2023-09-22T07:54:51-05:00 2022-12-31 WithumSmithBrown PC 200 Jefferson Park Suite 400 Whippany NJ 079811070 990 2022-01-01 222823794 ST ANN'S HOME FOR THE AGED CORP % ROBERT REYES LNHA STAN 2014330950 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 KYLE HREBEN COO 2016538300 2023-09-14 true KYLE HREBEN 000000000 HAYLEY L STOUT CPA P01293083 9738989494 3 2022 2023-04-26 12:10:37Z PEACE CARE ST ANN'S KYLE HREBEN 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 13558449 false 0928 X PEACECARENJ.ORG X 1987 NJ THE HOME PROVIDES LONG TERM NURSING CARE AS WELL AS ADULT DAYCARE TO THE COMMUNITY. 4 3 276 3 0 0 438725 251978 12888254 12956386 2808617 347679 5325 1486 16140921 13557529 0 0 0 0 9328279 9737842 0 0 77815 5104949 5498959 14433228 15236801 1707693 -1679272 33848969 28681178 12402323 11948894 21446646 16732284 X ST. ANN'S IS A COMMUNITY OF SKILLED, COMPASSIONATE, CAREGIVERS, ROOTED IN CATHOLIC TRADITION AND THE VALUES OF THE SISTERS OF ST. JOSEPH OF PEACE. ST. ANN'S PROVIDES CARE WITH DIGNITY FOR THE HEALING OF THE WHOLE PERSON. false false 13018524 0 12956386 ST. ANN'S HOME FOR THE AGED CORP D/B/A PEACE CARE ST. ANN'S (THE "HOME") IS A NONPROFIT ORGANIZATION WHICH OPERATES A 120-BED HOME IN JERSEY CITY, NEW JERSEY. THE HOME PROVIDES LONG-TERM, POST-ACUTE AND RESPITE CARE SERVICES AS WELL AS AN OUTPATIENT REHABILITATION PROGRAM. POST-ACUTE CARE IS A SHORT-TERM REHABILITATION SERVICE PROVIDED TO A PATIENT FOLLOWING SURGERY, HOSPITALIZATIONS, INJURY, OR A DISABILITY. THE SHORT-TERM REHABILITATION SERVICES INCLUDE SKILLED NURSING, SOCIAL SERVICES FOR THE OVERALL WELL-BEING OF THE PATIENT, PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND/OR SPEECH THERAPY PROVIDED BY HIGHLY TRAINED STAFF. THERAPY SERVICES ARE ALSO OFFERED AS PART OF THE OUTPATIENT REHABILITATION PROGRAM WHICH INCLUDES TRANSPORTATION FROM AND TO THE PATIENT'S HOME. RESPITE CARE IS A SHORT-TERM STAY AVAILABLE FOR A VARIETY OF CARE LEVELS FOR PATIENTS WHO NEED EXTRA ASSISTANCE BEFORE RETURNING HOME AFTER A HOSPITAL STAY OR SIMPLY FOR CARETAKERS WHO NEED A BREAK FROM TAKING CARE OF THEIR FAMILY MEMBER. IN ADDITION TO PROVIDING LONG-TERM, POST-ACUTE AND RESPITE CARE SERVICES, THE HOME ALSO OPERATES A 50-SLOT ADULT MEDICAL DAYCARE UNIT. 13018524 true true false true false false false false true false true false true false true false true true false false false false false false false false false false false true true false false false false false false false false false false false false false false false true false false false true 30 0 true 276 true false false false false false false false false false false false false X 4 3 false true false false true true true true true false false true true true true true true true false false NJ X X ROBERT REYES LNHA 2014330950 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 X ELIZABETH BAMBALAN-RATA DIRECTOR OF NURSING 40.0 0.0 X 218558 0 2687 JANET MERLY-LIRANZO LNHA TRUSTEE-PCSA ADMIN(TERM 10/22) 40.0 0.0 X X 150743 0 27617 MINERVA BANAYOS DIRECTOR OF REHABILITATION 40.0 0.0 X 104138 0 38884 KYLE HREBEN MBA LNHA TRUSTEE - COO (EFF 7/5/22) 19.5 20.5 X X 116042 0 5907 KERLANGE CLAUDE ALEXANDRE OCCUPATIONAL THERAPIST 40.0 0.0 X 100726 0 20304 CHERYL DORN TRUSTEE - COO (TERMED 2/17/22) 19.5 20.5 X X 112999 0 174 DONALD LYNCH LNHA PCSA ADMIN (10/22 - 12/22) 40.0 0.0 X 29474 0 0 CHRISTINE BACKIEL CSJP CHAIRPERSON - TRUSTEE 2.0 2.0 X X 0 0 0 CATHERINE YAXLEY MBACPARN SECRETARY - TRUSTEE 2.0 4.0 X X 0 0 0 SILVANA BUCCIANTI TREASURER - TRUSTEE 2.0 3.0 X X 0 0 0 KENNETH D ROBBINS TRUSTEE-INTERIM COO (2/14-6/3) 19.5 20.5 X X 0 0 0 CHARLES DEDERDING TREAS-TRUSTEE (TERMED 06/2022) 2.0 1.0 X X 0 0 0 832680 0 95573 6 false true false UNIDINE CORPORATION 1000 WASHINGTON STREET SUITE 510 BOSTON MA 02118 DIETARY 773413 ST BERNADINE HOME CARE SERVICES 591 SUMMIT AVENUE SUITE 