2012-11-29T15:01:01-06:00 2011-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2011-01-01 133676681 PROMESA RESIDENTIAL HEALTH CARE FACILITY INC PROM 7182991100 308 EAST 175TH STREET BRONX NY 10457 TOMAS DEL RIO 7182991100 2012-11-28 1 FREDERICK H ROTHMAN P01275277 2128674000 2011 2016-02-24 21:20:13Z TOMAS DEL RIO 308 EAST 175TH STREET BRONX NY 10457 18846271 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. 6 6 143 8 0 0 0 0 22148970 18541508 184606 147441 692229 48322 23025805 18737271 0 0 0 0 9211684 9002416 0 0 0 9513472 8994901 18725156 17997317 4300649 739954 42625977 40769034 17979021 15382124 24646956 25386910 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 13961180 16689827 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 2011, THE FACILITY PROVIDED 37,839 DAYS OF SKILLED NURSING CARE. 1180111 1851681 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. 15141291 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 0 1 30 0 143 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 X SANDRA M PALLEJA MD 1.00 X X 0 0 0 MILAGROS BAEZ-O'TOOLE 1.00 X X 0 0 0 IRIS W RAMIREZ 1.00 X 0 0 0 DR JOSE WILEY 1.00 X 0 0 0 WILFRED RENTA 1.00 X 0 0 0 INGLE STEPHENS 1.00 X 0 0 0 PEDRO FALCON 1.00 X 0 0 0 MAURICE LABONNE 1.00 X 0 0 0 HON HECTOR DIAZ 7.00 X 39074 146988 416 RAUL RUSSI 7.00 X 97230 331473 23610 PAMELA MATTEL 7.00 X 53072 188604 12926 TOMAS DEL-RIO 11.00 X 75094 167140 26290 ADRIENNE ROSELL 35.00 X 193133 0 23167 ROBERTO VELEZ 8.00 X 35995 135409 18263 RALPH DECLET 1.00 X 0 194031 8861 DR SAROJ BAKSHI 35.00 X 191535 0 14381 NWOKEJI KINGSLEY 35.00 X 175914 0 0 861047 1163645 127914 3 0 1 0 PROMESA ADMINISTRATIVE SERVICES ORGANIZA 1776 CLAY AVENUE BRONX NY 10457 MANAGEMENT 1341623 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 110926 3 MEDICAID AND MEDICARE 623000 18541508 18541508 18541508 147441 147441 109000 109000 0 0 INSURANCE RECOVERY 900099 19177 19177 PARKING LOT REVENUE 900099 18340 18340 VENDOR REBATES 900099 9814 9814 991 991 48322 18737271 18541508 0 195763 280898 280898 6204573 6081837 122736 240495 238013 2482 1681958 1596033 85925 594492 559702 34790 1341623 311686 1029937 89364 89364 60556 60556 36474 36474 2198574 1524034 674540 64767 9090 55677 1519132 1205402 313730 1215066 1193860 21206 126996 115541 11455 13032 719 12313 21255 20849 406 969347 948737 20610 149766 146839 2927 NYS DEPT. OF HEALTH ASS 1008913 1008913 BAD DEBTS 180036 180036 17997317 15141291 2856026 0 9428407 6472252 8371653 8417757 2541675 3337170 547575 553256 27793680 13272523 15336284 14521157 222869 222869 6177514 7244573 42625977 40769034 1496335 1486528 5565000 4880000 6427417 6303735 4490269 2711861 17979021 15382124 X 24646956 25386910 24646956 25386910 42625977 40769034 739954 0 X X 0 1 1 X 0 X 92402 92402 21092879 20146414 20399473 22148970 18541508 102329244 21185281 20146414 20399473 22148970 18541508 102421646 0 0 0 102421646 409052 358437 309741 293606 256441 1627277 409052 358437 309741 293606 256441 1627277 24639 574517 29876 692229 48322 1369583 21618972 21079368 20739090 23134805 18846271 105418506 0.97160 0.96940 0.01540 0.01670 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: REFUNDS FROM VENDORS. 