2019-11-13T10:09:25-06:00 2018-12-31 420174325 RSM US LLP 4 TIMES SQUARE NEW YORK NY 10036 990 2018-01-01 112164674 RUTLAND NURSING HOME INC RUTL 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 JOHN SCHMITT CFO 7186045532 2019-11-12 1 TAMAR PLOTZKER P02047230 2123721000 100.1.193.187 2019-11-12 13:17:41 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1101CBF66FFAA2599057FE7F4407BFB8CB39BD08 2018 2020-04-17 16:48:07Z PAUL ROSENFELD 585 SCHENECTADY AVENUE BROOKLYN NY 11203 60927383 0 X WWW.KINGSBROOK.ORG X 1971 NY ONE BROOKLYN HEALTH SYSTEM, INC. PROVIDES GREATER ACCESS TO HIGH QUALITY MEDICAL CARE AND KEEPS OUR COMMUNITIES HEALTHY THROUGH AN INTEGRATED CARE SYSTEM THAT RESPECTS THE DIVERSITY OF OUR COMMUNITIES AND ADDRESSES BOTH THE HEALTH NEEDS AND UNIQUE FACTORS THAT SHAPE THEM. 19 19 0 39 19106 18106 578092 63280 58498555 60844997 20260 19106 0 0 59096907 60927383 0 0 0 0 59728757 60580510 0 0 0 34287601 36856504 94016358 97437014 -34919451 -36509631 17962785 16124696 26540903 23932940 -8578118 -7808244 X ONE BROOKLYN HEALTH SYSTEM, INC. PROVIDES GREATER ACCESS TO HIGH QUALITY MEDICAL CARE AND KEEPS OUR COMMUNITIES HEALTHY THROUGH AN INTEGRATED CARE SYSTEM THAT RESPECTS THE DIVERSITY OF OUR COMMUNITIES AND ADDRESSES BOTH THE HEALTH NEEDS AND UNIQUE FACTORS THAT SHAPE THEM. 0 0 85858610 60844997 RUTLAND NURSING HOME, LOCATED ON THE CAMPUS OF KINGSBROOK JEWISH MEDICAL CENTER, IS A 466-BED, LONG AND SHORT-TERM CARE FACILITY OFFERING SKILLED NURSING, PHYSICAL REHABILITATION, COMPREHENSIVE WOUND CARE, A SPECIALTY UNIT FOR VENTILATOR DEPENDENT RESIDENTS AND AN ARRAY OF OTHER SUB-ACUTE SERVICES. ALL THE RESOURCES OF THE MEDICAL CENTER, INCLUDING GENERAL MEDICAL AND SUB-SPECIALTIES, SURGICAL, ORTHOPEDIC, PSYCHIATRIC AND DENTAL SERVICES, AND THE EMERGENCY ROOM, ARE IMMEDIATELY AVAILABLE TO THE RESIDENTS. NURSING HOME RESIDENTS ARE EASILY TRANSFERRED TO THE ACUTE SERVICES OF THE HOSPITAL IF MEDICAL NECESSITY REQUIRES, AND SUBSEQUENTLY RETURNED TO THE NURSING HOME. RUTLAND NURSING HOME HAS A DEDICATED 32-BED PEDIATRIC LONG-TERM CARE UNIT FOR CHILDREN WITH SEVERE DEVELOPMENTAL AND METABOLIC DISORDERS. THE UNIT IS STAFFED WITH NURSES AND PEDIATRICIANS 24 HOURS A DAY, SEVEN DAYS A WEEK. MEDICAL CARE IN THE RUTLAND NURSING HOME IS COORDINATED BY PHYSICIANS EXPERIENCED AND DEDICATED TO PEDIATRICS AND GERIATRICS. ENCOURAGING THE RESIDENTS TO MAXIMIZE THEIR ABILITY TO LEAD ACTIVE AND FULFILLING LIVES, LICENSED NURSES AND THERAPISTS DELIVER STATE OF THE ART PHYSICAL, OCCUPATIONAL, RECREATIONAL AND SPEECH THERAPIES. TO ENSURE COMPREHENSIVE CARE, DIETICIANS AND SOCIAL WORKERS AUGMENT THE TREATMENT TEAM. 85858610 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 0 0 0 1 7 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 19 19 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 NY X JOHN SCHMITT 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 X VICTOR AYALA PHD BOARD TRUSTEE 0.05 0.95 X 0 0 0 HENNA WHITE SECRETARY / TREASURER 0.05 1.45 X X 0 0 0 ALEX ROVT CHAIRPERSON (FROM 4/12/18) 0.05 