2023-11-08T20:51:40-06:00 2022-12-31 873231666 PKF O'CONNOR DAVIES ADVISORY LLC 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2022-01-01 141370000 HOOSICK FALLS HEALTH CENTER INC HOOS 5186864371 21 DANFORTH STREET HOOSICK FALLS NY 12090 ROBERT LABA CFO 5186864371 2023-11-08 1 ROBERT LABA 999009999 1 EVA MRUK P00543254 9143818900 2023-11-07 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z CENTER FOR NURSING AND REHABILITATION AT HOOSICK FALLS GREGORY LAURIN 21 DANFORTH STREET HOOSICK FALLS NY 12090 4800922 0 X WWW.NURSINGANDREHAB.ORG X 1914 NY THE CENTERS MISSION IS TO PROVIDE REHABILITATION AND LONG-TERM CARE SERVICES TO THOSE IN NEED. WE STRIVE TO PROVIDE RESIDENT CENTERED CARE IN OUR 82 BED SKILLED NURSING FACILITY SO THAT EACH RESIDENT HAS THE OPPORTUNITY TO REACH THEIR MAXIMUM POTENTIAL. 8 7 137 8 0 0 167834 252429 5906621 4540676 298 71 9901 7746 6084654 4800922 0 0 0 0 4984277 3663897 0 0 0 3178823 3466800 8163100 7130697 -2078446 -2329775 4877210 4891140 8082508 10444944 -3205298 -5553804 WE ARE AN 82 BED SKILLED NURSING HOME FACILITY PROVIDING 24 HR/7 DAYS A WEEK HEALTH CARE TO THOSE IN NEED IN A HOME LIKE ATMOSPHERE. 0 0 6028548 4540676 HOOSICK FALLS HEALTH CENTER FOCUSES ON DEVELOPING, MANAGING, AND OPERATING NURSING HOME CARE IN THE HOOSICK FALLS, NEW YORK AREA AND PROVIDING SERVICES TO THE COMMUNITY. THE ORGANIZATION SPECIALIZES IN LONG-TERM CARE AND REHABILITATION SERVICES, AND PROVIDES GREAT NURSING CARE, GOOD FOOD AND FRIENDLY AND HELPFUL PEOPLE, AND A SUPPORTING AND CARING ENVIRONMENT. THE HOOSICK FALLS HEALTH CENTER HAS 82 SKILLED NURSING BEDS. DURING THE YEAR, THE TOTAL PATIENT/RESIDENT DAYS WERE 17,780. 6028548 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 16 0 137 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 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 LABA 8024474587 21 DANFORTH STREET HOOSICK FALLS NY 12090 STEPHEN D MAJETICH TREASURER & CFO 1.00 46.15 X X 0 787032 133482 GREGORY LAURIN PRESIDENT 2.00 0.00 X X 0 0 0 WILLIAM KOESTER VICE PRESIDENT 1.00 0.00 X X 0 0 0 JOYCE DAVIS SECRETARY 1.00 0.25 X X 0 0 0 BILL COTTRELL DIRECTOR 1.00 0.00 X 0 0 0 PATTY RYAN DIRECTOR 1.00 0.00 X 0 0 0 KEN FACIN DIRECTOR 1.00 0.00 X 0 0 0 KEVIN DAILEY DIRECTOR 1.00 40.00 X 0 397185 87841 MEAGAN MOSSO ADMINISTRATOR 40.00 0.00 X 91342 0 13576 91342 1184217 234899 0 0 1 0 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 STAFFING AGENCY 300557 INTELYCARE INC PO BOX 787317 PHILADELPHIA PA 19178 STAFFING AGENCY 202131 QUEST DIAGNOSTICS PO BOX 829864 PITTSBURGH PA 19182 COVID-19 TESTING SERVICES 133791 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVE SUITE 301 HARRISON NY 10528 ACCOUNTING SERVICES 105235 4 16638 235791 252429 MEDICAID REVENUE 623000 2968596 2968596 PRIVATE PATIENT REVENU 623000 929417 929417 MEDICARE REVENUE 623000 642663 642663 4540676 71 71 6600 0 6600 6600 6600 OTHER INCOME 900099 1146 1146 1146 4800922 4540676 0 7817 X 104918 96306 8612 2809539 2578917 230622 76091 69845 6246 364172 334279 29893 309177 283798 25379 7461 7461 86731 86731 567 567 1741410 1299874 441536 3768 3768 433492 373783 59709 82239 82239 217124 209927 7197 10168 2303 7865 270162 270162 104244 104244 NY CASH RECEIPT ASSMT. 