ASCENSION LIVING SHERBROOKE VILLAGE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ASCENSION LIVING SHERBROOKE VILLAGE (EIN 43-1592502)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-09
IRS object ID
201421299349302502
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-09T15:05:51-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 S Wacker DriveAddressLine1
CityChicagoCity
StateILState
ZIP Code606064301ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431592502EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Alexian Brothers Sherbrooke VillageBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlALEXNameControl
Phone3145441111Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14005 RipaAddressLine1
CitySt LouisCity
StateMOState
ZIP Code63125ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMichael RothName
TitlePresidentTitle
Phone3145441111Phone
Date Signed2014-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLaura GillespieName
PTINP00855604PTIN
Phone3124861000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonC Michael RothNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14005 RipaAddressLine1
CitySt LouisCity
StateMOState
ZIP Code63125ZIPCode
FieldValueIRS element (for citing)
Gross Receipts15223418GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.alexianbrothershealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1991YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionSkilled Nursing FacilityActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees375TotalNbrEmployees
Total Nbr Volunteers46TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year54759ContributionsGrantsPriorYear
Contributions Grants Current Year10814ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5750444ProgramServiceRevenuePriorYear
Program Service Revenue CY14582652ProgramServiceRevenueCY
Investment Income Prior Year495017InvestmentIncomePriorYear
Investment Income Current Year561983InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year67969OtherRevenueCurrentYear
Total Revenue Prior Year6300220TotalRevenuePriorYear
Total Revenue Current Year15223418TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2772039SalariesEtcPriorYear
Salaries Etc Current Year6783673SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1974653OtherExpensePriorYear
Other Expenses Current Year5932507OtherExpensesCurrentYear
Total Expenses Prior Year4746692TotalExpensesPriorYear
Total Expenses Current Year12716180TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1553528RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2507238RevenuesLessExpensesCY
Total Assets BOY37255376TotalAssetsBOY
Total Assets EOY40210195TotalAssetsEOY
Total Liabilities BOY915531TotalLiabilitiesBOY
Total Liabilities EOY1009269TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY36339845NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY39200926NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionAlexian 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10720861Expense
Revenue14582652Revenue
DescriptionSkilled 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 174. In 2013, 6,307 days of care were provided to Medicaid recipients; 6,085 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 with respect to providing health care services. The cost of charity care provided was $98,315, and community benefits of $135,882 were provided in 2013.Description
Total Program Service Expense10720861TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109629NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees375NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Cindy WintersBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3147293500TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112250 Weber Hill Road Suite 200AddressLine1
CitySt LouisCity
StateMOState
ZIP Code63127ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Mike Roth
Ex Officio Member & President40.000.00XX028519356743
Alec Blanc
Director & Chairperson1.000.00XX000
Barbara Prosser
Director & Vice Chairperson1.000.00XX000
Charles Gulas
Director & Treasurer (start 7/12)1.000.00XX000
Patricia Yaeger
Director & Treasurer (end 7/12)1.000.00XX000
John Turongian
Director & Secretary0.0040.00XX033944250851
Brother Jeffrey Callander CFA
Director1.000.00X000
Mark Frey
Ex Officio Member0.0040.00X01434790179527
Donna Gauthier
Assistant Secretary0.0040.00X07100715381
Jim Lewandoski
Vice President0.0040.000468370805832X
Peggy Randell
Director of Finance40.000.00010705310449X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2705855TotalReportableCompFrmRltdOrgs
Total Other Compensation1118783TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
TouchPoint Support Services
PO Box 102289AtlantaGA303682289Dietary/Housekeeping Services1916329
Alexian Brothers Health System
3040 W Salt Creek LaneArlington HgtsIL60005Management Services574400
Interlock Pharmacy
345 Dunn RoadFlorissantMO63031Pharmaceuticals542850
Spellman Brady & Co
8251 Maryland Avenue Suite 300St LouisMO63105Interior Planning535832
United Healthcare Insurance Co
22561 Network PlaceChicagoIL60673Employee Health Insurance344040
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Related Organizations10814RelatedOrganizations
Total Contributions10814TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Skilled Nursing Srvcs62300085613428561342
Medicare/Medicaid62300037540563754056
Residential Care Srvcs62300022672542267254
FieldValueIRS element (for citing)
Total Program Service Revenue14582652TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column561983TotalRevenueColumn
Exclusion$561,983ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Barber/Beauty90009946063$46,063
Guest & Employee Meals72221017386$17,386
Vending Revenue9000991340$1,340

