2022-10-27T12:53:21-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN 100 FRONT STREET 7TH FLOOR WORCESTER MA 01608 990 2021-01-01 050275443 SAINT ANTOINE RESIDENCE SAIN 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 GARRETT SULLIVAN EXECUTIVE DIRECTOR 4017673500 2022-10-25 1 GARRETT SULLIVAN 999009999 LYNN O'MARRA P00821716 5087136900 2022-10-25 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z THOMAS J TOBIN 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 23067583 0 X WWW.STANTOINE.NET X 1913 RI THE MISSION OF SAINT ANTOINE RESIDENCE IS TO CARE FOR THE SICK AND ELDERLY IN ADDITION TO REFLECTING THE CHURCH'S COMMITMENT AND SUPPORT FOR ALL HUMAN LIFE AND AFFIRMATION OF THE VALUE OF EACH PERSON REGARDLESS OF AGE OR PHYSICAL CONDITION IN A COMPASSIONATE, CARING AND CHRISTIAN ENVIRONMENT. 5 2 294 0 0 0 6623933 6000721 21011201 16948724 18568 31399 84097 35782 27737799 23016626 0 0 0 0 15059042 12807249 0 0 0 9322286 8378030 24381328 21185279 3356471 1831347 20034909 20938269 3545246 2602543 16489663 18335726 X THE MISSION OF SAINT ANTOINE RESIDENCE IS TO CARE FOR THE SICK AND ELDERLY IN ADDITION TO REFLECTING THE CHURCH'S COMMITMENT AND SUPPORT FOR ALL HUMAN LIFE AND AFFIRMATION OF THE VALUE OF EACH PERSON REGARDLESS OF AGE OR PHYSICAL CONDITION IN A COMPASSIONATE, CARING AND CHRISTIAN ENVIRONMENT. 0 0 18063111 16896128 THE OPERATION OF A LONG-TERM CARE FACILITY FOR THE ELDERLY AND OTHER NEEDY INDIVIDUALS. DURING 2021 ST. ANTOINE RESIDENCE PROVIDED A TOTAL OF 58,654 PATIENT BED DAYS, INCLUDING 43,866 BED DAYS TO MEDICAID AND MEDICARE PATIENTS. 12501 52596 PROVISION OF MEALS TO ADULT DAY CARE PROGRAM OPERATED BY PACE, AN EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). 18075612 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 18 0 1 294 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 5 2 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X THE ORGANIZATION 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 028966999 MOST REV THOMAS J TOBIN PRESIDENT / TREASURER 1.00 39.00 X X 0 43734 30216 REV MSGR ALBERT A KENNEY VICE PRESIDENT 1.00 39.00 X X 0 44609 30216 REV TIMOTHY D REILLY SECRETARY 1.00 39.00 X X 0 31922 19416 DEBRAH PUTNAM ASST. TREASURER - THROUGH 10/9/2021 39.00 1.00 X X 108363 0 0 REV MSGR GEORGE FRAPPIER DIRECTOR 1.00 1.00 X 0 0 0 JAMES JAHNZ DIRECTOR 1.00 1.00 X 0 0 0 GARRETT E SULLIVAN EXECUTIVE DIRECTOR - BEG. 9/29/2021 40.00 X 46774 0 3383 MATTHEW RYAN EMPLOYEE 40.00 X 138258 0 22828 TAMMY DUQUETTE EMPLOYEE 40.00 X 129221 0 24412 TRACY MCCARTHY EMPLOYEE 40.00 X 135159 0 14196 RICHARD BERGERON JR EMPLOYEE 40.00 X 110807 0 13065 ALIOUNE BADARA KONTE EMPLOYEE 40.00 X 113324 0 0 781906 120265 157732 11 0 1 0 STRATEGIC CARE SOLUTIONS LLC 92 MONTVALE AVENUE STONEHAM MA 02180 STRATEGIC PLANNING SERVICES 460250 1 40000 5840990 119731 6000721 MEDICAID & MEDICARE REVENUES 623000 12683754 12683754 NURSING HOME FEES 623000 4129274 4129274 MANAGEMENT FEE INCOME 623000 83100 83100 MEALS REVENUE - PACE ADULT MEALS 623000 52596 52596 16948724 31399 31399 12000 528 11472 11472 11472 63605 40000 50429 13176 13176 OTHER INCOME 900099 11134 11134 11134 23016626 16948724 0 67181 X 158520 158520 9742968 8944603 798365 2905761 2628901 276860 304000 304000 20780 20780 172100 172100 30787 30787 3076895 2431520 645375 61212 61212 86311 86311 228625 228625 1439285 1356480 82805 6222 6222 8500 3526 4974 868 818 50 858359 808976 49383 252238 252238 PROVIDER TAXES 927893 927893 FOOD 578511 578511 MISCELLANEOUS 163191 29350 133841 BAD DEBT EXPENSE 94073 94073 68180 12501 55679 21185279 18075612 3109667 0 2145 1800 6106188 3660077 5400 0 3278512 1885442 107057 80582 96247 147887 25493756 15966543 9778304 9527213 415334 452534 245722 5182734 20034909 20938269 3545246 2602543 3545246 2602543 X 16224503 18114146 265160 221580 16489663 18335726 20034909 20938269 1831347 14716 0 X X 0 1 X 1 0 X 374393 164860 165608 6623933 6000721 13329515 24511455 25019988 25694695 21011201 16948724 113186063 6492 11500 12000 12000 41992 24892340 25196348 25872303 27647134 22949445 126557570 0 0 0 126557570 24209 48864 34221 12247 42871 162412 24209 48864 34221 12247 42871 162412 283920 18138 16779 40986 11134 370957 25200469 25263350 25923303 27700367 23003450 127090939 0.99580 0.99570 0.00130 0.00120 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 271,743. 2018 AMOUNT: $ 1,966. 2019 AMOUNT: $ 12,145. 2020 AMOUNT: $ 9,739. 2021 AMOUNT: $ 11,134. DISCOUNTS EARNED - 2017 AMOUNT: $ 12,177. 2018 AMOUNT: $ 16,172. 