2019-11-15T13:29:27-06:00 2018-12-31 061009205 BLUM SHAPIRO & COMPANY PC 1 CAPITAL WAY CRANSTON RI 02910 990 2018-01-01 050275443 SAINT ANTOINE RESIDENCE SAIN 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 JACKIE WOZNICKI ADMINISTRATOR 4017673500 2019-11-13 1 LYNN O'MARRA P00821716 4012725600 64.251.63.131 2019-11-13 11:18:09 ES P 3C3F3A9A6A2C4A7FAF67B2138946307825C80BAE 9F3B9057DC4C1AB93FF6CCB85D8B21EC61D194BB 2018 2020-03-31 21:24:44Z JACKIE WOZNICKI 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 25358056 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. 6 5 497 58 0 0 374393 164860 24513707 25019988 22574 49714 276611 52165 25187285 25286727 0 0 0 0 15421698 15366697 11413 4036 4036 9472108 9454197 24905219 24824930 282066 461797 18441991 19192332 5028135 5344342 13413856 13847990 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 22608366 24912150 THE OPERATION OF A LONG-TERM CARE FACILITY FOR THE ELDERLY AND OTHER NEEDY INDIVIDUALS. DURING 2018 ST. ANTOINE RESIDENCE PROVIDED A TOTAL OF 85,715 PATIENT BED DAYS, INCLUDING 69,366 BED DAYS TO MEDICAID AND MEDICARE PATIENTS. 98287 107838 PROVISION OF MEALS TO ADULT DAY CARE PROGRAM OPERATED BY PACE, AN EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). 22706653 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 20 0 1 497 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 6 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MARIO MACERA 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 028966999 MOST REV THOMAS J TOBIN PRESIDENT / TREASURER 1.00 1.00 X X 0 0 0 REV MSGR ALBERT A KENNEY VICE PRESIDENT 1.00 1.00 X X 0 0 0 REV TIMOTHY D REILLY SECRETARY 1.00 1.00 X X 0 0 0 JACKIE WOZNICKI ADMINISTRATOR/ASST TREAS 39.00 1.00 X X 125547 0 26844 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 124285 0 36397 RICHARD BERGERON LPN 40.00 X 102307 0 24549 352139 0 87790 3 0 1 0 0 164860 164860 MEDICAID & MEDICARE REVENUES 623000 16879840 16879840 NURSING HOME FEES 623000 7946910 7946910 MEALS REVENUE - PACE ADULT MEALS 623000 107838 107838 MANAGEMENT FEE INCOME 623000 85400 85400 25019988 48864 48864 12000 500 11500 11500 11500 850 0 850 850 850 93356 70829 22527 22527 DISCOUNTS EARNED 900099 16172 16172 OTHER INCOME 900099 1966 1966 18138 25286727 25019988 0 101879 313073 313073 11202772 10496570 706202 795764 750816 44948 2226379 2077059 149320 828709 759480 69229 3698 3698 50200 50200 4036 4036 36769 36769 231742 231742 59311 59311 104359 104359 140300 140300 1550784 1461565 89219 9943 9943 11794 11794 54562 51423 3139 666433 628092 38341 246047 246047 PURCHASED SERVICES 3764902 3764902 PROVIDER TAXES 1223675 1223675 FOOD 861238 861238 BAD DEBT EXPENSE 375843 375843 62597 62597 24824930 22706653 2114241 4036 2002 2144 4170195 2942067 52400 25650 3593953 6047704 502841 486908 107310 118252 90043 14243 22509528 13551914 9370926 8957614 375049 335019 177272 262731 18441991 19192332 3930734 5344342 1079425 0 17976 0 5028135 5344342 X 13156443 13694235 218663 116828 38750 36927 13413856 13847990 18441991 19192332 X 461797 -45639 17976 X X 0 1 X 1 0 X 925137 459450 554470 374393 164860 2478310 23054949 23943649 24076048 24511455 25019988 120606089 5815 6910 7123 6492 11500 37840 23985901 24410009 24637641 24892340 25196348 123122239 7550 4724 1850 14124 0 7550 4724 1850 14124 123108115 53462 39239 28900 24209 48864 194674 53462 39239 28900 24209 48864 194674 41364 49902 44718 283920 18138 438042 24080727 24499150 24711259 25200469 25263350 123754955 0.99480 0.99460 0.00160 0.00150 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2014 AMOUNT: $ 14,712. 2015 AMOUNT: $ 21,739. 2016 AMOUNT: $ 13,630. 2017 AMOUNT: $ 271,743. 2018 AMOUNT: $ 1,966. DISCOUNTS EARNED - 2014 AMOUNT: $ 26,652. 2015 AMOUNT: $ 28,163. 2016 AMOUNT: $ 31,088. 2017 AMOUNT: $ 12,177. 2018 AMOUNT: $ 16,172. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 375049 -21740 18290 335019 346604 44892 16447 375049 341931 21625 16952 346604 373621 -14516 17174 341931 380327 10015 16721 373621 0.56140 0.11020 0.32840 0 0 166000 166000 17104528 9270393 7834135 5174716 4281521 893195 64284 64284 8957614 X 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 93356 93356 1246 9130 16661 43792 93356 93356 1246 9130 16661 43792 70829 22527 X X 0 0 0 0 0 0 0 0 0 JACKIE WOZNICKI ADMINISTRATOR/ASST TREAS 125547 0 0 0 0 0 8771 0 18073 0 152391 0 0 0 MARIO MACERA DIRECTOR OF FINANCE 124285 0 0 0 0 0 14720 0 21677 0 160682 0 0 0 A RHODE ISLAND HEALTH AND EDUCATIONAL BUILDING CORPORATION 521300173 2016-09-29 3421000 TO FINANCE PAY-OFF OF THE OUTSTANDING 2009 SERIES A BONDS. 0 0 0 A 3421000 3421000 51000 3370000 2016 1 0 1 1 A 0 1 0 0 1 1 MERRILL LYNCH CAPITAL SERVICES 2.000000000000 0 0 0 0 1 A 1 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 XI, LINE 9: UNREALIZED GAIN ON INTEREST RATE SWAP 17,976. 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 1 501(C)(3) 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 THE VILLA AT SAINT ANTOINE D 486908 CASH THE VILLA AT SAINT ANTOINE L 75000 CASH