2012-11-15T09:03:48-06:00 2011-12-31 133385019 O'CONNOR DAVIES MUNNS & DOBBINS LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2011-01-01 135601035 CHAPIN HOME FOR THE AGING CHAP 7187392523 165-01 CHAPIN PARKWAY QUEENS NY 11432 JANET M UNGER 7187392523 2012-11-13 1 GARRETT HIGGINS P00543209 9143818900 2011 2016-02-24 21:20:13Z JANET M UNGER 165-01 CHAPIN PARKWAY QUEENS NY 11432 22018859 0 X WWW.CHAPINHOME.ORG X 1869 NY TO PROVIDE SKILLED NURSING SERVICES, AND LONG-TERM CARE SERVICES IN A RESIDENTIAL HEALTHCARE ENVIRONMENT AND ADULT DAY CARE HEALTHCARE SERVICES ON AN OUTPATIENT BASIS. 11 11 328 20 0 0 283481 28598 19142840 21156106 1066493 831109 0 3046 20492814 22018859 0 0 0 0 13408252 13471729 0 0 0 6662596 7216294 20070848 20688023 421966 1330836 62707949 61611096 20903879 18415810 41804070 43195286 X TO PROVIDE SKILLED NURSING CARE TO ITS FRAIL, ELDERLY RESIDENTS AND ADULT DAY HEALTH SERVICES TO PROGRAM PARTICIPANTS. 0 0 546847 797157 SINCE 1869, CHAPIN HOME HAS BEEN COMMITTED TO PROVIDING CARE, COMFORT, AND COMPANIONSHIP TO THE ELDERLY IN A WARM AND HOME-LIKE ENVIRONMENT. THIS CHAPIN TRADITION IS CARRIED ON WITHIN THE CHAPIN HOME ADULT DAY HEALTHCARE CENTER. THE CENTER PROVIDES COMPREHENSIVE, CREATIVE, AND SPECIALIZED SERVICES TO ENABLE THE OLDER INDIVIDUAL TO REMAIN IN THE COMMUNITY WHILE PROVIDING RESPITE FOR CAREGIVERS. THE CENTER'S GOAL IS TO BE IN PARTNERSHIP WITH THE PARTICIPANT AND THE CAREGIVER IN MAINTAINING QUALITY OF LIFE AND CARE FOR THOSE WE SERVE. CELEBRATION OF INDIVIDUAL DIVERSITY AS WELL AS OUR COMMON HUMANITY IS THE HALLMARK BY WHICH WE ARE GUIDED. WE SUPPLY A SECURE AND DIGNIFIED ENVIRONMENT IN WHICH THE FOLLOWING ARE ACHIEVED: - PROMOTION OF MAXIMUM INDEPENDENCE- PREVENTION OF FUNCTIONAL DETERIORATION - SOCIALIZATION TO ALLEVIATE ISOLATION- SUPPORT AND RESPITE FOR FAMILIES AND CAREGIVERS - DELAY IN OR AVOIDANCE OF INSTITUTIONALIZATION FOR THE CAREGIVER, WE SUPPLY RESPITE AND SUPPORT, COORDINATION OF MEDICAL DUTIES, HELP WITH THE PRESSURE OF CONSUMING RESPONSIBILITIES, AND CONTACT SUPERVISION.UTILIZING AN INTERDISCIPLINARY TEAM APPROACH TO COORDINATE CARE, ONE OR MORE OF THE FOLLOWING SERVICES ARE AVAILABLE: - COUNSELING- INFORMATION AND REFERRAL- MEDICAL - NURSING- NUTRITIONAL- REHABILITATION- SOCIAL WORK- THERAPEUTIC RECREATION- PERSONAL CARE- HOT MEALS- TRANSPORTATIONCHAPIN HOME'S ADULT DAY CENTER HAD 4,899 VISITS DURING 2011. THE DAY CARE CENTER SERVICES FOR UP TO 50 REGISTRANTS WERE PROVIDED TO QUEENS, NY AREA RESIDENTS. 18771591 20358949 PRIVATE, MEDICAID, AND MEDICARE COVERED RESIDENTS RECEIVED SKILLED NURSING CARE IN A 220 BED SKILLED NURSING FACILITY. DURING 2011, THERE WERE 222 ADMISSIONS AND 200 DISCHARGES, AND 75,105 DAYS OF CARE WERE DELIVERED TO THE RESIDENTS.UNDER THE DIRECTION OF THE MEDICAL DIRECTOR, TOTAL CARE IS PROVIDED THROUGH THE SERVICES OF BOARD CERTIFIED ATTENDING PHYSICIANS. CONSULTING PHYSICIANS IN A FULL SPECTRUM OF MEDICAL SPECIALTIES ARE AVAILABLE. ADDITIONALLY, THESE SERVICES ARE OFFERED AS NEEDED:- PSYCHIATRIC - PSYCHOLOGICAL- PODIATRY - AUDIOLOGY - DENTAL - OPHTHALMOLOGY/OPTOMETRYNURSINGA SKILLED DIRECTOR OF NURSING, A FULL STAFF OF REGISTERED NURSES, LICENSED PRACTICAL NURSES AND CERTIFIED NURSING ASSISTANTS PROVIDE PROFESSIONAL AND PERSONAL CARE, TWENTY-FOUR HOURS A DAY, ACCORDING TO THE INDIVIDUALIZED HEALTHCARE PLAN