2014-10-27T13:55:41-05:00 2013-12-31 061009205 BLUM SHAPIRO & COMPANY PC CPAS 50 HOLDEN STREET PROVIDENCE RI 02908 990 2013-01-01 050275443 ST ANTOINE RESIDENCE SAIN 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 WENDY FARGNOLI ADMINISTRATOR/ASSISTANT TREASURER 4017673500 2014-09-18 1 DONALD SULLIVAN P00059830 4012725600 2013 2015-11-30 17:44:51Z WENDY FARGNOLI 10 RHODES AVENUE NORTH SMITHFIELD RI 028966999 23043112 0 X WWW.STANTOINE.NET X 1913 RI THE MISSION OF SAINT ANTOINE RESIDENCE IS TO CARE FOR THE SICK AND ELDERLY IN ADDITION TO REFLECTING THE CHURCH'S COMMITMENT AND SUPPORT FOR ALL HUMAN LIFE AND AFFIRMATION OF THE VALUE OF EACH PERSON REGARDLESS OF AGE OR PHYSICAL CONDITION IN A COMPASSIONATE, CARING AND CHRISTIAN ENVIRONMENT. 6 5 484 65 0 0 822098 646609 22398207 22155668 37113 41933 92991 61036 23350409 22905246 0 0 0 0 13690168 14276412 0 23375 23375 8115705 8186274 21805873 22486061 1544536 419185 19787469 19104042 9012374 7646436 10775095 11457606 X THE MISSION OF SAINT ANTOINE RESIDENCE IS TO CARE FOR THE SICK AND ELDERLY IN ADDITION TO REFLECTING THE CHURCH'S COMMITMENT AND SUPPORT FOR ALL HUMAN LIFE AND AFFIRMATION OF THE VALUE OF EACH PERSON REGARDLESS OF AGE OR PHYSICAL CONDITION IN A COMPASSIONATE, CARING AND CHRISTIAN ENVIRONMENT. 0 0 20864845 22017614 THE OPERATION OF A LONG-TERM CARE FACILITY FOR THE ELDERLY AND OTHER NEEDY INDIVIDUALS. DURING 2013 ST. ANTOINE'S PROVIDED A TOTAL 91,745 PATIENT BED DAY, INCLUDING 77,243 BED DAYS TO MEDICAID AND MEDICARE PATIENTS. 90799 138054 PROVISION OF MEALS TO ADULT DAY CARE PROGRAM OPERATED BY PACE, AN EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). 20955644 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 7 0 1 484 1 0 0 0 0 0 1 1 0 0 0 0 X 6 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 X MARIO MACERA 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 028966999 MOST REV THOMAS J TOBIN PRESIDENT / TREASURER 1.00 X X 0 0 0 REV MSGR ALBERT A KENNEY VICE PRESIDENT 1.00 X X 0 0 0 REV TIMOTHY D REILLY SECRETARY 1.00 X X 0 0 0 WENDY FARGNOLI ADMINISTRATOR / ASST TREASURER 40.00 X X 129087 0 30461 REV MSGR GEORGE FRAPPIER DIRECTOR 1.00 X X 0 0 0 JOHN J BARRY III DIRECTOR 1.00 X 0 0 0 MARIO MACERA DIRECTOR OF FINANCE 40.00 X 107190 0 31913 236277 0 62374 2 0 1 0 0 261152 106380 279077 646609 MEDICAID & MEDICARE REVENUES 623000 16493859 16493859 NURSING HOME FEES 623000 5438355 5438355 MEALS REVENUE - PACE ADULT MEALS 623000 138054 138054 MANAGEMENT FEE INCOME 623000 85400 85400 22155668 41933 41933 10585 4041 6544 6544 6544 155825 133825 22000 22000 DISCOUNTS EARNED 900099 18439 18439 OTHER INCOME 900099 7980 7980 HAIRDRESSER REVENUE 900099 6073 6073 32492 22905246 22155668 0 102969 298651 17919 280732 10228766 9585660 643106 748217 709045 39172 2226624 2072952 153672 774154 709101 65053 52879 52879 23375 23375 8155 8155 89092 89092 38150 38150 25788 25788 40094 40094 472203 443871 28332 16693 16693 314213 295360 18853 715618 675084 40534 553998 534382 19616 PURCHASED SERVICES 2101429 2101429 MEDICAL & OTHER DIRECT 1365688 1365688 PROVIDER TAXES 1208118 1208118 FOOD 852594 852594 331562 