMH ADMINISTRATIVE SERVICES, INC.; COSTS INCURRED BY SMH ADMINISTRATIVE SERVICES, INC. ARE ALLOCATED TO INDIVIDUAL ST. MARY'S ENTITIES IN ACCORDANCE WITH EXPENSE-BASED METHODOLOGY THAT IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION A, LINE 6 ST. MARY'S HEALTHCARE SYSTEM FOR CHILDREN, INC. (SMHSC) IS THE SOLE CORPORATE MEMBER OF EXTRAORDINARY HOME CARE D/B/A ST. MARY'S HOME CARE. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER (SMHSC) HAS THE EXCLUSIVE POWER AND AUTHORITY TO ELECT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER (SMHSC) HAS THE EXCLUSIVE POWER AND AUTHORITY TO APPROVE THE FOLLOWING: MERGERS, SALES OR DISSOLUTIONS; AMENDMENTS TO THE CERTIFICATE OF INCORPORATION AND/OR BYLAWS; OPERATING AND CAPITAL BUDGETS; UNBUDGETED BORROWINGS IN EXCESS OF $1,000,000; UNBUDGETED CAPITAL EXPENDITURES IN EXCESS OF $500,000; A STRATEGIC PLAN; AND HIRING AND FIRING OF THE CEO. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE COMPLETED FORM 990 IS REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE. COMMENTS FROM THIS REVIEW ARE DISCUSSED AND CHANGES MADE AS NECESSARY. A FINAL DRAFT IS THEN POSTED TO THE BOARD WEBSITE WHERE IT IS MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ONCE A YEAR, EACH BOARD MEMBER, OFFICER OR KEY EMPLOYEE OF THE ORGANIZATION COMPLETES A CONFLICT OF INTEREST QUESTIONNAIRE, STATEMENT AND ACKNOWLEDGEMENT WHICH ACKNOWLEDGES THAT EACH INDIVIDUAL HAS DISCLOSED ANY POTENTIAL CONFLICT OF INTEREST; HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. DURING THE COURSE OF THE YEAR, EACH BOARD MEMBER, OFFICER, AND KEY EMPLOYEE IS REQUIRED TO PROMPTLY ADVISE THE CHIEF EXECUTIVE OFFICER OR HIS/HER DESIGNEE, OF ANY CHANGES TO THE INFORMATION PROVIDED IN THAT INDIVIDUAL'S LAST COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE. THE CHIEF EXECUTIVE OFFICER, OR HIS/HER DESIGNEE, REVIEWS ALL COMPLETED QUESTIONNAIRES AND ALL SUBSEQUENT ADVICE OF CHANGES, TAKING SUCH ACTION AS IS DEEMED APPROPRIATE TO ADDRESS AND ELIMINATE POTENTIAL CONFLICTS OF INTEREST, INCLUDING SUCH STEPS AS REASSIGNMENT OF RESPONSIBILITIES. ALL DISCLOSURES OF INTERESTS IN COMPLETED QUESTIONNAIRES OR SUBSEQUENT ADVICE, UNLESS CLEARLY IRRELEVANT OR IMMATERIAL, SHALL BE COMPILED AND REPORTED BY MANAGEMENT TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD, TOGETHER, IN EACH CASE, WITH THE RESPONSE OR RECOMMENDATION OF MANAGEMENT. THE AUDIT AND COMPLIANCE COMMITTEE SHALL DETERMINE WHETHER THE REPORTED RESOLUTION OF ISSUES RAISED BY THE DISCLOSURES IS SATISFACTORY AND, IF NOT, SHALL TAKE SUCH FURTHER ACTION AS IT DEEMS APPROPRIATE. EACH BOARD MEMBER, AND ANY OFFICER OR KEY EMPLOYEE PRESENTING A PROPOSED TRANSACTION OR OTHER MATTER TO THE BOARD SHALL DISCLOSE PROMPTLY AND IN GOOD FAITH TO THE BOARD SUCH INDIVIDUAL'S INTEREST IN A PROPOSED TRANSACTION OR OTHER MATTER TO BE CONSIDERED BY THE BOARD. THE INDIVIDUAL MAY NOT PARTICIPATE IN ANY WAY IN THE BOARD'S DELIBERATIONS CONCERNING MATTERS IN WHICH HE/SHE HAS DISCLOSED AN INTEREST. FOLLOWING ANY SUCH DISCLOSURE, AND AFTER SUCH DUE DILIGENCE AND SUCH DEVELOPMENT AND CONSIDERATION OF OTHER ALTERNATIVES, IF ANY, AS THE BOARD SHALL DEEM APPROPRIATE, THE BOARD MAY, IN ITS DISCRETION, AUTHORIZE OR APPROVE THE PROPOSED TRANSACTION OR ACTIONS AS AT LEAST AS FAIR AND REASONABLE TO THE ORGANIZATION AS WOULD OTHERWISE BE OBTAINABLE BY THE ORGANIZATION. SUCH ACTIONS SHALL BE BY A VOTE SUFFICIENT FOR SUCH PURPOSE WITHOUT COUNTING THE VOTE OR VOTES OF SUCH INTERESTED PERSON OR PERSONS AND SUCH PERSON OR PERSONS MAY NOT PARTICIPATE IN, DETERMINING THE PRESENCE OF A QUORUM AT THE MEETING. ANY DISCLOSURE, NON-PARTICIPATION, AND BOARD ACTION TAKEN IN ACCORDANCE WITH