2017-11-11T19:32:28-06:00 2016-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2016-01-01 760847915 MARGARET ANNA CUSACK CARE CENTER INC MARG 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 THOMAS P SHEEHY ADMINISTRATOR/SECRETARY 2016538300 2017-11-10 1 AARON SHAPIRO P01333816 2128674000 38.98.118.70 2017-11-10 14:01:21 ES P 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 2016 2018-03-14 21:41:22Z PEACE CARE ST JOSEPH'S THOMAS P SHEEHY JR 537 PAVONIA AVENUE JERSEY CITY NJ 07306 14906179 0 0928 X WWW.PEACECARENJ.ORG X 2006 NJ PROVIDING SKILLED NURSING CARE FOR THE ELDERLY. 9 8 235 16 0 0 547003 598662 14345268 14073259 102869 105910 53984 92260 15049124 14870091 0 0 0 0 7889312 8279519 0 0 214242 7112403 7084615 15001715 15364134 47409 -494043 28810964 28445560 14549726 14351385 14261238 14094175 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 13094641 14073259 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 2016, THE CENTER PROVIDED CARE AND SERVICES TO 483 RESIDENTS. 13094641 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 13 6 1 235 1 0 0 0 0 0 1 1 0 0 0 0 X 9 8 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 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 0.50 X X 0 0 0 LIZ DOREN 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 159764 0 28591 ERNEST CHESTER JR DIRECTOR OF FINANCE 40.00 X 103328 0 42420 SHIRLEY SANCHEZ-LISK DIRECTOR OF NURSING 40.00 X 103917 0 43810 PHULMATTEE JOSEPH REGISTERED NURSE 37.50 X 101215 0 0 JANE SUPUKO NURSING SUPERVISOR 37.50 X 102683 0 6737 570907 0 121558 5 0 1 0 UNIDINE 1000 WASHINGTON STREET SUITE 510 BOSTON MA 02118 DIETARY 1668270 SELECT REHABILITATION PO BOX 809056 CHICAGO IL 60680 REHAB 1152604 UNITED DIETARY SERVICE INC PO BOX 272 POMONA NY 10970 FOOD SERVICE PROVIDER 142289 3 60605 538057 598662 MEDICAID 623000 7739553 7739553 RESIDENT SERVICE REVENUES 623000 3578005 3578005 MEDICARE 623000 2755701 2755701 14073259 105910 105910 21875 60605 9713 12162 12162 52750 26375 26375 26375 MISCELLANEOUS 900099 53723 53723 53723 14870091 14073259 0 198170 X 334103 334103 5910437 5069904 703885 136648 52569 45093 6261 1215 1523062 1383821 117938 21303 459348 390905 68443 62288 62288 53778 53778 587 587 2235845 2156121 79724 32900 25978 6922 2366264 2172477 138711 55076 108578 108578 405082 344725 60357 4353 2045 2308 231516 197020 34496 991138 842467 148671 128788 128788 N.J. STATE ASSESSMENT 463498 463498 15364134 13094641 2055251 214242 58439 161696 1019786 1019689 1514851 1616274 83996 208250 36935702 18702706 18750312 18232996 7383580 7082365 0 124290 28810964 28445560 7235452 7785383 51110 30332 6852056 6227601 299382 191968 111726 116101 14549726 14351385 X 14261238 14094175 14261238 14094175 28810964 28445560 X -494043 422998 -96018 X X 0 1 X 1 0 X 384894 688838 508867 547003 598662 2728264 13464057 13510377 14566401 14345268 14073259 69959362 13848951 14199215 15075268 14892271 14671921 72687626 0 0 0 72687626 93154 85065 103995 102869 105910 490993 93154 85065 103995 102869 105910 490993 16667 15503 7352 12075 38537 90134 3119 13276 33076 41909 53723 145103 13961891 14313059 15219691 15049124 14870091 73413856 0.99010 0.99130 0.00670 0.00650 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 587 587 0 PART II-B LINE 1, LOBBYING ACTIVITIES: THE ORGANIGATION PAID $11,744 TO LEADING AGE(FORMALLY NJASHA) IN MEMBERSHIP DUES OF WHICH $587 IS USED FOR LOBBYING ACTIVITIES. 