2016-11-15T15:28:44-06:00 2015-12-31 221478099 COHNREZNICK LLP 1301 Avenue of the Americas New York NY 10019 990 2015-01-01 237085986 SAMUEL SCHULMAN INSTITUTE FOR nursing and rehabilitation SAMU 7182405200 101-01 AVENUE D BROOKLYN NY 11236 james porter chief financial officer 7182405200 2016-11-15 1 THOMAS LANNING P00851654 2122970400 2015 2017-02-10 21:41:12Z james porter 101-01 AVENUE D BROOKLYN NY 11236 68935644 0 X WWW.BROOKDALEHOSPITAL.ORG X 1970 NY THE ORGANIZATION IS A VOLUNTARY, NON-PROFIT, RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO PROVIDING THE HIGHEST QUALITY OF MEDICAL CARE IN HOMELIKE ENVIRONMENT 10 10 589 67 0 0 0 3254264 64122956 65279471 84 469 553107 401440 64676147 68935644 0 0 0 0 43416362 42819049 0 0 0 42691308 40464894 86107670 83283943 -21431523 -14348299 19124508 20559725 182762502 198850566 -163637994 -178290841 THE ORGANIZATION IS A VOLUNTARY, NON-PROFIT, RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO PROVIDING THE HIGHEST QUALITY OF MEDICAL CARE IN HOMELIKE ENVIRONMENT 0 0 74549518 65283908 THE SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHABILITATION IS A VOLUNTARY, NOT FOR PROFIT, RESIDENTIAL HEALTHCARE FACILITY CREATED TO PROVIDING PATIENT HEALTH CARE SERVICES INCLUDING MEDICAL, NURSING REHABILITATIVE, AND THERAPEUTIC SERVICES. 74549518 1 1 0 0 0 0 0 0 1 0 1 0 0 0 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 0 0 0 1 46 0 1 589 1 0 0 0 0 0 0 0 0 0 0 X 10 10 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X james porter CFO 7182405186 101-01 AVENUE D BROOKLYN NY 11236 ALEX ROVT TRUSTEE/CHAIRMAN 1.00 5.40 X 0 0 0 ANTHONY CLEMENZA TRUSTEE 1.00 5.40 X 0 0 0 ASCHER MESTEL MD TRUSTEE 1.00 5.40 X 0 0 0 BISHOP HUGH NELSON TRUSTEE 1.00 5.40 X 0 0 0 IRINA BENFIELD SECRETARY 1.00 5.40 X 0 0 0 ISSAC KREIZMAN MD TRUSTEE 1.00 5.40 X 0 0 0 LOWELL M RUBIN TRUSTEE/VICE CHAIRMAN 1.00 5.40 X 0 0 0 miCHAEL Scagnelli trustee 1.00 5.40 X 0 0 0 MICHAEL SPIEGEL TRUSTEE 1.00 5.40 X 0 0 0 STEPHEN PLOTNICK TRUSTEE 1.00 5.40 X 0 0 0 MARK E TONEY PRESIDENT/CEO 1.00 44.40 X 0 0 0 paul goldberg CFO 1.00 44.40 X 0 419022 5660 REGINALD BULLOCK ASSISTANT SECRETARY 1.00 44.40 X 0 340587 30641 Genevieve Sorenson Vice President 40.00 X 314244 0 14624 Louis Belzie Physician 40.00 X 144004 0 37442 Lucia Nixon Medical Director 40.00 X 211937 0 13618 Mostaque Ahmed Physician 40.00 X 150024 0 36879 Mridula Saxena Physician 40.00 X 219773 0 16462 1039982 759609 155326 51 0 1 0 AFFINITY REHABILITION LLP 10600 YORK ROAD SUITE 105 COCKYESVILLE MD 21030 THERAPY STAFFING 409927 HEALTHPRO MANAGEMENT LLP 10600 YORK ROAD SUITE 105 COCKYESVILLE MD 21030 THERAPY MANAGEMENT 140000 2 3254264 3254264 NET PATIENT REVENUE AFTER BAD DEB 623000 65279471 65279471 65279471 469 469 397003 0 397003 397003 397003 Miscellaneous 900099 4437 4437 4437 68935644 65283908 0 397472 31924557 27636084 4288473 2627001 2364301 262700 5644209 5086195 558014 2623282 2360954 262328 131019 117917 13102 6507 6507 2047514 1824331 223183 788987 729400 59587 895218 805696 89522 13004 6878 6126 11541 7210 4331 82 74 8 799697 719727 79970 155532 139979 15553 chargebacks 27780041 24999111 2780930 Cash Receipts Assesment 3854705 3854705 Medical and Pharmaceuti 1895601 1861569 34032 provision for bad debts 1265681 1265681 819765 769706 50059 83283943 74549518 8734425 0 821113 2602113 2100200 10522679 8978645 399964 330053 4500 51852240 45503521 7195245 6348719 185507 195495 19124508 20559725 4374499 4775748 189244 195495 178198759 193879323 182762502 198850566 X -163637994 -178290841 -163637994 -178290841 19124508 20559725 X -14348299 -304548 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 X 623716 623716 34754757 31116553 3638204 6967051 