DEVELOPED BY THE CLINICAL TEAM.NUTRITION A REGISTERED DIETITIAN EVALUATES THE NUTRITIONAL NEEDS OF EACH NEW RESIDENT. SPECIAL DIETS ARE PLANNED PROVIDING NUTRITIONAL CARE WITH CONSIDERATION FOR PERSONAL FOOD PREFERENCES. SPECIAL MENUS ARE PREPARED FOR HOLIDAYS AND FESTIVE OCCASIONS, WITH COOKOUTS PLANNED FREQUENTLY DURING THE SUMMER MONTHS. REHABILITATION CHAPIN HOME'S REHAB DEPARTMENT IS ABLE TO HANDLE ANY PLAN OF CARE, BOTH LONG TERM AND SHORT TERM, SET FORTH BY THE PHYSICIAN. OUR THERAPIES INCLUDE:- PHYSICAL THERAPY - OCCUPATIONAL THERAPY - SPEECH THERAPYOUR LICENSED PROFESSIONALS GUIDE RESIDENTS TO ENHANCE THEIR CURRENT POTENTIAL FOR PHYSICAL INDEPENDENCE, MAXIMIZING THEIR LEVEL OF SELF-SUFFICIENCY, AND OVERCOMING PROBLEMS OF DAILY LIVING. SOCIAL SERVICETHE SOCIAL SERVICE STAFF PROVIDES THE SENSITIVE ATTENTION THAT IS VITAL TO THE PROSPECTIVE RESIDENT AND FAMILY. BEGINNING WITH THE INITIAL INTERVIEW THROUGH THE MANY CONCERNS OF GROUP LIVING ADJUSTMENTS, OUR EXPERIENCED AND CARING PROFESSIONALS OFFER ONGOING SUPPORT IN ALL FACETS OF PERSONAL AND COMMUNITY LIVING. 19318438 1 1 0 1 0 0 0 0 1 1 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 1 0 0 0 1 31 0 1 328 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X WILLIAM O'HARA 7187392523 165-01 CHAPIN PARKWAY JAMAICA NY 11432 X REV SARAH BROWN 0.50 X X 0 0 0 DR MADELINE HURSTER 0.50 X X 0 0 0 FLORENCE FIEDLER 0.50 X X 0 0 0 RITA THOMPSON RN 0.50 X X 0 0 0 VIRGINIA BELLING RN 0.50 X 0 0 0 DIANE CUCCHI ESQ 0.50 X X 0 0 0 LAURA DOMINGUEZ 0.50 X 0 0 0 GRADITA TEAHAN 0.50 X 0 0 0 THERESA CLARK 0.50 X 0 0 0 KAREN DONNELLY 0.50 X 0 0 0 SR CAROL DERBY 0.50 X 0 0 0 JANET M UNGER 35.00 X 218462 0 33308 WILLIAM B O'HARA 35.00 X 141621 0 29858 ALYCE BRODY RN 35.00 X 126417 0 24250 DR JOHN RAWLINGS MD 35.00 X 117600 0 31997 ANDREW LOMBARDO 35.00 X 114417 0 13921 718517 0 133334 5 0 1 0 REHAB ALTERNATIVES 75 REMITTANCE DR CHICAGO IL 60603 THERAPIST SERV PT OT ST 345169 ANGELICA CORPORATION PO BOX 823283 PHILADELPHIA PA 19185 LAUNDRY SERVICES 300333 MERIDIAN NURSE RECRUITERS 471 N BROADWAY SUITE 349 JERICHO NY 11753 NURSING SERVICES 191422 DEPENDABLE AMBULETTE INC 2 HORTON AVE VALLEY STREAM NY 11581 AMBULETTE SERVICES 170535 4 28598 28598 MEDICAID NET RESIDENT 623000 14382619 14382619 MEDICARE NET RESIDENT 623000 3233755 3233755 PRIVATE RESIDENT REVEN 623000 2742575 2742575 ADULT DAY HEALTH CARE 621400 797157 797157 21156106 831109 831109 MEDICAL RECORDS FEE 900099 3046 3046 3046 22018859 21156106 0 834155 423249 423249 9312683 9143140 169543 827810 768523 59287 2184730 2115325 69405 723257 682760 40497 82403 82403 45520 45520 7164 7164 1666410 1561340 105070 348075 43937 304138 1393137 1393137 10514 8684 1830 724127 699507 24620 277660 267573 10087 CASH RECEIPTS ASSESSMEN 1046985 1046985 FOOD 777770 777770 LAUNDRY AND LINENS 316935 316935 BAD DEBT EXPENSE 288697 288697 230897 204125 26772 20688023 19318438 1369585 0 3042306 1337087 23859094 29323022 3119003 3940506 32522 78825 96977 23516188 15919273 8206692 7596915 24369507 19316589 62707949 61611096 2513681 2200069 446340 418606 14085070 13767247 3858788 2029888 20903879 18415810 X 41742686 43133902 61384 61384 41804070 43195286 62707949 61611096 X 1330836 60380 X X 0 1 1 X 1 1 X 36542 40550 27626 283481 28598 416797 20970740 20904554 20590451 19142840 21156106 102764691 21007282 20945104 