ASCENSION LIVING ALEXIAN VILLAGE TENNESEE: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
ASCENSION LIVING ALEXIAN VILLAGE TENNESEE (EIN 62-1136742)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-15
IRS object ID
201841359349309714
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-15T15:05:28-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN621136742EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Alexian Village of TennesseeBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlALEXBusinessNameControlTxt
Phone3147338000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line112250 Weber Hill Road 200AddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63127ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTonya MershonPersonNm
Person TitleTax OfficerPersonTitleTxt
Signature2018-05-15SignatureDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1MICHAEL GORDON CFOBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line112250 Weber Hill Road 200AddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63127ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$27,317,498GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.alexianbrothershealth.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1983FormationYr
Legal Domicile StateTNLegalDomicileStateCd
Activity Or MissionTo provide skilled nursing services to those in our Continuing Care Retirement Community for the short or long term.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee339TotalEmployeeCnt
Total Volunteers72TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$183,178PYContributionsGrantsAmt
CY Contributions Grants$116,200CYContributionsGrantsAmt
PY Program Service Revenue$26,077,853PYProgramServiceRevenueAmt
CY Program Service Revenue$26,281,953CYProgramServiceRevenueAmt
PY Investment Income-$559,045PYInvestmentIncomeAmt
CY Investment Income$423,199CYInvestmentIncomeAmt
PY Other Revenue$531,360PYOtherRevenueAmt
CY Other Revenue$464,973CYOtherRevenueAmt
PY Total Revenue$26,233,346PYTotalRevenueAmt
CY Total Revenue$27,286,325CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,496,955PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,608,252CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$18,212,374PYOtherExpensesAmt
CY Other Expenses$16,592,091CYOtherExpensesAmt
PY Total Expenses$27,709,329PYTotalExpensesAmt
CY Total Expenses$27,200,343CYTotalExpensesAmt
PY Revenues Less Expenses-$1,475,983PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$85,982CYRevenuesLessExpensesAmt
Total Assets BOY$83,708,718TotalAssetsBOYAmt
Total Assets EOY$85,454,913TotalAssetsEOYAmt
Total Liabilities BOY$42,715,060TotalLiabilitiesBOYAmt
Total Liabilities EOY$44,840,141TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$40,993,658NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$40,614,772NetAssetsOrFundBalancesEOYAmt
MissionAlexian Village of Tennessee ("AVT") 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$18,323,921ExpenseAmt
Revenue$23,395,355RevenueAmt
DescALEXIAN VILLAGE OF TENNESSEE ("AVT") PROVIDES A CONTINUUM OF SERVICES TO RESIDENTS OF AVT (113,854 RESIDENT DAYS SERVED), ASSISTED LIVING SERVICES TO RESIDENTS (13,297 DAYS SERVED), RESIDENTS OF MEMORY CARE (6,773 DAYS SERVED), AND RESIDENTS OF THE HEALTH CARE CENTER (39,112 DAYS SERVED) THAT MAXIMIZES DIGNITY AND INDEPENDENCE. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY FOR THE CONTINUUM OF SERVICES, AS A CHARITABLE ORGANIZATION, IT IS RECOGNIZED THAT NOT ALL PERSONS SERVED POSSESS THE ABILITY TO PURCHASE ESSENTIAL SERVICES NEEDED FOR CARE AND OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES. IN FY2017, OVER $81,600 WAS PROVIDED IN CHARITABLE CARE AT COST. AVT ALSO SERVES THE COMMUNITIES OF SIGNAL MOUNTAIN AND CHATTANOOGA BY PROVIDING PROGRAMS THROUGHOUT THE YEAR. MEETING ROOMS ARE PROVIDED AT NO COSTS TO LOCAL CHARITABLE ORGANIZATIONS AND COMMUNITY GROUPS. AS A RELIGIOUS ORGANIZATION, AVT ALSO EMPLOYS STAFF TO PROVIDE CHAPLAINCY SERVICES. THERE ARE MULTIPLE CHAPELS AT AVT, WHICH HAVE DAILY INTERDENOMINATIONAL SERVICES & PROGRAMS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,506,461ExpenseAmt
Revenue$2,046,173RevenueAmt
DescALEXIAN VILLAGE OF TENNESSEE, D/B/A ALEXIAN BROTHERS VALLEY RESIDENCE ("ABVR") IS A SEPARATE AND DISTINCT DIVISION OF AVT. IT EXISTS TO PROVIDE A SECURE ENVIRONMENT TO THOSE SUFFERING FROM DEMENTIA OR ALZHEIMER'S DISEASE. ON AVERAGE, 36.5 RESIDENTS WERE SERVED EACH DAY OF FY2017. SUCH SERVICES INCLUDE NURSING ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, RECREATIONAL ACTIVITIES, MEAL PREPARATION AND DINING, AND SPIRITUAL WELLNESS. IN ADDITION, ABVR PROVIDES SHORT TERM RESPITE CARE AND AN ADULT DAY CARE PROGRAM, ALSO TO SERVE THOSE SUFFERING FROM DEMENTIA OR ALZHEIMER'S DISEASE.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$691,277ExpenseAmt
Revenue$840,425RevenueAmt
