2019-11-11T10:02:12-06:00 2018-12-31 061009205 BLUM SHAPIRO & COMPANY PC 1 INTERNATIONAL PLACE 16TH FLOOR BOSTON MA 02110 990 2018-01-01 050258941 BETHANY HOME OF RI INC BETH 4018312870 111 SOUTH ANGELL STREET PROVIDENCE RI 02906 ELIZABETH SARRO PRESIDENT 4018312870 2019-10-29 1 LAURA J KENNEY P00202198 6177170831 2019-10-29 64.251.63.131 2019-10-29 17:40:28 ED P F655607A01BC9414CB150F5C2D5B642F4B7C09E6 9F3B9057DC4C1AB93FF6CCB85D8B21EC61D194BB 2018 2020-03-31 21:24:44Z ELIZABETH SARRO 111 SOUTH ANGELL STREET PROVIDENCE RI 02906 4927342 0 X WWW.BETHANYHOMEOFRI.ORG X 1892 RI BETHANY HOME'S MISSION IS TO PROVIDE SUPERIOR SKILLED NURSING CARE IN A COMFORTABLE HOMELIKE ENVIRONMENT THAT SUPPORTS OUR RESIDENTS' NEEDS TO SOCIALIZE, MAINTAIN FAMILY AND COMMUNITY TIES, AND ENJOY LIFE TO THE FULLEST EXTENT POSSIBLE WITH DIGNITY AND RESPECT. 14 14 128 14 0 0 262290 610183 4367230 4308856 1277 5253 29359 428 4660156 4924720 0 0 0 0 2841160 3157582 0 0 0 1676192 1430748 4517352 4588330 142804 336390 8952455 8831086 360798 440190 8591657 8390896 X THE BETHANY HOME OF RHODE ISLAND PROVIDES CONTINUOUS QUALITY PROGRESSIVE REHABILITATIVE SERVICES AS WELL AS SKILLED NURSING AND LONG TERM CARE IN A COMMUNITY ENVIRONMENT. THIS NON-PROFIT ORGANIZATION EXCEEDS EXPECTATIONS BY FOCUSING ON RESIDENT, FAMILY AND STAFF SATISFACTION WITH ITS SERVICES. 0 0 3879642 4308856 LICENSED TO CARE FOR 33 RESIDENTS, BETHANY HOME PROVIDES TOP-NOTCH SKILLED NURSING SERVICES, WITHIN AN INTIMATE, HOME-LIKE SETTING. THE FACILITY IS MEDICARE AND MEDICAID CERTIFIED. DURING 2018 BETHANY HOME PROVIDED 10,423 BED DAYS. INCLUDED IN THIS TOTAL WERE 3,786 MEDICAID AND 2,540 MEDICARE BED DAYS PROVIDED. 3879642 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 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 5 0 1 128 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X ELIZABETH SARRO 4018312870 111 SOUTH ANGELL STREET PROVIDENCE RI 02906 W PARISH LENTZ CHAIRMAN OF BOARD 0.50 0.50 X X 0 0 0 MARK CHAFEE TREASURER 0.50 0.50 X X 0 0 0 DORIS DONOVAN SECRETARY 0.50 0.50 X X 0 0 0 DONALD GARDNER BOARD MEMBER 0.50 0.50 X 0 0 0 LUCILLE JOHNSON BOARD MEMBER 0.50 0.50 X 0 0 0 FERDINAND JONES BOARD MEMBER 0.50 0.50 X 0 0 0 CAROLINE W KNOWLES BOARD MEMBER 0.50 0.50 X 0 0 0 ELIZABETH OLIVEIRA BOARD MEMBER 0.50 0.50 X 0 0 0 JANE G PARKER BOARD MEMBER 0.50 0.50 X 0 0 0 GAIL P PEET BOARD MEMBER 0.50 0.50 X 0 0 0 MERCEDES QUEVEDO BOARD MEMBER 0.50 0.50 X 0 0 0 RITA WARNOCK BOARD MEMBER 0.50 0.50 X 0 0 0 CAROLINE CORNWELL BOARD MEMBER 0.50 0.50 X 0 0 0 KEVIN LENIHAN BOARD MEMBER 0.50 0.50 X 0 0 0 HELAINE SCHUPACK BOARD MEMBER 0.50 0.50 X 0 0 0 DONALD BLOUGH BOARD MEMBER 0.50 0.50 X 0 0 0 ELIZABETH SARRO PRESIDENT/ADMINISTRATOR 