2016-05-13T10:30:51-05:00 2015-06-30 410746749 CLIFTONLARSONALLENLLP 5001 SPRING VALLEY ROAD SUITE 600W DALLAS TX 75244 990 2014-07-01 760139802 ST DOMINIC VILLAGE STDO 7137418701 2401 HOLCOMBE BOULEVARD HOUSTON TX 77021 GRADY MULLINS CFO 7137418701 2016-05-12 1 MICHAEL SIEGEL P01587323 9723835700 2014 2016-08-17 19:52:53Z AMY SHIELDS 2401 HOLCOMBE BOULEVARD HOUSTON TX 77021 16079043 0 0928 X WWW.STDOMINICVILLAGE.ORG X 1998 TX CARING FOR OUR ELDERS WITH THE COMPASSION OF CHRIST. 18 16 159 20 0 0 1700192 2023933 12646702 13645796 5472 19568 1349301 342965 15701667 16032262 7372 0 0 0 6933942 6988811 0 0 556038 7343264 8354686 14284578 15343497 1417089 688765 17395296 17444808 10964639 10322176 6430657 7122632 X CARING FOR OUR ELDERS WITH THE COMPASSION OF CHRIST BY HONORING OUR BELIEF IN THE DIGNITY OF LIFE AND SERVING A COMPASSIONATE COMMUNITY. 0 0 8701030 9570093 SKILLED NURSING FACILITY (SNF) - OUR REHABILITATION AND NURSING CENTER OFFERS BOTH SHORT TERM AND LONG TERM SERVICES. WE HAVE MEDICARE AND MEDICAID CERTIFIED BEDS IN ADDITION TO ACCEPTING PRIVATE PAY AND HOSPICE RESIDENTS. 1786747 1932885 INDEPENDENT LIVING - OUR INDEPENDENT LIVING FACILITY HAS 120 ROOMS AVAILABLE ON A PRIVATE PAY BASIS ONLY. WE HAVE THREE LOCATIONS TO CHOOSE FROM FOR OUR INDEPENDENT ROOMS - CHARLOTTE HALL, DOROTHY HALL AND THE TOWER. 1736541 1774714 ASSISTED LIVING - OUR ASSISTED LIVING FACILITY HAS 48 ROOMS AVAILABLE ON A PRIVATE PAY BASIS ONLY. THE ROOMS ARE LOCATED IN THE TOP THREE FLOORS OF THE TOWER. THERE IS A FULL TIME NURSING STAFF THERE TO ASSIST THE RESIDENTS IN THIS FACILITY. 344327 334094 PRIEST RETIREMENT HOME - OUR PRIEST RETIREMENT FACILITY HAS 17 ROOMS AVAILABLE FOR RETIRED PRIESTS. WE HAVE A COOK THAT PREPARES ALL OF THEIR MEALS AND A DEACON THAT "MANAGES" THE PRIEST RETIREMENT HOME. 102083 34010 WARREN CHAPEL - THE CHAPEL IS LOCATED ON OUR CAMPUS AND OFFERS A PLACE OF WORSHIP FOR BOTH CATHOLICS AND OTHER DENOMINATIONS THAT LIVE HERE AT ST. DOMINIC VILLAGE. THE DAILY AND WEEKEND MASSES ARE OPEN TO THE PUBLIC. 446410 368104 12670728 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 54 0 159 1 0 0 0 0 0 1 1 0 0 0 0 X 18 16 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 1 1 0 X GRADY MULLINS 7137418701 2401 HOLCOMBE BLVD HOUSTON TX 77021 FRANK RIZZO CHAIR 2.00 X X 0 0 0 BEN C MAZZARA VICE CHAIR 2.00 X X 0 0 0 BERNARD L HEBINCK TREASURER 2.00 X X 0 0 0 BICHLAN N THAI SECRETARY 2.00 X X 0 0 0 KATHERINE BINGHAM BOARD MEMBER 2.00 X 0 0 0 JOHN M CONNOLLY BOARD MEMBER 2.00 X 0 0 0 TOM DALY BOARD MEMBER 2.00 X 0 0 0 JAMES JDAVIS BOARD MEMBER 2.00 X 0 0 0 AIMEE D GARCIA MD BOARD MEMBER 2.00 X 0 0 0 DAVID HESSEL BOARD MEMBER 2.00 40.00 X 0 167743 0 STEVEN G MARGET BOARD MEMBER 2.00 X 0 0 0 SR CAROL MAYES OP BOARD MEMBER 2.00 X 0 0 0 PHUNG NGO-BURNS BOARD MEMBER 2.00 X 0 0 0 REV THOMAS F RAFFERTY BOARD MEMBER 2.00 X 0 0 0 ROGER SAHNI BOARD MEMBER 2.00 X 0 0 0 REV MSGR GEORGE SHELTZ BOARD MEMBER 2.00 40.00 X 0 19378 0 PATRICK J STUDDERT BOARD MEMBER 2.00 X 0 0 0 JAMES A WATTS JR BOARD MEMBER 2.00 X 0 0 0 AMY SHIELDS CEO 40.00 X 146255 0 2223 RUTH STANLEY COO/ ADMINISTRATOR 40.00 X 163909 0 9662 GRADY MULLINS CFO 40.00 X 106385 0 6906 ROBBIE BRADFORD CNO 40.00 X 109403 0 7101 525952 187121 25892 4 0 1 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 JANITORIAL, LAUNDRY AND DIETARY SERVICES 2193830 SELECT