2019-11-15T12:13:10-06:00 2018-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2018-01-01 135601035 CHAPIN HOME FOR THE AGING CHAP 7187392523 165-01 CHAPIN PARKWAY QUEENS NY 11432 JENNIFER MCMANAMAN LNHA EXECUTIVE VP & ADMINISTRATOR 7187392523 2019-11-15 1 GARRETT M HIGGINS P00543209 9143818900 2019-11-15 65.51.112.58 2019-11-15 12:13:07 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9616F4B14A694591D1E716C270910E6FA5556DA3 2018 2020-03-31 21:24:44Z JENNIFER MCMANAMAN LNHA 165-01 CHAPIN PARKWAY QUEENS NY 11432 21426960 0 X WWW.CHAPINHOME.ORG X 1869 NY SINCE 1869, THE MISSION OF THE ORGANIZATION HAS BEEN TO CARE FOR THE FRAIL AND ELDERLY. THE ORGANIZATION EXECUTES ITS MISSION THROUGH THE OPERATION OF A 220-BED SKILLED NURSING FACILITY AND A 50-REGISTRANT MEDICAL MODEL ADULT DAY HEALTHCARE CENTER. 12 12 264 12 0 0 51990 66890 20272041 20382167 800438 977116 2224 787 21126693 21426960 0 0 0 0 12544520 12399284 0 0 0 8889226 9887309 21433746 22286593 -307053 -859633 66174811 62368787 14795319 13226881 51379492 49141906 X THE MISSION OF THE ORGANIZATION IS TO PROVIDE VARIOUS LEVELS OF NECESSARY SHORT TERM AND LONG-TERM CARE THAT ARE TYPICALLY CHARACTERISTIC OF THE AGING PROCESS 0 0 19824388 19736952 THE ORGANIZATION CURRENTLY OPERATES A 220-BED SKILLED NURSING FACILITY. THE FACILITY DELIVERS NURSING CARE 24 HOURS PER DAY, 7 DAYS A WEEK TO EACH RESIDENT. RESIDENTS ARE EITHER RECEIVING SHORT TERM RESTORATIVE CARE, STRUCTURED TO RESTORE THEM TO A PRIOR LEVEL OF FUNCTIONING OR CUSTODIAL LONG-TERM CARE DESIGNED TO AID WITH THE ACTIVITIES OF DAILY LIVING (EATING, TOILETING, DRESSING). THE FOLLOWING ANCILLARY SERVICES ARE AVAILABLE TO EACH RESIDENT ON SIGHT:1) PSYCHIATRIC AND PSYCHOLOGICAL COUNSELING2) OPHTHALMOLOGY OPTOMETRY, PODIATRY, AUDIOLOGY, AND DENTAL SERVICES3) PHYSICAL, OCCUPATIONAL, SPEECH THERAPY4) INTRAVENOUS MEDICATION AND HYDRATION THERAPY5) WOUND CARE6) DEMENTIA CARE7) PALLIATIVE AND HOSPICE SERVICESDURING 2018, THERE WERE 119 ADMISSIONS AND 116 RESIDENTS DISCHARGED. DURING THE SAME PERIOD THERE WERE 69,101 RESIDENT DAYS OF CARE.THE PROGRAM UTILIZES THE DIRECT RESOURCES OF ALL THE CLINICAL DEPARTMENT. A BRIEF OVERVIEW OF EACH CLINICAL DEPARTMENT FOLLOWS:NURSING DEPARTMENTCOMPRISED OF OVER 140 EMPLOYEES, THE DEPARTMENT IS LED BY A DIRECTOR OF NURSING, WHO IS ALSO REGISTERED NURSE. THE CURRENT DIRECTOR ALSO HAS A MASTER'S DEGREE IN NURSING AND HAS SEVERAL YEARS OF EXPERIENCE IN ACUTE AND LONG-TERM CARE, WITH A FOCUS ON THE GERIATRIC POPULATION. DURING 2018 THE DEPARTMENT COMPLETED IMPLEMENTATION OF CONVERTING FROM A MANUAL MEDICAL RECORD TO A FULLY ELECTRON HEALTH RECORD THAT HAS ENABLED DIRECT PROVIDERS AND ADMINISTRATION TO IMPROVE QUALITY METRICS AND EFFICIENCIES. REPORTING DIRECTLY TO THE DNS ARE SEVERAL REGISTERED NURSES WHO PROVIDE ADMINISTRATIVE SUPPORT IN AREAS OF REGULATORY COMPLIANCE, CARE PLANNING, INFECTION