2018-11-15T13:00:07-06:00 2017-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2017-01-01 760847915 MARGARET ANNA CUSACK CARE CENTER INC MARG 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 THOMAS P SHEEHY ADMINISTRATOR/SECRETARY 2016538300 2018-11-14 1 AARON SHAPIRO P01333816 2128674000 64.22.227.161 2018-11-14 18:01:03 ES P 4275C7E7C8129915C35F764424C97B97C01C68F2 988419C5643A1C0877F6823E03E3852E0B43B763 2017 2018-06-14 16:35:46Z PEACE CARE ST JOSEPH'S THOMAS P SHEEHY JR 537 PAVONIA AVENUE JERSEY CITY NJ 07306 16000764 0 0928 X WWW.PEACECARENJ.ORG X 2006 NJ PROVIDING SKILLED NURSING CARE FOR THE ELDERLY. 9 8 229 16 0 0 598662 726057 14073259 14304577 105910 339634 92260 67951 14870091 15438219 0 0 0 0 8279519 8357322 0 0 98909 7084615 7655218 15364134 16012540 -494043 -574321 28445560 28991352 14351385 14841040 14094175 14150312 X TO PROVIDE HIGH QUALITY SHORT-TERM MEDICAL AND REHABILITATIVE CARE AS WELL AS COMPREHENSIVE LONG-TERM NURSING CARE TO ELDERLY IN A SAFE AND NURTURING ENVIRONMENT. 0 0 13597933 14304577 SEE SCHEDULE OTHE MARGARET ANNA CUSACK CARE CENTER INC. D/B/A PEACE CARE ST. JOSEPH'S (THE CENTER) AT THE HISTORIC ST. JOSEPH'S HOME FOR THE BLIND WAS ESTABLISHED IN 1891 BY THE SISTERS OF ST. JOSEPH OF PEACE AS A HOME FOR BLIND CHILDREN AND ADULTS. TODAY THE CENTER PROVIDES SUB-ACUTE AND LONG-TERM SKILLED NURSING CARE TO 139 BLIND AND SIGHTED OLDER ADULTS AT ITS STATE-OF-THE-ART FACILITY IN JERSEY CITY, NEW JERSEY.THE CENTER OFFERS A COMPLETE RANGE OF MEDICAL AND NURSING SERVICES, SUPPORTED BY REHABILITATION THERAPISTS, REGISTERED DIETITIANS AND OTHER CLINICAL SPECIALISTS.OUR PASTORAL CARE SERVICE PROVIDES SPIRITUAL PROGRAMS AS WELL AS COMFORT AND SUPPORT TO RESIDENTS, FAMILY MEMBERS AND STAFF.OUR RECREATIONAL PROFESSIONALS PROVIDE A FULL RANGE OF ACTIVITIES FOR RESIDENTS OF ALL LEVELS AND INTERESTS INCLUDING SOCIAL, PHYSICAL, CREATIVE, EDUCATIONAL, CULTURAL, COGNITIVE/SENSORY AWARENESS AND COMMUNITY INTEGRATING PROGRAMS.DURING FY 2017, THE CENTER PROVIDED CARE AND SERVICES TO 512 RESIDENTS. 13597933 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 6 1 229 1 0 0 0 0 0 1 1 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NJ X ERNEST CHESTER JR 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 JOHN J PROUT JR CHAIRPERSON / PRESIDENT 1.00 X X 0 0 0 CATHERINE YAXLEY CPA VICE CHAIRPERSON 1.00 X X 0 0 0 LIZ DOREN CPA TREASURER 1.00 X X 0 0 0 SILVANA BUCCIANTI BOARD TRUSTEE 0.50 X 0 0 0 BERNADETTE HOEHL BOARD TRUSTEE 0.50 X 0 0 0 PHYLLIS LIGUORI BOARD TRUSTEE 0.50 X 0 0 0 REV JAMES V PAGNOTTA STB BOARD TRUSTEE 0.50 X 0 0 0 SUSAN M WALSH MD FACP BOARD TRUSTEE 0.50 X 0 0 0 THOMAS P SHEEHY JR ADMINISTRATOR/SECRETARY 40.00 X X 177896 0 27979 SHIRLEY SANCHEZ-LISK DIRECTOR OF NURSING 40.00 X 110392 0 31989 JANE SUPUKO NURSING SUPERVISOR 37.50 X 100914 0 17340 389202 0 77308 3 0 1 0 UNIDINE 1000 WASHINGTON STREET SUITE 510 BOSTON MA 02118 DIETARY 1614086 SELECT REHABILITATION PO BOX 809056 CHICAGO IL 60680 REHABILITATION 1231228 LOUIS GARGIULO COM INC 44-46 STATE ST JERSEY CITY NJ 07304 STAIRCASE RENOVATION 149910 3 84071 641986 726057 MEDICAID 623000 7167966 7167966 PRIVATE & ANCILLARIES 623000 3672511 3672511 MEDICARE 623000 3464100 3464100 14304577 111631 111631 750000 521997 228003 228003 228003 21134 84071 21680 -546 -546 37735 18868 18867 18867 MISCELLANEOUS 900099 49630 49630 49630 15438219 14304577 0 407585 X 466510 260635 205875 5784818 4751257 984677 48884 285507 231006 48791 5710 1317408 1157460 159948 503079 428120 74959 61646 61646 46300 46300 2400654 2211454 189200 106972 1527 105445 2822160 2696074 81771 44315 693594 590248 103346 4405 1686 2719 964778 820061 