2018-11-15T08:08:18-06:00 2018-06-30 232108173 RKL LLP 91 CUMBERLAND PARKWAY MECHANICSBURG PA 17055 990 2017-07-01 231500399 ST ANNE'S RETIREMENT COMMUNITYINC STAN 7172855443 3952 COLUMBIA AVENUE COLUMBIA PA 175129715 MARY TURNBAUGH PRESIDENT 7172855443 2018-11-14 1 ALLYSON HORNBAKER CPA P00539212 7177909333 2018-11-14 50.202.190.94 2018-11-14 15:44:16 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 232CF639F263615E5077F7EE647706B60E150D7F 2017 2019-02-21 02:37:17Z MARY TURNBAUGH 3952 COLUMBIA AVENUE COLUMBIA PA 17512 18545574 0 0928 X WWW.STANNESRETIREMENTCOMMUNITY.COM X 1977 PA SEE SCHEDULE O 12 12 395 107 0 0 494534 359034 16680912 17028401 544607 1104040 34336 18258 17754389 18509733 0 0 0 0 11041427 11500598 0 0 184394 5699577 5714853 16741004 17215451 1013385 1294282 35908381 41068348 22279972 26583454 13628409 14484894 SEE SCHEDULE O 0 0 15073943 17028401 PATIENT ROOM & BOARD FEES: NURSING FACILITY - 119 BEDS (36,872 RESIDENT DAYS), PERSONAL CARE UNIT - 51 UNITS (17,325 RESIDENT DAYS), INDEPENDENT LIVING COTTAGES - 37 UNITS (16,065 RESIDENT DAYS), APARTMENTS - 35 UNITS (14,679 RESIDENT DAYS) 15073943 1 1 0 0 0 0 1 0 1 1 1 0 0 0 1 1 1 0 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 0 1 0 0 0 1 21 0 1 395 1 0 0 0 0 0 1 1 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X ST ANNES RETIREMENT COMMUNITY INC 7172855443 3952 COLUMBIA AVENUE COLUMBIA PA 175129715 SR JOAN HORNICK ASC TRUSTEE 1.00 24.00 X 0 0 0 SR FRAN SCHUMER ASC TRUSTEE 1.00 10.00 X 0 0 0 JON FARRELL CHAIR 1.00 X X 0 0 0 MARY ELLEN GLAH GENOESE TRUSTEE 1.00 X 0 0 0 JUDGE JEFFREY REICH TRUSTEE 1.00 X 0 0 0 STEPHEN RILEY TREASURER 1.00 X X 0 0 0 JACK MARKEL ESQ VICE CHAIR 1.00 X X 0 0 0 SR MIRIAM RAU ASC TRUSTEE 1.00 30.00 X 0 0 0 DR MARIBETH LEBRETON SECRETARY 1.00 X X 0 0 0 DR JEFFREY KIRCHNER TRUSTEE 1.00 X 0 0 0 JEFFREY FUNK TRUSTEE 1.00 X 0 0 0 SR MARIA HUGHES DIRECTOR 1.00 40.00 X 0 0 0 MARY TURNBAUGH PRESIDENT 40.00 X 183282 0 7391 MICHELE J BARD CFO 40.00 X 111994 0 40656 ELLEN HAUPT NURSING ADMIN 40.00 X 104706 0 17735 LISA HOLLYWOOD RN MANAGER 40.00 X 154244 0 26126 554226 0 91908 4 0 1 0 CURA HOSPITALITY PO BOX 827276 PHILADELPHIA PA 191827276 DIETARY CONSULT 226286 1 48375 310659 800 359034 RESIDENT ROOM & BOARD REVENUE 623000 15123875 15123875 RENTAL INCOME 623000 715733 715733 OCCUPANCY FEES 623000 590739 590739 THERAPY REVENUE 623000 198651 198651 ENTRANCE FEES 623000 196210 196210 203193 203193 17028401 303671 303671 800369 0 800369 800369 800369 54099 48375 35841 18258 18258 18509733 17028401 0 1122298 343322 343322 8821962 8128791 569774 123397 196403 169652 22975 3776 1456905 1207212 243008 6685 682006 591488 81176 9342 20810 20810 35876 35876 26542 26542 474893 451298 23595 105821 8660 97161 743513 653838 77975 11700 63841 37289 26349 203 1482228 1482228 18949 16223 2337 389 28744 27156 1588 6813 6813 1173150 1173150 170079 170079 FOOD EXPENSE 525102 513495 8880 2727 PATIENT MEDICATIONS 329529 329529 SERVICE CONTRACTS 216140 194899 21241 REPAIRS & MAINTENANCE 175390 174490 900 117433 -85455 176713 26175 17215451 15073943 1957114 184394 5700 5701 1712892 1031188 55000 1252381 959355 17702 15434 351673 436314 47574438 20925637 20377675 26648801 12010480 11563101 100000 100000 24878 308454 35908381 41068348 1629747 2581475 3263787 3144340 17266803 20534270 44635 25869 75000 297500 22279972 26583454 X 12612994 13470856 389786 388791 625629 625247 13628409 14484894 