REHABILITATION PO BOX 809056 CHICAGO IL 60680 THERAPY SERVICES 1106575 CHRISTIAN BROTHERS 1205 WINDHAM PARKWAY ROMEOVILLE IL 60446 HEALTH AND BENEFIT SERVICES 610650 3545 CONSULTING 11011 RICHMOND SUITE 600 HOUSTON TX 77042 IT CONSULTING SERVICES 178959 ROSEN & SPEARS 5075 WESTHEIMER SUITE 760 HOUSTON TX 77056 LEGAL CONSULTING 110000 5 38050 484899 1500984 2023933 PROGRAM SERVICE FEES 623000 13645796 13645796 13645796 19568 19568 90055 38050 46781 43274 43274 GAIN ON EARLY EXTINGUISHMENT OF L 525990 250000 250000 FOOD SALES AND INTERNAL CATERING 624210 25389 25389 OTHER REVENUE 623990 24302 24302 299691 16032262 13645796 0 362533 X 557276 230694 276203 50379 4992544 4048515 625289 318740 208788 161980 32733 14075 831370 689268 99319 42783 398833 312286 59841 26706 47550 47550 3508260 3029762 441345 37153 93130 13375 16056 63699 944744 907176 31489 6079 1047997 939513 103671 4813 17656 622 13825 3209 36176 1426 34750 227926 80989 146937 1217988 1147771 70217 230213 209764 20449 REPAIRS AND MAINTENANCE 592683 578255 14428 BAD DEBT 269140 269140 RECOGNITION EVENTS 142068 46476 60409 35183 OTHER EXPENSES 25936 3716 22220 -46781 -46781 15343497 12670728 2116731 556038 2377895 2741128 119847 509498 585568 27624684 13702929 14434603 13921755 73300 76510 17395296 17444808 966017 1428629 52618 9952688 8789628 45934 51301 10964639 10322176 X 5972821 6742386 398527 318633 59309 61613 6430657 7122632 17395296 17444808 688765 3210 0 X X 0 1 X 1 0 X 894274 1345793 1947365 1700192 1985883 7873507 12269729 11622847 11906490 12646702 13645796 62091564 122627 114357 105372 129209 128105 599670 13286630 13082997 13959227 14476103 15759784 70564741 0 0 0 70564741 82515 110417 151680 178569 19568 542749 82515 110417 151680 178569 19568 542749 42710 66054 52498 165956 49691 376909 13411855 13259468 14163405 14820628 15829043 71484399 0.98710 0.96420 0.00760 0.00780 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2010 AMOUNT: $ 16,850. 2011 AMOUNT: $ 17,846. 2012 AMOUNT: $ 6,600. 2013 AMOUNT: $ 72,966. 2014 AMOUNT: $ 24,302. FOOD SALES - 2010 AMOUNT: $ 25,860. 2011 AMOUNT: $ 48,208. 2012 AMOUNT: $ 45,898. 2013 AMOUNT: $ 92,990. 2014 AMOUNT: $ 25,389. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1362314 1362314 19927101 10027298 9899803 3356986 1500872 1856114 2978283 2174759 803524 13921755 ACCOUNTS PAYABLE TO THE ARCHDIOCESE 51301 51301 16082253 3210 46781 49991 16032262 0 16032262 15390278 46781 46781 15343497 0 15343497 PART IV, LINE 2B: THE ORGANIZATION HOLDS RESIDENT FUNDS IN A CUSTODIAL / TRUST ACCOUNT RECORDED ON ITS BALANCE SHEET. THOSE FUNDS ARE USED FOR THE BENEFIT OF EACH RESPECTIVE RESIDENT AS NEEDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT DONOR BENEFIT COSTS 46,781. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT DONOR BENEFIT COSTS 46,781. GOLF TOURNAMENT 100995 20250 80745 17811 11384 DINNER WITH BISHOP 27110 17800 9310 14651 2935 128105 38050 90055 32462 14319 46781 43274 X X 0 0 0 0 0 0 0 1 0 DAVID HESSEL BOARD MEMBER 0 167743 0 0 0 0 0 0 0 0 0 167743 0 0 RUTH STANLEY COO/ ADMINISTRATOR 148648 0 15261 0 0 0 9662 0 0 0 173571 0 0 0 PART I, LINE 7 THE ORGANIZATION PROVIDED A PERFORMANCE BASED BONUS TO THE COO / ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE CEO, THE OFFICERS OF THE BOARD OF DIRECTORS, AND THE CHAIR OF EACH COMMITTEE OF THE BOARD OF DIRECTORS. THE SPECIFIC