QUEENS-LONG ISLAND RENAL INSTITUTE: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- QUEENS-LONG ISLAND RENAL INSTITUTE (EIN 26-4827558)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201303189349306110
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T15:48:33-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271728945 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | O'CONNOR DAVIES LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 MAMARONECK AVENUE | AddressLine1 |
| City | HARRISON | City |
| State | NY | State |
| ZIP Code | 105281633 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264827558 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | QUEENS-LONG ISLAND RENAL INSTITUTE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | QUEE | NameControl |
| Phone | 7182892600 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 271-11 76TH AVENUE | AddressLine1 |
| City | NEW HYDE PARK | City |
| State | NY | State |
| ZIP Code | 11040 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT WERNER | Name |
| Title | CFO | Title |
| Phone | 7182892600 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GARRETT M HIGGINS | Name |
| PTIN | P00543209 | PTIN |
| Phone | 9143818900 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL ROSENBLUT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 271-11 76TH AVENUE | AddressLine1 |
| City | NEW HYDE PARK | City |
| State | NY | State |
| ZIP Code | 11040 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3937782 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.QLIRI.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2009 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | TO ASSURE DIALYSIS PATIENTS OF THE FINEST QUALITY OF CARE, STATE-OF-THE-ART TECHNOLOGY AND UNCOMPROMISED DIGNITY, IN A COMFORTABLE SETTING. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 38 | TotalNbrEmployees |
| Total Nbr Volunteers | 8 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 316127 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2269255 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3919259 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 253 | InvestmentIncomePriorYear |
| Investment Income Current Year | 117 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 15755 | OtherRevenuePriorYear |
| Other Revenue Current Year | 18406 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2601390 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3937782 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1002837 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1269527 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1856265 | OtherExpensePriorYear |
| Other Expenses Current Year | 2287000 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2859102 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3556527 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -257712 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 381255 | RevenuesLessExpensesCY |
| Total Assets BOY | 3323938 | TotalAssetsBOY |
| Total Assets EOY | 3414836 | TotalAssetsEOY |
| Total Liabilities BOY | 568792 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 278435 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2755146 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3136401 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO ASSURE DIALYSIS PATIENTS OF THE FINEST QUALITY OF CARE, STATE-OF-THE-ART TECHNOLOGY AND UNCOMPROMISED DIGNITY, IN A COMFORTABLE SETTING. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2836339 | Expense |
| Revenue | 3919259 | Revenue |
| Description | QUEENS-LONG ISLAND RENAL INSTITUTE, INC. IS A CHARITABLE ORGANIZATION THAT RENDERS RENAL REPLACEMENT THERAPY SERVICES TO THOSE IN NEED. THE FACILITY IS LOCATED IN NEW HYDE PARK, NEW YORK AND PROVIDES IN-CENTER HEMODIALYSIS TO PATIENTS SUFFERING FROM END STAGE RENAL DISEASE (ESRD). TREATMENTS ARE PROVIDED TO PATIENTS IN THREE DIFFERENT PATIENT SHIFTS, SIX DAY PER WEEK. HEMODIALYSIS SERVICES ARE PROVIDED TO PATIENTS BY LICENSED AND TRAINED PROFESSIONALS IN ACCORDANCE WITH ALL STATE AND FEDERAL REGULATIONS. THE ORGANIZATION WILL BILL MEDICARE, MEDICAID AND OTHER THIRD PARTY PAYERS FOR SERVICES RENDERED TO PATIENTS. IN 2012, THE ORGANIZATION PROVIDED 12,311 DAYS OF CARE. | Description |
| Total Program Service Expense | 2836339 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 38 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT WERNER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7183432100 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 271-11 76TH AVENUE | AddressLine1 |
