2023-11-15T06:09:32-06:00 2022-12-31 540737372 PBMARES LLP 150 BOUSH STREET SUITE 400 NORFOLK VA 23510 990 2022-01-01 540505952 ST MARY'S HOME FOR DISABLED CHILDREN INC STMA 7576222208 6171 KEMPSVILLE CIRCLE NORFOLK VA 23502 SHANNON EDSALL CURRENT CEO 7576222208 2023-10-30 1 SHANNON EDSALL 999009999 0 JENNIFER N FRENCH CPA P00659678 7576274644 2023-10-30 X 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SHANNON EDSALL 6171 KEMPSVILLE CIRCLE NORFOLK VA 23502 27404968 0 X SAINTMARYSHOME.ORG X 1901 VA TO PROVIDE CARE AS AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF/IID) AS A RESIDENTIAL FACILITY WITH 100 LICENSED BEDS. 16 16 415 16 0 0 1556122 1444977 23975682 25959991 -27010 -874 51512 0 25556306 27404094 0 0 0 0 14719022 19842877 0 0 229404 7088739 7505925 21807761 27348802 3748545 55292 13262085 17386377 13368751 9585642 -106666 7800735 TO PROVIDE CARE AS AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF/IID) AS A RESIDENTIAL FACILITY WITH 100 LICENSED BEDS. 0 0 23674347 25959117 INTERMEDIATE HEALTH CARE FOR INDIVIDUALS WITH SEVERE MENTAL AND PHYSICAL DISABILITIES WITH 88 LICENSED PEDIATRIC BEDS AND 12 LICENSED ADULT BEDS. 23674347 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 42 0 1 415 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X ROBYN JONES 7576222208 6171 KEMPSVILLE CIRCLE NORFOLK VA 23502 RICHARD KNAPP PRESIDENT 0.50 0.00 X X 0 0 0 RANDALL CRUTCHFIELD VICE PRESIDENT 0.50 0.50 X X 0 0 0 DR ALLEN WHITE III SECRETARY 0.50 0.50 X X 0 0 0 SHAWN FISCHER TREASURER 0.50 0.00 X X 0 0 0 GREGORY KILDUFF TRUSTEE 0.50 0.00 X 0 0 0 CHRIS D'SURNEY TRUSTEE 0.50 0.50 X 0 0 0 MICHAEL COTTER TRUSTEE 0.50 0.50 X 0 0 0 EMILY GRIMSLEY TRUSTEE 0.50 0.00 X 0 0 0 BRAD MASON TRUSTEE 0.50 0.50 X 0 0 0 DR JUANITA SMITH TRUSTEE 0.50 0.00 X 0 0 0 DR SHELDON VIOLA TRUSTEE 0.50 0.00 X 0 0 0 NANCY WILCOX TRUSTEE 0.50 0.00 X 0 0 0 GAELA NORMILE TRUSTEE 0.50 0.00 X 0 0 0 CHRIS LAGOW TRUSTEE 0.50 0.00 X 0 0 0 JANETTE CRUMLEY TRUSTEE 0.50 0.00 X 0 0 0 QUETTA RUFFIN TRUSTEE 0.50 0.00 X 0 0 0 H WAYNE JONES CEO 40.00 0.00 X 253443 0 17468 ELIZABETH MCCUEAN CHIEF OF NURSING AND CLINI 40.00 0.00 X 146801 0 14080 SHANNON EDSALL CHIEF OF RESIDENTIAL SERVICES 40.00 0.00 X 140675 0 5300 MICHELLE DEPELTEAU DIRECTOR OF HUMAN RESOURCE 40.00 0.00 X 119249 0 27392 ROBYN JONES CONTROLLER 40.00 0.00 X 110655 0 14887 DAWN TEETS REGISTERED NURSE 40.00 0.00 X 138524 0 18504 909347 0 97631 6 0 1 0 METRO MECHANICAL CORP 6017 PROVIDENCE ROAD VIRGINIA BEACH VA 23464 HEATING AND COOLING SERVICES 246779 PBMARES LLP 150 BOUSH STREET NORFOLK VA 23510 ASSURANCE AND TAX SERVICES 153348 CHILDREN'S HOSPITAL OF THE KING'S DAUGHT 601 CHILDRENS LANE NORFOLK VA 23507 LABORATORY SERVICES 137911 THOMPSON SIEGEL AND WALMSLEY LLC (TSW) 6641 WEST BROAD STREET SUITE 600 RICHMOND VA 23230 PENSION ADVISORY SERVICES 116436 MERCO BIOMEDICAL 1612 VIRGINIA BEACH BLVD SUITE 20 VIRGINIA BEACH VA 23454 OXYGEN/BIOMEDICAL SERVICES 116007 5 45265 900000 