2016-11-11T09:46:15-06:00 2015-12-31 390859910 Baker Tilly Virchow Krause LLP 1650 Market Street Suite 4500 Philadelphia PA 191037341 990 2015-01-01 221807020 Our Lady's Residence OURL 8563424100 1845 Haddon Avenue Camden NJ 08103 Robert Waite CONTROLLER 8563424100 2016-11-08 1 Julius C Green CPA P00350393 2159720701 2015 2017-02-10 21:41:12Z ROBERT WAITE 1845 Haddon Avenue Camden NJ 08103 14126549 0 0928 X www.camdendiocese.org X 1966 NJ A SKILLED NURSING FACILITY LICENSED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND HUMAN SERVICES. X 8 6 280 85 0 0 208515 160922 15637199 13931952 3926 12455 24671 21220 15874311 14126549 600 700 0 0 10785213 10385725 0 0 0 6189183 5337355 16974996 15723780 -1100685 -1597231 4696015 2442425 5941326 6945089 -1245311 -4502664 X Our mission is to operate a not-for-profit Catholic based skilled nursing facility providing our residents with the best nursing care and rehabilitation services, while enhancing the quality of life in a dignified, safe atmosphere. We seek to provide appropriate service to all who ask for our assistance. 0 1 14120967 700 13931952 Our Lady's Residence operates a 214 bed Skilled Nursing Facility in Pleasantville, New Jersey that is licensed by the New Jersey Department of Health and Human Services. Our Lady's Residence annual census count was 51,796 and the occupancy percentage was 69.75%. The home's sole member is Catholic Charities of the Diocese of Camden.Resident programs include restorative nursing care by licensed and certified nursing staff, comprehensive plan of care, social service, pharmacy, congregated dining, activities, special diets, spiritual counseling by a Catholic chaplain, housekeeping, and laundry.Rehabilitation services and physical, occupational, and speech therapies are available for those who are recovering from fractures, strokes and other short-term, post hospital stays. In addition to core therapies and treatment modalities, we provide a wide range of complex clinical care and specialized services, including: Gait and balance training, dysphasia therapy, IV Antibiotic therapy, enteral nutrition, wound care and pain management. 14120967 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 46 0 1 280 1 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 0 1 0 0 1 1 1 0 0 NJ X Robert Waite CONTROLLER 8563424186 1845 Haddon Avenue CAMDEN NJ 08103 Dorothy Powell PRESIDENT 5.00 0.00 X X 0 0 0 Richard Maxwell vice PRESIDENT 5.00 0.00 X X 0 0 0 MARTIN B IDLER Executive Director/SECRETAry 13.30 26.70 X X 0 197943 36014 Lawrence Reader Treasurer 0.50 39.50 X X 0 121588 15487 Mary Ann Marchetti trustee 5.00 0.00 X 0 0 0 SISTER Eleta Felli Trustee 5.00 0.00 X 0 0 0 Rev Joseph A Wagenhoffer Trustee 5.00 0.00 X 0 0 0 rev john vignone trustee 5.00 0.00 X 0 0 0 anna tosti Administrator 40.00 0.00 X 138266 0 26505 138266 319531 78006 1 0 1 0 Select Rehabilitation PO Box 809056 Chicago IL 606809056 PT, OT & ST Therapy 1306598 Crothall Healthcare 13028 Collections Center Drive Chicago IL 60693 Maintenance Service 324099 Sodexo Inc Box 360170 Pittsburgh PA 152516170 Food Service 296873 Hospitaler Sisters of Mercy 1100 Clematis Avenue Pleasantville NJ 08232 Nursing Services 110696 4 140000 20922 160922 Net Resident Service Rev 623000 13931952 13931952 13931952 12455 12455 MEALS REVENUE 900099 10855 10855 RESIDENT TV REVENUE 900099 5390 5390 Resident Phone & Vending Rev 900099 4092 4092 883 883 21220 14126549 13931952 0 33675 X 700 700 7235473 6430994 804479 574989 511059 63930 2065867 1836173 229694 509396 482246 27150 94516 94516 12293 12293 2179606 2118126 61480 101266 1859 99407 379114 318907 60207 150847 150847 417246 415600 1646 22604 8418 14186 5846 4621 1225 121430 121430 66985 66985 NURSING HOME ASSESSMENT 525946 525946 Food 483998 483998 Pharmacy/Drugs 289613 289613 medical supplies 135050 135050 350995 285380 65615 15723780 14120967 1602813 0 1000 724983 0 1929710 1861176 