2018-05-15T15:08:57-05:00 2017-06-30 990 2016-07-08 611759304 Providence Park Inc PROV 3147338000 12250 Weber Hill Road Suite 200 St Louis MO 63127 Tonya Mershon Tax Officer 2018-05-15 2016 2022-09-23 18:48:47Z X Michael Olmstead 12250 Weber Hill Road Suite 200 St Louis MO 63127 21276894 false X X TX TO PROVIDE SPIRITUALLY CENTERED, HOLISTIC, COMPASSIONATE SKILLED NURSING SERVICES AND ASSISTED LIVING SERVICES TO THOSE IN OUR COMMUNITY FOR THE SHORT TERM OR LONG TERM. 8 6 0 100 0 0 0 0 19496018 20218236 17129 619437 225983 439221 19739130 21276894 0 0 0 12058748 10569076 0 0 0 7976521 11096297 20035269 21665373 -296139 -388479 45309566 30437023 22083088 7482416 23226478 22954607 PROVIDENCE PARK, INC. CARRIES OUT THE HEALING MISSION OF THE CATHOLIC CHURCH AS A CORPORATE MEMBER OF ASCENSION HEALTH SENIOR CARE, DBA ASCENSION SENIOR LIVING (ASL). OUR MISSION CALLS FOR US TO PROVIDE SPIRITUALLY CENTERED, HOLISTIC CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF INDIVIDUALS AND COMMUNITIES, OF ALL FAITHS, RACES, AND SOCIO-ECONOMIC BACKGROUNDS, PARTICULARLY THOSE MOST IN NEED. WE COMMIT OURSELVES TO IDENTIFYING AND DEVELOPING EFFECTIVE RESPONSES TO THE HEALTH AND HOUSING NEEDS OF ALL PERSONS. WE ARE CALLED TO SERVE WITH SPECIAL ATTENTION TO THOSE WHO ARE POOR AND VULNERABLE. false false 19468722 0 20402711 PROVIDENCE PARK, INC. COMMUNITIES INCLUDE A SKILLED NURSING FACILITY (SNF), ASSISTED LIVING (AL), AND INDEPENDENT LIVING (IL). OUR SNF, INSPIRED BY THE HEALING MISSION OF THE CATHOLIC CHURCH TO THE ELDERLY, PROVIDES EACH RESIDENT CARE THAT MAXIMIZES DIGNITY AND INDEPENDENCE. ROOTED IN THE CATHOLIC TRADITION OF CARING, AS A CORPORATE MEMBER OF ASCENSION HEALTH SENIOR CARE, OUR COMMUNITY IS CONTINUALLY DEVELOPING AND ADOPTING NEW BEST PRACTICES IN CARE THAT ENHANCE THE EXPERIENCE OF OUR RESIDENTS, PROGRAM PARTICIPANTS AND PATIENTS. THE STAFF IS COMMITTED TO PROMOTING THE WELL-BEING OF THOSE WE SERVE THROUGH THE DELIVERY OF QUALITY CARE. THE SNF HAS 225 BEDS WITH AN AVERAGE OCCUPANCY OF 202. IN FY2017, 31,284 DAYS OF CARE WERE PROVIDED TO MEDICAID RECIPIENTS. 15,649 DAYS WERE PROVIDED TO MEDICARE RECIPIENTS. AS A CHARITABLE ORGANIZATION IT IS RECOGNIZED THAT NOT ALL PERSONS SERVED POSSESS THE ABILITY TO PURCHASE ESSENTIAL SERVICES. 19468722 true false false false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true true false false false true 32 0 true 0 false false false false false false false false false false X 8 6 false false false false true true true true true false false false true true true true true false false false X Brenda DeHass 3169465216 300 W Hwy 6 Waco TX 76712 MICHAEL OLMSTEAD EX-OFFICIO, VP - Long Term Care 1.0 49.0 X X 0 120268 28102 DENNIS MYERS CHAIR 1.0 0 X X 0 0 0 SISTER MARY ROGERS VICE CHAIR 1.0 0 X X 0 0 0 JOHN KINNAIRD SECRETARY/TREASURER 1.0 0 X X 0 0 0 STEVEN A PROVINCE BOARD MEMBER 1.0 40.0 X 0 295662 22323 JACKSON GRIGGS BOARD MEMBER 1.0 0 X 0 0 0 PHYLLIS HUBBARD BOARD MEMBER 1.0 0 X 0 0 0 KENNETH YOUNG BOARD MEMBER 1.0 0 X 0 0 0 NICK HARSHFIELD CHIEF FINANCIAL OFFICER 1.0 54.0 X 0 293044 37102 RICK CUMBERLAND CHIEF OPERATING OFFICER (END 4/2017) 1.0 54.0 X 0 428441 29576 0 1137415 117103 0 false true false SELECT REHABILITATION INC 2600 COMPASS RD GLENVIEW IL 60026 REHABILITATION SERVICES 630890 1 0 SKILLED NURSING SERVICES 623000 16828718 16828718 ASSISTED LIVING SERVICES 623000 1615635 1615635 INDEPENDENT LIVING SERVICES 623000 1773633 1773633 OTHER PROGRAM REVENUES 623000 250 250 0 0 0 0 20218236 616927 616927 117945 117945 0 117945 117945 2510 0 2510 2510 2510 BEAUTY & BARBER SVS REVENUE 900099 103108 103108 CAFETERIA REVENUE 722514 33693 33693 OTHER REVENUE 900099 184475 184475 0 0 0 0 321276 21276894 20402711 0 874183 8228918 7788370 440548 113165 107107 6058 1608753 1522626 86127 618240 585141 33099 242816 242816 0 0 6155 6079 76 129525 99582 29943 730141 715667 14474 17652 7200 10452 90 90 95229 95229 1053108 1053108 12311 10912 1399 Medical