35908381 41068348 1294282 -437797 0 X 0 1 X 1 0 X 1200745 817879 369041 494534 359034 3241233 15036179 14989304 16333359 16680912 17028401 80068155 16236924 15807183 16702400 17175446 17387435 83309388 559740 436465 3485 2352 2625 1004667 0 559740 436465 3485 2352 2625 1004667 82304721 244659 280226 405446 160114 303671 1394116 244659 280226 405446 160114 303671 1394116 16481583 16087409 17107846 17335560 17691106 84703504 0.97170 0.97190 0.01650 0.01590 X X 1 9.00 0 0 1 1 0 0 1 X 1015415 110772 -395 111754 1014038 1052344 24876 26463 88268 1015415 1366441 103292 -46539 370850 1052344 1382679 655071 -33784 637525 1366441 981327 1012424 47024 658096 1382679 0.61660 0.38340 1 1 1 2800091 2800091 28514017 14903413 13610604 7287111 6022224 1264887 8973219 8973219 26648801 DEPOSITS - WAITING LIST 297500 297500 X 18139893 -437797 -219823 -657620 18797513 -287780 -287780 18509733 17283408 287780 287780 16995628 219823 219823 17215451 PART II, LINE 5: THE ORGANIZATION, THE U.S. DEPARTMENT OF THE ARMY CORPS OF ENGINEERS (CORPS), OR THE PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION (PADEP) HAVE THE RIGHT TO ENTER UPON THE PROPERTY TO INSPECT THE CONSERVATION AREA TO MONITOR COMPLIANCE WITH AND ENFORCE THE TERMS OF THE CONSERVATION EASEMENT BY APPROPRIATE LEGAL PROCEEDINGS IN ACCORDANCE WITH PA COMMON LAW SO AS TO PREVENT ANY ACTIVITY ON OR USE OF THE PROPERTY THAT IS INCONSISTENT WITH THE CONSERVATION EASEMENT. THE CORPS, U.S. DEPARTMENT OF JUSTICE, AND/OR PADEP HAS THE DISCRETIONARY RIGHT TO ENFORCE THE CONSERVATION EASEMENT IN A JUDICIAL ACTION AGAINST ANY PERSON OR ENTITY VIOLATING OR ATTEMPTING TO VIOLATE THE RESTRICTIVE COVENANTS. IN ANY ENFORCEMENT ACTION, ENFORCING AGENCY SHALL BE ENTITLED TO A COMPLETE RESTORATION, AS WELL AS ANY OTHER JUDICIAL REMEDY SUCH AS CIVIL PENALTIES. PART II, LINE 9: THERE WAS A NOMINAL AMOUNT OF EXPENSES THAT THE ORGANIZATION INCURRED FOR THE CONSERVATION EASEMENT WHICH WERE EXPENSED TO PROFESSIONAL FEES. THE PROPERTY AFFECTED BY THE CONSERVATION EASEMENT IS RECORDED IN PROPERTY, PLANT AND EQUIPMENT AS LAND IN THE BALANCE SHEET. THE CONSERVATION EASEMENT WAS NOT CONTRIBUTED TO THE ORGANIZATION. PART IV, LINE 2B: THE ORGANIZATION IS CUSTODIAN FOR RESIDENT TRUST FUNDS FOR CERTAIN RESIDENTS OF THE RETIREMENT COMMUNITY. PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR VARIOUS OPERATIONAL AND RESIDENTIAL RELATED EXPENSES. PART X, LINE 2: INCOME TAXES - SAINT ANNES RETIREMENT COMMUNITY, INCORPORATED IS A NON- PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE CORPORATION IS ALSO REGISTERED WITH THE COMMONWEALTH OF PENNSYLVANIA AS A NON-PROFIT RELIGIOUS CORPORATION. THE IRS FORM 990 FOR THE YEARS ENDED JUNE 30, 2017, 2016 AND 2015 REMAIN OPEN FOR AN EXAMINATION OR COMPLIANCE CHECK BY THE IRS. THE CORPORATION HAS REVIEWED THE IMPACT OF ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES (FASC 740-10-05) ON THE FINANCIAL STATEMENTS AND HAS DETERMINED THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AND THERE IS NO MATERIAL IMPACT ON THE STATEMENTS OF FINANCIAL POSITION, ACTIVITIES, CHANGES IN NET ASSETS, OR CASH FLOWS. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUND DEVELOPMENT EXPENSES -219,823. PART XI, LINE 4B - OTHER ADJUSTMENTS: MAJOR EVENT EXPENSE -35,841. BAD DEBT EXPENSE -15,974. CONTRIBUTIONS IN KIND 800. CHANGE IN INTEREST RATE SWAP -236,765. PART XII, LINE 2D - OTHER ADJUSTMENTS: MAJOR EVENT EXPENSE 35,841. BAD DEBT EXPENSE 15,974. CONTRIBUTIONS IN KIND -800. CHANGE IN INTEREST RATE SWAP 236,765. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUND DEVELOPMENT EXPENSES 219,823. HARVEST FEST 89578 48375 41203 10250 3960 2494 12619 GOLF OUTING 12896 12896 1000 4690 828 102474 48375 54099 10250 1000 8650 2494 13447 35841 18258 X X 0 0 0 0 0 0 0 0 0 MARY TURNBAUGH PRESIDENT 183282 0 0 0 0 0 7391 0 0 0 190673 0 0 0 MICHELE J BARD CFO 111994 0 0 0 0 0 4516 0 36140 0 152650 0 0 0 LISA HOLLYWOOD RN MANAGER 154244 0 0 0 0 0 3219 0 22907 0 180370 0 0 0 A LANCASTER COUNTY HOSPITAL AUTHORITY 236648018 514045D34 2012-10-01 21278666 PAY OFF 1999 BONDS 0 0 0 B LANCASTER COUNTY HOSPITAL AUTHORITY 236648018 NONEAVAIL 2017-12-22 36000000 CONSTRUCTION 0 0 0 A 4250000 21278666 425573 5044057 15809036 2018 1 0 1 1 B 4745907 686012 3980565 79330 2020 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 0 1 1 FULTON BANK NA 11.000000000000 0 0 0 0 0 A 0 B 0 PART II, LINE 3: TOTAL PROCEEDS OF ISSUE AS OF JUNE 30, 2018 WERE $4,745,907. THIS AMOUNT DOES NOT MATCH ISSUE PRICE REPORTED IN PART I, COLUMN (F) OF $36,000,000 DUE TO THE FACT THAT PROCEEDS SHALL BE ADVANCED TO ST. ANNE'S RETIREMENT COMMUNITY, INC. IN ACCORDANCE WITH THE PROJECT FINANCING AGREEMENT ASSOCIATED WITH THIS BOND ISSUE TO FUND THE CONSTRUCTION PROJECT. PART IV, LINE 2C: THE REBATE COMPUTATION WAS PERFORMED ON 11/3/17. FORM 990, PART I, LINE 1 SAINT ANNE'S RETIREMENT COMMUNITY, SPONSORED BY THE ADORERS OF THE BLOOD OF CHRIST, IS DEDICATED TO CONTINUING THE HEALING MINISTRY OF JESUS IN THE SPIRIT OF SAINT MARIA DEMATTIAS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS ASC HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A ASC HEALTH HAS THE POWER TO APPOINT UP TO 3 MEMBERS OF THE BOARD OF TRUSTEES ACCORDING TO THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF TRUSTEES ARE CONTINGENT ON THE APPROVAL OF ASC HEALTH. FORM 990, PART VI, SECTION B, LINE 11B FINANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS AND APPROVES THE 990 PRIOR TO FILING. THE FINANCE COMMITTEE CHAIR MAKES A RECOMMENDATION TO THE ENTIRE BOARD TO APPROVE THE 990. IN ADDITION, A SECURE LINK IS USED TO UPLOAD THE 990 TO THE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C A DIRECTOR IS REQUIRED TO ANNUALLY, OR AT SUCH A TIME THAT A CONFLICT MAY ARISE, DISCLOSE THIS TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP MANAGEMENT OFFICIAL: THE ORGANIZATION USES LEADING AGE SALARY SURVEY DATA FOR CENTRAL PENNSYLVANIA, AS WELL AS APPROVAL FROM THE BOARD OF TRUSTEES IN DETERMINING COMPENSATION FOR THE PRESIDENT/ADMINISTATOR. COMPENSATION PROCESS FOR TOP FINANCIAL OFFICIAL: THE ORGANIZATION USES LEADING AGE SALARY SURVEY DATA FOR CENTRAL PENNSYLVANIA, AS WELL AS APPROVAL FROM THE BOARD OF TRUSTEES IN DETERMINING COMPENSATION FOR OTHER OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. ADORERS OF THE BLOOD OF CHRIST 4233 SULPHUR AVENUE ST LOUIS MO 63109 371402562 RELIGIOUS MO 501(C)(3) LINE 1 N/A 0 ASC HEALTH 4233 SULPHUR AVENUE ST LOUIS MO 63109 371186930 OVERSIGHT MO 501(C)(3) LINE 1 ADORERS OF THE BLOOD OF CHRIST 0 VILLA MARIA 116 SOUTH CENTRAL AVENUE MULVANE KS 67110 237422471 LTC KS 501(C)(3) LINE 3 ASC HEALTH 0 ST JOSEPH'S VILLA 927 SEVENTH STREET DAVID CITY NE 68632 470490837 LTC NE 501(C)(3) LINE 3 ASC HEALTH 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 ADORERS OF THE BLOOD OF CHRIST M 85853 ACTUAL AMOUNT