2022-07-29T08:56:08-05:00 2021-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-01-01 210634535 SAINT MARY'S CATHOLIC HOME SAIN 8563424100 1845 HADDON AVENUE CAMDEN NJ 08103 ROBERT WAITE CONTROLLER 8563424100 2022-07-28 1 ROBERT WAITE XXX-XX-XXXX KERRI N BOGDA CPA P00760402 7177404863 X 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ROBERT WAITE 1845 HADDON AVENUE CAMDEN NJ 08103 2543 0 0928 X WWW.CAMDENDIOCESE.ORG X 1952 NJ OUR MISSION WAS TO OPERATE A NOT-FOR-PROFIT CATHOLIC BASED SKILLED NURSING FACILITY PROVIDING OUR RESIDENTS WITH THE BEST NURSING CARE AND REHABILITATION SERVICES, WHILE ENHANCING THE QUALITY OF LIFE IN A DIGNIFIED, SAFE ATMOSPHERE. WE SOUGHT TO PROVIDE APPROPRIATE SERVICE TO ALL WHO ASKED FOR OUR ASSISTANCE. THE TAX ID # ALSO REMAINS ACTIVE TO REFLECT ADJUSTMENTS MADE TO ASSETS AND LIABILITIES ASSOCIATED WITH THE SKILLED NURSING FACILITY. 5 3 0 3 0 0 0 0 0 0 -300 2543 57189 0 56889 2543 0 0 0 0 0 0 0 0 0 84296 77078 84296 77078 -27407 -74535 12895379 12823144 18404190 18406490 -5508811 -5583346 X OUR MISSION WAS TO OPERATE A NOT-FOR-PROFIT CATHOLIC BASED SKILLED NURSING FACILITY PROVIDING OUR RESIDENTS WITH THE BEST NURSING CARE AND REHABILITATION SERVICES, WHILE ENHANCING THE QUALITY OF LIFE IN A DIGNIFIED, SAFE ATMOSPHERE. WE SOUGHT TO PROVIDE APPROPRIATE SERVICE TO ALL WHO ASKED FOR OUR ASSISTANCE. 0 0 10371 0 0 SAINT MARY'S CATHOLIC HOME'S ORIGINAL MISSION WAS TO OPERATE AS A NOT-FOR-PROFIT CATHOLIC BASED SKILLED NURSING FACILITY. CATHOLIC CHARITIES, DIOCESE OF CAMDEN SOLD THE SKILLED NURSING FACILITY ON DECEMBER 14, 2015. CATHOLIC CHARITIES RETAINED OWNERSHIP OF A BUILDING ONCE USED AS A CONVENT AND TWO PARCELS OF LAND ADJACENT TO THE FACILITY. THE BUILDING AND LAND ARE PART OF TAX ID # 21-0634535. THIS CONVENT BUILDING AND ADJACENT LAND IS MAINTAINED BY CATHOLIC CHARITIES, DIOCESE OF CAMDEN. THE TAX ID # ALSO REMAINS ACTIVE TO REFLECT ADJUSTMENTS MADE TO ASSETS AND LIABILITIES ASSOCIATED WITH THE SKILLED NURSING FACILITY. ADJUSTMENTS SUCH AS COLLECTIONS FOR OUTSTANDING SKILLED NURSING HOME RECEIVABLE BALANCES, EXPENDITURES INCURRED TO COMPLY WITH RECORD RETENTION POLICIES, AND EXPENDITURES TO RESOLVE ANY OTHER OUTSTANDING ISSUES THAT REMAIN FROM THE TIME OF OWNERSHIP OF THE SKILLED NURSING FACILITY ARE PROCESSED THROUGH THIS TAX ID. 10371 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 1 1 1 0 0 0 1 0 0 1 1 0 0 0 NJ X ROBERT WAITE CONTROLLER 8563424100 1845 HADDON AVENUE CAMDEN NJ 08103 REVERAND TERRY M ODIEN PRESIDENT & TRUSTEE 0.00 0.00 X X 0 0 0 DEACON ROBERT SCARPA VICE PRESIDENT & TRUSTEE 0.00 0.00 X X 0 0 0 DEACON GERARD JABLONOWSKI SECRETARY & TRUSTEE 0.00 40.00 X X 0 128090 28039 LAURA MONTGOMERY TRUSTEE 0.00 40.00 X 0 155546 35770 REVEREND JAMES L BARTOLOMA TRUSTEE 0.00 0.00 X 0 0 0 0 283636 63809 0 0 1 0 0 2543 0 2543 2543 2543 2543 0 0 2543 2722 2722 9000 9000 2932 2932 2204 2204 27801 27801 11926 11926 MEDICAL RECORDS EXPENSE 10371 10371 REPAIRS AND MAINTENANCE 10122 10122 77078 10371 66707 0 48950 38841 610111 429766 189728 180345 12656701 12603958 12895379 12823144 9458 9458 18394732 18397032 18404190 18406490 X -5548734 -5623269 39923 39923 -5508811 -5583346 12895379 12823144 -74535 0 X 0 0 0 X 9996 9525 282455 301976 12018 54077 66095 22014 63602 282455 368071 0 0 0 368071 111 111 111 111 243459 46938 35680 57189 383266 265584 110540 318135 57189 751448 0.48980 0.48660 0.00010 0.00680 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2019 AMOUNT: $ 689. RETURN OF ESCROW - 2017 AMOUNT: $ 200,000. 