2013-11-11T09:46:17-06:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 133438643 JACOB PERLOW HOSPICE CORPORATION JACO 7189217742 6323 7TH AVENUE BROOKLYN NY 11220 ALEX BALKO 7189217742 2013-10-30 1 FREDERICK H ROTHMAN P01275277 2128674000 2012 2016-02-24 21:20:13Z MJHS HOSPICE AND PALLIATIVE CARE ALEX BALKO 6323 7TH AVENUE BROOKLYN NY 11220 61389526 0 X N/A X 1987 NY TO PROVIDE HOSPICE SERVICES ON BOTH AN INPATIENT AND OUTPATIENT BASIS. 11 10 278 10 0 0 1068639 4821493 41447443 56527894 0 5765 106464 34374 42622546 61389526 0 0 0 0 17728539 22232452 0 0 0 28733926 37685391 46462465 59917843 -3839919 1471683 11620621 16850309 16387100 20145105 -4766479 -3294796 X JACOB PERLOW IS A NFP ORGANIZATION PROVIDING HOSPICE AND PALLIATIVE CARE SERVICES FOR ADULTS AND CHILDREN. CARE IS PROVIED IN A BROAD CROSS SECTION OF SETTINGS FROM THE COMFORT OF A PATIENT'S OWN HOME TO IN-PATIENT UNITS, NURSING HOMES AND ASSISTED LIVING FACILITIES. 0 0 53479421 56527894 JACOB PERLOW IS A NOT-FOR-PROFIT ORGANIZATION PROVIDING HOSPICE AND PALLIATIVE CARE SERVICES. PERLOW IS COMMITTED TO SERVING THE NEEDS OF ADULTS AND CHILDREN FACING LIFE LIMITING ILLNESSES AS WELL AS THEIR FAMILIES. IN ADDITION TO OFFERING OUR PATIENTS MEDICAL SUPPORT FROM PHYSICIANS AND NURSES CERTIFIED IN HOSPICE OR PALLIATIVE CARE, WE ALSO PROVIDE EMOTIONAL AND SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES THROUGH OUR SOCIAL WORKERS, PASTORAL STAFF AND MUSIC AND ART THERAPISTS. IN ORDER TO SERVE OUR PATIENTS AND FAMILIES WHEN AND WHERE THEY NEED IT MOST, JACOB PERLOW PROVIDES CARE IN THE COMFORT OF A PATIENT'S OWN HOME, OUR DEDICATED IN-PATIENT UNIT AT BETH ISRAEL HOSPITAL, A NUMBER OF HOSPITALS ACROSS GREATER NEW YORK, NURSING HOMES, ASSISTED LIVING FACILITIES AND OUR MOLLIE AND JACK ZICKLIN RESIDENCE IN RIVERDALE. IN 2012, JACOB PERLOW PROVIDED 57,874 HOSPICE DAYS, 166,385 CONTINUOUS HOME CARE DAYS, 145,602 ROUTINE HOME CARE DAYS, 36 INPATIENT RESPITE CARE DAYS AND 12,936 GENERAL INPATIENT CARE DAYS. 53479421 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 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 1 116 0 278 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X PEGGY GUNDERMAN 7189217742 6323-7TH AVE BROOKLYN NY 11220 ELI S FELDMAN 2.00 31.00 X X 82718 1177493 263416 SHMUEL LEFKOWITZ 0.50 3.00 X X 0 0 0 DAVID WIENER 0.50 1.00 X X 0 0 0 RONALD MILCH 0.50 3.50 X 0 0 0 JASON YU 0.50 0.00 X 0 0 0 ESTERE DUBOULAY 0.50 1.00 X 0 0 0 IRVING DAYAN 0.50 1.00 X 0 0 0 BURTON ESRIG 0.50 1.50 X 0 0 0 SUZANNE CUTLER 0.50 X 0 0 0 MARTIN MARCUS 0.50 X 0 0 0 STEVEN ROTTER 0.50 X 0 0 0 ROBERT LEAMER 2.00 31.00 X 27327 389004 125321 ALEX BALKO 2.50 31.00 X 53505 658622 166373 ELLIOT BROOKS 3.00 30.00 X 41252 372531 107053 SUSAN CAPUTO 7.50 24.00 X 117508 361454 172034 BARBARA HINEY 35.00 X 282050 0 28541 BERNARD LEE 35.00 X 323321 0 42691 OLGA BARATT 35.00 X 208263 0 38327 IRINA BELKINA 35.00 X 195081 0 12520 JOYCE PALMIERIE 35.00 X 183144 0 12462 MARA LUGASSY 35.00 X 168115 0 3477 1682284 2959104 972215 36 0 1 0 TOTAL HEALTHCARE STAFFING PO BOX 823461 PHILADELPHIA PA 191823461 TEMP STAFFING 1983743 GOUVERNEUR NURSING HOME 227 MADISON AVENUE NY NY 10002 NURSING HOME 1631123 SHOREFRONT JEWISH GERIATRIC CENTER 3015 W 29TH ST NEW YORK NY 11224 NURSING HOME 1211157 DEWITT REHABILITATION & NURSING 211 EAST 79TH STREET NEW YORK NY 10075 NURSING HOME 1024203 ATRIA SENIOR LIVING FROUP PO BOX 70469 LOUISVILLE KY 40270 