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MICHAEL MALOTZ SKILLED NURSING PAVILION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MICHAEL MALOTZ SKILLED NURSING PAVILION (EIN 31-1587828)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-08-02
IRS object ID
201122149349300107
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2011-08-02T08:50:28-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1O'CONNOR DAVIES MUNNS & DOBBINS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 MAMARONECK AVENUEAddressLine1
CityHARRISONCity
StateNYState
ZIP Code105281633ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN311587828EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MICHAEL MALOTZ SKILLED NURSING PAVILIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMICHNameControl
Phone9149643333Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1120 ODELL AVENUEAddressLine1
CityYONKERSCity
StateNYState
ZIP Code107011408ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARK POHARName
TitleADMINISTRATORTitle
Phone9149643333Phone
Date Signed2011-08-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone9143818900Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARK POHARNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1120 ODELL AVENUEAddressLine1
CityYONKERSCity
StateNYState
ZIP Code107011408ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13680813GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.RIVERSIDEHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE SKILLED NURSING AND REHABILITATION SERVICES TO GERIATRIC, SUBACUTE AND VENTILATOR DEPENDENT RESIDENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees208TotalNbrEmployees
Total Nbr Volunteers2TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3155ContributionsGrantsPriorYear
Contributions Grants Current Year7109ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13275709ProgramServiceRevenuePriorYear
Program Service Revenue CY13592296ProgramServiceRevenueCY
Investment Income Prior Year64582InvestmentIncomePriorYear
Investment Income Current Year45935InvestmentIncomeCurrentYear
Other Revenue Prior Year30187OtherRevenuePriorYear
Other Revenue Current Year35473OtherRevenueCurrentYear
Total Revenue Prior Year13373633TotalRevenuePriorYear
Total Revenue Current Year13680813TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8623353SalariesEtcPriorYear
Salaries Etc Current Year8907921SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5172734OtherExpensePriorYear
Other Expenses Current Year5514805OtherExpensesCurrentYear
Total Expenses Prior Year13796087TotalExpensesPriorYear
Total Expenses Current Year14422726TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-422454RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-741913RevenuesLessExpensesCY
Total Assets BOY19386061TotalAssetsBOY
Total Assets EOY18955910TotalAssetsEOY
Total Liabilities BOY21904399TotalLiabilitiesBOY
Total Liabilities EOY22216161TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-2518338NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-3260251NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE SKILLED NURSING AND ANCILLARY SERVICES TO RESIDENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense13363447Expense
Revenue13592296Revenue
DescriptionSKILLED NURSING, REHABILITATION AND ANCILLARY SERVICES PROVIDED TO GERIATRIC, SUB-ACUTE AND VENTILATOR DEPENDENT RESIDENTS. PATIENT DAYS OF CARE FOR THE YEAR WAS 41,476: GERIATRIC DAYS OF 39,129 AND VENTILATOR DEPENDENT DAYS OF 2,347. THE NUMBER OF RESIDENTS SERVED IN 2010 WAS 539: 508 GERIATRIC AND 31 VENTILATOR DEPENDENT RESIDENTS.Description
Total Program Service Expense13363447TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees208NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SHERWIN CHUEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9149643333TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1120 ODELL AVENUEAddressLine1
CityYONKERSCity
StateNYState
ZIP Code107011408ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
ALFRED M GOMEZ MD
CHAIRMAN0.30XX000
ANIL M JOSHI MD
TRUSTEE0.30X000
KEVIN T FAY
TRUSTEE0.30X000
GEORGE S GORMAN
TRUSTEE0.30X000
ROYDEN LETSEN
TRUSTEE0.30X000
RICHARD PETERSON
TRUSTEE0.30X000
ANN C CARROLL
ADMINISTRATOR37.50X186844021945
MARK POHAR
ADMINISTRATOR37.50X017678732259
SHERWIN CHUE
CONTROLLER37.50190476033312X
IYAD ANNABI MD
MEDICAL DIRECTOR20.00101335024245X
GEMMA MOORE
DIRECTOR OF NURSING37.50102905016485X
FieldValueIRS element (for citing)
Total Reportable Comp From Org581560TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs176787TotalReportableCompFrmRltdOrgs
Total Other Compensation128246TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ST JOHN'S RIVERSIDE HOSPITALBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1967 N BROADWAYAddressLine1
CityYONKERSCity
StateNYState
ZIP Code10701ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesVARIOUS SERVICES: FOOD, LAB, LAUNDRY, ADDescriptionOfServices
Compensation681985Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions7109AllOtherContributions
Total Contributions7109TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID62300083377468337746
MEDICARE62300028284072828407
PRIVATE62300013073191307319
OTHER62300011188241118824
FieldValueIRS element (for citing)
Total Program Service Revenue13592296TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column45935TotalRevenueColumn
Exclusion$45,935ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
