2022-10-31T11:33:35-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP TWO INTERNATIONAL PLACE 22ND FLOOR BOSTON MA 02110 990 2021-01-01 050258990 THE SAINT CLARE HOME SAIN 4018493204 309 SPRING STREET NEWPORT RI 02840 LAURA DOS SANTOS DIRECTOR OF OPERATIONS 4018493204 2022-10-27 1 LAURA DOS SANTOS 999009999 DANIELLE NIHILL P01350943 6177170831 2022-10-27 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MOST REV THOMAS TOBIN 309 SPRING STREET NEWPORT RI 02840 15625483 0 X STCLARENEWPORT.COM X 1909 RI TO IMPROVE THE QUALITY OF LIFE FOR OUR FAMILY AND COMMUNITY THROUGH CARE AND SERVICE. 3 0 167 0 0 0 2144950 422938 8881882 9334152 61 9154 28463 5859239 11055356 15625483 0 0 0 0 5939061 6292235 0 0 22096 5030930 5137776 10969991 11430011 85365 4195472 20650584 20386176 21372494 16780282 -721910 3605894 TO IMPROVE THE QUALITY OF LIFE FOR OUR FAMILY AND COMMUNITY THROUGH CARE AND SERVICE. 0 0 6712793 6263152 SKILLED NURSING FACILITY:ST CLARE SKILLED NURSING FACILITY WORKS TO MEET THE CHANGING NEEDS OF TODAY'S ELDERLY BY PROVIDING MORE THAN A HOME TO MEMBERS OF NEWPORT AND THE SURROUNDING COMMUNITIES. EACH RESIDENT RECEIVES THE SHORT-TERM REHABILITATION OR LONG-TERM CARE THAT BEST SUITS HIS OR HER NEEDS AND COMFORTS. THE FACILITY ACCOMMODATES 50 RESIDENTS.LONG-TERM NURSING CARE SERVICES PROVIDED TOTAL PATIENT BED DAYS OF 19,381. INCLUDED IN THIS AMOUNT ARE MEDICAID PATIENT DAYS TOTALING 12,015 AND MEDICARE PATIENT DAYS TOTALING 1,135. 3290678 3031010 ASSISTED LIVING FACILITY:ST CLARE ASSISTED LIVING FACILITY IS AN ASSISTED LIVING COMMUNITY WHERE SENIORS FIND THE SERVICES AND SECURITY THEY NEED WITHOUT GIVING UP THE TRADITIONS AND INDEPENDENCE THEY CHERISH. THE ASSISTED LIVING CREATES AN ENVIRONMENT WHERE RESIDENTS MAINTAIN THEIR DIGNITY, PRIDE AND INDIVIDUALITY NO MATTER WHAT LEVEL OF ASSISTANCE THEY MAY REQUIRE. THE MEMORY-IMPAIRMENT PROGRAM SERVES INDIVIDUALS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS. THE ASSISTED LIVING OFFERS 50 BEAUTIFULLY DESIGNED STUDIOS, ONE AND TWO-BEDROOM APARTMENTS. 174694 39990 ADULT DAY HEALTH:ST CLARE ADULT DAY HEALTH PROGRAM OFFERS ADULTS WITH DISABILITIES AND DEMENTIA THE CARE, COMPANIONSHIP AND SUPPORT SERVICES THEY NEED IN A SETTING DESIGNED FOR THEM. 10178165 1 1 0 0 0 0 0 0 0 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 0 0 1 1 1 0 0 1 2 0 1 167 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 1 1 0 0 X LAURA DOS SANTOS 4018493204 309 SPRING STREET NEWPORT RI 02840 LEILANY PALAYA REGISTERED NURSE 57.45 X 185100 0 10101 NANCY ROSARIO DIRECTOR OF NURSING SNF 42.43 X 101206 0 21749 EBRIMA JATTA C.N.A. 86.26 X 100450 0 25401 MARY BETH DAIGNEAULT ADMINISTRATOR & TREASURER 40.00 X 98311 0 33329 REV ALBERT KENNEY VICE PRESIDENT 1.00 39.00 X X 0 44609 30216 MOST REVEREND THOMAS TOBIN PRESIDENT/TREASURER 1.00 39.00 X X 0 43734 30216 REV TIMOTHY D REILLY SECRETARY 1.00 39.00 X X 0 31922 19416 485067 120265 170428 3 0 1 0 CARELINK 400 MASSASOIT AVE 113 EAST PROVIDENCE RI 02914 REHAB SERVICES 544208 HEALTHCARE SERVICES GROUP PO BOX 829677 PHILADELPHIA PA 19182 HOUSEKEEPING AND LAUNDRY 358800 STRATEGIC CARE SOLUTIONS 92 MONTVALE AVENUE SUITE 2300 STONEHAM MA 02180 CONSULTING SERVICES 314853 DIOCESE OF PROVIDENCE ONE CATHEDRAL SQUARE PROVIDENCE RI 02903 ADMINISTRATIVE SUPPORT 151266 DONOVAN & SONS 613 AQUIDNECK AVE MIDDLETOWN RI 02842 PLUMBING AND HVAC 126089 5 398106 24832 422938 RESIDENT SERVICE REVENUE 623000 6263152 6263152 ASSISTED/INDEPENDENT LIVING 623000 3031010 3031010 ADULT DAY CARE 623000 39990 39990 9334152 9154 9154 EXTINGUISHMENT OF DEBT 623000 5569307 5569307 DISTRIB. FROM CUTTING TRUST 623000 