SENIOR LIVING 836182 47 4300000 521493 4821493 HOSPICE AND PALLIATIVE CARE 623000 56527894 56527894 56527894 5765 5765 34374 34374 34374 61389526 56527894 0 40139 X 723795 310591 413204 16878725 15411631 1467094 865765 725641 140124 2261537 1875332 386205 1502630 1366189 136441 121998 121998 45468 45468 30751224 30566557 184667 1624587 247010 1377577 854330 412573 441757 434320 346142 88178 1820312 1493300 327012 466737 460569 6168 58610 32870 25740 3766 3766 319183 319183 328227 328227 PROVISION FOR BAD DEBTS 625613 625613 OTHER FEES 231016 231016 59917843 53479421 6438422 0 27000 71700 1486021 1697032 9048610 11428982 1969566 1496847 515351 472719 543639 3179876 11620621 16850309 9174961 12317829 7212139 7827276 16387100 20145105 X -5316479 -3844796 550000 550000 -4766479 -3294796 11620621 16850309 1471683 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 550000 1629 1629 550000 550000 550000 550000 550000 550000 550000 1.00000 0 0 449386 58566 390820 1470764 1438281 32483 49416 49416 472719 DUE FROM METROPOLITAN JEWISH HEALTH SYSTEM FOUNDATION 114661 DUE FROM PARTICIPATING AGENCIES OF METROPOLITAN JEWISH HEALTH SYSTEM 3065215 3179876 DUE TO PARTICIPATING AGENCIES OF MJHS 7827276 7827276 X 60763913 0 60763913 625613 625613 61389526 59292230 0 59292230 625613 625613 59917843 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPICE HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2009 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 625,613. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 625,613. 0 1 0 0 0 0 0 1 0 ELI S FELDMAN 63830 908618 0 0 18888 268875 14997 213486 2293 32640 100008 1423619 12257 174472 ROBERT LEAMER 23358 332497 699 9953 3270 46554 6285 89471 1941 27624 35553 506099 0 0 ALEX BALKO 47282 582012 1408 17336 4815 59274 10278 126516 2222 27357 66005 812495 0 0 ELLIOT BROOKS 35434 319991 1053 9512 4765 43028 9499 85785 1173 10596 51924 468912 0 0 SUSAN CAPUTO 103996 319892 3105 9550 10407 32012 35584 109458 6622 20370 159714 491282 0 0 BARBARA HINEY 265318 0 0 0 16732 0 18125 0 10416 0 310591 0 0 0 BERNARD LEE 321088 0 0 0 2233 0 18125 0 24566 0 366012 0 0 0 OLGA BARATT 206582 0 0 0 1681 0 11946 0 26381 0 246590 0 0 0 IRINA BELKINA 194313 0 0 0 768 0 11908 0 612 0 207601 0 0 0 JOYCE PALMIERIE 171115 0 8500 0 3529 0 12370 0 92 0 195606 0 0 0 MARA LUGASSY 167811 0 0 0 304 0 3385 0 92 0 171592 0 0 0 PART I, LINE 3 THE SALARIES FOR THE EXECUTIVES ARE DETERMINED BY METROPOLITAN JEWISH HEALTH SYSTEM, INC., A RELATED ORGANIZATION. THE METHODS UTILIZED INCLUDE A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANTS, REVIEW OF THE FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEYS OR STUDIES AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE BOARD. PART I, LINE 4B PARTICIPATED IN, OR RECEIVED PAYMENT FROM, A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: ALEXANDER BALKO - $17,782 ELLIOT BROOKS - $17,782 ROBERT LEAMER - $17,782 SUSAN CAPUTO - $17,782 PART I, LINE 7 BONUS ELIGIBILITY IS BASED ON THE EXTENT THAT EACH EXECUTIVE AND EMPLOYEE HAS ACHIEVED HIS/HER GOAL. FORM 990, PART VI, SECTION A, LINE 6 METROPOLITAN JEWISH HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF JACOB PERLOW HOSPICE CORPORATION FORM 990, PART VI, SECTION A, LINE 7A METROPOLITAN JEWISH HEALTH SYSTEM, INC. MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 DRAFTS OF THE COMPLETED RETURNS ARE REVIEWED BY THE EXECUTIVE VP/CFO, SENIOR VP/GENERAL