EMPLOYEE PARKING81293012949$12,949
SOLD SERVICES9000999000$9,000
REBATE9000996257$6,257

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column7267TotalRevenueColumn
Exclusion$7,267ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue35473TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13680813TotalRevenueColumn
Related Or Exempt Function Income13592296RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$81,408ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total475820Total
Management And General475820ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6169789Total
Program Services6029927ProgramServices
Management And General139862ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total661802Total
Program Services651491ProgramServices
Management And General10311ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1112580Total
Program Services1038538ProgramServices
Management And General74042ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total487930Total
Program Services458708ProgramServices
Management And General29222ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total40669Total
Management And General40669ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total40000Total
Management And General40000ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total4173Total
Management And General4173ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total167257Total
Program Services155656ProgramServices
Management And General11601ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total957992Total
Program Services928590ProgramServices
Management And General29402ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total63859Total
Program Services63859ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1103145Total
Program Services1077082ProgramServices
Management And General26063ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total9117Total
Program Services4681ProgramServices
Management And General4436ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total123970Total
Program Services120061ProgramServices
Management And General3909ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total940186Total
Program Services910537ProgramServices
Management And General29649ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total129934Total
Program Services121881ProgramServices
Management And General8053ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCH & CONTRACTED SERV762434652239110195
BAD DEBT EXPENSE580000580000
NYS CASH ASSESSMENT517981517981

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total74088Total
Program Services52216ProgramServices
Management And General21872ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total14422726Total
Program Services13363447ProgramServices
Management And General1059279ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY291952BOY
EOY464345EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY753905BOY
EOY360889EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2811590BOY
EOY3084625EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY12259BOY
EOY20259EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY40187BOY
EOY48103EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis20203852LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11202851LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9766545BOY
EOY9001001EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5709623BOY
EOY5976688EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19386061BOY
EOY18955910EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1589372BOY
EOY1763949EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY248613BOY
EOY208631EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY12870863BOY
EOY12580149EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7195551BOY
EOY7663432EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY21904399BOY
EOY22216161EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-2518338BOY
EOY-3260251EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-2518338BOY
EOY-3260251EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19386061BOY
EOY18955910EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-741913ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14779CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6537CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3333CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3155CurrentTaxYearMinus1Year
Current Tax Year7109CurrentTaxYear
Total34913Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13894393CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13759100CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14180053CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13275709CurrentTaxYearMinus1Year
Current Tax Year13592296CurrentTaxYear
Total68701551Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13909172CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13765637CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14183386CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13278864CurrentTaxYearMinus1Year
Current Tax Year13599405CurrentTaxYear
Total68736464Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50968736464PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years151202CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years136514CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years87521CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year64582CurrentTaxYearMinus1Year
