2012-11-12T14:27:13-06:00 2011-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-01-01 272153586 BROOKS SKILLED NURSING FACILITY A INC BROO 9043465584 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 DOUGLAS M BAER 9043465584 2012-11-06 1 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z X SAN MARCO TERRACE BRIAN FULLER 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 5215071 0 X WWW.BROOKSHEALTH.ORG X 2010 FL OPERATION OF SAN MARCO TERRACE, A NURSING AND REHABILITATION FACILITY 5 1 124 0 0 0 54 0 3029359 5144521 0 0 0 70550 3029413 5215071 0 0 0 0 1681175 2676348 0 0 0 1574135 2753063 3255310 5429411 -225897 -214340 4698288 8202605 4924185 8642842 -225897 -440237 X TO ADVANCE THE HEALTH AND WELL-BEING OF PERSONS REQUIRING REHABILITATION THROUGH SUPERIOR OUTCOMES, SERVICE, EDUCATION, AND RESEARCH 0 0 3270459 5144521 BROOKS SKILLED NURSING FACILITY A, INC. IS A 501(C)(3) NON-PROFIT ORGANIZATION CREATED BY BROOKS HEALTH SYSTEM OF JACKSONVILLE, FLORIDA TO OPERATE THE SAN MARCO TERRACE.SAN MARCO TERRACE, OWNED AND OPERATED BY BROOKS REHABILITATION VIA BROOKS SKILLED NURSING FACILITY A, IS AN AWARD-WINNING NURSING AND REHABILITATION FACILITY LOCATED IN THE HEART OF ST. AUGUSTINE. ONE OF ONLY A FEW FACILITIES IN NORTHEAST FLORIDA AWARDED THE 5-STAR QUALITY RATING BY MEDICARE, SAN MARCO TERRACE IS AMONG THE TOP 10% OF ALL SKILLED NURSING AND REHABILITATION FACILITIES IN THE UNITED STATES. LEARN MORE ABOUT SAN MARCO TERRACE AT:HTTP://WWW.BROOKSHEALTH.ORG/SKILLED-NURSING/SAN-MARCO-TERRACE/ 3270459 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 117 0 1 124 1 0 0 0 0 0 0 0 0 0 0 X 5 1 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X DOUGLAS M BAER 9043457600 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 X DOUGLAS M BAER 2.00 X X 0 493762 113383 BRUCE M BLAKE 2.00 X X 0 102760 16606 BRIAN FULLER 2.00 X X 0 182300 14449 MICHAEL SPIGEL 2.00 X X 0 378273 72792 GARY W SNEED 2.00 X 0 38567 0 DOUGLAS A HERNANDEZ 40.00 X 102193 0 16500 102193 1195662 233730 1 0 1 0 SENIOR CARE OF ST JOHNS 1240 MARBELA PLACE DR TAMPA FL 33629 MEDICAL SERVICES 611401 HEALTHCARE SERVICES GROUP INC 3220 TILMAN DR SUITE 300 BENSALEM PA 19020 MEDICAL SERVICES 304713 PHARMERICA PO BOX 741700 ATLANTA GA 30374 MEDICAL SUPPLIES 214415 3 NET PROGRAM SERVICE 621400 5144521 5144521 5144521 OTHER REVENUE 900099 70550 70550 70550 5215071 5144521 0 70550 2131721 1868296 263425 27290 26157 1133 345738 316057 29681 171599 148661 22938 645670 645670 172237 172237 15954 15954 459772 331704 128068 342 342 985299 468315 516984 95433 95433 10743 8396 2347 1577 1577 115343 115343 220187 5604 214583 28670 28670 BAD DEBT EXPENSE 1836 1836 5429411 3270459 2158952 0 353673 331587 861575 443182 14565 3141 198970 67499 172638 131471 491750 20597 3295837 6780877 4698288 8202605 528127 583169 3270058 3823383 4253708 572675 535907 4924185 8642842 X -225897 -440237 -225897 -440237 4698288 8202605 -214340 0 X X 0 1 1 X 0 X 60603 39779 20824 2556 1661 895 135811 26059 109752 131471 OTHER ASSETS 63900 LICENSURES AND START-UP COSTS, NET 6716977 6780877 ESTIMATED THIRD-PARTY PAYABLES 217754 DUE TO AFFILIATES 318153 535907 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION RECEIVES CONSOLIDATED FINANCIAL STATEMENTS INCLUDING CORPORATE PARENT AND SUBSIDIARIES. THE FOLLOWING DISCLOSURE APPLIES TO THE SYSTEM AS A WHOLE: BROOKS REHABILITATION HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. 0 1 0 0 0 0 0 0 0 DOUGLAS M BAER 0 326994 0 113219 0 53549 0 106500 0 6883 0 607145 0 0 BRIAN FULLER 0 126076 0 40142 0 16082 0 9697 0 4752 0 196749 0 0 MICHAEL SPIGEL 0 256192 0 94693 0 27388 0 67100 0 5692 0 451065 0 0 PART I, LINE 4B IN 2011, GENESIS HEALTH, INC., A RELATED ORGANIZATION, PROVIDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO CERTAIN KEY EMPLOYEES. THE PLAN IS AN UNFUNDED DEFERRED COMPENSATION PLAN DESCRIBED IN SECTION 457(F) AND IS INTENDED FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. AT THIS TIME, CONTRIBUTIONS TO AN INDIVIDUAL'S ACCOUNT UNDER THE PLAN ARE SET TO BE 20% OF THE INDIVIDUAL'S ANNUAL BASE SALARY, WITH THE OPTION FOR AS MUCH AS 25% OF ANNUAL BASE SALARY AT THE DISCRETION OF THE BOARD COMPENSATION COMMITTEE. VESTING IN THE PLAN FOR CURRENT MEMBERS OCCURS JANUARY 1, 2022, PROVIDED EMPLOYMENT IS MAINTAINED, AND DISREGARDING ACCELERATION DUE TO DEATH OR DISABILITY. FOR THE CURRENT TAX YEAR, ALLOCATIONS TO THE PLAN FOR LISTED INDIVIDUALS WERE AS FOLLOWS, (LISTED AS A COMPONENT OF PART II, COLUMN (C)): DOUGLAS BAER - $ 68,000 MICHAEL SPIGEL - 50,600 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE ORGANIZATION DOES NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES DIRECTLY. CERTAIN BOARD MEMBERS AND MANAGEMENT OFFICIALS ARE COMPENSATED BY BROOKS HEALTH SYSTEM, A RELATED ORGANIZATION. THE BOARD OF BROOKS HEALTH SYSTEM USES THE FOLLOWING METHODS TO DETERMINE EXECUTIVE COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION STUDY OR SURVEY - APPROVAL BY COMPENSATION COMMITTEE JACKSONVILLE ECONOMIC DEVELOPMENT COMMISSION 2011-05-31 3300000 CAPITAL IMPROVEMENTS, REFINANCING 0 0 0 3300000 21682 3018400 259918 2014 1 0 0 1 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 1 BBVA COMPASS 15.000000000000 1 0 0 0 0 SCHEDULE K, PART I, DESCRIPTION OF PURPOSE: THE JACKSONVILLE ECONOMIC DEVELOPMENT COMMISSION HEALTH CARE REVENUE BONDS, SERIES 2010 WAS APPROVED AT $65,000,000 TO BE DISBURSED IN THREE SEPARATE ISSUES. THE FIRST FUNDING WAS FOR $34,100,000 ISSUED IN AUGUST 2010, AND WAS ALLOCATED TO A RELATED ORGANIZATION. THE PURPOSE OF THE ISSUE WAS TO: (I) FINANCE A PORTION OF THE COST OF CAPITAL IMPROVEMENTS, (II) REFINANCE CERTAIN INDEBTEDNESS OF THE COMPANY WHICH FINANCED THE ACQUISITION OF BROOKS HOME CARE ADVANTAGE, INC. AND (III) PAY THE COSTS