DescALEXIAN VILLAGE OF TENNESSEE, D/B/A ALEXIAN GROVE IS A SEPARATE AND DISTINCT DIVISION OF THE AVT ORGANIZATION. IT EXISTS TO PROVIDE INDEPENDENT, RESIDENTIAL RETIREMENT LIVING WHILE PROMOTING THE WELL-BEING OF ALL THOSE SERVED THROUGH A DELIVERY OF QUALITY SERVICES. ALEXIAN GROVE IS HOME TO ABOUT 33 SENIOR CITIZENS IN INDEPENDENT APARTMENTS. IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF CHATTANOOGA AND THE SURROUNDING COMMUNITY, FREE OR SUBSIDIZED CARE AND OTHER ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY AT LARGE ARE CONSIDERED AND PROVIDED WHEN APPROPRIATE.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$20,521,659TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document73IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee339EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldTNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Julie TurleyBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3147293500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line112250 Weber Hill RdAddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63127ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
MIKE HAMBLEY
EX-OFFICIO, PRESIDENT & CEO (END 1/2017)50.00Yes (X)Yes (X)$161,570$0$28,190
ROBERT MAIN
BOARD MEMBER1.00Yes (X)Yes (X)$0$0$0
TERRY THOMPKINS
EX-OFFICIO, EXEC. DIRECTOR (START 5/2017)50.00Yes (X)Yes (X)$0$0$0
KATHLEEN PURI
CHAIR1.00Yes (X)Yes (X)$0$0$0
PETER ARROWSMITH
BOARD MEMBER1.00Yes (X)$0$0$0
KATYE JONES
BOARD MEMBER1.00Yes (X)$0$0$0
CHARLES MCCLOY
BOARD MEMBER1.00Yes (X)$0$0$0
RAYMOND STEELE
BOARD MEMBER1.00Yes (X)$0$0$0
BROTHER ANDREW THOME CFA
BOARD MEMBER1.00Yes (X)$0$0$0
BOYD VEAL
BOARD MEMBER1.00Yes (X)$0$0$0
NICK HARSHFIELD
CHIEF FINANCIAL OFFICER1.054.0Yes (X)$0$293,044$37,102
RICK CUMBERLAND
CHIEF OPERATING OFFICER (END 4/2017)1.054.0Yes (X)$0$428,441$29,576
DOUGLAS MALIN
Administrator50.00$120,178$0$13,198Yes (X)
JOE GIRARDI
FORMER OFFICER (END 7/2015)0.00.0$0$150,178$0Yes (X)
GARY MOHN
FORMER OFFICER (END 4/2016)0.040.0$0$251,634$18,452Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$281,748TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,123,297TotReportableCompRltdOrgAmt
Total Other Compensation$126,518TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
All Other Contributions$116,200AllOtherContributionsAmt
Total Contributions$116,200TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Skilled Nursing & Rehab623000$8,307,278$8,307,278
Assisted Living Care623000$4,235,234$4,235,234
Independent Living & Lifecare623000$13,671,601$13,671,601
Adult Day Care624100$66,575$66,575
Nutritonal Supplements621990$1,265$1,265

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$26,281,953TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$454,372TotalRevenueColumnAmt
Exclusion$454,372ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$31,997RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$31,997RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,997TotalRevenueColumnAmt
Exclusion$31,997ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$31,173OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other-$31,173OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$31,173TotalRevenueColumnAmt
Exclusion-$31,173ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
Transportation900099$3,462$3,462
Beauty Shop900099$135,448$135,448
Dietary/Nutrition900099$162,945$162,945

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$131,121TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$131,121ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$432,976OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$27,286,325TotalRevenueColumnAmt
Related Or Exempt Func Income$26,281,953RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$888,172ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$189,760TotalAmt
Management And General$189,760ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$7,869,983TotalAmt
Program Services$6,492,703ProgramServicesAmt
Management And General$1,377,280ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$206,433TotalAmt
Program Services$170,306ProgramServicesAmt
Management And General$36,127ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,774,219TotalAmt
Program Services$1,463,723ProgramServicesAmt
Management And General$310,496ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$567,857TotalAmt
Program Services$459,055ProgramServicesAmt
Management And General$108,802ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$74,426TotalAmt
Program Services$0ProgramServicesAmt
Management And General$74,426ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$373,420TotalAmt
Program Services$1,010ProgramServicesAmt
Management And General$372,410ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$80,301TotalAmt
Program Services$67,762ProgramServicesAmt
Management And General$12,539ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,082,382TotalAmt
Program Services$1,472,835ProgramServicesAmt
Management And General$609,547ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$40,640TotalAmt
