2022-11-14T21:15:40-07:00 2021-12-31 990 2021-01-01 237155198 BROTHERS OF MERCY NURSING HOME COMPANY INC BROT 7167596985 10570 BERGTOLD ROAD CLARENCE NY 14031 Joseph Widmer CFO 7167597600 2022-11-14 1 11 0 AAL2 2021 2022-09-23 18:48:47Z BROTHERS OF MERCY NURSING AND REHABILITATION CENTER Peter Eimer 4520 Ransom Road Clarence NY 14031 28194582 0 X BROTHERSOFMERCY.ORG X 1971 NY TO PROVIDE SKILLED NURSING CARE AND REHABILITATION SERVICES TO THE ELDERLY AND COMMUNITY 10 9 586 85 0 0 4687716 6829134 22741587 20639327 51121 -23797 277396 338852 27757820 27783516 0 0 0 0 17313301 15537998 0 0 0 8865488 8516445 26178789 24054443 1579031 3729073 16967208 20976201 8924732 8848646 8042476 12127555 TO PROVIDE SKILLED NURSING CARE AND REHABILITATION SERVICES TO THE ELDERLY AND COMMUNITY 0 0 20552063 0 20870323 NURSING CARE AND REHABILITATION SERVICES FOR A 240 BED NYS LICENSED NURSING FACILITY 0 0 0 20552063 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 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 1 28 0 1 586 1 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X X Joseph Widmer 7167596985 10570 BERGTOLD ROAD CLARENCE NY 14031 Peter Eimer Board Member/Corp CEO 18.75 18.75 X X 125179 125179 18332 Teresa Dillsworth Administrator 37.5 0 X 182890 0 18480 Joseph Widmer CFO 22.0 15.5 X 105162 74910 18405 Valerie Kane Corp Compliance Officer 15.00 22.50 X 57455 93743 10281 Nicole Eckert De Santiago Director of Nursing 37.5 0 X 130355 0 16581 Brittany Ivcic Assistant Director of Nursing 37.5 0 X 111280 0 16710 Shari Kersch Nurse Manager 37.5 0 X 100533 0 16888 Brother Kenneth Thomas Board Member 6.25 31.25 X 0 0 0 Brother Matthias Moller Board Member 0.5 2.5 X 0 0 0 Michael Noe Board Member/Secretary 0.5 2.5 X X 0 0 0 Sister Patricia Burkard Board Member/Chairwomen 0.5 2.5 X X 0 0 0 Michael McRae Board Member 0.5 2.5 X 0 0 0 Thomas Fentner Board Member 0.5 2.5 X 0 0 0 Msgr David LiPuma Board Member 0.5 2.5 X 0 0 0 David Nasca Board Member/Treasurer 0.5 2.5 X X 0 0 0 David Rogers Board Member 0.5 2.5 X 0 0 0 812854 293832 115677 7 0 1 0 Synergi Partners PO BOX 5599 FLORENCE SC 295025599 Consulting 915282 Point Click Care Technologies PO BOX 674802 Detroit MI 482674802 Electronic Medical Record System 100457 2 0 0 0 0 6828756 378 0 6829134 Resident Service Revenue 623000 20639327 20639327 0 0 0 0 0 0 20639327 30262 0 0 30262 0 0 0 0 0 0 0 0 0 0 357007 0 411066 0 -54059 0 -54059 0 0 -54059 0 Cafeteria Income 722210 102895 0 0 102895 Gift Shop Income 453220 4961 0 0 4961 Other Income 623000 230996 230996 0 0 0 0 0 0 338852 27783516 20870323 0 84059 0 0 0 0 0 0 0 0 424525 241635 182890 0 0 0 0 0 13112992 12509657 603335 0 121096 90101 30995 0 869097 791302 77795 0 1010288 951119 59169 0 1399990 0 1399990 0 37806 37806 0 0 228153 46615 181538 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50414 50414 0 0 0 0 0 0 0 0 0 0 0 0 0 0 350898 304906 45992 0 3254 1137 2117 0 0 0 0 0 0 0 0 0 88116 88116 0 0 0 0 0 0 637619 608902 28717 0 752029 735677 16352 0 NY State Assessment Fees 1061760 1061760 0 0 Medical Supplies/Equipment 543513 543513 0 0 Food/Dietary Supplies 747938 747938 0 0 Contracted Services 915282 915282 0 0 1699673 826183 873490 0 24054443 20552063 3502380 0 260276 72860 302911 306462 0 0 3674574 8866146 0 0 0 0 2819272 3034085 108130 108626 101225 83589 24179958 17287127 6788578 6892831 2776444 1466729 0 0 0 0 0 0 135798 144873 16967208 20976201 4315246 4423153 0 0 0 80798 104873 0 0 4276657 4027250 0 0 252031 293370 8924732 8848646 X 7987476 12087555 55000 40000 8042476 12127555 16967208 20976201 3729073 356006 0 0 0 0 X X 0 1 X 1 0 X 152326 163935 216500 238856 378 771995 22639247 23157558 24991585 22887438 20870323 114546151 164707 154874 176014 131545 107856 734996 0 0 0 0 0 0 0 0 0 0 0 0 22956280 23476367 25384099 23257839 20978557 116053142 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 116053142 47754 51589 66332 52344 332209 550228 0 0 0 0 0 0 47754 51589 66332 52344 332209 550228 0 0 0 0 0 0 0 0 0 4448860 6828756 11277616 23004034 23527956 25450431 27759043 28139522 127880986 0.90751 0.96158 0.00430 0.00195 X Schedule A, Part III, Line 12 REPRESENTS REVENUES FROM CARES ACT - PROVIDER RELIEF FUND PHASE 4 IN THE AMT OF 726,876 AND EMPLOYEE RETENTION TAX CREDIT IN THE AMOUNT OF 6,101,880. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 0 16000 16000 0 17286683 12644276 4642407 0 77709 76776 933 0 5964186 4566075 1398111 0 835380 0 835380 6892831 0 capital Lease Obligations 293370 293370 X 28139522 356006 0 0 0 356006 27783516 0 0 0 27783516 24054443 0 0 0 0 0 24054443 0 0 0 24054443 Schedule D, Part IV, Line 2b Resident Funds Held in Trust, consisting of amounts deposited on behalf of residents and used for their personal care. Schedule D, Part X, Line 2 The Home is a not-for-profit corporation as described in Section 509(a) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(c)(3) of the Code. Accordingly, no provision for federal income taxes is included in the financial statements. The Home files its Return of Organization Exempt from Income tax in the U.S. federal jurisdiction and its Annual Filing of Charitable Organizations in New York State. X X X 0 0 0 0 0 0 0 0 0 Peter Eimer Board Member/Corp CEO 125179 125179 0 0 0 0 1750 1750 7416 7416 134345 134345 0 Joseph Widmer CFO 105162 74910 0 0 0 0 2085 1486 8663 6171 115910 82567 Valerie Kane Corp Compliance Officer 57455 93742 0 0 0 0 1147 1872 2760 4503 61362 100117 Teresa Dillsworth Administrator 182890 0 0 0 0 0 3486 0 14994 0 201370 0 Nicole Eckert De Santiago Director of Nursing 130355 0 0 0 0 0 2641 0 13940 0 146936 0 Brittany Ivcic Assistant Director of Nursing 111280 0 0 0 0 0 1814 0 14896 0 127990 0 Shari Kersch Nurse Manager 100533 0 0 0 0 0 2030 0 14857 0 117420 0 Form 990, Part VI, Section B, Line 11b The Form 990 is reviewed by the CFO prior to filing. Form 990, Part VI, Section B, Line 12c Questionnaire is sent out annually and information regarding potential conflicts of interest is maintained by administration. Completed questionnaires are kept on file in the finance office. Form 990, Part VI, Section B, Line 15 The Board of Directors reviews salaries for top management officials and uses comparability data from Leading Age of NY in order to determine salaries. The process is documented in the Board Minutes. Form 990, Part VI, Section C, Line 18 The Form 1023 and Form 990 are available to the public upon request. Form 990, Part VI, Section C, Line 19 Disclosure of the organization's Governing documents, conflict of interest policy and financial statement is based on purpose of request. Form 990, Part XII, Line 2c There has been no change in the audit oversight process or the auditor selection process. Brothers of Mercy Holding Company Inc 4520 Ransom Road Clarence NY 14031 160746852 Holding Company NY 501 (C) (3) Line 12D N/A 0 Brothers of Mercy Sacred Heart Home 4526 Ransom Road Clarence NY 14031 161082636 Assisted Living Facility with Memory Care NY 501 (C) (3) Line 10 N/A 0 Brothers of Mercy Housing Co Inc 10500 Bergtold Road Clarence NY 14031 237117107 Housing for Elderly NY 501 (C) (3) Line 7 N/A 0 Brothers of Mercy Facilities Foundation 4520 Ransom Road Clarence NY 14031 161558645 Support Charitable purposes of Brothers NY 501 (C) (3) Line 7 N/A 0 Brothers of Mercy of Montabaur Apartment Complex Inc 4530 Ransom Road Clarence NY 14031 464619699 Housing for Elderly NY 501 (C) (3) Line 10 N/A 0 Brothers of Mercy Management Company 4520 Ransom Road Clarence NY 14031 813966963 Support Services for Related Parties NY 501 (C) (3) Line 10 N/A 0 Brothers of Mercy of Mary Help of Christians Inc 4520 Ransom Road Clarence NY 14031 830592366 Religious Order of Brothers NY 501 (C) (3) Line 12D N/A 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 Brothers of Mercy of Mary Help of Christians Inc k 94525 Accounting Records Brothers of Mercy of Montabaur Apartment Complex Inc d 9978 End of Year Balance Brothers of Mercy Management Company d 1170097 End of Year Balance Brothers of Mercy Sacred Heart Home d 1824315 End of Year Balance