2020-11-13T15:38:41-06:00 2019-12-31 061009205 BLUM SHAPIRO & COMPANY PC 1 CAPITAL WAY CRANSTON RI 02910 990 2019-01-01 050275443 SAINT ANTOINE RESIDENCE SAIN 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 DEBRAH PUTNAM ASST. TREASURER/ADMINISTRATOR 4017673500 2020-11-13 1 LYNN O'MARRA P00821716 4012725600 2020-11-13 64.251.63.131 2020-11-13 15:54:11 ES P B49528270D5C596423F272EFB472E66EFBF6AFC8 3C3F3A9A6A2C4A7FAF67B2138946307825C80BAE 2019 2021-01-29 14:40:06Z THOMAS J TOBIN 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 25998479 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 2 477 55 0 0 164860 173679 25019988 25694695 49714 26086 52165 40466 25286727 25934926 0 0 0 0 15366697 15962994 4036 3325 3325 9454197 10755004 24824930 26721323 461797 -786397 19192332 18115285 5344342 5013504 13847990 13101781 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 23980186 25503697 THE OPERATION OF A LONG-TERM CARE FACILITY FOR THE ELDERLY AND OTHER NEEDY INDIVIDUALS. DURING 2019 ST. ANTOINE RESIDENCE PROVIDED A TOTAL OF 87,237 PATIENT BED DAYS, INCLUDING 55,916 BED DAYS TO MEDICAID AND MEDICARE PATIENTS. 188522 190988 PROVISION OF MEALS TO ADULT DAY CARE PROGRAM OPERATED BY PACE, AN EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). 24168708 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 17 0 1 477 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 BISHOP THOMAS J TOBIN PRESIDENT / TREASURER 1.00 39.00 X X 0 42828 30799 MSGR ALBERT A KENNEY VICE PRESIDENT 1.00 39.00 X X 0 43849 30799 REV TIMOTHY D REILLY SECRETARY 1.00 39.00 X X 0 36168 19999 JACKIE WOZNICKI ADMINISTRATOR/ASST TREAS 39.00 1.00 X X 127346 0 30491 JOHN J BARRY III DIRECTOR 1.00 1.00 X 0 0 0 REV MSGR GEORGE FRAPPIER DIRECTOR 1.00 1.00 X 0 0 0 MARIO MACERA DIRECTOR OF FINANCE 39.00 1.00 X 126507 0 30195 RICHARD BERGERON LPN 40.00 X 101810 0 21494 TERRANCE PINKSTON RN 40.00 X 108422 0 245 464085 122845 164022 4 0 1 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY 913462 MAS MEDICAL STAFFING 156 HARVEY ROAD LONDONDERRY NH 03053 TEMPORARY NURSING STAFFING 361830 STRATEGIC CARE SOLUTIONS 92 MONTVALE AVENUE STONEHAM MA 02180 STRATEGIC PLANNING SERVICES 338813 FAVORITE HEALTHCARE STAFFING PO BOX 26225 OVERLAND PARK KS 66225 TEMPORARY NURSING STAFFING 244084 CAREER STAFF UNLIMITED PO BOX 301076 DALLAS TX 75303 TEMPORARY NURSING STAFFING 162754 5 17703 155976 173679 MEDICAID & MEDICARE REVENUES 623000 17662432 17662432 NURSING HOME FEES 623000 7768943 7768943 MEALS REVENUE - PACE ADULT MEALS 623000 190998 190998 MANAGEMENT FEE INCOME 623000 72322 72322 25694695 26086 26086 12000 1877 10123 10123 10123 62250 17703 61676 574 574 OTHER INCOME 900099 25135 25135 DISCOUNTS EARNED 900099 4634 4634 29769 25934926 25694695 0 66552 314539 314539 12197584 11426086 771498 700208 670621 29587 1841968 1717853 124115 908695 833913 74782 22724 22724 51480 51480 3325 3325 37011 37011 565284 565284 75192 75192 110720 110720 184876 184876 1680635 1583945 96690 15017 15017 10416 10416 1525 1437 88 689947 650253 39694 249022 249022 PURCHASED SERVICES 4059887 4059887 PROVIDER TAXES 1430034 1430034 FOOD 858695 858695 BAD DEBT EXPENSE 650580 650580 61959 21365 40594 26721323 24168708 2549290 3325 2144 2145 2942067 3591032 25650 5400 6047704 4968040 486908 0 118252 122043 14243 16467 23241022 14335721 8957614 8905301 335019 375774 262731 129083 19192332 18115285 5344342 5013504 5344342 5013504 X 13694235 12890799 153755 210982 13847990 13101781 19192332 18115285 -786397 40188 0 X X 0 1 X 1 0 X 459450 554470 374393 164860 165608 1718781 23943649 24076048 24511455 25019988 25694695 123245835 6910 7123 6492 11500 12000 44025 24410009 24637641 24892340 25196348 25872303 125008641 4724 1850 6574 0 4724 1850 6574 125002067 39239 28900 24209 48864 34221 175433 39239 28900 24209 48864 34221 175433 49902 44718 283920 18138 16779 413457 24499150 24711259 25200469 25263350 25923303 125597531 0.99530 0.99480 0.00140 0.00160 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2015 AMOUNT: $ 21,739. 2016 AMOUNT: $ 13,630. 2017 AMOUNT: $ 271,743. 2018 AMOUNT: $ 1,966. 2019 AMOUNT: $ 12,145. DISCOUNTS EARNED - 2015 AMOUNT: $ 28,163. 2016 AMOUNT: $ 31,088. 2017 AMOUNT: $ 12,177. 2018 AMOUNT: $ 16,172. 2019 AMOUNT: $ 4,634. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 335019 59274 18519 375774 375049 -21740 18290 335019 346604 44892 16447 375049 341931 21625 16952 346604 373621 -14516 17174 341931 0.58700 0.11000 0.30300 0 0 166000 166000 17355806 9843733 7512073 5654932 4491988 1162944 64284 64284 8905301 X 25975114 40188 40188 25934926 0 25934926 26721323 0 26721323 0 26721323 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. GOLF TOURNAMENT 71668 16150 55518 12552 20599 26456 BAZAR 6732 6732 920 78400 16150 62250 12552 20599 27376 60527 1723 X X 0 0 0 0 0 0 0 0 0 JACKIE WOZNICKI ADMINISTRATOR/ASST TREAS 127346 0 0 0 0 0 15393 0 15098 0 157837 0 0 0 MARIO MACERA DIRECTOR OF FINANCE 126507 0 0 0 0 0 15158 0 15037 0 156702 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE DIRECTOR OF FINANCE AND ASSISTANT TREASURER/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 XII, LINE 2C: THE FINANCE COMMITTEE IS 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 FINANCE COMMITTEE AND SUBMITTED TO THE ADVISORY BOARD AND CORPORATE BOARD. DAURAY LLC 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 050275443 REAL ESTATE RI 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 0 0 0 THE VILLA AT SAINT ANTOINE L 75000 CASH