2016-05-16T11:06:46-05:00 2015-06-30 350921680 CROWE HORWATH LLP 3815 River Crossing Parkway Suite 300 Indianapolis IN 462400977 990 2014-07-01 352024406 Saint Anne Home and Retirement Community SAIN 2604845555 1900 Randallia Drive Fort Wayne IN 46805 Michael S Rorick CFO 2016-05-16 true Rachel Spurlock P00520729 3175698989 2014 2016-08-17 19:52:53Z Michael S Rorick 1900 Randallia Drive Fort Wayne IN 46805 19023472 false 0928 X www.saintannehome.com X 1997 IN It is the mission of Saint Anne Home and Retirement Community to provide a safe, healthy and loving environment in which Senior's needs can be met, friendships can be formed and memories can be shared. 17 15 445 125 0 0 96548 106307 16567774 17280586 134296 191787 309588 306489 17108206 17885169 475 0 0 0 10877180 11090652 0 0 0 5805612 6118558 16683267 17209210 424939 675959 13240391 13767630 3642870 3568979 9597521 10198651 It is the mission of Saint Anne Home and Retirement Community (Saint Anne Home) to provide a safe, healthy and loving environment in which Senior's needs can be met, friendships can be formed and memories can be shared. (Continued in Schedule O) false false 13381992 14266107 NURSING, MEDICAL, AND ANCILLARY SERVICES - SAINT ANNE HOME AND RETIREMENT COMMUNITY (SAINT ANNE HOME) OPERATES A 166 BED NURSING FACILITY PROVIDING A FULL SPECTRUM OF QUALITY CARE INCLUDING PRIVATE REHABILITATION SUITES AND ALZHEIMER'S DEMENTIA CARE. EACH RESIDENT HAS AN INDIVIDUALIZED PROGRAM DESIGNED BY AN INTERDISCIPLINARY TEAM. A FEW OF THE MANY SERVICES PROVIDED INCLUDE: MEDICATION ADMINISTRATION AND MONITORING; ASSISTANCE WITH BATHING; TRANSPORTATION TO MEALS AND ACTIVITIES; AND ASSISTANCE WITH DRESSING. CERTIFIED NURSING ASSISTANTS AND LICENSED NURSES WORK AS A TEAM TO HELP EACH RESIDENT REACH AND MAINTAIN THEIR HIGHEST LEVEL OF FUNCTIONING. SERVICES WERE PROVIDED FOR 53,832 PATIENT DAYS WITH AN AVERAGE OCCUPANCY OF 89.38% DURING THE FISCAL YEAR ENDED JUNE 30, 2015. (CONTINUED IN SCHEDULE O) 2652787 3014479 RESIDENTIAL SERVICES - SAINT ANNE HOME AND RETIREMENT COMMUNITY (SAINT ANNE HOME) OFFERS 97 INDEPENDENT AND RESIDENTIAL LIVING UNITS FOR PEOPLE WHO ARE ABLE TO CARE FOR THEMSELVES AND THEIR APARTMENTS. ACCORDING TO THE CRITERIA, RESIDENTS WHO BECOME UNABLE TO FUNCTION WILL BE EVALUATED FOR ASSISTED LIVING. SERVICES PROVIDED INCLUDE MEALS, ACTIVITIES AND RELIGIOUS SERVICES. SAINT ANNE RETIREMENT COMMUNITY RESIDENTIAL LIVING UNITS PROVIDED 30,371 PATIENT DAYS DURING THE YEAR ENDED JUNE 30, 2015. 16034779 true true false true false false false false false false true true false false true true true false false false false false false false false false false false false false false false false false false false true false false false false false false true false false false true 9 0 true 445 true false false false false false false false false false false X 17 15 true false false false true true true true true false false true true true true true true false false false IN X Michael S Rorick CFO 2604845555 1900 RANDALLIA DRIVE Fort Wayne IN 46805 Monsignor John Suelzer Corporate Officer 1.00 X X 0 0 0 Deacon Jim Fitzpatrick Corporate Officer 1.00 X X 0 0 0 BOB NICHOLAS CHAIRMAIN OF THE BOARD(PRESIDENT & VP OF SAINT ANNE) 1.00 X X 0 0 0 MARK ANDORFER TREASURER OF THE BOARD 1.00 X X 0 0 0 MICHAEL Herald Vice President 1.00 X X 0 0 0 MOST REVEREND KEVIN C RHOADES Corporate Officer 1.00 40.00 X X 0 22665 0 MICHAEL Dahm Director 1.00 X 0 0 0 NANCY O'Brien Director 1.00 X 0 0 0 JOSEPH RYAN Director 1.00 40.00 X 0 91383 0 FRED Forte Director 1.00 X 0 0 0 BEN Miles Director 1.00 X 0 0 0 ED Welling Director 1.00 X 0 0 0 MICHAEL Isenberg Director 1.00 X 0 0 0 TOM Dixon Director / Legal Advisor 1.00 X 0 0 0 DANIEL Kohnen DIRECTOR 1.00 X 0 0 0 NICK Ciocca Director 1.00 X 0 0 