2016-11-15T15:38:51-06:00 2015-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2015-01-01 112388200 COBBLE HILL HEALTH CENTER INC COBB 7188556789 380 HENRY STREET BROOKLYN NY 11201 ANTHONY LEWIS PRESIDENT/CEO 7188556789 2016-11-15 1 ERIC GOLDFARB P01277125 2128674000 2015 2017-02-10 21:41:12Z ANTHONY LEWIS 380 HENRY STREET BROOKLYN NY 11201 60241912 0 X WWW.COBBLEHILL.ORG X 1977 NY TO MAINTAIN A NURSING FACILITY AND PROVIDE ADULT DAY CARE AND LONG TERM HOME HEALTH SERVICES ON AN OUTPATIENT BASIS. 9 9 544 198 0 0 235317 231090 48025998 52093771 637664 660425 -134929 56556 48764050 53041842 0 0 0 0 29490947 28969952 0 0 0 18950213 18862673 48441160 47832625 322890 5209217 99429107 95320512 60247566 52701372 39181541 42619140 X COBBLE HILL HEALTH CENTER, INC. (CENTER)OPERATES A 364 BED NURSING FACILITY. THE CENTER PROVIDES NURSING CARE TO PATIENTS AND IS LICENSED TO PROVIDE ADULT DAY CARE SERVICES. IN ADDITION, THE CENTER PROVIDES A LONG-TERM HOME HEALTH CARE PROGRAM. 0 0 40567197 49130291 SEE SCHEDULE O.THE CENTER HAS BEEN PROVIDING RESIDENTIAL AND COMMUNITY BASED SERVICES TO THE DISABLED AND ELDERLY FOR OVER 30 YEARS. THE CENTER OFFERS A COMPLETE RANGE OF MEDICAL, NURSING AND REHABILITATION SERVICES. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:>SUBACUTE CARE MEDICAL CARE, THE GOAL OF WHICH IS TO ENSURE A QUICK AND COMPLETE RECOVERY THEREBY RESTORING OUR RESIDENTS INDEPENDENCE AND HELP THEM RETURN TO COMMUNITY LIVING; >LONG TERM CARE, WHICH OFFERS A HOME-LIKE ALTERNATIVE THAT PROVIDES EACH INDIVIDUAL WITH HIS OR HER SPECIFIC NEEDS, BE IT PHYSICAL, PSYCHOLOGICAL OR EMOTIONAL, IN AN OPTIMUM ENVIRONMENT ENSURING THAT QUALITY OF LIFE IS MAINTAINED;>REHABILITATION, WHOSE GOAL IS TO RESTORE RESIDENTS FUNCTION AND THE ABILITIES THEY HAD PRIOR TO THE ONSET OF ILLNESS, INJURY OR TRAUMA; >A DIALYSIS CENTER, WHERE TREATMENT IS CONVENIENT BECAUSE IT IS ADMINISTERED ON-SITE AND PROVIDES MINIMAL DISRUPTION OF THEIR REGULAR SCHEDULES AND LIVES; >ALZHEIMERS SPECIAL CARE, WHICH, FOR OVER A DECADE, HAS LED THE WAY IN CARING FOR INDIVIDUALS WITH ALZHEIMERS DISEASE. THROUGH PROGRAM DEVELOPMENT, RESEARCH AND TRAINING,OUR ALZHEIMERS UNIT HAS RECEIVED THE BEST PRACTICES AWARD.THE CENTER PROVIDED 129,964,DAYS OF SKILLED NURSING CARE IN 2015. 2254580 2963480 THE CENTER, THOUGH ITS WHOLLY OWNED SUBSIDIARY COBBLE HILL LIFECARE PLUS, LLC, PROVIDES CARE MANAGEMENT SERVICES. A STAFF OF APPROXIMATELY THIRTY MULTILINGUAL NURSES, SOCIAL WORKERS AND CLERICAL SUPPORT STAFF PROVIDE TELEPHONIC CARE MANAGEMENT TO 1,200 MEMBERS IN BROOKLYN, MANHATTAN AND QUEENS. 42821777 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 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 51 0 544 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NY X ALAN GROSS 7188556789 380 HENRY STREET BROOKLYN NY 11201 DEMETRA POLIMEROS CHAIR (UNTIL NOV. 2015) 1.00 1.25 X X 0 0 0 THOMAS SPATH SECRETARY (CHAIR SINCE NOVEMBER 2015) 1.00 1.75 X X 0 0 0 PAUL SAYEGH BOARD MEMBER 1.00 1.25 X 0 0 0 MARK DONOVAN BOARD MEMBER (UNTIL MAY 2015) 1.00 0.25 X 0 0 0 JOSEPH BROADWIN BOARD MEMBER 1.00 1.25 X 0 0 0 PATRICK OWEN BURNS BOARD MEMBER 1.00 0.25 X 0 0 0 DR CIRIL GODEC BOARD MEMBER (UNTIL JULY 2015) 1.00 0.25 X 0 0 0 CHARLES CARAMES