ASSOCIATED WITH THE ISSUANCE OF THE DEBT. THE CAPITAL IMPROVEMENTS WILL CONSIST OF: (I) BUILDING THE INFRASTRUCTURE ON LAND HELD FOR INVESTMENT, (II) IMPROVEMENTS AT THE COMPANY'S EXISTING INPATIENT REHABILITATION HOSPITAL, (III) ROUTINE CAPITAL IMPROVEMENTS TO HEALTH CARE FACILITIES OF THE COMPANY. THE REMAINING FUNDS WERE ISSUED IN MAY 2011. THE FIRST DRAW OF $3,300,000 (REPORTED ON THIS SCHEDULE K) WAS ALLOCATED TO THE FILING ORGANIZATION. THE REMAINING $27,600,000 WAS ALLOCATED TO A RELATED ORGANIZATION. SCHEDULE K, PART IV, LINE 6: AT THE TIME OF FILING, NOT ENOUGH TIME HAD PASSED TO DETERMINE IF THE ISSUE QUALIFIED FOR AN EXCEPTION TO REBATE. PROGRAM SERVICE STATEMENT FORM 990, PART III, LINE 4A RESIDENTS AND THEIR FAMILIES WILL BE ASSURED THE VERY BEST IN QUALITY FROM A FACILITY THAT HAS ALSO RECENTLY RECEIVED THE BRONZE AWARD FOR COMMITMENT TO QUALITY FROM THE AMERICAN HEALTH CARE ASSOCIATION. AT SAN MARCO TERRACE, WE BELIEVE IN A HOLISTIC APPROACH TO HEALING, FOCUSING ON THE PHYSICAL, EMOTIONAL AND SPIRITUAL HEALTH OF OUR RESIDENTS. OUR CARING, COMPASSIONATE STAFF WORKS AROUND THE CLOCK TO ENSURE THAT OUR RESIDENTS' NEEDS ARE ALWAYS ATTENDED TO WITH PATIENCE AND UNDERSTANDING. REHABILITATION SAN MARCO TERRACE IS PROUD TO OFFER PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES TO OUR RESIDENTS WHO NEED THESE SERVICES. THERAPY TAKES PLACE IN A VARIETY OF SETTINGS THROUGHOUT OUR CAMPUS. IN ADDITION TO OUR THERAPY GYM, RESIDENTS MAY LEARN TECHNIQUES FOR NAVIGATING DIFFERENT SURFACES IN OUR OUTDOOR THERAPY COURTYARD, A THERAPIST MAY HAVE A RESIDENT PRACTICE WALKING DOWN A HALLWAY WHILE GREETING OTHER RESIDENTS. THERAPISTS ALSO RETRAIN RESIDENTS IN ACTIVITIES OF DAILY LIVING SUCH AS DRESSING AND BATHING. THERAPIES WOVEN THROUGHOUT THE DAY DURING A RESIDENT'S STAY WILL ENSURE CONTINUED SUCCESS AS THEY RETURN HOME OR TO ANOTHER LEVEL OF CARE. OUR THERAPISTS AND PROFESSIONAL STAFF ARE COMMITTED TO HELPING EACH CLIENT MAINTAIN QUALITY OF LIFE, INDEPENDENCE AND DIGNITY WHILE ACHIEVING THEIR HIGHEST LEVEL OF RECOVERY. WE REALIZE THAT EACH RESIDENT HAS UNIQUE NEEDS AND CHALLENGES. OUR STAFF WILL DEVELOP AN EQUALLY UNIQUE, COMPREHENSIVE REHABILITATION PROGRAM. SAN MARCO TERRACE IS LOCATED AT 189 SAN MARCO AVENUE, ST. AUGUSTINE, FL, 32084. FORM 990, PART VI, SECTION A, LINE 3 BEGINNING IN SEPTEMBER 2011, JOHN DRIGGERS, AN INDEPENDENT CONTRACTOR, BEGAN SERVING AS INTERIM ADMINISTRATOR OF THE BROOKS SAN MARCO TERRACE FACILITY. HIS DUTIES INCLUDE THE GENERAL SUPERVISION OF EMPLOYEES AND ADMINISTRATION OF THE FACILITY. BEGINNING IN OCTOBER 2011, LYNN PETERSON, CONTRACTED WITH THE ORGANIZATION THROUGH THE HEALTH DIMENSIONS GROUP, AN UNRELATED ORGANIZATION, SERVED AS THE INTERIM DIRECTOR OF NURSING FOR THE FACILITY. HER DUTIES INCLUDE DIRECTING AND LEADING THE FACILITY'S DELIVERY OF CARE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS