2018-11-15T14:54:13-06:00 2017-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2017-01-01 135601035 CHAPIN HOME FOR THE AGING CHAP 7187392523 165-01 CHAPIN PARKWAY QUEENS NY 11432 JENNIFER MCMANAMAN LNHA EXECUTIVE VP & ADMINISTRATOR 7187392523 2018-11-15 1 GARRETT M HIGGINS P00543209 9143818900 2018-11-15 65.51.112.58 2018-11-15 14:54:10 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9616F4B14A694591D1E716C270910E6FA5556DA3 2017 2019-02-21 02:37:17Z JENNIFER MCMANAMAN LNHA 165-01 CHAPIN PARKWAY QUEENS NY 11432 21126693 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 11 278 12 0 0 27681 51990 21811827 20272041 746291 800438 1197 2224 22586996 21126693 0 0 0 0 12945792 12544520 0 0 0 8397363 8889226 21343155 21433746 1243841 -307053 65432186 66174811 15130442 14795319 50301744 51379492 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 18185580 19632286 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 2017, THERE WERE 129 RESIDENTS ADMITTED AND 142 DISCHARGED. DURING THE SAME PERIOD THERE WERE 74,717 RESIDENT DAYS OF CARE.THE PROGRAM UTILIZES THE DIRECT RESOURCES OF ALL THE CLINICAL DEPARTMENT. THE FOLLOWING IS A BRIEF OVERVIEW OF EACH CLINICAL DEPARTMENT, NOT INTENDED TO BE AN ALL-INCLUSIVE DESCRIPTION OF ALL DUTIES AND RESPONSIBILITIES WITHIN THE DEPARTMENT. REPLACE THE ENTIRE SECTION:NURSING DEPARTMENTNURSING DEPARTMENTTHE NURSING DEPARTMENT IS STAFFED BY A REGISTERED NURSE AS THE DIRECTOR OF NURSING SERVICES (DNS), THE CURRENT DNS HOLD A BACHELOR OF SCIENCE IN NURSING AND HAS SEVERAL YEARS OF EXPERIENCE AND TRAINING IN ACUTE AND GERIATRIC LONG-TERM CARE. REPORTING DIRECTLY TO THE DNS ARE SEVERALREGISTERED NURSES WHO PROVIDE ADMINISTRATIVE AND MANAGERIAL SUPPORT IN THE AREAS OF CARE PLANNING, INFECTION CONTROL, REGULATORY COMPLIANCE AND IN-SERVICE EDUCATION. RN'S NOT ASSIGNED TO ADMINISTRATIVE POSITIONS DIRECT AND SUPERVISE THE NURSING CARE DELIVERED TO RESIDENTS AND ARE ASSIGNED TO POSITIONS OF NURSING SUPERVISOR, CLINICAL CARE MANAGER, OR NURSE CONSULTANT. ASSIGNED TO EACH SHIFT AND NURSING STATION ARE LICENSED PRACTICAL NURSES WHO ARE TRAINED TO ADMINISTER MEDICATIONS AND PERFORM TREATMENTS AND SUPERVISE THE CERTIFIED NURSING ASSISTANTS (CNA), THE CNA ASSISTS THE RESIDENT WITH "ACTIVITIES OF DAILY LIVING" SUCH AS EATING, TOILETING, AND BATHING. AN INDIVIDUALIZED CARE PLAN IS CREATED AND CONTINUOUSLY UPDATED FOR EACH RESIDENT. THE CARE PLAN IS A PRODUCT OF EACH DISCIPLINES ASSESSMENT AND IDENTIFICATION OF EACH RESIDENT'S RISKS, REFERRED TO AS A PERSON CENTERED PROBLEM (PCP). EACH PCP IS DISCUSSED AT AN INTER-DISCIPLINARY CARE PLAN MEETING THAT IS ATTENDED BY THE CLINICAL TEAM, THE RESIDENT AND FAMILY. EACH PCP IS ADDRESSED AND RESOLVED BY ASSIGNING AN ATTAINABLE GOAL(S) FOR EACH PCP WITH A PRESCRIPTION FOR INTERVENTIONS ATTAIN THOSE GOALS. SOCIAL WORK AND SERVICETHE DEPARTMENT IS STAFFED BY A TEAM OF SOCIAL WORKERS SUPERVISED BY A DIRECTOR LICENSED BY THE STATE OF NEW YORK AS A LICENSED MASTER SOCIAL WORKER (LMSW). THE RESPONSIBILITIES OF THE DEPARTMENT ARE BROAD AND ARE SENSITIVE TO INDIVIDUAL RESIDENT 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 RESIDENT AND FAMILY. ADVANCE DIRECTIVES ARE REVIEWED WITH THE RESIDENT AND FAMILY UPON ADMISSION. THE DEPARTMENT IS RESPONSIBLE FOR PLANNING THE DISCHARGE FOR SHORT TERM RESIDENTS AND CONTINUOUSLY MONITORING THE RESIDENT'S PROGRESS IN RELATION TO THE PLAN, AND TO UPDATE THE PLAN ACCORDINGLY.DIETARY DEPARTMENT AND NUTRITIONREGISTERED DIETICIANS EVALUATE THE NUTRITIONAL NEEDS OF EACH RESIDENT ON ADMISSION AND PERIODICALLY THEREAFTER. 