2013-07-23T11:30:39-05:00 2012-12-31 271728945 O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2012-01-01 311587828 MICHAEL MALOTZ SKILLED NURSING PAVILION MICH 9149643333 120 ODELL AVENUE YONKERS NY 107011408 MARK POHAR 9149643333 2013-07-22 1 GARRETT M HIGGINS P00543209 9143818900 2013-07-22 2012 2016-02-24 21:20:13Z MARK POHAR 120 ODELL AVENUE YONKERS NY 107011408 15398599 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. 8 8 233 8 0 0 50565 3537 14916272 15330802 38446 29148 31140 35112 15036423 15398599 0 0 0 0 9460087 10001657 0 0 0 5296568 5365801 14756655 15367458 279768 31141 19024050 18477700 22004533 21427041 -2980483 -2949341 TO PROVIDE SKILLED NURSING AND REHABILITATION SERVICES TO GERIATRIC, SUBACUTE AND VENTILATOR DEPENDENT RESIDENTS. 0 0 14413881 15330802 SKILLED NURSING, REHABILITATION AND ANCILLARY SERVICES PROVIDED TO GERIATRIC, SUB-ACUTE AND VENTILATOR DEPENDENT RESIDENTS. PATIENT DAYS OF CARE FOR THE YEAR WAS 42,097: GERIATRIC DAYS OF 39,531 AND VENTILATOR DEPENDENT DAYS OF 2,566. THE NUMBER OF RESIDENTS SERVED IN 2012 WAS 476: 430 GERIATRIC AND 46 VENTILATOR DEPENDENT RESIDENTS. 14413881 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 16 0 233 1 0 0 0 0 0 0 0 0 0 0 X 8 8 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 0.30 X X 0 0 0 ANIL M JOSHI MD 0.30 X X 0 0 0 KEVIN T FAY 0.30 X 0 0 0 GEORGE S GORMAN 0.30 3.60 X X 0 0 0 ROYDEN LETSEN 0.30 1.00 X 0 0 0 RICHARD PETERSON 0.30 X 0 0 0 DIANE SKALICKY 0.30 X 0 0 0 RICHARD KOMOSINSKI 0.30 1.00 X 0 0 0 MARK POHAR 37.50 X 185201 0 33761 SHERWIN CHUE 30.00 7.50 X 193860 0 34300 IYAD ANNABI MD 20.00 X 100915 0 24919 DEBRA DUNNE 37.50 X 108638 0 16939 BARBARA CRONIN-LAPERCHE 37.50 X 103404 0 7081 692018 0 117000 5 0 1 0 ST JOHN'S RIVERSIDE HOSPITAL 967 N BROADWAY YONKERS NY 10701 VARIOUS SERVICES: DIETARY, LAB, LAUNDRY, 663427 1 3537 3537 MEDICAID 623000 8218770 8218770 MEDICARE 623000 3651881 3651881 COMMERCIAL INSURANCE 623000 2335543 2335543 PRIVATE PAY 623000 1124608 1124608 15330802 29148 29148 EMPLOYEE PARKING 812930 19700 19700 OTHER INCOME 900099 9200 9200 REBATE 900099 3863 3863 2349 2349 35112 15398599 15330802 0 64260 408314 408314 6864326 6718183 146143 747192 735933 11259 1266996 1192881 74115 714829 679990 34839 45199 45199 40000 40000 6326 6326 268579 254962 13617 426651 393156 33495 44293 44293 1060402 1035615 24787 2617 1717 900 118101 114377 3724 775264 750816 24448 200535 190661 9874 PURCH & CONTRACTED SERV 771368 694831 76537 MEDICAL SUPPLIES 660030 660030 NYS CASH ASSESSMENT 627375 627375 BAD DEBT EXPENSE 261832 261832 57229 57229 15367458 14413881 953577 0 249083 176670 378069 453312 3018684 3006039 13976 12768 38145 35292 20532686 12839741 8355825 7692945 6970268 7100674 19024050 18477700 1419393 1494501 177854 187465 12269965 11939008 8137321 7806067 22004533 21427041 X -2980483 -2949341 -2980483 -2949341 19024050 18477700 X 31141 1 X X 0 1 X 1 1 1 X 3333 3155 7109 50565 3537 67699 14180053 13275709 13592296 14916272 15330802 71295132 14183386 13278864 13599405 14966837 15334339 71362831 640 500 1325 4420 950 7835 0 640 500 1325 4420 950 7835 71354996 87521 64582 45935 41336 29148 268522 87521 64582 45935 41336 29148 268522 51091 30187 35473 28250 35112 180113 14321998 13373633 13680813 15036423 15398599 71811466 0.99360 0.99150 0.00370 0.00530 X 0 0 0 0 0 0 0 0 1 6326 6326 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: COSTS ARE INCURRED AS PART OF DUES PAID TO NURSING HOME INDUSTRY ORGANIZATIONS. 0 1 X 10 10 18021786 11013730 7008056 2510890 1826011 684879 7692945 DUE FROM THIRD PARTY PAYORS 943348 ASSETS LIMITED AS TO USE - CASH AND CASH EQUIVALENTS 2688485 ASSETS LIMITED AS TO USE - CERTIFICATES OF DEPOSIT 3017252 SECURITY DEPOSITS 187465 INSURANCE RECOVERY RECEIVABLE 264124 7100674 DUE TO THIRD PARTY PAYORS 284571 DUE TO ST. JOHN'S RIVERSIDE HOSPITAL 7257372 PROFESSIONAL LIABILITIES 264124 7806067 X 15398599 0 15398599 0 15398599 15367458 0 15367458 0 15367458 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. THE FUNDS ARE DISBURSED BY THE PAVILION AT THE REQUEST OF, OR ON BEHALF OF RESIDENTS FOR THEIR PERSONAL USE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2009. X X 0 0 0 0 0 0 0 1 0 MARK POHAR 185201 0 0 0 0 0 14769 0 18992 0 218962 0 0 0 SHERWIN CHUE 193860 0 0 0 0 0 15397 0 18903 0 228160 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 BOARD OF TRUSTEES REVIEWS AND APPROVES SALARY RECOMMENDATIONS OF TOP MANAGEMENT EMPLOYEES, KEY EMPLOYEES AND OFFICERS. SALARY RECOMMENDATIONS ARE PROVIDED BY RIVERSIDE HEALTH CARE SYSTEM'S HUMAN RESOURCES DEPARTMENT WHICH INCLUDES STUDIES FROM INDEPENDENT OUTSIDE FIRMS AND SAMPLING OF LOCAL AREAS SALARY STRUCTURES. A COMPENSATION INCREASE WAS APPROVED IN JANUARY 2012 EFFECTIVE APRIL 2012. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: ROUNDING 1. 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) 3 RIVERSIDE HEALTH CARE SYSTEM INC 0 RIVERSIDE HEALTH CARE SYSTEM INC 967 NORTH BROADWAY YONKERS NY 10701 133237215 HOSPITAL NY 501(C)(3) 3 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) 3 RIVERSIDE HEALTH CARE SYSTEM INC 0 SJR MEDICAL PC 967 NORTH BROADWAY YONKERS NY 10701 134185781 MEDICAL SERVICES NY ST JOHNS RIVERSIDE HOSPITAL C 0 FOUNDATION FOR COMMUNITY HOSPITAL AT DOBBS FERRY 128 ASHFORD AVENUE DOBBS FERRY NY 10522 133971735 FUNDRAISING NY ST JOHNS RIVERSIDE HOSPITAL C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0