2014-02-03T11:56:31-06:00 2013-06-30 593070669 MOORE STEPHENS LOVELACE PA 701 BRICKELL AVENUE SUITE 550 MIAMI FL 33131 990 2012-07-01 161676092 ALDERSGATE HEALTHCARE INC ALDE 3055565654 5300 W 16TH AVENUE HIALEAH FL 33012 NICK ANTONACCI 3055565654 2014-02-03 1 LAWRENCE SCHIFF CPA P00479457 3058199555 2012 2015-11-30 17:44:51Z NICK ANTONACCI 5300 W 16TH AVENUE HIALEAH FL 33012 12950247 0 X N/A X 2003 FL THE ORGANIZATION OPERATES A NURSING FACILITY AND PROVIDES NURSING SERVICES TO PRIVATE RESIDENTS AND BENEFICIARIES OF FEDERAL AND STATE FUNDED PROGRAMS. 15 15 231 25 0 0 0 0 14311371 12930699 0 0 24591 19548 14335962 12950247 3667 4410 0 0 6666192 6709772 0 0 0 6546589 5734316 13216448 12448498 1119514 501749 4007750 5092873 1005292 1588666 3002458 3504207 X THE ORGANIZATION OPERATES A NURSING FACILITY AND PROVIDES NURSING SERVICES TO PRIVATE RESIDENTS AND BENEFICIARIES OF FEDERAL AND STATE FUNDED PROGRAMS. 0 0 10610066 4410 12950247 THE ORGANIZATION OPERATES A 120-BED NURSING HOME THAT PROVIDES SKILLED AND INTERMEDIATE CARE NURSING SERVICES TO PRIVATE RESIDENTS AND BENEFICIARIES OF FEDERAL AND STATE FUNDED PROGRAMS. 10610066 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 1 0 0 0 1 34 0 1 231 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X BILL CONOL 3055565654 5300 W 16TH AVENUE HIALEAH FL 33012 WILLIAM JACOBS 1.00 1.00 X X 0 0 0 PAUL LANDRUM 1.00 1.00 X X 0 0 0 GERTRUDE STEWART 0.50 0.50 X X 0 0 0 CRAIG W NELSON 0.50 0.50 X 0 0 0 NICK ANTONACCI 10.00 10.00 X 0 0 0 AVIS BROWN 0.50 0.50 X 0 0 0 JACKIE ETTINGER 0.50 0.50 X 0 0 0 LYN FARR 0.50 0.50 X 0 0 0 MARLENE LIEBERMAN 0.50 0.50 X 0 0 0 ODETTE LIGHTBOURNE 0.50 0.50 X 0 0 0 ADONIS MAIQUEZ MD 0.50 0.50 X 0 0 0 CINDY PALERMO 0.50 0.50 X 0 0 0 MARIA REGO 0.50 0.50 X 0 0 0 JAKE ROUDENBUSH 0.50 0.50 X 0 0 0 REV GUILLERMO SANCHEZ 0.50 0.50 X 0 0 0 JEAN TAXIS 0.50 0.50 X 0 0 0 MARTA DELGADO 40.00 0.00 X 144860 0 10654 EUNICE FOMBU 40.00 0.00 X 134273 0 16823 279133 0 27477 2 0 1 0 AGENCY FOR HEALTH CARE ADMINISTRATION 2727 MAHAN DRIVE TALLAHASSEE FL 32308 QUALITY ASSESSMENT FEE 669589 DOS HEALTH MANAGEMENT 300 71ST STREET STE 400 MIAMI BEACH FL 33141 MANAGEMENT FEE 577303 SYSCO FOOD SERVICES PO BOX 64000-A MIAMI FL 33164 FOOD, DIETARY SUPPLIES 495637 PARTNER RX LLC 6555 NOVA DRIVE SUITE 304 DAVIE FL 33317 PHARMACY 419897 OMNICARE OF SOUTH FLORIDA PO BOX 715268 COLUMBUS OH 432715268 PHARMACY 189442 7 RESIDENT SERVICE REVENUE 623000 12930699 12930699 12930699 OTHER REVENUE 623000 19548 19548 19548 12950247 12950247 0 0 4410 4410 5258133 4682388 575745 1792 1792 972078 848312 123766 477769 416891 60878 577303 577303 9767 9767 36525 36525 455659 455659 33005 33005 353374 89252 264122 1766354 1679547 86807 19188 14392 4796 71810 71810 32350 32350 SUPPLIES 841461 808831 32630 QUALITY ASSESSMENT FEE 621464 621464 BAD DEBT EXPENSE 481573 481573 PHARMACY MEDICARE EXPEN 425717 425717 8766 8028 738 12448498 10610066 1838432 0 