2019-07-15T09:59:09-05:00 2018-09-30 060903326 WHITTLESEY PC 280 TRUMBULL ST 24TH FL HARTFORD CT 06103 990 2017-10-01 060907212 MONSIGNOR BOJNOWSKI MANOR INC MONS 8602290336 50 PULASKI STREET NEW BRITAIN CT 06053 MOTHER MARY JENNIFER CARROLL PRESIDENT 8602290336 2019-07-15 1 NIKO YANOUZAS P01423868 8605223111 198.0.144.57 2019-07-15 10:58:53 ED P F5BB9DE8DEFA525D59874884BE5177D0837556B6 F5EACFD2DADC60B02E72C3D73265149A67947D31 2017 2019-02-21 02:37:17Z MOTHER MARY JENNIFER CARR 50 PULASKI STREET NEW BRITAIN CT 06053 6559404 0 X N/A X 1975 CT THE PROVIDING OF ROOM, BOARD AND CARE FOR ALL RESIDENTS OF THE FACILITY WHICH CARES FOR THE GENERAL PUBLIC IN CONNECTION WITH THE MISSION OF THE DAUGHTERS OF THE IMMACULATE CONCEPTION AND THE ROMAN CATHOLIC CHURCH. 15 14 140 16 0 0 779116 114959 6358240 6442986 1620 1459 0 0 7138976 6559404 0 0 0 0 4475380 4332372 0 0 0 2094886 2144770 6570266 6477142 568710 82262 2585433 2602152 2410334 2344791 175099 257361 THE PROVIDING OF ROOM, BOARD AND CARE FOR ALL RESIDENTS OF THE FACILITY WHICH CARES FOR THE GENERAL PUBLIC IN CONNECTION WITH THE MISSION OF THE DAUGHTERS OF THE IMMACULATE CONCEPTION AND THE ROMAN CATHOLIC CHURCH. 0 0 5724105 6442986 SIXTY BED SKILLED NURSING FACILITY FOR THE AGED PROVIDED 20,115 DAYS OF CARE TO THE GENERAL PUBLIC FURTHERING THE MISSION OF THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION AND THE ROMAN CATHOLIC CHURCH. 5724105 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 140 1 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X MARTIN JULMISSE 8602290336 50 PULASKI STREET NEW BRITAIN CT 06053 MOTHER MARY JENNIFER CARROLL PRESIDENT OF DMICC 1.00 X X 0 0 0 SISTER MARY CATHERINE SIROTNAK DM SECRETARY/TREASURER 40.00 X X 68458 0 10316 LEONARD GIZA CHAIRPERSON 1.00 X X 0 0 0 ROBERT STORY DIRECTOR 1.00 X 0 0 0 JADWIGA PANUS DIRECTOR 1.00 X 0 0 0 DORIS RUDNICKI DIRECTOR 1.00 X 0 0 0 STANISLAW JANKOWSKI DIRECTOR 1.00 X 0 0 0 MSGR DANIEL PLOCHARCZYK DIRECTOR 1.00 X 0 0 0 CAROL ANNE SALVIETTI ADMINISTRATOR THROUGH OCTOBER 2017 40.00 X X 97078 0 318 CLAIRS PIETRAS DIRECTOR 1.00 X 0 0 0 SHIELA AMARAL DIRECTOR 1.00 X 0 0 0 SISTER MARY LUCILLE BAMACH VP/TREASURER OF DMICC 1.00 X X 0 0 0 SISTER MARY CLAIRE MILEWSKI SECRETARY OF DMICC 1.00 X X 0 0 0 SISTER MARY JANICE ZDUCZYK COUNSELOR OF DMICC 1.00 X X 0 0 0 STEPHEN ZEBROWSKI MD DIRECTOR 1.00 X 0 0 0 MARTIN JULMISSE ADMINISTRATOR EFFECTIVE NOVEMBER 2017 1.00 X 0 0 0 165536 0 10634 0 0 0 0 PREFERRED THERAPY 850 SILAS DEANE HIGHWAY WETHERSFIELD CT 06109 THERAPY 405534 OMNICARE 525 KNOTTER DR CHESHIRE CT 06410 MEDICATION 148865 2 114959 114959 MEDICARE/MEDICAID PAYM 623110 4239268 4239268 PATIENT REVENUE 623110 2203718 2203718 6442986 1459 1459 6559404 6442986 0 1459 164241 164241 3128003 3045227 82776 11628 10756 872 792669 733195 59474 235831 218137 17694 6447 6447 26800 26800 25207 25207 143594 143594 73711 73711 258902 233012 25890 5509 4958 551 4221 4221 115835 115835 232563 232563 56238 56238 THERAPY AND MEDICAL 654545 654545 PROVIDER TAX 343673 343673 FOOD 140283 140283 57242 51518 5724 6477142 5724105 753037 0 761746 630375 44764 44797 408741 525215 21513 12423 17179 16000 6906839 5533497 1331490 1373342 2585433 2602152 326105 342505 3259 3259 2080970 1999027 2410334 2344791 X 175099 257361 175099 257361 2585433 2602152 82262 0 X 0 1 X 0 0 X 25347 16347 118892 779116 114959 1054661 6357250 6708955 6706889 6358240 6442986 32574320 6382597 6725302 6825781 7137356 6557945 33628981 0 0 0 33628981 1386 1319 1144 1620 1459 6928 1386 1319 1144 1620 1459 6928 6383983 6726621 6826925 7138976 6559404 33635909 0.99980 0.99980 0.00020 0.00020 X 5308387 4181799 1126588 106376 101101 5275 1492076 1250597 241479 1373342 LOAN DUE TO THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION 82462 NOTES PAYABLE TO THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION 1897907 RESIDENT FUNDS 18658 1999027 6559404 0 6559404 0 6559404 6477142 0 6477142 0 6477142 FORM 990, PART VI, SECTION B, LINE 11B THE ADMININSTRATOR OF THE MANOR WILL REVIEW THE 990 AND APPROVE THE FORM TO BE FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS MONITORS AND REVIEWS RELATIONSHIPS ANNUALLY AND ANY CONFLICTS ARE BROUGHT TO THE ATTENTION OF THE BOARD. THE BOARD WILL REVIEW THE CONFLICTS TO DETERMINE THEIR AFFECTS ON THE MANOR. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION FOR THE ADMINISTRATOR WILL BE BASED ON A FAIR MARKET RATE. THIS WILL BE ACCOMPLISHED BY COMPARING COMPENSATION PACKAGES OF SIMILIAR SIZE HEALTH CARE FACILITIES BY GATHERING COMPENSATION DATA FROM ONLINE RESOURCES AND TRADE ASSOCIATIONS. ADDITIONALLY, THE EXPERIENCE OF THE CANDIDATE IS CONSIDERED AS PART OF THE COMPENSATION DETERMINATION. THE COMPENSATION PACKAGE WILL BE REVIEWED BY THE BOARD OF DIRECTORS AND APPROVED BY THE PRESIDENT OF THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION, INC. FORM 990, PART VI, SECTION C, LINE 18 DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION 314 OSGOOD AVE NEW BRITAIN CT 06053 060995128 CHURCH CT 501(C)(3) LINE 1 N/A 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION E 1980369 HISTORICAL COST THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION C 84912 HISTORICAL COST