2013-10-23T14:12:01-05:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 800517818 ELDERSERVE HEALTH INC ELDE 7185811000 5901 PALISADE AVENUE BRONX NY 10471 DANIEL REINGOLD 7185811000 2013-10-09 1 FREDERICK H ROTHMAN P01275277 2128674000 2012 2016-02-24 21:20:13Z DANIEL REINGOLD 5901 PALISADE AVENUE BRONX NY 10471 275777840 0 X N/A X 2009 NY MANAGED LONG TERM CARE 5 3 140 0 0 0 0 0 49471387 259076154 176122 651250 42337 496595 49689846 260223999 0 0 0 0 4339917 10948981 0 0 0 42036172 239135791 46376089 250084772 3313757 10139227 28153184 72080831 21809238 55447982 6343946 16632849 SEE SCHEDULE O.TO SERVE FRAIL ELDERLY AND DISABLED INDIVIDUALS WITH HIGH QUALITY SERVICES TO HELP THEM MAINTAIN MAXIMUM INDEPENDENCE AND QUALITY OF LIFE. 0 0 237496898 259076154 MANAGED LONG TERM CARE FOR 6519 FRAIL ELDERLY AND DISABLED INDIVIDUALS WITH HIGH QUALITY SERVICES TO HELP THEM MAINTAIN MAXIMUM INDEPENDENCE AND QUALITY OF LIFE. 237496898 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 0 0 0 1 89 0 140 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 NY X LUZ LIEBESKIND 7185811317 5901 PALISADE AVENUE BRONX NY 10471 DANIEL REINGOLD 1.00 34.00 X X 0 720799 256163 DAVID POMERANZ 25.00 10.00 X X 0 449041 73587 JOSEPH WYGODA 1.00 8.00 X X 0 0 0 ISADORE KREEL MD 1.00 3.00 X 0 0 0 JAMES SHIFREN 1.00 3.00 X 0 0 0 SUSAN ALDRICH 35.00 1.00 X 420513 0 32653 LUZ LIEBESKIND 5.00 30.00 X 0 323518 30080 DAVID WEINSTEIN 1.00 34.00 X 0 348290 57812 JOHN MCKEON 40.00 X 224024 0 30833 ANNA MARIA ETIENNE 40.00 X 312747 0 19268 IRINA VAINRIB 35.00 X 177202 0 29113 SHELLEY EISENBERG 35.00 X 185747 0 9795 CAMILLE SANDS 35.00 X 182258 0 28883 JENNY LING 35.00 X 213466 0 10217 PAMELA BRYANT 35.00 X 172214 0 17104 1888171 1841648 595508 8 0 1 0 RELAY HEALTH 1564 NORTHEAST EXPRESSWAY ATLANTA GA 30329 PROVIDER CONSULTING 635224 ROPES & GRAY LLP 1211 AVENUE OF THE AMERICAS NEW YORK NY 10036 LEGAL 318886 CYRUSXP PO BOX 393 WYNNEWOOD PA 19096 IT CONSULTING 297156 ROLF KARL 245 HENRY STREET BROOKLYN NY 11201 ARCHITECT 122415 4 MEDICAID CAPITATION 623000 259044463 259044463 OTHER MEDICAID 623000 31691 31691 259076154 528624 528624 15676467 15553841 122626 122626 122626 MISCELLANEOUS 900099 496595 496595 496595 260223999 259076154 0 1147845 X 708023 708023 8672675 7338239 1334436 176794 170488 6306 711790 578136 133654 679699 534455 145244 4822785 4822785 372854 372854 104610 104610 82652 82652 213016887 212526804 490083 355334 22894 332440 4577309 3537709 1039600 1142828 1142828 388619 388619 12860106 12772859 87247 249584 249584 513747 15314 498433 BAD DEBT 648476 648476 250084772 237496898 12587874 0 18926899 32505365 2186086 481063 133007 47472 1615073 353956 771537 1261117 5595027 36718558 540628 1067256 28153184 72080831 