2015-08-11T09:23:19-07:00 2014-12-31 990 2014-01-01 111633518 NORWEGIAN CHRISTIAN HOME AND HEALTH CENTER NORW 7182322322 1250 67th Street Brooklyn NY 11219 William Van Lew CFO 7183065621 2015-08-12 2014 2016-02-25 16:41:14Z George A Jensen 1250 67th Street Brooklyn NY 11219 21309533 0 X www.nchhc.org X 1903 NY Motivated by Faith in God, the Belief that Redemption can only be found in Jesus Christ, and his Love extends to all Mankind, the Norwegian Christian Home and Health Center exists to provide exceptional physical, social, and spiritual care services to its residents in a pleasant environment where human dignity is preserved. 17 17 314 52 0 0 14544 386919 20575393 20638971 74332 56214 132664 227429 20796933 21309533 0 0 0 0 13396597 13347473 0 0 0 7996478 8347839 21393075 21695312 -596142 -385779 32720756 32348269 26120134 27177259 6600622 5171010 Motivated by faith in God, the Belief that Redemption can only be found in Jesus Christ, and His Love extends to all mankind, the Norwegian Christian Home and Health Center exists to provide exceptional physical, social, and spiritual care services to its residents in a pleasant environment where human dignity is preserved. 0 0 14822097 15406751 Skilled Nursing and Respite Care provided in a full service, state of the art 135 bed facility with 2 respite beds and 24/7 medical care to attend to the complete needs of every resident. Sub-acute care provides intensive restorative rehabilitation designed to improve the physical state of the resident. An interdisciplinary team is comprised of physicians, nurses, therapists, social workers and more. The goal is to attain measurable progress with every resident, as well as to be able to affect a safe discharge. All rooms are equipped with satellite television, telephones, security, and safety devices. Services include housekeeping, laundry service, 3 nutritional meals daily (tailored to individual dietary needs), pastoral care and elective group activities. In 2014, the Home provided 45,959 days of skilled nursing care and 28 days of respite care. There were a total of 448 admissions and 389 discharges during 2014. 3990565 5072386 Assisted Living for when a helping hand is needed. Program services include 88 beds in semi-private accomodations providing residents with uncompromised and accurate attention. Residents enjoy delicious meals, and social programs that keep their minds and bodies active. Independent Living studio and suites provide 28 residents a secure environment while maintaining their independence. Luxury apartments include full functioning kitchens, walk in closets, cable and internet access. Public areas include a bright atrium with a fireplace, outdoor garden with pond and gazebo, as well as a comfortable environment to relax. In 2014, the Home provided 38,940 days of assisted living and independent living care. 190027 159834 Outpatient Therapy program provides physical, occupational, and speech therapy. Our goal with our outpatient therapy program is to restore mobility, endurance, strength, and functional abilities to individuals with orthopedic, neurological, and other conditions. A coordinated and comprehensive treatment plan is individually designed for each patient. Flexible hours and parking are available. In 2014, the Home provided 4,325 billable treatments. 0 0 0 19002689 1 1 0 0 0 0 0 0 1 1 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 1 1 0 0 1 13 0 1 314 1 0 0 0 0 0 0 X 17 17 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X William Van Lew 7183065621 1250 67th Street Brooklyn NY 11219 George A Jensen Chairman 2.0 1.0 X X 0 0 0 Stanley Ramsdal Member 2 0 X 0 0 0 Ralph Aavik Treasurer 2 0 X X 0 0 0 Arthur J Goyena Asst Treasurer 2 0 X X 0 0 0 Arlene Rutuelo Vice Chairman 2 1 X X 0 0 0 Lori Aavik Secretary 2 0 X X 0 0 0 Torry Berntsen Member 2 1 X 0 0 0 Eleanor Bensen Member 2 0 X 0 0 0 Rebecca E Daniel Assistant Secretary 2 0 X X 0 0 0 Richard C Thompson Jr Member 2 0 X 0 0 0 Dan Reeve Member 2 1 X 0 0 0 Eleanor Sollie Member 2 0 X 0 0 0 Roy Swensen Member 2 0 X 0 0 0 Anstein Tjornhom Member 2 0 X 0 0 0 Edward Johannesen Member 2 0 X 0 0 0 Bill Dietrich Member 2 0 X 0 0 0 Arnold Oftedal Member 2.0 0 X 0 0 0 Earnest K Ragin Executive Director 37.5 1 X 217877 0 67041 William Van Lew CFO 35.00 2.50 X 163865 0 50421 Lisa Collie Assistant Administrator 37.50 0 X 101166 0 31128 Elizabeth Walsh Director of Nursing 37.50 0 X 139383 0 42888 Cristine Mello Director