2012-11-15T09:01:54-06:00 2011-12-31 133385019 O'CONNOR DAVIES MUNNS & DOBBINS LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2011-01-01 237012219 ST TERESA'S NURSING HOME INC STTE 6466334700 120 HIGHLAND AVENUE MIDDLETOWN NY 10940 ANNMARIE COVONE 6466334700 2012-11-14 1 GARRETT HIGGINS P00543209 9143818900 2012-11-14 2011 2016-02-24 21:20:13Z ARCHCARE AT ST TERESA'S NURSING AND REHABILITATION CENTER SCOTT P LA RUE 205 LEXINGTON AVENUE - 2ND FLOOR NEW YORK NY 10016 8925546 0 X WWW.ARCHCARE.ORG X 1968 NY AN INTIMATE 98-BED SKILLED NURSING AND REHABILITATION FACILITY, ST. TERESA'S NURSING HOME SERVES THE COMMUNITY OF MIDDLETOWN IN ORANGE COUNTY, NEW YORK AND OFFERS A HIGHLY PERSONALIZED AND COMPREHENSIVE LONG-TERM ELDERCARE AND SHORT-TERM REHABILITATION.ST. TERESA'S REPUTATION IN THE MIDDLETOWN AREA IS UNSURPASSED. WE HAVE 25% OF OUR RESIDENTS RETURN HOME TO THE COMMUNITY (AFTER BEING REHABILITATED) ON A REGULAR BASIS. OUR REHABILITATION PROGRAM, WHICH IS SIX DAYS A WEEK, IS RECOGNIZED BY THE COMMUNITY AND AREA HOSPITALS ROUTINELY. ADDITIONALLY, ST. TERESA'S DOES NOT USE AGENCY NURSING STAFF, WHICH HELPS TO ENHANCE ITS HOMELIKE ATMOSPHERE. 17 17 197 72 0 0 12475 85 9197949 8901696 1429 716 3415 1024 9215268 8903521 0 0 0 0 5652235 5745767 0 0 0 3210895 3370514 8863130 9116281 352138 -212760 4742650 3367568 6235525 5060192 -1492875 -1692624 X THE NURSING HOME IS DEVOTED TO CARING FOR THE SICK AND DISABLED WITH COMPASSION IN THE TRADITION OF CATHOLIC HEALTH CARE. IT SEEKS TO DELIVER HIGH QUALITY CARE, TO TREAT ALL PATIENTS WITH DIGNITY, AND TO PROVIDE A CARING ENVIRONMENT FOR PATIENTS AT THE NURSING HOME. AS A PARTICIPATING MEMBER OF THE CATHOLIC HEALTH CARE SYSTEM, THE NURSING HOME IS ALSO COMMITTED TO FURTHERING THE SYSTEM'S ABILITY TO PROMOTE HIGH QUALITY CARE, TO ENHANCE ITS SERVICES, AND TO OPERATE EFFECTIVELY AS A HEALTH CARE SYSTEM. 0 0 7954969 8901539 CARE SERVICES AT ST. TERESA'S INCLUDE: 24-HOUR SKILLED NURSING SERVICES; SHORT-TERM REHABILITATION SERVICES INCLUDING SPEECH, PHYSICAL AND OCCUPATIONAL THERAPY; CLINICAL AND PHYSICIAN SERVICES INCLUDING CONSULTING PHYSICIANS FOR DENTAL, OPHTHALMOLOGY, AND PODIATRY; LABORATORY SERVICES; RELIGIOUS SERVICES; RECREATION THERAPY; RADIOLOGY SERVICES; NUTRITION SERVICES; IV THERAPY; PAIN MANAGEMENT; HOSPICE; AND FAMILY AND RESIDENT COUNCILS. DURING 2011 THE ORGANIZATION PROVIDED APPROXIMATELY 34,904 DAYS OF CARE TO 258 PATIENTS. 7954969 1 0 0 1 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 0 1 12 0 1 197 1 0 0 0 0 0 0 0 0 0 0 X 17 17 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X X ANNMARIE COVONE 6466334702 205 LEXINGTON AVE - 2ND FLOOR NEW YORK NY 10016 X KARL P ADLER 1.00 X X 0 0 0 MANFRED ALTSTADT 1.00 X 0 0 0 MSGR WILLIAM BELFORD 1.00 X 0 0 0 WALTER M CADETTE 1.00 X 0 0 0 JOHN T DUNLAP 1.00 X 0 0 0 MSGR CHARLES J FAHEY 1.00 X 0 0 0 THOMAS J FAHEY JR MD 1.00 X 0 0 0 BERNARD P GAWLEY 1.00 X 0 0 0 RORY KELLEHER 1.00 X 0 0 0 JOHN MARINELLI 1.00 X 0 0 0 THOMAS M O'BRIEN 1.00 X X 0 0 0 SISTER PATRICIA RAWDON 1.00 X 0 0 0 FRANCIS J SERBAROLI ESQ 1.00 X X 0 0 0 JOAN M SQUIRES 1.00 X 0 0 0 DOMINICK M STANZIONE 1.00 X 0 0 0 BISHOP DENNIS SULLIVAN 1.00 X 0 0 0 GT SWEENEY 1.00 X 0 0 0 SISTER ANTHONY VEILLEUX 1.00 X 0 0 0 ROGER G WEAVING 1.00 X 0 0 0 JOSEPH P ANDERSON 1.00 X 0 0 0 ERIC P FELDMANN 1.00 X 0 0 0 MSGR GREGORY MUSTACIUOLO 1.00 X 0 0 0 KATHRYN ROONEY 1.00 X 0 0 0 MOTHER M MARK LOUIS OCARM 1.00 X 0 0 0 ANNMARIE COVONE 0.10 X 0 408824 49446 DOUGLAS SANSTED SECRETARY 1.00 X 0 0 0 SCOTT P LA RUE 0.10 X 0 457517 139344 MICHAEL CHAIKEN 40.00 X 176306 0 11400 DEBORAH ANN GRANATA 40.00 X 105242 0 26407 JAMES E INTRONE 0.00 X 0 993832 12506 281548 1860173 239103 2 1 1 0 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 NUTRITIONAL MANAGEMENT 887820 CATHOLIC HEALTH CARE SYSTEM 205 LEXINGTON AVE 2ND FLOOR NEW YORK NY 10016 ADMINISTRATIVE & CONSULTING SERVICES 748668 2 85 85 MEDICAID 623000 4235518 4235518 MEDICARE 623000 2406487 2406487 PRIVATE PATIENT 623000 1684623 1684623 OTHER PATIENT REVENUE 623000 575068 575068 8901696 716 716 21868 22025 -157 -157 INCOME ON PAST DUE ACC 900099 1099 1099 MISCELLANEOUS 900099 82 82 1181 8903521 8901539 0 1897 188771 188771 3908671 3794000 114671 322444 309983 12461 795022 736277 58745 530859 492917 37942 344631 344631 7784 7784 33000 33000 3323 3323 328112 296725 31387 258 258 461048 392439 68609 30059 30059 267742 256093 11649 4701 1062 3639 756 756 157524 149435 8089 163882 163882 NYS CASH RECEIPT ASSESS 485942 485942 PURCH & CONTRACTED SERV 450493 432228 18265 BAD DEBT 263548 263548 MEDICATIONS 209968 209968 157743 134352 23391 9116281 7954969 1161312 0 318057 113471 467069 437117 1572062 1462727 50973 51992 5302869 4550751 871761 752118 38977 18997 1423751 531146 4742650 3367568 2432449 1313554 55900 36336 246524 91524 3500652 3618778 6235525 5060192 X -1492875 -1692624 -1492875 -1692624 4742650 3367568 X -212760 13011 X X 0 1 1 X 0 X 25255 170039 2490 12475 85 210344 7491413 7935317 8923205 9197949 8923564 42471448 7516668 8105356 8925695 9210424 8923649 42681792 0 0 0 42681792 6072 9933 2273 1429 794 20501 6072 9933 2273 1429 794 20501 21362 14542 1026 3415 1181 41526 7544102 8129831 8928994 9215268 8925624 42743819 0.99850 0.99790 0.00050 0.00100 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME INCOME ON PAST DUE ACCOUNTS 0 0 0 0 0 0 0 0 1 3323 3323 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: ST. TERESA'S NURSING HOME, INC. PAYS DUES TO LOCAL 1199 - HEALTH EDUCATION PROJECT (LOCAL 1199). IN ACCORDANCE WITH SECTION 6033(E) OF THE INTERNAL REVENUE CODE, AND AS REPORTED BY LOCAL 1199, A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO 2011 LOCAL 1199 DUES WAS $3,323. 0 1 75000 75000 3620531 3184369 436162 1505927 1290547 215380 101411 75835 25576 752118 OTHER NON-CURRENT ASSETS 13146 INSURANCE RECOVERIES RECEIVABLE 518000 531146 DUE TO RELATED PARTIES 2059097 DUE TO THIRD-PARTY PAYORS 178770 ASSET RETIREMENT OBLIGATION 19600 ACCRUED PENSION LIABILITY 517978 SELF INSURED LIABILITIES 325333 PROFESSIONAL LIABILITIES 518000 3618778 8903521 9116281 -212760 13011 13011 -199749 8925546 22025 22025 8903521 0 8903521 9138306 22025 22025 9116281 0 9116281 PART