30.00 10.00 X 144414 14729 13334 144414 14729 13334 1 0 1 0 DOME CONSTRUCTION POST OFFICE BOX 157 CUMBERLAND RI 02864 WINDOW AND SIDING REPLACEMENT 129585 1 610183 610183 MEDICAID AND MEDICARE 623000 2393841 2393841 PROGRAM SERVICE REVENU 623000 1707952 1707952 ANCILLARY SERVICES 623000 207063 207063 4308856 7875 7875 2622 -2622 -2622 -2622 MISCELLANEOUS INCOME 900099 428 428 428 4924720 4308856 0 5681 156514 156514 2478947 2297280 181667 64720 61734 2986 237825 213801 24024 219576 192283 27293 12351 12351 30910 30910 139257 30775 108482 18990 18990 28039 28039 14574 14574 78629 78629 948 948 15682 15682 721 721 181741 169287 12454 118107 98649 19458 SUPPLIES 271648 271648 HEALTH CARE PROVIDER AS 240777 240777 PURCHASED SERVICES 113114 113114 FOOD 91968 91968 73292 19697 53595 4588330 3879642 708688 0 1099917 1112264 132942 560586 500027 464552 16183 16362 5681909 3531279 2142958 2150630 35546 34153 5024882 4492539 8952455 8831086 227909 291951 17498 11275 115391 136964 360798 440190 X 3536454 3907939 46824 9434 5008379 4473523 8591657 8390896 8952455 8831086 X 336390 -2295 -534856 X X 1 X 0 1 0 X 254924 186607 198983 262290 610183 1512987 4731675 4463866 4532437 4367230 4308856 22404064 4986599 4650473 4731420 4629520 4919039 23917051 154153 158994 185543 159548 174108 832346 0 154153 158994 185543 159548 174108 832346 23084705 3197 1193 965 1277 7875 14507 3197 1193 965 1277 7875 14507 7153 23395 7855 29359 428 68190 4996949 4675061 4740240 4660156 4927342 23999748 0.96190 0.96140 0.00060 0.00050 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2014 AMOUNT: $ 7,153. 2015 AMOUNT: $ 23,395. 2016 AMOUNT: $ 7,855. 2017 AMOUNT: $ 29,359. 2018 AMOUNT: $ 428. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 35546 -429970 5580 -422997 34153 33786 -499 2029 -230 35546 32068 169343 1799 169424 33786 32255 -114 -99 -26 32068 61867 -278462 6244 -242606 32255 1.00000 0 0 557679 557679 3864112 2597854 1266258 818333 717424 100909 441785 216001 225784 2150630 BENEFICIAL INTEREST IN PERPETUAL TRUST 4473523 DUE FROM AFFILIATE - BETHANY HOME FOUNDATION 19016 4492539 DUE TO THIRD PARTY PAYORS 136964 136964 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE SET ASIDE FOR THE SUPPORT OF THE GENERAL OPERATIONS OF BETHANY HOME'S FACILITY AND VARIOUS PROGRAMS. PART X, LINE 2: MANAGEMENT HAS DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS. FOLLOWING IS THE TEXT OF THE FINANCIAL STATEMENT FOOTNOTE. 