2011-11-15T17:36:57-06:00 2010-12-31 JH COHN LLP 1212 6TH AVENUE NEW YORK NY 10036 990 2010-01-01 237085986 SAMUEL SCHULMAN INSTITUTE FOR NURSING AND REHABILITATION SAMU 7182405200 101-01 AVENUE D BROOKLYN NY 11236 MOUNIR F DOSS 7182405200 2011-11-15 1 THOMAS LANNING 2122970400 2010 2016-03-07 17:11:31Z MOUNIR F DOSS 101-01 AVENUE D BROOKLYN NY 11236 76521025 0 X HTTP://BROOKDALEHOSPITAL.ORG X 1970 NY THE SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHABILITATION IS A VOLUNTARY, NON-PROFIT, RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO PROVIDING THE HIGHEST QUALITY OF MEDICAL CARE IN A HOMELIKE ENVIRONMENT. 22 18 601 100 0 0 250 0 67410398 73397274 104761 8595 230545 233291 67745954 73639160 0 0 0 0 34501785 37094426 0 0 0 53106704 50055305 87608489 87149731 -19862535 -13510571 33073658 34863554 126559728 141857856 -93486070 -106994302 THE SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHABILITATION IS A VOLUNTARY, NON-PROFIT, RESIDENTIAL HEALTHCARE FACILITY DEDICATED TO PROVIDING THE HIGHEST QUALITY OF MEDICAL CARE IN A HOMELIKE ENVIRONMENT. 0 0 72570704 73397274 THE SCHULMAN AND SCHACHNE INSTITUTE FOR NURSING AND REHABILITATION, INC. ("THE INSTITUTE") IS A 448 BED SKILLED NURSING FACILITY WHICH PROVIDES PATIENT HEALTH SERVICES TO ITS RESIDENTS. 72570704 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 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 0 1 51 0 1 601 1 0 0 0 0 0 0 0 0 0 0 X 22 18 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X MOUNIR F DOSS EXECUTIVE VP AND CFO 7182405773 101-01 AVE D BROOKLYN NY 11236 X ALEX ROVT 1.00 X X 0 0 0 ALLEN B SWERDLICK 1.00 X 0 0 0 ALVIN I KAHN MD 40.00 X X 0 297852 62954 ASCHER L MESTEL MD 1.00 X 0 0 0 DARRYL TOWNS 1.00 X 0 0 0 DAVID I SCHACHNE 1.00 X X 0 0 0 DAVID P ROSEN 80.00 X X 0 1737965 71372 DAVID R WILKES 1.00 X 0 0 0 DAVID SCHLANG 1.00 X 0 0 0 DIANE SIMON 1.00 X 0 0 0 EDWARD BIRNBAUM 1.00 X 0 0 0 EDWIN SCHULMAN 1.00 X 0 0 0 HUGH GREENBERG 1.00 X 0 0 0 HUGH NELSON 1.00 X 0 0 0 IRINA BENFELD 1.00 X 0 0 0 LAURENCE C ZALE 1.00 X X 0 0 0 LESLIE STEPHEN 1.00 X 0 0 0 LEWIS MARSHALL 1.00 X 0 386250 58789 LOWELL M RUBIN 1.00 X 0 0 0 RICHARD FOGLER 1.00 X 0 632683 56293 RICHARD RADUTZKY 1.00 X X 0 0 0 STEPHEN PLOTNICK 1.00 X 0 0 0 BRUCE J FLANZ 80.00 X 0 1340143 70165 MOUNIR F DOSS 80.00 X 0 1382657 72404 AHMED G HAIDER 40.00 X 152526 0 35027 GENEVIEVE SORENSEN 40.00 X 245452 0 46115 MOHAMMAD KALAM 40.00 X 131383 0 13341 MRIDULA SAXENA 40.00 X 157641 0 43985 VIMALSON MONIKAM 40.00 X 136069 0 26994 823071 5777550 557439 5 0 1 0 AFFINITY REHABILIATION LLP 10600 YORK ROAD SUITE 105 COCKEYSVILLE MD 21030 THERAPY STAFFING 729055 HEALTHPRO MANAGEMENT SERVICES 10600 YORK ROAD SUITE 105 COCKEYSVILLE MD 21030 THERAPY MANAGEMENT 459905 TRANE CO 45-18 COURT SQUARE LONG ISLAND CITY NY 11101 REPAIRS & MAINT. 