TY 2016 Form 990 Schedule O

efile Public Visual Render ObjectId: 201703179349303650 - Submission: 2017-11-13 TIN: 11-2290533

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2016

Open to Public
Inspection

Name of the organization

CONCORD NURSING HOME INC

Employer identification number

11-2290533

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	CONCORD NURSING HOME, INC. HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD FOR APPROVAL. ONCE THE BOARD HAS APPROVED THE RETURN IT IS FILED WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES OF THE FACILITY MUST ATTEMPT TO AVOID ANY ACTIONS THAT RESULT IN A DIRECT OR INDIRECT CONFLICT BETWEEN HIS OR HER PERSONAL INTERESTS AND THOSE OF THE CENTER. BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SIGN CONFLICT OF INTEREST STATEMENTS ANNUALLY. ALL POTENTIAL CONFLICTS ARE MONITORED AT BOARD MEETINGS THROUGHOUT THE YEAR. IF A POTENTIAL CONFLICT WERE TO ARISE, THE PERSON WOULD DISCLOSE THE CONFLICT TO THE GOVERNING BOARD. THE DISINTERESTED BOARD MEMBERS WOULD REVIEW THE CONFLICT, AND COME TO A RESOLUTION. THE RESOLUTION WOULD BE DOCUMENTED IN THE MINUTES TO THE MEETING.
FORM 990, PART VI, SECTION B, LINE 15A	THE BOARD HAS A COMPENSATION COMMITTEE THAT REVIEWS 990'S FOR OTHER SURROUNDING AREA'S SKILLED NURSING FACILITIES FOR COMPARISON OF COMPENSATION. THE COMPENSATION COMMITTEE ALSO REVIEWS THE EXECUTIVE DIRECTOR'S RESPONSIBILITIES AND DUTIES OF THE OTHER FACILITIES COMPARED TO THEIR OWN EXECUTIVE DIRECTOR'S RESPONSIBILITIES AND DUTIES. THE COMPENSATION COMMITTEE PRESENTS THEIR FINDINGS AND RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS VOTES ANNUALLY ON THE COMPENSATION COMMITTEE'S RECOMMENDATIONS, A MAJORITY VOTE IS NEEDED FOR APPROVAL. THE EXECUTIVE DIRECTOR PRESENTS TO THE HUMAN RESOURCE COMMITTEE OF THE BOARD OF DIRECTORS A PAY INCREASE RECOMMENDATION FOR HIGHLY COMPENSATED EMPLOYEES. THE HUMAN RESOURCE COMMITTEE THEN INVESTIGATES SURROUNDING AREA NURSING HOME SALARIES FOR SUCH HIGHLY COMPENSATED EMPLOYEES. THE HUMAN RESOURCE COMMITTEE THEN PRESENTS THEIR FINDINGS AND RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS VOTES ON THE HUMAN RESOURCES COMMITTEE'S RECOMMENDATIONS, A MAJORITY VOTE IS NEEDED FOR APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ALL ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE DURING REGULAR BUSINESS HOURS AT 300 MADISON STREET, BROOKLYN, NY 11216. THE ORGANIZATION ALSO FILES A COST REPORT WITH NYS DEPARTMENT OF HEALTH THAT CONTAINS FINANCIAL STATEMENTS AND NOTE DISCLOSURES, WHICH IS ALSO AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	CONSULTING: PROGRAM SERVICE EXPENSES 33,464. MANAGEMENT AND GENERAL EXPENSES 185,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 218,707. OCCUPATIONAL & PHYSICAL THERAPISTS: PROGRAM SERVICE EXPENSES 260,550. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 260,550. DIETICIAN: PROGRAM SERVICE EXPENSES 19,513. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,513. RESPIRATORY THERAPY: PROGRAM SERVICE EXPENSES 206,351. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 206,351. LPN & RN AGENCY: PROGRAM SERVICE EXPENSES 573,112. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 573,112. SECURITY: PROGRAM SERVICE EXPENSES 235,274. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 235,274. RADIOLOGY: PROGRAM SERVICE EXPENSES 20,505. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,505. SOCIAL SERVICES: PROGRAM SERVICE EXPENSES 8,286. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,286. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 66,549. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,549.
FORM 990, PART XII, LINE 2C:	THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE SELECTION & OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR.

