2017-11-11T19:21:18-06:00 2016-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2016-01-01 133676681 PROMESA RESIDENTIAL HEALTH CARE FACILITY INC PROM 7189607617 308 EAST 175TH STREET BRONX NY 10457 MILTON DERIENZO CFO 7189607617 2017-11-10 1 AARON SHAPIRO P01333816 2128674000 38.98.118.70 2017-11-10 12:23:23 ES P 225B73B148284D6C629F7CBF4AC09CDDFD7CF9F8 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 2016 2018-03-14 21:41:22Z MILTON DERIENZO 308 EAST 175TH STREET BRONX NY 10457 19538485 0 X WWW.ACACIANETWORK.ORG X 1992 NY PROMESA RESIDENTIAL HEALTH CARE FACILITY (PROMESA RHCF) OPERATES A 108 BED LONG TERM CARE FACILITY THAT PROVIDES COMPREHENSIVE, HOLISTIC, CULTURALLY AND LINGUISTICALLY COMPETENT SERVICES TO INDIVIDUALS LIVING WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR OTHER HIV RELATED ILLNESSES. 6 6 149 12 0 0 1000 5709 17137135 17208599 275007 -451035 81156 48231 17494298 16811504 0 0 0 0 9549935 9673456 0 0 0 7277089 6967212 16827024 16640668 667274 170836 42742376 44548279 14165629 15800696 28576747 28747583 X PROMESA RESIDENTIAL HEALTH CARE FACILITY OPERATES A 108 BED LONG TERM CARE FACILITY THAT PROVIDES COMPREHENSIVE, HOLISTIC, CULTURALLY AND LINGUISTICALLY COMPETENT SERVICES TO INDIVIDUALS LIVING WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR OTHER HIV RELATED ILLNESSES. 0 0 13932673 17208599 PROMESA RHCF PROVIDES HEALTH CARE AND RESIDENTIAL CARE FOR ADULTS WHO TEST POSITIVE FOR THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ARE DIAGNOSED AS HAVING ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS). TOTAL CAPACITY FOR THE FACILITY IS 108 BEDS. DURING 2016, THE FACILITY PROVIDED 36,449 DAYS OF SKILLED NURSING CARE. 13932673 1 0 0 1 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 5 0 149 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X MILTON DERINZO CFO ACACIA NETWORK INC 7189607617 1776 CLAY AVENUE BRONX NY 10457 MILAGROS BAEZ-O'TOOLE SECRETARY(LEFT 09/2016) 1.00 X X 0 0 0 IRIS W RAMIREZ VICE CHAIR 1.00 X X 0 0 0 WILFRED RENTA CHAIR(LEFT 09/2016) 1.00 X X 0 0 0 PEDRO FALCON VICE CHAIR(LEFT 09/2016) 1.00 X X 0 0 0 INGLE STEPHENS MEMBER(LEFT 09/2016) 1.00 X 0 0 0 EDEL BORRERO MEMBER 1.00 X 0 0 0 MARIA RIVERA MEMBER(LEFT 09/2016) 1.00 X 0 0 0 EDUARDO ALAYON CHAIR 1.00 X 0 0 0 KALEB H SANCHEZ SECRETARY 1.00 X 0 0 0 FRANK QUILES TREASURER 1.00 X 0 0 0 MARIO RODRIGUEZ MEMBER 1.00 X 0 0 0 ERICA Y MARTINEZ MEMBER(LEFT 09/2016) 1.00 X 0 0 0 HON HECTOR DIAZ PRESIDENT 4.23 16.77 X 48536 192443 11124 RAUL RUSSI CEO 6.97 28.03 X 118401 476154 22425 PAMELA MATTEL COO 7.12 27.88 X 69692 272890 60500 MILTON DERIENZO CFO 7.03 27.97 X 26706 106162 0 TOMAS DEL RIO CFO(LEFT 5/31/2016) 7.11 27.89 X 62321 244342 36808 ADRIENE ROSELL SENIOR ADMINISTRATOR 31.50 3.50 X 203613 22623 36448 DR SAROJ BAKSHI MEDICAL DIRECTOR 35.00 X 217556 0 21534 DAVID GLASEL DIRECTOR OF LEGAL AFFAIRS 7.04 27.96 X 87269 346862 19251 834094 1661476 208090 3 0 1 0 SERA SECURITY SERVICES LLC 2804A 3RD AVE BRONX NY 10455 SECURITY 155835 1 5709 5709 MEDICAID AND MEDICARE -INPATIENT 623000 17208599 17208599 17208599 236620 236620 109000 109000 0 1930326 2617981 -687655 -687655 -687655 EMPLOYEE PARKING FEES 812930 29951 29951 PURCHASE DISCOUNTS 900099 12321 12321 MISCELLANEOUS REVENUE 900099 5959 5959 48231 16811504 17208599 0 -402804 352150 331543 20607 6497215 6117014 380201 294566 277329 17237 1981188 1865253 115935 548337 516250 32087 1787827 409252 1378575 62819 62819 71647 71647 27428 27428 1247928 1023515 224413 35106 35106 1647897 1337262 310635 125447 123553 1894 12316 3338 8978 149672 146679 2993 714161 700519 13642 189915 186117 3798 NYS DEPT. OF HEALTH ASS 895049 895049 16640668 13932673 2707995 0 2106673 3188905 2868358 3406782 1686295 2924493 5376464 2790449 223003 267016 27220014 14896351 13277844 12323663 222869 222869 16980870 19424102 42742376 44548279 1970617 2207034 1510000 635000 50097 35207 7302796 11115949 3332119 1807506 14165629 15800696 X 28576747 28747583 28576747 28747583 42742376 44548279 170836 0 X X 0 1 X 1 0 X 1000 5709 6709 18471957 17999079 17581866 17137135 17208599 88398636 18471957 17999079 17581866 17138135 17214308 88405345 0 0 0 88405345 203216 192688 326327 384007 345620 1451858 203216 192688 326327 384007 345620 1451858 31139 142674 112701 81156 48231 415901 18706312 18334441 18020894 17603298 17608159 90273104 0.97930 0.98060 0.01610 0.01490 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC PARKING INCOME INSURANCE RECOVERY REFUNDS FROM VENDORS 0 0 0 0 0 0 0 0 1 27428 27428 0 PART II-B, LINE 1: PROMESA RHCF CONTRACTS WITH VARIOUS THIRD PARTY LOBBYING CONSULTANTS TO DEVELOP AND IMPLEMENT A COMPREHENSIVE STRATEGY ON ISSUES RELATED TO PROMESA RHCF AND OBTAIN SUPPORT FOR SUCH ISSUES FROM KEY STATE LEGISLATORS. IN ADDITION, A SMALL PERCENTAGE OF DUES PAID TO ASSOCIATIONS ON MATTERS RELATED TO REIMBURSEMENT AND OTHER HEALTH CARE NEEDS. 0 1 X 114311 114311 23426308 11966102 11460206 3294543 2556087 738456 384852 374162 10690 12323663 DUE FROM AFFILIATED ENTITIES 13630445 ACCRUED INTEREST RECEIVABLE 246450 INVESTMENT IN REAL ESTATE 5547207 19424102 DUE TO THIRD PARTIES 1807506 1807506 X 16920504 109000 109000 16811504 0 16811504 16749668 109000 109000 16640668 0 16640668 PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE MAINTAINED IN BANK ACCOUNTS SEPARATE FROM PROMESA RHCF'S ACCOUNTS. PART X, LINE 2: PROMESA RHCF HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. TAX RETURNS FOR THE YEARS DECEMBER 31, 2013 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 109,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 109,000. X X X 0 0 0 0 0 0 0 1 0 HON HECTOR DIAZ PRESIDENT 41737 165487 5985 23729 814 3227 2240 8884 0 0 50776 201327 0 0 RAUL RUSSI CEO 101576 408493 14285 57446 2540 10215 3958 15917 508 2042 122867 494113 0 0 PAMELA MATTEL COO 59021 231106 9009 35278 1662 6506 4043 15832 8264 32361 81999 321083 0 0 TOMAS DEL RIO CFO(LEFT 5/31/2016) 60581 237518 0 0 1740 6824 2693 10557 4788 18770 69802 273669 0 0 ADRIENE ROSELL SENIOR ADMINISTRATOR 203226 22580 0 0 387 43 9796 1088 23008 2556 236417 26267 