2013-01-30T14:55:14-06:00 2011-12-31 221478099 COHNREZNICK LLP 1212 6TH AVENUE NEW YORK NY 10036 990 2011-01-01 237085986 SAMUEL SCHULMAN INSTITUTE FOR NURSING AND REHABILITATION SAMU 7182405200 101-01 AVENUE D BROOKLYN NY 11236 JIM PORTER 7182405200 2013-01-30 1 THOMAS LANNING P00851654 2122970400 2011 2016-02-25 16:41:14Z JIM PORTER 101-01 AVENUE D BROOKLYN NY 11236 75249327 0 X HTTP://BROOKDALEHOSPITAL.ORG X 1970 NY THE SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHABILITATION IS A VOLUNTARY, NON-PROFIT, RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO PROVIDING THE HIGHEST QUALITY OF MEDICAL CARE IN A HOMELIKE ENVIRONMENT. 19 13 595 0 0 0 0 0 73397274 74789422 8595 17547 233291 442358 73639160 75249327 0 0 0 0 37094426 38624912 0 0 0 50055305 50551241 87149731 89176153 -13510571 -13926826 34863554 33496696 141857856 154417917 -106994302 -120921221 THE SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHABILITATION IS A VOLUNTARY, NON-PROFIT, RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO PROVIDING THE HIGHEST QUALITY OF MEDICAL CARE IN A HOMELIKE ENVIRONMENT. 0 0 80062033 74789422 PROVIDED PATIENT HEALTH SERVICES INCLUDING MEDICAL, NURSING, REHABILITATIVE AND THEAPEUTIFC SERVICES. 80062033 1 0 0 0 0 0 0 0 0 0 1 1 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 0 1 574 1 1 595 1 0 0 0 0 0 0 0 0 0 0 X 19 13 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X JIM PORTER CHIEF FINANCIAL OFFICER 7182405773 101-01 AVE D BROOKLYN NY 11236 X ALEX ROVT 1.00 X X 0 0 0 ALLEN B SWERDLICK 1.00 X 0 0 0 ALVIN I KAHN MD 40.00 X X 0 298166 67567 ASCHER L MESTEL MD 1.00 X 0 0 0 DARRYL TOWNS 1.00 X 0 0 0 DAVID I SCHACHNE 1.00 X X 0 0 0 DAVID P ROSEN 0.70 X X 0 355277 4793 DAVID R WILKES 1.00 X 0 0 0 DAVID SCHLANG 1.00 X 0 0 0 DIANE SIMON 1.00 X 0 0 0 EDWARD BIRNBAUM 1.00 X 0 0 0 EDWIN L SHULMAN 1.00 X 0 0 0 HUGH GREENBERG 1.00 X 0 0 0 HUGH NELSON 1.00 X 0 0 0 IRINA BENFELD 1.00 X 0 0 0 LAURENCE C ZALE 1.00 X X 0 0 0 LESLIE STEPHEN 1.00 X 0 0 0 LEWIS MARSHALL 1.00 X 0 397392 65948 LOWELL M RUBIN 1.00 X 0 0 0 RICHARD FOGLER 1.00 X 0 604002 84305 RICHARD RADUTZKY 1.00 X X 0 0 0 STEPHEN PLOTNICK 1.00 X 0 0 0 BRUCE J FLANZ 0.70 X 0 1526121 72500 MOUNIR F DOSS 0.70 X 0 1366746 12435 VITO BUCCELLATO 40.00 X 0 339398 75508 AHMED HAIDER 40.00 X 153183 0 50831 GENEVIEVE SORENSON 40.00 X 304103 0 55046 MOHAMMAD KALAM 40.00 X 135430 0 30583 MRIDULA SAXENA 40.00 X 162522 0 65718 VIMALSON MONICKAM 40.00 X 138789 0 35187 894027 4887102 620421 23 0 1 0 AFFINITY REHABILIATION LLP 10600 YORK ROAD SUITE 105 COCKEYSVILLE MD 21030 THERAPY STAFFING 731087 HEALTHPRO MANAGEMENT SERVICES 10600 YORK ROAD SUITE 105 COCKEYSVILLE MD 21030 THERAPY MANAGEMENT 266000 LOEB & TROPER 45-18 COURT SQUARE NEW YORK NY 10017 CONSULTING 126940 3 PATIENT SERVICES 623000 74789422 74789422 74789422 17547 17547 403961 0 403961 403961 403961 MISCELLANEOUS 623000 34715 34715 GIFT SHOP 453220 3682 3682 38397 75249327 74827819 0 421508 28474701 25442699 3032002 7975771 7178194 797577 2174440 1956996 217444 3926 3926 1040 1040 37668476 33894180 3774296 2000 2000 27599 26991 608 6395 495 5900 700061 630055 70006 10951 4788 6163 537337 537337 1407104 1266394 140710 153192 153192 CASH RECEIPT ASSESSMENT 4216435 4216435 SUPPLIES 2805036 2711712 93324 BAD DEBTS 2442789 2442789 0 EQUIPMENT LEASES/RENTAL 333070 270062 63008 235830 20243 215587 89176153 80062033 9114120 0 64849 119051 878568 1212062 14422589 16364590 18141 1842 50692577 40851627 10981889 9840950 8067940 5613324 262735 159708 166843 185169 34863554 33496696 4987285 5787196 11445932 8562558 125424639 140068163 141857856 154417917 X -106994302 -120921221 -106994302 -120921221 34863554 33496696 X -13926826 -93 X X 0 1 1 X 0 X 623716 623716 34110406 27703849 6406557 1141038 1052848 88190 8736258 6842664 1893594 6081159 5252266 828893 9840950 DUE TO THIRD PARTY PAYORS 51469875 FUNDS HELD IN TRUST FOR RESIDENTS 191234 DUE TO AFFILIATES 88407054 140068163 75249327 89176153 -13926826 -93 -93 -13926919 75249469 -93 235 142 75249327 0 75249327 89176153 0 89176153 0 89176153 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE INSTITUTE AND THE FUND QUALIFY AS TAX-EXEMPT, NONPROFIT 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 XII, LINE 2D - OTHER ADJUSTMENTS: RELATED PARTY INCOME 235. 