411 JERSEY CITY NJ 07306 STAFFING 170340 HOLY NAME MEDICAL CENTER 718 TEANECK ROAD TEANECK NE 07666 FINANCIAL MANAGEMENT 143514 RUBEN SAGUIL CONSTRUCTION 5 CRAIG ROAD SPRINGFIELD NJ 07081 CONSTRUCTION 133350 4 19588 150000 82390 251978 NET PATIENT SERVICE REVENUE 623110 12937977 12937977 OTHER HEALTHCARE RELATED REVENUE 623110 18409 18409 12956386 347679 347679 0 0 0 0 0 0 0 0 0 100 920 -820 -820 0 0 0 CANTEEN/GIFT SHOP/BEAUTY PARLOR 900099 2306 2306 2306 13557529 12956386 349165 0 0 0 0 178360 107016 71344 0 7422075 6550306 799723 72046 128961 105546 23068 347 1489308 1216905 268364 4039 519138 425833 91922 1383 143514 114032 29482 70707 56181 14526 53084 42179 10905 0 0 12454 12454 570240 453094 117146 9365 7441 1924 266428 211695 54733 7814 6209 1605 0 505083 401323 103760 35388 28118 7270 0 7701 6119 1582 302781 242225 60556 0 1015607 812858 202749 230790 183378 47412 PATIENT FOOD & NOURISHMENTS 1038260 896310 141950 MEDICAL SUPPLIES 434220 434220 NURSING ASSESMENT 415894 415894 REPAIRS AND MAINTENANCE 206998 164474 42524 172631 137168 35463 15236801 13018524 2140462 77815 2223056 565936 370607 263015 0 0 2028552 1758213 0 0 0 0 0 0 50745 49037 256588 269788 31891885 20167874 12143628 11724011 0 0 0 0 16665445 12975807 0 0 110348 1075371 33848969 28681178 1418815 1539766 0 0 0 0 9184807 8899710 370607 263015 0 0 0 0 0 0 1428094 1246403 12402323 11948894 X 21412504 16676146 34142 56138 21446646 16732284 33848969 28681178 -1679272 -3035090 X X false true X true false X 539289 515901 2999701 438725 251978 4745594 14274743 14797882 12505020 12892270 12956386 67426301 0 0 0 14814032 15313783 15504721 13330995 13208364 72171895 0 66323 13308 79631 66323 13308 79631 72092264 262794 365137 265469 247758 347679 1488837 0 262794 365137 265469 247758 347679 1488837 0 32432 88722 5122 5221 2306 133803 15109258 15767642 15775312 13583974 13558349 73794535 0.97693 0.97790 0.02017 0.01858 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false PART II-B, LINE 1 This organization is a member of the Catholic Health Association, which engages in lobbying efforts on behalf of its member organizations. During the year ended December 31, 2022 the organization did not pay dues to the Catholic Health Association and therefore there is no amount allocated to lobbying. false true X 2997898 2997898 25823045 17527145 8295900 3041642 2638603 403039 29300 2126 27174 11724011 MUTUAL FUNDS 11916899 F FIXED INCOME 999576 F ASSETS LIMITED AS TO USE, CASH 59332 F 12975807 0 DUE TO AFFILIATES 140951 DUE TO THIRD PARTIES 1028515 OTHER LIABILITIES 76937 1246403 10555353 -3035090 44448 -2990642 13545995 12454 -920 11534 13557529 15269715 44448 920 45368 15224347 12454 12454 15236801 SCHEDULE D, PART IV; LINE 2B The organization maintains separate bank accounts for resident security deposits and personal funds received on behalf of numerous residents. The organization has fiduciary responsibility for the administration of the bank accounts and the distribution of the funds to residents. SCHEDULE D, PART XI; LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 INCLUDE: - RAFFLE EXPENSES ($920). SCHEDULE D, PART XII; LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: - RAFFLE EXPENSES - $920. X X X false false false false false false false true false ELIZABETH BAMBALAN-RATA DIRECTOR OF NURSING 218346 0 0 0 212 0 1741 0 946 0 221245 0 0 0 JANET MERLY-LIRANZO LNHA TRUSTEE-PCSA ADMIN(TERM 10/22) 150605 0 0 0 138 0 1318 0 26299 0 178360 0 0 0 CORE FORM, PART VII AND SCHEDULE J TAXABLE COMPENSATION REPORTED HEREIN IS DERIVED FROM 2022 FORMS W-2. SCHEDULE J, PART I, QUESTION 7 CERTAIN INDIVIDUALS INCLUDED IN core form, part VII received a bonus during calendar year 2022 which was included in each individual's 2022 Form W-2, Box 5, as taxable Medicare wages. A NJ HEALTH CARE FACILITIES FINANCING AUTHORITY 221987084 