Return Reference

Explanation

FORM 990, PART VI, SECTION B, LINE 11B

CONCORD NURSING HOME, INC. HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD FOR APPROVAL. ONCE THE BOARD HAS APPROVED THE RETURN IT IS FILED WITH THE INTERNAL REVENUE SERVICE.

FORM 990, PART VI, SECTION B, LINE 12C

ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES OF THE FACILITY MUST ATTEMPT TO AVOID ANY ACTIONS THAT RESULT IN A DIRECT OR INDIRECT CONFLICT BETWEEN HIS OR HER PERSONAL INTERESTS AND THOSE OF THE CENTER. BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SIGN CONFLICT OF INTEREST STATEMENTS ANNUALLY. ALL POTENTIAL CONFLICTS ARE MONITORED AT BOARD MEETINGS THROUGHOUT THE YEAR. IF A POTENTIAL CONFLICT WERE TO ARISE, THE PERSON WOULD DISCLOSE THE CONFLICT TO THE GOVERNING BOARD. THE DISINTERESTED BOARD MEMBERS WOULD REVIEW THE CONFLICT, AND COME TO A RESOLUTION. THE RESOLUTION WOULD BE DOCUMENTED IN THE MINUTES TO THE MEETING.

FORM 990, PART VI, SECTION B, LINE 15A

THE BOARD HAS A COMPENSATION COMMITTEE THAT REVIEWS 990'S FOR OTHER SURROUNDING AREA'S SKILLED NURSING FACILITIES FOR COMPARISON OF COMPENSATION. THE COMPENSATION COMMITTEE ALSO REVIEWS THE EXECUTIVE DIRECTOR'S RESPONSIBILITIES AND DUTIES OF THE OTHER FACILITIES COMPARED TO THEIR OWN EXECUTIVE DIRECTOR'S RESPONSIBILITIES AND DUTIES. THE COMPENSATION COMMITTEE PRESENTS THEIR FINDINGS AND RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS VOTES ANNUALLY ON THE COMPENSATION COMMITTEE'S RECOMMENDATIONS, A MAJORITY VOTE IS NEEDED FOR APPROVAL. THE EXECUTIVE DIRECTOR PRESENTS TO THE HUMAN RESOURCE COMMITTEE OF THE BOARD OF DIRECTORS A PAY INCREASE RECOMMENDATION FOR HIGHLY COMPENSATED EMPLOYEES. THE HUMAN RESOURCE COMMITTEE THEN INVESTIGATES SURROUNDING AREA NURSING HOME SALARIES FOR SUCH HIGHLY COMPENSATED EMPLOYEES. THE HUMAN RESOURCE COMMITTEE THEN PRESENTS THEIR FINDINGS AND RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS VOTES ON THE HUMAN RESOURCES COMMITTEE'S RECOMMENDATIONS, A MAJORITY VOTE IS NEEDED FOR APPROVAL.

FORM 990, PART VI, SECTION C, LINE 19

THE ORGANIZATION MAKES ALL ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE DURING REGULAR BUSINESS HOURS AT 300 MADISON STREET, BROOKLYN, NY 11216. THE ORGANIZATION ALSO FILES A COST REPORT WITH NYS DEPARTMENT OF HEALTH THAT CONTAINS FINANCIAL STATEMENTS AND NOTE DISCLOSURES, WHICH IS ALSO AVAILABLE TO THE PUBLIC UPON REQUEST.

FORM 990, PART IX, LINE 11G

CONSULTING: PROGRAM SERVICE EXPENSES 33,464. MANAGEMENT AND GENERAL EXPENSES 185,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 218,707. OCCUPATIONAL & PHYSICAL THERAPISTS: PROGRAM SERVICE EXPENSES 260,550. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 260,550. DIETICIAN: PROGRAM SERVICE EXPENSES 19,513. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,513. RESPIRATORY THERAPY: PROGRAM SERVICE EXPENSES 206,351. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 206,351. LPN & RN AGENCY: PROGRAM SERVICE EXPENSES 573,112. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 573,112. SECURITY: PROGRAM SERVICE EXPENSES 235,274. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 235,274. RADIOLOGY: PROGRAM SERVICE EXPENSES 20,505. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,505. SOCIAL SERVICES: PROGRAM SERVICE EXPENSES 8,286. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,286. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 66,549. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,549.

FORM 990, PART XII, LINE 2C:

THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE SELECTION & OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2016

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