BOARD MEMBER 1.00 0.25 X 0 0 0 GREG O'CONNELL BOARD MEMBER 1.00 0.25 X 0 0 0 JOAN MILLMAN BOARD MEMBER 1.00 X 0 0 0 PETER D YATRAKIS BOARD MEMBER 1.00 0.25 X 0 0 0 W RUDY KAMUF BOARD MEMBER 1.00 0.25 X 0 0 0 OLGA LIPSCHITZ BOARD MEMBER (NON VOTING) 1.00 0.25 X 125000 0 0 JUDI FRANCES BOARD MEMBER (UNTIL SEP. 2015) 1.00 0.75 X 0 0 0 ANTHONY LEWIS PRESIDENT / CEO 30.00 8.00 X 342223 0 40946 DANIEL TUCHMAN ADMINISTRATOR / COO 30.00 8.00 X 295668 50000 60026 ALAN GROSS CFO 30.00 6.00 X 330243 61820 51789 SOMMER ESPINO MDS DIRECTOR 35.00 X 231710 0 56178 RAISA FORKOSH ADMISSIONS DIRECTOR 35.00 X 150263 0 38203 MEVE SHAKESPEARE DIRECTOR OF NURSING 35.00 X 150847 0 32043 MAMERTO ALVAREZ FOOD & NUTRITION DIRECTOR 35.00 X 142019 0 37319 VIRGINIA COHEN CHLCP DIRECTOR 35.00 X 128046 0 7332 1896019 111820 323836 21 0 1 0 THERADYNAMICS REHAB 225 CROSSWAYS PARK DRIVE WOODBURY NY 11797 REHAB/THERAPY SERVICES 1739095 WHITE GLOVE PLACEMENT 85 BARTLETT STREET BROOKLYN NY 11206 NURSING AGENCY 538235 FHS CONSULTANTS 2636 NOSTRAND AVENUE BROOKLYN NY 11210 HEALTHCARE CONSULTING AGENCY 152385 TOWNE NURSING STAFF 1413 38TH STREET BROOKLYN NY 11218 NURSING AGENCY 117343 QUALITY HEALTHCARE 3512 QUENTIN ROAD BROOKLYN NY 11234 NURSING AGENCY 109240 11 150000 81090 231090 SKILLED NURS. FACILITY 623000 49130291 49130291 CASE MANAGEMENT 624100 2963480 2963480 52093771 256074 256074 40000 183704 -143704 -143704 -143704 7420717 7016366 404351 404351 404351 MEDICAL RECORDS INCOME 900099 23101 23101 REBATES WEBSITE DONATIONS 900099 3992 3992 VENDING MACHINE INCOME 900099 3087 3087 170080 170080 200260 53041842 52093771 0 716981 1214487 1214487 19842885 18763276 1079609 1659693 1564301 95392 4607883 4195799 412084 1645004 1483317 161687 282358 282358 249208 249208 2941 2941 64461 64461 3871241 3605675 265566 8422 7593 829 3724228 3357775 366453 267361 241052 26309 3490373 3128855 361518 14542 13111 1431 2590670 2335756 254914 748512 674861 73651 CASH RECEIPTS ASSESSMEN 2552893 2552893 LAUNDRY AND LINEN 793392 715325 78067 202071 182188 19883 47832625 42821777 5010848 0 1972532 4753129 2832760 2501267 17804454 17211555 57937 58860 296214 211956 79636483 26543615 55136118 53092868 11949362 11783274 9379730 5707603 99429107 95320512 3867834 4678314 43470000 35450000 324402 316643 12585330 12256415 60247566 52701372 X 39087422 42525021 94119 94119 39181541 42619140 99429107 95320512 X 5209217 -768175 -1003443 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2941 2941 0 PART II-B, LINE 1: THE $2,941 IS AN ALLOCATION OF TRADE ASSOCIATION DUES FOR LOBBYING EXPENSES. 0 1 X 237000 237000 72805278 21581277 51224001 4264443 2901546 1362897 2329762 2060792 268970 53092868 MORTGAGE COSTS 1260158 DUE FROM COBBLE HILL FOUNDATION, INC. 106338 DUE FROM YOUR CHOICE AT HOME, INC. 808937 DEPOSITS AND OTHER RECEIVABLES 76006 DUE FROM THIRD PARTIES 3456164 5707603 DUE TO THIRD PARTIES 33069 SWAP AGREEMENTS 12223346 12256415 X 52392910 -768175 183704 -584471 52977381 64461 64461 53041842 47951868 183704 183704 47768164 64461 64461 47832625 PART IV, LINE 2B: RESIDENT PERSONAL FUNDS ARE MAINTAINED IN BANK ACCOUNTS SEPARATE FROM THE CENTER'S ACCOUNTS. INTEREST EARNED ON RESIDENT FUNDS IS CREDITED TO THE RESIDENTS' ACCOUNTS. PART X, LINE 2: THE CENTER HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2012 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 183,704. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 183,704. X X X 0 0 0 0 0 0 0 1 0 ANTHONY LEWIS PRESIDENT / CEO 319030 0 22000 0 1193 0 30895 0 10051 0 383169 0 0 0 DANIEL TUCHMAN ADMINISTRATOR / COO 210000 50000 22000 0 63668 0 22217 8678 20948 8183 338833 66861 0 0 ALAN GROSS CFO 246436 61820 22000 0 61807 0 22217 8678 15025 5869 367485 76367 0 0 SOMMER ESPINO MDS DIRECTOR 155923 0 10000 0 65787 0 27243 0 28935 0 287888 0 0 0 RAISA FORKOSH ADMISSIONS DIRECTOR 127617 0 10000 0 12646 0 16406 0 21797 0 188466 0 0 0 MEVE SHAKESPEARE DIRECTOR OF NURSING 133900 0 5000 0 11947 0 16326 0 15717 0 182890 0 0 0 MAMERTO ALVAREZ FOOD & NUTRITION DIRECTOR 124337 0 5000 0 12682 0 15528 0 21791 0 179338 0 0 0 PART I, LINE 7 THE BOARD APPROVES MERIT BASED BONUSES FOR ITS OFFICERS AND TOP EMPLOYEES FOR THEIR DEDICATION TO THE CENTER DURING THE YEAR. THESE BONUSES ARE APPROVED TOWARDS THE END OF THE YEAR. A NYC CAPITAL RESOURCE CORP 204099098 649437AEO 2008-01-30 35920000 RENOVATION 0 0 0 B NYC CAPITAL RESOURCE CORP 204099098 649437AF7 2008-01-30 4420000 REFINANCING 1 0 0 C NYC CAPITAL RESOURCE CORP 204099098 649437AG5 2008-01-30 7850000 CONSTRUCTION 0 0 0 A 35920000 12137676 1331784 22448875 2011 1 0 0 1 B 4420000 4261307 158691 2008 1 0 0 1 C 7850000 286416 7438143 2009 1 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 C 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE CFO AND PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. ANY QUESTIONS THAT ARISE ARE DISCUSSED AND RESOLVED PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CENTER REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICT. THIS INFORMATION IS REVIEWED BY THE AUDIT AND CORPORATE COMPLIANCE COMMITTEES. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING ANY CONFLICTS OF INTEREST WHICH OCCUR, AND WILL ENSURE SUCH INDIVIDUALS DO NOT PARTICIPATE IN DISCUSSIONS OR DECISIONS INVOLVING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED BY A RECOMMENDATION BY THE PRESIDENT/CEO AND APPROVAL OF THE BOARD. THE PRESIDENT/CEO'S COMPENSATION IS DETERMINED BY THE GOVERNING BOARD. THIS PROCESS WAS LAST DONE IN 2015. THE PROCESS INCLUDES A BOARD REVIEW OF COMPENSATION OF SIMILAR POSITIONS AT OTHER HEALTH CARE FACILITIES OBTAINED FROM IRS FORM 990S FILED ON GUIDESTAR OR CANVASSING OF THOSE FACILITES. FORM 990, PART VI, SECTION C, LINE 19 THE CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SWAP AGREEMENT -733,967. WRITE OFF OF MORTGAGE COSTS -269,476. FORM 990 PART XII QUESTION 12C THE PROCESS DID NOT CHANGE FROM PRIOR YEAR. COBBLE HILL LIFECARE PLUS LLC 380 HENRY STREET BROOKLYN NY 11201 461226428 PROVIDES CARE MANAGEMENT SERVICES FOR THE ELDERLY LIVING AT HOME NY 2963480 1435 N/A COBBLE HILL FOUNDATION INC 380 HENRY STREET BROOKLYN NY 11201 113122301 FUNDRAISING NY 501(C)(3) PF N/A 0 YOUR CHOICE AT HOME INC 380 HENRY STREET BROOKLYN NY 11201 461256502 HOME HEALTH CARE NY 501(C)(3) LINE 9 N/A 0 COBBLE HILL LIFECARE INC 380 HENRY STREET BROOKLYN NY 11201 461388106 SUPPORTING ORGANIZATION NY 501(C)(3) LINE 11B, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0