2016-11-08T18:32:10-06:00 2015-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2015-01-01 760847915 MARGARET ANNA CUSACK CARE CENTER INC MARG 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 THOMAS P SHEEHY CHIEF EXECUTIVE OFFICER 2016538300 2016-11-07 1 ERIC GOLDFARB P01277125 2128674000 2015 2017-02-10 21:41:12Z THOMAS P SHEEHY 537 PAVONIA AVENUE JERSEY CITY NJ 07306 15079584 0 0928 X WWW.CUSACKCARECENTER.ORG X 2006 NJ PROVIDING SKILLED NURSING CARE FOR THE ELDERLY. 14 13 225 30 0 0 508867 547003 14566401 14345268 103995 102869 40428 53984 15219691 15049124 0 0 0 0 7635605 7889312 0 0 99282 7429647 7112403 15065252 15001715 154439 47409 30262475 29023185 14584649 14761947 15677826 14261238 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 12836643 14345268 THE MARGARET ANNA CUSACK CARE 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 2015, THE CENTER PROVIDED CARE AND SERVICES TO 490 RESIDENTS. 12836643 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 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 16 5 1 225 1 0 0 0 0 0 1 1 0 0 0 0 X 14 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 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 JOHN M LAPILUSA CPA TREASURER 1.00 X X 0 0 0 SILVANA BUCCIANTI BOARD TRUSTEE 0.50 X 0 0 0 JAMES F CARON BOARD TRUSTEE 0.50 X 0 0 0 LLOYD R CURRIER BOARD TRUSTEE 0.50 X 0 0 0 SISTER TERESA M DONOHUE CSJP 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 MARY ANN OLSEN ESQ BOARD TRUSTEE 0.50 X 0 0 0 REV JAMES V PAGNOTTA STB BOARD TRUSTEE 0.50 X 0 0 0 GEORGE A POPKO BOARD TRUSTEE 1.00 X 0 0 0 SUSAN M WALSH MD BOARD TRUSTEE 0.50 X 0 0 0 THOMAS P SHEEHY JR CEO 40.00 X X 172394 0 30854 ERNEST CHESTER JR CFO 40.00 X 102970 0 42507 MONA DAUPHIN DIRECTOR OF NURSING 40.00 X 119314 0 27700 394678 0 101061 3 0 1 0 UNITED DIETARY SERVICE INC PO BOX 272 POMONA NY 10970 FOOD SERVICE PROVIDER 1593617 SELECT REHABILITATION PO BOX 809056 CHICAGO IL 606809056 REHAB 1167195 2 57445 489558 547003 MEDICAID 623000 6929848 6929848 PATIENT SERVICE REVENUES 623000 4158183 4158183 MEDICARE 623000 3257237 3257237 14345268 102869 102869 7535 57445 12960 -5425 -5425 35000 17500 17500 17500 MISCELLANEOUS 900099 41909 41909 41909 15049124 14345268 0 156853 X 348725 348725 5722534 4925785 740371 56378 53010 45494 6984 532 1281768 1140882 123130 17756 483275 411267 72008 77046 77046 52790 52790 510 510 1998507 1984722 13785 12089 8585 3504 2585277 2430119 130542 24616 101313 101313 459605 391124 68481 6879 1879 5000 253238 215506 37732 999540 849609 149931 133938 133938 N.J. STATE ASSESSMENT 431671 431671 15001715 12836643 2065790 99282 418084 58439 1181364 1019786 1393726 1514851 100932 83996 36793498 17830965 19691002 18962533 7477367 7383580 30262475 29023185 6552936 7235452 51110 7689546 7064277 238034 299382 104133 111726 14584649 14761947 X 15677826 14261238 15677826 14261238 30262475 29023185 X 47409 -195492 -1268505 X X 0 1 X 1 0 X 437192 384894 688838 508867 547003 2566794 14483747 13464057 13510377 14566401 14345268 70369850 14920939 13848951 14199215 15075268 14892271 72936644 0 0 0 72936644 93320 93154 85065 103995 102869 478403 93320 93154 85065 103995 102869 478403 16092 16667 15503 7352 12075 67689 2860 3119 13276 33076 41909 94240 15033211 13961891 14313059 15219691 15049124 73576976 0.99130 0.99160 0.00650 0.00670 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 1 510 510 0 PART II-B, LINE 1: THE ORGANIZATION PAID $10,788 TO LEADING AGE (FORMERLY NJAHSA) IN MEMBERSHIP DUES OF WHICH $510 IS USED FOR LOBBYING ACTIVITIES. 