2015-05-13T13:30:00-05:00 2014-06-30 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 606064301 990 2013-07-01 431592502 Alexian Brothers Sherbrooke Village ALEX 3145441111 4005 Ripa St Louis MO 63125 C Michael Roth President 3145441111 2015-05-12 1 Laura Gillespie P00855604 3124861000 2015-05-06 2013 2016-02-25 16:41:14Z C Michael Roth 4005 Ripa St Louis MO 63125 16516497 0 0928 X www.alexianbrothershealth.org X 1991 MO Skilled Nursing Facility 7 4 365 45 0 0 10814 38752 14582652 15744486 561983 586966 67969 146293 15223418 16516497 0 0 0 0 6783673 7372254 0 0 0 5932507 7291883 12716180 14664137 2507238 1852360 40210195 42980216 1009269 964324 39200926 42015892 X Alexian Brothers Sherbrooke Village ("ABSV") carries out the healing mission of the Catholic Church through the Alexian Brothers ministry by identifying and developing effective responses to the health and housing needs of those we are called to serve. 0 0 13808431 15823486 Skilled Nursing Facility - Inspired by the healing mission of the Alexian Brothers to the elderly, ABSV provides continuum of care to residents that maximizes dignity and independence. Rooted in the Catholic tradition of caring, the staff is committed to promoting the well being of those we serve through the delivery of quality care. The facility has 227 beds with an average occupancy of 183. In 2014, 5,785 days of care were provided to Medicaid recipients; 7,546 days of care were provided to Medicare recipients. Although reimbursement for services rendered is critical to the operations and stability of the organization, as a charitable organization, it is recognized that not all persons possess the ability to purchase essential services needed for care and our mission is to serve the community (See Schedule O) with respect to providing health care services. The cost of charity care provided was $187,519; and they also gave back to the community $139,960 in other types of programs and services, serving over 11,500 individuals. 13808431 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 39 0 1 365 1 0 0 0 0 0 0 0 0 0 0 X 7 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Joseph Girardi 3147293500 12250 Weber Hill Road Suite 200 St Louis MO 63127 Mike Roth Ex-Officio Member and President/CEO 50.00 1.00 X X 0 216430 68534 Alec Blanc Director and Chairperson 1.00 1.00 X X 0 0 0 Barbara Prosser Director and Vice Chairperson 1.00 1.00 X X 0 0 0 Charles Gulas Director and Treasurer 1.00 1.00 X X 0 0 0 Gary Mohn start 114 Director and Secretary 1.00 50.00 X X 0 248477 58314 John Turongian end 114 Secretary 1.00 50.00 X X 0 259070 48066 Brother Jeffrey Callender CFA Director 1.00 1.00 X 0 0 0 Mark Frey Ex-Officio Member 1.00 50.00 X 0 1498371 49865 Peggy Randell Director of Finance 25.00 25.00 X 0 113714 10286 Joe Girardi start 614 Chief Financial Officer 1.00 50.00 X 0 0 0 Ken Marx end 114 Chief Financial Officer 1.00 50.00 X 0 190506 42107 Donna Gauthier Assistant Secretary 1.00 40.00 X 0 74489 15715 Scott Peterson Vice President - Human Resources 1.00 50.00 X 0 342755 38484 Jim Lewandowski Former Key Employee 0.00 0.00 X 0 722305 15727 0 3666117 347098 0 1 1 0 TouchPoint Support Services PO Box 102289 Atlanta GA 303682289 Dietary/Environmental Services 2021182 Alexian Brothers Health System 3040 W Salt Creek Ln Arlington Heights IL 60005 Management Services 920076 United Healthcare Insurance Co 22561 Network Place Chicago IL 60673 Employee Health Insurance 275482 Ameren UE PO Box 88068 Chicago IL 606801068 Electric 229388 Atlas Restoration 820 Sun Park Dr St Louis IL 63026 Remodeling 229388 6 38752 38752 Skilled Nursng Service 623000 9312155 9312155 Medicare/Medicaid 623000 4270693 4270693 Residential Care Srvcs 623000 2160093 2160093 Other Revenue 900099 1545 1545 15744486 586966 586966 Claim Settlement 900099 79000 79000 Barber/Beauty 900099 48024 48024 Guest & Employee Meals 722210 13891 13891 5378 5378 146293 16516497 15823486 0 654259 X 6113236 6025344 87892 105930 104407 1523 705597 695565 10032 447491 413884 33607 6575 6575 -1541 -1541 2230622 2207860 22762 57892 57892 196928 134303 62625 234184 234184 457951 457951 16847 7244 9603 2728 963 1765 537962 537962 868053 843398 24655 39406 39406 Management Fees 1317864 1093163 224701 Food & Medical Supplies 934164 916164 18000 Provider Bed Taxes 347194 347240 -46 Purchased Svcs - Other 8580 8580 36474 14403 22071 14664137 13808431 855706 0 76740 133417 1570938 1508892 28402 16106 152722 29484 26743911 1806544 25430178 24937367 12878960 16247532 72255 107418 40210195 42980216 970645 921862 38624 42462 1009269 964324 X 39148459 41962425 52467 53467 39200926 42015892 40210195 42980216 1852360 962606 0 X 0 1 X 1 0 X 27468 13684 54759 10814 38752 145477 10762099 10916955 5750444 14582653 15823486 57835637 10789567 10930639 5805203 14593467 15862238 57981114 0 0 0 57981114 336885 643515 495017 561983 586966 2624366 336885 643515 495017 561983 586966 2624366 67969 67293 135262 11126452 11574154 6300220 15223419 16516497 60740742 0.95460 0.97450 0.04320 0.02430 X Schedule A, Part III, Line 12, Explanation of Other Income: Barber/Beauty Guest Employee Meals Vending Revenue All Other Revenue 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 - 6/03/2012 activity. Prior balances have been rolled backward. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7017 7017 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to trade association of senior centers that is specifically allocable for lobbying. Alexian Brothers Sherbrooke Village does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 1574116 1574116 21936354 1167226 20769128 2498067 570752 1927315 735374 68566 666808 24937367 Interest in Investments held by Ascension Health Alliance 16247532 F 16247532 Outstanding Reserve for Insurance Losses 34216 Due to Affiliates - Alexian Brothers Senior Ministries 7322 Due to Affiliates - Alexian Brothers Health System 924 42462 X Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Alexian Brothers Sherbrooke Village: The System accounts for uncertainty in income tax positions 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, 2014. 1 1 0 0 0 0 0 0 0 Mike Roth Ex-Officio Member and President/CEO 0 178139 0 28697 0 9594 0 35393 0 33141 0 284964 0 9594 Gary Mohn start 114 Director and Secretary 0 199745 0 34606 0 14126 0 28332 0 29982 0 306791 0 14126 John Turongian end 114 Secretary 0 222982 0 20058 0 16030 0 23254 0 24812 0 307136 0 16030 Mark Frey Ex-Officio Member 0 712178 0 693941 0 92252 0 14702 0 35163 0 1548236 0 74752 Ken Marx end 114 Chief Financial Officer 0 175708 0 10027 0 4771 0 14158 0 27949 0 232613 0 0 Scott Peterson Vice President - Human Resources 0 302795 0 39960 0 0 0 14311 0 24173 0 381239 0 0 Jim Lewandowski Former Key Employee 0 0 0 0 0 722305 0 0 0 15727 0 738032 0 722305 Part I, Line 3 Alexian Brothers Health System, a related organization of Alexian Brothers Sherbrooke Village, uses the following methods to establish the compensation of the organization's CEO/Executive Director: - Compensation committee, - Independent compensation consultant, - Form 990 of other organizations, - Compensation survey or study, and - Approval by the board or Compensation Committee. Part I, Line 4a: The following individual listed in Schedule J received the referenced amount of change in control payments in calendar 2013. 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 - $689,832 Part I, Line 4b: Alexian Brothers Health System 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. No distributions from the supplemental nonqualified retirement plan were made in the current year. Form 990, Part VI, Section A, line 2 John Turongian, Mike Roth, Mark Frey, Donna Gauthier, Scott Peterson, Gary Mohn, Ken Marx, and Joe Girardi have a business relationship due to joint employment by a common health system entity. Form 990, Part VI, Section A, line 6 Alexian Brothers Sherbrooke Village has two classes of corporate members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Senior Ministries (the "Area Member"). Form 990, Part VI, Section A, line 7a Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Brothers Sherbrooke Village. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Alexian Brothers Sherbrooke Village's financial information or corporation as a whole are subject to approval by the National Member, Alexian Brothers Health System. Form 990, Part VI, Section B, line 11 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, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs 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 its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's CEO, Executive Director, or top management official, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Compensation Committee of the Board of Governors of Alexian Brothers Health System reviewed and approved the compensation. In the review of the compensation, the CEO, Executive Director, or top management official were compared to individuals at other similarly situated organizations that hold the same or a similar title. During the review and approval of the compensation, the documentation of the decision was recorded in the Compensation Committee minutes. The individual was not present when his compensation was decided. In determining compensation of other officers or key employees of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were compared to other similarly situated organizations' employees that hold the same or similar title. During the review and approval of the compensation by the Compensation Committee, documentation of the decision was recorded in the minutes. Form 990, Part VI, Section C, line 19 The financial statements of Alexian Brothers Sherbrooke Village are available through the National Reporting Municipal Services Information Repository (NRMSIR). Conflicts of Interest statements and the governing documents of Alexian Brothers Sherbrooke Village are not made available to the public. Form 990, Part IX, line 11g Purchased Services Dietary - Labor: Program service expenses 821,804. Management and general expenses 0. Fundraising expenses 0. Total expenses 821,804. Purchased Services Dietary - Supplies: Program service expenses 694,303. Management and general expenses 0. Fundraising expenses 0. Total expenses 694,303. Purchased Services Housekeeping - Labor: Program service expenses 500,809. Management and general expenses 0. Fundraising