CONTROL AND IN-SERVICE EDUCATION. THE REMAINING RN'S PROVIDE DIRECT CARE TO RESIDENTS AND ARE ASSIGNED IN THE POSITIONS OF NURSING SUPERVISOR, CLINICAL CARE MANAGER AND RN CONSULTANT. THE DEPARTMENT IS COMPRISED OF APPROXIMATELY 20 LICENSED PRACTICAL NURSES WHO PROVIDE TREATMENTS AS WELL AS ADMINISTER MEDICATIONS. APPROXIMATELY 100 CERTIFIED NURSING ASSISTANTS (CNA) ARE ASSIGNED TO THE DEPARTMENT AND THEIR PRIMARY RESPONSIBILITY LIES IN THE PROVISION OF ASSISTANCE RELATED TO ACTIVITIES OF DAILY LIVING TO RESIDENT'S WHO HAVE EITHER TEMPORARY OR PERMANENT DEFICITS MAINTAINING INDEPENDENCE. THE CNA ASSISTS RESIDENTS WITH BATHING, TOILETING, EATING AND DRESSING. EACH RESIDENT HAS AN INDIVIDUALIZED PLAN OF CARE DEVELOPED BY AN INTERDISCIPLINARY TEAM AT AN INITIAL MEETING THAT IS MONITORED AND TAILORED BY THE SAME TEAM ON A CONTINUOUS BASIS THROUGHOUT THE ENTIRE STAY. ALL PLANS OF CARE ENCOURAGE, OFTEN REQUIRE PARTICIPATION FROM THE RESIDENT AND THEIR FAMILY. SOCIAL WORK AND SERVICETHE DEPARTMENT IS STAFFED BY A TEAM OF SOCIAL WORKERS SUPERVISED BY A DIRECTOR. THE RESPONSIBILITIES OF THE DEPARTMENT ARE BROAD BECAUSE THEY ENCOMPASS THE IDENTIFICATION OF EACH RESIDENT'S INDIVIDUAL NEEDS AS WELL AS AN UNDERSTANDING OF THE RESIDENT'S FAMILY WHO MAY RESIST OR OPPOSE THOSE NEEDS. EACH RESIDENT IS ASSIGNED TO A SOCIAL WORKER. THE SOCIAL WORK MUST ACCESS THE GOALS OF TREATMENT AND HELP MAKE THEM KNOWN AND UNDERSTOOD TO RESIDENTS AND FAMILY. ADVANCE DIRECTIVES ARE REVIEWED WITH THE RESIDENT AND FAMILY UPON ADMISSION AND THROUGHOUT THE STAY, TO ENSURE THAT THE RESIDENT'S DECISIONS ARE BASED ON CURRENT CLINICAL EVENTS AND CIRCUMSTANCES. DIETARY DEPARTMENT AND NUTRITIONREGISTERED DIETICIANS EVALUATE THE NUTRITIONAL NEEDS OF EACH RESIDENT ON ADMISSION AND CONTINUE TO MONITOR THOSE NEEDS DURING THE RESIDENT'S STAY AT CHAPIN HOME. AN EVALUATION WILL INCLUDE AN ASSESSMENT OF THE RESIDENT'S ABILITY TO EAT INDEPENDENTLY. SPECIALTY DIETS, ADAPTIVE DEVICES OR REFERRALS TO SPEECH THERAPY MAY BE REQUIRED DEPENDING UPON INDIVIDUAL CIRCUMSTANCES. GENERALLY, RESIDENTS AND FAMILIES PLACE SIGNIFICANT IMPORTANCE ON FOOD. WHEN OVERALL SATISFACTION IS CONTEMPLATED, MANY THINK OF FOOD AND A KEY INDICATOR. THE DIETARY DEPARTMENT CONTINUOUSLY STRIVES TO BE INNOVATIVE AND RECEPTIVE TO MEETING ALL DIETARY NEEDS AND REASONABLE REQUESTS. THE FOOD SERVICE TEAM RECEIVES PRAISE FROM THE RESIDENTS AND FAMILIES WHO CONTINUE TO SITE THE SPECIAL HOLIDAY MENUS AND THE WEEKLY OUTDOOR SUMMER BARBEQUE LUNCHES ORGANIZED BY THE DEPARTMENT TO PROMOTE FAMILY VISITING AND INTERACTION WITH THE RESIDENT. RESIDENT SHORT ON OR WITHOUT FAMILY ALSO DERIVE THE SOCIAL PLEASURE THAT THESE LARGE GATHERINGS PROVIDE AS WELL AS IMPROVED ATTITUDES AND OUTLOOKS IN THE CHAPIN COMMUNITY.PHYSICAL REHABILITATION THROUGH THERAPYCHAPIN HOME MAINTAINS A PROGRESSIVE AND FULLY EQUIPPED THERAPY DEPARTMENT