2016-05-16T20:30:40-05:00 2015-06-30 990 2014-07-01 621136742 Alexian Village of Tennessee ALEX 4238860100 437 Alexian Way Signal Mountain TN 37377 Michael E Hambley PRESIDENT AND CEO 2016-05-16 2014 2016-08-17 19:52:53Z Robin Baschnagel 437 Alexian Way Signal Mountain TN 37377 25591982 false 0928 X www.alexianbrothershealth.org X 1983 TN To provide skilled nursing services to those in our Continuing Care Retirement community for the short term or long term.. 7 5 295 100 0 0 360563 136770 24231171 24697284 43989 187922 0 570006 24635723 25591982 0 0 0 0 7577237 8731000 0 0 0 15757816 17245000 23335053 25976000 1300670 -384018 74392458 87682964 30711171 43684210 43681287 43998754 Alecian Village of Tennessee ("AVT") carries out the healing mission of the Catholic Church whose corporate Member is Ascension Health Senior Care. 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 16813000 22369919 ALEXIAN VILLAGE OF TENNESSEE ("AVT") PROVIDES A CONTINUUM OF SERVICES TO RESIDENTS OF AVT (102,498 RESIDENT DAYS SERVED), ASSISTED LIVING SERVICES TO RESIDENTS OF ALEXIAN INN (7,208 DAYS SERVED), RESIDENTS OF MEMORY CARE (3,973 DAYS SERVED), AND RESIDENTS OF THE HEALTH CARE CENTER (36,044 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 2015, OVER $33,500 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. 1216000 2005251 ALEXIAN 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, 37.7 RESIDENTS WERE SERVED EACH DAY OF FY2015. 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. 602000 893963 ALEXIAN 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 OVER 35 SENIOR CITIZENS IN INDEPENDENT APARTMENTS (ON AVERAGE 35 PERSONS SERVED EACH DAY). 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. 18631000 true true false false false false false false false true 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 true false false true 91 0 true 295 true false false false false false false false false false false X 7 5 true false false false true true true true true false false true true true true true true false false false TN X Tim Booth 4237553437 250 East 10th Street Chattanooga TN 37402 ROBIN T BASCHNAGEL EX-OFFICIO MEMBER & PRESIDENT & CEO 50.00 1.00 X X 0 183636 3551 LINDA BENNETT DIRECTOR & SECRETARY/TREASURER 1.00 0 X X 0 0 0 ROBERT MAIN DIRECTOR & VICE CHAIRPERSON 1.00 0 X X 0 0 0 KATHLEEN PURI RN MSN DIRECTOR & CHAIRPERSON 1.00 0 X X 0 0 0 MIKE HAMBLEY EX-OFFICIO MEMBER & PRESIDENT & CEO 50.00 0 X X 0 0 0 JOSEPH BLASS DIRECTOR 1.00 0 X 0 0 0 MARK FREY TRUSTEE (END 4/15) 1.00 62.00 X 0 1938610 40093 BROTHER ANDREW THOME CFA DIRECTOR 1.00 0 X 0 0 0 TIM BOOTH DIRECTOR OF FINANCE 17.00 34.00 X 0 134323 13811 JOE GIRARDI CHIEF FINANCIAL OFFICER 1.00 68.00 X 0 139916 3997 GARY MOHN DIRECTOR 1.00 43.00 X 0 295169 22681 ROBERT K NORRIS DIRECTOR OF NURSING 40.00 0 X 103410 0 1233 GEORGE S NORTON ADMINISTRATOR 40.00 0 X 124545 0 1263 JIM LEWANDOWSKI FORMER KEY EMPLOYEE 0.00 0.00 X 0 136675 21163 227956 2828329 107793 2 true true false THE WESTON GROUP 2222 SULLIVAN TRAIL EASTON PA 18040 THERAPY SERVICE CONTRACTOR 912160 Lawler-Wood LLC 900 S Gay Street 1600 Riverview Tower Knoxville TN 37902 General Contractor Services 141597 2 X 136770 136770 Lifecare & Independent 623000 13506424 13506424 Skilled Nursing & Rehab 623000 8128928 8128928 Assisted Living Care 623000 2965499 2965499 Adult Day Care 624100 55622 55622 40811 40811 0 0 24697284 186079 186079 0 0 1843 0 0 1843 1843 1843 Beauty Shop 900099 150450 150450 Dietary 900099 93000 93000 Therapy 900099 10070 10070 316486 316486 0 0 570006 25591982 25267290 0 187922 X 6800000 5569000 1231000 102000 102000 1358000 3000 1355000 471000 401000 70000 2591000 2591000 8000 8000 26000 26000 6706000 6438000 268000 0 814000 762000 52000 3089000 2262000 827000 40000 6000 34000 50000 50000 3036000 3036000 165000 165000 Other 720000 154000 566000 0 0 0 0 25976000 18631000 7345000 0 42724 32213 0 0 981372 802253 0 0 0 0 81036 90251 84976 110555 81946878 7692912 69823314 74253966 0 198725 0 0 3180311 12393726 74392458 87682964 1791328 1842397 0 0 0 0 0 0 0 28919843 41841813 30711171 43684210 41369240 41555894 1853231 1984044 458816 458816 0 0 0 43681287 43998754 74392458 87682964 X -384018 -338641 1040126 X false true X true false X 78402 64503 542841 360563 136770 1183079 22598336 11453410 22454998 24231171 25269133 106007048 22676738 11517913 22997839 24591734 25405903 107190127 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 107190127 181137 153636 85477 43989 186079 650318 181137 153636 85477 43989 186079 650318 0 0 0 0 0 0 22857875 11671549 23083316 24635723 25591982 107840445 0.9940 0.9929 0.0060 0.0070 X Schedule A, Part III For the year ended 6/30/12, the organization filed a short period return due to a change of accounting period. Thus, the amounts in column 2011 of Schedule A reflect the tax year 1/1/2012 - 6/30/2012 activity. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 458816 53240 512056 458816 0 0 0 0 0 458816 465192 0 -6376 0 0 0 458816 464231 0 961 0 0 0 465192 511922 0 2309 0 50000 0 464231 0.0 1.0 0.0 false true true 1930000 1930000 67401557 5975693 61425864 7343702 1212717 6130985 5271619 504502 4767117 74253966 Other Assets Assets under Bond Agreements 190886 Restricted Funds 2442860 Other Long term Investments 9759980 12393726 Unamortized life entry fees 27730959 Resident Security Fees Reserve for outstanding insurance losses 40791 Resident personal funds Intercompany Debt with Ascension Health Alliance 12917443 Other 1152620 41841813 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Alexian Village of Tennessee: The 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, 2015. true true false false false false false false false ROBIN T BASCHNAGEL EX-OFFICIO MEMBER & PRESIDENT & CEO 0 156759 0 26877 0 0 0 0 0 3551 0 187187 0 0 MARK FREY TRUSTEE (END 4/15) 0 715750 0 1205360 0 17500 0 19895 0 20198 0 1978703 0 0 GARY MOHN DIRECTOR 0 234987 0 36718 0 23464 0 17500 0 5181 0 317850 0 0 JIM LEWANDOWSKI FORMER KEY EMPLOYEE 0 0 0 0 0 136675 0 0 0 21163 0 157838 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Alexian Brothers Health System, a related organization of Alexian Village of Tennessee through June 30, 2014 , uses the following methods to establish the compensation of the organization's CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Alexian Village of Tennessee TRANSFERRED MEMBERSHIP TO ASCENSION HEALTH SENIOR CARE d.b.a. ASCENSION SENIOR LIVING EFFECTIVE 7/1/14. ASCENSION SENIOR LIVING USES THE FOLLOWING METHODS. - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4a Severance or change-of-control payment The following individual listed in Schedule J received the referenced amount of change in control payments in calendar 2014. The payments under a change-of-control arrangement are made in connection with retirement that changed the terms of employment resulting from a change in control of the organization: Jim Lewandowski - $136,675 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ASCENSION HEALTH SENIOR CARE, D.B.A. ASCENSION SENIOR LIVING, OFFERS A SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN TO ALL EMPLOYEES WHO PARTICIPATE IN THE EXECUTIVE BENEFITS PROGRAM AND WHOSE COMPENSATION EXCEEDS THE IRS ALLOWABLE LIMIT FOR A QUALIFIED PENSION PLAN. THE PURPOSE OF THE PLAN IS TO RESTORE RETIREMENT BENEFITS THAT ARE RESTRICTED BECAUSE OF COMPENSATION LIMITS FOR THE EXECUTIVES. NEITHER CONTRIBUTIONS TO NOR DISTRIBUTIONS FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WERE MADE IN THE CURRENT YEAR. Form 990, Part VI, Line 15 Process for Determining Compensation IN DETERMINING COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL THE PROCESS PERFORMED BY ASCENSION HEALTH SENIOR CARE, A RELATED ORGANIZATION, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. 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. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS OF THE ORGANIZATION, THE PROCESS PERFORMED BY ASCENSION HEALTH SENIOR CARE, A RELATED ORGANIZATION, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS OF THE ORGANIZATION 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 BOARD MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Many of the persons listed in Part VII, Section A have a "business relationship" with each other by virtue of employment by Ascension Senior Living related entities - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders Alexian Village of Tennessee has a SINGLE CORPORATE MEMBER, ASCENSION HEALTH SENIOR CARE (AHSC). Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Alexian 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 stockholders ASCENSION HEALTH SENIOR CARE, D.B.A. ASCENSION SENIOR LIVING, 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 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board members are provided the Form 990 and management team members are available to answer any Board Member's questions. Form 990, Part VI, Line 12c Conflict of interest policy The organization's Conflict of Interest Policy is monitored as part of the system-wide procedures and not at the organizational level. The system-wide procedures are as follows: 1. At time of appointment and annually thereafter, all interested persons, including board and committee members, complete a disclosure statement which addresses actual or potential conflicts of interest. 