2022-11-15T12:54:08-06:00 2021-12-31 271728945 PKF O'CONNOR DAVIES LLP 300 TICE BOULEVARD SUITE 315 WOODCLIFF LAKE NJ 07677 990 2021-01-01 465285330 VALLEY PHYSICIANS SERVICES PC VALL 2012916000 15 ESSEX ROAD 506 PARAMUS NJ 07652 ROBERT W BRENNER PRESIDENT 2012916000 2022-11-15 1 ROBERT BRENNER 999009999 EDWARD G O'CONNOR P00434443 2017129800 2022-11-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ROBERT W BRENNER 15 ESSEX ROAD 506 PARAMUS NJ 07652 185170254 0 X WWW.VALLEYHEALTH.COM X 2014 NJ TO PROVIDE MEDICAL CARE AND CARRY OUT THE PURPOSES OF VALLEY HEALTH SYSTEM, INC. 18 17 445 17 0 0 3860788 4322503 152265272 180847334 0 0 5446 417 156131506 185170254 24386912 44133513 0 0 112202183 118786849 0 0 0 21787502 25341874 158376597 188262236 -2245091 -3091982 24664339 21972839 33756929 34157411 -9092590 -12184572 TO PROVIDE MEDICAL CARE AND CARRY OUT THE PURPOSES OF VALLEY HEALTH SYSTEM, INC. 0 0 178591030 44133513 180847334 THE ORGANIZATION PROVIDED MEDICAL CARE TO A TOTAL OF 525,552 PATIENTS IN 2021 IN THE FIELDS OF FAMILY MEDICINE, INTERNAL MEDICINE, CARDIOLOGY, OB/GYN, URGENT CARE, AND ENDOCRINOLOGY. THE ORGANIZATION ALSO PROVIDED STRATEGIC FUNDING TO VALLEY HOSPITAL, INC. 178591030 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 445 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 17 0 1 0 0 1 0 1 1 1 0 0 1 1 0 0 1 1 0 1 0 X MARIETTA STONE 2012916391 15 ESSEX ROAD PARAMUS NJ 07652 AUDREY MEYERS PRESIDENT & CEO, VHS 0.50 39.50 X X 0 1715221 46536 VINCENT FORLENZA CHAIRMAN 0.10 0.40 X X 0 0 0 FRANK J SHEEHY VICE CHAIRMAN 0.10 0.40 X X 0 0 0 ANN LIMBERG DIRECTOR 0.10 0.40 X X 0 0 0 JOSEPH MARION DIRECTOR 0.10 0.40 X X 0 0 0 GAIL MATTHEWS TREASURER, THRU 4/2021 0.10 39.90 X X 414498 0 10931 JUDY BASELICE TRUSTEE 0.10 0.40 X 0 0 0 JAMES BUSH TRUSTEE 0.10 0.40 X 0 0 0 MICHELLE HASSON TRUSTEE 0.10 0.40 X 0 0 0 KEVIN LOBO TRUSTEE 0.10 0.40 X 0 0 0 BRUCE MACTAS TRUSTEE 0.10 0.40 X 0 0 0 DUANE SACHS TRUSTEE 0.10 0.40 X 0 0 0 DENIS SALAMONE TRUSTEE 0.10 0.40 X 0 0 0 SCOTT SCHROEDER TRUSTEE 0.10 0.40 X 0 0 0 EDWARD B SELF MD TRUSTEE 0.10 0.40 X 0 0 0 STEVEN SILVERSTEIN TRUSTEE 0.10 0.40 X 0 0 0 JEFFREY TUCKER TRUSTEE 0.10 0.40 X 0 0 0 PATRICIA VERDUIN TRUSTEE 0.10 0.40 X 0 0 0 WAYNE WALD ESQ TRUSTEE 0.10 0.40 X 0 0 0 WILLIAM KLUTKOWSKI SR. VP, FINANCE & CFO 2.00 38.00 X 0 709400 54102 ROBERT W BRENNER PRESIDENT CLINICAL INTEGRATION/ PHYSICIAN ENTERPRISE 2.00 38.00 X 0 1278073 25357 DAVID STRASSBERG VICE PRESIDENT 0.10 39.90 X 528097 0 27150 GERALD SOTSKY SECRETARY/TREASURER 2.00 38.00 X 784222 0 38389 ALEX ZAPOLANSKI PHYSICIAN 40.00 0.00 X 1480935 0 36529 ROBERT KORST MD CHIEF OF ONCOLOGY SURGERY 40.00 0.00 X 923336 0 50560 THOMAS AHLBORN MD CHAIR, SURGICAL SERVICES 40.00 0.00 X 1328315 0 37479 MICHAEL RAHMIN MD PHYSICIAN 