2015-05-14T17:43:20-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2013-07-01 481241079 Cornerstone Assisted Living Inc CORN 3169465215 2622 W Central No 100 Wichita KS 67203 Jerry Carley AHSC CEO 3169465215 2015-05-14 1 Rebecca Lyons P01487105 5137847100 2013 2016-02-25 16:41:14Z Doug Frihart 2622 W Central No 100 Wichita KS 67203 9123933 0 0928 X www.viachristi.org/locations/seniors X 2001 KS Provide quality residential retirement living that promotes general health of their residents. 5 4 174 30 0 0 814709 99731 3066566 8881511 46585 17846 55771 113990 3983631 9113078 0 0 0 0 1291160 5116374 0 0 0 1668888 4235392 2960048 9351766 1023583 -238688 21558112 24565977 16597415 19812982 4960697 4752995 X As a part of Via Christi Health, a Catholic health system, we share this Mission: "Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." Via Christi Health's history extends back over 100 years and today, along with our sponsoring organization, Ascension Health, we continue to respond to community needs in Kansas and northeastern Oklahoma.The obligation to reach out to those in need & improve community health flows directly from our identity as a faith-based healing ministry. As a mission-driven organization, we provide community benefit because we are committed to our core values of:Human dignity - we recognize & respect the sacredness of each person;Stewardship - we responsibly care for all resources entrusted to us;Excellence - we extend ourselves in outstanding service. 0 0 7735340 8907419 Cornerstone Assisted Living, Inc. (CAL) provides residential retirement living, including assisted living, food services, housekeeping, and plant operation. CAL serves people in the Wichita area. The primary counties include Sedgwick and Butler. A trend of significance in the community is the growing elderly population. To address this trend, CAL is collaborating with other community organizations, including but not limited to Meals on Wheels and Alzheimer's Association to provide services and education to the elderly. Financial surpluses are used to fulfill our charitable purpose. The Board of Directors includes members of the local community. Our organization offers discounted care to persons without adequate financial means to pay for such services. This includes the participation in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs. 7735340 1 1 0 1 0 0 0 0 0 0 1 0 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 0 0 0 1 14 0 1 174 1 0 0 0 0 0 0 0 0 0 0 X 5 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Judy Davis 3168584931 8200 E Thorn Drive Wichita KS 67226 X Mark A Kuhn Chair 1.00 0.00 X X 0 0 0 Jerry Carley end 1213 Secretary/Treasurer 1.00 49.00 X X 0 266485 69523 Gina Ervay start 1013 Trustee 1.00 0.00 X 0 0 0 Anthony Hain Trustee 1.00 0.00 X 0 0 0 Sr Sherri Marie Kuhn Sch O Trustee (end 09/13) 1.00 49.00 X 0 0 0 Lynnette RauvolaBouta Trustee (end 09/13) 1.00 49.00 X 0 263295 73196 Sr Gracelyn Soignet Trustee 1.00 0.00 X 0 0 0 Doug Frihart President 1.00 49.00 X X 0 130805 37204 Gayle Randa Secretary 1.00 49.00 X 0 112325 34915 Bill Slater start 0114 Treasurer 1.00 49.00 X 0 147287 32460 Roberta Johnson start 0514 Assistant Secretary 1.00 49.00 X 0 228937 48336 0 1149134 295634 0 0 1 0 Simpson & Associates 1831 S Anna PO Box 771088 Wichita KS 672771088 Construction (Sch O) 926746 Genesis Edlercare Rehabilitation Service PO Box 7247-6521 Philadelphia PA 19170 Therapy Services 886723 Burwell Construction 19844 W Kellog PO Box 317 Goddard KS 67052 Construction (Sch O) 196882 3 99731 99731 Resident Service 623000 8881511 8881511 8881511 17846 17846 12977 10855 2122 2122 Beauty & Barber 812900 64385 64385 Miscellaneous Revenue 900099 27937 25908 2029 Guest & Employee Meals 722210 19546 19546 111868 9113078 8907419 0 105928 4583629 4136188 447441 3578 2827 751 296106 247315 48791 233061 215436 17625 629584 629584 315 315 154548 90187 64361 76258 76258 990219 916914 73305 54132 2238 51894 676690 676690 5373 1265 4108 10169 6390 3779 811586 811586 608600 608600 25870 122 25748 Business Startup Costs 137030 137030 Membership Dues 34167 527 33640 Vehicle Fuel & Maint. 7212 7212 Client Entertainment 6903 6903 6736 4940 1796 9351766 7735340 1616426 0 1210635 1138649 70371 1134604 16740 32536 855 75754 22503738 696212 19715611 21807526 543900 376908 21558112 24565977 149244 832343 16448171 18980639 16597415 19812982 X 4960697 4752995 4960697 4752995 21558112 24565977 -238688 30986 0 X 0 1 X 1 0 X 2787 207 2591 814709 99731 920025 3779217 3943309 3860126 3066566 8907419 23556637 3782004 3943516 3862717 3881275 9007150 24476662 0 0 0 24476662 7089 11046 12141 9660 17846 57782 4151 4151 7089 11046 12141 9660 21997 61933 63051 73310 72040 55771 83931 348103 3852144 4027872 3946898 3946706 9113078 24886698 0.98350 0.98120 0.00250 0.00250 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous Income Beauty Barber Guest Employee Meals Schedule A, Part III: Effective April 1, 2013, Via Christi Health, the parent of the filing organization, was acquired by Ascension Health. Ascension Health is a subsidiary of Ascension Health Alliance. As part of the acquisition, the organization changed its tax year to June 30 in order to align with the tax year of Ascension Health. Amounts reported on Schedule A, Part III for the 2012 tax year represent the short period October 1, 2012 through June 30, 2013. