2011-11-09T13:26:57-06:00 2010-12-31 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2010-01-01 760847915 MARGARET ANNA CUSACK CARE CENTER INC MARG 2016538300 537 PAVONIA AVENUE JERSEY CITY NJ 07306 THOMAS P SHEEHY 2016538300 2011-11-08 1 FREDERICK H ROTHMAN 2128674000 2010 2016-02-24 21:20:13Z THOMAS P SHEEHY 537 PAVONIA AVENUE JERSEY CITY NJ 07306 14651565 0 0928 X WWW.CUSACKCARECENTER.ORG X 2006 NJ PROVIDING SKILLED NURSING CARE FOR THE ELDERLY 15 15 232 21 0 0 576440 378699 12969213 13242545 160895 111767 37512 12436 13744060 13745447 0 0 0 0 8296559 8147614 0 0 139106 6435013 6856516 14731572 15004130 -987512 -1258683 31321002 30917165 15184979 15409284 16136023 15507881 X SEE SCHEDULE O 0 0 12891553 13242545 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 2010, THE CENTER PROVIDED CARE AND SERVICES TO OVER 200 RESIDENTS. 12891553 1 1 0 1 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 23 10 1 232 1 0 0 0 0 0 1 1 0 0 0 0 X 15 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 SAVAGE 1.00 X X 0 0 0 RICHARD A RICCIO 0.50 X X 0 0 0 JOHN LAPILUSA CPA 1.00 X X 0 0 0 CATHERINE YAXLEY 0.50 X 0 0 0 EDWARD J DEFAZIO 0.50 X 0 0 0 JAMES CARON 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 JOHN PROUT 0.50 X 0 0 0 JOY L BARRY 0.50 X 0 0 0 SR ANN RUTAN CSJP 0.50 X 0 0 0 SR MAUREEN D'AURIA CSJP 0.50 X 0 0 0 REV JAMES PAGNOTTA 0.50 X 0 0 0 CURT PHILIPCZAK 0.50 X 0 0 0 GEORGE A POPKO 0.50 X 0 0 0 THOMAS P SHEEHY JR 40.00 X 152153 0 42831 VICTOR COLAIEMMA 40.00 X 110690 0 30783 MARY RODRIGUEZ 40.00 X 108897 0 30534 371740 0 104148 3 0 1 0 UNITED DIETARY SERVICE INC PO BOX 272 POMONA NY 10970 FOOD SERVICE 1556832 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 60680 THERAPY 1040364 LOUIS GARGIULO COMP INC 44-46 STATE STREET JERSEY CITY NJ 07304 CONSTRUCTION 412460 OMNICARE INC 100 EAST RIVERCENTER BLVD COVINGTON KY 41011 PHARMACEUTICAL 221262 MEDLINE INDUSTRIES INC PO BOX 382075 PITTSBURGH PA 15251 MEDICAL SUPPLIES 109607 7 66275 312424 378699 MEDICAID 623000 7982695 7982695 PATIENT SERVICE REVENU 623000 3003445 3003445 MEDICARE 623000 2256405 2256405 13242545 110372 110372 880082 878687 1395 1395 1395 5716 66275 11863 -6147 -6147 31135 15568 15567 15567 MISCELLANEOUS 900099 3016 3016 3016 13745447 13242545 0 124203 371740 99637 272103 5386925 4833281 480385 73259 738899 676071 62828 1126885 1003346 93242 30297 523165 478681 44484 124499 124499 44054 44054 8603 8603 1773369 1773369 34586 34586 2161366 1843705 282111 35550 676632 397016 279616 7755 7755 456101 417319 38782 943586 863354 80232 5166 5166 N.J. STATE ASSESSMENT 484488 484488 BAD DEBT EXPENSE 113496 113496 MISCELLANEOUS EXPENSES 22815 21286 1529 15004130 12891553 1973471 139106 96613 237186 958453 821933 1550312 1639463 163184 73669 35365913 12917838 22692560 22448075 5659026 5696839 200854 31321002 30917165 4497309 4928383 10352072 10117496 335598 363405 15184979 15409284 X 16136023 15507881 16136023 15507881 31321002 30917165 X -1258683 630541 X X 0 1 1 X 0 X 955216 1045347 576440 378699 2955702 9099011 13197927 12969213 13242545 48508696 10054227 14243274 13545653 13621244 51464398 0 0 0 51464398 178916 191870 165634 110372 646792 178916 191870 165634 110372 646792 38629 8116 52649 39867 139261 10271772 14443260 13763936 13771483 52250451 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS SPECIAL EVENT INCOME GAMING INCOME 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 NJAHSA IN DUES OF WHICH 5% IS USED FOR LOBBYING. 2149754 2149754 29806289 10043867 19762422 422975 238896 184079 2986895 2635075 351820 22448075 DUE TO THIRD-PARTY PAYORS 120309 RESIDENT SECURITY DEPOSITS AND PERSONAL FUNDS 243096 363405 13745447 15004130 -1258683 479478 151063 630541 -628142 14252356 479478 27431 506909 13745447 0 13745447 15031561 27431 27431 15004130 0 15004130 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, 2007 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 151,063. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 27,431. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENTS AND GAMING 27,431. GRANDPARENTS DAY LUNCH & RAFFLE 71991 66275 5716 1763 7050 200 2850 71991 66275 5716 1763 7050 200 2850 11863 -6147 31135 15568 0 31135 15568 15568 15567 NJ 1 0 0 0 0.05000 0.95000 SUSAN SIMS C/O MACCC 537 PAVONIA AVE JERSEY CITY NJ 07306 0 0 X X X 0 0 0 0 0 0 0 1 0 THOMAS P SHEEHY JR 138481 0 5000 0 8672 0 19523 0 23308 0 194984 0 0 0 PART I, LINE 7 THE AD-HOC COMPENSATION COMMITTEE MET IN JANUARY 2010 AND DECIDED TO AWARD THE EXECUTIVE DIRECTOR A BONUS IN 2010 BASED ON HIS 2009 PERFORMANCE. 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 THE CHAIRPERSON OF THE BOARD OF TRUSTEES APPOINTED AN AD HOC COMPENSATION COMMITTEE,COMPRISED OF THREE TRUSTEES AND CHAIRED BY THE TREASURER OF THE BOARD, TO REVIEW THE COMPENSATION STRUCTURE FOR THE CENTER'S CHIEF EXECUTIVE OFFICER, OFFICERS AND KEY EMPLOYEES. THIS PROCESS IS DONE ANNUALLY. THE COMMITTEE REVIEWED THE POSITION JOB DESCRIPTION, INCUMBENT'S PERFORMANCE AND CURRENT SALARY IN RELATION TO WAGE & SALARY DATA FOR LONG-TERM CARE FACILITIES IN NEW JERSEY. BASED ON THIS REVIEW, THE COMMITTEE RECOMMENDED A SALARY ADJUSTMENT TO THE BOARD CHAIRPERSON WHICH WAS PRESENTED TO THE BOARD OF TRUSTEES FOR APPROVAL AT A REGULARLY SCHEDULED MEETING.THE PROCESS WAS LAST DONE IN 2010. 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 GAINS ON INVESTMENTS: 479,478. PENSION ADJUSTMENT - TO REFLECT FUNDED STATUS ON BALANCE SHEET 151,063. TOTAL TO FORM 990, PART XI, LINE 5: 630,541. FORM 990, PART XII , LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 SPONSORED BY THE SISTERS OF ST. JOSEPH OF PEACE, THE MARGARET ANNA CUSACK CARE CENTER'S CARING COMMUNITY OFFERS THE FRAIL AND INFIRM ELDERLY, PERSONS OF ALL FAITHS, AND THE POOR, A HEALING MINISTRY BASED ON GOSPEL VALUES, OUR CATHOLIC HERITAGE AND OUR COMMITMENT TO "PEACE THROUGH JUSTICE." OUR CENTRAL BELIEF IN THE SACREDNESS OF LIFE AND DIGNITY OF EACH PERSON PROMPTS US TO PROMOTE, NURTURE AND SUSTAIN QUALITY OF CARE, ENABLING OUR RESIDENTS TO LIVE OUT THEIR DAYS IN COMFORT, COMPASSION AND PEACE. MARGARET ANNA CUSACK CARE CENTER HAS THE FOLLOWING "VISION STATEMENT" -PROVIDE A BROAD ARRAY OF CONTINUING CARE PROGRAMS AND SERVICES THAT ARE SELF-SUSTAINING, FINANCIALLY VIABLE AND MISSION DRIVEN. -UNDERSTAND ITS COMMUNITY AND STRIVE TO ADDRESS THEIR CARE NEEDS BY BEING RESPONSIVE AND FLEXIBLE. -PROVIDE QUALITY CARE IN A PERSON-CENTERED ENVIRONMENT, OFFER THE LEAST RESTRICTIVE SETTING TO THOSE IT CARES FOR AN EMBRACE CULTURE CHANGE IN ALL ACTIVITIES. -VALUE ITS EMPLOYEES AND REFLECT THE DIVERSITY OF ITS JERSEY CITY COMMUNITY IN ITS DELIVERY SYSTEM. -COLLABORATE WITHIN THE CORPORATE HEALTH CARE SYSTEM AND WITH OTHER PARTNERS TO FURTHER ITS MISSION AND BUSINESS GOALS.