2017-10-04T10:28:15-05:00 2016-12-31 061009205 BLUM SHAPIRO & COMPANY PC 1 INTERNATIONAL PLACE 16TH FLOOR BOSTON MA 02110 990 2016-01-01 050275443 SAINT ANTOINE RESIDENCE SAIN 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 WENDY FARGNOLI ADMINISTRATOR/ASSISTANT TREASURER 4017673500 2017-09-26 1 LAURA J KENNEY P00202198 6172211944 50.200.120.74 2017-09-26 10:51:02 ED P 1EAB3528AA1D164A312CA29E06AF0C3F5801D525 7B14BF2BF8F8AC217E314A41F868DB69370B8F6F 2016 2021-01-29 14:40:06Z WENDY FARGNOLI 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 24754393 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 65 0 0 421291 554470 23943649 24076048 27647 17338 102557 38207 24495144 24686063 0 0 0 0 14973227 15725149 1350 4143 4143 8835754 9445757 23810331 25175049 684813 -488986 18919760 18197374 5539046 5173224 13380714 13024150 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 23347375 23955261 THE OPERATION OF A LONG-TERM CARE FACILITY FOR THE ELDERLY AND OTHER NEEDY INDIVIDUALS. DURING 2016 ST. ANTOINE RESIDENCE PROVIDED A TOTAL 91,115 PATIENT BED DAYS, INCLUDING 75,323 BED DAYS TO MEDICAID AND MEDICARE PATIENTS. 84750 120787 PROVISION OF MEALS TO ADULT DAY CARE PROGRAM OPERATED BY PACE, AN EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). 23432125 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 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 19 0 1 497 1 0 0 0 0 0 1 1 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 WENDY FARGNOLI ADMINISTRATOR/ASST TREASUR 39.00 1.00 X X 138536 0 34057 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 125200 0 31811 263736 0 65868 2 0 1 0 0 38194 42532 309624 164120 554470 MEDICAID & MEDICARE REVENUES 623000 17196399 17196399 NURSING HOME FEES 623000 6673462 6673462 MEALS REVENUE - PACE ADULT MEALS 623000 120787 120787 MANAGEMENT FEE INCOME 623000 85400 85400 24076048 17338 17338 11562 3969 7593 7593 7593 43134 42532 64361 -21227 -21227 DISCOUNTS EARNED 900099 31088 31088 OTHER INCOME 900099 13630 13630 HAIRDRESSER REVENUE 900099 7123 7123 51841 24686063 24076048 0 55545 328836 328836 11368658 10707878 660780 885738 843484 42254 2311687 2159743 151944 830230 764245 65985 52879 52879 20755 20755 47280 47280 4143 4143 3370 3370 37406 37406 64368 64368 32602 32602 78528 78528 555251 521936 33315 9035 9035 165389 155466 9923 618977 584058 34919 581034 560990 20044 PURCHASED SERVICES 2998151 2998151 MEDICAL & OTHER DIRECT 1438199 1438199 PROVIDER TAXES 1268925 1268925 FOOD 893604 893604 580004 482567 97437 25175049 23432125 1738781 4143 2000 2000 5263909 4118562 128914 84983 2152504 2811249 651431 622332 96386 109172 92188 89072 22016386 12268632 9769055 9747754 341931 346604 421442 265646 18919760 18197374 1966702 2864608 3370000 2224411 202344 84205 5539046 5173224 X 13204885 12828896 137079 156504 38750 38750 13380714 13024150 18919760 18197374 X -488986 14283 118139 X X 0 1 X 1 0 X 457529 670700 925137 459450 554470 3067286 22323885 22155668 23054949 23943649 24076048 115554199 6411 6073 5815 6910 7123 32332 22787825 22832441 23985901 24410009 24637641 118653817 4200 10180 7550 4724 1850 28504 0 4200 10180 7550 4724 1850 28504 118625313 37113 41933 53462 39239 28900 200647 37113 41933 53462 39239 28900 200647 42720 24328 41364 49902 44718 203032 22867658 22898702 24080727 24499150 24711259 119057496 0.99640 0.99730 0.00170 0.00190 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2012 AMOUNT: $ 26,762. 2013 AMOUNT: $ 5,889. 2014 AMOUNT: $ 14,712. 2015 AMOUNT: $ 21,739. 2016 AMOUNT: $ 13,630. DISCOUNTS EARNED - 2012 AMOUNT: $ 15,958. 2013 AMOUNT: $ 18,439. 2014 AMOUNT: $ 26,652. 2015 AMOUNT: $ 28,163. 2016 AMOUNT: $ 31,088. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 341931 21625 16952 346604 373621 -14516 17174 341931 380327 10015 16721 373621 354168 42454 16295 380327 327175 34511 7518 354168 0.51250 0.11050 0.37700 0 0 166000 166000 16501805 8332911 8168894 4484271 3935721 548550 864310 864310 9747754 INTEREST RATE SWAP 84205 84205 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 85666 42532 43134 19636 25178 19547 85666 42532 43134 19636 25178 19547 64361 -21227 X X 0 0 0 0 0 0 0 0 0 WENDY FARGNOLI ADMINISTRATOR/ASST TREASUR 138536 0 0 0 0 0 16563 0 17494 0 172593 0 0 0 MARIO MACERA DIRECTOR OF FINANCE 125200 0 0 0 0 0 14009 0 17802 0 157011 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 1196589 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 MARIO MACERA, DIRECTOR OF FINANCE AND WENDY FARGNOLI, ASSISTANT TREASURER REVIEW THE FORM 990 PRIOR TO FILING. UPON REVIEW AND APPROVAL, THE RETURN IS SIGNED BY WENDY FARGNOLI AND FILED WITH THE IRS. IN THE EVENT THAT WENDY FARGNOLI IS NOT ABLE TO SIGN THE FORM 990 INFORMATION RETURN, MARIO MACERA IS AUTHORIZED TO DO SO. 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, SHE 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 118,139. 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 0 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 10 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 622332 CASH THE VILLA AT SAINT ANTOINE L 75000 CASH