Program Services$7,767ProgramServicesAmt
Management And General$32,873ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$2,297TotalAmt
Program Services$1,263ProgramServicesAmt
Management And General$1,034ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$442,178TotalAmt
Management And General$442,178ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,990,471TotalAmt
Program Services$3,990,471ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$106,942TotalAmt
Management And General$106,942ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PURCHASED SERVICES$4,397,543$4,259,669$137,874
MANAGEMENT FEE TO AFFILIATES$1,621,643$1,621,643
PROFESSIONAL FEES TO AFFILIATES$1,057,510$1,057,510
OTHER NON MEDICAL SUPPLIES$630,199$618,154$12,045

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,692,139TotalAmt
Program Services$1,516,941ProgramServicesAmt
Management And General$175,198ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$27,200,343TotalAmt
Program Services$20,521,659ProgramServicesAmt
Management And General$6,678,684ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$49,482BOYAmt
EOY$10,017EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,026,216BOYAmt
EOY$1,215,741EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$54,940BOYAmt
EOY$54,940EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$454,238BOYAmt
EOY$274,882EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$86,245,637LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$15,331,402LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$73,745,255BOYAmt
EOY$70,914,235EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$12,839,008EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$18,035BOYAmt
EOY$12,023EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$8,360,552BOYAmt
EOY$134,067EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$83,708,718BOYAmt
EOY$85,454,913EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,176,203BOYAmt
EOY$2,458,049EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$25,869,190BOYAmt
EOY$26,641,934EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,669,667BOYAmt
EOY$15,740,158EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$42,715,060BOYAmt
EOY$44,840,141EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$38,934,515BOYAmt
EOY$38,526,534EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,584,143BOYAmt
EOY$1,613,238EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$475,000BOYAmt
EOY$475,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$40,993,658BOYAmt
EOY$40,614,772EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$83,708,718BOYAmt
EOY$85,454,913EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$85,982ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$283,726NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$748,594OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$542,841CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$360,563CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$136,770CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$183,178CurrentTaxYearMinus1YearAmt
Current Tax Year$116,200CurrentTaxYearAmt
Total$1,339,552TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,454,998CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,231,171CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$25,269,133CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$26,574,916CurrentTaxYearMinus1YearAmt
Current Tax Year$26,281,953CurrentTaxYearAmt
Total$124,812,171TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,997,839CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,591,734CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$25,405,903CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$26,758,094CurrentTaxYearMinus1YearAmt
Current Tax Year$26,398,153CurrentTaxYearAmt
Total$126,151,723TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$126,151,723PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$85,477CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$43,989CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$186,079CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$50,297CurrentTaxYearMinus1YearAmt
Current Tax Year$486,369CurrentTaxYearAmt
Total$852,211TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$85,477CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$43,989CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$186,079CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$50,297CurrentTaxYearMinus1YearAmt
Current Tax Year$486,369CurrentTaxYearAmt
Total$852,211TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$432,976CurrentTaxYearAmt
Total$432,976TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$23,083,316CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,635,723CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$25,591,982CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$26,808,391CurrentTaxYearMinus1YearAmt