COUNSEL AND THEIR STAFF. ANY COMMENTS ARISING FROM THEIR REVIEW ARE DISCUSSED AND IF REQUIRED, CHANGES ARE MADE TO THE DRAFT. THAT DRAFT WILL BE SUBMITTED TO THE MJHS EXECUTIVE COMMITTEE FOR ITS REVIEW AND APPROVAL. ONCE THE COMMITTEE HAS COMPLETED ITS REVIEW COPIES OF THE RETURNS WILL BE PROVIDED TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS MUST FILE AND MAINTAIN CURRENT THE ORGANIZATION'S DIRECTORS BIOGRAPHICAL INFORMATION FORM AND, ON AN ANNUAL BASIS, COMPLETE THE ORGANIZATION'S DIRECTORS CONFLICT OF INTEREST STATEMENT AND ACKNOWLEDGEMENT WHICH ACKNOWLEDGES THAT EACH INDIVIDUAL HAS DISCLOSED ANY POTENTIAL CONFLICT OF INTEREST; RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; READ AND UNDERSTANDS THE CONFLICTS OF INTEREST POLICY; AND AGREED TO COMPLY WITH THE CONFLICTS OF INTEREST POLICY. THE SENIOR VICE PRESIDENT/GENERAL COUNSEL SUPERVISES THE DISTRIBUTION, COLLECTION AND REVIEW OF THE ANNUAL DIRECTORS CONFLICT OF INTEREST STATEMENT AND ACKNOWLEDGEMENT. FROM TIME TO TIME, DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES AND/OR COMMITTEE MEMBERS ARE REMINDED OF THEIR OBLIGATION TO DISCLOSE POTENTIAL OR ACTUAL CONFLICTS OF INTEREST WHEN AND IF THEY ARISE. PROCEDURES FOR MANAGING IDENTIFIED CONFLICTS: EACH DIRECTOR, PRINCIPAL OFFICER, KEY EMPLOYEE AND MEMBER OF A BOARD COMMITTEE IS REQUIRED TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST TO THE INDIVIDUAL CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. IN THE EVENT OF SUCH A DISCLOSURE, THE INTERESTED PARTY IS EXCUSED FROM THE MEETING AND THE BOARD/COMMITTEE DETERMINES WHETHER A CONFLICT EXISTS. IF THE BOARD/COMMITTEE DETERMINES THAT A CONFLICT EXISTS, THE CHAIRPERSON OF THE BOARD OR DESIGNEE (IF APPROPRIATE) WILL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE AND REPORT TO THE BOARD OF DIRECTORS ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. BASED ON THE INFORMATION FURNISHED BY THE DISINTERESTED PERSON OR COMMITTEE, THE BOARD OF DIRECTORS WILL MAKE A DETERMINATION OF WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR MORE REASONABLE ARRANGEMENTS FROM AN ENTITY OR PERSON THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST IS NOT REASONABLY ATTAINABLE UNDER THE CIRCUMSTANCES, THE BOARD OF DIRECTORS WILL DETERMINE, BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS, WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION. ALL OF THE ACTIONS STATED ABOVE SHALL BE REFLECTED IN THE BOARD/COMMITTEE MINUTES. IN THE EVENT THAT A DIRECTOR, PRINCIPAL OFFICER, KEY EMPLOYEE OR MEMBER OF A BOARD COMMITTEE FAILS TO DISCLOSE A POTENTIAL OR ACTUAL CONFLICT OF INTEREST, THE BOARD/COMMITTEE, AFTER AFFORDING THE INDIVIDUAL DUE PROCESS, SHALL DETERMINE WHETHER THE INDIVIDUAL VIOLATED THE CONFLICT OF INTEREST POLICY BY FAILING TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND, IN THE EVENT OF A DETERMINATION THAT A VIOLATION OCCURRED, TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 METROPOLITAN JEWISH HEALTH SYSTEM, INC., A RELATED ORGANIZATION RETAINS THE SERVICES OF A MAJOR EXECUTIVE COMPENSATION FIRM TO REVIEW MARKET PAY PRACTICES AND AVERAGE SALARY MOVEMENT AMONG SIMILARLY SITUATED EXECUTIVES. THE EXECUTIVE COMPENSATION FIRM IS ASKED TO DEVELOP A COMPARATIVE BASE THAT IS AS CLOSE AS POSSIBLE TO OUR ORGANIZATION. DIFFERENT COMPARATIVE GROUPS ARE CONSIDERED FOR EACH POSITION, CEO AND SENIOR VP'S AS APPROPRIATE. THIS WAS LAST COMPLETED IN SEPTEMBER 2012. THIS