144717 106304 106304 N.J. STATE ASSESSMENT 448405 448405 16012540 13597933 2315698 98909 161696 176791 1019689 1394866 1616274 1799690 208250 221730 37288280 19667484 18232996 17620796 7082365 7620634 124290 156845 28445560 28991352 7785383 8853348 30332 4323 6227601 5580701 191968 289047 116101 113621 14351385 14841040 X 14094175 14150312 14094175 14150312 28445560 28991352 X -574321 539551 90907 X X 0 1 X 1 0 X 688838 508867 547003 598662 726057 3069427 13510377 14566401 14345268 14073259 14304577 70799882 14199215 15075268 14892271 14671921 15030634 73869309 0 0 0 73869309 85065 103995 102869 105910 111631 509470 85065 103995 102869 105910 111631 509470 15503 7352 12075 38537 18867 92334 13276 33076 41909 53723 49630 191614 14313059 15219691 15049124 14870091 15210762 74662727 0.98940 0.99010 0.00680 0.00670 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS 0 0 0 0 0 0 0 0 1 608 608 0 PART II-B LINE 1, LOBBYING ACTIVITIES: THE ORGANIZATION PAID $12,163.72 TO LEADING AGE(FORMALLY NJASHA) IN MEMBERSHIP DUES OF WHICH $608 IS USED FOR LOBBYING ACTIVITIES. 0 1 X 2221004 2221004 30129945 15525819 14604126 4168317 3690467 477850 769014 451198 317816 17620796 ESTIMATED LIABILITIES DUE TO THIRD PARTIES 113621 113621 X 16186239 539551 167921 40548 748020 15438219 0 15438219 16221009 167921 40548 208469 16012540 0 16012540 PART IV, LINE 2B: RESIDENT SECURITY DEPOSITS AND PERSONAL FUNDS HELD ON BEHALF OF THE RESIDENTS ARE MAINTAINED IN BANK ACCOUNTS SEPARATE FROM THE CENTER'S ACCOUNTS. INTEREST EARNED IS CREDITED TO THE RESIDENTS' ACCOUNTS. PART X, LINE 2: THE CENTER HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2014 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 40,548. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 40,548. NJ GENERATIONS LUNCHEON 105205 84071 21134 10594 11086 105205 84071 21134 10594 11086 21680 -546 37735 18868 0 37735 18868 18868 18867 NJ 1 0 1 0 0.05000 0.95000 PAUL KAPLAN-DIRECTOR OF DEVELOPMENT C/O MACCC 537 PAVONIA AVE JERSEY CITY NJ 07306 0 PAUL KAPLAN 93192 PAUL KAPLAN IS THE FUNDRAISER AND GRANT WRITER, AND MANAGES THE 50/50 RAFFLES. X 0 X X X 0 0 0 0 0 0 0 1 0 THOMAS P SHEEHY JR ADMINISTRATOR/SECRETARY 162172 0 15000 0 724 0 2600 0 25379 0 205875 0 0 0 PART I, LINE 7 BONUS WAS BASED ON PERFORMANCE AS DETERMINED BY COMPENSATION COMMITTEE AND BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 PEACE CARE, INC. IS THE SOLE CORPORATE MEMBER OF THE CENTER AND ALSO IS THE SOLE CORPORATE MEMBER OF ST. ANN'S HOME FOR THE AGED D/B/A PEACE CARE ST. ANN'S. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER APPOINTS THE BOARD MEMBERS OF THE CENTER. FORM 990, PART VI, SECTION A, LINE 7B THE POWER TO AMEND, CHANGE OR ALTER THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE CENTER IS RESERVED EXCLUSIVELY TO THE BOARD OF TRUSTEES OF THE MEMBER, PEACE CARE, INC., AND REQUIRES THE FURTHER APPROVAL OF ITS SOLE MEMBER, PEACE MINISTRIES, INC. SIMILARLY, THE FOLLOWING POWERS ARE RESERVED TO THE MEMBER, SOME OF WHICH REQUIRE THE ADDITIONAL APPROVAL OF ITS MEMBER: A) THE CREATION BY THE CENTER OF ANY CORPORATION OR OTHER LEGAL ENTITY. B) THE CENTER'S AFFILIATION WITH OR PARTICIPATION IN, ANY JOINT VENTURE OR JOINT ENTERPRISE WITH ONE OR MORE OTHER ENTITIES. C) THE MANAGEMENT, ACQUISITION OR SPONSORSHIP BY THE CENTER OF ANY OTHER INSTITUTION, CORPORATION, ORGANIZATION, FACILITY OR ENTITY. D) THE SALE, ACQUISITION, EXCHANGE, TRANSFER, CONVEYANCE OR OTHER DISPOSITION BY THE CENTER OF ANY REAL PROPERTY OF INTEREST THEREIN OWNED BY THE CENTER. E) THE LEASING, MORTGAGING OR OTHER ENCUMBERING OF ANY REAL PROPERTY OWNED BY THE CENTER. F) THE PARTICIPATION IN ANY