Current Tax Year45935CurrentTaxYear
Total485754Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years151202CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years136514CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years87521CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year64582CurrentTaxYearMinus1Year
Current Tax Year45935CurrentTaxYear
Total485754Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years99405CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years68027CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years51091CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year30187CurrentTaxYearMinus1Year
Current Tax Year35473CurrentTaxYear
Total284183Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14159779CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13970178CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14321998CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13373633CurrentTaxYearMinus1Year
Current Tax Year13680813CurrentTaxYear
Total69506401Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98890PublicSupportPercentage509
Prior Year Support Percentage0.98740PriorYearSupportPercentage
Investment Income Percentage0.00700InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00710PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: VENDING MACHINES INCOME CASH DISCOUNT MEDICAL ABSTRACTION FEES REFUNDS AND REBATES SOLD SERVICES EMPLOYEE PARKING FEES OTHERGeneralExplanation

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$4,173OtherActivitiesAmount
Total Lobbying Expenditures IIB4173TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationCOSTS ARE INCURRED AS PART OF DUES PAID TO NURSING HOME INDUSTRY ORGANIZATIONS.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis10OtherCostOrOtherBasis
Book Value10BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis17963176OtherCostOrOtherBasis
Depreciation9711634Depreciation
Book Value8251542BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2240666OtherCostOrOtherBasis
Depreciation1491217Depreciation
Book Value749449BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9001001TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM THIRD PARTY PAYORS628357
ASSETS LIMITED AS TO USE - CASH AND CASH EQUIVALENTS2293105
ASSETS LIMITED AS TO USE - CERTIFICATES OF DEPOSIT3055226
FieldValueIRS element (for citing)
Total Book Value Other Assets5976688TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO THIRD PARTY PAYORS$379,178
DUE TO ST. JOHN'S RIVERSIDE HOSPITAL$1,606,998
NOTE PAYABLE TO ST. JOHN'S RIVERSIDE HOSPITAL$5,677,256
FieldValueIRS element (for citing)
Total Of Amounts7663432TotalOfAmounts
Total Revenue13680813TotalRevenue
Total Expenses14422726TotalExpenses
Excess Or Deficit For Year-741913ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-741913ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt13680813TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal13680813RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99013680813TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt14422726TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal14422726ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99014422726TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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.
PART X:THE PAVILION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE PAVILION HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION. THE PAVILION IS NO LONGER SUBJECT TO AUDITS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2007.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ANN C CARROLL
17228200014562014630073150208789000
MARK POHAR
01767870000014047018212020904600
SHERWIN CHUE
19047600000150980182140223788000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4AReturnReference
ExplanationANN C. CARROLL RECEIVED A SEVERANCE PAYMENT OF $14,562.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6RIVERSIDE HEALTH CARE SYSTEM, INC. IS THE SOLE MEMBER OF THE PAVILION.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER OF THE PAVILION HAS THE POWER TO ELECT AND REMOVE THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 7BRESERVED 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 11THE 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 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.
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.FORM 990, PART VI, SECTION B, LINE 12C
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.FORM 990, PART VI, SECTION B, LINE 15
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.FORM 990, PART VI, SECTION C, LINE 18
THE MICHAEL MALOTZ SKILLED NURSING PAVILION (PAVILION) MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAIABLE 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.FORM 990, PART VI, SECTION C, LINE 19
AVERAGE HOURS PER WEEK FOR RELATED ORGANIZATIONSALL OF THE BOARD MEMBERS WORK AN AVERAGE OF A HALF HOUR PER WEEK FOR THE RELATED ORGANIZATIONS. MARK POHAR, ADMINISTRATOR, WORKS AN AVERAGE OF 15.75 HOURS PER WEEK.FORM 990, PART VII, SECTION A
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.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
ST JOHN'S RIVERSIDE HOSPITAL
967 NORTH BROADWAYYONKERSNY10701131740126HOSPITALNY501(C)(3)3ST JOHN'S RIVERSIDE HOSPITAL0
RIVERSIDE HEALTH CARE SYSTEM INC
967 NORTH BROADWAYYONKERSNY10701133237215HOSPITALNY501(C)(3)30N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg