2018-11-14T18:56:51-06:00 2017-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2017-01-01 222823794 ST ANN'S HOME FOR THE AGED CORP STAN 2014330950 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 JANET MERLY-LIRANZO ADMINISTRATOR 2014330950 2018-11-14 1 AARON SHAPIRO P01333816 2128674000 64.22.227.161 2018-11-14 15:55:09 ES P BA06794AD5B91A3591AFF5AAC8EC9A7A19FD4A84 988419C5643A1C0877F6823E03E3852E0B43B763 2017 2019-02-21 02:37:17Z PEACE CARE ST ANN'S JANET MERLY-LIRANZO 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 15222719 0 X WWW.PEACECARENJ.ORG X 1987 NJ THE HOME PROVIDES LONG TERM NURSING CARE AS WELL AS ADULT MEDICAL DAYCARE TO THE COMMUNITY. 7 6 315 8 0 0 39120 198839 14425995 14230793 256821 251822 31102 54828 14753038 14736282 0 0 0 0 8747386 9186732 0 0 75636 5256370 5611189 14003756 14797921 749282 -61639 29014411 30386108 12736409 12654600 16278002 17731508 X SAINT ANN'S THROUGH ITS MINISTRY OF HEALTH CARE WITH COMAPASSION AND DIGNITY, ASSURES QUALITY OF LIFE, WHEREIN, ALL ARE ENCOURAGED TO REACH THEIR POTENTIAL. THIS IS ACHIEVED THROUGH MUTUTAL RESPECT, TEAMWORK AND COMMUNITY INVOLVEMENT. 0 0 12956083 14230793 SEE SCHEDULE OST. 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 NURSING 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. THE PHYSICAL THERAPY SERVICES ARE ALSO OFFERED AS PART OF OUR 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 SERVICE 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. 12956083 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 47 0 315 1 0 0 0 0 0 1 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NJ X JASMIN GOMEZ 2014330950 198 OLD BERGEN ROAD JERSEY CITY NJ 07305 SR CHRISTINE BACKIEL CHAIRPERSON 1.00 X X 0 0 0 CHARLES DEDERDING TREASURER 1.00 X X 0 0 0 JANET MERLY-LIRANZO PRESIDENT/ ADMINISTRATOR 40.00 X X 163165 0 4504 EDWARD REILLY TREASURER UNTIL JUNE 2017 1.00 X X 0 0 0 DR HAMMAD CHOUDHRY MD TRUSTEE 1.00 X 0 0 0 H REGGIE NEAL LMSW CCLS TRUSTEE 1.00 X 0 0 0 RYAN KENNEDY TRUSTEE 1.00 X 0 0 0 ELIZABETH BAMBALAN RATA DIRECTOR OF NURSING 40.00 X 136730 0 3691 299895 0 8195 2 0 1 0 UNIDINE CORPORATION 1000 WASHINGTON STREET BOSTON MA 02118 FOOD & DINING MANAGEMENT 1238015 RS CONTRACTING CO 5 CRAIG ROAD SPRINGFIELD NJ 07081 CONSTRUCTION 368800 NELBY'S GENERAL CONSTRUCTION 1300 5TH ST NORTH BERGEN NJ 07047 GENERAL CONTRACTING 133900 3 36000 162839 198839 MEDICARE 623000 5699641 5699641 MEDICAID 623000 4878609 4878609 PRIVATE, DAYCARE & ANCILLARIES 623000 3652543 3652543 14230793 251822 251822 471000 471000 0 17726 36000 15437 2289 2289 MISCELLANEOUS 541380 52539 52539 52539 14736282 14230793 0 306650 308090 117074 191016 6906551 6724569 127195 54787 1277785 1220434 43812 13539 694306 660849 26147 7310 23191 23191 68144 68144 134225 134225 3314580 2326475 988105 688330 537533 150797 41717 41717 985297 837502 147795 NJ STATE ASSESSMENT 355705 355705 14797921 12956083 1766202 75636 178820 451448 0 103222 1910866 1725654 431457 240214 29915236 15113817 14935887 14801419 10974367 12579349 583014 484802 29014411 30386108 883033 1539254 10705737 10528115 611546 445661 536093 141570 12736409 12654600 X 16278002 17731508 16278002 17731508 29014411 30386108 -61639 1515145 0 X X 0 1 X 1 0 X 530799 103004 38050 39120 198839 909812 12439776 12792478 13269131 14425995 14230793 67158173 0 0 12970575 12895482 13307181 14465115 14429632 68067985 0 0 0 68067985 760889 192689 221687 243914 251822 1671001 0 0 760889 192689 221687 243914 251822 1671001 6484 1517 28287 16870 2289 55447 7324 29988 14232 52539 104083 13737948 13097012 13587143 14740131 14736282 69898516 0.97380 0.97230 0.02390 0.02570 X 0 0 0 0 0 0 0 0 1 686 686 0 PART II-B LINE 1, LOBBYING ACTIVITIES: THE ORGANIZATION PAID TO CATHOLIC HEALTH AND NJ HOSPITAL ASSOCIATION IN MEMBERSHIP DUES OF WHICH $686 IS USED FOR LOBBYING ACTIVITIES. 