64579FVF7 2010-05-01 11625000 BUILDING EXPANSION AND RETIREMENT false false false A 2440193 0 11625000 59332 0 0 248623 0 0 11317045 0 0 2011 true false true true A false false false false 0 false false false false A false true false false 0 false 0 false false A false CORE FORM, PART VI, SECTION A; QUESTION 3 The organization is an affiliate within Peace Care, Inc. and affiliates. This organization has a financial management services agreement with Holy Name Medical Center, Inc.; an internal revenue code section 501(c)(3) tax-exempt hospital organization. Through this agreement, Holy Name provides this organization with certain back office financial support services and financial management services. Peace Care, Inc. is a related 501(C)(3) tax-exempt organization that serves as the parent entity of this organization. Peace Care, Inc. provides this organization with certain centralized administrative services, including management, finance, human resources, marketing, public relations and development. In addition, during the year ended December 31, 2022, Peace Care, Inc. delegated control over the management duties of its Chief Operating Officer position to an independent firm, Scott Senior Services, LLC. On behalf of Scott Senior Services, LLC, Kenneth D. Robbins assumed the role of interim Chief Operating Officer for the period February 14, 2022 through June 3, 2022. The amount paid for these services totaled $97,000. These payments were made by Peace Care St. Ann's, on behalf of Peace Care, Inc. and its affiliates. The amounts paid were rendered at fair market value pursuant to arm's length negotiations. CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7 Peace Care, Inc. is the sole member of this organization. Peace Care, Inc. has the ultimate authority and right to elect the members of this organization's board of trustees and has certain reserved powers as defined in this organization's bylaws. CORE FORM, PART VI, SECTION B; QUESTION 11B The organization is an affiliate within Peace Care, Inc. and affiliates ("system"). The organization's federal form 990 was provided to each voting member of the organization's governing body prior to filing of the form 990 with the internal revenue service ("irs"). As part of the tax return preparation process the organization hired a professional certified public accounting ("CPA") firm with experience and expertise in both healthcare and not-for-profit tax return preparation to prepare the federal form 990. The CPA firm's tax professionals worked closely with the system's finance personnel and various other system individuals ("internal working group") to obtain the information needed in order to prepare a complete and accurate tax return. The CPA firm prepared a draft federal form 990 and furnished it to the system's internal working group for their review. The internal working group reviewed the draft federal form 990 and discussed questions and comments with the CPA firm. Revisions were made to the draft federal form 990 where necessary and a final draft was furnished by the CPA firm to the internal working group for final review. Following this review, the form 990 was then presented to Peace Care, Inc.'s audit and compliance committee and provided to the organization's governing body prior to filing with the irs. CORE FORM, PART VI, SECTION B, LINE 12C The organization is an affiliate within Peace Care, Inc. and affiliates ("system"). The organization and system regularly monitor and enforce compliance with its conflict of interest policy. 