IV, LINE 2B: RESIDENTS' FUNDS ARE HELD BY THE HOME ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT ALLOWANCES RECEIVED BY RESIDENTS AS WELL AS OTHER RESIDENTS' FUNDS DEPOSITED WITH THE HOME FOR SAFEKEEPING. THESE FUNDS ARE DISBURSED BY THE HOME AT THE REQUEST OF, OR ON BEHALF OF, RESIDENTS FOR THEIR PERSONAL USE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOME RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE HOME HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE HOME IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2008. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT 13,011. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B 22,025. PART XIII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD REPORTED ON PART VIII, LINE 10B 22,025. 1 1 0 0 0 0 0 0 0 ANNMARIE COVONE 0 400466 0 0 0 8358 0 27900 0 21546 0 458270 0 0 SCOTT P LA RUE 0 456038 0 0 0 1479 0 117200 0 22144 0 596861 0 0 MICHAEL CHAIKEN 176306 0 0 0 0 0 11400 0 0 0 187706 0 0 0 JAMES E INTRONE 0 0 0 0 0 993832 0 0 0 12506 0 1006338 0 369000 PART I, LINE 3 CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT ITS EXECUTIVE COMPENSATION IS REASONABLE. TOWARD THAT END, THE BOARD OF TRUSTEES HAS A COMPENSATION COMMITTEE OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN ANY PROPOSED COMPENSATION ARRANGEMENT. IN 2008, THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT WHO CONDUCTED INDEPENDENT RESEARCH AND UTILIZED A WIDE RANGE OF INDUSTRY DATA TO DEVELOP COMPARABILITY OR BENCHMARKING DATA FOR APPROPRIATE LEVELS OF COMPENSATION FOR TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES. THE CONSULTANT PROJECTED THE DATA FOR THE FOLLOWING THREE YEARS FOR EACH SALARY LEVEL. THE COMPENSATION COMMITTEE, TAKING THE CONSULTANT'S RECOMMENDATIONS UNDER ADVISEMENT, HELD A MEETING AT WHICH CONTEMPORANEOUS MINUTES WERE KEPT AND AT THAT MEETING DETERMINED TO MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN CONSIDERED AND APPROVED THE RECOMMENDATIONS OF THE COMPENSATION COMMITTEE, WHICH APPROVAL WAS RECORDED IN THE MINUTES OF THE MEETING OF THE BOARD OF TRUSTEES. PART I, LINES 4A-B JAMES INTRONE RECEIVED A SEVERANCE PAYMENT OF $555,734 PAID BY CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. HE ALSO RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT OF $438,098 PAID BY CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. SCOTT P. LA RUE AND ANNMARIE COVONE ALSO PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE CONTRIBUTED $16,500 TO THE PLAN IN 2011 FOR EACH INDIVIDUAL. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT AGREEMENT FOR CERTAIN ADMINISTRATIVE AND CONSULTING SERVICES WITH CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE "MEMBER" IS CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE "MEMBER" HAS THE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES, APPOINT THE CHAIRMAN OF THE BOARD, AMEND THE BY-LAWS AND CERTIFICATE OF INCORPORATION AND APPROVE SUBSTANTIAL TRANSACTIONS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE "MEMBER" HAS THE RIGHT TO AMEND THE BY-LAWS AND CERTIFICATE OF INCORPORATION AND APPROVE SUBSTANTIAL TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD MEMBERS OF THE ORGANIZATION FOR ANY COMMENTS. ANY COMMENTS ARE THEN GROUPED, SUMMARIZED AND PROVIDED TO THE OUTSIDE ACCOUNTANTS. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED FOR FILING. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY ON CONFLICTS OF INTEREST IS DESIGNED TO PROVIDE GUIDANCE TO ALL MEMBERS OF THE BOARD, THE OFFICERS OF THE ORGANIZATION, AND TO ALL PERSONS EMPLOYED BY THE ORGANIZATION. A BOARD MEMBER OR OFFICER SHALL DISCLOSE ANY CONFLICT OF INTEREST OF WHICH HE OR SHE HAS KNOWLEDGE: (A) PRIOR TO VOTING ON OR OTHERWISE DISCHARGING HIS OR HER DUTIES WITH RESPECT TO ANY MATTER INVOLVING THE CONFLICT WHICH COMES BEFORE THE BOARD OR ANY COMMITTEE OF THE BOARD; (B) PRIOR TO ENTERING INTO ANY CONTRACT OR TRANSACTION INVOLVING THE ORGANIZATION; (C) AS SOON AS POSSIBLE AFTER THE BOARD MEMBER OR OFFICER SHALL LEARN OF A CONFLICT OF INTEREST IN ANY OTHER CONTEXT. DISCLOSURE OF THE MATERIAL FACTS SURROUNDING THE BOARD MEMBER OR OFFICER'S CONFLICT OF INTEREST SHALL BE MADE TO THE SECRETARY OF THE BOARD OF MANAGERS OR, IN THE CASE OF A COMMITTEE, TO THE CHAIRPERSON OF THAT COMMITTEE (WHO SHALL NOTIFY THE SECRETARY). THE SECRETARY OR COMMITTEE CHAIRPERSON SHALL INFORM THE OTHER MEMBERS OF THE BOARD OR COMMITTEES PRIOR TO ANY ACTION THEREON. FAILURE TO DISCLOSE ADEQUATELY A POTENTIAL OR ACTUAL CONFLICT OF INTEREST SHALL CONSTITUTE CAUSE FOR REMOVAL FROM THE BOARD. FOLLOWING RECEIPT OF INFORMATION CONCERNING A CONTRACT OR TRANSACTION INVOLVING A POTENTIAL CONFLICT OF INTEREST, THE BOARD SHALL CONSIDER THE MATERIAL FACTS CONCERNING THE PROPOSED CONTRACT OR TRANSACTION, INCLUDING THE PROCESS BY WHICH THE DECISION WAS MADE TO RECOMMEND ENTERING INTO THE ARRANGEMENT ON THE TERMS PROPOSED. (A) AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. AN INTERESTED BOARD MEMBER MAY NOT BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM AT A MEETING OF THE BOARD OR COMMITTEE AT WHICH DISCUSSION OR A VOTE ON THE TRANSACTION OR ARRANGEMENT TAKES PLACE. (B) AN INTERESTED BOARD MEMBER OR OFFICER SHALL NOT USE PERSONAL INFLUENCE WITH REGARD TO THE BOARD'S DETERMINATION THAT A CONFLICT EXISTS OR THE BOARD'S VOTE ON THE MATTER. (C) IF APPROPRIATE, THE CHAIRPERSON SHALL APPOINT A DISINTERESTED PERSON OR A COMMITTEE OF THE BOARD TO CONDUCT AN ASSESSMENT OF FAIR MARKET VALUE FOR A PARTICULAR TRANSACTION, OR TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. (D) THE BOARD SHALL APPROVE ONLY THOSE CONTRACTS OR TRANSACTIONS IN WHICH THE TERMS ARE FAIR AND REASONABLE TO THE ORGANIZATION AND THE ARRANGEMENTS ARE CONSISTENT WITH THE BEST INTERESTS OF THE ORGANIZATION. THE MINUTES OF THE BOARD AND OF ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN THE FOLLOWING WITH REGARD TO CONSIDERATION OF ANY MATTER INVOLVING A CONFLICT OF INTEREST: (A) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL OR OTHER INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE CONFLICT OF INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; (B) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, A