TRANSACTION PROVIDING FOR THE SALE, MORTGAGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CENTER. G) THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CENTER. H) THE APPOINTMENT AND REMOVAL OF TRUSTEES. I) THE APPOINTMENT AND REMOVAL OF THE ADMINISTRATOR. J) THE APPOINTMENT AND REMOVAL OF THE OFFICERS. K) THE ESTABLISHMENT OR CHANGE OF THE MISSION OF THE CENTER. L) TO ENTER INTO NEW BORROWINGS AND TO RENEGOTIATE, MODIFY OR OTHERWISE CHANGE EXISTING DEBT OBLIGATIONS IN EXCESS OF 15% OF THE NET ASSETS. FORM 990, PART VI, SECTION B, LINE 11B DRAFTS OF THE FORM 990 WERE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE AND CHANGES MADE AS NEEDED. A COPY OF THE FINAL 990 WAS THEN CIRCULATED TO THE FULL BOARD OF TRUSTEES FOR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE PRIMARY PURPOSE OF THE POLICY IS TO ENSURE THAT THE BOARD AND EXECUTIVE STAFF CAN MAKE DECISIONS IN AN OBJECTIVE MANNER WITHOUT UNDUE INFLUENCE BY INTERESTED PERSONS AND TO ENSURE THAT THE CENTER FULFILLS ITS CHARITABLE PURPOSES. EACH BOARD MEMBER AND PRINCIPAL OFFICER WITH BOARD DELEGATED POWER SHALL "ANNUALLY" SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSONS HAVE COMPLIED WITH THE FOLLOWING: 1)RECEIVED A COPY OF THIS POLICY,2)READ AND UNDERSTAND THIS POLICY,3)AGREED TO COMPLY WITH THIS POLICY,4)UNDERSTAND THAT THE CENTER IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES AND, 5) DISCLOSED ACTIVITIES AND FINANCIALS INTEREST WHICH MAY RESULT IN A CONFLICT OF INTEREST. POTENTIAL CONFLICTS ARE DISCUSSED AT THE APPROPRIATE AUDIT COMMITTEE MEETING AND A DECISION ON HOW TO HANDLE IS VOTED ON IN THE ABSENCE OF THE INDIVIDUAL WHO HAS A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES REVIEWS COMPARABLE DATA FROM OTHER ORGANIZATIONS WHICH ARE OF SIMILAR NATURE AND SIZE TO DETERMINE COMPENSATION FOR OFFICERS. THE SALARIES WERE BASED ON SALARY DETERMINATION THAT TOOK PLACE IN DECMBER 2016. ANOTHER BOARD REVIEW FOR SALARY DETERMINATION TOOK PLACE IN DECEMBER 2017. FORM 990, PART VI, SECTION C, LINE 19 EVERY REQUEST IS EVALUATED AGAINST LEGAL OBLIGATION AND IF DETERMINED TO BE NECESSARY A COPY OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIALS STATEMENTS ARE PROVIDED. FORM 990, PART IX, LINE 11G SECURITY EXPENSE: PROGRAM SERVICE EXPENSES 76,501. MANAGEMENT AND GENERAL EXPENSES 13,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,895. CONSULTANTS: PROGRAM SERVICE EXPENSES 61,474. MANAGEMENT AND GENERAL EXPENSES 31,453. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,927. PASTORAL CARE: PROGRAM SERVICE EXPENSES 14,671. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,671. DATA PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 144,353. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 144,353. NURSING IN-SERVICE EXPENSES: PROGRAM SERVICE EXPENSES 42,973. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,973. NURSING AGENCY: PROGRAM SERVICE EXPENSES 165,320. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,320. PHARMACEUTICAL EXPENSES: PROGRAM SERVICE EXPENSES 1,850,515. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,850,515. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET 90,907. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM LAST YEAR PEACE CARE INC 198 OLD BERGEN RD JERSEY CITY NJ 07305 812589807 PROVIDE ADMINISTRATIVE SERVICE TO NURSING HOMES NJ 501(C)(3) LINE 12C, III-FI PEACE MINISTRIES INC 0 ST ANN'S HOME FOR THE AGED 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 222823794 PROVIDE LONG TERM NURSING CARE AND ADULT MEDICAL DAY CARE TO THE COMMUNITY NJ 501(C)(3) LINE 10 PEACE CARE INC 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0