2014-11-11T15:13:57-06:00 2013-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2013-01-01 133676681 PROMESA RESIDENTIAL HEALTH CARE FACILITY INC PROM 7182991100 308 EAST 175TH STREET BRONX NY 10457 TOMAS DEL RIO CFO 7182991100 2014-11-10 1 ISRAEL TANNENBAUM P01589203 2128674000 2013 2015-11-30 17:44:51Z TOMAS DEL RIO 308 EAST 175TH STREET BRONX NY 10457 18334441 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. 6 6 140 6 0 0 0 0 18471957 17999079 94216 83688 31139 142674 18597312 18225441 0 0 0 0 8941051 9368703 0 0 0 8490816 8282089 17431867 17650792 1165445 574649 41684633 41687536 15064365 14416491 26620268 27271045 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 13692496 16622903 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 2013, THE FACILITY PROVIDED 37,249 DAYS OF SKILLED NURSING CARE. 1188968 1376176 PROMESA OPERATES AN OUTPATIENT ADULT DAY CARE PROGRAM FOR HIV PATIENTS IN THE COMMUNITY. THE PROGRAM SERVES 60 CLIENTS PER DAY. TOTAL VISITS FOR 2013 WAS 7,527. 14881464 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 0 0 1 0 0 0 0 0 1 0 0 0 1 22 0 140 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 CFO ACACIA NETWORK INC 7182991100 1776 CLAY AVENUE BRONX NY 10457 SANDRA M PALLEJA MD CHAIRPERSON 1.00 X X 0 0 0 MILAGROS BAEZ-O'TOOLE SECRETARY 1.00 X X 0 0 0 INGLE STEPHENS MEMBER 1.00 X 0 0 0 IRIS W RAMIREZ MEMBER 1.00 X 0 0 0 PEDRO FALCON MEMBER 1.00 X 0 0 0 WILFRED RENTA MEMBER 1.00 X 0 0 0 HON HECTOR DIAZ PRESIDENT 5.60 29.40 X 52450 157349 12862 PAMELA MATTEL COO 6.00 29.00 X 42430 240437 41715 RAUL RUSSI CEO 6.00 29.00 X 73399 415950 19886 TOMAS DEL RIO CFO 10.50 24.50 X 133519 163190 33722 ADRIENNE ROSELL SENIOR ADMINISTRATOR 1.00 35.00 X 0 206188 31910 DAVID C COLLYMORE CHIEF MEDICAL OFFICER 17.50 17.50 X 107897 107897 7980 DR SAROJ BAKSHI MEDICAL DIRECTOR 1.00 35.00 X 0 203959 19119 RALPH DECLET VP OF ECONOMIC DEVELOPMENT 1.00 34.00 X 0 195120 27442 PETER MARCUS PHYSICIAN 35.00 X 187685 0 26210 597380 1690090 220846 3 0 1 0 PROMESA ADMINISTRATIVE SERVICES ORGANIZA 1776 CLAY AVENUE NEW YORK NY 10457 MANAGEMENT 1424934 RC SOLUTIONS INC 75 SOUTH BROADWAY WHITE PLAINS NY 10601 ADMINISTRATIVE CONSULTING SERVICES 316800 LOEB & TROPER LLP 655 3RD AVENUE NEW YORK NY 10017 ACCOUNTING/CONSULTING 110631 3 MEDICAID AND MEDICARE -INPATIENT 623000 17999079 17999079 17999079 83688 83688 109000 109000 0 INSURANCE RECOVERY 900099 101499 101499 EMPLOYEE PARKING FEES 900099 23700 23700 PURCHASE DISCOUNTS 900099 15848 15848 1627 1627 142674 18225441 17999079 0 226362 301798 301798 6485469 6340187 145282 290873 271713 19160 1704714 1592424 112290 585849 547259 38590 3383917 1794387 1589530 75456 75456 75850 75850 24795 24795 219527 24074 195453 66585 66585 1622897 1513117 109780 299124 293142 5982 11180 4204 6976 299232 293247 5985 798110 782148 15962 232450 227801 4649 NYS DEPT. OF HEALTH ASS 1172966 1172966 17650792 14881464 2769328 0 6767514 7282617 7783207 7941243 3282429 2390080 547749 598417 29474839 15371154 14759782 14103685 222869 222869 8321083 9148625 41684633 41687536 