331562 22486061 20955644 1507042 23375 2000 2000 6631991 6394476 1636771 1654826 621251 670930 77666 68252 103304 167618 19781216 10519920 9768238 9261296 354168 380327 592080 504317 19787469 19104042 1910264 1754352 6405000 5430000 697110 462084 9012374 7646436 X 10185330 10764454 551015 654402 38750 38750 10775095 11457606 19787469 19104042 X 419185 28300 235026 X X 0 1 X 1 0 X 318059 434717 410451 457529 670700 2291456 21097651 21359483 21843385 22323885 22155668 108780072 6622 6370 5998 6411 6073 31474 21422332 21800570 22259834 22787825 22832441 111103002 0 0 0 111103002 61066 63113 55327 37113 41933 258552 61066 63113 55327 37113 41933 258552 3845 30260 14897 26762 5889 81653 21487243 21893943 22330058 22851700 22880263 111443207 0.99690 0.99670 0.00230 0.00250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 166000 166000 15400785 7050357 8350428 4106680 3469563 637117 107751 107751 9261296 INTEREST RATE SWAP 462084 462084 X 22727900 28300 239067 267367 22460533 444713 444713 22905246 22045389 4041 4041 22041348 444713 444713 22486061 PART X, LINE 2: THE ORGANIZATION HAS ADOPTED THE GUIDANCE IN ASC 740, INCOME TAXES, RELATING TO UNCERTAIN TAX POSITIONS. THIS GUIDANCE PRESCRIBES A TWO STEP PROCESS FOR THE MEASUREMENT OF UNCERTAIN TAX POSITIONS THAT HAVE BEEN TAKEN OR ARE EXPECTED TO BE TAKEN ON A TAX RETURN. THE FIRST STEP IS A DETERMINATION OF WHETHER THE TAX POSITION SHOULD BE RECOGNIZED IN THE FINANCIAL STATEMENTS. THE SECOND STEP DETERMINES THE MEASUREMENT OF THE TAX POSITION. ASC 740 ALSO PROVIDES GUIDANCE ON DE-RECOGNITION OF SUCH TAX POSITIONS, CLASSIFICATION, POTENTIAL INTEREST AND PENALTIES, AND DISCLOSURE. MANAGEMENT BELIEVES THERE ARE NO UNCERTAIN TAX POSITIONS WITHIN THE SCOPE OF ASC 740 EXIST AS OF THE YEAR ENDED DECEMBER 31, 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAIN ON INTEREST RATE SWAP CONTRACT 235,026. RENTAL PROPERTY DEPRECIATION 4,041. PART XI, LINE 4B - OTHER ADJUSTMENTS: UNITED WAY GRANT EXPENSES NETTED ON FINANCIAL STATEMENTS 223,910. EXPENSE FOR MEALS TO ADULT DAY CARE NETTED ON FINANCIAL STATEMENTS 90,799. GOVERNOR'S WORKFORCE GRANT EXPENSES NETTED ON FINANCIAL STATEMENTS 106,629. EXPENSE FOR FUNDRAISING NETTED ON FINANCIAL STATEMENTS 23,375. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL PROPERTY DEPRECIATION 4,041. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNITED WAY GRANT EXPENSES NETTED ON FINANCIAL STATEMENTS 223,910. EXPENSE FOR MEALS TO ADULT DAY CARE NETTED ON FINANCIAL STATEMENTS 90,799. GOVERNOR'S WORKFORCE GRANT EXPENSES NETTED ON FINANCIAL STATEMENTS 106,629. EXPENSE FOR FUNDRAISING NETTED ON FINANCIAL STATEMENTS 23,375. X X X X X 1 DAVID M WAHL 196 OLD RIVER ROAD 718 LINCOLN RI 02865 CAPITAL CAMPAIGN CONSULTING SERVICES 0 130000 10875 119125 BUTCHER & BRIGGS 15 FABYAN ROAD PLYMOUTH MA 02360 CONDUCT FEASIBILITY STUDY AND CAPITAL CAMPAIGN 0 0 12500 -12500 130000 23375 106625 RI GOLF TOURNAMENT 109168 109168 83557 CHRISTMAS TREE JUBILEE 25960 25960 41124 1 20697 20697 9144 155825 155825 133825 133825 22000 X X X 0 0 0 0 0 0 0 0 0 WENDY FARGNOLI ADMINISTRATOR / ASST TREASURER 129087 0 0 0 0 0 14050 0 16411 0 159548 0 0 0 A RHODE ISLAND HEALTH AND EDUCATIONAL BUILDING CORPORATION 521300173 762243ZA4 2009-11-12 9135000 TO FINANCE PAY-OFF OF ORIGINAL BOND LIABILITY ISSUED ON 09/11/1999. 