2017-11-14T16:27:25-06:00 2016-12-31 221478099 COHNREZNICK LLP 1301 AVENUE OF THE AMERICAS NEW YORK NY 10019 990 2016-01-01 237216197 JAMAICA HOSPITAL NURSING HOME COMPANY INC JAMA 7182065101 89-40 135TH STREET JAMAICA NY 114182898 mounir f doss exec. vp & cfo 7182065101 2017-11-14 1 THOMAS LANNING P00851654 2122970400 2017-11-09 209.3.217.20 2017-11-14 13:16:42 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 60BF0225ED9631091DB686CFA622195BA7284DF5 2016 2017-02-10 21:41:12Z TRUMP PAVILION mounir f doss 89-40 135TH STREET JAMAICA NY 114182898 33108992 0 X WWW.TRUMPPAVILION.ORG X 1972 NY THE JAMAICA HOSPITAL NURSING HOME CO INC (THE NURSING HOME) IS A 228 BED, NOT FOR PROFIT INSTITUTION PROVIDING SKILLED NURSING CARE TO THE COMMUNITY. 6 5 312 27 0 0 670953 1447054 31527051 31578711 668 591 79808 82636 32278480 33108992 0 0 0 0 17616895 16262561 0 0 0 19622402 21134630 37239297 37397191 -4960817 -4288199 51100375 50041017 86106334 89335175 -35005959 -39294158 THE JAMAICA HOSPITAL NURSING HOME CO INC (THE NURSING HOME) IS A 228 BED, NOT FOR PROFIT INSTITUTION PROVIDING SKILLED NURSING CARE TO THE COMMUNITY. 0 0 31644257 31584324 THE NURSING HOME, WHICH HAS 228 BEDS, FOCUSES ON PROVIDING SKILLED NURSING CARE AND REHABILITATION TO THE COMMUNITY. 31644257 1 1 0 1 0 0 0 0 1 0 1 0 0 1 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 0 0 0 1 124 0 1 312 1 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X LISA GARCIA 7182066291 89-40 135TH STREET JAMAICA NY 11418 X Antoietta Morisco MD trustee 1.00 X 0 0 0 bruce flanz first VP & secretary 2.50 62.50 X X 0 1465557 28703 Hon Timothy J Dufficy trustee 1.00 X 0 0 0 Neil Foster Phillips President 1.00 2.00 X X 0 0 0 Robert W Koop Second Vp & Treasurer 1.00 2.00 X X 0 0 0 Walter J Cook trustee 1.00 X 0 0 0 mounir doss CFO 2.50 62.50 X 0 977979 28703 anthony diMaria vice President 40.00 3.00 X 239128 0 29864 Conception Munson Assistant Director of Nursing 40.00 X 127470 0 19184 lisa garcia controller 40.00 X 152373 0 28704 Modupe-Adedeji-Fajobi Director of Nursing 40.00 X 136729 0 20684 Thomas Younghans Vice President 40.00 X 246874 0 28704 902574 2443536 184546 5 0 1 0 Rehab Alternatives PLLC 125 JERICHO TURNPIKE suite 404 jericho NY 11753 Rehab Staffing Services 529155 ARAMARK MANAGEMENT SERVICES 2300 WARRENVILLE ROAD DOWNERS GROVE IL 60515 Housingkeeping Management Services and S 250158 metropolitan pt ot 263 7th Ave brooklyn NY 11215 Rehab Staffing Services 202241 Masville Chand 91-50 120th street Richmond Hill NY 11418 Painting Services 113500 4 1447054 1447054 SKILLED NURSING FACILity 623000 31578711 31578711 31578711 591 591 22000 0 22000 22000 22000 TELEPHONE INCOME 900099 25210 25210 PARKING FACILITIES REV. 900099 22338 22338 gift shop 900099 7475 7475 5613 5613 60636 33108992 31584324 0 77614 X 12792907 11513616 1279291 904037 813633 90404 1298560 1008593 289967 1267057 1140351 126706 25592 25592 67658 67658 10800844 7076615 3724229 274923 255993 18930 496745 496745 3345 3345 2098754 2098754 2753737 2753737 703467 703467 cash assessments 1533071 1533071 food services 927886 835097 92789 MEDICAL SUPPLIES 877663 874829 2834 Provision of bad debt 294868 294868 276077 241543 34534 37397191 31644257 5752934 0 1368220 1945048 7416848 8429743 5393686 5231501 797421 823779 49716238 19820417 32210244 29895821 450000 450000 3463956 3265125 51100375 50041017 3023531 2878530 130838 82006 38555236 37921918 44396729 48452721 86106334 89335175 X -35005959 -39294158 -35005959 -39294158 51100375 50041017 -4288199 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 0 0 1 3312 0 0 3312 0 Part II-B, Line 1: THE ORGANIZATION PAID MEMBERSHIP DUES TO CCLC. OF THE AMOUNT PAID $672 REPRESENTED LOBBYING COSTS. IN ADDITION THE ORGANIZATION PAID LEADING AGE NY $2,640 IN LOBBYING COSTS. 