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. IN RESPONSE, THE DIETARY DEPARTMENT PROVIDES SPECIAL MENUS FOR ALL HOLIDAYS. DURING THE SUMMER MONTHS, THE DEPARTMENT ORGANIZES BARBEQUES THAT RESIDENTS AND THEIR FAMILY ARE INVITED TO, COMPLIMENTS OF CHAPIN HOME.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 THE HOSPITAL AFTER EITHER SUFFERING AN INJURY RESULTING FROM A FALL AT HOME, OCCUPATIONAL ACCIDENT, OR AUTO MOBILE ACCIDENT. THE DEPARTMENT IS ALSO SKILLED AT DELIVERING POST-ACUTE RESTORATIVE THERAPY FOLLOWING JOINT REPLACEMENT SURGERY, CARDIAC SURGERY RESTORING THE RESIDENT TO THEIR FORMER LEVEL OF FUNCTIONING.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 TO DEVELOP A PERSON-CENTERED PROGRAM THAT IS DESIGNED TO APPEAL TO EACH RESIDENTS' SPECIFIC INTERESTS AND MAXIMIZE THEIR PHYSICAL, MENTAL AND PSYCHOSOCIAL WELL-BEING. THE ASSESSMENT EXAMINES THE RESIDENT'S INTERESTS IN LEISURE, RECREATION, LIFE-LONG LEARNING, SERVICE AND SPIRITUALITY. BASED ON THE ASSESSMENT AN ACTIVITIES PLAN OF CARE IS DESIGNED. THE ACTIVITIES TEAM PROVIDES A WIDE VARIETY OF PROGRAMS TO ACCOMMODATE EACH RESIDENT'S PERSONAL INTERESTS AND NEEDS. AN EXAMPLE OF SOME ARE:EXERCISE PROGRAMS : CHAIR YOGA, ZUMBA, MORNING STRETCH, CHAIR DANCEDISCUSSION GROUPS: RESIDENTS WITH SIMILAR INTERESTS OR EXPERIENCES CONNECT THROUGH GROUPS. ART PROGRAMS: RESIDENTS EXPRESS INNER TALENTS THROUGH CREATIVE CRAFTS, ART, MUSIC, CHAPIN CHORUS, DRAMA CLUB.COMMUNITY ACTIVITIES: RESIDENT PARTICIPATE IN FASHION SHOWS, HOLIDAY CONCERTS, THEATER PERFORMANCES, LEISURE: MOVIES, KARAOKE, LADIES SOCIALFAMILY AND FRIENDS: ANNUAL CARNIVAL AND SUMMER BARBEQUES, HOLIDAY FAIR, HOLIDAY CELEBRATIONSMEMORY SUPPORT ACTIVITIES: DOWN MEMORY LANE, SONGS OF OLD, SENSATIONS CART, OUTDOOR PATIO PROGRAMSRESIDENT / STAFF PROGRAMS KARAOKE CONTEST, SPECIAL EVENTS, CENTENNIAL 417033 639755 IN 1996 THE ORGANIZATION EXPANDED ITS MISSION BY OPENING THE CHAPIN ADULT DAY HEALTH CARE CENTER. THE CENTER IS STRUCTURED AS A MEDICAL MODEL PROVIDER OF LONG TERM CARE, PROVIDING ALL THE ESSENTIAL SERVICES PROVIDED IN THE NURSING HOME, BUT TO THOSE STILL RESIDING IN THE COMMUNITY. BY PROVIDING THESE SERVICES TO THOSE IN THE COMMUNITY, THE REGISTRANT CAN RESIDE LONGER IN THE COMMUNITY AND ALLOWS THE FAMILY WHO IS ALSO THE COMMUNITY CAREGIVER NECESSARY RESPITE TIME. DURING 2017 THE CHAPIN ADULT DAY HEALTH CENTER INCREASED THE NUMBER OF ACTIVE REGISTRANTS FROM 38 TO 42. THE CENTER ACCEPTED 12 NEW REGISTRANTS AND DISCHARGED 8 REGISTRANTS. 