of Rehab 37.50 0 X 130846 0 40261 Angela Pezza Asst. Director of Nursing 37.5 0 X 103007 0 31695 856144 0 263434 6 0 1 0 Therapeutic Resources 36-36 33rd Street Long Island City NY 11106 Therapist Agency 297957 FJC Security Services 275 Jericho Turnpike Floral Park NY 11001 Security 261629 NPort PLLC PO Box 504884 St Louis MO 63150 Therapist Agency 297149 Total Healthcare Staffing PO Box 823461 Philadelphia PA 19182 Nursing Staffing Agency 326877 O'Connor Davies LLP 500 Mamaroneck Avenue Suite 301 Harrison NY 10528 Auditing and Consulting 124888 7 0 0 0 0 0 386919 0 386919 Medicaid Revenue 623000 11399164 11399164 0 0 Medicare Revenue 623000 6493459 6493459 0 0 Other Patient Service Revenue 623000 2746348 2746348 0 0 0 0 0 0 20638971 56214 56214 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria Income 900099 100979 100979 0 0 EQUAL Funds 921190 28502 28502 0 0 Clinical Admn PMPM 900099 9940 9940 0 0 88008 88008 0 0 227429 21309533 20922614 0 0 0 0 0 0 0 0 0 0 631498 0 631498 0 0 0 0 0 9387615 8819773 567842 0 580394 518609 61785 0 2045757 1827989 217768 0 702209 627457 74752 0 0 0 0 0 31721 0 31721 0 72705 0 72705 0 0 0 0 0 0 0 0 0 0 0 1333354 1280536 52818 0 3535 0 3535 0 38038 22632 15406 0 132863 0 132863 0 0 0 0 0 1704981 1517433 187548 0 0 0 0 0 0 0 0 0 20934 4590 16344 0 20630 0 20630 0 0 0 0 0 1334428 1187641 146787 0 414694 0 414694 0 NYS Assessment 651006 651006 0 0 Food and Supplements 715474 679878 35596 0 Medical Supplies & Prescription Drugs 689783 689783 0 0 Bad Debt 232516 232516 0 0 951177 942846 8331 0 21695312 19002689 2692623 0 1879405 1452153 36003 37766 0 0 1978006 1943277 0 0 0 0 0 0 0 0 92228 147983 36807095 20336138 17075267 16470957 11659847 12296133 32720756 32348269 2468341 3110782 0 0 0 0 20708898 19711630 804696 698039 0 0 0 0 0 0 2138199 3656808 26120134 27177259 X 4674990 3265562 1279242 1272591 646390 632857 6600622 5171010 32720756 32348269 X -385779 0 0 0 0 -1043833 X 0 1 X 1 1 1 X 52046 24404 23486 14544 386919 501399 20831504 22071418 21275423 20575393 20638971 105392709 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20883550 22095822 21298909 20589937 21025890 105894108 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 105894108 69647 194245 50208 74332 56214 444646 0 0 0 0 0 0 69647 194245 50208 74332 56214 444646 0 0 0 0 0 0 68996 101364 312442 132664 227429 842895 21022193 22391431 21661559 20796933 21309533 107181649 0.98799 0.98967 0.00415 0.00438 X Schedule A, Part III, Line 12 Income from Cafeteria, Television Charges, and Miscellaneous. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 646390 0 -13533 0 0 0 632857 589930 0 56460 0 0 0 646390 543748 0 46182 0 0 0 589930 591392 0 -47644 0 0 0 543748 480860 0 110532 0 0 0 591392 0 1 0 0 0 938541 0 938541 33282848 0 18204973 15077875 0 0 0 0 2286143 0 2041279 244864 299563 0 89886 209677 16470957 Due from Third Party Payors 279654 Other Receivables 369309 Due from Foundation 49403 Patient Trust Funds 698039 Assets Limited as to Use - Cash in Banks 41809 Assets Limited as to Use - US Treasury Bills 8434019 Deferred Financing Costs 518452 Interest in Net Assets of Norwegian Christian Home Foundation 1272591 Beneficial Interest in Perpetual Trust 632857 12296133 0 Due to third party payors 1714777 Pension Liability 1942031 3656808 X 21309533 0 0 0 0 0 21309533 0 0 0 21309533 21695312 0 0 0 0 0 21695312 0 0 0 21695312 Schedule D, Part IV, Line 2b Schedule D, Part IV, Line 2b - Resident's Funds are held by the Home on behalf of the residents. Such funds represent living allowances received by the residents as well as other funds deposited with the Home for safekeeping. The funds are disbursed at the request of, or on behalf of resident's for their personal use. Schedule D, Part V, Line 4 Schedule D, Part IV, Line 4 - The Konrad W. Frederiksen charitable trust was established in 1958 consisting of 4661.7 units of the Massachusetts Life Fund. The trust agreement stipulates that net income is to be paid quarterly to the Home. In 2001, the Home recorded it's beneficiary interest in the Vera J. Clark trust. The trust agreement states that the net income from the trust is to be paid quarterly to the Home and several other charitable organizations. Schedule D, Part X, Line 2 Schedule D, 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, 2011. X X 0 0 0 0 0 0 0 0 0 Earnest K Ragin Executive Director 217877 0 0 0 0 0 13073 0 53968 0 284918 0 0 0 William Van Lew CFO 163865 0 