0 1 X 583417 583417 45536542 17479467 28057075 3596279 2340950 1255329 29895821 DEFERRED FINANCING COSTS 555928 FUNDS HELD IN TRUST BY RESIDENTS 101459 insruance receivable 2607738 3265125 DUE TO realted parties 44545103 estimated malpractice liability 1629738 estimated workers comp liability 978000 DUE to THIRD-PARTY payors 1299880 48452721 X 33108992 0 33108992 0 33108992 37397191 0 37397191 0 37397191 Part IV, Line 2b: The Nursing Home provides banking services for our residents and manage those accounts on their behalf. The liability connected with these balances are reported as Funds Held in Trust on the Financial Statements. Part X, Line 2: The Nursing Home qualifies as a tax-exempt, nonprofit organization under Section 501(c)(3) of the Internal Revenue Code and its income is generally not subject to federal, state, or local income taxes. 0 1 0 0 0 0 0 0 0 bruce flanz first VP & secretary 0 1364996 0 0 0 100561 0 0 0 28920 0 1494477 0 0 mounir doss CFO 0 945457 0 0 0 32522 0 0 0 28920 0 1006899 0 0 anthony diMaria vice President 229528 0 0 0 9600 0 0 0 30081 0 269209 0 0 0 lisa garcia controller 152075 0 0 0 298 0 0 0 28921 0 181294 0 0 0 Modupe-Adedeji-Fajobi Director of Nursing 136686 0 0 0 43 0 0 0 20901 0 157630 0 0 0 Thomas Younghans Vice President 246350 0 0 0 524 0 0 0 28921 0 275795 0 0 0 Part I, Line 4b CERTAIN SENIOR MANAGEMENT OFFICIALS PARTICIPATE IN A SUPPLEMENTAL EXECUTIVERETIREMENT PLAN. DURING 2016 THERE WERE NO CONTRIBUTIONS TO THE PLAN. Form 990, Part VI, Section A, line 6 MEDISYS HEALTH NETWORK IS THE SOLE MEMBER in the organization. Form 990, Part VI, Section A, line 7a MEDISYS HEALTH NETWORK, AS the SOLE MEMBER CAN APPOINT THE BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 11b THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), IS PREPARED BY OUTSIDE ACCOUNTANT AND REVIEWED INTERNALLY BY MANAGEMENT, AT WHICH TIME IT IS CONSIDERED THE FINAL DRAFT. THE FINAL DRAFT OF THE FORM 990 IS PRESENTED TO THE TRUSTEES VIA EMAIL AND OR A BOARD MEETING. ONCE THE REVIEW OF THE FORM 990 HAS BEEN COMPLETED TO THE BOARD'S SATISFACTION, IT IS FINALIZED AND SUBSEQUENTLY FILED WITH THE IRS. Form 990, Part VI, Section B, line 12c DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY BY EMPLOYEES THAT SATISFY THE CRITERIA TO BE CONSIDERED AN "INTERESTED PERSON" IS SUBMITTED UPON HIRING AND ANNUALLY THEREAFTER. The compliance officers review the submissions for conflicts and reports them to the board. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1B: FOR BRUCE FLANZ, PRESIDENT & CEO, MOUNIR DOSS, EXECUTIVE VICE PRESIDENT & CFO, THE HOURS REPORTED BELOW REFLECT THE TOTAL TIME WORKED AS OFFICERS FOR ALL OF THE RELATED ORGANIZATIONS SHOWN ON SCHEDULE R. TOTAL COMPENSATION IS REPORTED ON EACH ENTITY'S FORM 990. COST ALLOCATION AMONG THE ENTITIES IS PERFORMED CONSISTENTLY WITH ACCOUNTING RULES AND APPLICABLE COST ALLOCATION METHODOLOGIES. ESTIMATED NUMBER OF HOURS WORKED PER WEEK FOR RELATED ORGANIZATIONS IS AS FOLLOWS: MEDISYS HEALTH NETWORK - 10 HOURS PER WEEK FLUSHING HOSPITAL MEDICAL CENTER - 15 HOURS PER WEEK JAMAICA HOSPITAL MEDICAL CENTER - 30 HOURS PER WEEK OTHER RELATED ENTITIES LISTED ON SCHEDULE R - 10.0 HOURS PER WEEK Form 990, Part IX, line 11g consulting: Program service expenses 0. Management and general