0.95 X X 0 0 0 REV WATERMAN VICE-CHAIRPERSON (FROM 4/12/18) 0.05 0.95 X X 0 0 0 MICHAEL IRWIN BOARD TRUSTEE (FROM 4/12/18) 0.05 0.95 X 0 0 0 MICHAEL SCAGNELLI BOARD TRUSTEE (FROM 4/12/18) 0.05 0.95 X 0 0 0 HOPE MASON BOARD TRUSTEE (FROM 4/12/18) 0.05 0.95 X 0 0 0 BISHOP RC HUGH NELSON BOARD TRUSTEE (FROM 4/12/18) 0.05 0.95 X 0 0 0 MARK SHELTON BOARD TRUSTEE (FROM 4/12/18) 0.05 0.95 X 0 0 0 DR SCOTT TENNER BOARD TRUSTEE (4/12/18 - 6/18/18) 0.05 0.95 X 0 0 0 RICHARD E GREEN BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 NUSIN SHTERN BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 MICHAEL L NAIRNE BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 MARURICE A REID BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 RABBI ARYEH LEV KATZIN BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 ANTHONY CLEMENZA SR BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 EDNA WELLS-HANDY BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 DR JOSEPH CUIFFO BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 DR K TORIAN EASTERLING BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 DR SOFIA NOVAK BOARD TRUSTEE (FROM 6/18/18) 0.05 0.95 X 0 0 0 EDWARD LIEBERSTEIN BOARD CHAIR (THRU 4/11/18) 0.05 0.95 X X 0 0 0 SEEMA GOLDSTEIN VICE CHAIR & SECRETARY(THRU 4/11/18) 0.05 0.95 X X 0 0 0 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 12.00 36.60 X 0 389930 61416 PAUL ROSENFELD ADMINISTRATOR (1/18-8/18) 40.00 X 0 339372 31870 NEIL POLLACK ADMINISTRATOR (FROM 12/18) 40.00 X 0 10152 2166 GRACE NMECHA DIRECTOR OF CLINICAL REIMBURSEMENT 40.00 X 0 191214 31792 GRACE CAMPBELL NYSNA - NURSE 40.00 X 0 160939 29082 SANDRA R LEWIS CO-ORDINATOR - NURSING 40.00 X 0 153752 31945 MARRA BLANK SENIOR ASSOCIATE DIRECTOR 40.00 X 0 146134 30613 COLLETTE MILLS DIR OF NURSING/CLINICAL SERVICES 40.00 X 0 153249 35314 LINDA BRADY MD THRU 72017 FORMER PRESIDENT & BOARD DIRECTOR 0.00 0.00 X 0 1128371 37417 0 2673113 291615 0 1 1 0 EXCLUSIVE AMBULETTE SERVICE INC PO BOX 476 LAWRENCE NY 11559 PATIENT TRANSPORTATION 137389 1 63280 63280 NET PATIENT SERVICE REVENUE 623000 59227611 59227611 MEDICARE DRUG BILLING 524114 1617386 1617386 60844997 19106 19106 60927383 60844997 19106 0 150434 134789 15645 42760896 38313763 4447133 3727063 3339448 387615 10682415 9571444 1110971 3259702 2920693 339009 2261581 1770818 490763 140103 140103 13654 10691 2963 8961601 7126634 1834967 676972 530069 146903 2175971 1703785 472186 75507 59122 16385 880517 689445 191072 662897 519048 143849 536153 419808 116345 MEDICAL & PHARMACEUTICA 8272975 8272975 MAINT & REPAIRS 3699061 2896365 802696 NY STATE ASSESSMENT 3222578 2523279 699299 BAD DEBT EXP 2500000 2500000 2776934 2556434 220500 97437014 85858610 11578404 0 2473020 1735759 311232 329844 8409268 7787587 45053798 38885695 6665668 6168103 103597 103403 17962785 16124696 2936400 2030661 311745 330513 23292758 21571766 26540903 23932940 X -8578118 -7808244 -8578118 -7808244 17962785 16124696 X -36509631 37279505 X 0 1 X 1 0 X 482975 3650320 2261120 587092 63280 7044787 63756790 