MARKET ANALYSIS IS THEN REVIEWED BY THE COMPENSATION COMMITTEE IN DETERMINING SALARY ADJUSTMENTS FROM THE PERSPECTIVE OF MARKET COMPETITIVENESS AND PRIOR YEAR PERFORMANCE. PERFORMANCE IS BASED ON THE EXTENT THAT EACH EXECUTIVE HAS ACHIEVED HIS/HER GOALS. BONUS ELIGIBILITY IS DONE IN A SIMILAR MANNER. OTHER KEY EMPLOYEES ARE MANAGED IN SIMILAR MANNER THROUGH THE HUMAN RESOURCES DEPARTMENT UNDER THE DIRECTION OF THE SENIOR VICE PRESIDENT FOR HUMAN RESOURCES IN CONJUNCTION WITH THE CEO, USING LOCAL SURVEYS TO ENSURE MARKET COMPETITIVENESS. FORM 990, PART VI, SECTION C, LINE 18 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST TO THE OFFICE OF THE PRESIDENT. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST TO THE OFFICE OF THE PRESIDENT. OTHER FEES FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 193,096. MANAGEMENT AND GENERAL EXPENSES 74,396. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 267,492. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 208,278. MANAGEMENT AND GENERAL EXPENSES 56,375. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 264,653. HHA AGENCIES: PROGRAM SERVICE EXPENSES 4,097,028. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,097,028. INPATIENT HOSPICE EXPENSE: PROGRAM SERVICE EXPENSES 20,905,334. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,905,334. MEDICAL EXPENSES: PROGRAM SERVICE EXPENSES 5,147,622. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,147,622. RECRUITMENT FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 50,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,619. TEMP SERVICES: PROGRAM SERVICE EXPENSES 15,199. MANAGEMENT AND GENERAL EXPENSES 3,277. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,476. FORM 990 PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. METROPOLITAN JEWISH HEALTH SYSTEM INC 6323 7TH AVENUE BROOKLYN NY 11220 113538697 ADMINISTRATIVE ACTIVITIES NY 501(C)(3) 7 N/A 0 MJG NURSING HOME CO INC 6323 7TH AVENUE BROOKLYN NY 11220 237123076 NURSING HOME NY 501(C)(3) 3 N/A 0 MENORAH HOME AND HOSPITAL FOR THE AGED AND INFIRM 6323 7TH AVENUE BROOKLYN NY 11220 111572777 NURSING HOME, ADULT DAY NY 501(C)(3) 3 METROPOLITAN JEWISH HEALTH SYSTEM INC 1 SHOREFRONT JEWISH GERIATRIC CENTER INC 6323 7TH AVENUE BROOKLYN NY 11220 113072153 NURSING HOME, ADULT DAY NY 501(C)(3) 9 METROPOLITAN JEWISH HEALTH SYSTEM INC 1 METROPOLITAN JEWISH HOME CARE INC 6323 7TH AVENUE BROOKLYN NY 11220 320060822 HOME CARE, HOSPICE NY 501(C)(3) 9 METROPOLITAN JEWISH HEALTH SYSTEM INC 1 ELDERPLAN INC 6323 7TH AVENUE BROOKLYN NY 11220 112625096 MEDICARE ADVANTAGE SPECIAL NEEDS PLAN / MEDICAID MANAGED LONG TERM CARE PLAN NY 501(C)(3) 9 N/A 0 MENORAH FOUNDATION INC 6323 7TH AVENUE BROOKLYN NY 11220 113471173 FUNDRAISING NY 501(C)(3) 11 TYPE I METROPOLITAN JEWISH HEALTH SYSTEM FOUNDATION 1 HOMEFIRST LHCSA INC 6323 7TH AVENUE BROOKLYN NY 11220 611501623 HOME CARE NY 501(C)(3) 11 TYPE I METROPOLITAN JEWISH HEALTH SYSTEM INC 1 METROPOLITAN JEWISH HEALTH SYSTEM FOUNDATION 6323 7TH AVENUE BROOKLYN NY 11220 111630753 FUNDRAISING NY 501(C)(3) 7 N/A 0 SHOREFRONT TOWERS HOUSING DEVELOPMENT FUND CORPORATION 6323 7TH AVENUE BROOKLYN NY 11220 113200785 HOUSING NY 501(C)(3) 9 N/A 0 MJHS MEDICAL ASSOCIATES PC 6323 7TH AVENUE BROOKLYN NY 11220 275273404 PROVIDING HEALTH CARE SERVICES FOR AFFILIATES OF MJHS NY 501(C)(3) 9 METROPOLITAN JEWISH HEALTH SYSTEM INC 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0