expenses 152,076. Fundraising expenses 0. Total expenses 152,076. Hospital Support: Program service expenses 5,749,119. Management and general expenses 3,515,879. Fundraising expenses 0. Total expenses 9,264,998. houskeeping: Program service expenses 225,732. Management and general expenses 25,081. Fundraising expenses 0. Total expenses 250,813. other: Program service expenses 44,748. Management and general expenses 4,972. Fundraising expenses 0. Total expenses 49,720. physicians & therapists: Program service expenses 786,612. Management and general expenses 0. Fundraising expenses 0. Total expenses 786,612. waste remoival: Program service expenses 34,413. Management and general expenses 0. Fundraising expenses 0. Total expenses 34,413. linen services: Program service expenses 235,991. Management and general expenses 26,221. Fundraising expenses 0. Total expenses 262,212. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESSES DID NOT CHANGE FROM THE PRIOR YEAR. FORM 990, PART IV, LINE 20: The organization is licensed under article 28 of New York State Public Health Law. However, subsection 10 of article 28 excludes certain healthcare facilities from the definition of general hospital. Therefore, the organization is not including schedule H in the current year form 990 as they do not meet this definition. ADVANCED CENTER FOR PSYCHOTHERAPY 89-06 135TH STREET JAMAICA NY 11418 111864871 HEALTHCARE NY 501(c)(3) 9 MEDISYS HEALTH NETWORK 0 ALLIED HEALTH foundation of queens inc 4500 PARSONS BLVD FLUSHING NY 11355 112813535 INACTIVE NY 501(c)(3) 9 MEDISYS HEALTH NETWORK 0 FLUSHING HOSPITAL MEDICAL CENTER 4500 PARSONS BLVD FLUSHING NY 11355 111631781 HOSPITAL NY 501(c)(3) 3 MEDISYS HEALTH NETWORK 0 INTERNATIONAL ASSOCIATION OF MEDICAL BIKE UNITS INC 8900 VAN WYCK EXPY JAMAICA NY 11418 113483140 INACTIVE NY 501(c)(3) 9 MEDISYS HEALTH NETWORK 0 JAMAICA HOSPITAL MEDICAL CENTER 8900 VAN WYCK EXPY JAMAICA NY 11418 111631788 HEALTHCARE NY 501(c)(3) 3 MEDISYS HEALTH NETWORK 0 MEDISYS AMBULANCE SERVICE 8900 VAN WYCK EXPY JAMAICA NY 11418 542124788 HEALTHCARE NY 501(c)(3) 9 MEDISYS HEALTH NETWORK 0 MEDISYS HEALTH NETWORK 8900 VAN WYCK EXPY JAMAICA NY 11418 113316802 ADMIN NY 501(c)(3) 11A N/A 0 THE JAMAICA HOSPITAL DIAG AND TREAT CTR 8900 VAN WYCK EXPY JAMAICA NY 11418 113340969 HEALTHCARE NY 501(c)(3) 3 MEDISYS HEALTH NETWORK 0 VWE PROPERTIES CORPORATION 8900 VAN WYCK EXPY JAMAICA NY 11418 113485165 PARKING garage NY 501(c)(3) 11A MEDISYS HEALTH NETWORK 0 NHP HOLDINGS LLC 521 FIFTH AVE 3RD FLOOR NEW YORK NY 10175 203418837 HOLDING COMPANY NY N/A FRR RECOVERY services 80 MARCUS DRIVE MELVILLE NY 11747 113454555 COLLECTION AGENCY NY N/A C 0 HI TECH MEDICAL EQUIPMENT 103-51 101 ST OZONE PARK NY 11416 113313334 Durable Medical Equipment Company NY N/A C 0 JAMAICA RX 8900 VAN WYCK EXPRESSWAY JAMAICA NY 11418 205292781 RETAIL PHARMACY NY N/A C 0 MEDISYS Home CARE SERVICE inc 8900 VAN WYCK EXPRESSWAY jAMAICA NY 11418 030474027 home care staffing/inactive NY N/A C 0 MEDISYS IPA 8900 VAN WYCK EXPRESSWAY jaMAICA NY 11418 113452476 PHYSICIAN CONTRACTING/INACTIVE NY N/A C 0 MEDISYS SERVICE CORPORATION 8900 VAN WYCK EXPRESSWAY jaMAICA NY 11418 113479920 HOLDING COMPANY NY N/A C 0 MEDISYS VENTURES 111 STEWART AVE HICKSVILLE NY 11801 113431792 HOLDING COMPANY NY N/A C 0 MHN REALTY 8900 VAN WYCK EXPRESSWAY jaMAICA NY 11418 113458286 real estate/inactive NY N/A C 0 second century service corporation 4500 PARSONS BLVD FLUSHING NY 11355 112843101 RETAIL PHARMACY NY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0