2014-05-09T15:05:51-05:00 2013-06-30 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 606064301 990 2012-07-01 431592502 Alexian Brothers Sherbrooke Village ALEX 3145441111 4005 Ripa St Louis MO 63125 Michael Roth 3145441111 2014-05-09 1 Laura Gillespie P00855604 3124861000 2012 2015-11-30 17:44:51Z C Michael Roth 4005 Ripa St Louis MO 63125 15223418 0 0928 X www.alexianbrothershealth.org X 1991 MO Skilled Nursing Facility 7 4 375 46 0 0 54759 10814 5750444 14582652 495017 561983 0 67969 6300220 15223418 0 0 0 0 2772039 6783673 0 0 0 1974653 5932507 4746692 12716180 1553528 2507238 37255376 40210195 915531 1009269 36339845 39200926 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 10720861 14582652 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 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. 10720861 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 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 29 0 1 375 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 1 1 0 X Cindy Winters 3147293500 12250 Weber Hill Road Suite 200 St Louis MO 63127 X Mike Roth 40.00 0.00 X X 0 285193 56743 Alec Blanc 1.00 0.00 X X 0 0 0 Barbara Prosser 1.00 0.00 X X 0 0 0 Charles Gulas 1.00 0.00 X X 0 0 0 Patricia Yaeger 1.00 0.00 X X 0 0 0 John Turongian 0.00 40.00 X X 0 339442 50851 Brother Jeffrey Callander CFA 1.00 0.00 X 0 0 0 Mark Frey 0.00 40.00 X 0 1434790 179527 Donna Gauthier 0.00 40.00 X 0 71007 15381 Jim Lewandoski 0.00 40.00 X 0 468370 805832 Peggy Randell 40.00 0.00 X 0 107053 10449 0 2705855 1118783 0 0 1 0 TouchPoint Support Services PO Box 102289 Atlanta GA 303682289 Dietary/Housekeeping Services 1916329 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Hgts IL 60005 Management Services 574400 Interlock Pharmacy 345 Dunn Road Florissant MO 63031 Pharmaceuticals 542850 Spellman Brady & Co 8251 Maryland Avenue Suite 300 St Louis MO 63105 Interior Planning 535832 United Healthcare Insurance Co 22561 Network Place Chicago IL 60673 Employee Health Insurance 344040 7 10814 10814 Skilled Nursing Srvcs 623000 8561342 8561342 Medicare/Medicaid 623000 3754056 3754056 Residential Care Srvcs 623000 2267254 2267254 14582652 561983 561983 Barber/Beauty 900099 46063 46063 Guest & Employee Meals 722210 17386 17386 Vending Revenue 900099 1340 1340 3180 3180 67969 15223418 14582652 0 629952 X 5800094 5372085 428009 63899 59184 4715 487447 451300 36147 432233 401335 30898 10548 10548 10800 10800 1969621 1945746 23875 30265 30265 177264 128052 49212 256920 256920 337291 337291 16102 6098 10004 5803 5021 782 755977 734742 21235 122519 122519 Management Fees - ABHS 574400 574400 Taxes 433845 433308 537 Purchased Srvcs - Other 242288 6871 235417 Food & Medical Supplies 24289 24289 964575 815539 149036 12716180 10720861 1995319 0 51674 76740 674973 1570938 20248 28402 123438 152722 26368668 938490 22052904 25430178 14035421 12878960 296718 72255 37255376 40210195 836909 970645 78622 38624 915531 1009269 X 36287378 39148459 52467 52467 36339845 39200926 37255376 40210195 2507238 353843 0 X 0 1 X 1 0 X 44399 27468 13684 54759 10814 151124 10255876 10762099 10916955 5750444 14582653 52268027 10300275 10789567 10930639 5805203 14593467 52419151 0 0 0 52419151 -732587 336885 643515 495017 561983 1304813 -732587 336885 643515 495017 561983 1304813 67969 67969 9567688 11126452 11574154 6300220 15223419 53791933 0.97450 0.99680 0.02430 0.00270 X Schedule 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 897 897 0 Explanation of Lobbying Activities: Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to Leading Age that is specifically allocable to lobbying. 1574117 1574117 21737931 600436 21137495 2371986 301228 2070758 684634 36826 647808 25430178 Beneficial Interest in Alexian Brothers Health System, Inc. Investment Trust 12878960 F 12878960 Outstanding Reserve for Insurance Losses 34216 Due to Affiliates 4408 38624 Part 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. 0 1 0 0 0 0 0 0 0 Mike Roth 0 220141 0 55673 0 9379 0 35963 0 20780 0 341936 0 9379 John Turongian 0 273039 0 55523 0 10880 0 22993 0 27858 0 390293 0 10880 Mark Frey 0 1110138 0 263024 0 61628 0 137956 0 41571 0 1614317 0 44628 Jim Lewandoski 0 328372 0 88552 0 51446 0 779279 0 26553 0 1274202 0 33988 Part I, Line 3 Alexian 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 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. The amount paid in calendar 2012 was included in income in Schedule J for the following individual: Jim Lewandoski - $19,123 Form 990, Part VI, Section A, line 2 John 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 6 Alexian 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 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/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 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 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. Other Fees Form 990, Part IX, line 11g Dietary 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. 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. 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 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 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 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 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 Alexian Brothers of St Louis Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 430653236 Acute care hospital (sponsorship transferred in 1997) MO Section 501(c)(3) Schedule A, Line 11c 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 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 3426 N Kennicott Avenue Arlington Heights IL 60004 363045007 Outpatient community mental health services IL Section 501(c)(3) Schedule A, Line 7 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 Workplace Solutions LLC 1100 E Woodfield Road Schaumburg IL 60173 364095007 Provision of EAP services 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 W 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 W 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 0 0 1 Alexian Brothers Health System P 574400 FMV Alexian Brothers Health System S 615139 FMV Alexian Brothers Senior Ministries P 119078 FMV