5793054 1173997 9506716 8593914 912802 6348719 DUE TO THIRD-PARTY PAYORS 51983481 DUE TO AFFILIATES 141895842 193879323 X 67669998 -1265646 -1265646 68935644 0 68935644 82018262 0 82018262 1265681 1265681 83283943 Part IV, Line 2b: THE ORGANIZATION HOLDS RESIDENTS' FUNDS IN A TRUST. Part X, Line 2: THE INSTITUTE AND THE FUND QUALIFY AS TAX - EXEMPT, NON- PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND THEIR INCOME IS GENERALLY NOT SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAXES. Part XI, Line 2d - Other Adjustments: Provision for bad debts -1,265,681. related party revenue 35. Part XII, Line 4b - Other Adjustments: Provision for bad debts 1,265,681. 0 0 0 0 0 0 0 0 0 paul goldberg CFO 0 419022 0 0 0 0 0 0 0 5660 0 424682 0 0 REGINALD BULLOCK ASSISTANT SECRETARY 0 339759 0 0 0 828 0 0 0 30641 0 371228 0 0 Genevieve Sorenson Vice President 297831 0 0 0 16413 0 0 0 14624 0 328868 0 0 0 Louis Belzie Physician 144004 0 0 0 0 0 0 0 37442 0 181446 0 0 0 Lucia Nixon Medical Director 211086 0 0 0 851 0 0 0 13618 0 225555 0 0 0 Mostaque Ahmed Physician 150024 0 0 0 0 0 0 0 36879 0 186903 0 0 0 Mridula Saxena Physician 219773 0 0 0 0 0 0 0 16462 0 236235 0 0 0 Form 990, Part VI, Section A, line 2 ALEX ROVT, CHAIRMAN AND TRUSTeE, IRINA BENFIELD, SECRETARY, AND STEPHEN PLOTNICK, TRUSTEE, ALL HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. Form 990, Part VI, Section A, line 3 IN MARCH 2012, GRANT THORNTON WAS ENGAGED BY THE BROOKDALE HOSPITAL MEDICAL CENTER (THE "HOSPITAL") TO PROVIDE RESTRUCTURING SERVICES TO THE HOSPITAL AND ALL OF THE ENTITIES CONTROLLED BY BROOKDALE HEALTH SYSTEM, INC. IN 2015, GRANT THORNTON'S RESTRUCTURING SERVICES INCLUDED PROVIDING A CHIEF FINANCIAL OFFICER FOR THE ORGANIZATION UNTIL MARCH 2015. STARTING IN DECEMBER 2012, THE HOSPITAL RETAINED TONEYKORF PARTNERS, LLC. TO PROVIDE INDIVIDUALS WHO WOULD SERVE AS THE CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER OF THE ORGANIZATION, IN THE PERSON OF MARK TONEY AND STEVEN KORF, RESPECTIVELY. IN 2015, TONEYKORF PARTNERS' SERVICES INCLUDED PROVIDING INDIVIDUALS WHO WOULD SERVE AS THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, AND SVP OF RESTRUCTURING FOR THE ORGANIZATION. ALL COMPENSATION PAID IN CONNECTION WITH THE ABOVE SERVICES WERE PAID DIRECTLY TO GRANT THORNTON OR TONEYKORF PARTNERS, LLC, RESPECTIVELY, BY THE HOSPITAL, A RELATED ENTITY OF THE ORGANIZATION. Form 990, Part VI, Section A, line 6 BROOKDALE HEALTH SYSTEM, INC., A NEW YORK NOT-FOR-PROFIT ORGANIZATION, IS THE SOLE MEMBER OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7a BROOKDALE HEALTH SYSTEM, INC., AS SOLE MEMBER OF THE ORGANIZATION, HAS THE AUTHORITY TO APPOINT AND REMOVE THE TRUSTEES OF THE ORGANIZATION, AND OTHER AUTHORITIES AS DELINEATED IN THE BYLAWS OF THE ORGANIZATION. Form 990, Part VI, Section B, line 11 THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED, IS PREPARED BY OUTSIDE ACCOUNTANTS AND REVIEWED INTERNALLY BY MANAGEMENT AND COUNSEL, AT WHICH TIME IT IS CONSIDERED THE FINAL DRAFT. THE FINAL DRAFT OF THE FORM 990 IS THEN FILED WITH THE IRS. Form 990, Part VI, Section B, line 12c DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY BY EMPLOYEES THAT SATISIFY THE CRITERIA TO BE CONSIDERED "INTERESTED PERSONS" IS SUBMITTED UPON HIRING AND ANNUALLY THEREAFTER. THE AUDIT AND COMPLIANCE COMITTEE REVIEWS THE SUBMISSIONS FOR CONFLICTS AND THE DEPARTMENT OF INTERNAL AUDIT MANAGES COMPLIANCE. Form 990, Part VI, Section C, line 19 THE DOCUMENTS ARE AVAILABLE UPON REQUEST. Form 990, Part XI, line 9: SBSI FUND BALANCE NOT removed in PY -304,548. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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