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column3180TotalRevenueColumn
Exclusion$3,180ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue67969TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column15223418TotalRevenueColumn
Related Or Exempt Function Income14582652RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$629,952ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5800094Total
Program Services5372085ProgramServices
Management And General428009ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total63899Total
Program Services59184ProgramServices
Management And General4715ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total487447Total
Program Services451300ProgramServices
Management And General36147ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total432233Total
Program Services401335ProgramServices
Management And General30898ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total10548Total
Management And General10548ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total10800Total
Management And General10800ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1969621Total
Program Services1945746ProgramServices
Management And General23875ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total30265Total
Management And General30265ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total177264Total
Program Services128052ProgramServices
Management And General49212ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total256920Total
Management And General256920ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total337291Total
Program Services337291ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total16102Total
Program Services6098ProgramServices
Management And General10004ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total5803Total
Program Services5021ProgramServices
Management And General782ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total755977Total
Program Services734742ProgramServices
Management And General21235ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total122519Total
Management And General122519ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
Management Fees - ABHS574400574400
Taxes433845537433308
Purchased Srvcs - Other2422882354176871
Food & Medical Supplies2428924289

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total964575Total
Program Services815539ProgramServices
Management And General149036ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12716180Total
Program Services10720861ProgramServices
Management And General1995319ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY51674BOY
EOY76740EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY674973BOY
EOY1570938EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY20248BOY
EOY28402EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY123438BOY
EOY152722EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis26368668LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec938490LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY22052904BOY
EOY25430178EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY14035421BOY
EOY12878960EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY296718BOY
EOY72255EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY37255376BOY
EOY40210195EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY836909BOY
EOY970645EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY78622BOY
EOY38624EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY915531BOY
EOY1009269EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY36287378BOY
EOY39148459EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY52467BOY
EOY52467EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY36339845BOY
EOY39200926EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37255376BOY
EOY40210195EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2507238ReconcilationRevenueExpenses
Reconciliation Unrealized Invest353843ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years44399CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years27468CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13684CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year54759CurrentTaxYearMinus1Year
Current Tax Year10814CurrentTaxYear
Total151124Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10255876CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10762099CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10916955CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5750444CurrentTaxYearMinus1Year
Current Tax Year14582653CurrentTaxYear
Total52268027Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10300275CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10789567CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10930639CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5805203CurrentTaxYearMinus1Year
Current Tax Year14593467CurrentTaxYear
Total52419151Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50952419151PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years-732587CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years336885CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years643515CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year495017CurrentTaxYearMinus1Year
Current Tax Year561983CurrentTaxYear
Total1304813Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years-732587CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years336885CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years643515CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year495017CurrentTaxYearMinus1Year
Current Tax Year561983CurrentTaxYear
Total1304813Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year67969CurrentTaxYear
Total67969Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9567688CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11126452CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11574154CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6300220CurrentTaxYearMinus1Year
Current Tax Year15223419CurrentTaxYear
Total53791933Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97450PublicSupportPercentage509
Prior Year Support Percentage0.99680PriorYearSupportPercentage
Investment Income Percentage0.02430InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00270PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSchedule A, Part IV, Supplemental Information: 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.GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$897OtherActivitiesAmount
Total Lobbying Expenditures IIB897TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationLobbying expenses represent the portion of dues paid to Leading Age that is specifically allocable to lobbying.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1574117OtherCostOrOtherBasis
Book Value1574117BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21737931OtherCostOrOtherBasis
Depreciation600436Depreciation
Book Value21137495BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2371986OtherCostOrOtherBasis
Depreciation301228Depreciation
Book Value2070758BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis684634OtherCostOrOtherBasis
Depreciation36826Depreciation
Book Value647808BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings25430178TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionBeneficial Interest in Alexian Brothers Health System, Inc. Investment TrustDescription
Book Value12878960BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities12878960TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Outstanding Reserve for Insurance Losses$34,216
Due to Affiliates$4,408
FieldValueIRS element (for citing)
Total Of Amounts38624TotalOfAmounts

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
ExplanationPart X, Line 2: Alexian Brothers Sherbrooke Village does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. There is no ASC 740 (fka FIN 48) footnote for the current year.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Mike Roth
Ex Officio Member & President022014105567309379035963020780034193609379
John Turongian
Director & Secretary02730390555230108800229930278580390293010880
Mark Frey
Ex Officio Member011101380263024061628013795604157101614317044628
Jim Lewandoski
Vice President0328372088552051446077927902655301274202033988