Current Tax Year$27,317,498CurrentTaxYearAmt
Total$127,436,910TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.9899PublicSupportCY509Pct
Public Support PY5090.9954PublicSupportPY509Pct
Investment Income CY0.0067InvestmentIncomeCYPct
Investment Income PY0.0046InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Part III, Line 12 Other IncomeFormAndLineReferenceDesc
ExplanationDESCRIPTION - TRANSPORTATION, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 3462.0, COLUMN F - 3462.0; DESCRIPTION - BEAUTY SHOP, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 135448.0, COLUMN F - 135448.0; DESCRIPTION - DIETARY/NUTRITION, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 162945.0, COLUMN F - 162945.0; DESCRIPTION - OTHER REVENUE, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 117850.0, COLUMN F - 117850.0; DESCRIPTION - HOUSEKEEPING, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 13271.0, COLUMN F - 13271.0;ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$475,000BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$0InvestmentEarningsOrLossesAmt
Grants Or Scholarships$0GrantsOrScholarshipsAmt
Other Expenditures$0OtherExpendituresAmt
Administrative Expenses$0AdministrativeExpensesAmt
End Year Balance$475,000EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$458,816BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$16,184InvestmentEarningsOrLossesAmt
Grants Or Scholarships$0GrantsOrScholarshipsAmt
Other Expenditures$0OtherExpendituresAmt
Administrative Expenses$0AdministrativeExpensesAmt
End Year Balance$475,000EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$458,816BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$0InvestmentEarningsOrLossesAmt
Grants Or Scholarships$0GrantsOrScholarshipsAmt
Other Expenditures$0OtherExpendituresAmt
Administrative Expenses$0AdministrativeExpensesAmt
End Year Balance$458,816EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$458,816BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$0InvestmentEarningsOrLossesAmt
Grants Or Scholarships$0GrantsOrScholarshipsAmt
Other Expenditures$0OtherExpendituresAmt
Administrative Expenses$0AdministrativeExpensesAmt
End Year Balance$458,816EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$465,192BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses-$6,376InvestmentEarningsOrLossesAmt
Grants Or Scholarships$0GrantsOrScholarshipsAmt
Other Expenditures$0OtherExpendituresAmt
Administrative Expenses$0AdministrativeExpensesAmt
End Year Balance$458,816EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.0BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.0PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.0TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (true)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (true)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,930,000OtherCostOrOtherBasisAmt
Book Value$1,930,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$75,441,261OtherCostOrOtherBasisAmt
Depreciation$12,735,185DepreciationAmt
Book Value$62,706,076BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,617,994OtherCostOrOtherBasisAmt
Depreciation$1,786,501DepreciationAmt
Book Value$4,831,493BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,256,382OtherCostOrOtherBasisAmt
Depreciation$809,716DepreciationAmt
Book Value$1,446,666BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$70,914,235TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)

DescDescAmtAmt
AR Credit Balances
Self Insurance Liability
Workers Comp Liability
Intercompany Debt with Ascension Health Alliance$12,589,560
Other Liability$365,751
AH Savings Plan - EAC$186,858
Real Estate Taxes$288,300
DUE TO AFFILIATES$2,309,689
FieldValueIRS element (for citing)
Total Liability$15,740,158TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationThe System accounts for uncertainty in income tax provisions 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
MIKE HAMBLEY
EX-OFFICIO, PRESIDENT & CEO (END 1/2017)$143,272$0$15,344$0$2,954$0$4,827$0$23,363$0$189,760$0$0$0
JOE GIRARDI
FORMER OFFICER (END 7/2015)$0$0$0$0$0$150,178$0$0$0$0$0$150,178$0$0
GARY MOHN
FORMER OFFICER (END 4/2016)$0$92,620$0$0$0$159,014$0$0$0$18,452$0$270,086$0$0
NICK HARSHFIELD
CHIEF FINANCIAL OFFICER$0$254,114$0$30,000$0$8,930$0$9,428$0$27,674$0$330,146$0$0
RICK CUMBERLAND
CHIEF OPERATING OFFICER (END 4/2017)$0$325,888$0$56,166$0$46,387$0$9,615$0$19,961$0$458,017$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationASCENSION HEALTH SENIOR CARE, A RELATED ORGANIZATION OF ALEXIAN VILLAGE OF TENNESSEE, USES THE FOLLOWING METHODS 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 4a Severance or change-of-control paymentThe following individual(s) received severance payments from the organization or a related organization during calendar year 2016 : JOE GIRARDI - $150,178 GARY MOHN - $159,014
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planEligible 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 .