0 1 X 2221004 2221004 30036591 14736828 15299763 3909093 3528246 380847 769014 437632 331382 18232996 ESTIMATED LIABILITIES DUE TO THIRD PARTIES 116101 116101 X 15283142 422998 36088 459086 14824056 46035 46035 14870091 15400222 36088 36088 15364134 0 15364134 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, 2013 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 36,088. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 46,035. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 36,088. X X X X X X X 0 NJ GENERATIONS LUNCHEON 82480 60605 21875 9120 593 82480 60605 21875 9120 593 9713 12162 52750 26375 0 52750 26375 26375 26375 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 92822 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 0 0 THOMAS P SHEEHY JR ADMINISTRATOR/SECRETARY 158972 0 0 0 792 0 4135 0 24456 0 188355 0 0 0 X LAND AND BUILDING 1 213750 MARKET VALUE 0 0 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 4 NEW BYLAWS ADOPTED. 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 OF THE CENTER IS EXCLUSIVELY RESERVED TO THE MEMBER OF THE CORPORATION. THE POWER TO MAKE, ALTER OR CHANGE THE BYLAWS OF THE CENTER IS EXCLUSIVELY RESERVED TO THE MEMBER OF THE CENTER. FURTHERMORE, THERE IS EXCLUSIVELY RESERVED TO THE MEMBER OF THE CENTER THE POWER TO AUTHORIZE BY RESOLUTION OF THE 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 OF THE MISSION OF THE CENTER. L) TO RECEIVE BEQUESTS AND GIFTS FOR THE CENTER, AND TO USE AND DISTRIBUTE THEM FOR THE ORIGINAL PURPOSES OF THIS CENTER IN ACCORD WITH THE HISTORICAL TRADITION OF PEACE MINISTRIES, INC AND THIS CENTER. FORM 990, PART VI, SECTION B, LINE 11B DRAFTS OF THE FORM 990 WERE FIRST REVIEWED BY THE FINANCE COMMITTEES AND CHANGES, IF ANY, WOULD BE MADE UNTIL FINAL FORM IS REACHED. A COPY OF FINAL 990 WAS THEN SUBMITTED TO THE FULL BOARD FOR FINAL REVIEW AND APPROVAL PRIOR TO BEING FILED. 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 15 THE BOARD OF TRUSTEES REVIEWS COMPARABLE DATA FROM OTHER ORGANIZATIONS WHICH ARE OF SIMILAR NATURE AND SIZE TO DETERMINE COMPENSATION FOR OFFICERS. THE LAST SALARY DETERMINATION FOR THE OFFICERS TOOK PLACE IN DECEMBER 2016. 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 70,841. MANAGEMENT AND GENERAL EXPENSES 12,403. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 83,244. CONSULTANTS: PROGRAM SERVICE EXPENSES 39,671. MANAGEMENT AND GENERAL EXPENSES 67,321. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 106,992. PASTORAL CARE: PROGRAM SERVICE EXPENSES 8,837. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,837. DIETARY EXPENSES: PROGRAM SERVICE EXPENSES 2,036,772. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,036,772. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET -49,983. PROVISION FOR BAD DEBTS -46,035. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. PEACE CARE INC 198 OLD BERGEN RD JERSEY CITY NJ 07305 812589807 TO SPONSOR HEALTH CARE RELATED INSTITUTIONS AND ORGANIZATIONS NJ 501(C)(3) LINE 10 N/A 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 N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART II PURPOSE: TO SPONSOR HEALTH CARE RELATED INSTITUTIONS AND ORGANIZATIONS OPERATED IN CONNECTION WITH AND CONDUCTED UNDER THE AUSPICES OF PEACE CARE, INC, A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH, PROVIDED ANY SUCH INSTITUTIONS AND ORGANIZATIONS ENJOY TAX EXEMPT STATUS UNDER THE INTERNAL REVENUE CODE; AND, TO PERFORM ANY OTHER ACT INCIDENTAL TO THE ACCOMPLISHMENT OF THESE PURPOSES.