2017-11-14T14:36:21-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 750 Trade Centre Way Ste 300 Portage MI 49002 990 2016-01-01 381872660 ST ANN'S HOME INC STAN 6164537715 2161 LEONARD STREET NW GRAND RAPIDS MI 495043829 SISTER GABRIELA HILKE PRESIDENT/TREASURER 6164537715 2017-09-22 1 Carol LaLonde CPA P00181637 2695674500 2017-09-20 67.59.56.31 2017-09-22 09:14:49 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 58F74DC53CB874483B207ADF23CD6921384352E9 2016 2017-02-10 21:41:12Z SISTER GABRIELA HILKE 2161 LEONARD STREET NW GRAND RAPIDS MI 495043829 10144158 0 X www.stannshome.com X 1951 MI BASIC NURSING CARE- PROVIDING NURSING CARE AND MISCELLANEOUS SERVICES FOR THE RESIDENTS OF THE HOME. HOME FOR THE AGED - PROVIDED CARE AND LIVING QUARTERS AT THE HOME TO ELDERLY PERSONS IN THE COMMUNITY. 4 4 324 13 0 0 286746 309063 9597048 9550819 17096 686 217590 275576 10118480 10136144 500 0 0 0 5949592 6412767 8969 0 16429 3666965 3672177 9626026 10084944 492454 51200 8410485 9280130 465124 560669 7945361 8719461 OUR MISSION IS TO PROVIDE A LOVING AND SPIRITUAL COMMUNITY FOR OLDER ADULTS TO LIVE LIVES OF CARING AND WHOLENESS, INSPIRED BY OUR CARMELITE FOUNDATION OF FRATERNITY, SERVICE AND PRAYER. 0 0 5124021 5576098 BASIC NURSING CARE - PROVIDED NURSING CARE AND MISCELLANEOUS SERVICES FOR THE RESIDENTS OF THE HOME. 3652475 3974721 HOME FOR THE AGED - PROVIDED CARE AND LIVING QUARTERS AT THE HOME TO ELDERLY PERSONS IN THE COMMUNITY. 8776496 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 6 0 1 324 1 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MI X JONI LAHMANN 6164537715 2161 LEONARD NW GRAND RAPIDS MI 49504 SISTER GABRIELA HILKE PRESIDENT/TREASURER 40.00 0.00 X X 0 0 0 SISTER MARIE GIUSEPPE VICE PRESIDENT/SECRETARY 1.00 0.00 X X 0 0 0 SISTER M IMMACULATA OSTERHAUS MEMBER 1.00 0.00 X 0 0 0 SISTER MARY EMMANUAL APANITAS MEMBER 1.00 0.00 X 0 0 0 ROBERT SCHMIDT EXECUTIVE DIRECTOR 40.00 0.00 X 130620 0 0 JONI LAHMANN DIRECTOR OF FINANCE 40.00 0.00 X 78250 0 4621 208870 0 4621 1 0 0 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 63150 REHABILITATION SERVICES 228609 CREATIVE DINING SERVICES 1 ROYAL PARK DRIVE ZEELAND MI 49464 DINING SERVICES 173799 MARY FREE BED REHABILITATION HOSPITAL 235 WEALTHY ST SE GRAND RAPIDS MI 49503 REHABILITATION SERVICES 163466 POST ASSOCIATES ARCHITECTS 40 PEARL ST NW STE 900 GRAND RAPIDS MI 49503 ARCHITECTS 111451 4 6500 302563 75000 309063 BASIC NURSING CARE 623000 5576098 5576098 HOME FOR THE AGED 623000 3974721 3974721 9550819 266 266 23837 0 23837 23837 23837 420 0 420 420 420 6735 6500 8014 -1279 -1279 ADMISSION FEES 623000 131000 131000 EMPLOYEE DAY CARE 624410 72478 72478 RESIDENT BEAUTY SHOP 812900 49540 49540 253018 10136144 9550819 0 276262 213491 106746 106745 5331659 4771630 560029 102979 102979 764638 764638 145536 145536 10281 10281 22300 22300 777774 723975 53799 109466 109466 73327 73327 357763 339658 18105 2606 2606 35288 9929 25359 485422 485422 73310 73310 MEDICAL SUPPLIES 461627 461627 FOOD FOR RESIDENTS 415993 415993 QAAP 370420 370420 rEPAIRS & MAINTENANCE 148482 130542 17940 182582 92937 73216 16429 10084944 8776496 1292019 16429 1624428 1826371 49901 49901 784988 671193 28415 30070 142715 176078 15303352 9236970 5590665 6066382 25033 27329 154340 391542 10000 41264 8410485 9280130 465124 493635 0 67034 465124 560669 X 7839607 8377564 105754 341897 7945361 8719461 8410485 9280130 X 51200 4008 718892 X X 1 X 0 1 0 X 255543 238593 546726 286746 309063 1636671 9248685 9421879 9017569 9597048 9550819 46836000 9504228 9660472 9564295 9883794 9859882 48472671 0 0 0 48472671 2674 2360 2163 2222 24103 33522 2674 2360 2163 2222 24103 33522 144889 149885 193769 217590 259753 965886 9651791 9812717 9760227 10103606 10143738 49472079 0.97980 0.98000 0.00070 0.00040 X Schedule A, Part III, Line 12, Explanation of Other Income: OTHER INCOME - 2012 Amount: $ 144,889. 2013 Amount: $ 149,885. 2014 Amount: $ 193,769. 