65195970 60459838 58498555 60844997 308756150 64239765 68846290 62720958 59085647 60908277 315800937 0 0 0 315800937 104663 1411 20260 126334 104663 1411 20260 126334 19106 19106 64344428 68846290 62722369 59105907 60927383 315946377 0.99950 0.99920 0.00040 0.00080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13654 13654 0 PART II-B, LINE 1: EXPLANATION: OTHER ACTIVITIES RUTLAND NURSING HOME PAYS DUES TO CONTINUING CARE LEADERSHIP COALITION (CCLC). IN ACCORDANCE WITH SECTION 6033(E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY CCLC, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO THE 2018 CCLC DUES WAS $13,654. 0 1 X 825000 825000 36917129 32104846 4812283 7311669 6780849 530820 6168103 ESTIMATED THIRD PARTY SETTLEMENTS 19602893 FIN 47 LIABILITY 108117 WATER & SEWER ACCRUAL 1860756 21571766 X PART IV, LINE 2B: AS PER NYS DOH REGULATIONS, THE NURSING HOME IS REQUIRED TO ESTABLISH AN IN-HOUSE PATIENT BANKING ACCOUNT FOR THE RESIDENTS TO USE WHILE THEY ARE LIVING AT THE NURSING HOME. THESE FUNDS ARE KEPT IN A SEPARATE CUSTODIAL ACCOUNT AT STERLING BANK. PART X, LINE 2: CONSOLIDATED FOOTNOTE: THE COMPANY IS EXEMPT FROM INCOME TAXES UNDER SECTIONS 501(C)(3) AND 509(A)(3) OF THE INTERNAL REVENUE CODE (THE CODE). ADDITIONALLY, THE COMPANY, AS A NONPROFIT ENTITY, IS SUBJECT TO UNRELATED BUSINESS INCOME TAX (UBIT), IF APPLICABLE. FOR THE TAX YEAR ENDED DECEMBER 31, 2018, THE COMPANY WAS SUBJECT TO UBIT OF APPROXIMATELY $81,000 RELATED TO FRINGE BENEFITS PROVIDED TO EMPLOYEES. MANAGEMENT EVALUATED THE COMPANY'S TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT THE COMPANY HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. GENERALLY, THE COMPANY IS SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS ENDED DECEMBER 31, 2016, AND THEREAFTER. PER THE REQUIREMENT TO ASSESS FOR TAX UNCERTAINTY, MANAGEMENT HAS DETERMINED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED. 1 0 0 0 0 0 0 0 0 JOHN SCHMITT CPA ASSISTANT TREASURER & CFO 0 376578 0 0 0 13352 0 24000 0 37416 0 451346 0 0 PAUL ROSENFELD ADMINISTRATOR (1/18-8/18) 0 333012 0 0 0 6360 0 0 0 31870 0 371242 0 0 GRACE NMECHA DIRECTOR OF CLINICAL REIMBURSEMENT 0 191214 0 0 0 0 0 6606 0 25186 0 223006 0 0 GRACE CAMPBELL NYSNA - NURSE 0 160939 0 0 0 0 0 10517 0 18565 0 190021 0 0 SANDRA R LEWIS CO-ORDINATOR - NURSING 0 153186 0 0 0 566 0 6759 0 25186 0 185697 0 0 MARRA BLANK SENIOR ASSOCIATE DIRECTOR 0 146134 0 0 0 0 0 5563 0 25050 0 176747 0 0 COLLETTE MILLS DIR OF NURSING/CLINICAL SERVICES 0 152900 0 0 0 349 0 10264 0 25050 0 188563 0 0 LINDA BRADY MD THRU 72017 FORMER PRESIDENT & BOARD DIRECTOR 0 0 0 0 0 1128371 0 0 0 37417 0 1165788 0 0 PART I, LINE 4A ONE INDIVIDUAL RECEIVED SEVERANCE PAYMENTS; THE AMOUNTS ARE REPORTED ON SCHEDULE J. DUE TO CONFIDENTIALITY CONCERNS, THE NAME OF THE INDIVIDUAL IS NOT DISCLOSED. THE DETAILED INFORMATION IS AVAILABLE TO THE IRS UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 4 ON OR AFTER APRIL 12, 2018, THE ORGANIZATION'S FORMER PARENT, KINGSBROOK HEALTHCARE SYSTEM, INC., AMENDED