2019 AMOUNT: $ 4,634. 2020 AMOUNT: $ 31,247. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 415334 55024 17824 452534 375774 58048 18488 415334 335019 59274 18519 375774 375049 -21740 18290 335019 346604 44892 16447 375049 0.61000 0.11000 0.28000 0 0 216000 216000 18266901 10931835 7335066 6726853 5027980 1698873 284002 6728 277274 9527213 ACCOUNTS RECEIVABLE - OTHER 4718 DUE FROM AFFILIATES 75000 ERC RECEIVABLE 3103016 DEMAND NOTE RECEIVABLE 2000000 5182734 X 22988054 14716 14716 22973338 30787 12501 43288 23016626 21141991 0 21141991 43288 43288 21185279 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PACE CATERING EXPENSES 12,501. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 30,787. PACE EXPENSES 12,501. GOLF TOURNAMENT 101500 40000 61500 38397 9682 101500 40000 61500 38397 9682 48079 13421 X X 0 0 0 0 0 0 0 0 0 MATTHEW RYAN EMPLOYEE 138258 0 0 0 0 0 8400 0 14428 0 161086 0 0 0 TAMMY DUQUETTE EMPLOYEE 129221 0 0 0 0 0 9984 0 14428 0 153633 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE DIOCESE HEALTH FACILITIES MANAGEMENT SERVICES GROUP AND THE EXECUTIVE DIRECTOR REVIEW THE FORM 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 12C ALL KEY EMPLOYEES AND MEMBERS OF THE BOARD OF DIRECTORS ARE ASKED TO READ THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND ANNUALLY THEY ARE ASKED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. THE EXECUTIVE DIRECTOR AND THE FINANCE DIRECTOR REVIEW ALL POTENTIAL CONFLICTS OF INTEREST DISCLOSED BY KEY EMPLOYEES AND DETERMINE IF A TRUE CONFLICT EXISTS. IF AN INDIVIDUAL HAS A CONFLICT, THE EXECUTIVE DIRECTOR AND THE DIRECTOR OF FINANCE REPORT THIS INFORMATION TO THE BOARD OF DIRECTORS. ALL MEMBERS OF THE BOARD ARE ASKED TO DISCLOSE ANY CONFLICTS OF INTEREST, AND DEPENDING UPON THE CONFLICT, THEY ARE ASKED TO RECUSE THEMSELVES FROM DISCUSSIONS AND VOTING ON THE RELATED ISSUE. ALL DECISIONS ARE RECORDED IN THE MINUTES OF THE BOARD OF DIRECTORS' MEETING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS FUNCTIONS AS A COMPENSATION COMMITTEE IN DETERMINING COMPENSATION FOR THE ADMINISTRATOR AND OTHER OFFICERS. IN MAKING ITS DECISION ON COMPENSATION, IT TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR ADMINISTRATORS AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE AREA. THE COMMITTEE CONSIDERS THE PERFORMANCE OF THE ORGANIZATION DURING THE REVIEW PERIOD AND CONSIDERS THE ADMINISTRATOR'S SUCCESS IN ACHIEVING ORGANIZATIONAL GOALS. THE ADMINISTRATOR REVIEWS COMPENSATION OF ALL OTHER EMPLOYEES. IN MAKING A DECISION ON THE AMOUNT OF COMPENSATION, THE ADMINISTRATOR TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR EXECUTIVES, PERFORMING SIMILAR TYPES OF DUTIES, AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE RHODE ISLAND AREA. COMPENSATION RELATED DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PAYROLL SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 15,352. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,352. PROFESSIONAL FEES - OTHER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 486. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 486. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,431,520. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,431,520. CONSULTANTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 629,537. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 629,537. FORM 990 PART XII, LINE 2C: THE DIOCESE HEALTH MANAGEMENT SERVICES GROUP AND THE EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR OVERSIGHT OF THE COMPLETION OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE DIOCESE HEALTH MANAGEMENT SERVICES GROUP AND THE EXECUTIVE DIRECTOR AND SUBMITTED TO THE ADVISORY BOARD AND CORPORATE BOARD. DAURAY LLC 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 050275443 REAL ESTATE RI -250 110000 SAINT ANTOINE RESIDENCE THE FRASSATI RESIDENCE DBA THE VILLA AT SAINT ANTOINE 400 MENDON ROAD NORTH SMITHFIELD RI 02896 050511505 OPERATION OF A 76-UNIT ASSISTED LIVING FACILITY. RI 501(C)(3) LINE 11 SAINT ANTOINE RESIDENCE 1 DIOCESAN SERVICE CORPORATION 1 CATHEDRAL SQUARE PROVIDENCE RI 02903 050493814 ROMAN CATHOLIC ORGANIZATION RI 501(C)(3) LINE 1 SAINT ANTOINE RESIDENCE 1 DIOCESAN ADMINISTRATION CORPORATION 1 CATHEDRAL SQUARE PROVIDENCE RI 02903 050508345 ROMAN CATHOLIC ORGANIZATION RI 501(C)(3) LINE 1 SAINT ANTOINE RESIDENCE 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 THE VILLA AT SAINT ANTOINE L 75000 CASH THE VILLA AT SAINT ANTOINE Q 5134 CASH