2013-11-13T17:31:49-06:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 112925535 THE SILVERCREST CENTER FOR NURSING AND REHABILITATION SILV 7184804097 144-45 87TH AVENUE JAMAICA NY 114353109 MICHAEL TRETOLA 7184804097 2013-11-13 1 FREDERICK H ROTHMAN P01275277 2128674000 2012 2016-02-24 21:20:13Z MICHAEL TRETOLA 144-45 87TH AVENUE JAMAICA NY 114353109 53031740 0 X WWW.SILVERCREST.ORG X 1990 NY SKILLED NURSING FACILITY 8 6 621 37 0 0 123878 139193 50868986 51888654 162012 36386 842101 919983 51996977 52984216 0 0 0 0 33507785 35014995 0 0 0 18026880 17282623 51534665 52297618 462312 686598 35534537 35582911 27839216 27180900 7695321 8402011 SEE SCHEDULE O 0 0 46400527 52689366 SILVERCREST CENTER FOR NURSING AND REHABILITATION IS A SKILLED NURSING FACILITY FOR 320 RESIDENTS THAT PROVIDES VENTILATOR-RESPIRATORY CARE, SHORT-TERM REHABILITATION, AND LONG-TERM CARE FOR ALZHEIMER AND GERIATRIC PATIENTS. 46400527 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 48 0 621 1 0 0 0 0 0 1 1 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MITCHELL DEFRIN CFO 7184804000 144-45 87TH AVENUE JAMAICA NY 114353109 X STEPHEN S MILLS FACHE 10.00 50.00 X X 133056 665285 93839 KATHLEEN M BURKE ESQ 1.00 59.00 X X 0 346153 43259 GEORGE F HEINRICH MD 8.00 25.50 X X 0 0 0 ALEXANDER DIPAOLO CPA 4.00 X 0 0 0 LAURENCE J BERGER 1.00 59.00 X 0 401717 39767 ANNE ALEXIS COTE TAYLOR 3.00 4.00 X 0 0 0 FRANK CORIGLIANO 1.00 X 0 0 0 PETER SARANTOS 1.00 X 0 0 0 REGINA PERGUGGI EDD 1.00 X 0 0 0 MICHAEL TRETOLA FACHE 50.00 10.00 X 254424 50885 43064 WILLIAM P WISSEMANN ESQ 2.00 58.00 X 11968 347079 30203 KEVIN J WARD CPA 3.00 57.00 X 25300 480704 44323 LINDA PROCHASKA CPA 58.50 1.50 X 246681 6325 27263 DANIEL RUSSOMD 60.00 X 286531 0 21755 KYLE JACOBI ESQ 2.00 58.00 X 6756 189153 26691 AUNG ZE YA 60.00 X 161187 0 24341 KAREN DIKEMAN 60.00 X 137274 0 25797 NATASHA ELIE-LOUISSAINT LNHA 58.00 2.00 X 163300 5631 37913 DENISE LAWSON 60.00 X 133631 0 24537 LORETTA MCMANUS 60.00 X 208538 0 28650 1768646 2492932 511402 9 0 1 0 COMPASS GROUP - MORRISON MANAGEMENT SPEC PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 2237694 OCEANSIDE INSTITUTION 2525 LONG BEACH ROAD OCEANSIDE NY 11572 LAUNDRY & LINEN 360849 LOEB & TROPER 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 ACCOUNTING 189145 DEFENDER SECURITY SERVICES INC 97-29 64TH ROAD REGO PARK NY 11374 SECURITY 167737 SOMETHING DIGITAL 58 WEST 40TH STREET 7TH FLOOR NEW YORK NY 10018 INFORMATION TECHNOLOGY SUPPORT 157084 6 108179 31014 2329 139193 MEDICARE/MEDICAID 623000 41584046 41584046 PRIVATE/HMO/HOSPICE AND OTHER 623000 10304608 10304608 51888654 36386 36386 60300 0 60300 60300 60300 26250 108179 47524 -21274 -21274 MANAGEMENT FEES 900099 421001 421001 CAFETERIA 900099 201058 201058 PURCHASE DISCOUNTS 900099 197815 197815 61083 61083 880957 52984216 51948954 0 896069 X 1070425 309989 760436 24036319 22781879 1254440 1657081 1506144 150937 6219419 5659671 559748 2031751 1848893 182858 438626 438626 98781 98781 125737 125737 6083 6083 15114 15114 