2017-11-07T08:08:55-06:00 2016-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2016-01-01 113109867 ST JOHNLAND NURSING CENTER INC STJO 6312695800 395 SUNKEN MEADOW ROAD KINGS PARK NY 11754 MARY JEAN WEBER CEO 6312695800 2017-11-07 1 AARON SHAPIRO P01333816 2128674000 38.98.118.70 2017-11-06 15:20:31 ES P 225B73B148284D6C629F7CBF4AC09CDDFD7CF9F8 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 2016 2017-02-10 21:41:12Z MARY JEAN WEBER 395 SUNKEN MEADOW ROAD KINGS PARK NY 11754 35024442 0 X WWW.STJOHNLAND.ORG X 1991 NY TO CREATE A CARING AND SUPPORTIVE ENVIRONMENT COMMITTED TO THE HIGHEST STANDARDS OF QUALITY HEALTHCARE. 8 8 516 8 0 0 200000 200000 35217294 34523197 461 2565 383320 298680 35801075 35024442 0 0 0 0 24917402 24506730 0 0 0 10147339 9621800 35064741 34128530 736334 895912 17100732 16887108 20408764 19804471 -3308032 -2917363 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 26608373 32696729 INPATIENT PROGRAM WITH 230 RESIDENT CARE BEDS. 1058672 1826468 ADULT DAY CARE PROGRAM FOR 100 REGISTRANTS. 27667045 1 1 0 0 0 0 0 0 1 1 1 0 0 0 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 27 0 516 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X MICHAEL BARTOLOTTA 6312695800 395 SUNKEN MEADOW RD KINGS PARK NY 11754 TRUDY H CALABRESE PRESIDENT 0.50 1.00 X X 0 0 0 CARL H DOERGE JR VICE PRESIDENT 0.50 1.00 X X 0 0 0 SHARON FUENTES VICE PRESIDENT 0.50 1.00 X X 0 0 0 DAVID H DEMING VICE PRESIDENT 0.50 1.00 X X 0 0 0 PETER FETTEROLF SECRETARY 0.50 1.00 X X 0 0 0 JOAN M HEANEY ASSISTANT SECRETARY 0.50 1.00 X X 0 0 0 WILLIAM D KEEN TREASURER 0.50 1.00 X X 0 0 0 FREDRIC R LAMARCA ASSISTANT TREASURER 0.50 1.00 X X 0 0 0 MARY JEAN WEBER CEO 30.00 7.50 X 261346 65337 46953 MICHAEL BARTOLOTTA FISCAL DIRECTOR 30.50 7.00 X 158562 36391 42960 DR MAUREEN ORSEN MEDICAL DIRECTOR 37.50 X 265242 0 44904 DEANNA BAEZ ASSISTANT ADMINISTRATOR 35.00 2.50 X 130767 9341 18711 DR ALEX CZIRA PHYSICIAN 37.50 X 116521 0 40062 EILEEN GIORDANO CASE MANAGER 37.50 X 121060 0 18082 MARJORIE MOMBELEUR PHYSICIAN 37.50 X 129970 0 40778 CATHIE B WARDELL DIRECTOR OF DEVELOPMENT 37.50 X 126805 0 18073 1310273 111069 270523 12 0 1 0 MORRISON MANAGEMENT PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 1597623 MEDLINE INDUSTRIES PO BOX 382075 PITTSBURGH PA 15251 MEDICAL SUPPLIES 593020 PROCARE PHARMACY 111 EXECUTIVE BLVD FARMINGDALE NY 11735 PHARMACEUTICAL 500376 CARE & COMFORT 1580 OCEAN AVENUE BOHEMIA NY 11716 TRANSPORTATION 445220 LOEB & TROPER LLP 655 THIRD AVE NEW YORK NY 10017 ACCOUNTING SERVICES 259126 27 200000 200000 SKILLED NURSING FACILITY 623000 32696729 32696729 ADULT DAY CARE 623000 1826468 1826468 34523197 2565 2565 OTHER 900099 181276 181276 PENSION CREDIT 900099 117404 117404 298680 35024442 34523197 0 301245 802557 658096 144461 17078364 14004258 3074106 96850 79417 17433 5215578 4276774 938804 1313381 1076972 236409 201392 201392 188676 188676 1903464 1560841 342623 8365 8365 1132419 928584 203835 1038572 851629 186943 450847 369695 81152 18045 14797 3248 66593 54606 11987 1035352 848989 186363 391357 320913 70444 NYS CASH RECEIPT ASSESS 1635166 1340836 294330 FOOD & KITCHEN 899995 737996 161999 PRESCRIPTION DRUGS/SUPP 445194 365059 80135 MISCELLANEOUS 206363 169218 37145 34128530 27667045 6461485 0 516032 690238 1390563 870403 4418771 4207851 1168262 1158565 105765 115414 566918 1160399 39542940 30878329 8605192 8664611 329229 19627 17100732 16887108 6336533 