THIS POLICY SHALL BE CLEARLY RECORDED IN THE MINUTES OF THE MEETING AT WHICH THE MATTER IS ADRESSED AND RESOLVED. UPON REASONABLE BELIEF THAT A BOARD MEMBER, OFFICER OR KEY EMPLOYEE FAILED TO COMPLY WITH THE POLICIES AND DIRECTIVES SET FORTH IN ITS DISCLOSURE POLICY, THE BOARD OR THE AUDIT AND COMPLIANCE COMMITTEE SHALL INFORM THE INDIVIDUAL OF THE BASIS OF THE BELIEF AND PROVIDE AN OPPORTUNITY TO EXPLAIN THE NONCOMPLIANCE. IF AFTER HEARING THE INDIVIDUAL'S RESPONSE AND MAKING FURTHER APPROPRIATE INVESTIGATIONS, THE BOARD OR AUDIT AND COMPLIANCE COMMITTEE DETERMINES THAT THE INDIVIDUAL HAS, IN FACT, FAILED TO COMPLY WITH SUCH POLICIES AND DIRECTIVES, IT SHALL TAKE OR RECOMMEND APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 ADMINISTRATIVE SALARIES ARE PAID OUT OF A RELATED ADMINISTRATIVE CORPORATION. THE POLICIES FOR DETERMINING COMPENSATION ARE AS FOLLOWS: THE BOARD OF ST. MARY'S HEALTHCARE SYSTEM FOR CHILDREN, THE SOLE MEMBER OF THE ORGANIZATION, RETAINS THE SERVICES OF AN EXECUTIVE COMPENSATION FIRM TO REVIEW MARKET PAY PRACTICES FOR SENIOR EXECUTIVES IN ORGANIZATIONS OF COMPARABLE SIZE AND TYPE. THIS MARKET ASSESSMENT WAS LAST UNDERTAKEN IN 2013. THIS MARKET ANALYSIS IS THEN REVIEWED BY THE EXECUTIVE REVIEW/COMPENSATION COMMITTEE AND USED AS A FACTOR IN DETERMINING SALARY ADJUSTMENTS RELATIVE TO MARKET COMPETITIVENESS. COMPENSATION FOR OTHER EXECUTIVES IS MANAGED IN A SIMILAR MANNER, WITH THE HUMAN RESOURCES DEPARTMENT IN CONSULTATION WITH THE CEO, USING LOCAL PERIODIC SURVEYS OF THE MARKET TO ENSURE THAT ST. MARY'S COMPENSATION IS COMPETITIVE. FORM 990, PART VI, SECTION C, LINE 18 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 14: ST. MARY'S HOSPITAL FOR CHILDREN, INC. HAS A DOCUMENT RETENTION POLICY, BUT NOT A DOCUMENT DESTRUCTION POLICY. SMH DOES HAVE A MEDICAL RECORDS DESTRUCTION POLICY. AN OVERALL DOCUMENT DESTRUCTION POLICY IS UNDER DEVELOPMENT, AND WILL BE COMPLETED IN 2014. FORM 990, PART VI, SECTION A, LINE 1B: SUBSEQUENT TO YEAR END, ST. MARY'S HEALTHCARE SYSTEM FOR CHILDREN, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, REVIEWED THE COMPOSITION OF THE BOARD OF DIRECTORS, AND DETERMINED THAT IN ACCORDANCE WITH GOOD GOVERNANCE PRINCIPLES, THE BOARD WOULD BE COMPRISED OF NON-EMPLOYED SYSTEM DIRECTORS, WITH THE EXCEPTION OF THE CEO, WHO WOULD SERVE AS AN EX-OFFICIO VOTING MEMBER. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 181,345. MANAGEMENT AND GENERAL EXPENSES 285,353. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 466,698. THERAPISTS FEES: PROGRAM SERVICE EXPENSES 14,366,871. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,366,871. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 29-01 216TH STREET BAYSIDE NY 11360 113574493 HEALTH CARE NY 501(C)(3) LINE 11A, I N/A 0 ST MARY'S HOSPITAL FOR CHILDREN INC 29-01 216TH STREET BAYSIDE NY 11360 111679599 HEALTH CARE NY 501(C)(3) LINE 3 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 ST MARY'S FOUNDATION FOR CHILDREN INC 29-01 216TH STREET BAYSIDE NY 11360 112728736 FUNDRAISING NY 501(C)(3) LINE 7 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 ST MARY'S COMMUNITY CARE PROFESSIONALS CORP 29-01 216TH STREET BAYSIDE NY 11360 113360276 PARAPROFESSIONAL HOME HEALTH CARE NY 501(C)(3) LINE 9 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 SMH ADMINISTRATIVE SERVICES INC 29-01 216TH STREET BAYSIDE NY 11360 271529374 MANAGEMENT AND SUPPORTING SERVICES NY 501(C)(3) LINE 11B, II ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 ST MARY'S REHABILITATION CENTER FOR CHILDREN 29-01 216TH STREET BAYSIDE NY 11360 136163550 HEALTH CARE NY 501(C)(3) LINE 9 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0