2014-11-13T11:43:50-06:00 2013-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2013-01-01 760847915 MARGARET ANNA CUSACK CARE CENTER INC MARG 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 THOMAS P SHEEHY CHIEF EXECUTIVE OFFICER 2016538300 2014-11-11 1 ISRAEL TANNENBAUM P01589203 2128674000 2013 2015-11-30 17:44:51Z THOMAS P SHEEHY 537 PAVONIA AVENUE JERSEY CITY NJ 07306 14333234 0 0928 X WWW.CUSACKCARECENTER.ORG X 2006 NJ PROVIDING SKILLED NURSING CARE FOR THE ELDERLY 15 14 208 14 0 0 384894 688838 13464057 13510377 93154 85065 19786 28779 13961891 14313059 0 0 0 0 7730821 7546671 45000 0 173899 6417763 6863330 14193584 14410001 -231693 -96942 30903750 31152536 16942361 14196900 13961389 16955636 X SEE SCHEDULE O 0 0 12208079 13510377 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 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 2013, THE CENTER PROVIDED CARE AND SERVICES TO OVER 200 RESIDENTS. 12208079 1 1 0 1 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 1 15 2 1 208 1 0 0 0 0 0 1 1 0 0 0 0 X 15 14 0 0 0 0 0 0 0 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 PROUT JR CHAIRMAN 1.00 X X 0 0 0 JAMES CARON VICE CHAIRPERSON 0.50 X X 0 0 0 JOHN LAPILUSA CPA TREASURER 1.00 X X 0 0 0 THOMAS P SHEEHY JR ADMINISTRATOR, TRUSTEE 40.00 X X 157426 0 28652 CATHERINE YAXLEY BOARD TRUSTEE 0.50 X 0 0 0 GEORGE A POPKO BOARD TRUSTEE 1.00 X 0 0 0 LLOYD R CURRIER BOARD TRUSTEE 0.50 X 0 0 0 SR SUZANNE GOLAS CSJP BOARD TRUSTEE 0.50 X 0 0 0 SR ROSEMARY COFFEY CSJP BOARD TRUSTEE 0.50 X 0 0 0 MARY ANN OLSEN ESQ BOARD TRUSTEE 0.50 X 0 0 0 BERNADETTE HOEHL BOARD TRUSTEE 0.50 X 0 0 0 REV JAMES PAGNOTTA STB BOARD TRUSTEE 0.50 X 0 0 0 SILVIANA BUCCIANTI BOARD TRUSTEE 0.50 X 0 0 0 SUSAN WALSH BOARD TRUSTEE 0.50 X 0 0 0 PHYLLIS LIGUORI BOARD TRUSTEE 0.50 X 0 0 0 ERNEST CHESTER JR DIRECTOR OF FINANCE 40.00 X 98685 0 14972 256111 0 43624 1 0 1 0 UNITED DIETARY SERVICE INC PO BOX 272 POMONA NY 10970 FOOD SERVICE PROVIDER 1104684 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 60680 THERAPY 942332 LOUIS GARGIULO COMP INC 44-46 STATE STREET JERSEY CITY NJ 07306 CONTRACTOR 167424 CARE PERSPECTIVES INC 171 CHURCH ROAD MILFORD NJ 08848 NURSING AGENCY 129850 4 102407 586431 688838 MEDICAID 623000 6504395 6504395 PATIENT SERVICE REVENUES 623000 4405381 4405381 MEDICARE 623000 2600601 2600601 13510377 85065 85065 5678 102407 5175 503 503 30000 15000 15000 15000 MISCELLANEOUS 900099 13276 13276 13276 14313059 13510377 0 113844 X 262575 262575 5505576 4675144 729838 100594 154727 138228 16499 1180232 1000751 155604 23877 443561 372678 63188 7695 155763 155763 49055 49055 1692542 1686639 5903 16833 13749 3084 2581242 2417194 122315 41733 89053 89053 410673 352170 58503 3197 3197 336935 288937 47998 978602 831812 146790 118658 118658 N.J. STATE ASSESSMENT 430777 430777 14410001 12208079 2028023 173899 624858 459435 1533450 1587746 1551216 1364159 108288 105496 36330653 15828180 20971149 20502473 6114789 7133227 30903750 31152536 7419470 5029097 8878397 8293725 644494 874078 16942361 14196900 X 13961389 16955636 13961389 16955636 30903750 31152536 X -96942 965951 2125238 X X 0 1 X 1 0 X 576440 378699 437192 384894 688838 2466063 12969213 13242545 14483747 13464057 13510377 67669939 13545653 13621244 14920939 13848951 14199215 70136002 0 0 0 70136002 165634 110372 93320 93154 85065 547545 165634 110372 93320 93154 85065 547545 34622 9420 16092 16667 15503 92304 2890 3016 2860 3119 13276 25161 13748799 13744052 15033211 13961891 14313059 70801012 0.99060 0.98930 0.00770 0.00920 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 507 507 0 PART II-B, LINE 1: THE ORGANIZATION PAID $10,148 TO LEADING AGE (FORMERLY NJAHSA) IN MEMBERSHIP DUES OF WHICH 5% IS USED FOR LOBBY ACTIVITIES. 2149754 2149754 29909716 12474173 17435543 767339 301977 465362 3503844 3052030 451814 20502473 ESTIMATED LIABILITIES DUE TO THIRD PARTIES 452984 RESIDENT SEC. DEP. AND PERSONAL FUNDS 421094 874078 X 15182483 965951 20175 986126 14196357 116702 116702 14313059 14430176 20175 20175 14410001 0 14410001 PART X, LINE 2: UNCERTAINTY IN INCOME TAXES - 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, 2010 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 20,175. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 116,702. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 20,175. X X X X X X 0 NJ GENERATIONS LUNCHEON 108085 102407 5678 5175 108085 102407 5678 5175 5175 503 30000 15000 0 30000 15000 15000 15000 NJ 1 0 1 0 0.05000 0.95000 SUSAN SIMS-DIRECTOR OF DEVELOPMENT C/O MACCC 537 PAVONIA AVE JERSEY CITY NJ 07306 0 SUSAN SIMS 805 SUSAN SIMS 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 ADMINISTRATOR, TRUSTEE 157426 0 0 0 0 0 2600 0 26052 0 186078 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 DRAFTS OF THE FORM 990 ARE FIRST REVIEWED JOINTLY BY THE AUDIT AND FINANCE COMMITTEES AND CHANGES, IF ANY, ARE MADE UNTIL FINAL FORM IS REACHED AND RECOMMENDED FOR SUBMISSION TO THE 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 ORGANIZATION 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 CORPORATION 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 2012. FORM 990, PART VI, SECTION C, LINE 18 A COPY OF THE FORM 990 IS MADE AVAILABLE UPON REQUEST. 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 72,471. MANAGEMENT AND GENERAL EXPENSES 5,903. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,374. CONSULTANTS: PROGRAM SERVICE EXPENSES 24,908. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,908. PASTORAL CARE: PROGRAM SERVICE EXPENSES 7,184. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,184. DIETARY EXPENSES: PROGRAM SERVICE EXPENSES 1,582,076. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,582,076. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET 2,241,940. PROVISION FOR BAD DEBTS -116,702. FORM 990 PART XII LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.