0 1 X 2149754 2149754 30023077 14067500 15955577 3944211 3481161 463050 676456 282304 394152 18962533 ESTIMATED LIABILITIES DUE TO THIRD PARTIES 111726 111726 X 14701278 -195492 30460 -165032 14866310 182814 182814 15049124 15032175 30460 30460 15001715 0 15001715 PART IV, LINE 2B: RESIDENT SECURITY DEPOSITS AND PERSONAL FUNDS HELD ON BEHALF OF THE RESIDENTS ARE MAINTAINED IN BANK ACCOUNTS SEPARATE FROM THE MARGARET ANNA CUSACK CARE CENTER INC.'S ACCOUNTS. INTEREST EARNED IS CREDITED TO THE RESIDENTS' ACCOUNTS. PART X, LINE 2: MARGARET ANNA CUSACK CARE CENTER INC HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2012 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 30,460. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 182,814. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 30,460. X X X X X X NJ GENERATIONS LUNCHEON 64980 57445 7535 8460 4500 64980 57445 7535 8460 4500 12960 -5425 35000 17500 0 35000 17500 17500 17500 NJ 1 0 1 0 0.05000 0.95000 MELANIE MCLAURIN-DEVELOPMENT ASSOCI C/O MACCC 537 PAVONIA AVE JERSEY CITY NJ 07306 0 MELANIE MCLAURIN 2600 MELANIE MCLAURIN IS THE SUPERVISOR OF ALL GAMING ACTIVITY AND RELATED MATTERS WHICH INCLUDES, PLANNING AND MANAGING THESE ACTIVITIES. X 0 X X X 0 0 0 0 0 0 0 0 0 THOMAS P SHEEHY JR CEO 172394 0 0 0 0 0 6635 0 24219 0 203248 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 PEACE MINISTRIES, INC IS THE SOLE MEMBER OF MARGARET ANNA CUSACK CARE CENTER INC.(CENTER) 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 11 DRAFTS OF THE FORM 990 WILL BE FIRST REVIEWED JOINTLY BY THE AUDIT AND FINANCE COMMITTEES AND CHANGES, IF ANY, WILL BE MADE UNTIL FINAL FORM IS REACHED AND RECOMMENDED FOR SUBMISSION TO THE FULL BOARD FOR FINAL REVIEW AND APPROVAL. 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 EXECUTIVE COMMITTEE REVIEWS COMPARABLE DATA FROM OTHER ORGANIZATIONS WHICH ARE OF SIMILAR NATURE AND SIZE TO DETERMINE COMPENSATION FOR THE CEO AND KEY EMPLOYEES. THE LAST SALARY DETERMINATION FOR THE CEO AND KEY EMPLOYEES TOOK PLACE IN DECEMBER 2014. 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 78,732. MANAGEMENT AND GENERAL EXPENSES 13,785. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,517. CONSULTANTS: PROGRAM SERVICE EXPENSES 70,395. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,395. PASTORAL CARE: PROGRAM SERVICE EXPENSES 12,930. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,930. DIETARY EXPENSES: PROGRAM SERVICE EXPENSES 1,822,665. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,822,665. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET -1,085,691. PROVISION FOR BAD DEBTS -182,814. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. PEACE MINISTRIES INC SHALOM CENTER 399 HUDSON TERRACE ENGLEWOOD CLIFFS NJ 07632 465202238 TO SPONSOR HEALTH CARE RELATED INSTITUTIONS AND ORGANIZATIONS NJ 501(C)(3) LINE 1 N/A 0 0 0 0 0 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 MINISTRIES, 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.