2020 AMOUNT: $ 31,224. RENTAL INCOME - 2017 AMOUNT: $ 43,459. 2018 AMOUNT: $ 34,620. 2019 AMOUNT: $ 34,991. 2020 AMOUNT: $ 25,965. CORRECT ACCRUED LIABILITIES - 2018 AMOUNT: $ 12,318. 0 1 X 114905 114905 475707 410539 65168 19499 19227 272 180345 BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 39923 DUE FROM AFFILIATE 12564035 12603958 DUE TO AFFILIATES 18019156 DUE TO OTHER PARTY 351164 DUE TO THIRD PARTY 18438 UNCLEARED CHECKS 8274 18397032 PART IV, LINE 2B: PRIOR TO THE SALE, PRIVATE PAY RESIDENTS WOULD HAVE ONE MONTH'S RENT DEPOSITED IN AN INTEREST-BEARING ACCOUNT AT A LOCAL BANK. UPON DEATH, LEAVING THE FACILITY, OR APPLYING FOR MEDICAID, THE ESCROW BALANCE WOULD HAVE BEEN APPLIED TO THE RESIDENT'S OUTSTANDING ACCOUNT BALANCE AND ANY REMAINING MONIES WOULD HAVE BEEN REFUNDED TO THE RESIDENT. THERE WAS NO ACTIVITY IN 2021. A LIABILITY EXISTS DUE TO UNCASHED CHECKS. 0 0 0 0 0 0 0 0 0 LAURA MONTGOMERY TRUSTEE 0 155546 0 0 0 0 0 23332 0 12438 0 191316 0 0 DEACON GERARD JABLONOWSKI SECRETARY & TRUSTEE 0 128090 0 0 0 0 0 3843 0 24196 0 156129 0 0 PART I, LINE 3 COMPENSATION FOR SENIOR/EXECUTIVE EMPLOYEES IS PAID FROM THE RELATED ORGANIZATION DIOCESE OF CAMDEN AND IS DETERMINED BY HUMAN RESOURCES, FINANCE, AND THE VICAR GENERAL OF THE DIOCESE OF CAMDEN. FORM 990, PART VI, SECTION A, LINE 6 CATHOLIC CHARITIES, DIOCESE OF CAMDEN, INC. IS THE SOLE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A AS SOLE MEMBER OF THE CORPORATION, CATHOLIC CHARITIES, DIOCESE OF CAMDEN, INC. HAS THE POWER TO APPOINT THE TRUSTEES OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO THE POWER TO APPOINT THE TRUSTEES AS INDICATED ABOVE, CATHOLIC CHARITIES OF THE DIOCESE OF CAMDEN, INC HAS OTHER POWERS SET FORTH IN THE CORPORATION'S BY-LAWS WHICH INCLUDE THE FOLLOWING: -ADOPT OR AMEND THE CERTIFICATE OF INCORPORATION OR BY-LAWS OF THE CORPORATION; -ADOPT OR PERMIT ADOPTION OF ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET OF THE CORPORATION AS WELL AS SIGNIFICANT CHANGES TO THE ORIGINAL BUDGET (5%); -AUTHORIZE OR PERMIT THE CORPORATION TO ENGAGE IN SIGNIFICANT TRANSACTIONS (AS FURTHER DEFINED IN THE BY-LAWS) IN EXCESS OF $100,000 AS WELL AS SUCH TRANSACTIONS RELATED TO THE ACQUISITION OR DISPOSITION OF LAND AND BUILDINGS OWNED BY THE CORPORATION; -APPROVE OR PERMIT THE APPROVAL OF ANY SECURED OR UNSECURED BORROWING OF MONEY BY THE CORPORATION; -APPROVE OR PERMIT THE APPROVAL OF ANY LONG-TERM STRATEGIC PLAN OF THE CORPORATION; -APPROVE A PLAN OF MERGER, CONSOLIDATION, AFFILIATION, OR DISSOLUTION OF THE CORPORATION; ORGANIZE, ACQUIRE, AUTHORIZE OR PERMIT THE ORGANIZATION OR ACQUISITION OF ANY NEW SUBSIDIARY OF THE CORPORATION; AND, -APPROVE OR PERMIT THE APPROVAL OF CONTRIBUTIONS, GRANTS, OR LOANS IN EXCESS OF AN AGGREGATE OF $100,000. FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER WILL REVIEW FORM 990 BEFORE IT IS SIGNED AND FILED WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. DIOCESE OF CAMDEN 631 MARKET STREET CAMDEN NJ 08102 210634498 RELIGIOUS SERVICES NJ 501(C)(3) LINE 1 N/A 0 OUR LADY'S RESIDENCE 1845 HADDON AVENUE CAMDEN NJ 08103 221807020 HEALTH CARE NJ 501(C)(3) LINE 10 CATHOLIC CHARITIES DIOCESE OF CAMDEN INC 0 BISHOP MCCARTHY RESIDENCE 1845 HADDON AVENUE CAMDEN NJ 08103 222051685 HEALTH CARE NJ 501(C)(3) LINE 10 CATHOLIC CHARITIES DIOCESE OF CAMDEN INC 0 CATHOLIC CHARITIES DIOCESE OF CAMDEN INC 1845 HADDON AVENUE CAMDEN NJ 08103 233759994 SOCIAL SERVICES NJ 501(C)(3) LINE 7 DIOCESE OF CAMDEN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0