40.00 0.00 X 1183432 0 45364 JUAN GRAU DIRECTOR, CARDIOTHORACIC SURGERY 40.00 0.00 X 1602819 0 30171 RICHARD KEENAN FORMER SENIOR VP FINANCE/CFO 0.00 0.00 X 0 4692143 0 8245654 8394837 402568 322 1 1 0 PROGRESSIVE RADIOLOGY LLC 86 CLINTON AVE MONTCLAIR NJ 07042 MEDICAL CONSULTING 532250 LAWRENCE SELTZER MD 215 HARRISON AVE WESTFIELD NJ 07090 MEDICAL CONSULTING 429597 MALWINDER SINGH MD 402 JAY COURT FRANKLIN LAKES NJ 07417 MEDICAL CONSULTING 420735 RAKESH SHARMA MD 1124 E RIDGEWOOD AVENUE SUITE 103 RIDGEWOOD NJ 07450 MEDICAL SERVICES 420595 PHYSICIAN SPECIALISTS OF NORTHERN NJ 1 SEARS DRIVE SUITE 306 PARAMUS NJ 07652 MEDICAL SERVICES 214270 10 4322503 4322503 PATIENT SERVICE REVENUE 624100 151907789 151907789 MEDICAL SVCS. TO TVH 624100 28939545 28939545 180847334 BAD DEBT RECOVERY 900099 417 417 417 185170254 180847334 0 417 44133513 44133513 1803286 1778557 24729 105990938 104579002 1411936 2716416 2705723 10693 3471660 3356022 115638 4804549 4791196 13353 6968559 6968559 5000 5000 76640 76640 13002905 12354647 648258 595812 199784 396028 16128 16128 7 7 22348 22291 57 355 355 3762439 3762439 CONTINUING EDUCATION 769982 769982 0 BAD DEBT EXPENSE 79420 79420 0 RECRUITMENT 33915 28955 4960 CLINICAL SUPPLIES 4855 4855 0 3509 3509 188262236 178591030 9671206 0 2339354 4684423 14083107 17246916 0 41500 8241878 0 24664339 21972839 22685499 23673765 11071430 10483646 33756929 34157411 X -9092590 -12184572 -9092590 -12184572 24664339 21972839 -3091982 0 X X 0 1 X 1 0 X 318156 3860788 4322503 8501447 133265190 149157797 162125590 152265272 180847334 777661183 133265190 149157797 162443746 156126060 185169837 786162630 0 0 0 786162630 98304 1436 417 100157 133363494 149157797 162443746 156127496 185170254 786262787 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 ADVANCE PAYMENT FROM MEDICARE 2726251 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 7757395 10483646 X 260390139 75299305 75299305 185090834 79420 79420 185170254 263482124 75299308 75299308 188182816 79420 79420 188262236 PART X, LINE 2: VMG RECOGNIZES THE BENEFIT FROM INCOME TAX POSITIONS TAKEN IN ITS INCOME TAX RETURNS ONLY WHEN THOSE POSITIONS ARE BELIEVED TO BE MORE LIKELY THAN NOT TO BE SUSTAINED UPON REVIEW BY THE TAX AUTHORITIES. VMG PROVIDES VALUATION ALLOWANCES FOR NET DEFERRED TAX ASSETS WHEN THE REALIZATION OF THE DEFERRED TAX ASSET IS UNCERTAIN. MANAGEMENT HAS DETERMINED THAT VMG HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE ENTITIES INCLUDED IN VMG ARE NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO THE 2018 TAX YEAR. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE OF RELATED ENTITIES INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 75,299,305. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH PATIENT SERVICE REVENUE IN FINANCIAL STATEMENTS 79,420. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES OF RELATED ENTITIES INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 75,299,308. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH PATIENT SERVICE REVENUE IN FINANCIAL STATEMENTS 79,420. 0 THE VALLEY HOSPITAL INC 223 NORTH VAN DIEN AVENUE RIDGEWOOD NJ 07450 221487307 501(C)(3) 44133513 0 STRATEGIC FUNDING 1 PART I, LINE 2: THE ORGANIZATION MADE A GRANT TO ITS RELATED ENTITY, THE VALLEY HOSPITAL, INC. THE ORGANIZATION MONITORS THE USE OF THE FUNDS THROUGH COMMON MANAGEMENT. 0 1 0 0 0 0 0 1 0 RICHARD KEENAN FORMER SENIOR VP FINANCE/CFO 0 0 0 0 0 4692143 0 0 0 0 0 4692143 0 4692143 AUDREY MEYERS PRESIDENT & CEO, VHS 0 1165777 0 450000 0 99444 0 21750 0 24786 0 1761757 0 0 JUAN GRAU DIRECTOR, CARDIOTHORACIC SURGERY 1478417 0 100000 0 24402 0 4092 0 26079 0 1632990 0 0 0 ALEX ZAPOLANSKI PHYSICIAN 870434 0 567999 0 42502 0 10150 0 26379 0 1517464 0 0 0 THOMAS AHLBORN MD CHAIR, SURGICAL SERVICES 996876 0 297461 0 33978 0 10150 0 27329 0 1365794 0 0 0 ROBERT W BRENNER PRESIDENT CLINICAL INTEGRATION/ PHYSICIAN ENTE 0 785377 0 235000 0 257696 0 13050 0 12307 0 1303430 0 0 MICHAEL RAHMIN MD PHYSICIAN 967177 0 191853 0 24402 0 10150 0 35214 0 1228796 0 0 0 ROBERT KORST MD CHIEF OF ONCOLOGY SURGERY 681136 0 237298 0 4902 0 15950 0 34610 0 973896 0 0 0 GERALD SOTSKY SECRETARY/TREASURER 598466 0 158732 0 27024 0 10150 0 28239 0 822611 0 0 0 WILLIAM KLUTKOWSKI SR. VP, FINANCE & CFO 0 489691 0 95000 0 124709 0 20300 0 33802 0 763502 0 0 DAVID STRASSBERG VICE PRESIDENT 414097 0 103000 0 11000 0 10150 0 17000 0 555247 0 0 0 GAIL MATTHEWS TREASURER, THRU 4/2021 196783 0 74781 0 142934 0 7452 0 3479 0 425429 0 0 0 PART I, LINE 3 VALLEY HEALTH SYSTEM HAS DEVELOPED A COMPENSATION PLAN, WHICH GOVERNS THE COMPENSATION FOR ALL EXECUTIVES, INCLUDING THE CEO AND VICE PRESIDENTS OF THE ORGANIZATION. THE PLAN WAS DEVELOPED IN CONJUNCTION WITH A CONSULTING FIRM, REVIEWED BY THE PHYSICIAN LEADERSHIP COUNCIL AND APPROVED BY THE BOARD OF TRUSTEES AND THE VALLEY HEALTH SYSTEM PHYSICIAN COMPENSATION COMMITTEE. ON AN ANNUAL BASIS, THE PLAN IS REVIEWED AND UPDATED AS NEEDED. PART I, LINE 4B RICHARD KEENAN RECEIVED A FINAL DISTRIBUTION PAYMENT FROM HIS SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN IN 2021 AS REPORTED IN PART II, COLUMNS B(III) AND F. AUDREY MEYERS AND WILLIAM KLUTKOWSKI ALSO PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THEY DID NOT RECEIVE A PAYMENT DURING 2021. AUDREY MEYERS PARTICIPATED IN A CAP-EX (SPLIT-DOLLAR LIFE INSURANCE PLAN). THEY DID NOT RECEIVE A PAYMENT DURING 2021. PART I, LINE 7 EMPLOYEES OF THE ORGANIZATION RECEIVED A BOARD-APPROVED DISCRETIONARY BONUS, AWARDED BASED ON PERFORMANCE, AS REPORTED FOR THEM IN PART II, COLUMN