2018-09-11T09:23:31-05:00 2017-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 191037341 990 2017-01-01 210634535 SAINT MARY'S CATHOLIC HOME SAIN 8563424100 1845 HADDON AVENUE CAMDEN NJ 08103 ROBERT WAITE CONTROLLER 8563424100 2018-09-10 1 JULIUS C GREEN CPA P00350393 2159720701 X 216.255.126.197 2018-09-10 17:18:57 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2017 2018-06-14 16:35:46Z ROBERT WAITE 1845 HADDON AVENUE CAMDEN NJ 08103 265584 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 0 130 9996 0 12018 5031 111 40 243459 5201 265584 0 0 0 0 1742691 2647808 0 0 0 728032 376223 2470723 3024031 -2465522 -2758447 34661045 12617179 8524412 18326290 26136633 -5709111 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 33531 12018 CATHOLIC CHARITIES, DIOCESE OF CAMDEN SOLD ITS' SKILLED NURSING HOME, SAINT MARY'S CATHOLIC HOME, IN DECEMBER 2015. THE FACILITY CHANGED OWNERSHIP ON DECEMBER 14, 2015. THE NEW OWNERS HAVE CHANGED THE NAME TO SAINT MARY'S CENTER FOR REHABILITATION AND HEALTHCARE. ST. MARY'S CATHOLIC HOME OPERATED A 215 BED SKILLED NURSING FACILITY AND 98 BED RESIDENTIAL HEALTHCARE FACILITY IN CHERRY HILL, NEW JERSEY. IT WAS LICENSED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE HOME'S SOLE MEMBER IS CATHOLIC CHARITIES, DIOCESE OF CAMDEN. RESIDENT PROGRAMS INCLUDED RESTORATIVE NURSING CARE BY LICENSED AND CERTIFIED NURSING STAFF, COMPREHENSIVE PLAN OF CARE, SOCIAL SERVICE, PHARMACY, CONGREGATED DINING, ACTIVITIES, SPECIAL DIETS, SPIRITUAL COUNSELING BY A CATHOLIC CHAPLAIN, HOUSEKEEPING AND LAUNDRY.REHABILITATION SERVICES AND PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES WERE AVAILABLE FOR THOSE RECOVERING FROM FRACTURES, STROKES AND OTHER SHORT-TERM, POST HOSPITAL STAYS. IN ADDITION TO CORE THERAPIES AND TREATMENT MODALITIES, WE PROVIDED A WIDE RANGE OF COMPLEX CLINICAL CARE AND SPECIALIZED SERVICES, INCLUDING: GAIT AND BALANCE TRAINING, DYSPHASIA THERAPY, IV ANTIBIOTIC THERAPY, ENTERAL NUTRITION, WOUND CARE AND PAIN MANAGEMENT. 33531 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 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 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 DEACON ROBERT SCARPA VICE PRESIDENT 0.00 0.00 X X 0 0 0 DEACON GERARD JABLONOWSKI SECRETARY 0.00 40.00 X X 0 115096 27287 LAWRENCE J READER TREASURER 0.00 40.00 X X 0 119672 16159 JOSEPH GILSON TRUSTEE 0.00 0.00 X 0 0 0 0 234768 43446 0 0 0 0 0 9996 9996 NET RESIDENT SERV REV. 623000 12018 12018 12018 111 111 RETURN OF ESCROW 900099 200000 200000 RENTAL INCOME 900099 43459 43459 243459 265584 12018 0 243570 2322930 2322930 324878 324878 86445 86445 13850 13850 3676 1473 2203 55338 55338 66747 66747 REPAIRS AND MAINTENANCE 89067 89067 BAD DEBT EXPENSE 29391 29391 MEDICAL RECORDS EXPENSE 15966 15966 CHAPEL AND CONVENT 13076 13076 2667 2667 3024031 33531 2990500 0 434866 14947 299744 268656 495206 341823 153383 153383 33773052 12180193 34661045 12617179 16851 610 11397 11397 8496164 18314283 8524412 18326290 X 26096710 -5749034 39923 39923 26136633 -5709111 34661045 12617179 X -2758447 -29087297 X 0 0 0 X 40106 19276 6577 130 9996 76085 21545497 22792098 20931695 12018 65281308 21585603 22811374 20938272 130 22014 65357393 0 0 0 65357393 9298 10917 13018 5031 111 38375 9298 10917 13018 5031 111 38375 71394 70951 76713 40 243459 462557 21666295 22893242 21028003 5201 265584 65858325 0.99240 0.99160 0.00060 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2013 AMOUNT: $ 23,208. 2014 AMOUNT: $ 26,284. 2015 AMOUNT: $ 11,311. 2016 AMOUNT: $ 40. RESIDENT PHONE VENDING REV - 2013 AMOUNT: $ 19,224. 2014 AMOUNT: $ 16,916. 2015 AMOUNT: $ 14,742. MEALS REVENUE - 2013 AMOUNT: $ 12,792. 2014 AMOUNT: $ 13,470. 2015 AMOUNT: $ 10,777. TRIAL STAY ROOM BOARD - 2013 AMOUNT: $ 16,170. 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. 0 1 X 475707 323650 152057 19499 18173 1326 153383 BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 39923 DUE FROM AFFILIATE 12140270 12180193 DUE TO AFFILIATES 17950646 DUE TO OTHER PARTY 363637 18314283 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 2017. 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. FORM 990, PART XI, LINE 9: TRANSFER TO DIOCESE OF CAMDEN HEALTHCARE FOUNDATION, INC. -29,087,297. DIOCESE OF CAMDEN 1845 HADDON AVENUE CAMDEN NJ 08103 210634498 RELIGIOUS SERVICES NJ 501(C)(3) LINE 1 CATHOLIC CHARITIES DIOCESE OF CAMDEN INC 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 MATER DEI NURSING HOME 1845 HADDON AVENUE CAMDEN NJ 08103 221840494 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 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0