178926 320786 25000 1444977 MEDICAID PATIENT CARE 623000 25941852 25941852 MEDICAID PATIENT PAY 623000 18139 18139 25959991 874 -874 -874 -874 27404094 25959117 0 0 270910 270910 14615601 13137546 1341188 136867 1221822 1088284 127116 6422 2617559 2327622 270039 19898 1116985 987069 119810 10106 25256 25256 325828 325828 1752627 1591278 161225 124 95950 57746 38123 81 2266655 1859215 398379 9061 404414 319117 41626 43671 62754 51051 9872 1831 357268 342124 15144 688493 659308 29185 407393 156675 250032 686 FOOD & DIETARY SUPPLIES 672379 672379 REPAIRS & MAINTENANCE 433188 421745 11435 8 DUES 13680 3148 9883 649 LICENSES 40 40 27348802 23674347 3445051 229404 441075 11154 101785 71953 2470339 4132449 156511 178076 180119 169616 24621071 14991057 9871318 9630014 40938 3193115 13262085 17386377 1768400 1917586 6539783 5857158 101785 71953 1432368 4958783 306577 13368751 9585642 X -198915 7640590 92249 160145 -106666 7800735 13262085 17386377 X 55292 7852109 X X 0 1 X 1 0 X 1091323 1143060 1570782 1556122 1444977 6806264 20139184 22414082 22855265 23975682 25959991 115344204 21230507 23557142 24426047 25531804 27404968 122150468 0 387613 364277 555700 644167 625853 2577610 387613 364277 555700 644167 625853 2577610 119572858 175 185 360 175 185 360 8056 -40 3905 51512 9737 73170 21238738 23557287 24429952 25583316 27414705 122223998 0.97830 0.97910 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 3157751 3157751 16789003 11374995 5414008 2926577 2367247 559330 1747740 1248815 498925 9630014 ACCRUED INCOME RECEIVABLE 520014 ACCRUED PENSION ASSET 2673101 3193115 FAIR VALUE OF HEDGE 306577 306577 X 27996412 592318 592318 27404094 0 27404094 27338191 0 27338191 10611 10611 27348802 PART IV, LINE 2B: THE FACILITY DOES NOT REQUIRE THE INDIVIDUAL OR AUTHORIZED REPRESENTATIVE TO DEPOSIT PERSONAL FUNDS WITH THE FACILITY. THE FACILITY SHALL MAINTAIN AN INDIVIDUAL TRUST ACCOUNT FOR THOSE INDIVIDUALS WHO, OR WHOSE AUTHORIZED REPRESENTATIVE, DESIRE THAT THEIR PERSONAL FUNDS OR A PORTION THEREOF, BE DEPOSITED AND DISBURSED BY THE FACILITY. THE FUNDS SHALL BE MAINTAINED IN AN ACCOUNT SEPARATE FROM FACILITY FUNDS WHERE APPROPRIATE. INDIVIDUAL TRUST FUND ACCOUNT SHALL BE ESTABLISHED AS AN INTEREST BEARING ACCOUNT. THE FACILITY SHALL ISSUE WRITTEN STATEMENTS TO THE INDIVIDUAL OR AUTHORIZED REPRESENTATIVE QUARTERLY AND UPON REQUEST OF THE INDIVIDUAL OR AUTHORIZED REPRESENTATIVE. UPON DISCHARGE FROM THE FACILITY, INDIVIDUAL IS ENTITLED TO A REFUND OF THE BALANCE OF HIS OR HER INDIVIDUAL TRUST FUND ACCOUNT. IF THE INDIVIDUAL PASSES AWAY WITH AN INDIVIDUAL ACCOUNT BALANCE WHILE RESIDING AT THE FACILITY, THE REMAINDER WILL BE REIMBURSED TO THEIR ESTATE. THE FACILITY SHALL NOT IMPOSE A CHARGE AGAINST THE PERSONAL FUNDS OF THE INDIVIDUAL FOR ANY ITEM OR SERVICE FOR WHICH PAYMENT IS MADE UNDER MEDICAID OR OTHER PAYOR (EXCEPT FOR APPLICABLE DEDUCTIBLE OR CO-PAY AMOUNTS). PART X, LINE 2: ST. MARY'S AND THE FOUNDATION ARE EXEMPT