BROOKS SKILLED NURSING, INC. A FLORIDA NOT FOR PROFIT CORPORATION. BROOKS SKILLED NURSING, INC. IS A SUBSIDIARY OF GENESIS HEALTH, INC., A FLORIDA 501(C)(3) NOT FOR PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION SHALL HAVE AT ALL TIMES AT LEAST THREE MEMBERS OF THE BOARD OF DIRECTORS. THE MEMBERS OF THE BOARD OF DIRECTORS ARE ELECTED BY THE SOLE MEMBER ORGANIZATION AS PROVIDED IN THE BYLAWS OF THE ORGANIZATION. SEE THE RESPONSE TO LINE 6 ABOVE. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE THE APPROVAL OF THE SOLE MEMBER: - A CHANGE IN THE PURPOSE OF THE ORGANIZATION - THE TERMINATION OF THE TAX-EXEMPT STATUS OF THE ORGANIZATION UNDER SECTION 501(C)(3) - THE SALE OR DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION OR A SUBSIDIARY OF THE ORGANIZATION - THE DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION OR A SUBSIDIARY OF THE ORGANIZATION - THE ADDITION OF A MEMBER OF THE ORGANIZATION - THE MERGER OR CONSOLIDATION OF THE ORGANIZATION OR A SUBSIDIARY OF THE ORGANIZATION OR THE ESTABLISHMENT OF A SUBSIDIARY OF THE ORGANIZATION - THE AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE ORGANIZATION FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE GUIDANCE AND ASSISTANCE OF MANAGEMENT. THE FORM WAS REVIEWED INTERNALLY AND THEN PRESENTED TO THE AUDIT COMMITTEE FOR REVIEW. THE AUDIT COMMITTEE THEN PREPARED A SUMMARY THAT WAS PRESENTED TO THE BOARD OF DIRECTORS ALONG WITH THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR BOARD MEMBERS ARE REQUIRED TO COMPLETE A FORM THAT WILL DISCLOSE ANY RELATIONSHIPS THAT MAY CREATE A CONFLICT OF INTEREST. THE FORMS ARE REVIEWED BY MANAGEMENT AND ANY CONCERNS ARE REFERRED TO THE BOARD IF NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 BROOKS HEALTH USES AN OUTSIDE CONSULTANT FOR ALL OFFICER, EXECUTIVE, AND TOP MANAGEMENT OFFICIAL COMPENSATION DECISIONS. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS MUST APPROVE ANY AND ALL DECISIONS REGARDING EXECUTIVE PAY. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST. ADDITIONALLY, RECENT FILINGS OF THE FORM ARE AVAILABLE ON GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. AVERAGE HOURS PER WEEK FOR RELATED ORGANIZATIONS: FORM 990, PART VII, LINE 1: OFFICERS OF THIS ORGANIZATION RECEIVING COMPENSATION FROM A RELATED ORGANIZATION ARE COMPENSATED BY BROOKS HEALTH SYSTEM. THE SYSTEM PROVIDES MANAGERIAL OVERSIGHT TO ITS SUBSIDIARIES, AND OFFICERS IN PART VII SHOWN AS WORKING TWO HOURS FOR THE FILING ORGANIZATION PERFORM AN AVERAGE OF 50 HOURS PER WEEK FOR BROOKS HEALTH SYSTEM. INDEPENDENCE OF GOVERNING BODY: PART VII, LINE 1: THE ORGANIZATION IS A SUBSIDIARY OF GENESIS HEALTH, INC., A 501(C)(3) ORGANIZATION. THE BOARD OF DIRECTORS OF THIS ORGANIZATION FAILS TO HAVE A MAJORITY OF INDEPENDENT BOARD MEMBERS PER THE DEFINITION PROVIDED BY THE IRS. PLEASE NOTE, HOWEVER, THAT THE PARENT ORGANIZATION HAS A MAJORITY INDEPENDENT BOARD OF DIRECTORS, AND THROUGH ITS MEMBERSHIP PROVIDES GOVERNANCE OVERSIGHT OVER THE FILING ORGANIZATION. PLEASE SEE THE RESPONSES TO FORM 990, PART VI, LINES 6 THROUGH 7B FOR DETAILS ON THE SOLE MEMBER, THE SOLE MEMBER'S CORPORATE PARENT, AND ITS AUTHORITY. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GENESIS HEALTH INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 592249370 HEALTHCARE FL 501(C)(3) LINE 11A, I N/A 0 GENESIS REHABILITATION HOSPITAL INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 593284221 HEALTHCARE / REHAB CARE FL 501(C)(3) LINE 3 GENESIS HEALTH INC 0 PHYSICAL MEDICINE SPECIALISTS INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 593530305 HEALTHCARE / PHYSICIANS FL 501(C)(3) LINE 11A, I GENESIS REHABILITATION HOSPITAL INC 0 BROOKS HOME CARE ADVANTAGE INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 262216181 HEALTHCARE / HOME THERAPY FL 501(C)(3) LINE 9 GENESIS HEALTH INC 0 GENESIS HEALTH DEVELOPMENT INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 592249372 HEALTHCARE / REHAB THERAPY FL 501(C)(3) LINE 9 GENESIS HEALTH INC 0 BROOKS SKILLED NURSING INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 264561148 HEALTHCARE / SKILLED NURSING FL 501(C)(3) LINE 9 GENESIS HEALTH INC 0 BROOKS SKILLED NURSING FACILITY B INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 452623130 HEALTHCARE / SKILLED NURSING FL 501(C)(3) PENDING BROOKS SKILLED NURSING INC 0 THE GENESIS HEALTH FOUNDATION INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 592249340 SUPPORT / FUNDRAISING FL 501(C)(3) LINE 7 GENESIS HEALTH INC 0 BROOKS SKILLED NURSING FACILITY HOLDINGS A INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 272187557 REAL ESTATE HOLDING FL 501(C)(3) LINE 11A, I BROOKS SKILLED NURSING INC 0 BROOKS SKILLED NURSING FACILITY HOLDINGS B INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 452623488 REAL ESTATE HOLDING FL 501(C)(3) PENDING BROOKS SKILLED NURSING INC 0 HB REHABILITATIVE SERVICES INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 452622986 HEALTHCARE FL 501(C)(3) PENDING GENESIS HEALTH INC 0 ST AUGUSTINE MOB LTD 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 593397507 REAL ESTATE HOLDING FL N/A GH HOLDINGS INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 593007328 HOLDING COMPANY FL N/A C GH MANAGEMENT INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 592387438 HOLDING COMPANY FL N/A C GENESIS MANAGEMENT SERVICES INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 592183211 MANAGEMENT SERVICES FL N/A C GH MEDICAL SERVICES INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 592742895 MEDICAL SERVICES FL N/A C GH PARTNERSHIP HOLDINGS PPA INC 3599 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 593075439 INVESTMENT HOLDINGS FL N/A C 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0