2. The disclosure statement is done electronically and the return of the completed statement is a condition of continued appointment, employment, or participation with the organization. 3. All actual conflicts are investigated, and resolved by the chief governance officer and the corporate responsibility officer, with the results shared with the chief executive of the organization. 4. Periodic reviews are conducted by governance, compliance, and internal audit to ensure the organization is operating consistent with the policy and enforcing the policy's terms. 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 VII, Section B, Line 1 Explanation of Compensation paid to New Blue Construction New Blue Construction provided construction services. The payments made to New Blue Construction included both materials and labor. Form 990, Part VIII, Line 2f Other Program Service Revenue Other Resident Services - Total Revenue: 40811, Related or Exempt Function Revenue: 40811, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; - Total Revenue: , Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Transportation - Total Revenue: 3556, Related or Exempt Function Revenue: 3556, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Other - Total Revenue: 312930, Related or Exempt Function Revenue: 312930, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; - Total Revenue: , Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Physician Fees - Total Expense: 39000, Program Service Expense: 36000, Management and General Expenses: 3000, Fundraising Expenses: ; Professional Fees - Total Expense: 1378000, Program Service Expense: 1334000, Management and General Expenses: 44000, Fundraising Expenses: ; Purchased Services - Total Expense: 5289000, Program Service Expense: 5068000, Management and General Expenses: 221000, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Equity Transfer - 1040126; Ascension Health Alliance PO BOX 45998 ST LOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false Ascension Health PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE false Ascension Health Senior Care 12250 Weber Hill Road ST LOUIS MO 63127 431227406 PARENT COMPANY MO 501(c)(3 Type I Ascension Health false Alexian Village of Milwaukee Inc 9301 N 76th Street Milwaukee WI 53223 391351584 Continuing care retirement community WI 501(c)(3 9 Ascension Health Senior Care true Alexian Brothers Senior Neighbors 250 East 10th Street Chattanooga TN 37402 620646376 Supports the provision of community services for senior citizens TN 501(c)(3 7 Ascension Health Senior Care true Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 63116 431470362 Skilled nursing facility MO 501(c)(3 9 Ascension Health Senior Care true Seton Manor Inc 1000 Seton Drive Orwigsburg PA 17961 232960726 Skilled nursing facility PA 501(c)(3 9 Ascension Health Senior Care true Alexian Brothers Sherbrooke Village 4005 Ripa Avenue St Louis MO 63125 431592502 Skilled nursing facility MO 501(c)(3 9 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 9 Ascension Health Senior Care true Borgess Nursing Home Inc 3057 Gull Road Kalamazoo MI 49048 382555589 Skilled nursing facility MI 501(c)(3 9 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 9 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 9 Ascension Health Senior Care true St Catherine's Laboure Manor 1750 Stockton Street Jacksonville FL 32204 591878316 Skilled nursing facility FL 501(c)(3 9 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 9 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 9 Via Christi Villages Inc true Via Christi Village Hays Inc 2225 Canterbury Drive Hays KS 67601 202828680 Retirement Community KS 501(c)(3 9 Via Christi Villages Inc true Via Christi Village Manhattan Inc 2800 Willow Grove Road Manhattan KS 66502 481078862 Retirement Community KS 501(c)(3 9 Via Christi Villages Inc true Via Christi Village McLean Inc 777 N McLean Blvd McLean KS 67203 481247723 Retirement Community KS 501(c)(3 9 Via Christi Villages Inc true Via Christi Village Pittsburg Inc 1502 E Centennial Drive Pittsburg KS 66762 743070971 Retirement Community KS 501(c)(3 9 Via Christi Villages Inc true Cornerstone Assisted Living Inc 2622 W Centra Suite 100 Wichita KS 67203 481241079 Retirement Community KS 501(c)(3 9 Via Christi Villages Inc true Via Christi Villages Inc 2622 W Centra Suite 100 Wichita KS 67203 480559086 Management Company KS 501(c)(3 Type I Ascension Health Senior Care true Via Christi Village Georgetown Inc 1655 S Georgetown Georgetown KS 67218 481129325 Retirement Community KS 501(c)(3 9 Via Christi Villages Inc true false false true false false false false false false false false false false false false false true false false Live at Home Q 477256 FMV ALEXIAN BROTHERS COMMUNITY SERVICES Q 543385 FMV