Supplies 1063414 1038872 24542 MANAGEMENT FEE TO AFFILIATE 1242122 1242122 PROFESSIONAL FEES TO AFFILIATE 929449 929449 PURCHASED SERVICES 4482426 4338440 143986 1091859 1023263 68596 0 21665373 19468722 2196651 0 106540 328885 2401234 3197871 0 0 0 53695 36105 0 2736 33384489 15616217 18470107 17768272 0 0 24277990 9103154 45309566 30437023 1360116 2215659 0 20722972 5266757 22083088 7482416 X 23226478 22954607 23226478 22954607 45309566 30437023 X -388479 329542 -212934 X false true X true false X 3250850 3250850 24766522 11664965 13101557 3777661 2909789 867872 1589456 1041463 547993 17768272 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE 8088464 DUE FROM AFFILIATES 860508 Estimated Settlements from Third-Party Payor 108467 Other Receivables 30000 Miscellaneous Assets 15715 9103154 INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE 2711334 Self Insurance Liability DUE TO AFFILIATES 2072470 OTHER Liabilities 29179 Pension and Other Post retirement Liability 453774 5266757 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2017. false true false false false false false false false STEVEN A PROVINCE BOARD MEMBER 0 244718 0 42484 0 8460 0 12208 0 10115 0 317985 0 0 NICK HARSHFIELD CHIEF FINANCIAL OFFICER 0 254114 0 30000 0 8930 0 9428 0 27674 0 330146 0 0 RICK CUMBERLAND CHIEF OPERATING OFFICER (END 4/2017) 0 325888 0 56166 0 46387 0 9615 0 19961 0 458017 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH SENIOR CARE, A RELATED ORGANIZATION OF PROVIDENCE PARK, INC. USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No individuals received current year distributions during calendar year 2016. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL IN DETERMINING COMPENSATION OF THE ORGANIZATION'S top management official, THE PROCESS PERFORMED BY ASCENSION HEALTH SENIOR CARE, A RELATED ORGANIZATION of providence park, inc., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE top management official WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS IN DETERMINING COMPENSATION OF OTHER OFFICERS OF THE ORGANIZATION, THE PROCESS PERFORMED BY ASCENSION HEALTH SENIOR CARE, A RELATED ORGANIZATION OF PROVIDENCE PARK, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders PROVIDENCE PARK, INC. HAS A SINGLE CORPORATE MEMBER, ASCENSION HEALTH SENIOR CARE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PROVIDENCE PARK, INC. HAS A SINGLE CORPORATE MEMBER, ASCENSION HEALTH SENIOR CARE, WHO HAS THE AUTHORITY TO APPOINT AND REMOVE DIRECTORS AND EXECUTIVE OFFICERS OF PROVIDENCE PARK, INC. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Ascension Health Senior Care has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals' evaluation debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part XI, Line 9 Other changes in net assets or fund balances TRANSFERS WITH AFFILIATES - 98228; FAS 158 PENSION ADJUSTMENT - -311162; Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTS The activity of PROVIDENCE PARK, INC. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of PROVIDENCE PARK, INC. is completed. Therefore, the audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of PROVIDENCE PARK, INC. . Form 990, Part XII, Line 2c oversight of audit or selection of independent accountant PROVIDENCE PARK, INC. is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole. Schedule A, Part I REASON FOR PUBLIC CHARITY STATUS Providence Park, Inc. is exempt as a hospital under Internal Revenue Code 170(b)(1)(A)(iii), however it is not a hospital as defined by Form 990, Schedule H Instructions. General Information-C Physical Address The physical address of Providence Park, Inc. is 300 W. Highway 6, Waco, Texas 76712. The address listed on page 1 on this return is for mailing purposes only. ASCENSION HEALTH ALLIANCE PO BOX 45998 St Louis MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3) NA false ASCENSION HEALTH PO BOX 45998 St Louis MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3) ASCENSION