5468877 4940049 528828 25834 25834 4372473 4132736 239737 246885 246885 1504872 806468 698404 39625 12658 26967 1386986 1206678 180308 608423 529328 79095 NURSING HOME ASSESSMENT 2646772 2646772 297535 19262 278273 52297618 46400527 5897091 0 36504 63722 1804504 2787669 9062667 9327673 70629 83002 176583 391984 49310755 35085433 14582894 14225322 6977522 5592991 176214 161322 2647020 2949226 35534537 35582911 5707410 6397381 16870389 15919945 5261417 4863574 27839216 27180900 X 7656379 8377011 38942 25000 7695321 8402011 35534537 35582911 X 686598 -6392 26484 X X 0 1 X 1 0 X 258509 664069 92754 123878 139193 1278403 48365716 49222324 50227278 50868986 51888654 250572958 48624225 49886393 50320032 50992864 52027847 251851361 0 0 0 251851361 457455 254885 187300 185112 96686 1181438 457455 254885 187300 185112 96686 1181438 550022 983053 662941 844258 880957 3921231 49631702 51124331 51170273 52022234 53005490 256954030 0.98010 0.97590 0.00460 0.00740 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MANAGEMENT FEES CAFETERIA PURCHASE DISCOUNTS MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6083 6083 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: CCLC DUES, LEADING AGE NY DUES, NY PRESBYTERIAN DUES, AND 1199 SEIU DUES. 1713566 1713566 28805846 21753278 7052568 18070093 12839833 5230260 721250 492322 228928 14225322 RESIDENT TRUST FUNDS 372717 DUE FROM THIRD PARTIES 1308317 DUE FROM RELATED ORGANIZATIONS 1268192 2949226 RESIDENT FUNDS PAYABLE 372717 DUE TO THIRD PARTIES 1869471 DUE TO RELATED ORGANIZATIONS 54308 SWAP LIABILITY 2567078 4863574 X 53037051 -6392 59227 52835 52984216 0 52984216 52330361 32743 32743 52297618 0 52297618 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: SILVERCREST HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2009 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON SWAP AGREEMENT 59,227. PART XII, LINE 2D - OTHER ADJUSTMENTS: FORGIVENESS OF INTERCOMPANY BORROWINGS 32,743. ANNUAL GOLF CLASSIC 134429 108179 26250 5328 31155 11041 134429 108179 26250 5328 31155 11041 47524 -21274 X X X X X 0 1 0 0 0 0 0 0 0 STEPHEN S MILLS FACHE 127668 638343 0 0 5388 26942 10833 54167 4807 24032 148696 743484 0 0 KATHLEEN M BURKE ESQ 0 284047 0 56686 0 5420 0 25000 0 18259 0 389412 0 0 LAURENCE J BERGER 0 250014 0 65181 0 86522 0 18611 0 21156 0 441484 0 0 MICHAEL TRETOLA FACHE 250198 50040 0 0 4226 845 16667 3333 19220 3844 290311 58062 0 0 WILLIAM P WISSEMANN ESQ 11717 339806 0 0 251 7273 667 19333 340 9863 12975 376275 0 0 KEVIN J WARD CPA 24039 456742 0 0 1261 23962 1000 19000 1216 23107 27516 522811 0 0 LINDA PROCHASKA CPA 243243 6237 0 0 3438 88 19500 500 7081 182 273262 7007 0 0 DANIEL RUSSOMD 282346 0 0 0 4185 0 20000 0 1755 0 308286 0 0 0 KYLE JACOBI ESQ 6738 188652 0 0 18 501 552 15448 369 10322 7677 214923 0 0 AUNG ZE YA 161187 0 0 0 0 0 7457 0 16884 0 185528 0 0 0 KAREN DIKEMAN 136625 0 0 0 649 0 11105 0 14692 0 163071 0 0 0 NATASHA ELIE-LOUISSAINT LNHA 163014 5621 0 0 286 10 13497 465 23153 798 199950 6894 0 0 DENISE LAWSON 