88 263693 446590 27019 15938 1648176 11081 128365 123578 4696015 2442425 1170911 311472 14139 4756276 6633617 5941326 6945089 X -1285133 -4502664 39822 0 -1245311 -4502664 4696015 2442425 X -1597231 56242 -1716364 X 0 0 0 X 66120 45093 23826 208515 160922 504476 16121322 15399193 15602121 15637199 13931952 76691787 16187442 15444286 15625947 15845714 14092874 77196263 0 0 0 77196263 8744 6773 2766 3926 12455 34664 8744 6773 2766 3926 12455 34664 27812 50016 82920 24671 21220 206639 16223998 15501075 15711633 15874311 14126549 77437566 0.99690 0.99660 0.00040 0.00070 X Schedule A, Part III, Line 12, Explanation of Other Income: 1 MISCELLANEOUS REVENUE - 2011 Amount: $ 2,838. 2012 Amount: $ 20,590. 2013 Amount: $ 56,378. 2014 Amount: $ 720. 2015 Amount: $ 883. 2 RESIDENT TELEPHONE REV - 2011 Amount: $ 4,865. 2012 Amount: $ 10,151. 2013 Amount: $ 5,774. 2014 Amount: $ 4,670. 2015 Amount: $ 4,092. 3 MEALS REVENUE - 2011 Amount: $ 12,774. 2012 Amount: $ 11,860. 2013 Amount: $ 14,335. 2014 Amount: $ 12,981. 2015 Amount: $ 10,855. 4 RESIDENT TV REVENUE - 2011 Amount: $ 7,335. 2012 Amount: $ 7,415. 2013 Amount: $ 6,433. 2014 Amount: $ 6,300. 2015 Amount: $ 5,390. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 14139 48570 62709 0 1 27019 15938 11081 11081 Resident PNA Funds 77950 BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 39922 due from affiliates 5706 123578 Resident PNA Funds 77950 Due to Third Party Payors 139400 Due to Other Parties 2183 Due to Diocese of Camden 6237439 Overdraft Fees 176645 6633617 Part IV, Line 1b: Private Pay residents have one month's rent deposited in an interest-bearing account at PNC Bank. Upon death, leaving the facility, or applying for Medicaid, the escrow balance is applied to the resident's outstanding account balance and any remaining monies are refunded to the resident. As of year-end they were all closed. 1 0 0 0 0 0 0 0 0 MARTIN B IDLER Executive Director/SECRETAry 0 197943 0 0 0 0 0 15836 0 20178 0 233957 0 0 anna tosti Administrator 138266 0 0 0 0 0 11061 0 15444 0 164771 0 0 0 Part I, Line 3 Salary of the Executive Director is paid by a related organization and is reviewed annually by the Diocese of Camden (related party) - receiving the same annual increase percentage as all other Diocesan employees. Approval is determined by the board. In July 2015, there was a 2% Diocesan increase. There is no performance based compensation. Part I, Line 4a Anna Tosti - $3,809 Furniture, Fixtures & Equipment, Land & Bldg, Other Assets 2015-12-14 10100000 appraisal 475665781 pleasantville lot LLC 137-42 71st street flushing NY 11367 Partnership appraisal 474339120 1100 Pleasantville Realty LLC 137-42 71st Street flushing NY 11367 Partnership 0 0 0 0 Form 990, Part III, line 3 On December 14, 2015, the nursing home was sold to a for-profit company. At present, we are in the process of winding down the corporate entity. Form 990, Part VI, Section A, line 6 Catholic Charities of the Diocese of Camden, Inc. is the sole member of the corporation. Form 990, Part VI, Section A, line 7a As sole member of the corporation, Catholic Charities of the Diocese of Camden, Inc. has the power to appoint the trustees of the corporation. Form 990, Part VI, Section A, line 7b In addition to the power to appoint the trustees as indicated above, Catholic Charities of the Diocese of Camden, Inc has other powers set forth in the corporation's by-laws which include the following: - adopt or amend the Certificate of Incorporation or By-Laws of the Corporation; - adopt or permit adoption of any annual or long-term capital or operational budget of the Corporation as well as significant changes to the original budget (5%); - Authorize or permit the Corporation to engage in significant transactions (as further defined in the by-laws) in excess of $100,000 as well as such transactions related to the acquisition or disposition of land and buildings