SENIOR CARE CONNECTION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SENIOR CARE CONNECTION INC (EIN 14-1708754)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-08-15
IRS object ID
201112279349303441
Schema version
2010v3.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-15T13:03:51-07:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Northeast HealthBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12212 Burdett AveAddressLine1
CityTroyCity
StateNYState
ZIP Code121802401ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN141708754EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Senior Care Connection IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSENINameControl
Phone5183823290Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1504 State StreetAddressLine1
CitySchenectadyCity
StateNYState
ZIP Code12305ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRich PettersonName
TitleCFOTitle
Date Signed2011-08-15DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts10792744GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteNEHEALTH.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTo provide a high quality,accessible continuum of healthcare,supportive housing and community services.ActivityOrMissionDescription
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees172TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year2178ContributionsGrantsPriorYear
Contributions Grants Current Year1437ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11152436ProgramServiceRevenuePriorYear
Program Service Revenue CY10567308ProgramServiceRevenueCY
Investment Income Prior Year1283InvestmentIncomePriorYear
Investment Income Current Year-788InvestmentIncomeCurrentYear
Other Revenue Prior Year78611OtherRevenuePriorYear
Other Revenue Current Year224787OtherRevenueCurrentYear
Total Revenue Prior Year11234508TotalRevenuePriorYear
Total Revenue Current Year10792744TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5456902SalariesEtcPriorYear
Salaries Etc Current Year5597641SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5645518OtherExpensePriorYear
Other Expenses Current Year5618365OtherExpensesCurrentYear
Total Expenses Prior Year11102420TotalExpensesPriorYear
Total Expenses Current Year11216006TotalExpensesCurrentYear
Revenues Less Expenses Prior Year132088RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-423262RevenuesLessExpensesCY
Total Assets BOY3006193TotalAssetsBOY
Total Assets EOY2878749TotalAssetsEOY
Total Liabilities BOY1121886TotalLiabilitiesBOY
Total Liabilities EOY1257608TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1884307NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1621141NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide a high quality,accessible continuum of healthcare,supportive housing and community services.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense10208594Expense
Revenue10567308Revenue
DescriptionChronic care management program for the care of the elderly and disabled individualsincluding long term home health care,social day care and a hospital extension clinic.Description
Total Program Service Expense10208594TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109649NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees172NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRichard M MontalNamePerson
Telephone Number5188316350TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1504 State StreetAddressLine1
CitySchenectadyCity
StateNYState
ZIP Code12305ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerFormerFormerKey EmployeeKeyEmployee
William J Foley PhD
Board Member2.00X000
Thomas Nowak
Treasurer4.00X000X
Russell Oster
Board Member2.00X000
Ronald L Guzior
Board Member2.00X000
Robert W Johnson III Esq
Chair4.00X000X
Robert Fortune
Board Member2.00X000
Robert C DavenportMD
0.0001072727300X
Robert Bylancik CHE
Board Member2.00X0500000
Richard Petterson
VP,Fiscal & Adm1.90020984426700X
Nancy Barkowski MD
M.D.36.0015487201135X
Mark Cartwright
Board Member2.00X000
Lisa ThornMD
Board Member2.00X0250000
John M Lang
Board Member2.00X000
JoAnn Constantino
CEO of the Eddy1.00034292818369X
Jane AltesPHD
Board Member2.00X000
James VPuleoMD
Board Member2.00X0250000
James Slavin MD
Board Member2.00X000
James K Reed MD
Board Member0.00X050807328508
James H Puleo MD
Board Member2.00X000
James E ProutEsq
Board Member2.00X000
Harry L Robinson Esq
Board Member2.00X000
Harold Gordon Esq
Vice Chair4.00X000X
Craig Duncan
0.0004026370X
Chester Opalka
Board Member2.00X000
Bernadette Hallam
VP/Director40.0012691304299X
Anthony Tartaglia MD
Secretary4.00X000X
Ann DiSarro
Board Member2.00X000
Alan Goldberg
Board Member2.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org281785TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1670754TotalReportableCompFrmRltdOrgs
Total Other Compensation86311TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Royal Care Pharmacy
PO Box 631285CincinnatiOH452631285Pharmacy799001
Rose & Kiernan
99 Troy Road PO Box 640East GreenbushNY12061Employee Beni Admin420726
Glendale Nursing Home
59 Hetcheltown RoadScotiaNY12302Skilled Nursing Faci535768
Ellis Hospital
1101 Nott StreetSchenectadyNY12308Hospital Services847992
Baptist Health And Rehabilitation
297 N Ballston AvenueScotiaNY12302Skilled Nursing Faci335305
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
All Other Contributions1437AllOtherContributions
Total Contributions1437TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionCapitation revenueDescription
Total Revenue Column10567308TotalRevenueColumn
Related Or Exempt Function Income10567308RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10567308TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column-788TotalRevenueColumn
Related Or Exempt Function Income-788RelatedOrExemptFunctionIncome