1953146 1702131 1462811 1256924 6060 6060 84872 101759 570691 221763 335861 348928 165000 1677071 4007750 5092873 980798 840077 24494 748589 1005292 1588666 X 3002458 3504207 3002458 3504207 4007750 5092873 501749 0 X X 0 1 X 1 0 X 11355349 12718586 13713665 14311371 12930699 65029670 11355349 12718586 13713665 14311371 12930699 65029670 0 0 0 65029670 923 923 923 923 12079 36574 42417 24591 19548 135209 11368351 12755160 13756082 14335962 12950247 65165802 0.99790 0.99800 0.00000 0.00010 X 1 120837 4457 125294 0 229179 30067 199112 341512 191696 149816 348928 DUE FROM RELATED PARTIES 1651184 OTHER RECEIVABLES 25887 1677071 OTHER LIABILITIES 9589 DUE TO LANDLORD 720000 DUE TO MEDICARE 19000 748589 12950247 0 12950247 0 12950247 12448498 0 12448498 0 12448498 PART IV, LINE 1B: THE COMPANY OFFERS A CASH MANAGEMENT SERVICE TO ITS RESIDENTS. THESE FUNDS REMAIN THE SOLE PROPERTY OF EACH RESPECTIVE RESIDENT, TO BE DISBURSED ONLY AS REQUESTED AND, ACCORDINGLY, THESE FUNDS ARE EXCLUDED FROM THE ACCOMPANYING FINANCIAL STATEMENTS. THE COMPANY HAS A FIDUCIARY DUTY OF ACCOUNTABILITY FOR THESE FUNDS. AT JUNE 30, 2013 AND 2012, THESE FUND BALANCES APPROXIMATED $125,000 AND $121,000, RESPECTIVELY. 0 0 0 0 0 0 0 0 0 MARTA DELGADO 139110 0 5750 0 0 0 0 0 10654 0 155514 0 0 0 EUNICE FOMBU 134273 0 0 0 0 0 0 0 16823 0 151096 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED MANAGEMENT DUTIES TO DOS HEALTH SERVICES, INC. THROUGH A BOARD-APPROVED CONTRACT. FORM 990, PART VI, SECTION B, LINE 11 THE ACCOUNTING DIRECTOR CONDUCTS A COMPREHENSIVE REVIEW OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. A COPY OF THE FORM 990 IS PROVIDED TO EACH VOTING MEMBER OF THE BOARD OF DIRECTORS BEFORE ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT-OF-INTEREST POLICY COVERS ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS. IT IS THE RESPONSIBILITY OF ALL PERSONS COVERED TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES WHEN DETERMINED. THE ORGANIZATION'S BOARD OF DIRECTORS MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ANNUALLY. THE BOARD OF DIRECTORS REVIEWS ACTUAL CONFLICTS THAT ARE IDENTIFIED BY THE DISCLOSURE PROCESS AND DETERMINES WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO THE ORGANIZATION. THE PERSON WITH THE CONFLICT OF INTEREST WILL BE EXCLUDED FROM DISCUSSION AND APPROVAL OF SUCH TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT FORM 990, PART XI, LINE 2C THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION, MONITORING AND EVALUATION OF AN INDEPENDENT AUDIT FIRM AND OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS. THERE WAS NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR. ALDERSGATE RETIREMENT INC 5300 WEST 16TH AVENUE HIALEAH FL 33012 161676095 OPERATES ASSISTED AND INDEPENDENT LIVING FACILITY FL 501(C)(3) LINE 9 N/A 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALDERSGATE RETIREMENT INC D 1651184 FAIR MARKET VALUE