0 0 DR SAROJ BAKSHI MEDICAL DIRECTOR 208206 0 5000 0 4350 0 10769 0 10765 0 239090 0 0 0 DAVID GLASEL DIRECTOR OF LEGAL AFFAIRS 79351 315392 7134 28356 784 3114 1717 6825 2153 8556 91139 362243 0 0 PART I, LINE 7 IN ADDITION TO THE BASE SALARY, MANAGEMENT SHALL BE ELIGIBLE TO RECEIVE, AT THE EMPLOYER'S DISCRETION, AN ANNUAL INCENTIVE BONUS IN AN AMOUNT NOT GREATER THAN TEN PERCENT OF THE EXECUTIVE'S BASE SALARY, AS ADJUSTED FROM TIME TO TIME AS DETERMINED BY THE BOARD OF DIRECTORS BASED UPON THE ACCOMPLISHMENT OF SPECIFIC PERFORMANCE GOALS AND CRITERIA ESTABLISHED ANNUALLY BY THE BOARD AND COMMUNICATED IN WRITING TO THE EXECUTIVE PRIOR TO JANUARY 31ST OF EACH YEAR. A DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 64983QDG1 2005-04-13 8500402 REFUND PRIOR ISSUE (7/15/93) 0 0 0 A 8500793 476992 167980 8014797 1995 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 1 0 0 0 1 0 A 0 SCHEDULE K, PART IV, ARBITRAGE, LINE 2C (A) ISSUER NAME: DORMITORY AUTORITY - STATE OF NEW YORK DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2014 PART II, LINE 3 - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. PART II, LINE 3 - THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4 - 12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY ALL MEMBERS OF THE BOARD PRIOR TO BEING FILED THEY FORWARDED ANY COMMENTS THAT THEY HAVE BACK TO THE CHIEF FINANCIAL OFFICER. FORM 990, PART VI, SECTION B, LINE 12C PROMESA RHCF HAS POLICIES AND PROCEDURES TO ENSURE THAT THERE ARE NO CONFLICTS OF INTEREST BETWEEN THE FACILITY AND DIRECTORS AND OFFICERS. THESE POLICIES INCLUDE THAT THE OFFICERS AND DIRECTORS ARE CHARGED WITH A DUTY TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST THAT MAY ARISE DUE TO A FINANCIAL TRANSACTION OR ARRANGEMENTS BETWEEN THEMSELVES AND PROMESA RHCF. FAILURE TO DISCLOSE MAY LEAD TO DISCIPLINARY ACTION. ALL ACTIONS REGARDING DISCLOSURE WILL BE DOCUMENTED AND RECORDED IN THE MINUTES OF THE GOVERNING BOARD. A FORM AFFIRMING THE DIRECTORS AND OFFICERS' ACCEPTANCE, UNDERSTANDING, AND COMPLIANCE WITH PROMESA RHCF'S CONFLICT OF INTEREST POLICY IS FILLED OUT ANNUALLY. PERIODIC REVIEWS ARE DONE TO ENSURE THAT THERE IS COMPLETE COMPLIANCE WITH THESE POLICIES. IN THE EVENT OF A CONFLICT, THE CONFLICT IS REPORTED TO THE QUALITY ASSURANCE OFFICER. THE INDIVIDUAL IS REQUIRED TO RECUSE HIMSELF OR HERSELF AND NOT PARTICIPATE IN DECISIONS RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO, CFO, AND COO ARE REVIEWED AND APPROVED ANNUALLY BY THE FINANCE COMMITTEE OF PROMESA ADMINISTRATIVE SERVICES ORGANIZATION,INC'S BOARD OF DIRECTORS. PERIODICALLY, THAT BOARD WILL ENGAGE AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE THE APPROPRIATENESS OF THE COMPENSATION PACKAGES OFFERED TO THE OFFICERS AND KEY EMPLOYEES OF PROMESA RHCF. THIS PROCESS INCLUDES UTILIZATION OF A COMPARATIVE SALARY ANALYSIS WITH EXECUTIVES OF COMPARABLE ORGANIZATIONS. THIS PROCESS WAS LAST UNDERTAKEN IN 2016. FORM 990, PART VI, SECTION C, LINE 19 PROMESA RHCF'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THAT