2013-11-14T15:48:33-06:00 2012-12-31 271728945 O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2012-01-01 264827558 QUEENS-LONG ISLAND RENAL INSTITUTE INC QUEE 7182892600 271-11 76TH AVENUE NEW HYDE PARK NY 11040 ROBERT WERNER 7182892600 2013-11-14 1 GARRETT M HIGGINS P00543209 9143818900 2013-11-14 2012 2016-02-24 21:20:13Z MICHAEL ROSENBLUT 271-11 76TH AVENUE NEW HYDE PARK NY 11040 3937782 0 X WWW.QLIRI.ORG X 2009 NY TO ASSURE DIALYSIS PATIENTS OF THE FINEST QUALITY OF CARE, STATE-OF-THE-ART TECHNOLOGY AND UNCOMPROMISED DIGNITY, IN A COMFORTABLE SETTING. 7 7 38 8 0 0 316127 0 2269255 3919259 253 117 15755 18406 2601390 3937782 0 0 0 0 1002837 1269527 0 0 0 1856265 2287000 2859102 3556527 -257712 381255 3323938 3414836 568792 278435 2755146 3136401 TO ASSURE DIALYSIS PATIENTS OF THE FINEST QUALITY OF CARE, STATE-OF-THE-ART TECHNOLOGY AND UNCOMPROMISED DIGNITY, IN A COMFORTABLE SETTING. 0 0 2836339 3919259 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. 2836339 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 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 12 0 38 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X X ROBERT WERNER 7183432100 271-11 76TH AVENUE NEW HYDE PARK NY 11040 PHILIP KAPLAN 1.00 2.00 X X 0 0 0 JERRY LANDSBERG 1.00 2.00 X X 0 0 0 HENRY TPAT SCHWAEBERPAST CHAIRMAN 1.00 2.00 X X 0 0 0 LEONARD TANZER 1.00 2.00 X X 0 0 0 NINA KOPELMAN 1.00 2.00 X 0 0 0 GARY GRANOFF 1.00 2.00 X X 0 0 0 FRANCES R KATZ 1.00 2.00 X X 0 0 0 PETER SEIDEMAN 1.00 2.00 X X 0 0 0 MICHAEL ROSENBLUT 5.50 49.00 X 0 701735 39757 ROBERT WERNER 2.50 47.50 X 0 290099 32021 STUART ALMER 5.00 46.50 X 0 263038 39553 JOHN DRIVAS 1.40 45.60 X 0 216096 16582 KATHLEEN DARMSTADT 2.50 47.50 X 0 154550 4772 GEORGIENE KENNY 11.30 33.80 X 0 158463 14736 0 1783981 147421 0 0 1 0 INFIAN LLC 2810 N PARHAM RD RICHMOND VA 23294 BILLING & AR SERVICES 101917 1 MEDICARE 623000 2495878 2495878 OTHER PATIENT SERVICE 623000 1423381 1423381 3919259 117 117 PURCHASE DISCOUNTS 900099 18406 18406 18406 3937782 3919259 0 18523 1032679 865115 167564 8235 6899 1336 131255 109957 21298 97358 81561 15797 9460 9460 147433 147433 196027 193475 2552 10707 4573 6134 1676 1676 91170 91170 3287 80 3207 326323 326323 4009 4009 PHARMACEUTICALS 817563 817563 MEDICAL SUPPLIES 312487 312487 PURCHASED SERVICE AGREE 200000 200000 PROVISION FOR BAD DEBTS 135858 135858 31000 27136 3864 3556527 2836339 720188 0 2000 645729 60121 2 635874 482341 58071 61841 24886 348 3036318 811743 2541426 2224575 1560 0 3323938 3414836 568792 278435 568792 278435 X 2755146 3136401 2755146 3136401 3323938 3414836 381255 0 X X 0 1 X 1 0 X 2223891 434548 1789343 812427 377195 435232 2224575 X 3937782 0 3937782 0 3937782 3556527 0 3556527 0 3556527 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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. 0 0 0 0 0 0 0 0 0 MICHAEL ROSENBLUT 0 701735 0 0 0 0 0 5000 0 34757 0 741492 0 0 ROBERT WERNER 0 290099 0 0 0 0 0 1100 0 30921 0 322120 0 0 STUART ALMER 0 263038 0 0 0 0 0 5000 0 34553 0 302591 0 0 JOHN DRIVAS 0 216096 0 0 0 0 0 4219 0 12363 0 232678 0 0 KATHLEEN DARMSTADT 0 154550 0 0 0 0 0 3086 0 1686 0 159322 0 0 GEORGIENE KENNY 0 158463 0 0 0 0 0 3185 0 11551 0 173199 0 0 PART I, LINE 3 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. 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. 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 N/A 0 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 AGEWELL NEW YORK LLC 271-11 76TH AVENUE NEW HYDE PARK NY 11040 300743059 OPERATES A PARTIALLY CAPITATED MEDICAID MANAGED LONG-TERM CARE PROGRAM NY PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION UNRELATED 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 0