18602613 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 27 0 278 1 0 0 0 0 0 0 0 0 0 0 X 12 11 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 X 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 SEE SCHEDULE O 34.50 0.50 X X 144733 0 17535 WILLIAM B O'HARA JD CPA CFO 34.50 0.50 X 180880 0 27612 JENNIFER MCMANAMAN LNHA EXEC. VP & ADMINISTRATOR 34.50 0.50 X 180003 0 18569 VERNITA FORD RN DIRECTOR OF NURSING SERVICES 35.00 X 139606 0 24161 ANDREW LOMBARDO DIRECTOR OF PLANT OPERATIONS 35.00 X 127720 0 13190 772942 0 101067 5 0 1 0 HEALTH CARE SERVICES GROUP 3220 TILLMAN DR SUITE 300 BENSILENT PA 19020 CLEANING SERVICES 1402068 REHAB ALTERNATIVES PO BOX 75343 CHICAGO IL 60603 STAFF AGENCY THERAPIST 981860 MERIDIAN NURSE RECRUITERS 471 N BROADWAY SUITE 349 JERICHO NY 11753 NURSING SERVICES 470446 UNITEX TEXTILE RENTAL SERVICES 401 SOUTH MAC QUESTEN PARKWAY MT VERNON NY 105501700 LAUNDRY SERVICES 166579 N AND I JANAS MEDICAL PC 20 WESTWOOD CIRCLE EAST HILLS NY 11577 MEDICAL DIRECTOR SERVICES 121125 5 7850 44140 51990 MEDICAID NET RESIDENT REVENUE 623000 14258986 14258986 MEDICARE NET RESIDENT REVENUE 623000 2797611 2797611 PRIVATE RESIDENT REVENUE 623000 2179603 2179603 ADULT DAY HEALTH CARE 623000 639755 639755 UNIVERSAL SETTLEMENT 623000 396086 396086 20272041 800438 800438 MEDICAL RECORDS FEE 900099 2224 2224 2224 21126693 20272041 0 802662 X 569332 569332 8704860 8169038 535822 713974 681329 32645 1841021 1453119 387902 715333 641468 73865 127125 6000 121125 48363 48363 53773 53773 5509 5509 3814881 3494118 320763 265879 224832 41047 391572 365642 25930 10197 9419 778 19836 7084 12752 435181 420198 14983 589160 573973 15187 428469 428469 CASH RECEIPTS ASSESSMEN 1075112 1075112 FOOD 812830 812830 DISPOSABLE DIAPERS AND 310872 310872 OTHER EXPENSES 297897 155009 142888 202570 202570 21433746 18602613 2831133 0 2258152 1133768 40181671 40136523 3325890 4136456 94848 215477 25636268 19138623 6513748 6497645 12987097 13935682 70780 119260 65432186 66174811 1956429 2231182 309695 243608 11831756 11329462 1032562 991067 15130442 14795319 X 50240360 51318108 61384 61384 50301744 51379492 65432186 66174811 -307053 1384801 0 X X 0 1 X 1 1 1 X 50436 45090 19990 27681 51990 195187 20807843 20272424 20739805 21811827 20272041 103903940 20858279 20317514 20759795 21839508 20324031 104099127 15995 16162 32157 0 15995 16162 32157 104066970 608146 657438 711455 746291 800438 3523768 608146 657438 711455 746291 800438 3523768 3377 3431 687 1197 2224 10916 21469802 20978383 21471937 22586996 21126693 107633811 0.96690 0.96720 0.03270 0.03240 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MEDICAL RECORDS FEE - 2013 AMOUNT: $ 3,377. 2014 AMOUNT: $ 3,431. 2015 AMOUNT: $ 687. 2016 AMOUNT: $ 1,197. 2017 AMOUNT: $ 2,224. 0 0 0 0 0 0 0 0 1 5509 5509 0 PART II-B, LINE 1: DURING 2017, 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 2017 HAS REPRESENTED THAT A PERCENTAGE OF THE 2017 MEMBER DUES PAID FOR IN 2017 WAS USED IN FURTHERANCE INFLUENCING LEGISLATION FOR THE BENEFIT OF ITS MEMBERS. APPLYING THE ASSOCIATION'S 2017 DUE TO THE 2017 LOBBYING PERCENTAGE RESULTED IN THE FOLLOWING AMOUNTS USED FOR 2017 LOBBYING ACTIVITY: CONTINUING CARE LEADERSHIP COALITION (CCLC) $ 2,250 LEADING AGE OF NEW YORK ASSOCIATION $ 2,833 SOUTHERN NEW YORK ASSOCIATION $ 426 ____________ TOTAL $ 5,509 0 1 X 61384 23 23 61384 61384 11 11 61384 61384 6 6 61384 61384 6 6 61384 61384 63 6 61384 1.00000 0 0 9600 9600 22478323 16578198 5900125 3148345 2560425 587920 6497645 