SUMMARY OF THE CONTENT OF THE DISCUSSION, INCLUDING CONSIDERATION OF ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT AND THE NATURE OF AND SOURCE OF ANY DATA RELIED UPON IN MAKING AN ASSESSMENT OF FAIR MARKET VALUE, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH; AND (C) IN ANY CASE WHEN THE BOARD APPROVES AN ARRANGEMENT OR TRANSACTION INVOLVING A CONFLICT OF INTEREST, THE MINUTES OF THE MEETING SHALL SET FORTH THE BASIS FOR THE BOARD'S DECISION. AN EMPLOYEE OF THE ORGANIZATION WITH A POTENTIAL CONFLICT OF INTEREST IN A PARTICULAR MATTER SHALL PROMPTLY AND FULLY DISCLOSE THE POTENTIAL CONFLICT TO HIS OR HER SUPERVISOR. THE EMPLOYEE SHALL THEREAFTER REFRAIN FROM PARTICIPATING IN ANY DECISIONS RELATING TO THE MATTER AND FOLLOW THE DIRECTION OF THE SUPERVISOR AS TO HOW THE ORGANIZATION'S DECISIONS WHICH ARE THE SUBJECT OF THE CONFLICT WILL BE DETERMINED. THE COMPLIANCE DIRECTOR OF THE ORGANIZATION SHALL BE RESPONSIBLE FOR DETERMINING THE PROPER WAY FOR THE ORGANIZATION TO HANDLE THE ORGANIZATION'S DECISIONS WHICH INVOLVE UNRESOLVED EMPLOYEE CONFLICTS OF INTEREST. IN MAKING SUCH DETERMINATIONS, THE COMPLIANCE DIRECTOR OF THE ORGANIZATION MAY CONSULT WITH LEGAL COUNSEL, AS APPROPRIATE. THE COMPLIANCE DIRECTOR OF THE ORGANIZATION SHALL REPORT TO THE BOARD AT LEAST ANNUALLY CONCERNING EMPLOYEE CONFLICTS OF INTEREST WHICH HAVE BEEN DISCLOSED AND CONTRACTS AND TRANSACTIONS INVOLVING EMPLOYEE CONFLICTS WHICH THE SECRETARY OF THE ORGANIZATION'S BOARD OF MANAGERS HAS APPROVED. EACH BOARD MEMBER, OFFICER, MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS, AND KEY EMPLOYEE OF THE ORGANIZATION SHALL SIGN A STATEMENT WITHIN 30 DAYS OF ASSUMING SUCH RESPONSIBILITY, AND ANNUALLY THEREAFTER, AFFIRMING THAT SUCH PERSON: (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS THAT THE ORGANIZATION CANNOT ENGAGE IN A TRANSACTION OR ENTER INTO A COMPENSATION ARRANGEMENT WITH BOARD MEMBERS, OFFICERS, SENIOR STAFF MEMBERS, OR OTHERS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION THAT PROVIDES AN ECONOMIC BENEFIT TO SUCH PERSON IN EXCESS OF THE CONSIDERATION OR SERVICES THAT THE ORGANIZATION RECEIVES IN RETURN. IN ADDITION, THOSE INDIVIDUALS COMPLETING THE STATEMENT ARE ALSO REQUIRED TO DISCLOSE PERSONAL OR OTHER BUSINESS INTERESTS THAT COULD GIVE RISE TO CONFLICTS WITH THEIR ROLE WITH ARCHCARE. THESE STATEMENTS ARE SUMMARIZED AND PROVIDED TO THE GOVERNING BODY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION UNDERTAKES A RIGOROUS PROCESS TO ENSURE THAT ITS EXECUTIVE COMPENSATION IS REASONABLE. TOWARD THAT END, THE BOARD OF TRUSTEES HAS A COMPENSATION COMMITTEE OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN ANY PROPOSED COMPENSATION ARRANGEMENT. IN 2008, THE BOARD ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT WHO CONDUCTED INDEPENDENT RESEARCH AND UTILIZED A WIDE RANGE OF INDUSTRY DATA TO DEVELOP COMPARABILITY OR BENCHMARKING DATA FOR APPROPRIATE LEVELS OF COMPENSATION FOR TOP MANAGEMENT, OFFICERS, AND KEY EMPLOYEES. THE CONSULTANT PROJECTED THE DATA FOR THE FOLLOWING THREE YEARS FOR EACH SALARY LEVEL. THE COMPENSATION COMMITTEE, TAKING THE CONSULTANT'S RECOMMENDATIONS UNDER ADVISEMENT, HELD A MEETING AT WHICH CONTEMPORANEOUS MINUTES WERE KEPT AND AT THAT MEETING DETERMINED TO MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN CONSIDERED AND APPROVED THE RECOMMENDATIONS OF THE COMPENSATION COMMITTEE, WHICH APPROVAL WAS RECORDED IN THE MINUTES OF THE MEETING OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS POSTED ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION, FORM 990, FORM 1023, AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST OR BY CALLING THE ORGANIZATION DIRECTLY. THE ORGANIZATION ALSO FILES AN ANNUAL COST REPORT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH WHICH CONTAINS FINANCIAL STATEMENTS AND RELATED NOTE DISCLOSURES. THIS COST REPORT IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: THE FOLLOWING ORGANIZATIONS, INCLUDING ST. TERESA'S NURSING HOME, HAVE MIRROR BOARDS: MARY MANNING WALSH NURSING HOME COMPANY, CARMEL RICHMOND NURSING HOME INC., CATHOLIC HEALTH CARE FOUNDATION OF THE ARCHDIOCESE OF NEW YORK, INC., CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE, ST. VINCENT DE PAUL RESIDENCE, KATERI RESIDENCE, FERNCLIFF NURSING HOME COMPANY, INC., AND TERENCE CARDINAL COOKE HEALTH CARE CENTER. AT THE BOARD MEETINGS, ALL OF THE ENTITIES ARE DISCUSSED. ON AVERAGE, THE BOARD MEMBERS SPEND ONE HOUR WORKING ON THESE ORGANIZATIONS. ANNMARIE COVONE, SENIOR VP/CFO, AND SCOTT P. LA RUE, PRESIDENT AND CEO, EACH SPEND ON AVERAGE .10 HOURS PER WEEK, WORKING ON THE FILING ORGANIZATION AS WELL AS THE RELATED ENTITIES. THEY SPENT 35 HOURS PER WEEK WORKING FOR CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE. THE FOLLOWING BOARD MEMBERS AND OFFICERS OF THE FILING ORGANIZATION ALSO SPENT ON AVERAGE .10 HOURS PER WEEK WORKING ON CATHOLIC MANAGED LONG TERM CARE, INC: KARL P. ADLER MD, FRANCIS J. SERBAROLI ESQ., G.T. SWEENEY, SCOTT P. LA RUE, AND ANNMARIE COVONE. MANFRED ALSTAD AND DR. THOMAS FAHEY JR. ARE BOARD MEMBERS OF CALVARY HOSPITAL, AND SERVE ON AVERAGE, 2 HOURS A WEEK AT CALVARY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PENSION LIABILITY ADJUSTMENT 13,011. TOTAL TO FORM 990, PART XI, LINE 5: 13,011. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 133896624 MGT SVCS FOR HEALTH-RELATED FACILITIES IN THE ARCHDIOCESE NY 501(C)(3) 9 PROVIDENCE HEALTH SERVICES 0 CATHOLIC HEALTH CARE FOUNDATION OF THE ARCHDIOCESE OF NY INC 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 134054158 PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) 7 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 FERNCLIFF NURSING HOME COMPANY INC 21 FERNCLIFF DRIVE RHINEBECK NY 12572 141514053 OPERATE SKILLED NURSING FACILITY & ADULT HEALTH CARE PROGRAM NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 KATERI RESIDENCE 150 RIVERSIDE DRIVE NEW YORK NY 10024 133086309 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 MARY MANNING WALSH NURSING HOME COMPANY INC 1339 YORK AVENUE NEW YORK NY 100214707 136220617 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 