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIALIn determining the compensation of the Organization's CEO, the process performed by Ascension Health Senior CARE, a related organization of Alexian Village of Tennessee, 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 CEO 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 Committee minutes. The individual was not present when his compensation was decided.
Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERSIN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS, THE PROCESS PERFORMED BY ASCENSION HEALTH SENIOR CARE, A RELATED ORGANIZATION OF ALEXIAN VILLAGE OF TENNESSEE, Inc., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE 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 stockholdersAlexian Village of Tennessee has a SINGLE CORPORATE MEMBER, ASCENSION HEALTH SENIOR CARE.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyAlexian Village of Tennessee HAS A SINGLE CORPORATE MEMBER, ASCENSION HEALTH SENIOR CARE, WHO HAS THE AUTHORITY TO APPOINT AND REMOVE DIRECTORS AND EXECUTIVE OFFICERS OF Alexian Village of Tennessee.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersASCENSION 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 bodyDURING 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 policyThe 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 publicTHE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST.
Form 990, Part VIII, Line 11d Other Miscellaneous RevenueOther Revenue - Total Revenue: 117850, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 117850; Housekeeping Revenue - Total Revenue: 13271, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 13271;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesTransfer to Affiliates - -748594;
Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTSThe activity of ALEXIAN VILLAGE OF TENNESSEE is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of ALEXIAN VILLAGE OF TENNESSEE is completed. Therefore, the audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of ALEXIAN VILLAGE OF TENNESSEE.
Form 990, Part XII, Line 2c oversight of audit or selection of independent accountantALEXIAN VILLAGE OF TENNESSEE 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.
GENERAL INFORMATION - BOX C PHYSICAL ADDRESSTHE PHYSICAL ADDRESS OF ALEXIAN VILLAGE OF TENNESSEE IS: 437 ALEXIAN WAY, SIGNAL MOUNTAIN, TN 37377. THE ADDRESS LISTED ON PAGE 1 ON THIS RETURN IS FOR MAILING PURPOSES ONLY.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (25 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndPublic Charity StatusPublicCharityStatusTxtAddress Line2USAddress/AddressLine2Txt
ASCENSION HEALTH ALLIANCE
PO BOX 45998St LouisMO63145453358926NATIONAL HEALTH SYSTEMMO501(c)(3)NAfalse
ASCENSION HEALTH
PO BOX 45998St LouisMO63145311662309NATIONAL HEALTH SYSTEMMO501(c)(3)ASCENSION HEALTH ALLIANCEfalse
ASCENSION HEALTH SENIOR CARE
12250 Weber Hill RoadSt LouisMO63127431227406PARENT COMPANYMO501(c)(3)ASCENSION HEALTHfalse
ALEXIAN VILLAGE OF MILWAUKEE INC
9301 N 76th StreetMilwaukeeWI53223391351584CONTINUING CARE RETIREMENT COMMUNITYWI501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
ALEXIAN BROTHERS COMMUNITY SERVICES
425 Cumberland St Suite 110ChattanoogaTN37404364344423PACE- COMPREHENSIVE & COORDINATED COMMUNITY BASED SERVICESTN501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
ALEXIAN BROTHERS LANSDOWNE VILLAGE
12250 Weber Hill RoadST LOUISMO63127431470362SKILLED NURSING FACILITYMO501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10SUITE 200
ALEXIAN BROTHERS SHERBROOKE VILLAGE
