2012-10-05T09:30:48-05:00 2011-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2011-01-01 760847915 MARGARET ANNA CUSACK CARE CENTER INC MARG 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 THOMAS P SHEEHY 2016538300 2012-09-17 1 FREDERICK H ROTHMAN P01275277 2128674000 2011 2016-02-24 21:20:13Z THOMAS P SHEEHY 537 PAVONIA AVENUE JERSEY CITY NJ 07306 15158934 0 0928 X WWW.CUSACKCARECENTER.ORG X 2006 NJ PROVIDING SKILLED NURSING CARE FOR THE ELDERLY 16 15 221 22 0 0 378699 437192 13242545 14483747 111767 193320 12436 18952 13745447 15133211 0 0 0 0 8147614 7893525 0 0 156306 6856516 7009454 15004130 14902979 -1258683 230232 30917165 30753128 15409284 16910678 15507881 13842450 X SEE SCHEDULE O 0 0 12872998 14483747 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 2011, THE CENTER PROVIDED CARE AND SERVICES TO OVER 200 RESIDENTS. 12872998 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 11 2 221 1 0 0 0 0 0 1 1 0 0 0 0 X 16 15 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 146652 0 20063 CATHERINE YAXLEY 0.50 X 0 0 0 EDWARD J DEFAZIO 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 BERNADETTE HOEHL 0.50 X 0 0 0 REV JAMES PAGNOTTA STA 0.50 X 0 0 0 CURT PHILIPCZAK CPA 0.50 X 0 0 0 SR ANN RUTAN CSJP 0.50 X 0 0 0 SR MAUREEN D'AURIA CSJ 0.50 X 0 0 0 VICTOR COLAIEMMA 40.00 X 52289 0 0 ERNEST CHESTER JR 40.00 X 66538 0 928 MARY RODRIGUEZ 40.00 X 107486 0 15137 372965 0 36128 2 0 1 0 UNITED DIETARY SERVICE INC PO BOX 272 POMONA NY 10970 FOOD SERVICE 1483481 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 60680 THERAPY 1201424 LOUIS GARGIULO COMP INC 44-46 STATE STREET JERSEY CITY NJ 07304 CONSTRUCTION 159573 3 52748 82400 302044 437192 MEDICAID 623000 7961187 7961187 MEDICARE 623000 3507325 3507325 PATIENT SERVICE REVENU 623000 3015235 3015235 14483747 93320 93320 100000 100000 100000 100000 8470 52748 9051 -581 -581 33345 16672 16673 16673 MISCELLANEOUS 900099 2860 2860 2860 15133211 14483747 0 212272 286577 286577 5424236 4794091 542560 87585 649213 585364 63849 1004761 880752 90544 33465 528738 475758 52980 89373 89373 47491 47491 1717945 1688526 29419 35764 31679 4085 2190867 2098514 57097 35256 83589 83589 621616 559330 62286 41418 35414 6004 434223 390714 43509 966272 869645 96627 104254 104254 N.J. STATE ASSESSMENT 463211 463211 BAD DEBT EXPENSE 213431 213431 14902979 12872998 1873675 156306 237186 906086 821933 1248820 1639463 1230797 73669 87268 35672283 13884110 22448075 21788173 5696839 5491984 30917165 30753128 4928383 7107933 10117496 9519388 363405 283357 15409284 16910678 X 15507881 13842450 15507881 13842450 30917165 30753128 X 230232 -1895663 X X 0 1 1 X 0 X 955216 1045347 576440 378699 437192 3392894 9099011 13197927 12969213 13242545 14483747 62992443 10054227 14243274 13545653 13621244 14920939 66385337 0 0 0 66385337 178916 191870 165634 110372 93320 740112 178916 191870 165634 110372 93320 740112 13620 16642 34622 9420 16092 90396 2116 2599 2890 3016 2860 13481 10248879 14454385 13748799 13744052 15033211 67229326 0.98740 0.99860 0.01100 0.01240 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 1 489 489 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION, PAID $9,784 TO LEADING AGE (FORMERLY NJAHSA) IN MEMBERSHIP DUES OF WHICH 5% IS USED FOR LOBBY ACTIVITIES. 2149754 2149754 29876259 10864083 19012176 502625 263405 239220 3143645 2756622 387023 21788173 ESTIMATED LIABILITIES DUE TO THIRD PARTIES 119009 RESIDENT SEC. DEP. AND PERSONAL FUNDS 164348 283357 15133211 14902979 230232 -74000 -1821663 -1895663 -1665431 15084934 -74000 25723 -48277 15133211 0 15133211 14928702 25723 25723 14902979 0 14902979 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2008 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET -1,821,663. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 25,723. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 25,723. GENERATIONS LUNCHEON 61218 52748 8470 1895 7156 61218 52748 8470 1895 7156 9051 -581 33345 16672 0 33345 16672 16672 16673 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 870 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 139625 0 0 0 7027 0 16362 0 3701 0 166715 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, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD DELEGATING 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 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 AN AD-HOC COMPENSATION COMMITTEE REVIEWS THE COMPENSATION ANNUALLY OF THE CEO AND KEY EMPLOYEES. POTENTIAL CONFLICTS ARE DISCUSSED AT THE APPROPRIATE 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -74,000. PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET -1,821,663. TOTAL TO FORM 990, PART XI, LINE 5: -1,895,663. FORM 990, PART XII, LINE 2C SAME AS PRIOR YEAR.