2023-11-12T22:09:23-06:00 2022-12-31 873231666 PKF O'CONNOR DAVIES ADVISORY LLC 300 TICE BOULEVARD SUITE 315 WOODCLIFF LAKE NJ 07677 990 2022-01-01 453125678 VALLEY PHYSICIAN SERVICES NY PC VALL 2014478000 15 ESSEX ROAD PARAMUS NJ 07652 WILLIAM KLUTKOWSKI SR. VP, FINANCE & CFO 2014478000 2023-11-12 1 WILLIAM KLUTKOWSKI 999009999 0 EDWARD G O'CONNOR P00434443 2017129800 2023-11-09 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z AUDREY MEYERS 15 ESSEX ROAD PARAMUS NJ 07652 12569653 0 X WWW.VALLEYHEALTH.COM X 2011 NY TO PROVIDE MEDICAL CARE AND TO CARRY OUT THE PURPOSES OF THE VALLEY HEALTH SYSTEM, INC. 19 18 28 18 0 0 0 0 9742651 12569653 0 0 0 0 9742651 12569653 1610384 3347152 0 0 6117490 6813007 0 0 0 2014776 2409493 9742650 12569652 1 1 2226917 2370017 1566788 1709887 660129 660130 X TO ENGAGE IN THE RENDERING OF PROFESSIONAL SERVICES OF AND RELATED TO THE PRACTICE OF MEDICINE PURSUANT TO "THE PROFESSIONAL SERVICES CORPORATION ACT, AND TO SUPPORT AND CARRY OUT THE CHARITABLE PURPOSE OF VALLEY HEALTH SYSTEM, INC. THE ORGANIZATION ALSO PROVIDED STRATEGIC FUNDING TO VALLEY HOSPITAL, INC. 0 0 12517824 3347152 12569653 VALLEY PHYSICIAN SERVICES NY, P.C. RENDERED MEDICAL CARE TO A TOTAL OF 42,946 PATIENTS. MEDICAL CARE PROVIDED WAS IN THE FIELDS OF CLINICAL CARDIAC ELECTROPHYSIOLOGY, INTERNAL MEDICINE, AND CARDIOLOGY. THE ORGANIZATION ALSO PROVIDED PROGRAM FUNDING TO VALLEY HOSPITAL, INC. 12517824 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 28 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 18 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X MARIETTA STONE 2012916391 15 ESSEX ROAD PARAMUS NJ 07652 AUDREY MEYERS PRESIDENT & CEO, VHS 1.00 39.00 X X 0 3974039 49572 VINCENT FORLENZA CHAIRMAN 0.10 0.40 X X 0 0 0 KEVIN LOBO VICE CHAIRMAN 0.10 0.40 X X 0 0 0 FRANK J SHEEHY VICE CHAIRMAN 0.10 0.40 X X 0 0 0 ANN LIMBERG VICE CHAIR & SECRETARY 0.10 0.40 X X 0 0 0 JOSEPH MARION TREASURER 0.10 0.40 X X 0 0 0 JUDY BASELICE TRUSTEE 0.10 0.40 X 0 0 0 JAMES BUSH TRUSTEE 0.10 0.40 X 0 0 0 MICHELLE HASSON TRUSTEE 0.10 0.40 X 0 0 0 M SHAWN KENNEDY TRUSTEE 0.10 0.40 X 0 0 0 BRUCE MACTAS TRUSTEE 0.10 0.40 X 0 0 0 DUANE SACHS TRUSTEE 0.10 0.40 X 0 0 0 DENIS SALAMONE TRUSTEE 0.10 0.40 X 0 0 0 SCOTT SCHROEDER TRUSTEE 0.10 0.40 X 0 0 0 EDWARD B SELF MD TRUSTEE 0.10 0.40 X 0 0 0 STEVEN SILVERSTEIN TRUSTEE 0.10 0.40 X 0 0 0 JEFFREY TUCKER TRUSTEE 0.10 0.40 X 0 0 0 PATRICIA VERDUIN TRUSTEE 0.10 0.40 X 0 0 0 WAYNE WALD ESQ TRUSTEE 0.10 0.40 X 0 0 0 ROBERT W BRENNER - PRESIDENT CLINICAL INTEGRATION/ PHYSICIAN ENT. 2.00 38.00 X 0 1461032 28405 WILLIAM KLUTKOWSKI SR. VP, FINANCE & CFO 1.00 39.00 X 0 1016955 57305 DAVID STRASSBERG CHAIR, PRIMARY CARE SERVICES 0.10 39.90 X 0 478540 33620 SUNEET MITTAL PHYSICIAN 0.10 39.90 X 1455507 0 49501 TINA SICHROVSKY MD PHYSICIAN 40.00 0.00 X 669734 0 44206 DAN MUSAT MD PHYSICIAN 40.00 0.00 X 651488 0 12178 ADVAY BHATT MD PHYSICIAN 40.00 0.00 X 566748 0 49132 MARK PREMINGER MD PHYSICIAN 40.00 0.00 X 548428 0 37192 3891905 6930566 361111 10 0 1 0 0 MANAGEMENT FEE 900099 6108543 6108543 PATIENT REVENUE 624100 5695417 5695417 MEDICAL SVCS. TO TVH 624100 765693 765693 12569653 12569653 12569653 0 0 3347152 3347152 6322469 6321469 1000 101928 101928 128856 128856 259754 259702 52 1237214 1237214 102576 51800 50776 59739 59739 583785 583785 4192 4192 100365 100365 61893 61893 CLINICAL SUPPLIES 