THE CERTIFICATE OF INCORPORATION OF THE ORGANIZATION TO PROVIDE FOR ITS REMOVAL AS SOLE CORPORATE MEMBER AND THE APPOINTMENT OF ONE BROOKLYN HEALTH SYSTEM, INC., A NEW YORK NOT FOR PROFIT CORPORATION AND EXEMPT ORGANIZATION UNDER IRC 501(C)(3), AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. THE ORGANIZATION ALSO AMENDED ITS BYLAWS TO APPOINT ONE BROOKLYN HEALTH SYSTEM, INC., AS ITS SOLE CORPORATE MEMBER WITH THE POWER TO ELECT OR REMOVE THE MEMBERS OF THE BOARD AND BOARD OFFICERS OF THE ORGANIZATION, APPOINT AND REMOVE THE CORPORATE OFFICERS OF THE ORGANIZATION, AND APPROVE CHANGES TO THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE ORGANIZATION, AMONG OTHER POWERS. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE ORGANIZATION: ONE BROOKLYN HEALTH SYSTEM, INC. ("OBHS") IS THE SOLE MEMBER OF RUTLAND NURSING HOME INC. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF THE GOVERNING BODY: MEMBERS MAY ELECT AND APPOINT MEMBERS OF THE GOVERNING BOARD AND BOARD OFFICERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY: OBHS IS THE SOLE MEMBER OF RUTLAND NURSING HOME, INC., AND IT HAS RESERVED POWERS THAT ARE DELINEATED IN THE BYLAWS OF RUTLAND NURSING HOME INC. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS FOR FORM 990: THE CFO HAS CONDUCTED A REVIEW OF THE 990 WITH THE HOSPITAL'S TAX ACCOUNTANT AND ALL APPROPRIATE CHANGES HAVE BEEN MADE. DRAFT RETURNS WERE THEN PROVIDED TO THE BOARD MEMBERS OF THE FINANCE AUDIT AND COMPLIANCE COMMITTEE (FACC) FOR THEIR REVIEW FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS. FORM 990, PART VI, SECTION B, LINE 12 CONFLICT OF INTEREST POLICY: RUTLAND NURSING HOME, INC FOLLOWS KINGSBROOK JEWISH MEDICAL CENTER'S CONFLICT OT INTEREST POLICY. AT KINGSBROOK JEWISH MEDICAL CENTER, ALL CONFLICTS OF INTEREST ARE REVIEWED BY THE COMPLIANCE OFFICER. ANY POTENTIAL CONFLICTS INVOLVING BOARD MEMBERS ARE REFERRED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW AND/OR ACTION, AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION POLICY AND REVIEW PROCESS: RUTLAND NURSING HOME, INC. DID NOT PAY COMPENSATION DIRECTLY FOR ITS EMPLOYEES. THE COMPENSATION AND BENEFITS ARE PAID THROUGH KINGSBROOK JEWISH MEDICAL CENTER'S PAYROLL SYSTEM AND ARE RECORDED ON THE FORM 941 FILED BY KINGSBROOK JEWISH MEDICAL CENTER UNDER THE EMPLOYER INDENTIFICATION NUMBER 11-1631759. THE COMPENSATION OF EXECUTIVE OFFICERS IS REVIEWED ANNUALLY BY KINGSBROOK JEWISH MEDICAL CENTER (KJMC). FOLLOWING BELOW PROCESS: CONSISTENT WITH BEST PRACTICES IN GOVERNANCE AND FIDUCIARY OVERSIGHT OF TAX EXEMPT FUNDS, KINGSBROOK JEWISH MEDICAL CENTER (KJMC) HAS INSTITUTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. THE COMPENSATION COMMITTEE IS AUTHORIZED BY THE BOARD TO DEVELOP AND RECOMMEND FOR BOARD APPROVAL THE COMPENSATION OF THE PRESIDENT AND CEO AND MEMBERS OF SENIOR MANAGEMENT (SENIOR VICE PRESIDENTS, VICE PRESIDENTS AND ASSISTANT VICE PRESIDENTS). ONLY INDEPENDENT MEMBERS OF THE BOARD SHALL PARTICIPATE IN COMPENSATION DELIBERATIONS AND DECISIONS (I.E., EMPLOYEES, MEMBERS OF THE MEDICAL STAFF AND CONSULTANTS ARE NOT DEEMED INDEPENDENT FOR THESE PURPOSES). ALL EXECUTIVE COMPENSATION DECISIONS ARE BASED ON COMPETITIVE MARKET DATA, ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE RESULTS, AND ALIGNMENT WITH KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY. THE BOARD'S COMPENSATION COMMITTEE REVIEWS AND APPROVES ALL EXECUTIVE COMPENSATION TO ENDURE LEGAL AND REGULATORY COMPLIANCE AND ADHERENCE TO GOVERNANCE BEST PRACTICES AND PROPER FIDUCIARY OVERSIGHT AS STEWARDS OF TAX EXEMPT ASSETS. THE EXECUTIVE COMPENSATION PHILOSOPHY STATES ITS INTENT IS TO MAINTAIN A COMPETITIVE EXECUTIVE COMPENSATION PROGRAM IN ORDER TO ATTRACT, RETAIN AND MOTIVATE QUALIFIED EMPLOYEES TO SUPPORT THE MISSION AND BUSINESS GOALS OF KJMC. THE COMPENSATION COMMITTEE RETAINS OUTSIDE LEGAL COUNSEL WHO REVIEWS COMPLIANCE WITH TAX AND REGULATORY REQUIREMENTS AS WELL AS THE SERVICES OF AN INDEPENDENT QUALIFIED COMPENSATION CONSULTANT WHO COMPILES AND ANALYZES PUBLISHED SURVEY - DATA FOR BASE SALARIES AND TOTAL COMPENSATION PROVIDED BY TAX EXEMPT HOSPITALS AND MEDICAL CENTERS SIMILAR TO KJMC IN SIZE, OPERATIONS AND LOCATION. THE COMMITTEE'S REVIEW OF COMPENSATION OCCURS ANNUALLY SUCH THAT EXECUTIVE COMPENSATION AND BENEFITS CONTINUE TO BE COMPETITIVE AND REASONABLE BY FOLLOWING THE PRECEDING GOVERNANCE AND FIDUCIARY PRACTICES, THE COMMITTEE QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS REGULATIONS OF THE INTERNAL REVENUE CODE SUCH THAT THE TOTAL COMPENSATION PROVIDED TO THE EXECUTIVES IS COMPARED TO WHAT IS ORDINARILY PAID FOR LIKE SERVICES BY LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES," AS DEFINED IN THE INTERMEDIATE SANCTIONS REGULATIONS. BASE PAY FOR EACH EXECUTIVE IS BASED ON FACTORS INCLUDING MARKET DATA, TENURE, EXPERIENCE, AND INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. EXECUTIVE BASE PAY IS REVIEWED AND SET ANNUALLY BY THE INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE OF THE INDEPENDENT DIRECTORS OF KINGSBROOK JEWISH MEDICAL CENTER (KJMC), BASED ON THE EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. AS DESCRIBED IN KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER, KJMC SUPPORTS PERFORMANCE BASED COMPENSATION AND THEREFORE HAS IMPLEMENTED AN ANNUAL INCENTIVE PAY PROGRAM (EXECUTIVE MANAGEMENT ANNUAL INCENTIVE PLAN) FOR THE EXECUTIVES, WHICH IS CURRENTLY SUSPENDED, AND A LONG-TERM INCENTIVE PAY PROGRAM (ANNUALIZED STRATEGIC PERFORMANCE INCENTIVE) FOR THE PRESIDENT AND CEO. THE ANNUAL AND LONG-TERM INCENTIVE PAY PROGRAMS ARE DESIGNED TO SUPPORT THE ATTAINMENT OF ANNUAL AND STRATEGIC PERFORMANCE OBJECTIVES AND REFLECT A COMBINATION OF FORMULAIC WEIGHTINGS PROVIDING FOR THRESHOLD, TARGET AND MAXIMUM BONUS LEVELS AND DISCRETIONARY JUDGMENT AS DETERMINED BY THE COMPENSATION COMMITTEE. THE PERFORMANCE MEASURES ARE SET PRIOR TO THE BEGINNING OF EACH PLAN YEAR AND PLAN PAYMENTS ARE DETERMINED BASED ON AUDITED FINANCIAL RESULTS AND OTHER MEASURES. THE PROCESS USED FOR DETERMINING THE COMPENSATION OF THE CEO ALSO