STAFFED WITH PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS AND SPEECH THERAPISTS. SHORT TERM RESIDENTS ARE USUALLY ADMITTED FROM HOME AND ARE SUFFERING AN INJURY RESULTING FROM A FALL, OCCUPATIONAL ACCIDENT, OR AUTO MOBILE ACCIDENT. THE DEPARTMENT IS ALSO SKILLED AT DELIVERING POST-ACUTE RESTORATIVE THERAPY FOLLOWING JOINT REPLACEMENT SURGERY, CARDIAC SURGERY. SOMETIMES A CLINICAL INCIDENT HAS CAUSED THE RESIDENT A LOSS OF PHYSICAL ABILITY THAT WILL BE A PERMANENT LOSS WITHOUT THE CHANCE FOR INTERVENTION. ACTIVITIES AND THERAPEUTIC RECREATIONTHE PROFESSIONAL RECREATION TEAM AT CHAPIN HOME IS LED BY A CERTIFIED ACTIVITIES DIRECTOR AND INTERFAITH MINISTER. THE DIRECTOR MEETS WITH EACH RESIDENT EARLY IN ADMISSION TO DEVELOP A PERSON-CENTERED PROGRAM DESIGNED TO APPEAL TO THE INDIVIDUAL'S INTERESTS AS WELL AS TO MAXIMIZE THE RESIDENT'S PHYSICAL, MENTAL AND PSYCHOLOGICAL WELL-BEING. THE ASSESSMENT EXAMINES THE RESIDENT'S PREADMISSION INTERESTS IN LEISURE, RECREATION , LEARNING, SERVICE AND SPIRITUALITY. THROUGH THE DEPARTMENT, AN EXTENSIVE AND EXPANSIVE LIST OF ACTIVITIES THROUGH GROUPS ARE OFFERED, SUCH AS:EXERCISE: CHAIR YOGA, ZUMBA, MORNING STRETCH, CHAIR DANCEDISCUSSION/ SIMILAR INTEREST: VETERANS GROUP, MEN'S GROUPART: CREATIVE CRAFTS, MUSIC, CHAPIN CHORUS, DRAMA CLUB COMMUNITY: HOLIDAY CONCERT, FASHION SHOW, MASS,LEISURE: MOVIES FAMILY/ FRIENDS: CARNIVAL/ OCTOBERFESTRESIDENT/ STAFF INTERACTIONS: KARAOKE 419928 645215 IN 1996 THE ORGANIZATION EXPANDED ITS MISSION BY OPENING THE CHAPIN ADULT DAY HEALTH CARE CENTER (ADHC). CHAPIN'S ADHC IS STRUCTURED AND LICENSED AS A MEDICAL MODEL PROVIDER OF LONG-TERM CARE AND BECAUSE IT IS LOCATED ON SITE WITH THE NURSING HOME, ALL THE SERVICES PROVIDED TO NURSING HOME RESIDENTS ARE AVAILABLE TO ADHC PARTICIPANTS. THROUGH THE DELIVERY OF THESE CLINICAL SERVICES, INCLUDING THERAPEUTIC RECREATION AND THE BENEFITS OF SOCIALIZATION, IT IS THE GOAL AND COMMITMENT OF THE ADHC FOR PARTICIPANT TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING AND FOR THE PARTICIPANT TO THRIVE IN THE COMMUNITY FOR AS LONG AS POSSIBLE. CHAPIN HOME'S ADHC AND NURSING HOME COLLABORATE TO ENSURE SMOOTH TRANSITIONS OF CARE WHEN THE NEED FOR RESIDENTIAL LONG-TERM CARE IS DETERMINED. DURING 2018 THE CHAPIN ADULT DAY HEALTH CENTER MAINTAINED A REGISTRANT LIST OF 38 PARTICIPANTS. 20244316 1 1 0 1 0 0 0 0 1 1 1 0 0 0 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 1 0 0 0 1 25 0 264 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X WILLIAM O'HARA 7187392523 165-01 CHAPIN PARKWAY JAMAICA NY 11432 REV SARAH BROWN PRESIDENT 0.50 0.50 X X 0 0 0 DIANE CUCCHI ESQ VICE PRESIDENT 0.50 0.50 X X 0 0 0 THERESA CLARK TREASURER 0.50 0.50 X X 0 0 0 VIRGINIA BELLING RN TRUSTEE 0.50 0.50 X 0 0 0 SISTER CAROL DERBY TRUSTEE 0.50 0.50 X 0 0 0 LAURA DOMINGUEZ TRUSTEE 0.50 0.50 X 0 0 0 KAREN DONNELLY TRUSTEE 0.50 0.50 