ST THERESA'S RESIDENCE 30 SOUTH 10TH AVENUE MT VERNON NY 10550 133110063 INTERMEDIATE CARE FACILITY FOR DEVELOPMENTALLY DISABLED NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 ST VINCENT DE PAUL RESIDENCE 900 INTERVALE AVENUE BRONX NY 10459 133598842 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CARMEL RICHMOND NURSING HOME INC 88 OLD TOWN ROAD STATEN ISLAND NY 103044299 132720248 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 TERENCE CARDINAL COOKE HEALTH CARE CENTER 1249 FIFTH AVENUE NEW YORK NY 10029 133007801 OPERATE SKILLED NURSING FACILITY & REHABILITATION FACILITY NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CATHOLIC MANAGED LONG TERM CARE INC 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 208180809 OPERATE A MANAGED LONG TERM CARE PLAN NY 501(C)(3) 9 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CALVARY HOSPITAL INC 1740 EASTCHESTER ROAD BRONX NY 10461 131740274 OPERATE A TAX EXEMPT HOSPITAL NY 501(C)(3) 3 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 OUR LADY OF MERCY HEALTHCARE SYSTEM INC 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 133395946 PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) TYPE I CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 OUR LADY OF MERCY FUND OF NEW YORK NY 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 133452084 PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) 7 OUR LADY OF MERCY HEALTHCARE SYSTEM INC 0 CALVARY HOLDING COMPANY 1740 EASTCHESTER ROAD BRONX NY 10461 061531426 SUPPORT THE CALVARY HOSPITAL AND ITS AFFILIATED ORGANIZATIONS NY 501(C)(3) TYPE I CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 PROVIDENCE HEALTH SERVICES 1011 1ST AVENUE NEW YORK NY 10022 133354940 SPONSOR OF CATHOLIC HEALTH CARE SYSTEM D/B/A ARCHCARE NY 501(C)(3) 3 N/A 0 CALVARY FUND INC 1740 EASTCHESTER ROAD BRONX NY 10461 133259649 SUPPORT CALVARY HOSPITAL NY 501(C)(3) TYPE I CALVARY HOLDING COMPANY INC 0 CATHOLIC RESOURCES INC 1339 YORK AVENUE NEW YORK NY 10021 261306110 SUPPORT CATHOLIC MANAGED LONG TERM CARE, INC. NY 501(C)(3) 1 CATHOLIC MANAGED LONG TERM CARE INC 0 ST AGNES HOSPITAL 305 NORTH STREET WHITE PLAINS NY 10605 131740121 OPERATE A TAX EXEMPT HOSPITAL NY 501(C)(3) 3 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 CATHOLIC HEALTH CARE SYSTEM OF THE HUDSON VALLEY 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 PROVIDE FUNDS TO SUPPORT THE MISSION OF CHCS FACILITIES NY 501(C)(3) 1 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 BENEFICE ADVANTAGE INC 205 LEXINGTON AVE - 2ND FL NEW YORK NY 10016 134201050 PROVIDE ADMINISTRATIVE, BENEFITS COORDINATING AND OTHER SERVICES TO ARCHCARE NY 501(C)(3) 1 CATHOLIC HEALTH CARE SYSTEM DBA ARCHCARE 0 ROSALIE HALL INC 4150 BRONX BLVD BRONX NY 10466 133757241 OPERATE AND MAINTAIN A HOME FOR UNMARRIED MOTHERS NY 501(C)(3) 9 OUR LADY OF MERCY HEALTHCARE SYSTEM INC 0 OLM DEVELOPMENT CORPORATION 205 LEXINGTON AVENUE - 2ND FLOOR NEW YORK NY 10016 133272992 HEALTH CARE SERVICES NY OUR LADY OF MERCY HEALTH CARE SYSTEM INC C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0