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOther Operating RevenueDescription
Total Revenue Column224787TotalRevenueColumn
Related Or Exempt Function Income224787RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue224787TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10792744TotalRevenueColumn
Related Or Exempt Function Income10791307RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total287218Total
Program Services156007ProgramServices
Management And General131211ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4284185Total
Program Services4041512ProgramServices
Management And General242673ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1026238Total
Program Services942304ProgramServices
Management And General83934ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1398303Total
Program Services1368937ProgramServices
Management And General29366ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total202974Total
Program Services184743ProgramServices
Management And General18231ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Purchased Services40167693514772501997
Bad debt319319

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11216006Total
Program Services10208594ProgramServices
Management And General1007412ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1592655BOY
EOY1533112EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY30096BOY
EOY67091EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY56191BOY
EOY12346EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1996729LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1309456LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY762007BOY
EOY687273EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY565244BOY
EOY578927EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3006193BOY
EOY2878749EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY833619BOY
EOY1007701EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY288267BOY
EOY249907EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1121886BOY
EOY1257608EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1873585BOY
EOY1609531EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY10722BOY
EOY11610EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1884307BOY
EOY1621141EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3006193BOY
EOY2878749EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-423262ReconcilationRevenueExpenses
Reconcilation Other Changes160096ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1653CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1183CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3419CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2178CurrentTaxYearMinus1Year
Current Tax Year1437CurrentTaxYear
Total9870Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5991001CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8036912CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10424824CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11152436CurrentTaxYearMinus1Year
Current Tax Year10567308CurrentTaxYear
Total46172481Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5992654CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8038095CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10428243CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11154614CurrentTaxYearMinus1Year
Current Tax Year10568745CurrentTaxYear
Total46182351Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50946182351PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Total0Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5992654CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8038095CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10428243CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11154614CurrentTaxYearMinus1Year
Current Tax Year10568745CurrentTaxYear
Total46182351Total
FieldValueIRS element (for citing)
Public Support Percentage5091.00000PublicSupportPercentage509
Prior Year Support Percentage1.00000PriorYearSupportPercentage
Investment Income Percentage0.00000InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis975641OtherCostOrOtherBasis
Depreciation675345Depreciation
Book Value300296BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis980441OtherCostOrOtherBasis
Depreciation619451Depreciation
Book Value360990BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis40647OtherCostOrOtherBasis
Depreciation14660Depreciation
Book Value25987BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings687273TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Risk Reserve Fund524554
Interest in Northeast Health Foundation11610
Estimated Third party settlements42763
FieldValueIRS element (for citing)
Total Book Value Other Assets578927TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Net Pension Liability$110,213
Due to LTC, Eddy$129,622
Due to Affiliates$10,072
FieldValueIRS element (for citing)
Total Of Amounts249907TotalOfAmounts
Total Revenue10792744TotalRevenue
Total Expenses11216006TotalExpenses
Excess Or Deficit For Year-423262ExcessOrDeficitForYear
Other$160,096OtherAmount
Total Adjustments160096TotalAdjustments
Excess Or Deficit Per FS-263166ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt10792744TotRevenueEtcAuditedFinclStmt
Revenue Subtotal10792744RevenueSubtotal
Total Revenue Per Form99010792744TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11216006TotExpensesEtcAuditedFinclStmt
Expenses Subtotal11216006ExpensesSubtotal
Total Expenses Per Form99011216006TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part XPart X : FIN48 FootnoteNortheast Health is classified for tax purposes as an organization under 501(c)(3)of the Internal Revenue Code (the Code),and as such it is generally exempt from income taxes under the provisions of Section 501(a)of the Code.
Part XI, Line 8Part XI, Line 8: Other Changes in Net Assets or Fund BalancesNet Assets released for PP&E $148918 Pension related changes other than net periodic Pension cost $11849 Change in Elderfund & NEH Foundation $888 Transfer to Affiliate $ -1559

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Robert C DavenportMD
96364934997442783022114572
Richard Petterson
2062003230414872317977236544
Nancy Barkowski MD
154872315820156007
JoAnn Constantino
312858776522305116726697361297
James K Reed MD
46079714190330861482713681536581
Craig Duncan
402637402637