459616 IN STEP INTERIORS PO BOX 756 26 ROBIN LANE LEVITTOWN NY 11756 OFFICE FURNITURE 137145 DAVMAR MEDICAL PRODUCTS 35 E GRASSY SPRAIN RD YONKERS NY 10710 MEDICAL SUPPLIES 102257 5 PATIENT SERVICES 623000 73397274 73397274 73397274 23460 23460 219648 219648 219648 219648 2867000 2881865 -14865 -14865 -14865 MISCELLANEOUS 623000 9920 9920 GIFT SHOP 453220 3723 3723 13643 73639160 73407194 0 231966 27508179 24776702 2731477 1599109 1439198 159911 5872782 5285504 587278 2114356 1902920 211436 26196 26196 38065564 27845719 10219845 7042 2385 4657 37602 34727 2875 725717 725717 8442 3774 4668 8942 6981 1961 669522 602451 67071 1357794 1222015 135779 108929 62777 46152 CASH RECEIPT ASSESSMENT 3888469 3888469 SUPPLIES 2403940 2339017 64923 BAD DEBTS 2246574 2246574 EQUIPMENT LEASES/RENTAL 233489 161571 71918 DUES & LICENSES 132665 24203 108462 134418 134418 87149731 72570704 14579027 0 423266 64849 498656 878568 11276516 14422589 1842 18141 50416113 39434224 10611633 10981889 9705332 8067940 386536 262735 169877 166843 33073658 34863554 4736124 4987285 14217166 11445932 107606438 125424639 126559728 141857856 X -93486070 -106994302 -93486070 -106994302 33073658 34863554 X -13510571 2339 X X 0 1 1 X 0 X 0 0 0 0 0 0 1 31553 0 0 31553 0 623716 623716 34094551 27330157 6764394 1137684 1043182 94502 13861833 10462883 3398950 698329 598002 100327 10981889 US GOVERNMENT AND AGENCY SECURITIES 8067940 F 8067940 DUE TO THIRD PARTY PAYORS 51337924 FUNDS HELD IN TRUST FOR RESIDENTS 172908 DUE TO AFFILIATES 73913807 125424639 73639160 87149731 -13510571 2339 2339 -13508232 73641973 2339 474 2813 73639160 0 73639160 87149731 0 87149731 0 87149731 PART XII, LINE 2D - OTHER ADJUSTMENTS: RELATED PARTY INCOME 474. 0 0 0 0 0 0 0 0 0 ALVIN I KAHN MD 0 296456 0 0 0 1396 0 57756 0 5198 0 360806 0 0 DAVID P ROSEN 0 1378292 0 0 0 359673 0 57756 0 13616 0 1809337 0 0 LEWIS MARSHALL 0 385008 0 0 0 1242 0 43317 0 15472 0 445039 0 0 RICHARD FOGLER 0 632439 0 0 0 244 0 45114 0 11179 0 688976 0 0 BRUCE J FLANZ 0 1091240 0 0 0 248903 0 57756 0 12409 0 1410308 0 0 MOUNIR F DOSS 0 1093356 0 0 0 289301 0 59969 0 12435 0 1455061 0 0 AHMED G HAIDER 152060 0 0 0 466 0 21408 0 13619 0 187553 0 0 0 GENEVIEVE SORENSEN 235267 0 0 0 10185 0 40917 0 5198 0 291567 0 0 0 MRIDULA SAXENA 155487 0 0 0 2154 0 27306 0 16679 0 201626 0 0 0 VIMALSON MONIKAM 135917 0 0 0 152 0 12682 0 14312 0 163063 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 A. KAHN, MD, TRUSTEE & CHAIRMAN, HAS A FAMILY RELATIONSHIP WITH D. SIMON, TRUSTEE. FORM 990, PART VI, SECTION A, LINE 6 MEDISYS HEALTH NETWORK IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A