213930 213930 CONTINUING EDUCATION 34352 34352 MISCELLANEOUS EXPENSES 7806 7806 BAD DEBT EXPENSE 3641 3641 12569652 12517824 51828 0 352371 329978 1129189 1339634 30881 43572 1512570 1357367 252047 155203 462429 501630 2226917 2370017 768738 877118 798050 832769 1566788 1709887 X 660129 660130 660129 660130 2226917 2370017 1 0 X X 0 1 X 1 0 X 1177775 386370 237923 0 0 1802068 6237667 7719881 8573685 9742651 12569653 44843537 7415442 8106251 8811608 9742651 12569653 46645605 0 0 0 46645605 4916 265 5181 7420358 8106516 8811608 9742651 12569653 46650786 X PART III, SECTION A, COLUMN B THE ORGANIZATION IS REPORTING A SHORT YEAR 3/9/18 THROUGH 12/31/18 IN COLUMN (A). 1511405 1357367 154038 1165 1165 155203 SECURITY DEPOSITS 80179 OPERATING LEASE-RIGHT-OF-USE ASSET 409444 DUE FROM AFFILIATE 12007 501630 LEASE LIABILITIES FOR OPERATING LEASE 443993 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 388776 832769 X 281598039 275623947 275623947 5974092 6595561 6595561 12569653 284739390 278765299 278765299 5974091 6595561 6595561 12569652 PART X, LINE 2: VMG RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT VMG HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. VMG IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE OF RELATED ENTITIES INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 275,623,947. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH PATIENT SERVICE REVENUE IN FINANCIAL STATEMENTS 3,641. REVENUE FROM RELATED ORGANIZATION ELIMINATED IN COMBINED FINANCIAL STATEMENT 6,108,543. GRANT TO RELATED ORG. NET WITH REVENUE IN COMBINED FINANCIAL STATEMENT 483,377. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES OF RELATED ENTITIES INCLUDED IN CONSOLIDATED FINANCIAL STATEMENT 278,765,299. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH PATIENT SERVICE REVENUE IN FINANCIAL STATEMENTS 3,641. REVENUE FROM RELATED ORGANIZATION ELIMINATED IN COMBINED FINANCIAL STATEMENT 6,108,543. GRANT TO RELATED ORG. NET WITH REVENUE IN COMBINED FINANCIAL STATEMENT 483,377. 1 THE VALLEY HOSPITAL INC 223 NORTH VAN DIEN AVENUE RIDGEWOOD NJ 07450 221487307 501(C)(3) 3347152 0 PROGRAM FUNDING 1 PART I, LINE 2: THE ORGANIZATION PROVIDED PROGRAM FUNDING TO VALLEY HOSPITAL, INC. THE ORGANIZATION MONITORS THE USE OF THE FUNDS THROUGH COMMON MANAGEMENT. 0 1 0 0 0 0 0 1 0 AUDREY MEYERS PRESIDENT & CEO, VHS 0 1249299 0 984960 0 1739780 0 22875 0 26697 0 4023611 0 1583249 SUNEET MITTAL PHYSICIAN 1138919 0 293465 0 23123 0 10675 0 38826 0 1505008 0 0 0 ROBERT W BRENNER - PRESIDENT CLINICAL INTEGRATION/ PHYSICIAN ENT. 0 816543 0 357704 0 286785 0 13725 0 14680 0 1489437 0 0 WILLIAM KLUTKOWSKI SR. VP, FINANCE & CFO 0 627904 0 192180 0 196871 0 21138 0 36167 0 1074260 0 0 TINA SICHROVSKY MD PHYSICIAN 505112 0 162000 0 2622 0 9450 0 34756 0 713940 0 0 0 DAN MUSAT MD PHYSICIAN 407374 0 242000 0 2114 0 10675 0 1503 0 663666 0 0 0 ADVAY BHATT MD PHYSICIAN 386412 0 179000 0 1336 0 10675 0 38457 0 615880 0 0 0 MARK PREMINGER MD PHYSICIAN 409703 0 132500 0 6225 0 10675 0 26517 0 585620 0 0 0 DAVID STRASSBERG CHAIR, PRIMARY CARE SERVICES 0 429075 0 38625 0 10840 0 10675 0 22945 0 512160 0 0 PART I, LINE 3 VALLEY HEALTH SYSTEM HAS DEVELOPED A COMPENSATION PLAN, WHICH GOVERNS THE COMPENSATION FOR ALL EXECUTIVES, INCLUDING THE CEO AND VICE PRESIDENTS OF THE ORGANIZATION. THE PLAN WAS DEVELOPED IN CONJUNCTION WITH A CONSULTING