expenses 0. Total expenses 500,809. Purchased Services Housekeeping - Supplies: Program service expenses 62,514. Management and general expenses 0. Fundraising expenses 0. Total expenses 62,514. Purchased Services: Program service expenses 75,851. Management and general expenses 11,726. Fundraising expenses 0. Total expenses 87,577. Purchased Services - Other: Program service expenses 52,579. Management and general expenses 11,036. Fundraising expenses 0. Total expenses 63,615. Form 990, Part XII, Line 2b - Audit Disclosure: The financial statements of Alexian Brothers Sherbrooke Village were audited on a consolidated basis. The Audit Committee of the Board of Governors of Alexian Brothers Health System has been delegated the responsibility to oversee the audited financial statements and the selection of the independent accountants that audit the financial statements. Ascension Health Alliance PO Box 45998 St Louis MO 631455998 453358926 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 60005 363260495 Supports provision of healthcare services for related corporations IL Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Alexian Brothers Bonaventure House 825 Wellington Avenue Chicago IL 60657 363527899 Housing and supportive care services for persons with HIV/AIDS IL Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Health System Inc Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 60005 363801585 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Brothers Specialty Group 3040 W Salt Creek Lane Arlington Heights IL 60005 800710751 Specialty physician practice group IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 941530037 Acute care hospital (sold in 1998) TX Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights IL 60005 364484290 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 431295333 HUD housing MO Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights IL 60005 363276552 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Village of Milwaukee Inc 9301 N 76th Street Milwaukee WI 53223 391351584 Continuing care retirement community WI Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Community Services 425 Cumberland Street Suite 110 Chattanooga TN 37404 364344423 Provides comprehensive & coordinated community based services IL Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Senior Neighbors 250 East 10th Street Chattanooga TN 37402 620646376 Supports the provision of community services for senior citizens TN Section 501(c)(3) Schedule A, Line 7 Alexian Brothers Health System 1 Alexian Village of Tennessee 437 Alexian Way Signal Mountain TN 37377 621136742 Continuing care retirement community TN Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Elderly Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 392039667 Community outreach WI Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 63116 431470362 Skilled nursing facility MO Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363308965 Owns or leases properties where healthcare services are delivered IL Section 501(c)(2) N/A Alexian Brothers Health System 1 Alexian Brothers Center for Mental Health 3436 N Kennicott Avenue Arlington Heights IL 60004 363045007 Outpatient community mental health services IL Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Behavioral Health Hospital 1650 Moon Lake Blvd Hoffman Estates IL 60194 364251848 Behavioral health hospital IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 St Alexius Medical Center 1555 Barrington Road Hoffman Estates IL 60194 364251846 Acute care hospital IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights IL 60005 364336931 Physician services IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village IL 60007 362596381 Acute care hospital TX Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Rehabilitation Services LLC 935 Beisner Road Elk Grove Village IL 60007 300221481 Rehabilitation hospital IL N/A Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 870783164 Provision of NeuroMeg services IL N/A Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights IL 60005 363853289 Medical office building IL N/A Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 363978153 Manages managed care contracts DE N/A Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 861115516 Ownership of Gamma Knife IL N/A St Alexius Center for Sleep Health LLC 1300 S Main Street Lombard IL 60148 205876371 Operation of sleep lab IL N/A Thelen Corporation 3040 West Salt Creek Lane Arlington Heights IL 60005 363266316 Owns/leases property; joint venture partner IL N/A C 0 Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363853286 Messenger model IPA IL N/A C 0 Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 943465394 Tax credit financed housing IL N/A C 0 Alexian Village of Elk Grove 3040 West Salt Creek Lane Arlington Heights IL 60005 352211303 Tax credit financed housing IL N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 Alexian Brothers Health System P 1458001 FMV Alexian Brothers Senior Ministries P 224701 FMV Alexian Brothers Community Services Q 105623 FMV Alexian Brothers Senior Ministries R 65465 FMV Alexian Brothers Health System S 1453613 FMV