| City | NEW HYDE PARK | City |
| State | NY | State |
| ZIP Code | 11040 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| PHILIP KAPLAN | |||||||||
| TREASURER | 1.00 | 2.00 | X | X | 0 | 0 | 0 | ||
| JERRY LANDSBERG | |||||||||
| VICE CHAIRMAN | 1.00 | 2.00 | X | X | 0 | 0 | 0 | ||
| HENRY TPAT SCHWAEBERPAST CHAIRMAN | |||||||||
| TERM ENDED OCTOBER 2012 | 1.00 | 2.00 | X | X | 0 | 0 | 0 | ||
| LEONARD TANZER | |||||||||
| CHAIRMAN | 1.00 | 2.00 | X | X | 0 | 0 | 0 | ||
| NINA KOPELMAN | |||||||||
| TRUSTEE | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| GARY GRANOFF | |||||||||
| TRUSTEE | 1.00 | 2.00 | X | X | 0 | 0 | 0 | ||
| FRANCES R KATZ | |||||||||
| SECRETARY | 1.00 | 2.00 | X | X | 0 | 0 | 0 | ||
| PETER SEIDEMAN | |||||||||
| TRUSTEE | 1.00 | 2.00 | X | X | 0 | 0 | 0 | ||
| MICHAEL ROSENBLUT | |||||||||
| PRESIDENT/ CEO | 5.50 | 49.00 | X | 0 | 701735 | 39757 | |||
| ROBERT WERNER | |||||||||
| CFO/ VP OF FINANCE | 2.50 | 47.50 | X | 0 | 290099 | 32021 | |||
| STUART ALMER | |||||||||
| EXECUTIVE VP | 5.00 | 46.50 | 0 | 263038 | 39553 | X | |||
| JOHN DRIVAS | |||||||||
| VP HR | 1.40 | 45.60 | 0 | 216096 | 16582 | X | |||
| KATHLEEN DARMSTADT | |||||||||
| DIRECTOR OF FIANCE | 2.50 | 47.50 | 0 | 154550 | 4772 | X | |||
| GEORGIENE KENNY | |||||||||
| ASSOCIATE VP OF QM | 11.30 | 33.80 | 0 | 158463 | 14736 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1783981 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 147421 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INFIAN LLC | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2810 N PARHAM RD | AddressLine1 |
| City | RICHMOND | City |
| State | VA | State |
| ZIP Code | 23294 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | BILLING & AR SERVICES | DescriptionOfServices |
| Compensation | 101917 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE | 623000 | 2495878 | 2495878 |
| OTHER PATIENT SERVICE | 623000 | 1423381 | 1423381 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3919259 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 117 | TotalRevenueColumn |
| Exclusion | $117 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PURCHASE DISCOUNTS | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 18406 | TotalRevenueColumn |
| Exclusion | $18,406 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 18406 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3937782 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3919259 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $18,523 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1032679 | Total |
| Program Services | 865115 | ProgramServices |
| Management And General | 167564 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8235 | Total |
| Program Services | 6899 | ProgramServices |
| Management And General | 1336 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131255 | Total |
| Program Services | 109957 | ProgramServices |
| Management And General | 21298 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97358 | Total |
| Program Services | 81561 | ProgramServices |
| Management And General | 15797 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9460 | Total |
| Management And General | 9460 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147433 | Total |
| Management And General | 147433 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 196027 | Total |
| Program Services | 193475 | ProgramServices |
| Management And General | 2552 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10707 | Total |
| Program Services | 4573 | ProgramServices |
| Management And General | 6134 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1676 | Total |
| Management And General | 1676 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91170 | Total |
| Program Services | 91170 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3287 | Total |
| Program Services | 80 | ProgramServices |
| Management And General | 3207 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 326323 | Total |
| Program Services | 326323 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4009 | Total |
| Management And General | 4009 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PHARMACEUTICALS | 817563 | 817563 | |
| MEDICAL SUPPLIES | 312487 | 312487 | |
| PURCHASED SERVICE AGREE | 200000 | 200000 | |