MEDISYS HEALTH NETWORK, AS SOLE MEMBER CAN APPOINT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND APPROPRIATE SCHEDULES, AS REQUIRED (FORM 990), ARE PREPARED BY OUTSIDE ACCOUNTANT AND REVIEWED INTERNALLY BY MANAGEMENT, AT WHICH TIME IT IS CONSIDERED THE FINAL DRAFT. THE FINAL DRAFT OF THE FORM 990 IS PRESENTED TO THE TRUSTEES VIA EMAIL AND OR A BOARD MEETING. ONCE THE REVIEW OF THE FORM 990 HAS BEEN COMPLETED TO THE BOARD'S SATISFACTION AND THE BOARD IS COMFORTABLE WITH ITS CONTENTS, THE FORM 990 IS THEN MAILED TO ALL BOARD MEMBERS AS READY TO FILE, SUBSEQUENTLY IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURE IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY BY EMPLOYEES THAT SATISFY THE CRITERIA TO BE CONSIDERED AN "INTERESTED PERSON" IS SUBMITTED UPON HIRING AND ANNUALLY THEREAFTER. THE AUDIT & COMPLIANCE COMMITTEE REVIEWS THE SUBMISSIONS FOR CONFLICTS AND THE DEPARTMENT OF INTERNAL AUDIT MONITORS COMPLIANCE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS - CERTIFICATE OF INCORPORATION FILED WITH THE NYS DEPARTMENT OF STATE; CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1B: FOR DAVID ROSEN, PRESIDENT & CEO, MOUNIR DOSS, EXECUTIVE VICE PRESIDENT & CFO, AND BRUCE FLANZ, EXECUTIVE VICE PRESIDENT & COO, THE HOURS REPORTED REFLECT TOTAL TIME WORKED AS OFFICERS FOR ALL OF THE RELATED ORGANIZATIONS SHOWN ON SCHEDULE R. TOTAL COMPENSATION IS REPORTED ON EACH ENTITY'S FORM 990. COST ALLOCATION AMONG THE ENTITIES IS PERFORMED CONSISTENT WITH ACCOUNTING RULES AND APPLICABLE COST ALLOCATION METHODOLOGIES. ALVIN I. KAHN M.D., RECEIVED COMPENSATION FOR THE PERFORMANCE OF SERVICES AS A PHYSICIAN FOR BROOKDALE HOSPITAL MEDICAL CENTER. ALVIN I. KAHN M.D. RECEIVED NO COMPENSATION AS A CHAIRMAN OF THE BOARD FOR THE SCHULMAN BROOKDALE HOSPITAL MEDICAL CENTER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,339. FORM 990, PART XI, 2C: THE OVERSIGHT AND SELECTION PROCESS DID NOT CHANGE FROM PRIOR YEAR. FORM 990, PART VII, COLUMN C: MANAGEMENT HAS IN THE PREPARATION OF ITS FORM 990 REVIEWED PERSONNEL IN THE INSTITUTION TO SEE IF ANYONE MEETS THE CRITERIA ESTABLISHED TO BE CONSIDERED A "KEY EMPLOYEE" FOR IRS PURPOSES. IT IS THE CONTENTION OF MANAGEMENT THAT NO EMPLOYEE FULFILLS ANY OF THE SITUATIONS UNDER THE RESPONSIBILITY TEST ESTABLISHED BY THE IRS TO MEET TITLE OF KEY EMPLOYEE. THEREFORE, PART VII OF FORM 990 DOES NOT HAVE ANY INDIVIDUALS WHO WOULD BE CONSIDERED A "KEY EMPLOYEE". FORM 990, PART IV, LINE 20: THE ORGANIZATION RECEIVED ITS PUBLIC EXEMPTION STATUS UNDER A HOSPITAL SECTION 170(B)(1)(A)(III), HOWEVER, ITS OPERATING CERTIFICATE DOES NOT CLASSIFY THEM AS A HOSPITAL FOR PURPOSES OF FILING SCHEDULE H. 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