B(II). FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION RECEIVED MANAGEMENT SERVICES FROM TWO RELATED ORGANIZATIONS, VALLEY PHYSICIAN SERVICES NY, P.C. AND VALLEY PHYSICIAN SERVICES, INC. SERVICES PROVIDED INCLUDED HUMAN RESOURCE MANAGEMENT, MARKETING AND OTHER ADMINISTRATIVE SERVICES. THE ORGANIZATION INCURRED EXPENSES OF $1,714,910 AND $5,253,649 RESPECTIVELY FOR SERVICES FROM THESE RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A PROFESSIONAL CORPORATION WITH SHAREHOLDERS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING DECISIONS OF THE ORGANIZATION ARE RESERVED TO THE BOARD OF VALLEY PHYSICIAN SERVICES: STRATEGIC ACTIONS, WHICH SHALL INCLUDE, BUT NOT BE LIMITED TO, NEW STRATEGIC PLANS, MODIFICATIONS OF EXISTING STRATEGIC PLANS OR MISSION STATEMENTS; MAJOR CORPORATE DECISIONS, WHICH MAY POTENTIALLY IMPACT THE PHILOSOPHY OF THE VALLEY SYSTEM, WHICH SHALL INCLUDE, BUT NOT BE LIMITED TO, JOINT VENTURES, CORPORATE ACQUISITIONS, PROGRAMMATIC AFFILICATIONS, MERGERS OR CONSOLIDATIONS, CONVERSION OF THE TAX-EXEMPT STATUS, SALE OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE DISSOLUTION OF THE CORPORATION; ANY SINGLE EXPENDITURE GREATER THAN FIVE PERCENT (5%) OF THE ANNUAL OPERATING BUDGET OF THE CORPORATION AND AMENDMENTS THERETO; THE ELECTION, APPOINTMENT, REPLACEMENT OR REMOVAL OF TRUSTEES OF THE CORPORATION WITH OR WITHOUT CAUSE; THE SELECTION OF AUDITORS; THE APPOINTMENT AND REMOVAL OF THE PRESIDENT OF THE CORPORATION (OR THE APPROVAL OF ANY RECCOMENDATION OF THE VPS BOARD FOR REMOVAL); THE ADOPTION, AMENDMENT, REVISION OR DELETION OF THE CORPORATION'S BYLAWS AND THE CREATION OR APPROVAL OF ANY AMENDMENTS, ALTERATIONS OR REVISIONS TO THE CORPORATION'S CERTIFICATE OF INCORPORATION; THE ADOPTION OF THE CORPORATION'S ANNUAL CAPITAL AND OPERATING BUDGETS; MAJOR CORPORATE DECISIONS REGARDING THE INCURRENCE OF DEBT IN EXCESS OF FIVE PERCENT (5%) OF THE OPERATING BUDGET OF THE CORPORATION (INCLUDING CAPITAL AND OPERATING LEASES), AND THE TRANSFER OR LOAN OF CASH OR THE CONVEYANCE, LEASE OR OTHER DISPOSITION OF OTHER ASSETS TO AN AFFILIATE OR SUBSIDIARY WITHOUT RECEIVING EQUIVALENT VALUE IN RETURN. THE APPROVAL OF THE PURCHASE OR SALE OF ANY REAL PROPERTY BY THE CORPORATION AND THE APPROVAL OF THE CREATION OF A MORTGAGE, LIEN, OR ANY OTHER SECURITY INTERESTS IN THE CORPORATION'S REAL OR PERSONAL PROPERTY; DETERMINATIONS OF HOW ANY AND ALL EXCESS CASH GENERATED BY THE CORPORATION WILL BE SPENT; THE CESSATION OR ANY CHANGE IN THE CORPORATION'S PROVISION OF SERVICES TO MEDICARE AND MEDICAID RECIPIENTS AND ITS PROVISION OF CHARITY CARE SERVICES IN ACCORDANCE WITH CHARITY CARE SERVICES IN ACCORDANCE WITH CHARITY CARE POLICIES ESTABLISHED BY THE VALLEY HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. IT IS REVIEWED