FROM INCOME TAXES AS PROVIDED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). FASB ASC 740, INCOME TAXES, PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS EVALUATED THE IMPACT OF THIS GUIDANCE TO ITS CONSOLIDATED FINANCIAL STATEMENTS. ST. MARY'S AND THE FOUNDATION'S INCOME TAX RETURNS ARE SUBJECT TO EXAMINATION BY TAXING AUTHORITIES, GENERALLY FOR A PERIOD OF THREE YEARS FROM THE DATE THE RETURNS ARE FILED. INCOME TAX RELATED INTEREST AND PENALTIES, IF ANY, ARE CLASSIFIED IN INTEREST EXPENSE AND PENALTIES EXPENSE, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF HEDGE FUND 602,929. MEDICAID SETTLEMENT COSTS -10,611. PART XII, LINE 4B - OTHER ADJUSTMENTS: MEDICAID SETTLEMENT COSTS 10,611. X 1 1 X X 0 0 0 0 0 0 0 0 0 H WAYNE JONES CEO 253443 0 0 0 0 0 4980 0 12488 0 270911 0 0 0 ELIZABETH MCCUEAN CHIEF OF NURSING AND CLINI 146801 0 0 0 0 0 2835 0 11245 0 160881 0 0 0 DAWN TEETS REGISTERED NURSE 138524 0 0 0 0 0 0 0 18504 0 157028 0 0 0 PART I, LINE 1A THE ORGANIZATION REIMBURSES THE CEO FOR YMCA DUES. PART I, LINE 4 CHANGE IN FAIR MARKET VALUE DEFINED BENEFIT PLAN: H. WAYNE JONES $-108,160 ELIZABETH MCCUEAN $-13,318 DAWN TEETS $-3,211 A NORFOLK AIRPORT AUTHORITY 521375010 2003-02-01 4000000 ACQUISITION, CONSTRUCTION AND EQUIPPING OF A REPLACEMENT FACILITY 0 0 0 A 2326565 4000000 10000 3990000 2005 0 0 1 1 A 0 0 0 0 1 0 0 A 0 0 1 0 1 1 BANK OF AMERICA 25.000000000000 0 0 0 0 0 A 0 FORM 990, PART V LINE 7G THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTION OF QUALIFIED INTELLECTUAL PROPERTY. FORM 990 PART V LINE 7H THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS THAT REQUIRED IT TO FILE FORM 1098-C FORM 990, PART VI, SECTION B, LINE 11B THE BOARD MEMBERS ARE PROVIDED A COPY OF THE FORM 990 FOR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY WAS WRITTEN AND APPROVED IN 2008. TRANSACTIONS WITH POTENTIAL CONFLICTS ARE REVIEWED BY THE ENTIRE BOARD. FORM 990, PART VI, SECTION B, LINE 15A AN INDEPENDENT SUB-COMMITTEE PERFORMS AN EVALUATION OF THE CEO'S COMPENSATION. THE INDEPENDENT COMMITTEE THEN REPORTS TO THE BOARD FOR FURTHER EVALUATION. FORM 990, PART VI, SECTION C, LINE 18 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. A SUMMARY OF FINANCIAL PERFORMANCE IS INCLUDED IN THE HOME'S ANNUAL REPORT. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF HEDGE 602,929. COMPONENTS OF NET PERIODIC PENSION COST 7,249,180. FORM 990, PART XII, LINE 2C THE ENTIRE BOARD OF DIRECTORS SERVES AS THE FINANCE/AUDIT COMMITTEE, WHICH MEETS ANNUALLY TO DISCUSS THE AUDIT AND ITS FINDINGS. THE BOARD ALSO DETERMINES ANNUALLY WHETHER OR NOT TO CHANGE INDEPENDENT ACCOUNTING FIRMS. SAINT MARYS HOME FOR DISABLED CHILDREN FOUNDATION 6171 KEMPSVILLE CIRCLE NORFOLK VA 23502 541868069 FINANCIAL SUPPORT TO ST. MARY'S HOME VA 501(C)(3) 12 A ST MARY'S HOME FOR DISABLED CHILDREN INC 1 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 SAINT MARYS HOME FOR DISABLED CHILDREN FOUNDATION C 900000 CASH