19402637 52312102 77602 109683 102700 91880 2226299 2934317 21809238 55447982 X 6343946 16632849 6343946 16632849 28153184 72080831 10139227 149676 0 X X 0 1 X 1 0 X 1602448 49471387 259076154 310149989 1602448 49471387 259076154 310149989 0 0 0 310149989 70373 119752 528624 718749 70373 119752 528624 718749 42337 496595 538932 1672821 49633476 260101373 311407670 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS 375125 78987 296138 1134948 252657 882291 105000 22312 82688 1261117 DUE TO THE HEBREW HOME FOR THE AGED AT RIVERDALE 2752720 DUE TO THIRD PARTIES 181597 2934317 X 260291023 149676 149676 260141347 82652 82652 260223999 250002120 0 250002120 82652 82652 250084772 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: EHI 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. X X X X 0 1 0 0 0 0 0 0 0 DANIEL REINGOLD 0 647036 0 61850 0 11913 0 223918 0 32245 0 976962 0 0 DAVID POMERANZ 0 413426 0 28050 0 7565 0 42750 0 30837 0 522628 0 0 SUSAN ALDRICH 414177 0 0 0 6336 0 30825 0 1828 0 453166 0 0 0 LUZ LIEBESKIND 0 306445 0 15500 0 1573 0 25300 0 4780 0 353598 0 0 DAVID WEINSTEIN 0 322492 0 16500 0 9298 0 28750 0 29062 0 406102 0 0 JOHN MCKEON 204668 0 15000 0 4356 0 9201 0 21632 0 254857 0 0 0 ANNA MARIA ETIENNE 295683 0 15000 0 2064 0 10000 0 9268 0 332015 0 0 0 IRINA VAINRIB 177202 0 0 0 0 0 7172 0 21941 0 206315 0 0 0 SHELLEY EISENBERG 185747 0 0 0 0 0 7335 0 2460 0 195542 0 0 0 CAMILLE SANDS 182258 0 0 0 0 0 7362 0 21521 0 211141 0 0 0 JENNY LING 213466 0 0 0 0 0 8595 0 1622 0 223683 0 0 0 PAMELA BRYANT 172214 0 0 0 0 0 6956 0 10148 0 189318 0 0 0 PART I, LINE 4B DANIEL REINGOLD - 220,668 LUZ LIEBESKIND - $15,500 DAVID POMERANZ - $28,050 DAVID WEINSTEIN - $16,500 FORM 990, PART VI, SECTION A, LINE 6 HEBREW HOME HOLDING CORP. IS THE SOLE MEMBER OF ELDERSERVE HEALTH, INC.. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE REVIEWS THE 990 WITH THE CHIEF FINANCIAL OFFICER AND THE PREPARER, AND REPORTS THEIR FINDINGS TO THE FULL BOARD OF DIRECTORS. THE COMPLETE 990 IS ALSO MADE AVAILABLE FOR THE ENTIRE BOARD OF DIRECTORS TO REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C ON A YEARLY BASIS, THE COMPLIANCE OFFICER, WORKING WITH ADMINISTRATION, DISTRIBUTES CONFLICT OF INTEREST QUESTIONNAIRES TO BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES WITH INSTRUCTIONS TO COMPLETE THE FORMS AND RETURN THEM TO THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER REVIEWS ALL SUBMITTED FORMS AND IDENTIFIES ANY CONFLICTS WHICH NEED TO BE REPORTED, CONSULTING WITH LEGAL COUNSEL, IF NECESSARY. THE COMPLIANCE OFFICER NOTIFIES THE CHAIRMAN OF THE BOARD AND THE CEO OF ANY CONFLICTS SO THAT CONFLICTED INDIVIDUALS APPROPRIATELY RECUSE THEMSELVES FROM DISCUSSIONS AND VOTING ON MATTERS ON WHICH THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 18 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. COMPENSATION DETERMINATION FORM 990, PART VI, LINE 15 THE CEO AND OFFICERS AND KEY EMPLOYEES COMPENSATION IS PAID THROUGH A RELATED COMPANY, HEBREW HOME FOR THE AGED AT RIVERDALE. DETERMINATION OF THE COMPENSATION IS BASED ON INDEPENDENT COMPARATIVE ANALYSIS OF COMPENSATION LEVELS FOR OTHER CEO'S AND OFFICERS IN ORGANIZATIONS OF SIMILAR SIZE IN THE LONG-TERM CARE INDUSTRY IN THE NY METROPOLITAN AREA. THIS IS DONE BY AN INDEPENDENT COMPENSATION CONSULTANT AND THE INFORMATION IS THEN REVIEWED BY A COMPENSATION COMMITTEE AND APPROVED BY THE FULL BOARD OF THE RELATED ENTITIES PAYING THE COMPENSATION. THIS PROCESS WAS LAST DONE IN 2012. OTHER FEES FORM 990, PART IX, LINE 11G NURSING: PROGRAM SERVICE EXPENSES 18,603,414. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,603,414. PERSONAL CARE WORKERS: PROGRAM SERVICE EXPENSES 175,133,123. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,133,123. OTHER: PROGRAM SERVICE EXPENSES 10,441,245. MANAGEMENT AND GENERAL EXPENSES 490,083. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,931,328. SOCIAL DAY CARE FEES: PROGRAM SERVICE EXPENSES 8,349,022. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,349,022. FORM 990, PART XII, LINE 2C PROCESS HAS NOT CHANGED FROM PRIOR YEAR. PALISADE NURSING HOME COMPANY INC 5901 PALISADE AVENUE RIVERDALE NY 10471 132668331 NURSING HOME NY 501(C)(3) 3 HEBREW HOME HOLDING CORP 0 HEBREW HOME HOUSING DEVELOPMENT FUND CO INC 5901 PALISADE AVENUE RIVERDALE NY 10471 132956755 HOUSING NY 501(C)(3) 9 HEBREW HOME HOLDING CORP 0 ELDERSERVE LICENSED HOME CARE SERVICE AGENCY INC 3547 JOHNSON AVENUE BRONX NY 10463 133900644 SERVICE AGENCY NY 501(C)(3) 9 HEBREW HOME HOLDING CORP 0 RIVERDALE TERRACE HOUSING DEVELOPMENT FUND CO INC 5901 PALISADE AVENUE RIVERDALE NY 10471 133900256 HOUSING NY 501(C)(3) 9 HEBREW HOME HOLDING CORP 0 HEBREW HOME FOR THE AGED AT RIVERDALE FOUNDATION INC 5901 PALISADE AVENUE RIVERDALE NY 10471 204352212 FOUNDATION FOR HHAR NY 501(C)(3) 7 N/A 0 HEBREW HOME FOR THE AGED AT RIVERDALE INC 5901 PALISADE AVENUE RIVERDALE NY 10471 131739971 NURSING HOME NY 501(C)(3) 9 HEBREW HOME HOLDING CORP 0 HEBREW HOME HOLDING CORP 5901 PALISADE AVENUE RIVERDALE NY 10471 270996795 TO SUPPORT HEALTHCARE SERVICES NY 501(C)(3) 11 TYPE 1 N/A 0 NATIONAL ALZHEIMER'S CENTER INC 5901 PALISADE AVENUE RIVERDALE NY 10471 133403753 TO PROMOTE ALZHEIMER'S CARE NY 501(C)(3) 11 TYPE 1 HEBREW HOME HOLDING CORP 0 HUDSON HOUSE HOUSING DEVELOPMENT FUND CO INC 5901 PALISADE AVENUE RIVERDALE NY 10471 275547643 HOUSING NY 501(C)(3) 9 HEBREW HOME HOLDING CORP 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 0