| PROVISION FOR BAD DEBTS | 135858 | 135858 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31000 | Total |
| Program Services | 27136 | ProgramServices |
| Management And General | 3864 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3556527 | Total |
| Program Services | 2836339 | ProgramServices |
| Management And General | 720188 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2000 | BOY |
| EOY | 645729 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60121 | BOY |
| EOY | 2 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 635874 | BOY |
| EOY | 482341 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58071 | BOY |
| EOY | 61841 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24886 | BOY |
| EOY | 348 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 3036318 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 811743 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2541426 | BOY |
| EOY | 2224575 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1560 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3323938 | BOY |
| EOY | 3414836 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 568792 | BOY |
| EOY | 278435 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 568792 | BOY |
| EOY | 278435 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2755146 | BOY |
| EOY | 3136401 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2755146 | BOY |
| EOY | 3136401 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3323938 | BOY |
| EOY | 3414836 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 381255 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2223891 | OtherCostOrOtherBasis |
| Depreciation | 434548 | Depreciation |
| Book Value | 1789343 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 812427 | OtherCostOrOtherBasis |
| Depreciation | 377195 | Depreciation |
| Book Value | 435232 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2224575 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 3937782 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 3937782 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 3937782 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3556527 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 3556527 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 3556527 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | QLIRI RECOGNIZES THE EFFECT OF TAX POSITIONS WHEN THEY ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT QLIRI HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. QLIRI IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS SINCE INCEPTION IN 2010 AND PRIOR. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL ROSENBLUT | ||||||||||||||
| PRESIDENT/ CEO | 0 | 701735 | 0 | 0 | 0 | 0 | 0 | 5000 | 0 | 34757 | 0 | 741492 | 0 | 0 |
| ROBERT WERNER | ||||||||||||||
| CFO/ VP OF FINANCE | 0 | 290099 | 0 | 0 | 0 | 0 | 0 | 1100 | 0 | 30921 | 0 | 322120 | 0 | 0 |
| STUART ALMER | ||||||||||||||
| EXECUTIVE VP | 0 | 263038 | 0 | 0 | 0 | 0 | 0 | 5000 | 0 | 34553 | 0 | 302591 | 0 | 0 |
| JOHN DRIVAS | ||||||||||||||
| VP HR | 0 | 216096 | 0 | 0 | 0 | 0 | 0 | 4219 | 0 | 12363 | 0 | 232678 | 0 | 0 |
| KATHLEEN DARMSTADT | ||||||||||||||
| DIRECTOR OF FIANCE | 0 | 154550 | 0 | 0 | 0 | 0 | 0 | 3086 | 0 | 1686 | 0 | 159322 | 0 | 0 |
| GEORGIENE KENNY | ||||||||||||||
| ASSOCIATE VP OF QM | 0 | 158463 | 0 | 0 | 0 | 0 | 0 | 3185 | 0 | 11551 | 0 | 173199 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 3 | ReturnReference |
| Explanation | THE CEO'S COMPENSATION IS DETERMINED BY A RELATED PARTY, PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION, USING THE FOLLOWING PROCESS: A WRITTEN EMPLOYMENT CONTRACT IS CURRENTLY IN PLACE FOR THE PRESIDENT/CEO. THE CONTRACT WAS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD AND INCLUDED IN THE CHAIRMANS REPORT TO THE BOARD OF TRUSTEES. EXTERNAL INFORMATION AND SURVEYS WERE USED FOR COMPARATIVE PURPOSES IN DETERMINING THE COMPENSATION AMOUNTS IN THE CONTRACT. PERFORMANCE IS REVIEWED ANNUALLY BY THE CHAIRMAN OF THE BOARD OF TRUSTEES. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS GERIATRIC RESOURCES OF NEW YORK, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | AT EACH ANNUAL MEETING OF GERIATRIC RESOURCES OF NEW YORK, INC., THE SOLE CORPORATE MEMBER OF THE CORPORATION, TRUSTEES OF THE CORPORATION, OTHER THAN THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, SHALL BE ELECTED TO VACANT POSITIONS ON THE BOARD OF TRUSTEES, EACH FOR A TERM OF ONE (1) YEAR, TO HOLD OFFICE UNTIL THEIR SUCCESSORS HAVE BEEN ELECTED AND DULY QUALIFIED. THERE SHALL BE NO LIMITATION AS TO THE NUMBER OF TERMS TRUSTEES MAY SERVE AND TRUSTEES SHALL BE PERMITTED TO SERVE SUCCESSIVE TERMS. NEWLY CREATED TRUSTEESHIPS RESULTING FROM AN INCREASE IN THE NUMBER OF TRUSTEES, AND VACANCIES OCCURRING IN THE BOARD OF TRUSTEES FOR ANY REASON, SHALL BE FILLED BY VOTE OF THE BOARD OF TRUSTEES OF GERIATRIC RESOURCES OF NEW YORK, INC., THE SOLE MEMBER OF THE CORPORATION. TRUSTEES ELECTED TO FILL NEWLY CREATED TRUSTEESHIPS SHALL HOLD OFFICE IN ACCORDANCE WITH THEIR CLASSIFICATION (IF TRUSTEES ARE CLASSIFIED) AND UNTIL THEIR SUCCESSORS HAVE BEEN ELECTED AND HAVE QUALIFIED. TRUSTEES ELECTED TO FILL VACANCIES SHALL SERVE UNTIL THE END OF THE VACATED TERM AND UNTIL THEIR SUCCESSORS ARE ELECTED AND HAVE QUALIFIED. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE REPEAL OR AMENDMENT OF ANY BYLAW OF THE CORPORATION SHALL BE EFFECTED BY EITHER OF THE FOLLOWING METHODS: (I) BY ACT OF THE BOARD OF TRUSTEES OF GERIATRIC RESOURCES OF NEW YORK, INC., THE SOLE CORPORATE MEMBER OF THE CORPORATION; OR (II) BY A VOTE OF A MAJORITY OF THE VOTING TRUSTEES OF THE BOARD OF TRUSTEES OF THE CORPORATION, PROVIDED THAT WRITTEN NOTICE OF EITHER THE TEXT OR THE SUBSTANCE OF ANY PROPOSED AMENDMENT OR REPEAL OF THE BYLAWS SHALL BE GIVEN TO ALL TRUSTEES AT LEAST FIVE (5) BUSINESS DAYS PRIOR TO THE DATE OF THE MEETING AT WHICH THE AMENDMENT OR REPEAL IS TO BE PROPOSED. IN ADDITION, ANY TRUSTEE MAY RESIGN AT ANY TIME BY GIVING WRITTEN NOTICE TO THE CHAIRMAN OR TO THE SECRETARY OF GERIATRIC RESOURCES OF NEW YORK, INC., THE SOLE CORPORATE MEMBER OF THE CORPORATION. SUCH RESIGNATION SHALL TAKE EFFECT AT THE TIME SPECIFIED THEREIN OR, IF NO TIME IS SPECIFIED, ON DELIVERY. ANY OR ALL OF THE TRUSTEES MAY BE REMOVED FOR CAUSE OR WITHOUT CAUSE BY AN ACTION OF THE BOARD OF TRUSTEES OF GERIATRIC RESOURCES OF NEW YORK, INC., THE SOLE CORPORATE MEMBER OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | QUEENS-LONG ISLAND RENAL INSTITUTE INC. 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 FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD MEMBERS OF THE ORGANIZATION FOR ANY COMMENTS. ANY COMMENTS ARE THEN GROUPED, SUMMARIZED AND PROVIDED TO THE OUTSIDE ACCOUNTANTS. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED FOR FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, THE BOARD OF TRUSTEES AND OFFICERS OF THE BOARD ARE ASKED TO REVIEW THE CONFLICT OF INTEREST POLICY. EACH PERSON MUST COMPLETE A STATEMENT AFFIRMING THAT THEY DO NOT HAVE ANY CONFLICTS OR POTENTIAL CONFLICTS. IF A CONFLICT WERE TO ARISE, IT WOULD BE BROUGHT TO THE BOARD'S ATTENTION THROUGH THE EXECUTIVE COMMITTEE AND THE CORPORATE COMPLIANCE COMMITTEE FOR REVIEW. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS FORM 990 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS POSTED ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION, FORM 990, FORM 1023, AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST OR BY CALLING THE ORGANIZATION DIRECTLY. |
| FORM 990, PART XII, LINE 2C | THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PARKER JEWISH INSTITUTE FOR HEALTH CARE & REHAB FOUNDATION | |||||||||||
| 271-11 76TH AVENUE | NEW HYDE PARK | NY | 11040 | 113041480 | TO SUPPORT PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION | NY | 501(C)3 | 7 | GERIATRIC RESOURCES OF NEW YORK | 0 | |
| GERIATRIC RESOURCES OF NEW YORK | |||||||||||
| 271-11 76TH AVENUE | NEW HYDE PARK | NY | 11040 | 113100541 | SUPPORT PJI FOR HEALTH CARE AND REHABILITATION AND ITS AFFILIATES | NY | 501(C)3 | TYPE II | 0 | N/A | |
| PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION | |||||||||||
| 271-11 76TH AVENUE | NEW HYDE PARK | NY | 11040 | 132631069 | OPERATE A SKILLED NURSING FACILITY | NY | 501(C)3 | 9 | GERIATRIC RESOURCES OF NEW YORK | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AGEWELL NEW YORK LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 271-11 76TH AVENUE | AddressLine1 |
| City | NEW HYDE PARK | City |
| State | NY | State |
| ZIP Code | 11040 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300743059 | EIN |
| Primary Activity | OPERATES A PARTIALLY CAPITATED MEDICAID MANAGED LONG-TERM CARE PROGRAM | PrimaryActivity |
| Legal Domicile State | NY | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | UNRELATED | PredominantIncomeType |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |