2018-11-15T15:42:37-06:00 2017-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2017-01-01 237155198 BROTHERS OF MERCY NURSING HOME CO INC BROT 7167596985 10570 BERGTOLD ROAD CLARENCE NY 14031 PETER EIMER CEO 7167596985 2018-11-15 1 MARY MADONIA P00405803 7168472651 2018-11-15 104.193.28.34 2018-11-15 13:52:33 ES P 81B56A05D8F48412CE9D3D11E933E5C72CA8DF76 E588FD00060AA28C1C0A55A690DA468E89E687D8 2017 2019-02-21 02:37:17Z PETER EIMER 10570 BERGTOLD ROAD CLARENCE NY 14031 23906753 0 X N/A X 1971 NY TO PROVIDE REHABILITATION SERVICES AND SKILLED NURSING CARE. 5 3 661 85 0 0 37800 152326 21621418 22290078 24811 68300 567814 513876 22251843 23024580 0 0 0 0 13249200 12491901 0 0 0 8125899 9610748 21375099 22102649 876744 921931 8452039 9469993 3974489 4023170 4477550 5446823 TO PROVIDE REHABILITATION SERVICES AND SKILLED NURSING CARE. 0 0 19694996 22639247 NURSING CARE AND REHABILITATION SERVICE FOR A 240 BED NYS LICENSED NURSING FACILITY. 19694996 1 1 0 0 0 0 0 0 1 0 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 1 51 0 661 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X JOSEPH WIDMER 7167596985 4520 RANSOM ROAD CLARENCE NY 14031 BROTHER KENNETH THOMAS PRESIDENT 6.25 31.25 X X 0 0 0 BROTHER FIDELIS VERRALL SECRETARY 32.50 5.00 X X 0 0 26974 BROTHER MATHIAS MOLLER TREASURER 6.25 31.25 X X 0 0 0 PETER EIMER CEO AND MEMBER 24.50 13.00 X X 117243 63130 5549 DR JOSEPH DUNN CHAIRMAN OF THE BOARD 5.00 5.00 X X 0 0 0 JOSEPH WIDMER CFO 37.50 1.00 X 54837 69794 20383 THOMAS BLOOMER ADMINISTRATOR 37.50 X 165514 0 22588 NICOLE M DEKAY DIRECTOR OF NURSING 37.50 X 119344 0 10469 VALERIE KANE CORPORATE COMPLIANCE OFFIC 15.00 22.50 X 60599 90898 22512 517537 223822 108475 3 0 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 DIETARY, HOUSEKEEPING/LAUNDRY, PLANT OPS 708530 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 600689056 PHYSICAL, OCCUPATIONAL & SPEECH THERAPY 232282 BRIMS LLC (DBA BEACON SOLUTIONS GROUP) 100 CORPORATE PARKWAY SUITE 200 AMHERST NY 14226 CLINICAL/NURSING CONSULTING SERVICES 183685 3 132386 19940 152326 RESIDENT SERVICE REVENUE 623000 22290078 22290078 22290078 47754 47754 902719 881027 1146 21692 -1146 20546 20546 OTHER INCOME 623000 259319 259319 CAFETERIA INCOME 722210 135402 135402 NURSE AIDE TRAINING INCOME 611430 50552 50552 68603 39298 29305 513876 23024580 22639247 0 233007 X 198405 26325 172080 10643152 10091131 552021 93138 81634 11504 741310 670875 70435 815896 765579 50317 1245601 1245601 29385 29385 172238 39778 132460 7895 7895 3078653 3078653 191687 191687 363756 326902 36854 7405 3890 3515 20193 20193 462780 439641 23139 596911 584376 12535 NEW YORK STATE FEES 997376 997376 MEDICAL SUPPLIES/EQUIPM 883799 883799 MISCELLANEOUS 843206 758886 84320 FOOD 677800 677800 32063 27086 4977 22102649 19694996 2407653 0 1049850 82939 411513 646508 2589031 2885929 383617 1292748 94618 89854 179590 227109 18674233 15738131 2368529 2936102 1021482 818093 353809 490711 8452039 9469993 3336038 3207228 246840 106951 82415 66849 92094 327881 217102 314261 3974489 4023170 X 4477550 5446823 4477550 5446823 8452039 9469993 921931 47342 0 X X 0 1 X 1 0 X 63044 25770 35409 37800 152326 314349 19114944 19657643 20967283 22046576 22639247 104425693 187849 118578 89131 142656 164707 702921 19365837 19801991 21091823 22227032 22956280 105442963 0 0 0 105442963 9645 11788 26620 20407 47754 116214 9645 11788 26620 20407 47754 116214 89628 143327 232955 19465110 19957106 21118443 22247439 23004034 105792132 0.99670 0.99560 0.00110 0.00080 X 0 1 X 16000 16000 13090959 11420114 1670845 470097 401332 68765 4623909 3916685 707224 473268 473268 2936102 ESTIMATED AMOUNTS DUE FROM THRID PARTY PAYORS 423862 RESIDENT FUNDS HELD IN TRUST 66849 490711 CAPTIAL LEASE OBLIGATIONS 308266 LINE OF CREDIT 5995 314261 X 23071922 47342 47342 23024580 0 23024580 22102649 0 22102649 0 22102649 PART IV, LINE 2B: RESIDENT FUNDS HELD IN TRUST, CONSISTING OF AMOUNTS DEPOSITED ON BEHALF OF RESIDENTS AND USED FOR THEIR PERSONAL CARE. PART X, LINE 2: THE HOME IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 509(A) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES IS INCLUDED IN THE FINANCIAL STATEMENTS. THE COMPANY FILES ITS RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX IN THE U.S FEDERAL JURISDICTION AND ITS ANNUAL FILING OF CHARITABLE ORGANIZATIONS IN NEW YORK STATE. X X X 0 0 0 0 0 0 0 0 0 PETER EIMER CEO AND MEMBER 117243 63130 0 0 0 0 2055 1106 1552 836 120850 65072 0 0 THOMAS BLOOMER ADMINISTRATOR 165514 0 0 0 0 0 3339 0 19249 0 188102 0 0 0 VALERIE KANE CORPORATE COMPLIANCE OFFIC 60599 90898 0 0 0 0 1209 1814 7796 11693 69604 104405 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT OUTSIDE ACCOUNTING FIRM. IT IS REVIEWED BY THE CFO AND A COPY IS PROVIDED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C QUESTIONNAIRE IS SENT OUT ANNUALLY AND INFORMATION REGARDING POTENTIAL CONFLICTS OF INTEREST IS MAINTAINED BY ADMINISTRATION. COMPLETED QUESTIONNAIRES ARE KEPT ON FILE IN THE FINANCE OFFICE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEWS SALARIES FOR TOP MANAGEMENT OFFICIALS AND USES COMPARABILITY DATA FROM NYAHSA (NEW YORK ASSOCATION FOR HOMES AND SERVICES FOR THE AGING) IN ORDER TO DETERMINE SALARIES. THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 1023 AND FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS IS BASED ON THE PURPOSE OF THE REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,827,440. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,827,440. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 274,124. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 274,124. X-RAY SERVICES: PROGRAM SERVICE EXPENSES 99,332. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 99,332. CONSULTING: PROGRAM SERVICE EXPENSES 877,757. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 877,757. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN THE AUDIT OVERSIGHT PROCESS OR THE AUDITOR SELECTION PROCESS. BROTHERS OF MERCY INC 4520 RANSON ROAD CLARENCE NY 14031 160746852 HOUSING, LIVING EXPENSE, ECT FOR BROTHERS OF MERCY NY 501(C)(3) LINE 12D N/A 0 BROTHERS OF MERCY SACRED HEART HOME 4520 RANSON ROAD CLARENCE NY 14031 161082636 ADULT CARE FACILITY NY 501(C)(3) LINE 10 N/A 0 BROTHERS OF MERCY HOUSING CO INC 10500 BERGTOLD ROAD CLARENCE NY 14031 237117107 HOUSING FOR ELDERLY NY 501(C)(3) LINE 7 N/A 0 BROTHERS OF MERCY FACILITIES FOUNDATION 4520 RANSON ROAD CLARENCE NY 14031 161558645 SUPPORT CHARITABLE PURPOSES OF BROTHERS NY 501(C)(3) LINE 7 N/A 0 BROTHERS OF MERCY OF MONTABAUR APARTMENT COMPLEX INC 4530 RANSON ROAD CLARENCE NY 14031 464619699 HOUSING FOR ELDERLY NY 501(C)(3) LINE 10 N/A 0 BROTHERS OF MERCY FOUNDATION 4520 RANSON ROAD CLARENCE NY 14031 166074666 INVESTMENTS FOR RELATED PARTIES NY 501(C)(3) LINE 1 N/A 0 BROTHERS OF MERCY MANAGEMENT COMPANY 4520 RANSON ROAD CLARENCE NY 14031 813966963 SUPPORT SERVICES FOR RELATED PARTIES NY 501(C)(3) LINE 10 N/A 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 BROTHERS OF MERCY INC K 94525 ACCOUNTING RECORDS BROTHERS OF MERCY OF MONTABAUR APARTMENTS COMPLEX INC D 960857 END OF YEAR BALANCE BROTHERS OF MERCY MANAGEMENT COMPANY D 220698 END OF YEAR BALANCE