FIRM, REVIEWED BY THE PHYSICIAN LEADERSHIP COUNCIL AND APPROVED BY THE BOARD OF TRUSTEES AND THE VALLEY HEALTH SYSTEM PHYSICIAN COMPENSATION COMMITTEE. ON AN ANNUAL BASIS, THE PLAN IS REVIEWED AND UPDATED AS NEEDED. PART I, LINE 4B AUDREY MEYERS AND WILLIAM KLUTKOWSKI PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN. AUDREY MEYERS RECEIVED A PAYMENT IN THE AMOUNT OF $1,583,249 FROM THIS PLAN AS REPORTED IN PART II, COLUMN BIII AND COLUMN F. AUDREY MEYERS PARTICIPATED IN A CAP-EX (SPLIT-DOLLAR LIFE INSURANCE PLAN). SHE DID NOT RECEIVE A PAYMENT DURING 2022. PART I, LINE 7 EMPLOYEES OF THE ORGANIZATION RECEIVED A BOARD-APPROVED DISCRETIONARY BONUS, AWARDED BASED ON PERFORMANCE, AS REPORTED FOR THEM IN PART II, COLUMN B(II). FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A PROFESSIONAL CORPORATION WITH SHAREHOLDERS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SHAREHOLDERS ELECT THE TRUSTEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. IT IS REVIEWED BY MANAGEMENT AND THE AUDIT COMMITTEE OF VALLEY HEALTH SYSTEM. A COMPLETE COPY OF THE FORM 990 IS MADE AVAILABLE TO ALL MEMBERS OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE VALLEY HEALTH SYSTEM HAS A CONFLICT OF INTEREST POLICY WHICH COVERS ALL CONTROLLED ORGANIZATIONS WITHIN THE HEALTH SYSTEM, INCLUDING THIS ORGANIZATION. THE POLICY REQUIRES ALL TRUSTEES, OFFICERS, AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS, TO ANNUALLY SIGN A CONFLICT OF INTEREST STATEMENT, DISCLOSING ANY POTENTIAL CONFLICTS WHICH MAY EXIST. SUCH PERSONS ARE ALSO REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS AS THEY ARISE. CONFLICTS ARE DETERMINED BY THE BOARD OF TRUSTEES OR DELEGATED COMMITTEE CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. PERSONS WITH CONFLICTS OF INTEREST MUST NOT PARTICIPATE IN THE DISCUSSION OR VOTE ON THE RELATED MATTER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE VALLEY HOSPITAL FOUNDATION INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 222324554 SOLICITS AND RECEIVES CONTRIBUTIONS FOR THE BENEFIT OF HEALTH SYSTEM NJ 501(C)(3) LINE 7 VALLEY HEALTH SYSTEM INC 0 THE VALLEY HOSPITAL INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 221487307 PROVIDE HEALTHCARE PROGRAMS AND SERVICES TO ALL NJ 501(C)(3) LINE 3 VALLEY HEALTH SYSTEM INC 0 VALLEY HEALTH SYSTEM INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 222922016 PROVIDE MANAGEMENT AND PLANNING SERVICES FOR ITS MEMBERS NJ 501(C)(3) LINE 3 N/A 0 VALLEY HOME CARE INC 15 ESSEX ROAD PARAMUS NJ 07652 223208480 PROVIDE HOME CARE AND HOSPICE SERVICES TO RESIDENTS OF NORTHERN NJ NJ 501(C)(3) LINE 10 VALLEY HEALTH SYSTEM INC 0 VALLEY MEDICAL SERVICES PC 15 ESSEX ROAD PARAMUS NJ 07652 465297054 PROVIDE PRIMARY AND SPECIALTY MEDICAL CARE NJ 501(C)(3) LINE 10 VALLEY PHYSICIAN SERVICES INC 0 VALLEY PHYSICIAN SERVICES INC 223 NORTH VAN DIEN AVE RIDGEWOOD NJ 07450 320041186 PROVIDES MANAGEMENT AND VARIED CONSULTING SERVICES NJ 501(C)(3) LINE 10 THE VALLEY HOSPITAL INC 0 VALLEY PHYSICIAN SERVICES PC 15 ESSEX ROAD PARAMUS NJ 07652 465285330 PROVIDE PRIMARY AND SPECIALTY MEDICAL CARE NJ 501(C)(3) LINE 10 VALLEY PHYSICIAN SERVICES INC 0 VHS INSURANCE COMPANY LTD 010 MAIN STREET CAYMAN ISLANDS CJ 980408200 PROVIDES PROFESSIONAL, MEDICAL, AND COMMERCIAL GENERAL LIABILITY INSURANCE CJ VALLEY HEALTH SYSTEM INC C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1