133115 0 0 0 516 0 5990 0 18547 0 158168 0 0 0 LORETTA MCMANUS 203538 0 5000 0 0 0 16283 0 12367 0 237188 0 0 0 PART I, LINE 4B STEPHEN S MILLS- 457 F PLAN - 45,000 FORM 990, PART VI, SECTION A, LINE 6 SILVERCREST CENTER FOR NURSING AND REHABILITATION (THE "ORGANIZATION") IS A MEMBERSHIP CORPORATION, WHOSE MEMBERS ARE SELECTED BY NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM, INC. ("SYSTEM INC."). SYSTEM INC. IS A TAX-EXEMPT ORGANIZATION WHOSE MEMBERS ARE APPOINTED BY NEW YORK-PRESBYTERIAN FOUNDATION, INC., WHICH IS ALSO A TAX-EXEMPT ORGANIZATION. THE MEMBERS OF THE ORGANIZATION ELECT THE ORGANIZATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A SILVERCREST CENTER FOR NURSING AND REHABILITATION (THE "ORGANIZATION") IS A MEMBERSHIP CORPORATION, WHOSE MEMBERS ARE SELECTED BY NEW YORK-PRESBYTERIAN HEALTHCARE SYSTEM, INC, WHOSE MEMBERS ARE SELECTED BY NEW YORK-PRESBYTERIAN FOUNDATION, INC. THE ORGANIZATION'S MEMBERS ELECT THE ORGANIZATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B (A) THE MEMBERS SHALL HAVE THE SOLE AUTHORITY TO ESTABLISH FROM TIME TO TIME THE NUMBER OF TRUSTEES TO BE ELECTED AT LARGE, TO ELECT TRUSTEES TO BE ELECTED AT LARGE AND TO REMOVE TRUSTEES, INCLUDING TRUSTEES SERVING BY REASON OF THEIR OFFICE, WITH OR WITHOUT CAUSE. (B) THE APPROVAL OF THE MEMBERS SHALL BE REQUIRED FOR (1) THE ELECTION OR THE REMOVAL BY THE BOARD OF THE CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER AND CHIEF INFORMATION OFFICER, IF ANY, OR ANY OTHER CORPORATE OFFICER WHOSE POWERS AND DUTIES INCLUDE THOSE WHICH USUALLY APPERTAIN TO SUCH OFFICES, (2) THE AMENDMENT OF THE CERTIFICATE OF INCORPORATION OR BY-LAWS OF THE CORPORATION, (3) THE DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, (4) THE MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER ENTITY OR (5) THE DISSOLUTION OF THE CORPORATION. EXCEPT AS MAY BE LIMITED BY APPLICABLE LAW GOVERNING HEALTH CARE INSTITUTIONS, THE MEMBERS SHALL HAVE SUCH OTHER POWERS AND AUTHORITY AS ARE AFFORDED TO THE MEMBERS UNDER THE CORPORATION'S CERTIFICATE OF INCORPORATION OR GENERALLY TO MEMBERS OF NOT-FOR-PROFIT CORPORATIONS UNDER THE LAWS OF THE STATE OF NEW YORK. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE FORM 990 WAS PRESENTED TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD AT A MEETING HELD DURING THE MONTH OCTOBER OF 2013. EACH MEMBER REVIEWED IT AND WHEN SATISFIED, APPROVED IT, THE FORM 990 WAS APPROVED BY AUDIT MEMBERS AND RECORDED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER, AND ANY OFFICER OR KEY PERSON PRESENTING A PROPOSED TRANSACTION OR OTHER MATTER TO A BOARD, SHALL DISCLOSE PROMPTLY AND IN GOOD FAITH TO THE BOARD SUCH INDIVIDUAL'S INTEREST IN A PROPOSED TRANSACTION OR OTHER MATTER TO BE CONSIDERED BY THE BOARD. THE INDIVIDUAL MAY NOT PARTICIPATE IN THE DELIBERATIONS OF THE BOARD OR USE PERSONAL INFLUENCE IN ITS MATTERS. FOLLOWING ANY SUCH DISCLOSURE, AND AFTER SUCH DUE DILIGENCE AND SUCH DEVELOPMENT AND CONSIDERATION OF OTHER ALTERNATIVES, IF ANY, AS THE BOARD SHALL