5885979 101119 5865 150172 169130 4156316 3072804 798652 960102 8865972 9710591 20408764 19804471 X -3350532 -2959863 42500 42500 -3308032 -2917363 17100732 16887108 X 895912 -505243 X X 0 1 X 1 1 1 X 200000 533147 566439 200000 200000 1699586 35438542 34286331 33593781 35217294 34523197 173059145 35638542 34819478 34160220 35417294 34723197 174758731 0 0 0 174758731 95360 63898 529 461 2565 162813 95360 63898 529 461 2565 162813 461318 344003 622068 383320 298680 2109389 36195220 35227379 34782817 35801075 35024442 177030933 0.98720 0.98870 0.00090 0.00090 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUES AMNESTY PROGRAM INCOME PENSION REFUND OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 42500 42500 42500 42500 42500 42500 42500 42500 42500 42500 1.00000 0 0 452043 452043 21855647 16885661 4969986 16999424 13992668 3006756 235826 235826 8664611 LINE OF CREDIT 700000 SECURITY DEPOSITS 18743 ACCRUED PENSION 8662783 CAPITAL LEASE PAYABLE 23549 ESTIMATED AMOUNT DUE TO THIRD PARTY PAYORS 305516 9710591 X 35024442 0 35024442 0 35024442 34128530 0 34128530 0 34128530 PART IV, LINE 1B: RESIDENT FUNDS AND SECURITY DEPOSITS - RESIDENT FUNDS AND SECURITY DEPOSITS ARE MAINTAINED IN BANK ACCOUNTS THAT ARE SEPARATE FROM THE CENTER'S ACCOUNTS. INTEREST EARNED ON RESIDENT FUNDS AND SECURITY DEPOSITS ARE CREDITED TO THEIR ACCOUNTS. PART IV, LINE 2B: AMOUNTS HELD IN TRUST FOR RESIDENTS. PART V, LINE 4: THE CENTER HAS ONE INDIVIDUAL DONOR-RESTRICTED ENDOWMENT FUND ESTABLISHED FOR SUPPORT FOR THE ELDERLY. PART X, LINE 2: 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, 2013 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPPLICABLE TAXING AUTHORITIES. X X X X X 0 0 0 0 0 0 0 0 0 MARY JEAN WEBER CEO 259762 65337 0 0 1584 0 7840 1960 29722 7431 298908 74728 0 0 MICHAEL BARTOLOTTA FISCAL DIRECTOR 158010 36391 0 0 552 0 4757 1092 30184 6927 193503 44410 0 0 DR MAUREEN ORSEN MEDICAL DIRECTOR 262194 0 0 0 3048 0 7957 0 36947 0 310146 0 0 0 DEANNA BAEZ ASSISTANT ADMINISTRATOR 130491 9341 0 0 276 0 3923 280 13541 967 148231 10588 0 0 DR ALEX CZIRA PHYSICIAN 116521 0 0 0 0 0 3496 0 36566 0 156583 0 0 0 MARJORIE MOMBELEUR PHYSICIAN 129970 0 0 0 0 0 3899 0 36879 0 170748 0 0 0 PART I, LINE 3 THE ORGANIZATION RELIES ON THE BOARD OF DIRECTORS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. THIS PROCESS WAS LAST DONE IN DECEMBER 2012. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD ELECT THE DIRECTORS OF EACH PROGRAM EACH SPRING AT THE ANNUAL MEETING OF EACH CORPORATION. IF A VACANCY OCCURS ON THE BOARD IN THE INTERIM, THE REMAINING DIRECTORS MAY ELECT A SUCCESSOR TO SERVE UNTIL THE NEXT ANNUAL MEETING OF MEMBERS. AT THE NEXT ANNUAL MEETING, THE MEMBERS ELECT DIRECTORS 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 11B PRIOR TO FILING WITH THE IRS, COPIES HAVE BEEN PROVIDED TO ALL BOARD MEMBERS FOR REVIEW. QUESTIONS AND COMMENTS HAVE BEEN FOWARDED TO THE CEO, WHO HAS DISCUSSED 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 B, LINE 15A THE ORGANIZATION RELIES ON THE BOARD OF DIRECTORS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. THIS PROCESS WAS LAST DONE IN DECEMBER 2012. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ADJUSTMENT TO REFLECT PENSION FUNDED STATUS -505,243. 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) LINE 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)(3) LINE 12A, I N/A 0 0 0 1 0 1 0 0 0 0 0 0 1 1 0 1 0 0 0 0