0 Carolyn Tyndall Director - Partial Year 1.00 X 0 0 0 Marita Marquardt Director - Partial Year 1.00 X 0 0 0 Sr Marilyn Oliver Director 1.00 X 0 0 0 DAVID Deffenbaugh Administrator 40.00 X 74859 0 4127 74859 114048 4127 0 false false false SELECT REHABILITATION PO BOX 809056 CHICAGO IL 606809056 THERAPY SERVICES 866288 1 X 0 0 0 0 0 106307 0 106307 NURSING AND MEDICAL SERVICES 623000 10413797 10413797 ANCILLARY SERVICES 623000 3852310 3852310 RESIDENTIAL SERVICES 623000 2960169 2960169 ADULT DAY SERVICES 623000 54310 54310 0 0 0 0 17280586 45671 45671 0 0 1284419 1138303 146116 0 146116 146116 DINING/VENDING SERVICES 722210 250018 250018 LAUNDRY/TELEPHONE SERVICES 812300 35104 35104 THERAPY SUPPLIES 900099 2419 2419 18948 0 0 18948 306489 17885169 17280586 0 498276 X 78986 78986 8427413 8078517 348896 453068 421136 31932 1464162 1247819 216343 667023 621067 45956 0 0 5406 5406 44274 44274 0 0 7476 7476 2013255 1915110 98145 0 75496 75496 57600 57600 412482 328057 84425 19319 19319 49867 49867 601942 601942 27139 27139 MEDICAL & OTHER SUPPLIES 1941647 1868532 73115 PROVIDER TAXES 788874 788874 RESIDENT RELATIONS 49531 49531 MISCELLANEOUS 24250 24250 0 0 0 0 17209210 16034779 1174431 0 0 0 1300 1448 1240031 1962720 1411112 1281286 0 0 0 213897 236814 94489 87454 17496901 10456443 7152629 7040458 2505274 2573694 0 621659 583756 13240391 13767630 1393194 1614700 1920000 1640000 -156 -154 0 329832 314433 3642870 3568979 X 9597521 10198651 9597521 10198651 13240391 13767630 X 675959 -97983 0 0 0 23154 X false true X true false X 127477 290030 81559 96548 106307 701921 14914596 15067777 15663727 16567774 17280586 79494460 309304 263282 362803 309588 306489 1551466 15351377 15621089 16108089 16973910 17693382 81747847 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 81747847 31505 31524 17624 32098 45671 158422 31505 31524 17624 32098 45671 158422 0 0 0 0 0 0 15382882 15652613 16125713 17006008 17739053 81906269 0.9981 0.9980 0.0019 0.0020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1632 1632 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE ORGANIZATION INDIRECTLY INFLUENCED LEGISLATION THROUGH ITS ANNUAL DUES PAID TO LEADING AGE AND LEADNG AGE INDIANA. FOR THE YEAR ENDING 6/30/15, 2.8% OF THE LEADNG AGE DUES, 8.1% OF LEADING AGE INDIANA AND 2.98% OF CATHOLIC HEALTH ASSO. DUES WERE USED FOR LOBBING PURPOSES. 13593335 7579813 6013522 222797 125146 97651 3409527 2651549 757978 271242 99935 171307 7040458 Northern Trust pooled investments 2573694 F 2573694 Security Deposits 241250 Other liabilities 44903 Residents council funds 5804 Fair value adjustment on interest rate swap 22476 314433 X 17802864 -97983 23154 -74829 17877693 7476 0 7476 17885169 17201734 0 0 17201734 7476 0 7476 17209210 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Current accounting standards require the organization to disclose the amount of potential benefit or obligation to be realized as a result of an examination performed by a taxing authority. For the years ended June 30, 2015 and 2014, management has determined that the organization does not have any tax positions that result in any uncertainties regarding the possible impact on the organization's financial statements. The uncertain tax positions are not expected to change in the next 12 months. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 UNREALIZED GAIN ON INTEREST RATE SWAP AGREEMENT - 23154 ANNE NICHOLAS SPOUSE (BOB NICHOLAS) IS A BOARD MEMBER 11766 EMPLOYEE COMPENSATION false Form 990, Part III, Line 1 ORGANIZATION'S MISSION (CONTINUED FROM PART III) SAINT ANNE HOME IS A NOT-FOR-PROFIT CHARITABLE CORPORATION ORGANIZED UNDER THE ROMAN CATHOLIC CHURCH, DIOCESE OF FORT WAYNE - SOUTH BEND TO PROVIDE NONSECTARIAN SERVICES TO MEET HUMAN NEEDS. SAINT ANNE HOME PROVIDES THE HIGHEST QUALITY CARE TO ALL THOSE ENTRUSTED TO US. THIS IS DONE IN A CHRISTIAN ATMOSPHERE WITH LOVE AND CONCERN FOR THE INDIVIDUAL, AND WHERE THE SPECIAL NEEDS OF EACH RESIDENT ARE RESPECTED AND MET. SINCE ITS OPENING, SAINT ANNE HOME HAS BECOME THE BENCHMARK FOR HIGH-QUALITY HEALTHCARE IN FORT WAYNE. STARTING AS A NURSING HOME, OVER THE YEARS, SAINT ANNE HOME HAS ADDED 103 APARTMENTS TO ITS CAMPUS AND 16 REHAB SUITES. CURRENTLY, WE HAVE THE ABILITY TO SERVE 165 NURSING HOME RESIDENTS AND 168 RESIDENTIAL CARE RESIDENTS. WHEN YOU WALK IN ANY ENTRANCE TO SAINT ANNE'S, A WARM FEELING OF HOME EMBRACES YOU. WE TREAT EACH OF OUR RESIDENTS AS FAMILY, AND WE WANT TO MEET THE NEEDS AND EXPECTATIONS OF EACH RESIDENT. Form 990, Part III, Line 4a NURSING, MEDICAL, AND ANCILLARY SERVICES (CONTINUED FROM PART III) SAINT ANNE HOME ALSO PROVIDES ADULT DAY SERVICES FOR OLDER ADULTS WHO ARE UNABLE OR UNCOMFORTABLE STAYING HOME ALONE THROUGHOUT THE DAY. THESE PROGRAMS INCORPORATE A SOCIAL MODEL AND MEDICAL SUPPORT FOR THE ADULTS WE SERVE. THE ATMOSPHERE PROVIDES A SAFE, CARING ENVIRONMENT WHERE PARTICIPANTS CAN SOCIALIZE, PARTICIPATE IN THERAPEUTIC ACTIVITIES AND RECEIVE SUPPORT SERVICES AND HEALTH MONITORING. THESE PROGRAMS OFFER FAMILIES AND CAREGIVERS DAILY RESPITE FOR THE DEMANDS OF 24-HOUR CARE. Form 990, Part VI, Line 15b PROCESS USED TO ESTABLISH COMPENSATION FOR OTHER OFFICERS THE ORGANIZATION DOES NOT HAVE ANY OTHER COMPENSATED OFFICERS; THEREFORE, THIS QUESTION HAS BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS. Form 990, Part VI, Line 15a PROCESS USED TO ESTABLISH COMPENSATION FOR TOP MANAGEMENT OFFICIAL ANNUALLY, THE ADMINISTRATOR'S PERFORMANCE AND COMPENSATION ARE REVIEWED BY THE PRESIDENT AND VICE PRESIDENT OF THE BOARD OF DIRECTORS. DURING THE REVIEW PROCESS, THE EXECUTIVE COMMITTEE COMPLETES AN EVALUATION WITH INPUT FROM THE DIOCESE OF FORT WAYNE-SOUTH BEND DIRECTORS THAT SIT ON THE SAINT ANNE HOME AND RETIREMENT COMMUNITY BOARD. THE EXECUTIVE COMMITTEE LOOKS AT THE PAY STRUCTURE OF THE DIOCESE OF FORT WAYNE-SOUTH BEND, A SIMILAR ORGANIZATION, AND ALSO SPEAKS WITH OUR INDEPENDENT AUDITORS FOR INFORMATION REGARDING INDUSTRY TRENDS. THEY ALSO BASE THEIR FINAL DECISION ON THE RATE OF INCREASE SET BY THE BOARD OF DIRECTORS FOR SAINT ANNE HOME. A COPY OF THE ADMINISTRATOR'S REVIEW, ALONG WITH A LETTER FROM THE BOARD PRESIDENT, IS GIVEN TO HUMAN RESOURCES AND THE CONTROLLER AT THE DIOCESE. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MEETING MINUTES AND WAS LAST COMPLETED DURING FYE 06/30/ 2015. Form 990, Part VI, Line 1a Delegate broad authority to a committee Bylaws Article VI, Committees: 6.02(b) Executive Committee: There shall be an executive committee of the Board consisting of the President, Vice-President, Secretary and Treasurer and three (3) additional persons, one of whom shall be a Member of the Corporation. The duties of the Executive committee shall be: 1) To handle any administrative matter delegated to the Committee by the Board. 2) To exercise the authority of the Board between meetings and to report back to the Board at the next meeting on all considerations, decision and recommendations. 3) To be responsible for the annual evaluation of the St. Anne Home Administrator. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Bob Nicholas - Family relationship, Ed Welling - Business relationship, Nick Ciocca - Business relationship, Joe Ryan - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders The organization has three members, the Diocesan Bishop of the Diocese of Fort Wayne-South Bend, Inc., and two other persons designated by the Diocesan Bishop. The three members are ex-officio members of the board of directors; these ex-officio members have the right to vote as directors. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The directors (who are not also members of the organization) are elected by a majority vote of the members and serve at the sole discretion of the members. Any director may be removed with or without cause or notice by a majority vote of the members at any time. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's members have the following powers: approval by majority vote of the board of directors' proposal to dissolve the organization; amendment or repeal of bylaws and adoption of amended bylaws; authorization of any officer, the administrator, or other corporate agents to enter into contracts or to execute any contracts in the name of and on behalf of the organization; and consultation with the board of directors concerning the appointment, retention, and termination of the administrator. Form 990, Part VI, Line 11b Review of form 990 by governing body A final draft of the full Form 990, including all applicable schedules, is reviewed by management prior to filing with the IRS. A copy of the full Form 990, including all applicable schedules, is then provided to each member of the governing body prior to its filing with the IRS. Form 990, Part VI, Line 12c Conflict of interest policy Annual disclosure is provided to each board member and administrative staff. Each person completes an annual conflict of interest questionnaire. Once the questionnaires are completed, the Administrative Assistant reviews the responses and determines whether or not there are any potential conflicts of interest. If there is a potential conflict of interest, the President, Treasurer and Administrator review the corresponding issue and determine if there is an actual conflict of interest. If an actual conflict of interest is determined to exist, that person is excluded from any discussions concerning the conflicting issue and is not permitted to vote on any decisions regarding the conflicting issue. Any purchases and/or bidding proposals are also reviewed for any potential conflicts of interest prior to submitting bids or making purchases. The Controller attends the board meetings as a guest to ensure that compliance with these guidelines is followed. Form 990, Part VI, Line 19 Required documents available to the public The organization's governing documents, conflict of interest policy, and financial statements are made available to the public upon request. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Misc Revenue - Total Revenue: 9645, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 9645; Barber/Beauty Shop - Total Revenue: 9303, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 9303; Form 990, Part IX, Line 11g Other Fees CONSULTING - Total Expense: 24180, Program Service Expense: 21643, Management and General Expenses: 2537, Fundraising Expenses: ; LAB SERVICES - Total Expense: 29744, Program Service Expense: 29744, Management and General Expenses: , Fundraising Expenses: ; THERAPY SERVICES - Total Expense: 1407329, Program Service Expense: 1407329, Management and General Expenses: , Fundraising Expenses: ; CONTRACT LABOR - Total Expense: 514224, Program Service Expense: 418616, Management and General Expenses: 95608, Fundraising Expenses: ; PROFESSIONAL FEES - Total Expense: 8788, Program Service Expense: 8788, Management and General Expenses: , Fundraising Expenses: ; MEDICAL DIRECTOR - Total Expense: 28990, Program Service Expense: 28990, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Unrealized Gain in Interest rate swap Agreement - 23154; DIOCESE OF FORT WAYNE-SOUTH BEND PO BOX 390 FORT WAYNE IN 46801 350876373 RELIGIOUS ORDER IN 501(c)(3 1 NA false false false false false false false false false false true true false false false false false false false false