20618077 19426321 21184704 103181488 5000 5000 0 5000 5000 103176488 1237852 1255229 1241166 1066493 831109 5631849 1237852 1255229 1241166 1066493 831109 5631849 3046 3046 22245134 22200333 21859243 20492814 22018859 108816383 0.94820 0.94580 0.05180 0.05410 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MEDICAL RECORDS FEE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7164 7164 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: CHAPIN HOME FOR THE AGING PAYS DUES TO CONTINUING CARE LEADERSHIP COALITION (CCLC). IN ACCORDANCE WITH SECTION 6033(E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY CCLC, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO CCLC DUES WERE $7,164. 0 1 61384 114 114 61384 61384 198 198 61384 61384 1568 1568 61384 61384 2367 2367 61384 1.00000 0 0 9600 9600 21033754 13815312 7218442 2472834 2103961 368873 7596915 ESTIMATED THIRD PARTY LIABILITY 2029888 2029888 22018859 20688023 1330836 60380 60380 1391216 22079239 60380 60380 22018859 0 22018859 20688023 0 20688023 0 20688023 PART IV, LINE 2B: RESIDENTS' FUNDS ARE HELD BY THE HOME ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT LIVING ALLOWANCES RECEIVED BY RESIDENTS AND OTHER RESIDENTS' FUNDS DEPOSITED WITH THE HOME FOR SAFEKEEPING. THESE FUNDS ARE DISBURSED BY THE HOME AT THE REQUEST OF, OR ON BEHALF OF, RESIDENTS FOR THEIR PERSONAL USE. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUND IS TO PROVIDE INTEREST INCOME TO BE USED FOR GENERAL OPERATIONS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOME RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE HOME HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE HOME IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2008. X X X X X 0 0 0 0 0 0 0 0 0 JANET M UNGER 218462 0 0 0 0 0 21076 0 12232 0 251770 0 0 0 WILLIAM B O'HARA 141621 0 0 0 0 0 13901 0 15957 0 171479 0 0 0 ALYCE BRODY RN 126417 0 0 0 0 0 12642 0 11608 0 150667 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 CHAPIN HOME IS A NOT FOR PROFIT MEMBERSHIP CORPORATION FOUNDED IN 1869. CORPORATE MEMBERS PROVIDE BROAD SUPPORT TO THE CORPORATION. THE BOARD OF TRUSTEES IS SELECTED FROM THE CORPORATE MEMBER. THE BOARD OF TRUSTEES MEET MONTHLY EXCEPT DURING THE MONTHS OF JULY AND AUGUST. THE MEMBERSHIP MEETS ANNUALLY. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATION HAS MEMBERS THAT ELECT THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES ELECT, FROM THEMSELVES, THE OFFICERS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERSHIP APPROVES ALL DECISIONS AND ACTIONS BY THE BOARD OF TRUSTEES AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11 CHAPIN HOME'S FORM 990 IS PREPARED BY THE HOME'S COMPTROLLER AND IS THEN REVIEWED BY THE HOME'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM. THE 990 IS THEN DISTRIBUTED TO THE TRUSTEES FOR THEIR REVIEW AT A BOARD MEETING. TRUSTEES ARE ASKED TO REVIEW THE FORM AND DIRECT ANY QUESTIONS TO THE COMPTROLLER FOR RESOLUTION. AT THE NEXT BOARD OF TRUSTEES MEETING, THE TRUSTEES VOTE TO APPROVE THE FORM 990. APPROVAL IS DOCUMENTED IN THE MINUTES OF THE BOARD OF TRUSTEES MEETING. FORM 990, PART VI, SECTION B, LINE 12C CHAPIN HOME HAS A CONFLICT OF INTEREST POLICY APPLICABLE TO ALL BOARD MEMBERS AND KEY EMPLOYEES REQUIRING DISCLOSURE OF ALL ACTUAL AND POTENTIAL CONFLICTS. TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. THERE IS AN OBLIGATION FOR TRUSTEES AND KEY EMPLOYEES TO REMAIN IN COMPLIANCE WITH THIS POLICY THROUGHOUT THE YEAR. COMPLIANCE WITH THE POLICY IS MONITORED CONTINUOUSLY AT BOARD MEETINGS THROUGHOUT THE YEAR. THE POLICY IS ALSO REVIEWED ANNUALLY. IF A CONFLICT IS DISCLOSED THE BOARD DECIDES APPROPRIATE ACTION ON A CASE BY CASE BASIS. THE BOARD MEMBER WITH THE CONFLICT IS EXCUSED FROM VOTING ON THE APPROPRIATE ACTION THAT SHOULD BE TAKEN REGARDING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE EXECUTIVE VICE-PRESIDENT/ADMINISTRATOR IS DETERMINED BY THE BOARD OF TRUSTEES BASED ON THE RESULTS OF SALARY AND COMPENSATION SURVEYS PERFORMED BY INDEPENDENT CONSULTANTS, THE NURSING HOME ASSOCIATION, AND COMPENSATION INFORMATION FROM 990'S FILED BY COMPARABLE NURSING FACILITIES. THE BOARD ALSO WEIGHS THE EXPERIENCE AND PERFORMANCE OF THE EXECUTIVE VICE PRESIDENT IN ARRIVING AT A COMPENSATION ARRANGEMENT. THIS PROCESS IS DOCUMENTED AND SUPPORTED BY THE MINUTES TO THE BOARD OF TRUSTEES' MEETING. ANNUALLY, THE EXECUTIVE VICE PRESIDENT/ADMINISTRATOR PERFORMS A SALARY REVIEW OF ALL UNION FREE EMPLOYEES, INCLUDING THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. BASED ON COMPARABLE SALARIES AT OTHER NURSING HOMES, FORM 990S OF OTHER NURSING HOMES, CURRENT ECONOMIC CONDITIONS, VARIOUS INDUSTRY TRENDS AND INDIVIDUAL EMPLOYEE PERFORMANCE, THE EXECUTIVE VICE PRESIDENT/ADMINISTRATOR DETERMINES WHETHER COMPENSATION SHOULD BE ADJUSTED. BASED ON THE EXECUTIVE PRESIDENT'S REVIEW, HER RECOMMENDATION IS PRESENTED TO THE BOARD OF TRUSTEES FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE FOR INSPECTION DURING REGULAR BUSINESS HOURS AND ON GUIDE STAR. FORM 990, PART VI, SECTION C, LINE 19 CHAPIN HOME MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY FORM 1023, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CHAPIN HOME ALSO FILES AN ANNUAL COST REPORT WITH NEW YORK STATE DEPARTMENT OF HEALTH WHICH CONTAINS FINANCIAL STATEMENTS AND RELATED NOTE DISCLOSURES, WHICH IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: ALL OF THE BOARD MEMBERS OF THE CHAPIN HOME FOR THE AGING, AS WELL AS THE TWO OFFICERS OF THE ORGANIZATION, JANET M. UNGER AND WILLIAM O'HARA, SPEND ON AVERAGE, A HALF HOUR PER MONTH WORKING ON THE RELATED ENTITY, CHAPIN FOUNDATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 60,380. FORM 990, PART XII, LINE 2C: CHAPIN HOME HAS BOARD MEMBERS THAT FUNCTION AS A FINANCE COMMITTEE WHICH HAS THE RESPONSIBILITY FOR ENGAGING AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM TO CONDUCT AN AUDIT OF THE HOME'S FINANCIAL STATEMENTS ON AN ANNUAL BASIS. THE COMMITTEE, THROUGH ITS DESIGNATION TO THE HOME'S CEO AND CFO, MEETS WITH THE AUDITORS PRE-AUDIT TO DISCUSS THE SCOPE OF SERVICES AND ADDRESS POTENTIAL CONCERNS. THE BOARD ALSO MEETS WITH THE AUDITORS POST-AUDIT TO RECEIVE AND REVIEW THE AUDITED FINANCIAL STATEMENTS. THE AUDITORS REPORT TO THE FULL BOARD AND MEMBERSHIP THE RESULTS OF THEIR AUDIT AND THEIR REQUIRED COMMUNICATION WITH THOSE IN CHARGE OF GOVERNANCE AND MANAGEMENT COMMENTS, IF ANY. THIS PROCESS HAS BEEN CONSISTENTLY FOLLOWED YEAR TO YEAR. CHAPIN FOUNDATION INC 165-01 CHAPIN PARKWAY QUEENS NY 11432 112650375 SUPPORT CHARITABLE ORGANIZATIONS NY 501(C)3 7 CHAPIN HOME FOR THE AGING 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0