0 0 0 0 0 0 0 0 1 36474 36474 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 4360000 20516269 10644703 14231566 2803100 2627820 175280 14521157 SECURITY DEPOSITS 300000 DUE FROM AFFILIATED ENTITIES 4122770 ESTIMATED RETROACTIVE ADJUSTMENTS-THIRD PARTY PAYORS 1707279 DUE FROM DORMITORY AUTHORITY OF THE STATE OF NY 943477 DEFERRED MORTGAGE COSTS 171047 7244573 DUE TO THIRD PARTIES 2693812 DUE TO RESIDENTS 18049 2711861 18737271 17997317 739954 739954 18846271 109000 109000 18737271 0 18737271 18106317 109000 109000 17997317 0 17997317 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2008 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 109,000. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 109,000. X X X 0 0 0 0 0 0 0 1 0 HON HECTOR DIAZ 33586 126345 3360 12640 2128 8003 0 0 87 329 39161 147317 0 0 RAUL RUSSI 83849 285854 11340 38660 2041 6959 5355 18255 0 0 102585 349728 0 0 PAMELA MATTEL 46967 166909 4392 15608 1713 6087 2642 9390 196 698 55910 198692 0 0 TOMAS DEL-RIO 65610 146035 6200 13800 3284 7305 4316 9605 3834 8535 83244 185280 0 0 ADRIENNE ROSELL 192816 0 0 0 317 0 7616 0 15551 0 216300 0 0 0 ROBERTO VELEZ 33838 127296 2100 7900 57 213 0 0 3835 14428 39830 149837 0 0 RALPH DECLET 0 179850 0 5000 0 9181 0 8861 0 0 0 202892 0 0 DR SAROJ BAKSHI 187185 0 0 0 4350 0 9165 0 5216 0 205916 0 0 0 NWOKEJI KINGSLEY 175500 0 0 0 414 0 0 0 0 0 175914 0 0 0 PART I, LINE 7 BONUSES ARE APPROVED BY THE BOARD OF DIRECTORS AS PART OF THE OVERALL COMPENSATION PACKAGE ON AN ANNUAL BASIS. THE CEO AND PRESIDENT'S BONUSES WERE BASED ON A SALARY SURVEY CONDUCTED BY A COMPENSATION CONSULTANT. THE COO AND CFO HAVE SALARY CONTRACTS, WHICH WERE BASED ON THE GUIDE STAR COMPENSATION BENCHMARKS. DORMITORY AUTHORITY OF THE STATE OF NEW YORK 146000293 64983QDG1 2005-04-13 8500402 REFUND PRIOR ISSUE (7/15/93) 0 0 0 3445000 8504041 504246 167980 8014797 1995 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 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 ALL MEMBERS OF THE BOARD OF DIRECTORS AND FINANCE DEPARTMENT STAFF INCLUDING THE CFO, CORPORATE CONTROLLER, AND ASSISTANT CONTROLLER HAVE RECEIVED COPIES OF THE DRAFT 990 AND COMPARED THEM TO THE FINANCIAL STATEMENTS AND REVIEWED THEM FOR TECHNICAL ACCURACY IN SUBSTANCE AND FORM. 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 2011. 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 VII, COLUMN (B) HECTOR DIAZ DEVOTED 28 HOURS PER WEEK FOR RELATED ORGANIZATIONS. RAUL RUSSI DEVOTED 28 HOURS PER WEEK FOR RELATED ORGANIZATIONS. PAMELA MATTEL DEVOTED 28 HOURS PER WEEK FOR RELATED ORGANIZATIONS. TOMAS DEL RIO DEVOTED 24 HOURS PER WEEK FOR RELATED ORGANIZATIONS. RALPH DECLET DEVOTED 35 HOURS PER WEEK FOR RELATED ORGANIZATIONS. ROBERTO VELEZ DEVOTED 27 HOURS PER WEEK FOR RELATED ORGANIZATIONS. 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 PROMESA SYSTEMS, INC. & SUBSIDIARIES 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 PROMESA SYSTEMS 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 1 0 1 0 0 0 0 0 0