HEALTH ALLIANCE false ASCENSION HEALTH SENIOR CARE 12250 Weber Hill Road St Louis MO 63127 431227406 PARENT COMPANY MO 501(c)(3) ASCENSION HEALTH false ALEXIAN VILLAGE OF MILWAUKEE INC 9301 N 76th Street Milwaukee WI 53223 391351584 CONTINUING CARE RETIREMENT COMMUNITY WI 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true ALEXIAN VILLAGE OF TENNESSEE 437 Alexian Way Signal Mountain TN 37377 621136742 CONTINUING CARE RETIREMENT COMMUNITY TN 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true ALEXIAN BROTHERS COMMUNITY SERVICES 425 Cumberland St Suite 110 Chattanooga TN 37404 364344423 PACE- COMPREHENSIVE & COORDINATED COMMUNITY BASED SERVICES TN 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true ALEXIAN BROTHERS LANSDOWNE VILLAGE 12250 Weber Hill Road SUITE 200 ST LOUIS MO 63127 431470362 SKILLED NURSING FACILITY MO 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true ALEXIAN BROTHERS SHERBROOKE VILLAGE 4005 Ripa Avenue St Louis MO 63125 431592502 SKILLED NURSING FACILITY MO 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true SETON MANOR INC 1000 Seton Drive Orwigsburg PA 17961 232960726 SKILLED NURSING FACILITY PA 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true OUR LADY OF PEACE INC 5285 Lewiston Road Lewiston NY 14092 161608735 SKILLED NURSING FACILITY NY 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true BORGESS NURSING HOME INC 3057 Gull Road Kalamazoo MI 49048 382555589 SKILLED NURSING FACILITY MI 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true ST JOSEPH'S MINISTRIES INC 331 S Seton Avenue Emmitsburg MD 21727 521835288 SKILLED NURSING FACILITY MD 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true CARONDELET LONG-TERM CARE FACILITIES INC 621 Carondelet Drive Kansas City MO 64114 742505427 SKILLED NURSING FACILITY MO 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true ST CATHERINE'S LABOURE MANOR 1750 Stockton Street Jacksonville FL 32204 591878316 SKILLED NURSING FACILITY FL 501(c)(3) 3 ASCENSION HEALTH SENIOR CARE true WHEATON FRANCISCAN HEALTHCARE - TERRACE ST ST FRANCIS 3200 SOUTH 20TH STREET MILWAUKEE WI 53215 391486775 RETIREMENT COMMUNITY WI 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true VIA CHRISTI VILLAGES INC 2622 W Centra Suite 100 Wichita KS 67203 480559086 MANAGEMENT COMPANY KS 501(c)(3) ASCENSION HEALTH SENIOR CARE true VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS INC 2622 W Centra Suite 100 Wichita KS 67203 481236589 PACE (SNF) KS 501(c)(3) 10 VIA CHRISTI VILLAGES INC true VIA CHRISTI VILLAGE PONCA CITY INC 1601 Academy Road Ponca City OK 74604 731153337 RETIREMENT COMMUNITY OK 501(c)(3) 10 VIA CHRISTI VILLAGES INC true VIA CHRISTI VILLAGE HAYS INC 2225 Canterbury Drive Hays KS 67601 202828680 RETIREMENT COMMUNITY KS 501(c)(3) 10 VIA CHRISTI VILLAGES INC true VIA CHRISTI VILLAGE MCLEAN INC 777 N McLean Blvd McLean KS 67203 481247723 RETIREMENT COMMUNITY KS 501(c)(3) 10 VIA CHRISTI VILLAGES INC true CORNERSTONE ASSISTED LIVING INC 2622 W Centra Suite 100 Wichita KS 67203 481241079 RETIREMENT COMMUNITY KS 501(c)(3) 10 VIA CHRISTI VILLAGES INC true VIA CHRISTI VILLAGE MANHATTAN INC 2800 Willow Grove Road Manhattan KS 66502 481078862 RETIREMENT COMMUNITY KS 501(c)(3) 10 VIA CHRISTI VILLAGES INC true VIA CHRISTI VILLAGE GEORGETOWN INC 1655 S Georgetown Georgetown KS 67218 481129325 RETIREMENT COMMUNITY KS 501(c)(3) 10 VIA CHRISTI VILLAGES INC true VIA CHRISTI VILLAGE PITTSBURG INC 1502 E Centennial Drive Pittsburg KS 66762 743070971 RETIREMENT COMMUNITY KS 501(c)(3) 10 VIA CHRISTI VILLAGES INC true NAZARETH AHLL 1475 RAYNOLDS STREET EL PASO TX 79903 742387843 RETIREMENT COMMUNITY TX 501(c)(3) 10 ASCENSION HEALTH SENIOR CARE true ALEXIAN BROTHERS CORPUS CHRISTI HOUSING PROJECT LLC 3900 SOUTH GRAND ST LOUIS MO 63118 943465394 HOUSING MO NA C Corporation true false false false false false false false false false false false false false false false true false false false