0 0 0 A 3705000 9135000 182700 75651 1749 1994 1 0 1 1 A 0 1 0 0 1 1 BANK OF AMERICA MERRILL LYNCH 9.000000000000 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11 MARIO MACERA, DIRECTOR OF FINANCE AND WENDY FARGNOLI, ASSISTANT TREASURER REVIEW THE FORM 990 PRIOR TO FILING. UPON REVIEW AND APPROVAL, THE RETURN IS SIGNED BY WENDY FARGNOLI AND FILED WITH THE IRS. IN THE EVENT THAT WENDY FARGNOLI IS NOT ABLE TO SIGN THE 990 INFORMATION RETURN, MARIO MACERA IS AUTHORIZED TO DO SO. A COPY IS SUBMITTED TO THE FISCAL OFFICE AT THE DIOCESE OF PROVIDENCE AND ONE IS KEPT AT THE BUSINESS OFFICE. FORM 990, PART VI, SECTION B, LINE 12C ALL KEY EMPLOYEES AND MEMBERS OF THE BOARD OF DIRECTORS ARE ASKED TO READ THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND ANNUALLY THEY ARE ASKED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. THE EXECUTIVE DIRECTOR AND THE FINANCE DIRECTOR REVIEW ALL POTENTIAL CONFLICTS OF INTEREST DISCLOSED BY KEY EMPLOYEES AND DETERMINE IF A TRUE CONFLICT EXISTS. IF AN INDIVIDUAL HAS A CONFLICT, THE EXECUTIVE DIRECTOR AND THE DIRECTOR OF FINANCE REPORT THIS INFORMATION TO THE BOARD OF DIRECTORS. ALL MEMBERS OF THE BOARD ARE ASKED TO DISCLOSE ANY CONFLICTS OF INTEREST, AND DEPENDING UPON THE CONFLICT, THEY ARE ASKED TO RECUSE THEMSELVES FROM DISCUSSIONS AND VOTING ON THE RELATED ISSUE. ALL DECISIONS ARE RECORDED IN THE MINUTES OF THE BOARD OF DIRECTORS' MEETING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS FUNCTIONS AS A COMPENSATION COMMITTEE IN DETERMINING SALARY FOR THE ADMINISTRATOR AND KEY EMPLOYEES. IN MAKING ITS DECISION ON COMPENSATION, IT TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR ADMINISTRATORS AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE AREA. THE COMMITTEE CONSIDERS THE PERFORMANCE OF THE ORGANIZATION DURING THE REVIEW PERIOD AND CONSIDERS THE ADMINISTRATOR'S SUCCESS IN ACHIEVING ORGANIZATIONAL GOALS. THE ADMINISTRATOR REVIEWS SALARY OF ALL OTHER EMPLOYEES. IN MAKING A DECISION ON THE AMOUNT OF COMPENSATION, SHE TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR EXECUTIVES, PERFORMING SIMILAR TYPES OF DUTIES, AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE RHODE ISLAND AREA. COMPENSATION RELATED DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ALL GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: UNREALIZED LOSS ON INTEREST RATE SWAP 235,026. FORM 990 PART XII, LINE 2C THE FINANCE COMMITTEE IS RESPONSIBLE FOR OVERSIGHT OF THE COMPLETION OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE FINANCE COMMITTEE AND SUBMITTED TO THE ADVISORY BOARD AND CORPORATE BOARD. DAURAY LLC 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 050275443 REAL ESTATE RI 0 0 THE FRASSATI RESIDENCE DBA THE VILLA AT SAINT ANTOINE 400 MENDON ROAD NORTH SMITHFIELD RI 02896 050511505 OPERATION OF A 76-UNIT ASSISTED LIVING FACILITY. RI 501(C)(3) LINE 1 0 501(C)(3) 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0