2013-10-14T15:04:33-05:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 760847915 MARGARET ANNA CUSACK CARE CENTER INC MARG 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 THOMAS P SHEEHY 2016538300 2013-10-11 1 FREDERICK H ROTHMAN P01275277 2128674000 2012 2016-02-25 16:41:14Z THOMAS P SHEEHY 537 PAVONIA AVENUE JERSEY CITY NJ 07306 13986564 0 0928 X WWW.CUSACKCARECENTER.ORG X 2006 NJ PROVIDING SKILLED NURSING CARE FOR THE ELDERLY 15 14 205 14 0 0 437192 384894 14483747 13464057 193320 93154 18952 19786 15133211 13961891 0 0 0 0 7893525 7730821 0 45000 175791 7009454 6417763 14902979 14193584 230232 -231693 30753128 30903750 16910678 16942361 13842450 13961389 X SEE SCHEDULE O 0 0 12368868 13464057 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 2012, THE CENTER PROVIDED CARE AND SERVICES TO OVER 200 RESIDENTS. 12368868 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 11 2 1 205 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 1.00 X X 0 0 0 JAMES CARON 0.50 X X 0 0 0 JOHN LAPILUSA CPA 1.00 X X 0 0 0 THOMAS P SHEEHY JR 40.00 X X 146950 0 6495 CATHERINE YAXLEY 0.50 X 0 0 0 GEORGE A POPKO 0.50 X 0 0 0 GERARD COSTA PHD 0.50 X 0 0 0 LLOYD R CURRIER 0.50 X 0 0 0 JOSEPH DICRISTO 0.50 X 0 0 0 SR SUZANNE GOLAS CSJP 0.50 X 0 0 0 JOY L BARRY 0.50 X 0 0 0 SR ROSEMARY COFFEY CSJP 0.50 X 0 0 0 MARY ANN OLSEN ESQ 0.50 X 0 0 0 BERNADETTE HOEHL 0.50 X 0 0 0 REV JAMES PAGNOTTA STA 0.50 X 0 0 0 ERNEST CHESTER JR 40.00 X 94298 0 6112 MARY RODRIGUEZ 40.00 X 106279 0 4070 347527 0 16677 2 0 1 0 UNITED DIETARY SERVICE INC PO BOX 272 POMONA NY 10970 FOOD SERVICE PROVIDER 1493654 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 60680 THERAPY 1184834 2 30345 354549 384894 MEDICAID 623000 6878561 6878561 PATIENT SERVICE REVENUES 623000 4077585 4077585 MEDICARE 623000 2507911 2507911 13464057 93154 93154 7645 30345 7826 -181 -181 33695 16847 16848 16848 MISCELLANEOUS 900099 3119 3119 3119 13961891 13464057 0 112940 X 241248 241248 5465388 4594860 766402 104126 218349 201903 16446 1289376 1197662 91714 516460 477559 38901 39580 39580 46050 46050 45000 45000 1707985 1702119 5866 27270 25145 2125 2009088 1924316 58107 26665 79578 79578 559973 517795 42178 13549 475 13074 411339 380356 30983 965468 892747 72721 101064 101064 N.J. STATE ASSESSMENT 452066 452066 4753 1865 2888 14193584 12368868 1648925 175791 906086 624858 1248820 1533450 1230797 1551216 87268 108288 35820727 14849578 21788173 20971149 5491984 6114789 30753128 30903750 7107933 7419470 9519388 8878397 283357 644494 16910678 16942361 X 13842450 13961389 13842450 13961389 30753128 30903750 X -231693 533628 -182996 X X 0 1 X 1 0 X 1045347 576440 378699 437192 384894 2822572 13197927 12969213 13242545 14483747 13464057 67357489 14243274 13545653 13621244 14920939 13848951 70180061 0 0 0 70180061 191870 165634 110372 93320 93154 654350 191870 165634 110372 93320 93154 654350 16642 34622 9420 16092 16667 93443 2599 2890 3016 2860 3119 14484 14454385 13748799 13744052 15033211 13961891 70942338 0.98930 0.98740 0.00920 0.01100 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 493 493 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION PAID $9,865 TO LEADING AGE (FORMERLY NJAHSA) IN MEMBERSHIP DUES OF WHICH 5% IS USED FOR LOBBY ACTIVITIES. 2149754 2149754 29909716 11679125 18230591 518389 282691 235698 3242868 2887762 355106 20971149 ESTIMATED LIABILITIES DUE TO THIRD PARTIES 284847 RESIDENT SEC. DEP. AND PERSONAL FUNDS 359647 644494 X 14490533 533628 24673 558301 13932232 29659 29659 13961891 14218257 24673 24673 14193584 0 14193584 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2009 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 24,673. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 29,659. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 24,673. X X X X X X 1 CHANGING OUR WORLD INC 220 E 42ND STREET 5TH FLOOR NEW YORK NY 10017 FUNDRASING CONSULTANTS 0 0 45000 0 45000 NJ GENERATIONS LUNCHEON 37990 30345 7645 7826 37990 30345 7645 7826 7826 -181 33695 16847 0 33695 16847 16847 16848 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 834 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 140335 0 6615 0 0 0 2708 0 3787 0 153445 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. OTHER FEES FORM 990, PART IX, LINE 11G SECURITY EXPENSE: PROGRAM SERVICE EXPENSES 72,018. MANAGEMENT AND GENERAL EXPENSES 5,866. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 77,884. CONSULTANTS: PROGRAM SERVICE EXPENSES 26,096. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,096. PASTORAL CARE: PROGRAM SERVICE EXPENSES 8,850. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,850. DIETARY EXPENSES: PROGRAM SERVICE EXPENSES 1,595,155. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,595,155. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET -153,337. PROVISION FOR BAD DEBTS -29,659. FORM 990 PART XII LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.