2018-11-15T09:12:55-06:00 2017-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2017-01-01 141370000 HOOSICK FALLS HEALTH CENTER INC HOOS 5186864371 21 DANFORTH STREET HOOSICK FALLS NY 12090 GREGORY LAURIN PRESIDENT 5186864371 2018-11-15 1 GARRETT M HIGGINS P00543209 9143818900 2018-11-13 65.51.112.58 2018-11-15 09:12:53 ES P 45D10729E84C80409783239EA0C370A8A08632B7 9616F4B14A694591D1E716C270910E6FA5556DA3 2017 2018-06-14 16:35:46Z CENTER FOR NURSING AND REHABILITATION AT HOOSICK FALLS GREGORY LAURIN 21 DANFORTH STREET HOOSICK FALLS NY 12090 6514731 0 X 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 SNF SO THAT EACH RESIDENT HAS THE OPPORTUNITY TO REACH THEIR MAXIMUM POTENTIAL. 10 10 203 24 0 0 157528 25520 6090754 6326025 16366 4342 10171 149700 6274819 6505587 0 0 0 0 4412472 4539303 0 0 0 2185384 3034096 6597856 7573399 -323037 -1067812 3633166 4220583 2833015 4419591 800151 -199008 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 6592280 6326025 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 24,242. 6592280 1 1 0 1 0 0 0 0 1 0 1 0 0 1 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 10 0 203 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X X DREW LERMAN 8024474587 21 DANFORTH STREET HOOSICK FALLS NY 12090 GREGORY LAURIN PRESIDENT 2.00 X X 0 0 0 WILLIAM KOESTER VICE PRESIDENT 1.00 X X 0 0 0 WILLIAM JOHNSTON TREASURER 1.50 X X 0 0 0 JOYCE DAVIS SECRETARY 1.00 0.25 X X 0 0 0 EDWARD J GORMAN ESQ BOARD MEMBER 1.00 X 0 0 0 DENNIS PERRY BOARD MEMBER 1.00 X 0 0 0 HAROLD MCCLELLAN BOARD MEMBER 1.00 X 0 0 0 PATTY RYAN BOARD MEMBER 1.00 X 0 0 0 BILL COTTRELL BOARD MEMBER 1.00 X 0 0 0 KEVIN ROBICHAUD BOARD MEMBER 1.00 X 0 0 0 LAURA REYNOLDS CEO THRU SEPTEMBER 2017 40.00 0.50 X 158961 0 14516 TERRI WILLIAMS CEO 40.00 X 38233 0 0 197194 0 14516 1 0 1 0 0 4900 20620 25520 MEDICAID REVENUE 623000 3511333 3511333 MEDICARE REVENUE 623000 1851309 1851309 PRIVATE PATIENT REVENU 623000 841050 841050 OTHER PATIENT REVENUE 623000 77906 77906 MEDICAID UNIVERSAL SET 623000 44427 44427 6326025 3634 3634 7800 0 7800 7800 7800 9852 9144 708 708 708 LOAN FORGIVENESS 900099 130730 130730 OTHER INCOME 900099 11170 11170 141900 6505587 6326025 0 154042 X 211710 191950 19760 3554649 3222871 331778 12595 11419 1176 344267 312135 32132 416082 377247 38835 54583 54583 41753 41753 1029 1029 1564 1564 992897 764996 227901 2657 239 2418 835189 722715 112474 155663 155663 12174 2342 9832 70705 48214 22491 272499 268345 4154 79239 79239 NYS CASH RECEIPTS ASSES 275684 275684 BAD DEBT EXPENSE 232561 232561 LAB SERVICES 5899 5899 7573399 6592280 981119 0 64793 55403 49695 55887 685330 882764 42861 37888 29436 11286 8637630 6033067 2217643 2604563 134743 161821 408665 410971 3633166 4220583 496362 1462787 902245 537763 24989 34790 787911 1259321 621508 1124930 2833015 4419591 X 738721 -266854 61430 67846 800151 -199008 3633166 4220583 X -1067812 31743 36910 X X 0 1 X 1 0 X 105469 6657 168402 157528 25520 463576 6336640 6234172 6096278 6090754 6326025 31083869 6442109 6240829 6264680 6248282 6351545 31547445 0 0 0 31547445 42281 25986 17396 12489 11434 109586 42281 25986 17396 12489 11434 109586 2121 858 1065 2371 141900 148315 6486511 6267673 6283141 6263142 6504879 31805346 0.99190 0.99750 0.00340 0.00230 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: REBATES DISCOUNTS - 2013 AMOUNT: $ 1,259. 2014 AMOUNT: $ 231. 2015 AMOUNT: $ 468. 2016 AMOUNT: $ 1,700. MISCELLANEOUS - 2015 AMOUNT: $ 155. 2016 AMOUNT: $ 671. VENDING MACHINE REBATES - 2013 AMOUNT: $ 242. 2014 AMOUNT: $ 561. 2015 AMOUNT: $ 442. SERVICES SOLD - 2013 AMOUNT: $ 470. 2014 AMOUNT: $ 66. LOAN FORGIVENESS - 2017 AMOUNT: $ 130,730. OTHER INCOME - 2013 AMOUNT: $ 150. 2017 AMOUNT: $ 11,170. 0 0 0 0 0 0 0 0 1 1029 1029 0 PART II-B, LINE 1: COSTS ARE INCURRED AS PART OF DUES PAID TO NURSING HOME INDUSTRY ORGANIZATIONS. 0 1 X 60499 60499 2802493 1694937 1107556 5169558 3873267 1296291 605080 464863 140217 2604563 BENEFICIAL INTEREST IN TRUST 67846 INSURANCE RECOVERIES 343125 410971 DUE TO THIRD PARTY PAYORS 150594 FAIR MARKET VALUE OF SWAP AGREEMENT 13263 DUE TO FOUNDATION 33969 ESTIMATED INSURANCE LIABILITIES 343125 DUE TO AFFILIATES 583979 1124930 X 6558682 31743 27014 58757 6499925 762 4900 5662 6505587 7573256 5519 5519 7567737 762 4900 5662 7573399 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, 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE ATTRIBUTED TO AFFILIATE 27,014. PART XI, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS ON CONSOLIDATED FINANCIAL STATEMENTS 4,900. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES ATTRIBUTED TO AFFILIATE 5,519. PART XII, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS ON CONSOLIDATED FINANCIAL STATEMENTS 4,900. X X 1 0 0 0 0 0 0 0 0 LAURA REYNOLDS CEO THRU SEPTEMBER 2017 77143 0 0 0 81818 0 0 0 14516 0 173477 0 0 0 PART I, LINE 4A LAURA REYNOLDS RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $81,818 WHICH IS REPORTED IN HER 2017 W-2. 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 B, LINE 15 THE ORGANIZATION USES COMPENSATION SURVEYS AND COMPARABLE ANALYSIS OF OTHER SIMILAR SIZE NURSING HOMES TO DETERMINE COMPENSATION OF THE CEO. 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 676,078. MANAGEMENT AND GENERAL EXPENSES 227,901. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 903,979. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 9,900. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,900. DENTAL SERVICES: PROGRAM SERVICE EXPENSES 1,736. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,736. CONSULTANTS: PROGRAM SERVICE EXPENSES 77,282. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 77,282. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUST 6,416. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 30,494. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0