DEEM APPROPRIATE, THE BOARD MAY, IN ITS DISCRETION, AUTHORIZE OR APPROVE THE PROPOSED TRANSACTION OR OTHER MATTER AS AT LEAST AS FAIR AND REASONABLE TO THE SILVERCREST ORGANIZATION AS WOULD OTHERWISE BE OBTAINABLE BY THE SILVERCREST ORGANIZATION. SUCH ACTIONS SHALL BE BY A VOTE SUFFICIENT FOR SUCH PURPOSE WITHOUT COUNTING THE VOTE OR VOTES OF SUCH INTERESTED PERSON OR PERSONS AND SUCH PERSON OR PERSONS MAY NOT PARTICIPATE IN DETERMINING THE PRESENCE OF A QUORUM AT THE MEETING. NO EMPLOYEE, MEMBER OF THE MEDICAL STAFF OR ANY OTHER PERSON RECEIVING COMPENSATION DIRECTLY OR INDIRECTLY FROM A SILVERCREST ORGANIZATION SHALL SERVE AS A MEMBER OF A BOARD COMMITTEE RESPONSIBLE FOR AUDIT AND CORPORATE COMPLIANCE OR EXECUTIVE COMPENSATION MATTERS. UPON REASONABLE BELIEF THAT A BOARD MEMBER, OFFICER OR KEY PERSON FAILED TO COMPLY WITH THE POLICIES AND DIRECTIVES SET FORTH IN THIS POLICY STATEMENT, THE BOARD OF THE SILVERCREST ORGANIZATION OR AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF SILVERCREST SHALL INFORM THE INDIVIDUAL OF THE BASIS OF THE BELIEF AND PROVIDE AN OPPORTUNITY TO EXPLAIN THE NONCOMPLIANCE. IF AFTER HEARING THE RESPONSE FROM THE INDIVIDUAL AND MAKING FURTHER APPROPRIATE INVESTIGATIONS, THE BOARD OR AUDIT AND CORPORATE COMPLIANCE COMMITTEE DETERMINES THAT THE INDIVIDUAL HAS, IN FACT, FAILED TO COMPLY WITH SUCH POLICIES AND DIRECTIVES, IT SHALL TAKE OR RECOMMEND APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION AND KEY EMPLOYEE COMPENSATION WAS REVIEWED BY THE COMPENSATION COMMITTEE IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE FOR THE PUBLIC UPON REQUEST. FORM 990, PART VII,SECTION A FOR PURPOSES OF REPORTING SALARY ALLOCATIONS ON PART VII SCH A. BETWEEN THE ORGANIZATION(COL D) AND RELATED ORGANIZATIONS(COL E) THE FOLLOWING FORMULA WAS USED: THE RATIO OF HOURS DEDICATED TO THE ORGANIZATION TO TOTAL HOURS WORKED BY THE INDIVIDUAL ACROSS ALL ORGANIZATIONS APPLIED TO TOTAL COMPENSATION PAID BY ALL ORGANIZATIONS. THIS METHOD IS APPLIED CONSISTENTLY FOR ALL INDIVIDUALS WHO DEDICATED MORE THAN ONE HOUR WEEKLY TO THE ORGANIZATION REGARDLESS OF WHAT ORGANIZATION THEY RECEIVED DIRECT W2 COMPENSATION FROM. OTHER FEES FORM 990, PART IX, LINE 11G PATIENT SERVICE FEES: PROGRAM SERVICE EXPENSES 1,365,415. MANAGEMENT AND GENERAL EXPENSES 54,585. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,420,000. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 30,259. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,259. OTHER PURCHASE SERVICE: PROGRAM SERVICE EXPENSES 54,910. MANAGEMENT AND GENERAL EXPENSES 9,054. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,964. FOOD: PROGRAM SERVICE EXPENSES 885,212. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 885,212. FOOD SERVICE FEE: PROGRAM SERVICE EXPENSES 2,345,041. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,345,041. BUILDING SERVICE FEE: PROGRAM SERVICE EXPENSES 244,990. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 244,990. SECURITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 192,346. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192,346. MISCELLANEOUS CONTRACT SERVICE FEE: PROGRAM SERVICE EXPENSES 14,222. MANAGEMENT AND GENERAL EXPENSES 9,165. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,387. BILLING SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 158,061. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 158,061. EMPLOYMENT SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 105,617. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,617. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: GAIN ON SWAP AGREEMENT 59,227. FORGIVENESS OF INTERCOMPANY BORROWINGS -32,743. PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MISSION STATEMENT FORM 990, PART III, LINE 1 SILVERCREST CENTER FOR NURSING AND REHABILITATION LOCATED IN QUEENS, NEW YORK HAS CHOSE OUR MISSION TO PROVIDE A CONTINUUM OF CARE THROUGH DIVERSE PROGRAMS THAT PROVIDE QUALITY HEALTH CARE AND PROMOTE INDEPENDENCE AND DIGNITY FOR ALL, IN AN ENVIRONMENT WHERE LEADERSHIP IS BY EXAMPLE, KNOWLEDGE IS SHARED, CREATIVITY IS SOUGHT AFTER AND CONTINUED EDUCATION IS PROMOTED. SIMPLY PUT, "GIVING QUALITY TO LIFE". SILVERCREST HAS HARNESSED THE RESOURCE AND CREATED THE SPIRIT AND ENVIRONMENT THAT IS NEEDED TO EXCEL IN LONG-TERM CARE, SUB-ACUTE REHABILITATION AND VENTILATOR PATIENTS. IT IS, IN FACT, THE SYNERGY THAT HAS DEVELOPED BETWEEN OUR THREE PATIENT CARE SYSTEMS THAT ALLOWS US TO DELIVER A LEVEL OF QUALITY FOR EACH THAT WOULD BE HARD TO ACHIEVE FOR INDIVIDUAL SERVICES EXISTING ON THEIR OWN. JUST AS OUR LONG TERM CARE RESIDENTS BENEFIT FROM THE PRESENCE OF A VIBRANT, ON-SITE SUB-ACUTE REHABILITATION PROGRAM, AND FROM THE SOPHISTICATED MEDICAL RESOURCES NEEDED TO RUN OUR AWARD-WINNING VENTILATOR AND RESPIRATORY CARE UNIT, SO THE LIVES OF OUR VENTILATOR PATIENTS ARE ENRICHED BY THE RECREATIONAL AND PASTORAL RESOURCES OF OUR LONG TERM CARE PROGRAM. PLEASE VISIT THE WEBSITE FOR A VIRTUAL TOUR AT WWW.SILVERCREST.ORG. NETWORK RECOVERY SERVICES INC 525EAST 68TH STREET BOX 156 NEW YORK NY 10065 113160901 COLLECTION NY 501 C (3) 11 TYPE III NYP SYSTEM INC 1 NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS 56-45 MAIN STREET FLUSHING NY 11355 111839362 HEALTHCARE NY 501 C (3) 3 NYP SYSTEM INC 1 CRT SURGICAL ASSOCIATES PC 56-45 MAIN STREET FLUSHING NY 11355 112226870 HEALTHCARE NY 501 C (3) 11 TYPE I NYHQ 1 BMA MEDICAL FOUNDATION 56-45 MAIN STREET FLUSHING NY 11355 112848858 EDU/RESEARCH NY 501 C (3) 4 NYHQ 1 NY PRESBYTERIAN HEALTHCARE SYSTEM INC 525 EAST 68TH STREET BOX 156 NEW YORK NY 10065 133792361 SPONSOR NY 501 C (3) 11 TYPE III NYP FDN 1 NEW YORK PRESBYTERIAN FUND INC 525 EAST 68TH STREET NEW YORK NY 10065 133160356 FUNDRAISING NY 501 C (3) 7 NYP FDN 1 NEW YORK PRESBYTERIAN FOUNDATION INC 525 EAST 68TH STREET BOX 156 NEW YORK NY 10065 134153668 SUPPORT ORG NY 501 C (3) 11 TYPE I N/A 0 THE NEW YORK AND PRESBYTERIAN HOSPITAL 525 EAST 68TH STREET BOX 156 NEW YORK NY 10065 133957095 HEALTHCARE NY 501 C (3) 3 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