ESTIMATED THIRD PARTY LIABILITY 991067 991067 X 22511494 1384801 1384801 21126693 0 21126693 21433746 0 21433746 0 21433746 PART IV, LINE 2B: RESIDENT FUNDS ARE MAINTAINED ON BEHALF OF THE RESIDENTS. AT DECEMBER 31, 2017, THE FACILITY MAINTAINED $157,292 FOR THE RESIDENTS' PERSONAL ALLOWANCE AND DISCRETIONARY SPENDING, THE REMAINING AMOUNT OF $86,316 REPRESENTS 2 MONTHS OF SECURITY DEPOSIT WITH ACCRUED INTEREST FROM FROM THE TIME THE SECURITY DEPOSIT WAS MADE. PART V, LINE 4: INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUND IS TO PROVIDE INTEREST INCOME 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 PERIODS PRIOR TO DECEMBER 31, 2014. X X X X X 0 0 0 0 0 0 0 0 0 JANET M UNGER MPA LNHA SEE SCHEDULE O 144519 0 0 0 214 0 14452 0 3083 0 162268 0 0 0 WILLIAM B O'HARA JD CPA CFO 171443 0 0 0 9437 0 18210 0 9402 0 208492 0 0 0 JENNIFER MCMANAMAN LNHA EXEC. VP & ADMINISTRATOR 169623 0 0 0 10380 0 18045 0 524 0 198572 0 0 0 VERNITA FORD RN DIRECTOR OF NURSING SERVICES 139030 0 0 0 576 0 13963 0 10198 0 163767 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 CHAPIN HOME FOR THE AGING CONTRACTS WITH AN UNRELATED ORGANIZATION FOR THE SERVICES OF ITS MEDICAL DIRECTOR POSITION. THE MEDICAL DIRECTOR IS RESPONSIBLE FOR OVERSEEING ALL MEDICAL SERVICES AT CHAPIN HOME FOR THE AGING. THE MEDICAL DIRECTOR WAS PAID $121,125 FOR THEIR SERVICES IN 2017. NO CURRENT OR FORMER OFFICER, DIRECTOR, KEY EMPLOYEE OF CHAPIN HOME WAS COMPENSATED BY THE MEDICAL DIRECTOR OR HIS AFFILIATES, DURING 2017. 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 CHAPIN HOME'S FORM 990 IS PREPARED BY THE HOME'S CFO AND IS THEN REVIEWED BY THE HOME'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM. THE 990 IS THEN DISTRIBUTED TO THE TRUSTEES FOR THEIR REVIEW AT A BOARD MEETING. TRUSTEES ARE ASKED TO REVIEW THE FORM AND DIRECT ANY QUESTIONS TO THE CFO FOR RESOLUTION. AT THE NEXT BOARD OF TRUSTEES MEETING, THE TRUSTEES VOTE TO APPROVE THE FORM 990. APPROVAL IS DOCUMENTED IN THE MINUTES OF THE BOARD OF TRUSTEES 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 ALSO REVIEWED ANNUALLY. IF A CONFLICT IS DISCLOSED THE BOARD DECIDES APPROPRIATE ACTION ON A CASE BY CASE BASIS. THE BOARD MEMBER WITH THE CONFLICT IS EXCUSED FROM VOTING ON THE APPROPRIATE ACTION THAT SHOULD BE TAKEN REGARDING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE EXECUTIVE VICE-PRESIDENT/ADMINISTRATOR IS DETERMINED BY THE BOARD OF TRUSTEES BASED ON THE RESULTS OF SALARY AND COMPENSATION SURVEYS PERFORMED BY INDEPENDENT CONSULTANTS, THE NURSING HOME ASSOCIATIONS, AND COMPENSATION INFORMATION FROM 990'S FILED BY COMPARABLE NURSING FACILITIES. THE BOARD ALSO WEIGHS THE EXPERIENCE AND PERFORMANCE OF THE EXECUTIVE VICE PRESIDENT IN ARRIVING AT A COMPENSATION ARRANGEMENT. THIS PROCESS IS DOCUMENTED AND SUPPORTED BY THE MINUTES TO THE BOARD OF TRUSTEES' MEETING. ANNUALLY, THE EXECUTIVE VICE PRESIDENT/ADMINISTRATOR PERFORMS A SALARY REVIEW OF ALL UNION FREE EMPLOYEES, INCLUDING THE OTHER OFFICERS OF THE ORGANIZATION. BASED ON COMPARABLE SALARIES AT OTHER NURSING HOMES, FORM 990'S OF OTHER NURSING HOMES, CURRENT ECONOMIC CONDITIONS, VARIOUS INDUSTRY TRENDS AND INDIVIDUAL EMPLOYEE PERFORMANCE, THE