X 0 0 0 GRADITA TEAHAN TRUSTEE 0.50 0.50 X 0 0 0 ROSE MARIE CURLEY TRUSTEE 0.50 0.50 X 0 0 0 MAUREEN MCDONALD TRUSTEE 0.50 0.50 X 0 0 0 VIRGINIA O'LEARY TRUSTEE 0.50 0.50 X 0 0 0 JANET M UNGER MPA LNHA TRUSTEE 0.50 0.50 X 0 0 0 WILLIAM B O'HARA JD CPA CFO 34.50 0.50 X 181704 0 29237 JENNIFER MCMANAMAN LNHA EXEC. VP & ADMINISTRATOR 34.50 0.50 X 218782 0 23678 VERNITA FORD RN DIRECTOR OF NURSING SERVICES 35.00 X 140054 0 23486 ANDREW LOMBARDO DIRECTOR OF PLANT OPERATIONS 35.00 X 129032 0 13303 669572 0 89704 4 0 1 0 HEALTH CARE SERVICES GROUP 3220 TILLMAN DR SUITE 300 BENSILENT PA 19020 CLEANING AND HOUSEKEEPING 1311439 REHAB ALTERNATIVES PO BOX 75343 CHICAGO IL 60603 STAFFING AGENCY NURSES 988078 MERIDIAN NURSE RECRUITERS 471 N BROADWAY SUITE 349 JERICHO NY 11753 STAFFING AGENCY NURSES 506295 RN EXPRESS STAFFING REGISTRY 71 WEST 23RD ST NEW YORK NY 10010 STAFFING AGENCY NURSES 242565 UNITEX TEXTILE RENTAL SERVICES 401 SOUTH MACQUESTEN PARKWAY MT VERNON NY 10550 LAUNDRY SERVICES 160120 8 6876 60014 66890 MEDICAID NET RESIDENT REVENUE 623000 15384307 15384307 MEDICARE NET RESIDENT REVENUE 623000 2373039 2373039 PRIVATE RESIDENT REVENUE 623000 1549921 1549921 ADULT DAY HEALTH CARE 623000 645215 645215 UNIVERSAL SETTLEMENT 623000 429685 429685 20382167 977116 977116 MEDICAL RECORDS FEE 900099 787 787 787 21426960 20382167 0 977903 X 453401 453401 8388228 8090385 297843 761693 715597 46096 2108532 2081352 27180 687430 624282 63148 129500 6000 123500 32040 32040 48890 48890 6292 6292 4393995 4085797 308198 8000 8000 225136 172281 52855 890754 869957 20797 863 764 99 17365 3679 13686 415909 415494 415 625542 609417 16125 344103 344103 CASH RECEIPTS ASSESSMEN 1154980 1154980 FOOD 804344 804344 DISPOSABLE DIAPERS AND 252240 252240 OTHER EXPENSES 148967 148967 388389 208780 179609 22286593 20244316 2042277 0 1133768 553665 40136523 36669829 4136456 4170848 215477 280686 25857008 19764165 6497645 6092843 13935682 14600916 119260 0 66174811 62368787 2231182 2194324 243608 203297 11329462 10807897 991067 21363 14795319 13226881 X 51318108 49080522 61384 61384 51379492 49141906 66174811 62368787 -859633 -1377953 0 X X 0 1 X 1 1 1 X 45090 19990 27681 51990 66890 211641 20272424 20739805 21811827 20272041 20382167 103478264 20317514 20759795 21839508 20324031 20449057 103689905 16162 16162 0 16162 16162 103673743 657438 711455 746291 800438 977716 3893338 657438 711455 746291 800438 977716 3893338 3431 687 1197 2224 787 8326 20978383 21471937 22586996 21126693 21427560 107591569 0.96360 0.96690 0.03620 0.03270 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MEDICAL RECORDS FEE - 2014 AMOUNT: $ 3,431. 2015 AMOUNT: $ 687. 2016 AMOUNT: $ 1,197. 2017 AMOUNT: $ 2,224. 2018 AMOUNT: $ 787. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6292 6292 0 PART II-B, LINE 1: DURING 2018, THE FACILITY DID NOT DIRECTLY ATTEMPT TO INFLUENCE LEGISLATION. HOWEVER, THE ORGANIZATION IS A MEMBER OF 3 TRADE ASSOCIATIONS THAT RENDER MANY TYPES OF SERVICES TO MEMBER FACILITIES, SUCH AS CHAPIN HOME FOR THE AGING. EACH ASSOCIATION THAT CHAPIN WAS A MEMBER DURING 2018 HAS REPRESENTED THAT A PERCENTAGE OF THE 2018 MEMBER DUES PAID FOR IN 2018 WAS USED IN FURTHERANCE INFLUENCING LEGISLATION FOR THE BENEFIT OF ITS MEMBERS. APPLYING THE ASSOCIATION'S 2018 DUE TO THE 2018 LOBBYING PERCENTAGE RESULTED IN THE FOLLOWING AMOUNTS USED FOR 2018 LOBBYING ACTIVITY: CONTINUING CARE LEADERSHIP COALITION (CCLC) $ 3,019 LEADING AGE OF NEW YORK ASSOCIATION $ 2,794 SOUTHERN NEW YORK ASSOCIATION $ 479 ____________ TOTAL $ 6,692 0 1 X 61384 5 5 61384 61384 23 23 61384 61384 11 11 61384 61384 6 6 61384 61384 6 6 61384 1.00000 0 0 9600 9600 22590268 17043281 5546987 3257140 2720884 536256 6092843 ESTIMATED THIRD PARTY LIABILITY 21363 21363 X 20049007 -1377953 -1377953 21426960 0 21426960 22286593 0 22286593 0 22286593 PART IV, LINE 2B: RESIDENT FUNDS ARE MAINTAINED ON BEHALF OF THE RESIDENTS. AT DECEMBER 31, 2018, THE FACILITY MAINTAINED $203,297 FOR THE RESIDENTS' PERSONAL ALLOWANCE AND DISCRETIONARY SPENDING, THE REMAINING AMOUNT OF $65,386 REPRESENTS 2 MONTHS OF SECURITY DEPOSIT WITH ACCRUED INTEREST FROM THE TIME THE SECURITY DEPOSIT WAS MADE. PART V, LINE 4: THE ENDOWMENT FUND IS A DONOR RESTRICTED FUND REQUIRING THE ANNUAL INTEREST EARNED ON A CERTIFICATE DEPOSIT TO BE USED FOR GENERAL OPERATIONS. PART X, LINE 2: THE HOME RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE HOME HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE HOME IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIOD PERIOD TO DECEMBER 31, 2015. X X X X X 0 0 0 0 0 0 0 0 0 WILLIAM B O'HARA JD CPA CFO 180984 0 0 0 720 0 18210 0 11027 0 210941 0 0 0 JENNIFER MCMANAMAN LNHA EXEC. VP & ADMINISTRATOR 218402 0 0 0 380 0 21154 0 2524 0 242460 0 0 0 VERNITA FORD RN DIRECTOR OF NURSING SERVICES 139478 0 0 0 576 0 14008 0 9478 0 163540 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 JANET UNGER AND JENNIFER MCMANAMAN HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 PRESENTLY, THE MEDICAL DIRECTOR IS AN INDEPENDENT CONTRACTOR AND IS RESPONSIBLE FOR MEDICAL SERVICES AT THE FACILITY. DURING 2018 THE MEDICAL DIRECTOR WAS PAID $123,500 AND RECEIVED NO OTHER BENEFITS RELATED TO HIS POSITION. NO CURRENT OR FORMER OFFICER, DIRECTOR, OR KEY EMPLOYEE OF CHAPIN HOME WAS COMPENSATED BY THE MEDICAL DIRECTOR OR HIS AFFILIATES. FORM 990, PART VI, SECTION A, LINE 6 CHAPIN HOME IS A NOT FOR PROFIT MEMBERSHIP CORPORATION FOUNDED IN 1869. CORPORATE MEMBERS PROVIDE BROAD SUPPORT TO THE CORPORATION. THE BOARD OF TRUSTEES IS SELECTED FROM THE CORPORATE MEMBERS. THE BOARD OF TRUSTEES MEET MONTHLY EXCEPT DURING THE MONTHS OF JULY AND AUGUST. THE MEMBERSHIP MEETS ANNUALLY. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATION HAS MEMBERS THAT ELECT THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES ELECT, FROM THEMSELVES, THE OFFICERS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERSHIP APPROVES ALL DECISIONS AND ACTIONS BY THE BOARD OF TRUSTEES AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF TRUSTEES IS AN ACTIVE PARTICIPANT IN THE PREPARATION OF THE ORGANIZATION'S 990. A ROUGH DRAFT IS PREPARED BY THE ORGANIZATION'S CFO AND A COPY IS DISTRIBUTED TO EACH TRUSTEE FOR THEIR INDIVIDUAL REVIEW AND INPUT. EACH YEAR THE PRESIDENT OF THE BOARD REVIEWS WITH HER OFFICERS AND TRUSTEES THE IMPORTANCE OF MAINTAINING TAX-EXEMPT STATUS AS WELL AS FILING A COMPLETE AND ACCURATE 990. PRIOR TO FILING THE 990, THE ORGANIZATION'S INDEPENDENT CPA FIRM CONDUCTS A DETAILED REVIEW ENSURING THAT THE FILING CONFORMS WITH THE FINANCIAL POSITION THAT IS PRESENTED IN THE ANNUAL AUDITED FINANCIAL STATEMENTS. THE BOARD'S FINAL ACCEPTANCE OF THE 990 IS DOCUMENTED IN THE MINUTES TO THE NOVEMBER MEETING. FORM 990, PART VI, SECTION B, LINE 12C CHAPIN HOME HAS A CONFLICT OF INTEREST POLICY APPLICABLE TO ALL BOARD MEMBERS AND KEY EMPLOYEES REQUIRING DISCLOSURE OF ALL ACTUAL AND POTENTIAL CONFLICTS. TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. THERE IS AN OBLIGATION FOR TRUSTEES AND KEY EMPLOYEES TO REMAIN IN COMPLIANCE WITH THIS POLICY THROUGHOUT THE YEAR. COMPLIANCE WITH THE POLICY IS MONITORED CONTINUOUSLY AT BOARD MEETINGS THROUGHOUT THE YEAR. THE POLICY IS REVIEWED ANNUALLY. IF A CONFLICT IS DISCLOSED TO THE BOARD, THE BOARD DELIBERATES ON AN APPROPRIATE RESOLUTION ON A CASE BY CASE BASIS. THE BOARD MEMBER WITH THE CONFLICT IS EXCUSED FROM VOTING ON THE APPROPRIATE ACTION CONTEMPLATED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE EXECUTIVE VICE-PRESIDENT/ ADMINISTRATOR AND CHIEF FINANCIAL OFFICER IS DETERMINED BY THE BOARD OF TRUSTEES BASED ON THE RESULTS OF SALARY AND COMPENSATION SURVEYS PERFORMED BY INDEPENDENT ADVISORS. THE BOARD CONSIDERS OTHER FACTORS SUCH AS YEARS OF SERVICE, EXPERIENCE, PERFORMANCE IN ARRIVING AT A FINAL COMPENSATION LEVEL. THE PROCESS IS REFLECTED IN THE MINUTES OF THE BOARD MEETING. ANNUAL, COMPENSATION OF UNION FREE STAFF IS EVALUATED BY THE ADMINISTRATOR BASED ON DISCUSSIONS AND RECOMMENDATIONS WITH THE CHIEF FINANCIAL OFFICER AND DIRECTOR OF HUMAN RESOURCES. CURRENT FINANCIAL POSITION AND CURRENT FINANCIAL OUTLOOK ARE KEY DETERMINANTS. ALL OTHER EMPLOYEES ARE SUBJECT MEMBERS OF 1199SEIU WHOSE ECONOMIC TERMS OF EMPLOYMENT ARE NEGOTIATED AND CONTAINED IN THE COLLECTIVE BARGAINING AGREEMENT. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE FOR INSPECTION DURING REGULAR BUSINESS HOURS AND IS POSTED ON GUIDE STAR (WWW.GUIDESTAR.ORG). FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 1023 AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CHAPIN HOME ALSO FILES AN ANNUAL COST REPORT WITH NEW YORK STATE DEPARTMENT OF HEALTH (RHCF-4). THIS REPORT CONTAINS VERY DETAILED FINANCIAL INFORMATION AND FINANCIAL STATEMENT DATA WITH RELATED FOOTNOTE DISCLOSURES, WHICH IS ALSO AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G NURSING SERVICES: PROGRAM SERVICE EXPENSES 1,007,997. MANAGEMENT AND GENERAL EXPENSES 29,581. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,037,578. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 8,986. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,986. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 14,497. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,497. PHARMACY CONSULTANTS: PROGRAM SERVICE EXPENSES 21,312. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,312. DENTAL FEES: PROGRAM SERVICE EXPENSES 42,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,000. THERAPY: PROGRAM SERVICE EXPENSES 1,001,638. MANAGEMENT AND GENERAL EXPENSES 41,400. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,043,038. ACTIVITIES PROGRAM FEES: PROGRAM SERVICE EXPENSES 8,537. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,537. FOOD SERVICES: PROGRAM SERVICE EXPENSES 7,359. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,359. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 1,510,599. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,510,599. LINEN AND LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 73,079. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,079. SECURITY: PROGRAM SERVICE EXPENSES 4,151. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,151. DAYCARE SERVICES: PROGRAM SERVICE EXPENSES 144,018. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 144,018. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 12,516. MANAGEMENT AND GENERAL EXPENSES 237,217. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 249,733. GROUNDS AND MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 229,108. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 229,108. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE IS COMPRISED OF TRUSTEES AND IS RESPONSIBLE FOR ENGAGING THE CERTIFIED PUBLIC ACCOUNTING FIRM FOR THE ANNUAL EXAMINATION. THROUGH THE DELEGATION OF THIS RESPONSIBILITY, THE EXECUTIVE VICE PRESIDENT AND CFO MEET WITH THE ENGAGEMENT TEAM FOR AN INTERIM AUDIT MEETING TO DISCUSS THE SCOPE OF THE AUDIT, CONCERNS AND RELATED SERVICES, AND THE FEE. AT THE CONCLUSION OF THE AUDIT THE FINANCIAL STATEMENTS ARE PRESENTED TO THE FULL BOARD OF TRUSTEES AT A SCHEDULE MONTHLY MEETING. THE ACCOUNTANTS DISCUSS AUDIT RESULTS WHICH INCLUDE THE REQUIRED COMMUNICATIONS AND ISSUANCE AND REVIEW OF THE MANAGEMENT LETTER. THIS PROCESS HAS BEEN CONSISTENTLY FOLLOWED ON AN ANNUAL BASIS. CHAPIN FOUNDATION INC 165-01 CHAPIN PARKWAY QUEENS NY 11432 112650375 SUPPORT CHARITABLE ORGANIZATIONS NY 501(C)(3) PF CHAPIN HOME FOR THE AGING 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0