2013-03-06T14:35:30-06:00 2012-09-30 061533253 SASLOW LUFKIN & BUGGY LLP TEN TOWER LANE AVON CT 06001 990 2011-10-01 060907212 MONSIGNOR BOJNOWSKI MANOR INC MONS 8602290336 50 PULASKI STREET NEW BRITAIN CT 06053 CAROL ANNE SALVIETTI 8602290336 2013-03-06 1 BETH THURZ P00346435 8606789200 2011 2016-02-25 16:41:14Z CAROL ANNE SALVIETTI 50 PULASKI STREET NEW BRITAIN CT 06053 6197515 0 X N/A X 1975 CT A SKILLED NURSING FACILITY WHICH PROVIDES ROOM, BOARD, AND CARE FOR ALL RESIDENTS OF THE MANOR. 11 10 116 65 0 0 11841 13450 6558627 6175656 2067 514 4888 5514 6577423 6195134 0 0 0 0 4005197 4052981 0 0 0 2251276 2230726 6256473 6283707 320950 -88573 2941371 2722028 2977446 2846676 -36075 -124648 THE PROVIDING OF ROOM, BOARD AND CARE FOR ALL RESIDENTS OF THE FACILITY WHICH CARES FOR THE GENERAL PUBLIC IN CONNECTION WITH THE MISSION OF THE DAUGHTERS OF THE IMMACULATE CONCEPTION AND THE ROMAN CATHOLIC CHURCH. 0 0 5864475 6175656 SIXTY BED SKILLED NURSING FACILITY FOR THE AGED. PROVIDED 19,975 DAYS OF CARE TO THE GENERAL PUBLIC FURTHERING THE MISSION OF THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION AND THE ROMAN CATHOLIC CHURCH. 5864475 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 6 0 1 116 1 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X CAROL ANNE SALVIETTI 8602290336 50 PULASKI STREET NEW BRITAIN CT 06053 CAROL ANNE SALVIETTI 40.00 X X 98290 0 0 CHRISTOPHER LASARACINA 0.50 X 0 0 0 CLAIRE PIETRAS 0.50 X 0 0 0 MARK PIZZOTTI 0.50 X 0 0 0 MSGR DANIEL PLOCHARCZYK 0.50 X 0 0 0 LEONARD GIZA 0.50 X X 0 0 0 SR CATHERINE SIRONTAK 40.00 X X 63335 0 1161 ROBERT STORY 0.50 X 0 0 0 MATTHEW RICH 0.50 X 0 0 0 DORIS RUDNICKI 0.50 X 0 0 0 STEPHEN ZEBROWSKI MD 0.50 X 0 0 0 STAN JANKOWSKI 0.50 X 0 0 0 161625 0 1161 0 0 0 0 GENESIS HEALTH VENTURES PO BOX 7247-6524 PHILADELPHIA PA 191706524 THERAPY 419909 1 13450 13450 MEDICARE/MEDICAID PAYM 623110 4631177 4631177 PATIENT REVENUE 623110 1544479 1544479 6175656 514 514 7895 2381 5514 5514 6195134 6175656 0 6028 162786 162786 3061538 2981426 80112 10826 10014 812 587574 544580 42994 230257 212988 17269 8333 8333 26250 26250 16964 16964 23116 23116 233971 210574 23397 4878 4878 152353 152353 169529 169529 50541 50541 NURSING AND OTHER MEDIC 683328 683328 PROVIDER TAX 351017 351017 BAD DEBT EXPENSE 216386 216386 DIETARY LAUNDRY HOUSEKE 170849 170849 123211 110890 12321 6283707 5864475 419232 0 1082277 1069560 44340 44340 776148 632693 14299 39256 10842 9988 5372244 4464341 984710 907903 28755 18288 2941371 2722028 352405 378112 44970 19000 2580071 2449564 2977446 2846676 X -36075 -124648 -36075 -124648 2941371 2722028 -88573 0 X X 0 1 1 X 0 X 4445 8623 12012 11841 13450 50371 5725010 5933322 5937500 6558627 6175656 30330115 5729455 5941945 5949512 6570468 6189106 30380486 0 0 0 30380486 17285 4166 5051 2067 514 29083 17285 4166 5051 2067 514 29083 5746740 5946111 5954563 6572535 6189620 30409569 0.99900 0.99860 0.00100 0.00140 X 2856932 2533354 323578 1345167 928095 417072 1070573 903320 167253 99572 99572 0 907903 LOAN DUE TO THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION 82462 NOTES PAYABLE DUE TO THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION 2350509 RESIDENT FUNDS 16593 2449564 6195134 6283707 -88573 -88573 6195134 0 6195134 0 6195134 6283707 0 6283707 0 6283707 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MANOR ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH CERTAIN PROVISIONS OF FASB ASC 740, "INCOME TAXES", WHICH PROVIDE A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. UNDER FASB ASC 740, THE MANOR MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THEN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE MANOR HAS NO UNRECOGNIZED TAX BENEFITS AS OF SEPTEMBER 30, 2012 AND 2011 AND DOES NOT BELIEVE IT IS REASONABLY POSSIBLE THAT ITS UNRECOGNIZED TAX BENEFITS WILL MATERIALLY CHANGE IN THE NEXT TWELVE MONTHS. AS OF SEPTEMBER 30, 2012 AND 2011, THE MANOR DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNRECOGNIZED TAX BENEFITS. ALL TAX YEARS FROM 2008 FORWARD ARE OPEN AND SUBJECT TO EXAMINATION. FORM 990, PART VI, SECTION B, LINE 11 THE ADMINSTRATOR OF THE MANOR WILL REVIEW THE 990 AND APPROVE THE FORM TO BE FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS MONITORS AND REVIEWS RELATIONSHIPS ANNUALLY AND ANY CONFLICTS ARE BROUGHT TO THE ATTENTION OF THE BOARD. THE BOARD WILL REVIEW THE CONFLICTS TO DETERMINE THEIR AFFECTS ON THE MANOR. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION FOR THE ADMINISTRATOR WILL BE BASED ON A FAIR MARKET RATE. THIS WILL BE ACCOMPLISHED BY COMPARING COMPENSATION PACKAGES OF SIMILAR SIZE HEALTH CARE FACILITIES BY GATHERING COMPENSATION DATA FROM ONLINE RESOURCES AND TRADE ASSOCIATIONS. ADDITIONALLY, THE EXPERIENCE OF THE CANDIDATE IS CONSIDERED AS PART OF THE COMPENSATION DETERMINATION. THE COMPENSATION PACKAGE WILL BE REVIEWED BY THE BOARD OF DIRECTORS AND APPROVED BY THE PRESIDENT OF THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION INC. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XII, LINE 2C THERE IS NO CHANGE FROM THE PRIOR YEAR. THE DAUGHTERS OF MARY OF THE IMMACULATE CONCEPTION 314 OSGOOD AVENUE NEW BRITAIN CT 06053 060995128 CHURCH CT 501(C)(3) LINE 1 N/A 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0