2015 Amount: $ 217,590. 2016 Amount: $ 253,018. FUNDRAISING EVENT REVENUE - 2016 Amount: $ 6,735. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 464789 464789 11816404 7267243 4549161 339525 271604 67921 2274530 1698123 576407 408104 408104 6066382 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 67034 67034 10931316 4008 109460 673690 787158 10144158 -8014 -8014 10136144 10166177 109460 8014 117474 10048703 36241 36241 10084944 Part XI, Line 2d - Other Adjustments: equity transfers from carmelite sisters 673,690. Part XI, Line 4b - Other Adjustments: FUNDRAISING EVENT EXPENSES -8,014. Part XII, Line 2d - Other Adjustments: FUNDRAISING EVENT EXPENSES 8,014. Part XII, Line 4b - Other Adjustments: STRATEGIC PLANNING EXPENSES 36,241. X 2 49916 EXCHANGE MEAN 0 0 0 Part I, Column (b): THE AMOUNT LISTED IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. Form 990, Part VI, Section B, line 11b THE ORGANIZATION DOES NOT PROVIDE A DRAFT COPY OF THE 990 TO THE GOVERNING BODY BEFORE ITS SUBMISSION; HOWEVER, THE 990 IS REVIEWED BY THE ADMINISTRATOR PRIOR TO FILING. Form 990, Part VI, Section B, line 12c THE CONFLICT OF INTEREST POLICY COVERS ALL DIRECTORS, OFFICERS AND MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT HAS A DIRECT OR INDIRECT FINANCIAL INTEREST WITH THE HOME. THE CONFLICT OF INTEREST POLICY IS PROVIDED TO EVERY DIRECTOR ON AN ANNUAL BASIS, AND THE DIRECTOR MUST SUBMIT A WRITTEN STATEMENT ACKNOWLEDGING RECEIPT OF THE POLICY, UNDERSTANDING, AGREEMENT, AND APPLICATION OF THE POLICY. THE HOME'S ACTIVITIES ARE REVIEWED PERIODICALLY TO ENSURE THE HOME IS OPERATING IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. WHEN A CONFLICT OF INTEREST IS DETERMINED TO EXIST THE BOARD OR COMMITTEE SHALL MEET WITHOUT THE PRESENCE OF THE INTERESTED PARTY. THE INTERESTED PARTY MAY MAKE A PRESENTATION TO THE BOARD OR COMMITTEE, AND THE BOARD OR COMMITTEE THEN DETERMINES WHETHER THERE HAS BEEN A CONFLICT OF INTEREST, OR WHETHER A NON-INTERESTED PERSON TO INVESTIGATE ALTERNATIVES TO THE TRANSACTION OF ARRANGEMENT THAT IS A CONFLICT OF INTEREST. THE ISSUE IS THEN DECIDED BY A MAJORITY VOTING WITHOUT THE INTERESTED PERSON AFTER DETERMINING IF THE HOME IS ABLE TO OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH ANOTHER DISINTERESTED PARTY. ANY INTERESTED PARTY THAT VIOLATES THE CODE OF CONDUCT POLICY IS SUBJECT TO APPROPRIATE DISCIPLINE, UP TO AND INCLUDING REMOVAL FROM OFFICE. Form 990, Part VI, Section B, line 15 COMPENSATION OF THE TOP MANAGEMENT OFFICIAL IS APPROVED BY THE PRESIDENT OF THE GOVERNING BOARD AND TWO ADVISORY BOARD MEMBERS. COMPENSATION IS DETERMINED BY REVIEWING THE FORM 990 RETURNS OF OTHER LOCAL NURSING HOMES AND BY REFERENCE TO A SALARY SURVEY FROM THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING. COMPENSATION OF THE FINANCIAL DIRECTOR IS APPROVED BY THE ADVISORY BOARD BASED ON PREDETERMINED PAY SCALES ALSO APPROVED BY THE ADVISORY BOARD. IN ADDITION TO THE SCALE, MERIT INCREASES MAY ALSO BE GIVEN. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS 2016. Form 990, Part VI, Section C, line 19 THE ORGANIZATION DOES NOT PROVIDE GOVERNING DOCUMENTS, CONFLICT OF INTEREST, AND FINANCIAL STATEMENTS TO THE PUBLIC. Form 990, Part XI, line 9: CHANGE IN INVESTMENT IN EMMANUEL HOSPICE 237,202. equity transfer from carmelite sisters 481,690. FORM 990, PART XII, LINE 2C: OVERSIGHT OF FINANCIAL STATEMENT review IS PERFORMED BY THE ADVISORY BOARD AND THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR. CARMELITE SISTERS OF THE DIVINE HEART OF JESUS OF WI 1230 KAVANAUGH PL MILWAUKEE WI 53213 396048667 CHURCH WI 501(c)(3) Line 1 N/A 0 EMMANUEL HOSPICE 2161 LEONARD ST NW GRAND RAPIDS MI 49504 454485835 HOSPICE CARE MI 501(c)(3) Line 10 ST ANN'S HOME INC 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 CARMELITE SISTERS OF THE DIVINE HEART OF JESUS OF WI B 192000 CASH CARMELITE SISTERS OF THE DIVINE HEART OF JESUS OF WI C 673690 CASH