owned by the Corporation; - approve or permit the approval of any secured or unsecured borrowing of money by the Corporation; - Approve or permit the approval of any long-term strategic plan of the Corporation; - Approve a plan of merger, consolidation, affiliation, or dissolution of the Corporation; - Organize, acquire, authorize or permit the organization or acquisition of any new subsidiary of the Corporation; and, - Approve or permit the approval of contributions, grants, or loans in excess of an aggregate of $100,000. Form 990, Part VI, Section B, line 11 The Controller will review Form 990 before it is signed and filed. Form 990, Part VI, Section B, line 15a Salary of the Executive Director is reviewed annually by the Diocese of Camden (related party) - receiving the same annual increase percentage as all other Diocesan employees. In July 2015, there was a 2% Diocesan increase. There is no performance based compensation. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policies and financial statements will be made available to the public upon request. Form 990, Part IX, line 11g FOOD AND DIETICIAN COSTS: Program service expenses 324,296. Management and general expenses 0. Fundraising expenses 0. Total expenses 324,296. HOUSEKEEPING FEES: Program service expenses 190,353. Management and general expenses 0. Fundraising expenses 0. Total expenses 190,353. DIAPERS AND LINENS: Program service expenses 72,241. Management and general expenses 0. Fundraising expenses 0. Total expenses 72,241. GARBAGE DISPOSAL SERVICES: Program service expenses 36,346. Management and general expenses 0. Fundraising expenses 0. Total expenses 36,346. EXTERMINATION FEES: Program service expenses 11,556. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,556. SECURITY: Program service expenses 75,297. Management and general expenses 0. Fundraising expenses 0. Total expenses 75,297. MAINTENANCE ADMIN FEES: Program service expenses 105,726. Management and general expenses 0. Fundraising expenses 0. Total expenses 105,726. MEDICAL DIRECTOR FEES: Program service expenses 50,000. Management and general expenses 0. Fundraising expenses 0. Total expenses 50,000. PHARMACEUTICAL CONSULTANT: Program service expenses 37,798. Management and general expenses 0. Fundraising expenses 0. Total expenses 37,798. LAB FEES: Program service expenses 53,201. Management and general expenses 0. Fundraising expenses 0. Total expenses 53,201. PT, OT, AND SPEECH THERAPY: Program service expenses 1,157,197. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,157,197. PAYROLL PROCESSING EXPENSE: Program service expenses 0. Management and general expenses 21,209. Fundraising expenses 0. Total expenses 21,209. CONSULTING EXPENSE: Program service expenses 0. Management and general expenses 40,267. Fundraising expenses 0. Total expenses 40,267. REGULATORY FEES: Program service expenses 0. Management and general expenses 4. Fundraising expenses 0. Total expenses 4. Snow Removal: Program service expenses 4,115. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,115. Form 990, Part XI, line 9: Impairment Loss -1,716,364. Bishop McCarthy Residence 1845 HADDON AVENUE CAMDEN NJ 08103 222051685 HEALTH CARE NJ 501(c)(3) Line 9 CATHOLIC CHARITIES OF THE DIOCESE OF CAMDEN INC 0 Saint Mary's Catholic Home 1845 HADDON AVENUE CAMDEN NJ 08103 210634535 HEALTH CARE NJ 501(c)(3) Line 9 CATHOLIC CHARITIES OF THE DIOCESE OF CAMDEN INC 0 Mater Dei Nursing Home 1845 HADDON AVENUE CAMDEN NJ 08103 221840494 HEALTH CARE NJ 501(c)(3) Line 9 CATHOLIC CHARITIES OF THE DIOCESE OF CAMDEN INC 0 Diocese of Camden 1845 HADDON AVENUE CAMDEN NJ 08103 210634498 religious services NJ 501(c)(3) Line 1 CATHOLIC CHARITIES OF THE DIOCESE OF CAMDEN INC 0 CATHOLIC CHARITIES OF THE DIOCESE OF CAMDEN INC 1845 HADDON AVENUE CAMDEN NJ 08103 223759994 SOCIAL SERVICES NJ 501(c)(3) Line 7 N/A 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0