4005 Ripa AvenueSt LouisMO63125431592502SKILLED NURSING FACILITYMO501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
SETON MANOR INC
1000 Seton DriveOrwigsburgPA17961232960726SKILLED NURSING FACILITYPA501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
OUR LADY OF PEACE INC
5285 Lewiston RoadLewistonNY14092161608735SKILLED NURSING FACILITYNY501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
BORGESS NURSING HOME INC
3057 Gull RoadKalamazooMI49048382555589SKILLED NURSING FACILITYMI501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
ST JOSEPH'S MINISTRIES INC
331 S Seton AvenueEmmitsburgMD21727521835288SKILLED NURSING FACILITYMD501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
CARONDELET LONG-TERM CARE FACILITIES INC
621 Carondelet DriveKansas CityMO64114742505427SKILLED NURSING FACILITYMO501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
ST CATHERINE'S LABOURE MANOR
1750 Stockton StreetJacksonvilleFL32204591878316SKILLED NURSING FACILITYFL501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)3
PROVIDENCE PARK INC
300 W Highway 6WacoTX76712611759304SKILLED NURSING FACILITYTX501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)3
WHEATON FRANCISCAN HEALTHCARE - TERRACE ST ST FRANCIS
3200 SOUTH 20TH STREETMILWAUKEEWI53215391486775RETIREMENT COMMUNITYWI501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10
VIA CHRISTI VILLAGES INC
2622 W Centra Suite 100WichitaKS67203480559086MANAGEMENT COMPANYKS501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)
VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS INC
2622 W Centra Suite 100WichitaKS67203481236589PACE (SNF)KS501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
VIA CHRISTI VILLAGE PONCA CITY INC
1601 Academy RoadPonca CityOK74604731153337RETIREMENT COMMUNITYOK501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
VIA CHRISTI VILLAGE HAYS INC
2225 Canterbury DriveHaysKS67601202828680RETIREMENT COMMUNITYKS501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
VIA CHRISTI VILLAGE MCLEAN INC
777 N McLean BlvdMcLeanKS67203481247723RETIREMENT COMMUNITYKS501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
CORNERSTONE ASSISTED LIVING INC
2622 W Centra Suite 100WichitaKS67203481241079RETIREMENT COMMUNITYKS501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
VIA CHRISTI VILLAGE MANHATTAN INC
2800 Willow Grove RoadManhattanKS66502481078862RETIREMENT COMMUNITYKS501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
VIA CHRISTI VILLAGE GEORGETOWN INC
1655 S GeorgetownGeorgetownKS67218481129325RETIREMENT COMMUNITYKS501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
VIA CHRISTI VILLAGE PITTSBURG INC
1502 E Centennial DrivePittsburgKS66762743070971RETIREMENT COMMUNITYKS501(c)(3)VIA CHRISTI VILLAGES INCYes (true)10
NAZARETH HALL
1475 RAYNOLDS STREETEL PASOTX79903742387843RETIREMENT COMMUNITYTX501(c)(3)ASCENSION HEALTH SENIOR CAREYes (true)10

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ALEXIAN BROTHERS CORPUS CHRISTI HOUSING PROJECT LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13900 SOUTH GRANDAddressLine1Txt
CityST LOUISCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63118ZIPCd
FieldValueIRS element (for citing)
EIN943465394EIN
Primary ActivitiesHOUSINGPrimaryActivitiesTxt
Legal Domicile StateMOLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CorporationEntityTypeTxt
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Alexian Brothers Community ServicesBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeQTransactionTypeTxt
Involved$1,559,329InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt

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