0 0 0 0 9832 0 40589 0 214286 0 0 0 Lisa Collie Assistant Administrator 101166 0 0 0 0 0 6070 0 25058 0 132294 0 0 0 Elizabeth Walsh Director of Nursing 139383 0 0 0 0 0 8363 0 34525 0 182271 0 0 0 Cristine Mello Director of Rehab 130486 0 0 0 0 0 7829 0 32432 0 170747 0 0 0 Angela Pezza Asst. Director of Nursing 103007 0 0 0 0 0 6180 0 25515 0 134702 0 0 0 Form 990, Part VI, Section A, Line 2 Board Member Torry Berntsen is the son-in-law of Board Chair George A. Jensen. Secretary Lori Aavik is the daughter of Treasurer Ralph Aavik. Form 990, Part VI, Section B, Line 11b The Form 990 is completed by the CFO. Upon completion, the draft Form 990 is distributed to the Finance Committee of the Board of Directors for their review and comments. Shortly thereafter, the return will be distributed to all members of the Board of Directors for their review and comments. Any questions or comments are forwarded to the CFO for research and final edits will be made by the CFO to produce the final Form 990 that will be filed with the IRS. The Board of Directors documents its review and approval of the final report. Form 990, Part VI, Section B, Line 12c Annually all employees are provided with the Employee Attestation Notice reminding them of their responsibilities and rights as it relates to Corporate Compliance & Federal False Claims Act, Federal Elder Justice Act, and Employees Rights Under Family and Medical Act. The notice was last reviewed and revised in February 2015. The Board of Directors policy requires that any Board member who has conflict of interest must disclose the conflict to the full Board and excuse themselves from any vote that involves a particular conflict of interest. Annually, a formal annual conflict of interest disclosure statement is distributed and signed by each Board member. Form 990, Part VI, Section B, Line 15 The compensation of the Executive Director/Administrator is decided by the Board of Directors which includes an annual review and approval by the Board. The Board utilizes data and / or benchmarks related to comparable compensation for similar qualified persona in comparable positions at similar facilities. His compensation is voted on during a Board meeting and documented in the Board minutes. The salaries of key employees and senior management officials are decided during the hiring process by the Executive Director/Administrator and Assistant Administrator/Human Resources jointly, which includes a review of comparable compensation for similar qualified persons in comparable positions at similar facilities. After the hiring process, nominal salary increases may be granted taking into account cost of living increases and facility's financial situation. Periodic salary reviews of key employees and top management may also be conducted taking into account employee performance and any additional responsibilities assigned including a review of comparable compensation for similar qualified persons in comparable positions at similar facilities. The Board authorizes the Executive Director/Administrator to increase all eligible non-union employees salaries by a certain percentage; each individual employee's salary increase is determined by the Executive Director/Administrator. The Board of Directors did not approve a salary increase for non-union employees in 2014. Form 990, Part VI, Section C, Line 19 The organization makes its governing documents, conflict of interest policy and audited financial statements available to the general public upon request. The organization also files an annual cost report with the New York State Department of Health which contains the financial statements and related note disclosures. The cost report is available to the public upon request. Form 990, Part XI, Line 9 Pension Liability Adjustment ($1,023,649), Change in value of split-interest agreements ($13,533) and Change in interest in net assets of Norwegian Christian Home Foundation ($6,651). Norwegian Christian Home Foundation 1270 67th Street Brooklyn NY 11219 743219871 Fundraising NY 501(c)3 9 Norwegian Christian Home and Health Center 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 Norwegian Christian Home Foundation p 37912 Rent collected on behalf of NCHF, Miscellaneous expenses paid by NCHHC and charged to NCHF. Norwegian Christian Home Foundation q 140656 Cost of salaries and benefits for Development Director, and cost of share of utilities, maintenance, and supplies.