233011 233011 REPAIRS AND MAINTENANCE 134824 134744 80 BAD DEBT EXPENSE 92714 92714 PHARMACEUTICALS 46843 46843 2042 2042 7130697 6028548 1102149 0 333746 299620 83795 47251 524634 734362 26557 62743 11707490 8084824 3763335 3622666 145143 124498 4877210 4891140 1637980 1965372 64136 83795 47251 6360733 8368185 8082508 10444944 X -3283604 -5613379 78306 59575 -3205298 -5553804 4877210 4891140 X -2329775 -18731 X 0 1 X 0 0 X 2811091 1314630 837264 167834 252429 5383248 5894979 6589604 6209239 5906621 4540676 29141119 8706070 7904234 7046503 6074455 4793105 34524367 0 0 0 34524367 8248 6916 7378 6898 6671 36111 8248 6916 7378 6898 6671 36111 55762 52759 72737 3301 1146 185705 8770080 7963909 7126618 6084654 4800922 34746183 0.99360 0.98990 0.00100 0.00110 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: RECOVERY OF BAD DEBT EXPENSE - 2020 AMOUNT: $ 70,268. 2021 AMOUNT: $ 1,241. OTHER INCOME - 2018 AMOUNT: $ 55,762. 2019 AMOUNT: $ 52,759. 2020 AMOUNT: $ 2,469. 2021 AMOUNT: $ 2,060. 2022 AMOUNT: $ 1,146. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 567 567 0 PART II-B, LINE 1: AMOUNTS REPORTED ON LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES, PAID BY THE ORGANIZATION TO TRADE OR PROFESSIONAL ASSOCIATIONS, ATTRIBUTABLE TO LOBBYING ACTIVITIES. 0 1 X 60499 60499 3433077 2232080 1200997 7622504 5312807 2309697 591410 539937 51473 3622666 DUE TO THIRD PARTY PAYORS 285230 DUE TO FOUNDATION 29223 ESTIMATED INSURANCE LIABILITIES 132143 DUE TO AFFILIATES 7921589 8368185 X 4700872 0 4700872 100050 100050 4800922 7037983 0 7037983 92714 92714 7130697 PART IV, LINE 2B: RESIDENTS' FUNDS ARE HELD BY THE HEALTH CENTER ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT ALLOWANCES RECEIVED BY RESIDENTS AS WELL AS OTHER RESIDENTS' FUNDS DEPOSITED WITH THE HEALTH CENTER FOR SAFEKEEPING. THESE FUNDS ARE DISBURSED BY THE HEALTH CENTER AT THE REQUEST OF, OR ON BEHALF OF, RESIDENTS FOR THEIR PERSONAL USE. PART X, LINE 2: THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24 92,714. REVENUE ATTRIBUTED TO AFFILIATE 7,336. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE TO PART IX, LINE 24 92,714. 0 1 0 0 0 0 0 0 0 STEPHEN D MAJETICH TREASURER & CFO 0 328667 0 125719 0 332646 0 78400 0 55082 0 920514 0 0 KEVIN DAILEY DIRECTOR 0 228654 0 89927 0 78604 0 56200 0 31641 0 485026 0 0 PART I, LINE 4B STEPHEN D. MAJETICH, PARTICIPATED IN NONQUALIFIED DEFERRED COMPENSATION PLAN DESCRIBED 457(F) SPONSORED BY A RELATED TAX-EXEMPT ENTITY, SOUTHWESTERN VERMONT MEDICAL CENTER. DURING THE YEAR, $70,400 WAS CONTRIBUTED TO THE PLAN. ADDITIONALLY, HE RECEIVED A DISTRIBUTION FROM THE PLAN IN THE AMOUNT OF $261,827. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CENTER IS SVHC - HOOSICK FALLS LLC, A SINGLE MEMBER LLC OF SOUTHWESTERN VERMONT HEALTH CARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE POWER TO APPOINT, FIX THE NUMBER OF, AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE POWER TO: (1) APPROVE, INTERPRET AND CHANGE THE STATEMENT OF MISSION AND PHILOSOPHY ADOPTED BY THE CORPORATION AND TO REQUIRE THAT THE CORPORATION OPERATE IN CONFORMANCE WITH ITS MISSION AND PHILOSOPHY; (2) APPROVE AND AMEND THE BYLAWS AND CERTIFICATE OF INCORPORATION OF THE CORPORATION; (3) APPROVE ANY PLAN OF MERGER, CONSOLIDATION, DISSOLUTION OR REORGANIZATION OF THE CORPORATION OR ANY SALE, LEASE OR OTHER DISPOSITION OF ALL OF SUBSTANTIALLY ALL OF THEIR ASSETS; (4) ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND/OR THE ADMINISTRATOR OF THE NURSING HOME IF OTHER THAN THE CEO; (5) TO APPROVE THE DEBT OF THE CORPORATION, IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE CORPORATION, EXCEPT FOR DEBT NECESSARY TO FINANCE THE COST OF COMPLIANCE WITH OPERATIONAL OR PHYSICAL PLAN STANDARDS REQUIRED BY LAW; (6) TO APPROVE THE SALE, ACQUISITION, LEASE, TRANSFER, MORTGAGE, PLEDGE OR OTHER ALIENATION OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE BOARD OF MANAGERS OF THE MEMBER; (7) TO APPROVE THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION TO ENSURE THAT SUCH BUDGETS CONFORM TO THE MISSION AND PHILOSOPHY OF THE CORPORATION; (8) TO APPROVE SETTLEMENTS OF LITIGATION WHEN SUCH SETTLEMENTS EXCEED APPLICABLE INSURANCE COVERAGE OR THE AMOUNT OF ANY APPLICABLE SELF-INSURANCE FUND; (9) TO APPROVE ANY CORPORATE REORGANIZATION OF THE CORPORATION AND THE DEVELOPMENT OR DISSOLUTION OF ANY SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; (10) TO APPROVE THE STRATEGIC PLAN OF THE CORPORATION, PROVIDED THAT SUCH RIGHT OF APPROVAL SHALL NOT PERMIT THE CORPORATION TO EXERCISE ANY OF THE GOVERNANCE AUTHORITY UNDER APPLICABLE REGULATIONS UNLESS THE CORPORATION HAS RECEIVED ESTABLISHMENT APPROVAL FROM THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL; (11) TO APPROVE ANY APPLICATION TO THE NEW YORK STATE DEPARTMENT OF HEALTH BY THE CORPORATION FOR A CERTIFICATE OF NEED; (12) TO APPROVE ANY FINAL SETTLEMENT BY THE CORPORATION RELATED TO MEDICAID OR ANY OTHER PAYOR AUDITS; AND (13) TO APPROVE ANY RATE APPEALS TO BE INITIATED BY THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION 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 FOR APPROVAL. ONCE THE BOARD HAS APPROVED THE RETURN IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH EMPLOYEE AND BOARD MEMBER HAS A RESPONSIBILITY AT ALL TIMES TO PROMOTE THE BEST INTERESTS OF THE CENTER FOR NURSING AND REHABILITATION AT HOOSICK FALLS. A CONFLICT OF INTEREST OCCURS WHEN AN EMPLOYEE'S JUDGMENT IN ACTING FOR THE FACILITY IS ADVERSELY AFFECTED. EXAMPLES OF CONFLICTS OF INTEREST INCLUDE BUT ARE NOT LIMITED TO: - ACCEPTING GRATUITIES FROM OTHER COMPANIES OR INDIVIDUALS WHO DO BUSINESS WITH THIS FACILITY OR SEEK TO DO BUSINESS WITH IT. - RENDERING SERVICES TO COMPETITORS. - USING, FACILITATING, CONVEYING, OR PERMITTING OTHERS TO USE FACILITY DOCUMENTS, EQUIPMENT, CONFIDENTIAL INFORMATION OR TRADE SECRETS. - BENEFITING PERSONALLY FROM ANY PURCHASES OR SALES BY THIS FACILITY. - ENGAGING IN OTHER EMPLOYMENT TO THE DETRIMENT OF THE EMPLOYEE'S WORK FOR THE FACILITY. ANNUALLY, ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM REPORTING ANY POTENTIAL CONFLICT OF INTERESTS. IF ONE BELIEVES A CONFLICT OF INTEREST EXISTS THE INDIVIDUAL MUST CONSULT THEIR SUPERVISOR, DEPARTMENT MANAGER, OR ADMINISTRATOR IN WHICH THE DETERMINATION OF WHETHER A CONFLICT EXISTS WILL BE MADE AND REVIEWED. ENGAGEMENT IN ANY BUSINESS PRACTICES THAT COMPROMISE THE FACILITY IN ANY WAY MAY RESULT IN THE IMMEDIATE TERMINATION OF ANY AND ALL EMPLOYEES INVOLVED IN SUCH ACTIVITY, AND MAY BE GROUNDS FOR LEGAL ACTION AGAINST THOSE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 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 AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST AT 21 DANFORTH STREET, HOOSICK FALLS, NY 12090 OR BY CALLING THE ORGANIZATION DIRECTLY AT 518-686-4371. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 79,916. MANAGEMENT AND GENERAL EXPENSES 441,536. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 521,452. PHYSICIAN & NURSING PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 787,646. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 787,646. COVID TESTING: PROGRAM SERVICE EXPENSES 52,628. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 52,628. PHARMACY/DIETARY CONSULTING: PROGRAM SERVICE EXPENSES 209,609. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 209,609. CONTINUING EDUCATION SERVICES: PROGRAM SERVICE EXPENSES 510. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 510. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 169,565. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 169,565. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUST -18,731. HOOSICK FALLS HEALTH CENTER FOUNDATION INC 21 DANFORTH STREET HOOSICK FALLS NY 12090 223186959 SUPPORT THE OPERATIONS OF THE HOOSICK FALLS HEALTH CENTER, INC. NY 501(C)(3) LINE 7 HOOSICK FALLS HEALTH CENTER INC 1 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 030179435 HOSPITAL VT 501(C)(3) LINE 3 N/A 0 SOUTHWESTERN VT HEALTH CARE FOUNDATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 453362785 FUNDRAISING VT 501(C)(3) LINE 12A, I SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 SOUTHWESTERN VERMONT MEDICAL CENTER 100 HOSPITAL DRIVE BENNINGTON VT 05201 222563241 HOSPITAL VT 501(C)(3) LINE 3 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 MOUNT ANTHONY HOUSING CORPORATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 030279740 NURSING HOME VT 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 TWIN RIVERS MEDICAL PC 2 SUNRISE DRIVE HOOSICK FALLS NY 12090 473028931 HEALTHCARE NY 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 NORTHERN BERKSHIRE MEDICAL PC 375 MAIN STREET WILLIAMSTOWN MA 01267 814023607 HEALTHCARE MA 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 SOUTHWESTERN VERMONT HEALTH CARE AUXILIARY 100 HOSPITAL DRIVE BENNINGTON VT 05201 222563243 TO SERVE AND ASSIST SOUTHWESTERN VERMONT HEALTH CARE CORPORATION VT 501(C)(3) LINE 10 SOUTHWESTERN VERMONT HEALTH CARE CORPORATION 0 SOUTHWESTERN VT HEALTH CARE ENTERPRISES 100 HOSPITCAL DRIVE BENNINGTON VT 05201 030314501 HEALTHCARE VT N/A C 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0