2015-11-02T09:33:23-06:00 2014-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2014-01-01 133676681 PROMESA RESIDENTIAL HEALTH CARE FACILITY INC PROM 7182991100 308 EAST 175TH STREET BRONX NY 10457 TOMAS DEL RIO CFO 7182991100 2015-10-29 1 AARON SHAPIRO P01333816 2128674000 2014 2016-04-25 22:37:26Z TOMAS DEL RIO 308 EAST 175TH STREET BRONX NY 10457 18020894 0 X WWW.ACACIANETWORK.ORG X 1992 NY PROMESA RESIDENTIAL HEALTH CARE FACILITY OPERATES A 108 BED LONG TERM CARE FACILITY AS WELL AS AN ADULT DAY CARE PROGRAM THAT PROVIDES COMPREHENSIVE, HOLISTIC, CULTURALLY AND LINGUISTICALLY COMPETENT SERVICES TO INDIVIDUALS LIVING WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR OTHER HIV RELATED ILLNESSES. 8 8 140 9 0 0 0 0 17999079 17581866 83688 217327 142674 112701 18225441 17911894 0 0 0 0 9368703 9563346 0 0 0 8282089 7585035 17650792 17148381 574649 763513 41687536 43246025 14416491 15336552 27271045 27909473 X A BRONX BASED HEALTH, HUMAN SERVICES, AND COMMUNITY DEVELOPMENT ORGANIZATION WHOSE MISSION IS TO ENABLE NEW YORK CITY RESIDENTS TO BECOME SELF-SUFFICIENT CITIZENS WHO CONTRIBUTE TO THE QUALITY OF LIFE OF THEIR COMMUNITIES. PROMESA RHCF WORKS TO ACCOMPLISH THIS BY BEING A LEADER IN THE HEALTH AND HUMAN SERVICES ARENA; ADDRESSING THE UNDER-SERVED IN HEALTH, EDUCATION, EMPLOYMENT, ECONOMIC, COMMUNITY DEVELOPMENT ACTIVITIES AND HOUSING. 0 0 13611283 16420277 PROMESA RESIDENTIAL HEALTH CARE FACILITY 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 2014, THE FACILITY PROVIDED 36,935 DAYS OF SKILLED NURSING CARE. 988985 1161589 PROMESA OPERATES AN OUTPATIENT ADULT DAY CARE PROGRAM FOR HIV PATIENTS IN THE COMMUNITY. THE PROGRAM SERVES 60 CLIENTS PER DAY. TOTAL VISITS FOR 2014 WAS 6,256. 14600268 1 0 0 1 0 0 0 0 0 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 1 0 1 0 0 0 0 0 1 0 0 0 1 21 0 140 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X TOMAS DEL RIO CFO ACACIA NETWORK INC 7182991100 1776 CLAY AVENUE BRONX NY 10457 SANDRA M PALLEJA MD CHAIR EMERITUS 1.00 X X 0 0 0 MILAGROS BAEZ-O'TOOLE SECRETARY 1.00 X X 0 0 0 IRIS W RAMIREZ TREASURER 1.00 X X 0 0 0 INGLE STEPHENS MEMBER 1.00 X 0 0 0 PEDRO FALCON VICE CHAIR 1.00 X X 0 0 0 WILFRED RENTA CHAIR 1.00 X X 0 0 0 EDEL BORRERO MEMBER 1.00 X 0 0 0 MARIA RIVERA MEMBER 1.00 X 0 0 0 ERICA Y MARTINEZ MEMBER 1.00 X 0 0 0 RAUL RUSSI CEO 7.80 27.20 X 112085 392123 22000 TOMAS DEL RIO CFO 8.40 26.60 X 74483 235994 34377 PAMELA MATTEL COO 7.90 27.10 X 66998 229451 49252 HON HECTOR DIAZ PRESIDENT 4.50 15.50 X 49020 168361 10896 ADRIENNE ROSELL ADMINISTRATOR 35.00 0.00 X 206531 0 33883 DR SAROJ BAKSHI MEDICAL DIRECTOR 35.00 0.00 X 204023 0 20107 713140 1025929 170515 3 0 1 0 0 MEDICAID AND MEDICARE -INPATIENT 623000 17581866 17581866 17581866 217327 217327 109000 109000 0 INSURANCE RECOVERY 900099 80888 80888 EMPLOYEE PARKING FEES 812930 22920 22920 PURCHASE DISCOUNTS 900099 7372 7372 1521 1521 112701 17911894 17581866 0 330028 329312 329312 6576712 6427292 149420 313363 304548 8815 1798309 1693346 104963 545650 509798 35852 1750061 415733 1334328 46721 46721 76482 76482 42133 42133 278874 49842 229032 27715 27715 2877363 2767116 110247 181975 178335 3640 10416 3344 7072 236765 232030 4735 815903 783267 32636 250492 245482 5010 NYS DEPT. OF HEALTH ASS 990135 990135 17148381 14600268 2548113 0 7282617 2053755 7941243 6046348 2390080 2176618 5151429 598417 287265 30057646 16263986 14103685 13793660 222869 222869 9148625 13514081 41687536 43246025 1894401 2103508 3135000 2340000 37382 6057660 7500988 3329430 3354674 14416491 15336552 X 27271045 27909473 27271045 27909473 41687536 43246025 763513 -125085 0 X X 0 1 X 1 0 X 22148970 18541508 18471957 17999079 17581866 