DUTIES OF THE EXECUTIVE COMMITTEE INCLUDE, BUT ARE NOT LIMITED TO (I) RECOMMEND THE AGENDA FOR MEETINGS OF THE BOARD OF DIRECTORS; (II) COORDINATE THE WORK OF OTHER COMMITTEES, STAYING INFORMED ON PROPOSALS BEING PREPARED BY COMMITTEES AND WORKING WITH COMMITTEE CHAIRS TO SCHEDULE AND REVIEW PROPOSALS PRIOR TO PRESENTATION TO THE FULL BOARD OF DIRECTORS; (III) APPOINT CHAIRS OF STANDING AND AD HOC COMMITTEES; (IV) APPROVE POLICIES FOR OVERSIGHT AND GOVERNANCE OF THE ORGANIZATION; (V) OVERSEE MANAGEMENT OF COMMITTEES; (VI) REVIEW THE PERFORMANCE OF THE EXECUTIVE DIRECTOR ANNUALLY AND REPORT THE PERFORMANCE SUMMARY TO THE SOLE MEMBER; AND (VII) RECOMMEND TO THE BOARD OF DIRECTORS THE ANNUAL OPERATING BUDGET, STRATEGIC PLANS AND MAJOR FUNDRAISING ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ST. DOMINIC VILLAGE IS THE BISHOP OF THE ARCHDIOCESE OF GALVESTON-HOUSTON. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS ARE APPOINTED BY THE ARCHDIOCESE OF GALVESTON-HOUSTON'S SELECTION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE FOLLOWING RIGHTS AND RESPONSIBILITIES. (I) REMOVE ANY DIRECTOR, WITH OR WITHOUT CAUSE, AT ANY TIME; (II) APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS; (III) APPROVE THE INCURRENCE OF INDEBTEDNESS IN EXCESS OF $10,000 IN ANY ONE TRANSACTION, THE GRANTING OF ANY MORTGAGE OR SECURITY INTEREST IN PROPERTY TO SECURE INDEBTEDNESS, OR THE SALE, LEASE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE ORGANIZATION'S ASSETS; AND (IV) THE POWER TO HIRE AND DISMISS THE EXECUTIVE DIRECTOR, IN CONNECTION WITH WHICH THE MEMBER MAY APPOINT A COMMITTEE TO ASSIST IN THE SEARCH FOR AN EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 11 THE GOVERNING BODY OF ST. DOMINIC VILLAGE HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE. THE FINANCE COMMITTEE REVIEWS THE FORM 990 FOR ACCURACY AND PROVIDES A FORMAL RECOMMENDATION TO THE BOARD OF DIRECTORS TO FILE. THE BOARD OF DIRECTORS ACCEPTS THE COMMITTEE'S RECOMMENDATION, AND THE FORM 990 IS FILED WITH THE IRS. A COPY OF THE FORM 990 IS MADE AVAILABLE TO MEMBERS OF THE BOARD OF DIRECTORS UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT 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 ONE OR MORE OF ITS TAX EXEMPT PURPOSES. EACH BOARD MEMBER IS REQUIRED TO DISCLOSE ANY CONFLICTS. IF A CONFLICT IS BROUGHT TO THE BOARD'S ATTENTION OR IT BECOMES AWARE OF A POTENTIAL CONFLICT, THE BOARD MEMBER MUST REMOVE HIMSELF/HERSELF FROM THE MEETING WHILE INDEPENDENT BOARD MEMBERS VOTE ON THE TRANSACTION OR ARRANGEMENT. THE DISINTERESTED BOARD MEMBERS DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15 ST. DOMINIC VILLAGE'S BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION OF TOP MANAGEMENT AND KEY EMPLOYEES. A MARKET COMPENSATION STUDY THAT IS REVIEWED BY THE EXECUTIVE COMMITTEE IS USED TO HELP DETERMINE THE COMPENSATION OF THE OFFICERS AND OTHER KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 ST. DOMINIC VILLAGE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 3,029,762. MANAGEMENT AND GENERAL EXPENSES 441,345. FUNDRAISING EXPENSES 37,153. TOTAL EXPENSES 3,508,260. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCESS IS CONSISTENT WITH PRIOR YEARS. ARCHDIOCESE OF GALVESTON-HOUSTON 1700 SAN JACINTO HOUSTON TX 77002 746018777 RELIGIOUS TX 501(C)(3) 1 N/A 0 0 0 1 0 1 0 0 0 0 0 1 0 0 1 0 1 1 0 0