2011-11-11T14:56:40-06:00 2010-12-31 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2010-01-01 113109867 ST JOHNLAND NURSING CENTER INC STJO 6312695800 395 SUNKEN MEADOW ROAD KINGS PARK NY 11754 MARY JEAN WEBER 6312695800 2011-11-11 1 FREDERICK H ROTHMAN 2128674000 2010 2016-03-07 17:11:31Z MARY JEAN WEBER 395 SUNKEN MEADOW ROAD KINGS PARK NY 11754 35159343 0 X WWW.STJOHNLAND.ORG X 1991 NY TO CREATE A CARING AND SUPPORTIVE ENVIRONMENT COMMITTED TO THE HIGHEST STANDARDS OF QUALITY HEALTHCARE. IT SEEKS TO UPHOLD THE PRINCIPLES OF HUMAN DIGNITY AND WORTH, AND AFFIRMS THE RIGHT OF EVERY INDIVIDUAL TO MAINTAIN THE OPTIMUM QUALITY OF LIFE. 17 17 458 0 0 0 200000 200000 34744044 34650391 91995 3894 66413 305058 35102452 35159343 0 0 0 0 24957952 23515283 0 0 0 11094282 11183445 36052234 34698728 -949782 460615 22823209 21212504 27755711 25710390 -4932502 -4497886 TO CREATE A CARING AND SUPPORTIVE ENVIRONMENT COMMITTED TO THE HIGHEST STANDARDS OF QUALITY HEALTHCARE. IT SEEKS TO UPHOLD THE PRINCIPLES OF HUMAN DIGNITY AND WORTH, AND AFFIRMS THE RIGHT OF EVERY INDIVIDUAL TO MAINTAIN THE OPTIMUM QUALITY OF LIFE. 0 0 25505233 30959328 INPATIENT PROGRAM WITH 230 RESIDENT CARE BEDS. 1683923 2044017 ADULT DAY CARE PROGRAM FOR 100 REGISTRANTS. 1356887 1647046 LONG TERM HOME HEALTHCARE PROGRAM FOR 50 REGISTRANTS. 28546043 1 1 0 1 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 43 0 1 458 1 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X MICHAEL BARTOLOTTA 6312695800 395 SUNKEN MEADOW RD KINGS PARK NY 11754 X GORDON S HARGRAVES 0.50 X X 0 0 0 JOAN M HEANEY 0.50 X X 0 0 0 PETER FETTEROLF 0.50 X X 0 0 0 VIRGINIA P JACOBSEN 0.50 X X 0 0 0 WILLIAM D KEEN 0.50 X X 0 0 0 CARL H DOERGE JR 0.50 X X 0 0 0 JOHN M PERKINS 0.50 X X 0 0 0 STEPHEN VAN R ULMAN 0.50 X X 0 0 0 WILLIAM A BAUM III 0.50 X X 0 0 0 JOAN P SHEPARD 0.50 X X 0 0 0 SUSAN L WALKER 0.50 X X 0 0 0 TRUDY H CALABRESE 0.50 X X 0 0 0 PHILLIP D CALDERONE 0.50 X 0 0 0 SHARON FUENTES 0.50 X 0 0 0 FREDRIC LAMARCA 0.50 X 0 0 0 HEATHER LANE SPEHR 0.50 X 0 0 0 THOMAS J EKKERS MD 0.50 X 0 0 0 MARY JEAN WEBER 30.00 X 232575 58144 37271 MICHAEL BARTOLOTTA 30.50 X 134431 30853 31517 DR MAUREEN ORSEN 37.50 X 236172 0 36481 LOU ANN RUTHINOSKI 37.50 X 146689 0 31680 DEANNA BAEZ 35.00 X 116891 8349 16279 BETH STEWART 35.00 X 107434 7674 15697 MAUREEN RIZZO 35.00 X 102501 7321 15915 DR ALEX CZIRA 37.50 X 108568 0 27701 1185261 112341 212541 8 0 1 0 CARE & COMFORT 1580 OCEAN AVENUE BOHEMIA NY 11716 TRANSPORTATION 377597 LOEB & TROPER LLP 655 3RD AVENUE NEW YORK NY 10017 ACCOUNTING 197908 UNITEX 161 SOUTH MACQUESTEN PKWY MT VERNON NY 10550 LAUNDRY SERVICE 173182 ABRAMS FESTERMAN FESTERMAN 1111 MARCUS AVENUE LAKE SUCCESS NY 11042 ATTORNEY 115628 SDC TRANSPORTATION PO BOX 66 KINGS PARK NY 11754 TRANSPORTATION 103220 5 200000 200000 SKILLED NURSING FACILI 623000 30959328 30959328 ADULT DAY CARE 623000 2044017 2044017 LONG TERM HOME HEALTH 623000 1647046 1647046 34650391 3894 3894 AMNESTY PROGRAM INCOME 900099 248326 248326 OTHER REVENUES 623000 56732 56732 305058 35159343 34650391 0 308952 697455 265033 432422 16384026 13700300 2683726 856490 716138 140352 4272448 3531072 741376 1304864 1069988 234876 213055 213055 190469 190469 14848 14848 1799595 1692307 107288 6582 6582 2003635 1756260 247375 1553436 1316547 236889 508246 433162 75084 24341 19960 4381 190345 156083 34262 1578304 1294209 284095 354399 288878 65521 NYS CASH RECEIPT ASSESS 1349287 1106415 242872 BAD DEBT 820000 705200 114800 PRESCRIPTION DRUGS/SUPP 576903 473061 103842 34698728 28546043 6152685 0 35967 197887 1021922 1065905 6014371 6011832 88853 64723 361364 357681 34601045 22980793 12999079 11620252 739302 669880 1562351 1224344 22823209 21212504 4874005 4739813 94502 89659 7982612 7422425 3927463 3273319 10877129 10185174 27755711 25710390 X -4975002 -4540386 42500 42500 -4932502 -4497886 22823209 21212504 X 460615 -25999 X X 0 1 1 X 1 1 X 264470 3395401 3160859 200000 200000 7220730 33511292 33391743 35015994 34744044 34650391 171313464 33775762 36787144 38176853 34944044 34850391 178534194 0 0 0 178534194 26007 30045 41935 91995 3894 193876 26007 30045 41935 91995 3894 193876 71498 69044 74722 66413 305058 586735 33873267 36886233 38293510 35102452 35159343 179314805 0.99560 0.99670 0.00110 0.00120 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUES AMNESTY PROGRAM INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14848 14848 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE NURSING CENTER IS PART OF THE NYASHA HEALTH CARE ASSOCIATION. 