2014-11-11T15:10:09-06:00 2013-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2013-01-01 133623600 NORTHERN MANOR MULTICARE CENTER INC NORT 8456233904 199 NORTH MIDDLETOWN ROAD NANUET NY 10954 MORRIS KLEIN EXECUTIVE DIRECTOR 8456233904 2014-11-10 1 ISRAEL TANNENBAUM P01589203 2128674000 2013 2015-11-30 17:44:51Z MORRIS KLEIN 2000 FOUNTAINVIEW DRIVE MONSEY NY 10952 35223874 0 X WWW.NORTHERNMANOR.COM X 1991 NY TO OPERATE A RESIDENTIAL HEALTH FACILITY & ADULT DAY CARE PROGRAM 11 11 415 25 0 0 5477669 177541 35539562 35037654 1173 8679 841098 0 41859502 35223874 4675585 1785128 0 0 18501542 18109860 0 0 0 13534127 13515547 36711254 33410535 5148248 1813339 18799707 18628519 18718048 23233521 81659 -4605002 TO OPERATE A RESIDENTIAL HEALTH FACILITY & ADULT DAY CARE PROGRAM 0 0 23170502 1785128 28355720 HEALTH CARE SERVICES FOR THE ELDERLY 6111771 6681934 OUTPATIENT ADULT DAY CARE SERVICES 29282273 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 82 0 415 1 0 0 0 0 0 0 0 0 0 0 X 11 11 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 NY X MICHAEL ITZKOWITZ 8453569880 2000 FOUNTAINVIEW DRIVE MONSEY NY 10952 STUART MEYERS CHAIRMAN 0.10 0.90 X 0 4750 0 MARTIN HAUBENSTOCK SECRETARY 0.10 0.90 X 0 4000 0 LEON STEINMETZ BOARD MEMBER 0.10 0.90 X 0 8720 0 RABBI SIMON LAUBER BOARD MEMBER 0.10 0.90 X 0 1500 0 REGINA AUSLANDER BOARD MEMBER 0.10 0.90 X 0 250 0 BENJAMIN KLEIN BOARD MEMBER 0.10 0.90 X 0 0 0 HINDI GINSBERG BOARD MEMBER 0.10 0.90 X 0 750 0 CHARLES F KENNY ESQ BOARD MEMBER 0.10 0.90 X 0 3000 0 ABRAHAM ZACHARIASH BOARD MEMBER 0.10 0.90 X 0 4000 0 RABBI HERSHEL HAGER BOARD MEMBER 0.10 0.90 X 0 0 0 ISRAEL ORZEL BOARD MEMBER 0.10 0.90 X 0 4000 0 MORRIS KLEIN EXECUTIVE DIRECTOR 6.00 29.00 X 115094 556284 170226 GEDALIA KLEIN CHIEF OPERATING OFFICER 3.00 14.50 X 18480 89320 15122 MICHAEL NOWICKI COMPLIANCE OFFICER 6.00 29.00 X 27469 132766 0 JILL WECHSLER CASE MANAGER 35.00 X 161097 0 0 AKIVA FOGEL ADMINISTRATOR 35.00 X 187275 0 3822 GELENA DEVERMAN ADC DIRECTOR 35.00 X 154903 0 2288 GENNADIY GOLDVEKHT REGISTERED NURSE 35.00 X 105858 0 0 CAROL P SCHIAVONE NURSE MANAGER 35.00 X 110310 0 0 ELIZABETH GEROSA DIRECTOR OF NURSING 35.00 X 128666 0 8384 1009152 809340 199842 7 0 1 0 TOWNE NURSING STAFF 1413 38TH STREET BROOKLYN NY 11218 NURSING SERVICES 1198560 NORTHERN METROPOLITAN FOUNDATION 2000 FOUNTAINVIEW DRIVE MONSEY NY 10952 ADMINISTRATIVE SERVICES 769636 CENTERS FOR CARE 4770 WHITE PLAINS ROAD BRONX NY 10470 ADMINISTRATIVE SERVICES 482112 SENIOR CARE 855 BRUSH AVENUE BRONX NY 10465 TRANSPORTATION 473382 CLEAN TEX SERVICES 491 LYONS AVE IRVINGTON NJ 07111 LAUNDRY AND LINEN SERVICE 179741 5 177541 