94743380 22148970 18541508 18471957 17999079 17581866 94743380 0 0 0 94743380 293606 256441 203216 192688 326327 1272278 293606 256441 203216 192688 326327 1272278 692229 48322 31139 142674 112701 1027065 23134805 18846271 18706312 18334441 18020894 97042723 0.97630 0.97790 0.01310 0.01260 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC PARKING INCOME INSURANCE RECOVERY REFUNDS FROM VENDORS FORGIVENESS OF PENALTIES AND INTEREST 0 0 0 0 0 0 0 0 1 42133 42133 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 23112964 10570048 12542916 3372908 2690504 682404 3072611 2757556 315055 384852 245878 138974 13793660 SECURITY DEPOSITS 352870 DUE FROM AFFILIATED ENTITIES 9578491 ESTIMATED RETROACITVE ADJUSTMENTS-THIRD PAYORS 23571 ACCRUED INTEREST RECEIVABLE 186136 OTHER RECEIVABLES 33238 INVESTMENT IN REAL ESTATE 3339775 13514081 DUE TO THIRD PARTIES 3354674 3354674 X 17895809 -125085 109000 -16085 17911894 0 17911894 17257381 109000 109000 17148381 0 17148381 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, 2011 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 109,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 109,000. X X X 0 0 0 0 0 0 0 1 0 RAUL RUSSI CEO 99556 348291 10020 35055 2509 8777 4335 15165 556 1944 116976 409232 0 0 TOMAS DEL RIO CFO 65996 209104 6612 20951 1875 5939 3059 9691 5188 16439 82730 262124 0 0 PAMELA MATTEL COO 59026 202149 6170 21130 1802 6172 2842 9732 8289 28389 78129 267572 0 0 HON HECTOR DIAZ PRESIDENT 42079 144522 4211 14461 2730 9378 2367 8130 90 309 51477 176800 0 0 ADRIENNE ROSELL ADMINISTRATOR 206101 0 0 0 430 0 10331 0 23552 0 240414 0 0 0 DR SAROJ BAKSHI MEDICAL DIRECTOR 200315 0 0 0 3708 0 10257 0 9850 0 224130 0 0 0 PART I, LINE 7 IN ADDITION TO THE BASE SALARY, THE EXECUTIVE 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 5985000 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 1V, ARBITRAGE, LINE 2C: (A) ISSUER NAME: DORMITORY AUTHORITY - STATE OF NEW YORK DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2009 SCHEDULE K PART II, LINE 3 PART II LINE, LINE 3 PART II, LINE 3 - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E)DUE TO INVESTMENT EARNINGS SCHEDULE K PART II, LINE 3 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. CARLOS D NAZARIO JR AND RUBIN A MEDINA ENTITY MORE THAN 35% OWNED BY FORMER BOARD MEMBERS 56892 INDEPENDENT CONTRACTOR ARRANGEMENT 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS REVIEWED BY ALL MEMBERS OF THE BOARD PRIOR TO BEING FILED. 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 PRINCIPAL 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 THE FACILITY. 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 THE FACILITY'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 MEMBER 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, THE BOARD WILL ENGAGE AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE THE APPROPRIATENESS OF THE COMPENSATION PACKAGES OFFERED TO THE EXECUTIVES OF PROMESA RHCF. THIS PROCESS INCLUDES UTILIZATION OF A COMPARATIVE SALARY ANALYSIS WITH EXECUTIVES OF COMPARABLE ORGANIZATIONS. THIS PROCESS WAS LAST UNDERTAKEN IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'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 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 11A, 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 11A, 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 9 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 11A, 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 LINE 7 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 9 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 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0