1757063 1894401 3890000 3135000 6184681 6057660 3232621 3329430 15064365 14416491 X 26620268 27271045 26620268 27271045 41684633 41687536 574649 76128 0 X X 0 1 X 1 0 X 20399473 22148970 18541508 18471957 17999079 97560987 20399473 22148970 18541508 18471957 17999079 97560987 0 0 0 97560987 309741 293606 256441 203216 192688 1255692 309741 293606 256441 203216 192688 1255692 29876 692229 48322 31139 142674 944240 20739090 23134805 18846271 18706312 18334441 99760919 0.97790 0.97270 0.01260 0.01390 X PART III, LINE 12, EXPLANATION FOR OTHER INCOME: EMPLOYEE PARKING FEES. PURCHASE DISCOUNTS. INSURANCE RECOVERY. 0 0 0 0 0 0 0 0 1 24795 24795 0 PART II-B, LINE 1: PROMESA CONTRACTS WITH VARIOUS THIRD PARTY LOBBYING CONSULTANTS TO DEVELOP AND IMPLEMENT A COMPREHENSIVE STRATEGY ON ISSUES RELATED TO PROMESA 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 0 114311 114311 22575631 9925160 12650471 3372909 2565421 807488 3027136 2666766 360370 384852 213807 171045 14103685 SECURITY DEPOSITS 300000 DUE FROM AFFILIATED ENTITIES 8038519 ESTIMATED RETROACITVE ADJUSTMENTS-THIRD PAYORS 23458 DUE FROM DORMITORY OF THE STATE OF NY 679744 DEFERRED MORTGAGE COSTS 106904 9148625 DUE TO THIRD PARTIES 3312656 DUE TO RESIDENTS 16774 3329430 X 18410569 76128 109000 185128 18225441 0 18225441 17759792 109000 109000 17650792 0 17650792 PART X, LINE 2: 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, 2010 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 HON HECTOR DIAZ PRESIDENT 45191 135572 4532 13596 2727 8181 3010 9029 206 617 55666 166995 0 0 PAMELA MATTEL COO 37388 211865 3900 22100 1142 6472 1477 8371 4780 27087 48687 275895 0 0 RAUL RUSSI CEO 64673 366481 6564 37198 2162 12271 2869 16256 114 647 76382 432853 0 0 TOMAS DEL RIO CFO 116889 142864 11813 14438 4817 5888 5738 7013 9437 11534 148694 181737 0 0 ADRIENNE ROSELL SENIOR ADMINISTRATOR 0 205918 0 0 0 270 0 9938 0 21972 0 238098 0 0 DAVID C COLLYMORE CHIEF MEDICAL OFFICER 107816 107816 0 0 81 81 3753 3753 237 237 111887 111887 0 0 DR SAROJ BAKSHI MEDICAL DIRECTOR 0 200251 0 0 0 3708 0 9872 0 9247 0 223078 0 0 RALPH DECLET VP OF ECONOMIC DEVELOPMENT 0 187998 0 0 0 7122 0 10249 0 17193 0 222562 0 0 PETER MARCUS PHYSICIAN 187485 0 0 0 200 0 8269 0 17941 0 213895 0 0 0 PART I, LINE 7 IN ADDITION TO THE BASE SALARY, THE EXECUTIVE SHALL BE ELIGIBLE TO RECEIVE, AT THE EMPLOYERS DISCRETION, AN ANNUAL INCENTIVE BONUS IN AN AMOUNT NOT GREATER THAN TEN PERCENT OF THE EXECUTIVES 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 5190000 8501885 480080 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 AUTHORITY - STATE OF NEW YORK DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2009 SCHEDULE K PART II, 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 RUBEN A MEDINA ENTITY MORE THAN 35% OWNED BY FORMER BOARD MEMBERS 316800 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 BASIC HOUSING INC 1064 FRANKLIN AVENUE BRONX NY 10456 260076866 HOUSING COMPANY 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 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0