177541 RESIDENT SERVICE REVENUE 623000 28355720 28355720 ADULT DAY CARE 623000 6681934 6681934 35037654 8679 8679 35223874 35037654 0 8679 1785128 1785128 545014 474162 70852 12826248 11151686 1674562 783944 681598 102346 2709182 2355529 353653 1245472 1082893 162579 1275676 1109154 166522 385286 385286 17106 17106 791845 688480 103365 28908 25134 3774 1275376 1108892 166484 1799552 1564645 234907 1718728 1677413 41315 960 835 125 310762 270196 40566 769604 669143 100461 473810 411961 61849 FOOD EXPENSE 1883656 1637771 245885 MEDICAL SUPPLIES 1506286 1309661 196625 NYS ASSESSMENT 1277992 1277992 33410535 29282273 4128262 0 671442 635068 901372 759324 7562747 7803350 446548 456555 22663744 14130538 8792621 8533206 59964 59964 365013 381052 18799707 18628519 5935421 4728522 6550000 5935000 2814345 5875217 3418282 6694782 18718048 23233521 X 81659 -4605002 81659 -4605002 18799707 18628519 X 1813339 -6500000 X X 0 1 X 1 0 X 5477669 177541 5655210 35966570 35941663 36626627 36380660 35037654 179953174 35966570 35941663 36626627 41858329 35215195 185608384 0 0 0 185608384 1123 540 813 1173 8679 12328 1123 540 813 1173 8679 12328 22743 71361 94104 35990436 35942203 36698801 41859502 35223874 185714816 0.99940 0.99880 0.00010 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 790000 790000 16910780 9842685 7068095 548459 483172 65287 3975747 3667515 308232 438758 137166 301592 8533206 ESTIMATED LIABILITIES TO THIRD-PARTY PAYORS 5896000 RESIDENT FUNDS HELD IN TRUST 285336 DUE TO RELATED PARTIES 513446 6694782 X 28723874 0 28723874 6500000 6500000 35223874 31625407 0 31625407 1785128 1785128 33410535 PART X, LINE 2: NORTHERN MANOR MULTICARE CENTER, INC. HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2010 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES PART XI, LINE 4B - OTHER ADJUSTMENTS: ADULT DAYCARE REVENUE SETTLEMENT AGREEMENT 6,500,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANT TO RELATED ENTITY 1,785,128. 0 CONGREGATION CHEVRA LIADY NUSACH HOARY 1580 53RD STREET BROOKLYN NY 11219 113133470 501(C) (3) 1785128 TO SUPPORT THE RELIGIOUS MISSION OF CHEVRA LIADY NUSACH HOARY 1 0 0 1 0 0 0 0 0 0 0 MORRIS KLEIN EXECUTIVE DIRECTOR 105162 508280 0 0 9932 48004 24009 116043 5173 25001 144276 697328 0 0 MICHAEL NOWICKI COMPLIANCE OFFICER 27469 132766 0 0 0 0 0 0 0 0 27469 132766 0 0 JILL WECHSLER CASE MANAGER 161097 0 0 0 0 0 0 0 0 0 161097 0 0 0 AKIVA FOGEL ADMINISTRATOR 187275 0 0 0 0 0 0 0 3822 0 191097 0 0 0 GELENA DEVERMAN ADC DIRECTOR 154903 0 0 0 0 0 0 0 2288 0 157191 0 0 0 PART I, LINE 3 THE STUDY WAS CONDUCTED BY THE SOLE CORPORATE MEMBER "NORTHERN METROPOLITAN FOUNDATION" ON BEHALF OF NORTHERN MANOR MULTICARE, INC. PART I, LINE 4B MORRIS KLEIN, $140,052 FORM 990, PART VI, SECTION A, LINE 2 CHIEF OPERATING OFFICER GEDALIA KLEIN IS RELATED TO EXECUTIVE DIRECTOR, MORRIS KLEIN. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FINAL FORM 990 WILL BE REVIEWED BY THE DIRECTOR OF FINANCE AND CHAIRMAN OF THE BOARD PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS PROVIDED WITH THE CONFLICT OF INTEREST POLICY, AND IS REQUIRED TO FILL OUT A FORM WHICH WILL DISCLOSE ANY CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE BOARD MEMBER WILL RECUSE HIM/HERSELF FROM VOTING ON ANY ISSUE THAT CREATES THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A A PRICEWATERHOUSECOOPERS STUDY REVIEWED AND SUBSTANTIATED THE TOP MANAGEMENT COMPENSATION. THE LAST SALARY DETERMINATION FOR TOP MANAGEMENT COMPENSATION TOOK PLACE IN JUNE 2011. THE STUDY WAS CONDUCTED BY THE SOLE CORPORATE MEMBER "NORTHERN METROPOLITAN FOUNDATION" ON BEHALF OF NORTHERN MANOR MULTICARE, INC. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ADULT DAYCARE REVENUE SETTLEMENT AGREEMENT -6,500,000. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. NORTHERN RIVERVIEW HEALTH CARE CENTER INC 87 SOUTH ROUTE 9W HAVERSTRAW NY 10927 133832251 NURSING HOME NY 501 (C)(3) LINE 9 NORTHERN METROPOLITAN FOUNDATION FOR HEALTH CARE INC 0 ASSISTED LIVING AT NORTHERN RIVERVIEW INC 89 SOUTH ROUTE 9W HAVERSTRAW NY 10927 133976617 ASSISTED LIVING FOUNDATION NY 501 (C)(3) LINE 9 NORTHERN METROPOLITAN FOUNDATION FOR HEALTH CARE INC 0 FOUNTAINVIEW AT COLLEGE ROAD INC 2000 FOUNTAINVIEW DRIVE MONSEY NY 10952 133935070 INDEPENDANT LIVING FACILITY NY 501 (C)(3) LINE 9 NORTHERN METROPOLITAN FOUNDATION FOR HEALTH CARE INC 0 NORTHERN METROPOLITAN FOUNDATION FOR HEALTH CARE INC 2000 FOUNTAINVIEW DRIVE MONSEY NY 10952 113354023 CHARITABLE FOUNDATION AND ADMINISTRATIVE SUPPORT ORGANIZATION NY 501 (C)(3) LINE 11A, I CHEVRA LIADY NUSACH 0 NORTHERN SERVICES GROUP INC 2000 FOUNTAINVIEW DRIVE MONSEY NY 10952 134120014 ADMINISTRATIVE SUPPORT ORGANIZATION NY 501 (C)(3) LINE 11B, II NORTHERN METROPOLITAN FOUNDATION FOR HEALTH CARE INC 0 LIFESTYLE OPTIONS FOR SENIORS FOUNDATIONINC 2000 FOUNTAINVIEW DRIVE MONSEY NY 10952 134133472 CHARITABLE FOUNDATION NY 501 (C)(3) LINE 9 NORTHERN METROPOLITAN FOUNDATION FOR HEALTH CARE INC 0 NORTHERN METROPOLITAN INC 225 MAPLE AVENUE MONSEY NY 10952 133070759 NURSING HOME NY 501 (C)(3) LINE 9 NORTHERN METROPOLITAN FOUNDATION FOR HEALTH CARE INC 0 CHEVRA LIADY NUSACH HOARY - 11-3133470 1580 53RD STREET BROOKLYN NY 11219 113133470 RELIGOUS ENTITY NY 501 (C)(3) LINE 1 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0