2019-07-30T10:07:22-05:00 2018-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 221 W PHILADELPHIA STREET SUITE 200 YORK PA 17401 990 2018-01-01 210634535 SAINT MARY'S CATHOLIC HOME SAIN 8563424100 1845 HADDON AVENUE CAMDEN NJ 08103 ROBERT WAITE CONTROLLER 8563424100 2019-07-29 1 KERRI N BOGDA P00760402 7178467000 216.255.126.197 2019-07-29 08:28:58 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2018 2019-02-21 02:37:17Z ROBERT WAITE 1845 HADDON AVENUE CAMDEN NJ 08103 110540 0 0928 X WWW.CAMDENDIOCESE.ORG X 1952 NJ A SKILLED NURSING FACILITY LICENSED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND HUMAN SERVICES. 5 3 0 3 0 0 9996 9525 12018 54077 111 0 243459 46938 265584 110540 0 0 0 0 2647808 0 0 0 0 376223 252618 3024031 252618 -2758447 -142078 12617179 12599498 18326290 18450687 -5709111 -5851189 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 10440 54076 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 CONVENT AND TWO PARCELS OF LAND ADJACENT TO THE FACILITY . THE BUILDING AND LAND ARE PART OF TAX ID # 21-0634535. THE CONVENT SERVES AS A RESIDENCE TO THE LITTLE SISTER SERVANTS WHO WORK TO SERVICE PEOPLE MOST IN NEED OF HELP, SPIRITUAL AND MATERIAL, ESPECIALLY CHILDREN, THE POOR AND THE SICK. THE LITTLE SERVANT SISTERS PAY A RENT TO CATHOLIC CHARITIES, DIOCESE OF CAMDEN FOR USE OF THE CONVENT THROUGHOUT THE YEAR. 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. 10440 1 1 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 0 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 8563424186 1845 HADDON AVENUE CAMDEN NJ 08103 REVERAND TERRY M ODIEN PRESIDENT 0.00 0.00 X X 0 0 0 LAWRENCE J READER TREASURER 0.00 40.00 X X 0 122748 16363 DEACON GERARD JABLONOWSKI SECRETARY 0.00 40.00 X X 0 118036 30493 DEACON ROBERT SCARPA VICE PRESIDENT 0.00 0.00 X 0 0 0 REVEREND JAMES L BARTOLOMA TRUSTEE 0.00 0.00 X 0 0 0 0 240784 46856 0 0 0 0 0 9525 9525 NET RESIDENT SERV REV. 623000 54077 54077 54077 RENTAL INCOME 900099 34620 34620 CORRECT ACCRUED LIABIL 900099 12318 12318 46938 110540 54077 0 46938 8417 8417 13950 13950 46256 46256 55080 55080 52165 52165 13344 13344 BAD DEBT EXPENSE 26202 26202 NJ UNEMPLOYMENT TRUST 16507 16507 MEDICAL RECORDS EXPENSE 10440 10440 REPAIRS AND MAINTENANCE 10257 10257 252618 10440 242178 0 14947 5833 268656 281839 495206 393988 153383 101218 12180193 12210608 12617179 12599498 25761 83562 11397 9458 18289132 18357667 18326290 18450687 X -5749034 -5891112 39923 39923 -5709111 -5851189 12617179 12599498 -142078 0 X 0 0 0 X 19276 6577 130 9996 9525 45504 22792098 20931695 12018 54077 43789888 22811374 20938272 130 22014 63602 43835392 0 0 0 43835392 10917 13018 5031 111 29077 10917 13018 5031 111 29077 70951 76713 40 243459 46938 438101 22893242 21028003 5201 265584 110540 44302570 0.98950 0.99240 0.00070 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2014 AMOUNT: $ 26,284. 2015 AMOUNT: $ 11,311. 2016 AMOUNT: $ 40. RESIDENT PHONE VENDING REV - 2014 AMOUNT: $ 16,916. 2015 AMOUNT: $ 14,742. MEALS REVENUE - 2014 AMOUNT: $ 13,470. 2015 AMOUNT: $ 10,777. TRIAL STAY ROOM BOARD - 2014 AMOUNT: $ 11,321. 2015 AMOUNT: $ 15,859. ANCILLARY SERVICES - 2015 AMOUNT: $ 7,251. TELEVISION REVENUE - 2014 AMOUNT: $ 2,960. 2015 AMOUNT: $ 16,773. RETURN OF ESCROW - 2017 AMOUNT: $ 200,000. RENTAL INCOME - 2017 AMOUNT: $ 43,459. 2018 AMOUNT: $ 34,620. CORRECT ACCRUED LIABILITIES - 2018 AMOUNT: $ 12,318. 0 1 X 475707 374994 100713 19499 18994 505 101218 BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 39923 DUE FROM AFFILIATE 12170685 12210608 DUE TO AFFILIATES 18013947 DUE TO OTHER PARTY 343720 18357667 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 2018. A LIABILITY EXISTS DUE TO UNCASHED CHECKS. 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. 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 1 0 0 0 0 0 0 0 0 0