0 1 42500 42500 42500 42500 1.00000 0 0 452043 452043 18995522 11258854 7736668 13493437 10475697 3017740 1660043 1246242 413801 11620252 DUE FROM THE SOCIETY OF ST. JOHNLAND 78574 RESIDENT FUNDS 89659 ESTIMATED RETROACTIVE RATE ADJUSTMENTS RECEIVABLE 1056111 1224344 LINE OF CREDIT 905419 DUE TO THIRD PARTY PAYORS 1309479 SECURITY DEPOSITS 13864 ACCRUED PENSION 7956412 10185174 35159343 34698728 460615 -25999 -25999 434616 35159343 0 35159343 0 35159343 34698728 0 34698728 0 34698728 PART IV, LINE 2B: AMOUNTS HELD IN TRUST FOR RESIDENTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE CENTER HAS ONE INDIVIDUAL DONOR-RESTRICTED ENDOWMENT FUND ESTABLISHED FOR SUPPORT FOR THE ELDERLY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2007 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPPLICABLE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: ADJUSTMENT TO REFLECT PENSION FUNDED STATUS -25,999. X X X X 0 0 0 0 0 0 0 0 0 MARY JEAN WEBER 232575 58144 0 0 0 0 12108 977 19349 4837 264032 63958 0 0 MICHAEL BARTOLOTTA 134431 30853 0 0 0 0 6998 740 19340 4439 160769 36032 0 0 DR MAUREEN ORSEN 236172 0 0 0 0 0 12295 0 24186 0 272653 0 0 0 LOU ANN RUTHINOSKI 146689 0 0 0 0 0 7637 0 24043 0 178369 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE ORGANIZATION ARE THE SAME PERSONS WHO ARE THE TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE TRUSTEES EACH SPRING AT THE ANNUAL MEETING OF EACH CORPORATION. IF A VACANCY OCCURS ON THE BOARD IN THE INTERIM, THE REMAINING TRUSTEES MAY ELECT A SUCCESSOR TO SERVE UNTIL THE NEXT ANNUAL MEETING OF MEMBERS. AT THE NEXT ANNUAL MEETING, THE MEMBERS ELECT TRUSTEES FOR SPECIFIC TERMS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS HAVE THE RIGHTS AND DUTIES PROVIDED BY STATUTE UNDER THE NEW YORK NOT-FOR-PROFIT CORPORATION LAW WHICH ARE NOT UNLIKE THOSE OF STOCKHOLDERS IN A TRADITIONAL FOR PROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING WITH THE IRS, COPIES WILL BE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW. QUESTIONS AND COMMENTS WILL BE FOWARDED TO THE CEO, WHO WILL THEN DISCUSS WITH THE PREPARER ANY CHANGES THAT MAY NEED TO BE ADDRESSED. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF ST. JOHNLAND NURSING CENTER, INC. THAT ALL DIRECTORS, OFFICERS, EMPLOYEES, AGENTS AND CONTRACTORS AVOID ANY ALL ACTIVITIES THAT CONFLICT WITH OR APPEAR TO CONFLICT WITH THEIR RESPONSIBILITIES AND OBLIGATIONS TO ST. JOHNLAND. CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE REQUIRED TO BE SIGNED BY EMPLOYEES. WHEN A CONFLICT ARISES, IT IS BROUGHT TO THE BOARD'S ATTENTION TO BE DISCUSSED. THE BOARD MEMBER WHO HAS THIS CONFLICT MUST RECUSE THEMSELVES FROM PARTICIPATING IN ANY DISCUSSION RELATED TO THE MATTER. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. HOURS WORKED FOR RELATED ORGANIZATIONS: FORM 990, PART VII, LINE 1A: MARY JEAN WEBER - 7.5 HOURS MICHAEL BARTOLOTTA - 7 HOURS DEANNA BAEZ - 2.5 HOURS BETH STEWART - 2.5 HOURS MAUREEN RIZZO - 2.5 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: ADJUSTMENT TO REFLECT PENSION FUNDED STATUS -25,999. TOTAL TO FORM 990, PART XI, LINE 5: -25,999. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SOCIETY OF ST JOHNLAND 395 SUNKEN MEADOW RD KINGS PARK NY 11758 111890580 FUND RAISING NY 501(C)(3) 7 N/A 0 ST JOHNLAND RESIDENCES II INC 395 SUNKEN MEADOW RD KINGS PARK NY 11758 200316499 TO ESTABLISH, OPERATE AND MAINTAIN AN ADULT RESIDENTIAL FACILITY NY 501(C)(4) N/A 0 0 0 1 0 1 0 0 0 0 0 1 1 0 1 0 0 0 0 ST JOHNLAND RESIDENCES II INC N 52914 FMV