2013-11-13T13:38:02-06:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 133676681 PROMESA RESIDENTIAL HEALTH CARE FACILITY INC PROM 7182991100 308 EAST 175TH STREET BRONX NY 10457 TOMAS DEL RIO 7182991100 2013-11-13 1 FREDERICK H ROTHMAN P01275277 2128674000 2012 2016-02-24 21:20:13Z TOMAS DEL RIO 308 EAST 175TH STREET BRONX NY 10457 18706312 0 X WWW.PROMESA.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. 5 5 129 8 0 0 0 0 18541508 18471957 147441 94216 48322 31139 18737271 18597312 0 0 0 0 9002416 8941051 0 0 0 8994901 8490816 17997317 17431867 739954 1165445 40769034 41684633 15382124 15064365 25386910 26620268 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 13552684 16600159 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 2012, THE FACILITY PROVIDED 38,210 DAYS OF SKILLED NURSING CARE. 1212926 1871798 PROMESA OPERATES AN OUTPATIENT ADULT DAY CARE PROGRAM FOR HIV PATIENTS IN THE COMMUNITY. THE PROGRAM SERVES 60 CLIENTS PER DAY. TOTAL VISITS FOR 2011 WAS 10,058. 14765610 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 21 0 129 1 0 0 0 0 0 0 0 0 0 0 X 5 5 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 1.00 X X 0 0 0 MILAGROS BAEZ-O'TOOLE 1.00 X X 0 0 0 INGLE STEPHENS 1.00 X 0 0 0 IRIS W RAMIREZ 1.00 X 0 0 0 PEDRO FALCON 1.00 X 0 0 0 WILFRED RENTA 1.00 X 0 0 0 HON HECTOR DIAZ 5.60 29.40 X 38500 202128 9817 PAMELA MATTEL 6.00 29.00 X 52216 254936 29491 RAUL RUSSI 6.00 29.00 X 92282 450556 19766 TOMAS DEL-RIO 10.50 24.50 X 92539 215925 30338 ADRIENNE ROSELL 35.00 X 198352 0 29194 DAVID C COLLYMORE 17.50 X 100000 100162 0 DR SAROJ BAKSHI 35.00 X 196374 0 17817 RALPH DECLET 1.00 34.00 X 0 204608 25823 ROBERTO VELEZ 5.60 29.40 X 28387 149035 30699 798650 1577350 192945 2 0 1 0 PROMESA ADMINISTRATIVE SERVICES ORGANIZA 1776 CLAY AVENUE NEW YORK NY 10457 MANAGEMENT 1504936 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 110630 3 MEDICAID AND MEDICARE -INPATIENT 623000 18471957 18471957 18471957 94216 94216 109000 109000 0 EMPLOYEE PARKING FEES 900099 18840 18840 PURCHASE DISCOUNTS 900099 10645 10645 INSURANCE RECOVERY 900099 830 830 824 824 31139 18597312 18471957 0 125355 275537 275537 6262737 6132198 130539 324311 304169 20142 1524747 1430049 94698 553719 519329 34390 1315753 281844 1033909 34007 34007 65000 65000 1850874 1255033 595841 23034 23034 1211073 911259 299814 1133792 1112694 21098 104053 93836 10217 9593 1205 8388 23820 23344 476 765785 750469 15316 192565 188714 3851 NYS DEPT. OF HEALTH ASS 1261467 1261467 DEPARTMENT OF HEALTH PE 500000 500000 17431867 14765610 2666257 0 6472252 6767514 8417757 7783207 3337170 3282429 553256 547749 28875018 14115236 14521157 14759782 222869 222869 7244573 8321083 40769034 41684633 1486528 1757063 4880000 3890000 6303735 6184681 2711861 3232621 15382124 15064365 X 25386910 26620268 25386910 26620268 40769034 41684633 1165445 67913 0 X X 0 1 X 1 0 X 20146414 20399473 22148970 18541508 18471957 99708322 20146414 20399473 22148970 18541508 18471957 99708322 0 0 0 99708322 358437 309741 293606 256441 203216 1421441 358437 309741 293606 256441 203216 1421441 574517 29876 692229 48322 31139 1376083 21079368 20739090 23134805 18846271 18706312 102505846 0.97270 0.97160 0.01390 0.01540 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: EMPLOYEE PARKING FEES. PURCHASE DISCOUNTS. INSURANCE RECOVERY. 0 0 0 0 0 0 0 0 1 24128 24128 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 22258232 8913767 13344465 3372909 2440239 932670 2744714 2579494 165220 384852 181736 203116 14759782 SECURITY DEPOSITS 300000 DUE FROM AFFILIATED ENTITIES 6148879 ESTIMATED RETROACITVE ADJUSTMENTS-THIRD PAYORS 1056796 DUE FROM DORMITORY OF THE STATE OF NY 676433 DEFERRED MORTGAGE COSTS 138975 8321083 DUE TO THIRD PARTIES 3214829 DUE TO RESIDENTS 17792 3232621 X 18774225 67913 109000 176913 18597312 0 18597312 17540867 109000 109000 17431867 0 17431867 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2009 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 26331 138243 10637 55843 1532 8042 1489 7816 82 430 40071 210374 0 0 PAMELA MATTEL 42377 206896 8500 41500 1339 6540 1761 8600 3252 15878 57229 279414 0 0 RAUL RUSSI 66914 326701 23763 116020 1605 7835 2680 13086 680 3320 95642 466962 0 0 TOMAS DEL-RIO 69228 161532 15000 35000 8311 19393 3667 8556 5435 12680 101641 237161 0 0 ADRIENNE ROSELL 198082 0 0 0 270 0 9657 0 19537 0 227546 0 0 0 DAVID C COLLYMORE 100000 100000 0 0 0 162 0 0 0 0 100000 100162 0 0 DR SAROJ BAKSHI 192666 0 0 0 3708 0 9627 0 8190 0 214191 0 0 0 RALPH DECLET 0 179486 0 18000 0 7122 0 9702 0 16121 0 230431 0 0 ROBERTO VELEZ 26718 140274 1600 8400 69 361 1393 7313 3519 18474 33299 174822 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 4435000 8502901 491026 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 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 0 0 0 0 0