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 TAX 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 PERIODS IN PROGRESS. THE ORGANIZATION REPORTS TAX RELATED INTEREST AND PENALTIES, IF ANY, AS A COMPONENT OF INCOME TAX EXPENSE. X 0 0 0 0 0 0 0 0 0 ELIZABETH SARRO PRESIDENT/ADMINISTRATOR 144414 14729 0 0 0 0 5777 589 6323 645 156514 15963 0 0 PART I, LINE 3 THE ADMINISTRATOR'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR ADMINISTRATORS AT COMPARABLE NON-PROFITS IN THE AREA. ADDITIONALLY, THE BOARD CONSIDERS THE ADMINISTRATOR'S SUCCESS IN ACHIEVING THE ORGANIZATIONAL GOALS. THE DISCUSSIONS AND DECISIONS OF THE ADMINISTRATOR'S COMPENSATION ARE DOCUMENTED BY THE BOARD OF DIRECTORS DURING THE BOARD MEETING. 990, SCHEDULE J, PART II: ELIZABETH SARRO IS THE PRESIDENT/ADMINISTRATOR OF BETHANY HOME OF RHODE ISLAND, INC. SHE IS ALSO THE ADMINISTRATOR OF BETHANY HOME FOUNDATION. HER TIME IS SPLIT BETWEEN THE TWO ORGANIZATIONS. BETHANY HOME FOUNDATION, INC. IS A SUPPORTING ORGANIZATION AS DESCRIBED IN SECTION 509(A)(3). SALARY AND BENEFITS ARE REIMBURSED BY BETHANY HOME FOUNDATION TO BETHANY HOME OF RI FOR THE TIME MS. SARRO WORKS FOR BETHANY HOME FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS REVIEWS THE FORM 990 PRIOR TO ITS FILING, AND THE PRESIDENT/ADMINISTRATOR OF BETHANY HOME OF RHODE ISLAND HAS THE AUTHORITY TO SIGN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ADMINISTRATOR MONITORS ALL POSSIBLE CONFLICTS AT ALL TIME, IN PARTICULAR IF THERE ARE ANY CHANGES IN BOARD MEMBERS OR KEY EMPLOYEES. IF THE ADMINISTRATOR DISCOVERS A CONFLICT OF INTEREST IS DETERMINED TO EXIST, THE ADMINISTRATOR AND OTHER APPROPRIATE MEMBERS OF THE BOARD OF DIRECTORS WILL TAKE THE NECESSARY STEPS TO ADDRESS AND RESOLVE THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR ADMINISTRATORS AT COMPARABLE NON PROFIT NURSING HOMES IN THE AREA. ADDITIONALLY, THE BOARD CONSIDERS THE PERFORMANCE OF THE ORGANIZATION DURING THE REVIEW PERIOD AND THE ADMINISTRATOR'S SUCCESS IN ACHIEVING THE ORGANIZATIONAL GOALS. THE DISCUSSIONS AND DECISION ON THE ADMINISTRATOR'S COMPENSATION ARE DOCUMENTED BY THE BOARD OF DIRECTORS IN THE MINUTES TO THE BOARD MEETING. THE ADMINISTRATOR REVIEWS ALL OTHER EMPLOYEES' COMPENSATION. THE ADMINISTRATOR COMPARES COMPENSATION PAID AT SIMILAR-SIZED NURSING HOME FACILITIES IN THE STATE WHEN DETERMINING A COMPETITIVE SALARY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: LOSS ON BENEFICIAL INTEREST IN PERPETUAL TRUST -534,856. PART XII, LINE 2C THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE ANNUAL REVIEW. BETHANY HOME FOUNDATION INC 111 SOUTH ANGELL STREET PROVIDENCE RI 02906 222575208 BETHANY HOME FOUNDATION SUPPORTS INDEPENDENT LIVING FOR THE ELDERLY RI 501(C)(3) LINE 10 BETHANY HOME OF RHODE ISLAND INC 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 BETHANY HOME FOUNDATION INC O 53647 CASH BETHANY HOME FOUNDATION INC Q 53647 CASH BETHANY HOME FOUNDATION INC C 416234 CASH