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 315 315 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to a trade association of the senior center that is specifically allocable to lobbying. Cornerstone Assisted Living, Inc. does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 670606 670606 19914118 549530 19364588 1145284 58777 1086507 773730 87905 685825 21807526 Residency Funds 116000 Resident Restricted Funds 525 Due to Related Party 75398 Note Payable to AHC 18788716 18980639 X Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member entities ("The System") which include the activity of Cornerstone Assisted Living, Inc.: 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, 2014. 0 1 0 0 0 0 0 0 0 Jerry Carley end 1213 Secretary/Treasurer 0 254530 0 8511 0 3444 0 51432 0 18091 0 336008 0 0 Lynnette RauvolaBouta Trustee (end 09/13) 0 250568 0 8148 0 4579 0 60038 0 13158 0 336491 0 0 Doug Frihart President 0 124587 0 2860 0 3358 0 16581 0 20623 0 168009 0 0 Bill Slater start 0114 Treasurer 0 141488 0 3150 0 2649 0 18259 0 14201 0 179747 0 0 Roberta Johnson start 0514 Assistant Secretary 0 213515 0 7055 0 8367 0 41052 0 7284 0 277273 0 2444 Part I, Line 3 Via Christi Health, Inc., a related organization of Cornerstone Assisted Living, Inc., uses the following to establish the compensation of the organization's President: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Part I, Line 4b Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are funded annually based on participation and are not vested until the 5 year service requirement is reached. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. The amount funded annually under the program to the executives is reported as compensation on Form 990 Schedule J, Part II, Column B in the year funded. The amount ultimately paid under the program to executives is reported on Form 990 Schedule J, Part II, Column F. There were no distributions to a supplemental nonqualified retirement plan during the year. Keysop plan-frozen: Eligible executives participated in a frozen supplemental option benefit program that provides for supplemental retirement benefits that was limited to Via Christi Hospital St. Francis, Preferred Medical Associates Physicians, Mount Carmel Regional Medical Center and Via Christi Health system executives. The payment of benefits under the program, if any, was linked to the exercise date for the options or to earned dividends on the options. Executives were vested in full when the options were granted. The amount ultimately paid under the program to executives receiving net option value is reported on Form 990 Schedule J, Part II, Column F. The following individual received a distribution from the Keysop plan in the amount listed below: Roberta Johnson - $2,444 Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of employment by Via Christi Health, Inc. related entities. Form 990, Part VI, Section A, line 6 Cornerstone Assisted Living, Inc. has a single corporate member, Via Christi Villages, Inc. Form 990, Part VI, Section A, line 7a Cornerstone Assisted Living, Inc. has a single corporate member, Via Christi Villages, Inc., who has the ability to elect members to the governing body of Cornerstone Assisted Living, Inc. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Cornerstone Assisted Living, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, Via Christi Villages, Inc. Form 990, Part VI, Section B, line 11 Management, including certain officers, work 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 Members' questions. Form 990, Part VI, Section B, line 12c The organization's Conflict of Interest Policy is monitored as part of the system-wide procedures of Via Christi Health, Inc. 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 or potential conflicts are reviewed, investigated, and resolved by the chief governance officer and the corporate responsibility officer, with the results shared with the chief executive of the organization; and 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, Section B, line 15 Cornerstone Assisted Living, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the cmpensation package for VCH executives in advance. On an annual basis, the committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: - Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope; - Difficulties in recruiting and retaining executives; - Skills, experience and performance history of individual executives; - Critical business or strategic issues that the organization may face; and - Market position for total compensation. The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the intermediate sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation. Form 990, Part VI, Section C, line 19 Cornerstone Assisted Living, Inc.'s governing documents and conflict of Interest Policy are available to the public upon request. Form 990, Part VII, Section B: Simpson & Associates provided construction services. The payments made to Simpson & Associates included both materials and labor. There is no easy way to break out these amounts. Burwell Construction provided construction services. The payments made to Burwell Construction included both materials and labor. There is no easy way to break out these amounts. Form 990, Part VII, Section A: Sister Sherri Marie Kuhn receives compensation from Via Christi Hospitals Wichita, Inc. Her compensation is not paid directly to her but is paid to her religious order in accordance with her vow of poverty. Ascension Health