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 center 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 center 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 financial interests 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. CORE FORM, PART VI, SECTION B, LINE 15A THE ORGANIZATION IS AN AFFILIATE WITHIN PEACE CARE, INC. AND AFFILIATES ("SYSTEM"). THE ORGANIZATION HAS A COMPENSATION COMMITTEE ("COMMITTEE") OF THE BOARD OF TRUSTEES. THE COMPENSATION AND BENEFITS OF THIS ORGANIZATION'S OFFICER(S) ARE REVIEWED BY THE COMMITTEE ON AN ANNUAL BASIS TO ENSURE FAIR MARKET VALUE COMPENSATION IS PAID. WHERE APPROPRIATE, THE COMMITTEE ALSO REVIEWS EXTERNAL COMPARABLE DATA AND SEEKS ADVICE FROM EXTERNAL INDUSTRY CONSULTANTS. CORE FORM, PART VI, SECTION C; QUESTION 18 Pursuant to State of New Jersey P.L. 2021, Chapter 457, (which was effective on November 1, 2022), this organization has posted on its internet website a copy of this Internal Revenue Service (IRS) Form 990 and all schedules and supporting documentation required to be submitted to the IRS in conjunction with the Form 990 with the exception of those schedules not open for public inspection. Said Form 990 was posted by the organization after filing its Form 990 with the IRS. CORE FORM, PART VI, SECTION C; QUESTION 19 The organization's filed certificate of incorporation and any amendments can be obtained and reviewed through the State of New Jersey Department of the Treasury. In addition, the organization's conflict of interest policy and audited financial statements are available upon request. CORE FORM, PART VII AND SCHEDULE J Core form, part vii and schedule j reflect certain board members and officers receiving compensation and benefits from this organization or a related organization. Please note that this remuneration was for services rendered as full-time employees of the organization or a related organization and not for services rendered as a voting member or officer of this organization's board of trustees. CORE FORM, PART XII; QUESTION 2 The organization is an affiliate within Peace Care, Inc. and affiliates ("system"). An independent CPA firm audited the consolidated financial statements of Peace Care, Inc. and affiliates, for the years ended December 31, 2022 and December 31, 2021; respectively. The audited consolidated financial statements contain consolidating schedules on an entity by entity basis. The independent CPA firm issued an unmodified opinion with respect to the audited consolidated financial statements each year. In addition, an independent CPA firm audited the separate financial statements of Peace Care St. Ann's, for the years ended December 31, 2022 and December 31, 2021; respectively. The independent CPA firm issued an unmodified opinion with respect to the audited separate financial statements each year. Peace Care, Inc.'s audit and compliance committee has assumed responsibility for the oversight of the audit of the consolidated financial statements, which includes this organization and the selection of an independent auditor. PEACE CARE INC 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 812589807 HEALTH SVCS. NJ 501(C)(3) 509(A)(3) PEACE MINIST false MARGARET ANNA CUSACK CARE CENTER INC 537 PAVONIA AVENUE JERSEY CITY NJ 07306 760847915 HEALTH SVCS. NJ 501(C)(3) 509(A)(2) PEACE CARE false PEACE MINISTRIES INC 399 HUDSON TERRACE ENGLEWOOD CLIFFS NJ 07632 465202238 RELIGIOUS NJ 501(C)(3) 509(A)(1) NA false false false true true false false false false false false false false false true true true true false false SCHEDULE R, PART V This organization is a member of Peace Care, Inc. and affiliates ("system"). Funds are routinely transferred between affiliates and business activities are common on behalf of the system's affiliates, including this organization. These transactions may be recorded on the revenue/expense and balance sheet statements of this organization and other affiliates. These entities work together to deliver high quality cost effective healthcare and wellness services to their communities and in furtherance of charitable tax-exempt purposes.