0 0 0 0 0 0 0 0 0 ALVIN I KAHN MD 0 296456 0 0 0 1710 0 60091 0 7476 0 365733 0 0 DAVID P ROSEN 0 355277 0 0 0 0 0 0 0 4793 0 360070 0 0 LEWIS MARSHALL 0 396150 0 0 0 1242 0 53569 0 12379 0 463340 0 0 RICHARD FOGLER 0 604002 0 0 0 0 0 70366 0 13939 0 688307 0 0 BRUCE J FLANZ 0 1209510 0 0 0 316611 0 60091 0 12409 0 1598621 0 0 MOUNIR F DOSS 0 1097377 0 0 0 269369 0 0 0 12435 0 1379181 0 0 VITO BUCCELLATO 0 326331 0 0 0 13067 0 61569 0 13939 0 414906 0 0 AHMED HAIDER 152717 0 0 0 466 0 38452 0 12379 0 204014 0 0 0 GENEVIEVE SORENSON 286410 0 0 0 17693 0 47570 0 7476 0 359149 0 0 0 MOHAMMAD KALAM 135334 0 0 0 96 0 18204 0 12379 0 166013 0 0 0 MRIDULA SAXENA 160368 0 0 0 2154 0 50279 0 15439 0 228240 0 0 0 VIMALSON MONICKAM 138515 0 0 0 274 0 27711 0 7476 0 173976 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 ALEX ROVT, TRUSTEE/VICE CHAIRMAN AND ALLEN SWERDLICK, TRUSTEE EACH HAVE A BUSINESS RELATIONSHIP WITH BROOKDALE HOSPITAL MEDICAL CENTER. ALVIN KAHN, MD, TRUSTEE & CHAIRMAN, HAS A FAMILY RELATIONSHIP WITH DIANE SIMON, TRUSTEE. DAVID SCHACHNE, TREASURER HAS A FAMILY MEMBER THAT WORKS FOR SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING & REHABILITATION. FORM 990, PART VI, SECTION A, LINE 6 MEDISYS HEALTH NETWORK IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A MEDISYS HEALTH NETWORK, AS SOLE MEMBER CAN APPOINT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), ARE 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 AND THE BOARD IS COMFORTABLE WITH ITS CONTENTS, THE FORM 990 IS THEN MAILED TO ALL BOARD MEMBERS AS READY TO FILE, SUBSEQUENTLY IT IS 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 AUDIT & COMPLIANCE COMMITTEE REVIEWS THE SUBMISSIONS FOR CONFLICTS AND THE DEPARTMENT OF INTERNAL AUDIT MONITORS COMPLIANCE. 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, AND DAVID ROSEN, PRIOR PRESIDENT & CEO, 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 JAMAICA HOSPITAL MEDICAL CENTER - 25 HOURS PER WEEK FLUSHING HOSPITAL MEDICAL CENTER - 10 HOURS PER WEEK BROOKDALE HOSPITAL MEDICAL CENTER - 10 HOURS PER WEEK OTHER RELATED ENTITIES LISTED ON SCHEDULE R - 10 HOURS PER WEEK AS OF MARCH 12, 2011, DAVID ROSEN, PRIOR PRESIDENT & CEO, IS NO LONGER AN EMPLOYEE OF MEDISYS HEALTH NETWORK. ALVIN I. KAHN M.D., LEWIS MARSHALL, AND RICHARD FOGLER M.D., RECEIVED COMPENSATION FOR THE PERFORMANCE OF SERVICES AS A PHYSICIAN FOR BROOKDALE HOSPITAL MEDICAL CENTER. ALVIN I. KAHN M.D., LEWIS MARSHALL, AND RICHARD FOGLER M.D., DID NOT RECEIVE COMPENSATION AS A TRUSTEE FOR BROOKDALE HOSPITAL MEDICAL CENTER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -93. FORM 990, PART XII, 2C: THE OVERSIGHT AND SELECTION PROCESS DID NOT CHANGE FROM PRIOR YEAR. FORM 990, PART VII, COLUMN C: MANAGEMENT HAS IN THE PREPARATION OF ITS FORM 990 REVIEWED PERSONNEL IN THE INSTITUTION TO SEE IF ANYONE MEETS THE CRITERIA ESTABLISHED TO BE CONSIDERED A "KEY EMPLOYEE" FOR IRS PURPOSES. IT IS THE CONTENTION OF MANAGEMENT THAT NO EMPLOYEE FULFILLS ANY OF THE SITUATIONS UNDER THE RESPONSIBILITY TEST ESTABLISHED BY THE IRS TO MEET TITLE OF KEY EMPLOYEE. THEREFORE, PART VII OF FORM 990 DOES NOT HAVE ANY INDIVIDUALS WHO WOULD BE CONSIDERED A "KEY EMPLOYEE". FORM 990, PART IV, LINE 20: THE ORGANIZATION RECEIVED ITS PUBLIC EXEMPTION STATUS UNDER A HOSPITAL SECTION 170(B)(1)(A)(III), HOWEVER, ITS OPERATING CERTIFICATE DOES NOT CLASSIFY THEM AS A HOSPITAL FOR PURPOSES OF FILING SCHEDULE H. 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