OF THE PRIOR YEAR. ACACIA NETWORK INC 1776 CLAY AVENUE BRONX NY 10457 134014082 PARENT ORG OF THE PROMESA CONTINUUM OF HEALTH CARE, EDUCATION, HOUSING ETC. NY 501(C)(3) LINE 12A, I N/A 0 PROMESA ADMINISTRATIVE SERVICES ORGANIZATIONINC 1776 CLAY AVENUE BRONX NY 10457 133653276 MANAGEMENT CO, FOR ACACIA NETWORK, INC. NY 501(C)(3) LINE 12A, I ACACIA NETWORK INC 0 PROMESA INC 311 EAST 175TH STREET BRONX NY 10457 132663328 PROVIDES HEALTH, EDUCATIONAL, SOCIAL AND DAY CARE NY 501(C)(3) LINE 10 ACACIA NETWORK INC 0 PROMESA FOUNDATION INC 1776 CLAY AVENUE BRONX NY 10457 133411787 DEVELOPMENT ARM FOR ACACIA NETWORK, INC. NY 501(C)(3) LINE 12A, I ACACIA NETWORK INC 0 PROMESA HOUSING DEVELOPMENT FUND CORPORATION INC 1776 CLAY AVENUE BRONX NY 10457 133608906 HOUSING COMPANY NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 EAST HARLEM COUNCIL FOR COMMUNITY IMPROVEMENT INC 1776 CLAY AVENUE BRONX NY 10035 132969933 SUPERVISED HOUSING SERVICES NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 CORPORATION FOR YOUTH ENERGY CORPS 1776 CLAY AVENUE BRONX NY 10457 133072640 YOUTH CORP PROGRAM NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 BRONX ADDICTION SERVICES INTEGRATED CONCEPTS SYSTEMS INC 1064 FRANKLIN AVENUE BRONX NY 10456 133244626 DRUG ADDICTION REHABILITATION SERVI NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 GENERAL DEVELOPMENT AND ORIENTATION COUNCIL INC 717SOUTHERN BOULEVARD BRONX NY 10455 133333051 SUPPORTED HOUSING & PSYCHOSOCIAL CL NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 THE JULIO A MARTINEZ MEMORIAL FUND 1064 FRANKLIN AVENUE BRONX NY 10456 810623501 DEVELOPMENT ARM FOR BASICS NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 CAPITAL DISTRICT LATINOS INC 1776 CLAY AVENUE BRONX NY 10457 453647494 HOUSING NY PENDING PENDING ACACIA NETWORK INC 0 LA RAMA 300 EAST 175TH STREET BRONX NY 10457 454797184 HOUSING NY PENDING PENDING ACACIA NETWORK INC 0 BUFFALO HISPANIC MANAGEMENT COMPANY INC 254 VIRGINIA STREET BUFFALO NY 14201 223035890 MANAGEMENT NY 501(C)(2) ACACIA NETWORK INC 0 HISPANOS UNIDOS DE BUFFALO INC 254 VIRGINIA STREET BUFFALO NY 14201 161243094 SOCIAL SERVICES NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 LOISAIDA INC 300 EAST 175TH STREET BRONX NY 10457 133023183 ANNUAL FAIR NY 501(C)(3) LINE 10 ACACIA NETWORK INC 0 AUDOBON PARTNERSHIP FOR ECONOMIC DEVELOPMENT 300 EAST 175TH STREET BRONX NY 10457 133927797 ECONOMIC DEVELOPMENT NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 1068 FRANKLIN HOUSING DEVELOPMENT 1776 CLAY AVENUE BRONX NY 10457 208317595 HOUSING NY 501(C)(4) ACACIA NETWORK INC 0 ACDP INC 3940 BROADWAY NEW YORK NY 10032 133266145 SOCIAL SERVICES NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 PALACIO DORADO MANAGEMENT CORP 300 EAST 175TH STREET BRONX NY 10457 464966129 HOUSING NY 501(C)(3) PENDING ACACIA NETWORK INC 0 EL REGRESO INC 141 SOUTH THIRD STREET BROOKLYN NY 11211 061179595 HEALTH SERVICES NY 501(C)(3) LINE 7 ACACIA NETWORK INC 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0