0 1 X 2997795 2997795 24367460 14058186 10309274 2193684 867069 1326615 356297 188562 167735 14801419 DUE TO MARGARET ANNA CUSACK CARE CENTER 52814 ESTIMATED LIABILITY DUE TO THIRD PARTIES 88756 141570 X 16434785 1515145 167921 15437 1698503 14736282 0 14736282 14981279 167921 15437 183358 14797921 0 14797921 PART IV, LINE 2B: RESIDENT SECURITY DEPOSITS AND PERSONAL FUNDS HELD ON BEHALF OF THE RESIDENTS ARE MAINTAINED IN BANK ACCOUNTS SEPARATE FROM THE HOME'S ACCOUNTS. INTEREST EARNED IS CREDITED TO THE RESIDENTS' ACCOUNTS. PART X, LINE 2: THE CORPORATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2014 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST FOR SPECIAL EVENT 15,437. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST FOR SPECIAL EVENT 15,437. GALA 53726 36000 17726 10834 900 3703 53726 36000 17726 10834 900 3703 15437 2289 X X X 0 0 0 0 0 0 0 1 0 JANET MERLY-LIRANZO PRESIDENT/ ADMINISTRATOR 137356 0 21987 0 3822 0 4504 0 0 0 167669 0 0 0 PART I, LINE 7 BONUS WAS BASED ON PERFORMANCE AS DETERMINED BY COMPENSATION COMMITTEE AND BOARD OF TRUSTEES. A NEW JERSEY HEALTH CARE FACILITIES FINANCING AUTHORITY 64579FVF7 2010-05-01 11625000 BUILDING EXPANSION AND RENOVATION PROJECT 1 1 1 A 11625000 59332 254054 11556893 2040 0 0 0 0 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 PEACE CARE, INC. IS THE SOLE CORPORATE MEMBER OF ST. ANN'S HOME FOR THE AGED AND ALSO IS THE SOLE CORPORATE MEMBER OF MARGARET ANNA CUSACK CARE CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER APPOINTS THE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE POWER TO AMEND, CHANGE OR ALTER THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE HOME IS RESERVED EXCLUSIVELY TO THE BOARD OF TRUSTEES OF THE MEMBER, PEACE CARE, INC., AND REQUIRES THE FURTHER APPROVAL OF ITS SOLE MEMBER, PEACE MINISTRIES, INC. SIMILARLY, THE FOLLOWING POWERS ARE RESERVED TO THE MEMBER, SOME OF WHICH REQUIRE THE ADDITIONAL APPROVAL OF ITS MEMBER. A) THE CREATION BY THE HOME OF ANY CORPORATION OR OTHER LEGAL ENTITY. B) THE HOME'S AFFILIATION WITH OR PARTICIPATION IN, ANY JOINT VENTURE OR JOINT ENTERPRISE WITH ONE OR MORE OTHER ENTITIES. C) THE MANAGEMENT, ACQUISITION OR SPONSORSHIP BY THE HOME OF ANY OTHER INSTITUTION, CORPORATION, ORGANIZATION, FACILITY OR ENTITY. D) THE SALE, ACQUISITION, EXCHANGE, TRANSFER, CONVEYANCE OR OTHER DISPOSITION BY THE HOME OF ANY REAL PROPERTY OF INTEREST THEREIN OWNED BY THE HOME. E) THE LEASING, MORTGAGING OR OTHER ENCUMBERING OF ANY REAL PROPERTY OWNED BY THE HOME. F) THE PARTICIPATION IN ANY TRANSACTION PROVIDING FOR THE SALE, MORTGAGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HOME. G) THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE HOME. H) THE APPOINTMENT AND REMOVAL OF TRUSTEES. I) THE APPOINTMENT AND REMOVAL OF THE ADMINISTRATOR. J) THE APPOINTMENT AND REMOVAL OF THE OFFICERS. K) THE ESTABLISHMENT OR CHANGE OF THE MISSION OF THE HOME. L) TO ENTER INTO NEW BORROWINGS AND TO RENEGOTIATE, MODIFY OR OTHERWISE CHANGE EXISTING DEBT OBLIGATIONS IN EXCESS OF 15% OF THE NET ASSETS. FORM 990, PART VI, SECTION B, LINE 11B DRAFTS OF THE FORM 990 WERE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE AND CHANGES MADE AS NEEDED. A COPY OF THE FINAL 990 WAS THEN CIRCULATED TO THE FULL BOARD OF TRUSTEES FOR REVIEW AND APPROVAL PRIOR TO FILING. 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 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 FINANCIALS INTEREST 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. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES REVIEWS COMPARABLE DATA FROM OTHER ORGANIZATIONS WHICH ARE OF SIMILAR NATURE AND SIZE TO DETERMINE COMPENSATION FOR OFFICERS. THIS YEAR'S SALARY WAS DETERMINED BASED ON DECEMBER 2016 SALARY DETERMINATION. THE LAST SALARY DETERMINATION FOR THE OFFICERS TOOK PLACE IN DECEMBER 2017. 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. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM LAST YEAR. PEACE CARE INC 198 OLD BERGEN RD JERSEY CITY NJ 07305 812589807 PROVIDE ADMINISTRATIVE SERVICE TO NURSING HOMES NJ 501(C)(3) LINE 12C, III-FI PEACE MINISTRIES INC 0 MARGARET ANNA CUSACK CARE CENTER INC 537 PAVONIA AVENUE JERSEY CITY NJ 07306 760847915 PROVIDING SKILLED NURSING CARE FOR THE ELDERLY NJ 501(C)(3) LINE 10 PEACE CARE INC 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0