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 3Alexian Brothers Health System, a related organization of Alexian Brothers Sherbrooke Village, uses all of the items in Schedule J, Part I, Line 3 to establish the compensation of the organization's CEO.
Part I, Line 4bAlexian 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. The amount paid in calendar 2012 was included in income in Schedule J for the following individual: Jim Lewandoski - $19,123

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 2John Turongian, Mike Roth, Mark Frey, Donna Gauthier, and Jim Lewandowski have a business relationship due to joint employment by a common health system entity.
Form 990, Part VI, Section A, line 6Alexian Brothers Sherbrooke Village has two members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Senior Ministries (the "Area Member").
Form 990, Part VI, Section A, line 7aAlexian 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 7bAll 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 11Management, 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 12cThe 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 15In 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/her 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 19The 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 VII, Section A:Officers and certain key employees for Alexian Brothers Sherbrooke Village provide services to Alexian Brothers Health System (the National Member) and its subsidiaries. Hours worked are not tracked on an entity by entity basis, and a 40 hour work week is used as a proxy for all individuals listed on Part VII if employed by the filing organization or a related organization (even though more hours may be worked on average). Therefore, all officers, directors, trustees, and key employee hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees represent aggregate hours for worked per week for all entities. Compensation amount for John Turongian represents payment for services rendered to Alexian Brothers Senior Ministries, a related entity and compensation amount for Mark Frey represents payment for services rendered to Alexian Brothers Health System, a related entity. The amounts are not for services as a board member of Alexian Brothers Sherbrooke Village.
Form 990, Part IX, line 11gDietary and Environmental Purchased Services: Program service expenses 1,833,546. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,833,546. Beautician Services: Program service expenses 36,691. Management and general expenses 0. Fundraising expenses 0. Total expenses 36,691. Other fees-for-service: Program service expenses 75,509. Management and general expenses 23,875. Fundraising expenses 0. Total expenses 99,384.Other Fees
Form 990, Part VIII, Line 3 and Schedule D, Part VII:The amount reflected as dividends and interest reflects Alexian Brothers Sherbrooke Village's share of interest, dividends and realized gains/losses from Alexian Brothers Sherbrooke Village's beneficial share in the Alexian Brothers Health System, Inc. Investment Trust (ABHSIT). ABHSIT is a related entity whose purpose is to pool the investments of the not-for-profit entities in Alexian Brothers Health System and act as an internal mutual fund. Details of gains and losses are shown on the Form 990 of ABHSIT.
Form 990, Part XII, Line 2b Audit Disclosure:The financial statements of Aleixan 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 audits the financial statements.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (22 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Ascension Health
PO Box 45998St LouisMO63145311662309National Health SystemMOSection 501(c)(3)Schedule A, Line 11aAscension Health Alliance0
Alexian Brothers Health System
3040 W Salt Creek LaneArlington HeightsIL60005363260495Supports provision of healthcare services for related corporationsILSection 501(c)(3)Schedule A, Line 11cAscension Health0
Alexian Brothers Bonaventure House
825 Wellington AvenueChicagoIL60657363527899Housing and supportive care services for persons with HIV/AIDSILSection 501(c)(3)Schedule A, Line 9Alexian Brothers Health System1
Alexian Brothers Health System Inc Investment Trust
3040 W Salt Creek LaneArlington HeightsIL60005363801585Manages pooled investments of related not-for-profit entitiesILSection 501(c)(3)Schedule A, Line 11cAlexian Brothers Health System1
Alexian Brothers Specialty Group
3040 W Salt Creek LaneArlington HeightsIL60005800710751Specialty physician practice groupILSection 501(c)(3)Schedule A, Line 3Alexian Brothers Health System1
Alexian Brothers of San Jose Inc
3040 W Salt Creek LaneArlington HeightsIL60005941530037Acute care hospital (sold in 1998)TXSection 501(c)(3)Schedule A, Line 11cAlexian Brothers Health System1
Alexian Brothers Services Inc
3040 W Salt Creek LaneArlington HeightsIL60005431295333HUD housingMOSection 501(c)(3)Schedule A, Line 9Alexian Brothers Health System1
Alexian Village of Milwaukee Inc
9301 N 76th StreetMilwaukeeWI53223391351584Continuing care retirement communityWISection 501(c)(3)Schedule A, Line 9Alexian Brothers Health System1
Alexian Brothers Community Services
425 Cumberland Street Suite 110ChattanoogaTN37404364344423Provides comprehensive & coordinated community based servicesILSection 501(c)(3)Schedule A, Line 9Alexian Brothers Health System1
Alexian Brothers Senior Neighbors
250 East 10th StreetChattanoogaTN37402620646376Supports the provision of community services for senior citizensTNSection 501(c)(3)Schedule A, Line 7Alexian Brothers Health System1
Alexian Village of Tennessee
437 Alexian WaySignal MountainTN37377621136742Continuing care retirement communityTNSection 501(c)(3)Schedule A, Line 9Alexian Brothers Health System1
Alexian Brothers Senior Ministries
3040 W Salt Creek LaneArlington HeightsIL60005364484290Supports the provision of healthcare services for related corporationsILSection 501(c)(3)Schedule A, Line 11cAlexian Brothers Health System1
Alexian Elderly Services Inc
3040 W Salt Creek LaneArlington HeightsIL60005392039667Community outreachWISection 501(c)(3)Schedule A, Line 9Alexian Brothers Health System1
Alexian Brothers Lansdowne Village
4624 LansdowneSt LouisMO63116431470362Skilled nursing facilityMOSection 501(c)(3)Schedule A, Line 9Alexian Brothers Health System1
Alexian Brothers of St Louis Inc
3040 W Salt Creek LaneArlington HeightsIL60005430653236Acute care hospital (sponsorship transferred in 1997)MOSection 501(c)(3)Schedule A, Line 11cAlexian Brothers Health System1
Alexian Brothers Hospital Network
3040 W Salt Creek LaneArlington HeightsIL60005363276552Supports the provision of healthcare services for related corporationsILSection 501(c)(3)Schedule A, Line 11cAlexian Brothers Health System1
Savelli Properties Inc
3040 W Salt Creek LaneArlington HeightsIL60005363308965Owns or leases properties where healthcare services are deliveredILSection 501(c)(2)N/AAlexian Brothers Health System1
Alexian Brothers Center for Mental Health
3426 N Kennicott AvenueArlington HeightsIL60004363045007Outpatient community mental health servicesILSection 501(c)(3)Schedule A, Line 7Alexian Brothers Health System1
Alexian Brothers Behavioral Health Hospital
1650 Moon Lake BlvdHoffman EstatesIL60194364251848Behavioral health hospitalILSection 501(c)(3)Schedule A, Line 3Alexian Brothers Health System1
St Alexius Medical Center
1555 Barrington RoadHoffman EstatesIL60194364251846Acute care hospitalILSection 501(c)(3)Schedule A, Line 3Alexian Brothers Health System1
Alexian Brothers Ambulatory Group
3040 W Salt Creek LaneArlington HeightsIL60005364336931Physician servicesILSection 501(c)(3)Schedule A, Line 3Alexian Brothers Health System1
Alexian Brothers Medical Center
800 Biesterfield RoadElk Grove VillageIL60007362596381Acute care hospitalTXSection 501(c)(3)Schedule A, Line 3Alexian Brothers Health System1

Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
Alexian Rehabilitation Services LLC
935 Beisner RoadElk Grove VillageIL60007300221481Rehabilitation hospitalILN/A
Illinois NeuroMeg Center LLC
3040 W Salt Creek LaneArlington HeightsIL60005870783164Provision of NeuroMeg servicesILN/A
Elk Grove MOB Limited Partnership
3040 W Salt Creek LaneArlington HeightsIL60005363853289Medical office buildingILN/A
Workplace Solutions LLC
1100 E Woodfield RoadSchaumburgIL60173364095007Provision of EAP servicesILN/A
Bonaventure Medical Foundation LLC
3040 W Salt Creek LaneArlington HeightsIL60005363978153Manages managed care contractsDEN/A
Neurosciences Equipment LLC
3040 W Salt Creek LaneArlington HeightsIL60005861115516Ownership of Gamma KnifeILN/A
St Alexius Center for Sleep Health LLC
1300 S Main StreetLombardIL60148205876371Operation of sleep labILN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrg
Thelen Corporation
3040 W Salt Creek LaneArlington HeightsIL60005363266316Owns/leases property; joint venture partnerILN/AC0
Alexian Brothers Health Providers Association Inc
3040 W Salt Creek LaneArlington HeightsIL60005363853286Messenger model IPAILN/AC0
Alexian Brothers Corpus Christi Housing Project LLC
3040 W Salt Creek LaneArlington HeightsIL60005943465394Tax credit financed housingILN/AC0
Alexian Village of Elk Grove
3040 W Salt Creek LaneArlington HeightsIL60005352211303Tax credit financed housingILN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Alexian Brothers Health System
P574400FMV
Alexian Brothers Health System
S615139FMV
Alexian Brothers Senior Ministries
P119078FMV

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