BY MANAGEMENT AND THE AUDIT COMMITTEE OF VALLEY HEALTH SYSTEM. ANY ISSUES ARE ADDRESSED AND RESOLVED. A COMPLETE COPY OF THE FORM 990 IS MADE AVAILABLE TO ALL MEMBERS OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 15B THE EXECUTIVE COMPENSATION COMMITTEE OF VALLEY HOSPITAL WILL BE RESPONSIBLE FOR APPROVING THE COMPENSATION OF THE PRESIDENT AND OTHER KEY EXECUTIVES OF VPS, P.C. THE COMPENSATION FOR OTHER PHYSICIANS WILL BE APPROVED BY THE PHYSICIAN COMPENSATION COMMITTEE OF VALLEY HEALTH SYSTEM. TOTAL COMPENSATION WILL BE SET BASED ON INFORMATION REGARDING COMPENSATION PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR SIMILAR SERVICES, CURRENT COMPENSATION SURVEYS COMPLETED BY INDEPENDENT FIRMS, OR ACTUAL WRITTEN OFFERS FROM SIMILARLY SITUATED ORGANIZATIONS. THE COMPENSATION IS CONTEMPORANEOUSLY DOCUMENTED AND THE PROCESS WAS LAST UNDERTAKEN IN 2021. FORM 990, PART VI, SECTION C, LINE 19 VPS P.C MAKES ITS FORM 990, FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS AVAILABLE UPON WRITTEN REQUEST AT 223 NORTH VAN DIEN AVE, RIDGEWOOD, NJ 07450 OR BY CALLING THE ORGANIZATION DIRECTLY AT 201-447-8000. FORM 990, PART XI, LINE 2C THE FINANCE COMMITTEE IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT AND FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE VALLEY HOSPITAL FOUNDATION INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 222324554 SOLICITS AND RECEIVES CONTRIBUTIONS FOR THE BENEFIT OF HEALTH SYSTEM NJ 501(C)(3) LINE 7 VALLEY HEALTH SYSTEM INC 0 THE VALLEY HOSPITAL INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 221487307 PROVIDE HEALTHCARE PROGRAMS AND SERVICES TO ALL NJ 501(C)(3) LINE 3 VALLEY HEALTH SYSTEM INC 0 VALLEY HEALTH SYSTEM INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 222922016 PROVIDE MANAGEMENT AND PLANNING SERVICES FOR ITS MEMBERS NJ 501(C)(3) LINE 3 N/A 0 VALLEY HOME CARE INC 15 ESSEX ROAD PARAMUS NJ 07652 223208480 PROVIDE HOME CARE AND HOSPICE SERVICES TO RESIDENTS OF NORTHERN NJ NJ 501(C)(3) LINE 10 VALLEY HEALTH SYSTEM INC 0 VALLEY MEDICAL SERVICES PC 15 ESSEX ROAD PARAMUS NJ 07652 465297054 PROVIDE PRIMARY AND SPECIALTY MEDICAL CARE NJ 501(C)(3) LINE 10 VALLEY PHYSICIAN SERVICES INC 0 VALLEY PHYSICIAN SERVICE NY PC 15 ESSEX ROAD PARAMUS NJ 07450 453125678 OPERATES URGENT/PRIMARY CARE CLINICS NY 501(C)(3) LINE 10 VALLEY PHYSICIAN SERVICES INC 0 VALLEY PHYSICIAN SERVICES INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 320041186 PROVIDES MANAGEMENT AND VARIED CONSULTING SERVICES NJ 501(C)(3) LINE 10 THE VALLEY HOSPITAL INC 0 VHS INSURANCE COMPANY LTD 010 MAIN STREET CAYMAN ISLANDS CJ 980408200 PROVIDES PROFESSIONAL, MEDICAL, AND COMMERCIAL GENERAL LIABILITY INSURANCE CJ VALLEY HEALTH SYSTEM INC C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1