2011-08-02T08:50:28-05:00 2010-12-31 O'CONNOR DAVIES MUNNS & DOBBINS LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2010-01-01 311587828 MICHAEL MALOTZ SKILLED NURSING PAVILION MICH 9149643333 120 ODELL AVENUE YONKERS NY 107011408 MARK POHAR 9149643333 2011-08-01 1 9143818900 2010 2016-02-24 21:20:13Z MARK POHAR 120 ODELL AVENUE YONKERS NY 107011408 13680813 0 X WWW.RIVERSIDEHEALTH.ORG X 1998 NY TO PROVIDE SKILLED NURSING AND REHABILITATION SERVICES TO GERIATRIC, SUBACUTE AND VENTILATOR DEPENDENT RESIDENTS. 6 6 208 2 0 0 3155 7109 13275709 13592296 64582 45935 30187 35473 13373633 13680813 0 0 0 0 8623353 8907921 0 0 0 5172734 5514805 13796087 14422726 -422454 -741913 19386061 18955910 21904399 22216161 -2518338 -3260251 TO PROVIDE SKILLED NURSING AND ANCILLARY SERVICES TO RESIDENTS. 0 0 13363447 13592296 SKILLED 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. 13363447 1 0 0 1 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 0 1 11 0 1 208 1 0 0 0 0 0 0 0 0 0 0 X 6 6 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 X ALFRED M GOMEZ MD 0.30 X X 0 0 0 ANIL M JOSHI MD 0.30 X 0 0 0 KEVIN T FAY 0.30 X 0 0 0 GEORGE S GORMAN 0.30 X 0 0 0 ROYDEN LETSEN 0.30 X 0 0 0 RICHARD PETERSON 0.30 X 0 0 0 ANN C CARROLL 37.50 X 186844 0 21945 MARK POHAR 37.50 X 0 176787 32259 SHERWIN CHUE 37.50 X 190476 0 33312 IYAD ANNABI MD 20.00 X 101335 0 24245 GEMMA MOORE 37.50 X 102905 0 16485 581560 176787 128246 4 0 1 0 ST JOHN'S RIVERSIDE HOSPITAL 967 N BROADWAY YONKERS NY 10701 VARIOUS SERVICES: FOOD, LAB, LAUNDRY, AD 681985 1 7109 7109 MEDICAID 623000 8337746 8337746 MEDICARE 623000 2828407 2828407 PRIVATE 623000 1307319 1307319 OTHER 623000 1118824 1118824 13592296 45935 45935 EMPLOYEE PARKING 812930 12949 12949 SOLD SERVICES 900099 9000 9000 REBATE 900099 6257 6257 7267 7267 35473 13680813 13592296 0 81408 475820 475820 6169789 6029927 139862 661802 651491 10311 1112580 1038538 74042 487930 458708 29222 40669 40669 40000 40000 4173 4173 167257 155656 11601 957992 928590 29402 63859 63859 1103145 1077082 26063 9117 4681 4436 123970 120061 3909 940186 910537 29649 129934 121881 8053 PURCH & CONTRACTED SERV 762434 652239 110195 BAD DEBT EXPENSE 580000 580000 NYS CASH ASSESSMENT 517981 517981 74088 52216 21872 14422726 13363447 1059279 0 291952 464345 753905 360889 2811590 3084625 12259 20259 40187 48103 20203852 11202851 9766545 9001001 5709623 5976688 19386061 18955910 1589372 1763949 248613 208631 12870863 12580149 7195551 7663432 21904399 22216161 X -2518338 -3260251 -2518338 -3260251 19386061 18955910 -741913 0 X X 0 1 1 X 1 1 X 14779 6537 3333 3155 7109 34913 13894393 13759100 14180053 13275709 13592296 68701551 13909172 13765637 14183386 13278864 13599405 68736464 0 0 0 68736464 151202 136514 87521 64582 45935 485754 151202 136514 87521 64582 45935 485754 99405 68027 51091 30187 35473 284183 14159779 13970178 14321998 13373633 13680813 69506401 0.98890 0.98740 0.00700 0.00710 X SCHEDULE 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 OTHER 0 0 0 0 0 0 0 0 1 4173 4173 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: COSTS ARE INCURRED AS PART OF DUES PAID TO NURSING HOME INDUSTRY ORGANIZATIONS. 0 1 10 10 17963176 9711634 8251542 2240666 1491217 749449 9001001 DUE FROM THIRD PARTY PAYORS 628357 ASSETS LIMITED AS TO USE - CASH AND CASH EQUIVALENTS 2293105 ASSETS LIMITED AS TO USE - CERTIFICATES OF DEPOSIT 3055226 5976688 DUE TO THIRD PARTY PAYORS 379178 DUE TO ST. JOHN'S RIVERSIDE HOSPITAL 1606998 NOTE PAYABLE TO ST. JOHN'S RIVERSIDE HOSPITAL 5677256 7663432 13680813 14422726 -741913 0 -741913 13680813 0 13680813 0 13680813 14422726 0 14422726 0 14422726 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: 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. X X 1 0 0 0 0 0 0 0 0 ANN C CARROLL 172282 0 0 0 14562 0 14630 0 7315 0 208789 0 0 0 MARK POHAR 0 176787 0 0 0 0 0 14047 0 18212 0 209046 0 0 SHERWIN CHUE 190476 0 0 0 0 0 15098 0 18214 0 223788 0 0 0 PART I, LINE 4A ANN C. CARROLL RECEIVED A SEVERANCE PAYMENT OF $14,562. 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 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. 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. 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. 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 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. AVERAGE HOURS PER WEEK FOR RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A ALL 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 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 ST JOHN'S RIVERSIDE HOSPITAL 0 RIVERSIDE HEALTH CARE SYSTEM INC 967 NORTH BROADWAY YONKERS NY 10701 133237215 HOSPITAL NY 501(C)(3) 3 N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0