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSch J, Part I, Line 7Identifier
Return ReferencePart I, Line 7: Non-Fixed payments not listed aboveReturnReference
ExplanationA bonus based on objective non financial performance measures was paid to Bernadette Hallam,the amount of which is included in Part VII, Section A, Line 1a, column (D).Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part VII,Section A Line 1a.Hours of Officers,Directors,Key Employees and Highest Compensated Employees:The following officers,directors,key employees and highest compensated employees devote the indicated average number of weekly hours to related organizations:Rich Petterson 38.1 hours per weekJo-Ann Costantino 39.0 hours per weekDr. James Reed 40.0 hours per week
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableIn 2010,Northeast Health and its affilates did not make the above-named documents available to the public,although certificates of incorporation were available fron the NYS Secretary of State.Form 990, Part VI, Line 19
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe executive compensation policy described in the note for Line 15a also applies to other officers and key employees of the organization.Form 990, Part VI, Line 15b
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsNortheast Health, the health system to which Eddy SeniorCare belongs,has two system-wide conflict of interest policies,one applicable to the board of directors of each system affiliate and one applicable to administrative staff and select employees and medical staff.Together,the two policies require annual disclosure of conflicts of interest by all directors,officers and key employees,and prescribe various responses to such conflicts applying customary conflicts of interest principles.Employee disclosure forms are reviewed annually by the system compliance officer for a determination of any conflict's impact on the integrity of the disclosing individual's acts and decisions.Violation of the policy subjects an employee to potential disciplinary action.Board of directors conflict of interest disclosure forms are reviewed and summarized by the system compliance officer, and the summary is reviewed by the board corporate compliance and audit committee and any necessary action taken by such committee.Customary procedures are followed,including non-participation by affected individuals in the deliberation and vote on any matters that potentially conflict with the individual's outside interests.Appropriate corrective action is taken by the Board in the event of a director's failure to disclose a conflict of interest or other violation of the policy.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11: Form 990 Review ProcessFirst,Form 990 was presented to the Board Audit/Compliance Committee for review at a special meeting,to which all other Board members were invited to attend. The 990 was then made available on the Board website for all Board members to review.Form 990, Part VI, Line 11
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyNortheast Health elects the members of the organization's governing body.Form 990, Part VI, Line 7a
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderLTC(EDDY),Inc.Form 990, Part VI, Line 6
Form 990, Part VI, Line 4: Description of Significant Changes to Organizational DocumentsThe organization amended its bylaws to extend the date until which the number of directors is set at no less than 17 nor more than 27,to January 2012,and to provide that directors whose final term expires in January 2011 may be re-elected and serve for an additional year,until January 2012.Form 990, Part VI, Line 4
Form 990, Part VI, Line 3: Description of Delegated Duties to Management CompanyThe organization delegated control over certain duties of key employees to a related exempt organization.Form 990, Part VI, Line 3
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtDirectors James E. Prout and Robert W. Johnson,have a business relationship.Directors James H.Puleo,M.D. and James V.Puleo,M.D.have a family relationship.Form 990, Part VI, Line 2

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (16 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgLegal Domicile StateLegalDomicileState
The Capital Region Geriatric Center Inc
421 West Columbia StreetCohoesNY12047141701597Nursing home501(c)(3)Line 9NAfalse
Shaker Properties Inc
2212 Budett AvenueTroyNY12180223119822Real estate holding501(c)(2)N/ANAfalseNY
Beechwood Inc
2218 Burdett AvenueTroyNY12180141651563Real estate holding501(c)(2)N/ANAfalseNY
Glen Eddy Inc
1 Glen Eddy DriveNiskayunaNY12309141794150Independent/assisted living501(c)(3)Line 9NAfalseNY
Beverwyck Inc
40 Autumn DriveSlingerlandsNY12159141717028Independent/assisted living501(c)(3)Line 9NAfalseNY
Hawthorne Ridge Inc
30 Community WayEast GreenbushNY12061800102840Independent/assisted living501(c)(3)Line 9NAfalseNY
Empire Home Infusion Service Inc
10 Blacksmith Drive Suite 2MaltaNY12020141795732Home Care501(c)(3)Line 9NAfalseNY
The Marjorie Doyle Rockwell Center Inc
421 West Columbia StreetCohoesNY12047141793885Adult home/Alzheimer501(c)(3)Line 9NAfalseNY
Home Aide Service of Eastern New YorkIn
433 River StreetTroyNY12180141514867Home Care510(c)(3)Line 9NAfalseNY
Heritage House Nursing Center Inc
2920 Tibbits AvenueTroyNY12180141725101Nursing home501(c)(3)Line 9NAfalseNY
The James A Eddy Memorial Geriatric Cen
2256 Burdett AvenueTroyNY12180222570478Nursing home501(c)(3)Line 9NAfalseNY
Sunnyview Hospital and Rehabilitation Ce
1270 Belmont AvenueSchenectadyNY12308141338386Rehabilitation hospital501(c)(3)Line 3NAfalseNY
Samaritan Hospital of Troy New York
2215 Burdett AvenueTroyNY12180141338544General hospital501(c)(3)Line 3NAfalseNY
Memorial Hospital Albany NY
600 Northern BoulevardAlbanyNY12204141338457General hospital501(c)(3)Line 3NAfalseNY
LTC Eddy Inc
2212 Burdett AvenueTroyNY12180222564710Elderly health/housing501(c)(3)Line11,Type 2NAfalseNY
Northeast HealthInc
2212 Burdett AveTroyNY12180042450756Health System501(c)(3)Line11,Type 2NAfalseNY

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Samaritan Medical Office Building IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12231 Burdett AveAddressLine1
CityTroyCity
StateNYState
ZIP Code12180ZIPCode
FieldValueIRS element (for citing)
EIN141607244EIN
Primary ActivityReal EstatePrimaryActivity
Legal Domicile StateNYLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CorpTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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