148135 148135 MISCELLANEOUS INCOME 623000 141797 141797 5859239 15625483 9334152 0 5868393 131640 131640 4320842 4307483 10188 3171 178200 178200 448649 448649 1212904 1117780 76199 18925 598299 598299 59886 59886 64726 64726 59593 59593 95328 95328 45423 45423 800753 800753 18711 18711 505393 499544 5849 517003 511342 5661 108162 108162 RESIDENT RELATED PURCHA 984636 984636 BAD DEBTS 420349 420349 HEALTH CARE PROVIDER AS 338635 338635 FOOD 324437 324437 196442 6555 189887 11430011 10178165 1229750 22096 1263973 1530789 5274 5275 26500 0 916036 785519 95462 4898 20277271 4363085 16298338 15914186 65892 86840 1979109 2058669 20650584 20386176 4073286 3363453 200037 294000 14830503 113804 2268668 13009025 21372494 16780282 X -2742036 1506208 2020126 2099686 -721910 3605894 20650584 20386176 X 4195472 20949 31823 79560 X 0 1 X 1 0 X 91917 263905 642545 2144950 422938 3566255 5937091 7503233 8411775 8881882 9334152 40068133 6029008 7767138 9054320 11026832 9757090 43634388 0 0 0 43634388 318 991 1186 61 9154 11710 318 991 1186 61 9154 11710 520831 45075 96774 28463 5859239 6550382 6550157 7813204 9152280 11055356 15625483 50196480 0.86930 0.98240 0.00020 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 95,831. 2018 AMOUNT: $ 45,075. 2019 AMOUNT: $ 89,074. 2020 AMOUNT: $ 28,463. 2021 AMOUNT: $ 141,797. CUTTING TRUST - 2017 AMOUNT: $ 425,000. 2019 AMOUNT: $ 7,700. 2021 AMOUNT: $ 148,135. EXTINGUISHMENT OF DEBT - 2021 AMOUNT: $ 5,569,307. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 214009 214009 18939417 3388018 15551399 1117345 975067 142278 6500 6500 15914186 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 2058669 2058669 DUE TO STATE OF RHODE ISLAND 472505 LONG TERM DEBT 12536520 13009025 15725992 20949 79560 100509 15625483 0 15625483 11430011 0 11430011 0 11430011 PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON BENEFICIAL INTEREST IN PERPETUAL TRUST 79,560. 0 0 0 0 0 0 0 0 0 LEILANY PALAYA REGISTERED NURSE 185100 0 0 0 0 0 8282 0 1819 0 195201 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 BISHOP THOMAS J. TOBIN, PRESIDENT/TREASURER, MSGR. ALBERT A. KENNEY, VICE PRESIDENT, AND REV. TIMOTHY D. REILLY, SECRETARY, ALL ARE PART OF THE ROMAN CATHOLIC DIOCESE OF PROVIDENCE. FORM 990, PART VI, SECTION B, LINE 11B THE DIOCESE'S HEALTH FACILITIES MANAGEMENT SERVICE GROUP AND THE EXECUTIVE DIRECTOR REVIEW THE 990 PRIOR TO FILING. UPON REVIEW AND APPROVAL THE RETURN IS FILED WITH THE IRS. A COPY IS SUBMITTED TO THE FISCAL OFFICE AT THE DIOCESE OF PROVIDENCE AND ONE IS KEPT AT THE BUSINESS OFFICE. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS USED FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT ENTAILS COMPARING WHAT IS PAID FOR THE SAME POSITION IN SIMILAR ENTITIES. COMPENSATION IS EVALUATED ON AN ANNUAL BASIS BY THE BOARD OF DIRECTORS, AND THE DECISION IS DOCUMENTED. THE BOARD OF DIRECTORS USES A STANDARD APPROACH AND FORM TO PERFORM THE EVALUATION FOR THE ADMINISTRATOR AND RELATED ORGANIZATIONS OF THE DIOCESE OF PROVIDENCE. THERE IS NO MERIT INCREASE ASSOCIATED WITH THE COMPENSATION EVALUATION. THE LAST EVALUATION WAS CONDUCTED DECEMBER 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: GAIN ON BENEFICIAL PERPETUAL TRUST 79,560. DIOCESAN SERVICE CORPORATION 1 CATHEDRAL SQUARE PROVIDENCE RI 02903 050493814 ROMAN CATHOLIC ORGANIZATION RI 501(C)(3) LINE 1 THE SAINT CLARE HOME 1 DIOCESAN ADMINISTRATION CORPORATION 1 CATHEDRAL SQUARE PROVIDENCE RI 02903 050508345 ROMAN CATHOLIC ORGANIZATION RI 501(C)(3) LINE 1 THE SAINT CLARE HOME 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DIOCESAN SERVICE CORPORATION E 11928885 CASH