EXECUTIVE VICE PRESIDENT/ADMINISTRATOR DETERMINES WHETHER COMPENSATION SHOULD BE ADJUSTED. BASED ON THE EXECUTIVE VICE-PRESIDENT'S REVIEW, HER RECOMMENDATION IS PRESENTED TO THE BOARD OF TRUSTEES FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE FOR INSPECTION DURING REGULAR BUSINESS HOURS AND ON GUIDE STAR. FORM 990, PART VI, SECTION C, LINE 19 CHAPIN HOME MAKES ITS 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 WHICH CONTAINS FINANCIAL STATEMENTS AND RELATED NOTE DISCLOSURES, WHICH IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, LINE 12: ON AUGUST 28, 2017 JANET M. UNGER STEPPED DOWN AS EXEC. VP & ADMINISTRATOR OF CHAPIN HOME FOR THE AGING. ON SEPTEMBER 27, 2017 SHE BECAME THE ACTING SECRETARY OF THE BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G NURSING SERVICES: PROGRAM SERVICE EXPENSES 608,907. MANAGEMENT AND GENERAL EXPENSES 37,225. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 646,132. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 12,949. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,949. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 16,686. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,686. PHARMACY CONSULTANTS: PROGRAM SERVICE EXPENSES 22,041. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,041. DENTAL FEES: PROGRAM SERVICE EXPENSES 42,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,000. THERAPY: PROGRAM SERVICE EXPENSES 927,344. MANAGEMENT AND GENERAL EXPENSES 40,694. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 968,038. ACTIVITIES PROGRAM FEES: PROGRAM SERVICE EXPENSES 1,493,323. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,493,323. FOOD SERVICES: PROGRAM SERVICE EXPENSES 5,172. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,172. LINEN AND LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 84,150. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,150. SECURITY: PROGRAM SERVICE EXPENSES 4,875. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,875. DAYCARE SERVICES: PROGRAM SERVICE EXPENSES 130,998. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130,998. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 242,844. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 242,844. GROUNDS AND MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 145,673. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 145,673. FORM 990, PART XII, LINE 2C: CHAPIN HOME HAS BOARD MEMBERS THAT FUNCTION AS A FINANCE COMMITTEE AND WHICH HAVE THE RESPONSIBILITY FOR ENGAGING AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM TO CONDUCT AN AUDIT OF THE HOME'S FINANCIAL STATEMENTS ON AN ANNUAL BASIS. THE COMMITTEE, THROUGH ITS DESIGNATION TO THE HOME'S CEO AND CFO, MEETS WITH THE AUDITORS PRE-AUDIT TO DISCUSS THE SCOPE OF SERVICES AND ADDRESS POTENTIAL CONCERNS. THE BOARD ALSO MEETS WITH THE AUDITORS POST-AUDIT TO RECEIVE AND REVIEW THE AUDITED FINANCIAL STATEMENTS. THE AUDITORS REPORT THE RESULTS OF THEIR AUDIT TO THE FULL BOARD AND THEIR REQUIRED COMMUNICATION WITH THOSE IN CHARGE OF GOVERNANCE AND MANAGEMENT COMMENTS, IF ANY. THIS PROCESS HAS BEEN CONSISTENTLY FOLLOWED YEAR TO YEAR. 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