APPLIES TO MEMBERS OF THE EXECUTIVE STAFF, DEPARTMENT CHAIRS AND OTHER HIGHLY COMPENSATED STAFF EXCEPT THAT THE PRESIDENT AND CEO MAKES COMPENSATION RECOMMENDATIONS TO THE COMPENSATION SUBCOMMITTEE FOR THOSE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION: THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART VI, LINE 13 WHISTLEBLOWER POLICY: KINGSBROOK JEWISH MEDICAL CENTER HAS A WRITTEN WHISTLEBLOWER POLICY WHICH APPLIES TO THE ACTIVITIES OF RUTLAND NURSING HOME INC. FORM 990, PART VI, LINE 14 DOCUMENT RETENTION POLICY: KINGSBROOK JEWISH MEDICAL CENTER'S DOCUMENT RETENTION AND DESTRUCTION POLICY APPLIES TO ALL BOOKS AND RECORDS HELD BY RUTLAND NURSING HOME INC. FORM 990, PART VII, LINE 2 RUTLAND NURSING HOME, INC. DOES NOT DIRECTLY PAY ITS EMPLOYEES. THE COMPENSATION AND BENEFITS ARE ALLOCATED FROM KINGSBROOK JEWISH MEDICAL CENTER. THE COMPENSATION AND BENEFITS ARE RECORDED ON FORM 941 FILED BY KINGSBROOK JEWISH MEDICAL CENTER UNDER EMPLOYER IDENTIFICATION NUMBER 11-1631759. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATE (KJMC) 37,279,505. KINGSBROOK JEWISH MEDICAL CENTER (KJMC) 585 SCHENECTADY AVENUE BROOKLYN NY 11201 111631759 HEALTHCARE NY 501(C)(3) LINE 3 ONE BROOKLYN HEALTH SYSTEM INC 0 KINGSBROOK JEWISH MEDICAL CENTER AUXILIARIES 585 SCHENECTADY AVENUE BROOKLYN NY 11201 113016121 SUPPORT ORG NY 501(C)(3) LINE 12A, I KJMC 0 KINGSBROOK HEALTHCARE SYSTEM INC (KHS) 585 SCHENECTADY AVENUE BROOKLYN NY 11201 030464734 SUPPORT ORG NY 501(C)(3) LINE 12A, I N/A 0 KINGSBROOK HEALTHCARE FOUNDATION INC 585 SCHENECTADY AVENUE BROOKLYN NY 11201 112845058 SUPPORT ORG NY 501(C)(3) LINE 12A, I KHS 0 BROOKDALE HOSPITAL MEDICAL CENTER 101-01 AVENUE D BROOKLYN NY 11236 111631746 HEALTHCARE NY 501(C)(3) LINE 3 ONE BROOKLYN HEALTH SYSTEM INC 0 INTERFAITH MEDICAL CENTER 1545 ATLANTIC AVENUE BROOKLYN NY 11213 112626155 HEALTHCARE NY 501(C)(3) LINE 3 ONE BROOKLYN HEALTH SYSTEM INC 0 URBAN STRATEGIESBROOKDALE FAMILY CARE CENTER 101-01 AVENUE D BROOKLYN NY 11236 113237480 HEALTHCARE NY 501(C)(3) LINE 3 ONE BROOKLYN HEALTH SYSTEM INC 0 BROOKDALE FAMILY CARE CENTER 101-01 AVENUE D BROOKLYN NY 11236 113237483 HEALTHCARE NY 501(C)(3) LINE 3 ONE BROOKLYN HEALTH SYSTEM INC 0 THE SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHAB (SSI) 101-01 AVENUE D BROOKLYN NY 11201 237270262 HEALTHCARE NY 501(C)(3) LINE 3 ONE BROOKLYN HEALTH SYSTEM INC 0 ONE BROOKLYN HEALTH SYSTEM INC ONE BROOKDALE PLAZA BROOKLYN NY 11212 815323275 SUPPORT ORG NY 501(C)(3) LINE 7 N/A 0 KSI INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327654 INACTIVE NY N/A C 0 SINGULAB INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327669 INACTIVE DE N/A C 0 ATM NURSE REGISTRY 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327649 INACTIVE NY N/A 0 KINGSBROOK LTACH INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 800712226 INACTIVE NY N/A C 0 KINGSBROOK MEDICAL ASSOCIATES PC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 452351859 BILLING & COLLECTION NY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1