Alliance PO Box 45998 St Louis MO 63145 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 Via Christi Health Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 481172107 Health System Parent KS Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Via Christi Villages Inc 2622 W Central Suite 100 Wichita KS 67203 480559086 Management Company KS Section 501(c)(3) Schedule A, Line 11c Via Christi Health Inc 0 Via Christi Village Hays Inc 2225 Canterbury Drive Hays KS 67601 202828680 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Care at Home Inc 2622 W Central Suite 100 Wichita KS 67203 271889960 Health Agency KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Healthcare Outreach Program for Elders Inc 2622 W Central Suite 101 Wichita KS 67203 481236589 PACE Community Program KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Georgetown Inc 1655 S Georgetown Wichita KS 67218 481129325 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Manhattan Inc 2800 Willow Grove Road Manhattan KS 66502 481078862 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village McLean Inc 777 N McLean Blvd Wichita KS 67203 481247723 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Pittsburg Inc 1502 E Centennial Drive Pittsburg KS 66762 743070971 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Ponca City Inc 1601 Academy Road Ponca City OK 74604 731153337 Retirement Home OK Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Hospital Pittsburg Inc 1 Mt Carmel Way Pittsburg KS 66762 480543778 Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Health Inc 0 Mount Carmel Foundation Inc 1 Mt Carmel Way Pittsburg KS 66762 480961283 Foundation KS Section 501(c)(3) Schedule A, Line 11a Via Christi Hospital Pittsburg Inc 0 Via Christi Health Alliance in Accountable Care Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 462872857 ACO KS Via Christi Health Inc 0 Via Christi Hospital Wichita St Teresa Inc 14800 W St Teresa Wichita KS 67235 271965272 Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Health Inc 0 Via Christi Hospitals Wichita Inc 929 N Saint Francis Wichita KS 67214 481172106 Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Health Inc 0 Gerard House Inc 3144 N Hood Wichita KS 67204 481049532 Hospital Support KS Section 501(c)(3) Schedule A, Line 9 Via Christi Hospitals Wichita Inc 0 Via Christi Rehabilitation Hospital Inc 1151 N Rock Road Wichita KS 67206 481158274 Rehabilitation Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Hospitals Wichita Inc 0 Via Christi Property Services Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 480948571 Property Management KS Section 501(c)(4) N/A Via Christi Hospitals Wichita Inc 0 Via Christi Health Partners Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 480958974 Management Company KS Section 501(c)(3) Schedule A, Line 9 Via Christi Health Inc 0 Mercy Regional Health Center Inc 1823 College Avenue Manhattan KS 66502 481186704 Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Health Inc 0 Mercy Community Health Foundation Inc PO Box 13 Manhattan KS 66502 481152279 Foundation KS Section 501(c)(3) Schedule A, Line 9 Mercy Regional Health Center Inc 0 Wamego Hospital Association Inc 711 Genn Drive Wamego KS 66547 721526400 Hospital KS Section 501(c)(3) Schedule A, Line 3 Mercy Regional Health Center Inc 0 Mercy Regional Home Medical Services LLC 2439 Claflin Road Manhattan KS 66502 432024491 Medical Equipment KS Section 501(c)(3) Schedule A, Line 9 Mercy Regional Health Center Inc 0 Salina Regional Home Medical Services LLC 520 South Santa Fe Ave Salina KS 67401 431948057 Medical Equipment KS Section 501(c)(3) Schedule A, Line 9 Salina Regional Health Center Inc 0 Ambulatory Surgery Center LP 8200 E Thorn Drive Suite 300 Wichita KS 67226 481114690 Surgery Center KS N/A AMS Diagnostics LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481223653 Radiology Services KS N/A Kansas Surgery and Recovery Center LLC 2770 North Webb Road Wichita KS 67226 481148580 Surgery Center KS N/A MR Imaging Center LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481000538 Imaging Center KS N/A St Joseph MRI LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481007220 Imaging Center KS N/A Mercy Imaging LLC 1823 College Avenue Manhattan KS 66502 481251984 Radiology Services KS N/A Affiliated Medical Services Laboratory Inc 2916 E Central Wichita KS 67214 481239522 Medical Laboratory KS N/A C 0 Integrated Healthcare Systems Inc 3311 East Murdock Wichita KS 67208 480941549 Clinic Services KS N/A C 0 VCH Iowa PC Trust 8200 E Thorn Drive Suite 300 Wichita KS 67226 276937322 Beneficiary Trust IA N/A T 0 VCH Iowa PC 8200 E Thorn Drive Suite 300 Wichita KS 67226 273983977 Professional Association IA N/A C 0 Via Christi Clinic PA 3311 East Murdock Wichita KS 67208 480993446 Professional Association KS N/A C 0 Sunflower Assurance Ltd PO Box 1085 Grand Cayman CJ KY1-1102 980223159 Insurance Company CJ N/A C 0 Via Christi Clinic Services Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 273984287 Clinic Services KS N/A C 0 0 1 0 0 0 0 0 0 1 0 1 0 1 0 1 1 1 1 1 Via Christi Villages Inc M 478296 Amount Actually Transferred Via Christi Villages Inc O 252970 Amount Actually Transferred Via Christi Villages Inc P 120185 Amount Actually Transferred Via Christi Villages Inc S 902917 Amount Actually Transferred Via Christi Health Inc P 57817 Amount Actually Transferred Via Christi Health Inc S 79545 Amount Actually Transferred