FURP.ORG / PUBLIC DATA EXPLORER

SAINT ANNE HOME AND RETIRMENT COMMUNITY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SAINT ANNE HOME AND RETIRMENT COMMUNITY (EIN 35-2024406)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-15
IRS object ID
201441359349309499
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)
Timestamp2014-05-15T19:41:04-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CROWE HORWATH LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13815 River Crossing ParkwayAddressLine1
Address Line2Suite 300AddressLine2
CityIndianapolisCity
StateINState
ZIP Code462400977ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN352024406EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SAINT ANNE HOME AND RETIREMENT COMMUNITYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSAINNameControl
Phone2604845555Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 Randallia DriveAddressLine1
CityFort WayneCity
StateINState
ZIP Code46805ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID DEFFENBAUGHName
TitleADMINISTRATORTitle
Date Signed2014-05-12DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRachel SpurlockName
PTINP00520729PTIN
Phone3175698989Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1DAVID DEFFENBAUGHBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11900 Randallia DriveAddressLine1
CityFort WayneCity
StateINState
ZIP Code46805ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16371668GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.SAINTANNEHOME.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionIT IS THE MISSION OF SAINT ANNE HOME AND RETIREMENT COMMUNITY TO PROVIDE A SAFE, HEALTHY AND LOVING ENVIRONMENT IN WHICH SENIOR'S NEEDS CAN BE MET, FRIENDSHIPS CAN BE FORMED AND MEMORIES CAN BE SHARED.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees390TotalNbrEmployees
Total Nbr Volunteers83TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year290030ContributionsGrantsPriorYear
Contributions Grants Current Year81559ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15067777ProgramServiceRevenuePriorYear
Program Service Revenue CY15657738ProgramServiceRevenueCY
Investment Income Prior Year117127InvestmentIncomePriorYear
Investment Income Current Year75068InvestmentIncomeCurrentYear
Other Revenue Prior Year263282OtherRevenuePriorYear
Other Revenue Current Year362803OtherRevenueCurrentYear
Total Revenue Prior Year15738216TotalRevenuePriorYear
Total Revenue Current Year16177168TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1953GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY652GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9869418SalariesEtcPriorYear
Salaries Etc Current Year10382880SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5529411OtherExpensePriorYear
Other Expenses Current Year5383464OtherExpensesCurrentYear
Total Expenses Prior Year15400782TotalExpensesPriorYear
Total Expenses Current Year15766996TotalExpensesCurrentYear
Revenues Less Expenses Prior Year337434RevenuesLessExpensesPriorYear
Revenues Less Expenses CY410172RevenuesLessExpensesCY
Total Assets BOY13119662TotalAssetsBOY
Total Assets EOY13055391TotalAssetsEOY
Total Liabilities BOY4641020TotalLiabilitiesBOY
Total Liabilities EOY4017622TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8478642NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9037769NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionIT IS THE MISSION OF SAINT ANNE HOME AND RETIREMENT COMMUNITY (SAINT ANNE HOME) TO PROVIDE A SAFE, HEALTHY AND LOVING ENVIRONMENT IN WHICH SENIOR'S NEEDS CAN BE MET, FRIENDSHIPS CAN BE FORMED AND MEMORIES CAN BE SHARED. (CONTINUED IN SCHEDULE O)MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense11868222Expense
Grants652Grants
Revenue12964087Revenue
DescriptionNURSING, MEDICAL, AND ANCILLARY SERVICES - SAINT ANNE HOME AND RETIREMENT COMMUNITY (SAINT ANNE HOME) OPERATES A 166 BED NURSING FACILITY PROVIDING A FULL SPECTRUM OF QUALITY CARE INCLUDING PRIVATE REHABILITATION SUITES AND ALZHEIMER'S DEMENTIA CARE. EACH RESIDENT HAS AN INDIVIDUALIZED PROGRAM DESIGNED BY AN INTERDISCIPLINARY TEAM. A FEW OF THE MANY SERVICES PROVIDED INCLUDE: MEDICATION ADMINISTRATION AND MONITORING; ASSISTANCE WITH BATHING; TRANSPORTATION TO MEALS AND ACTIVITIES; AND ASSISTANCE WITH DRESSING. CERTIFIED NURSING ASSISTANTS AND LICENSED NURSES WORK AS A TEAM TO HELP EACH RESIDENT REACH AND MAINTAIN THEIR HIGHEST LEVEL OF FUNCTIONING. SERVICES WERE PROVIDED FOR 55,255 PATIENT DAYS WITH AN AVERAGE OCCUPANCY OF 91.5% DURING THE FISCAL YEAR ENDED JUNE 30, 2013. (CONTINUED IN SCHEDULE O)Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2329914Expense
Grants0Grants
Revenue2693651Revenue
DescriptionRESIDENTIAL SERVICES - SAINT ANNE HOME AND RETIREMENT COMMUNITY (SAINT ANNE HOME) OFFERS 97 INDEPENDENT AND RESIDENTIAL LIVING UNITS FOR PEOPLE WHO ARE ABLE TO CARE FOR THEMSELVES AND THEIR APARTMENTS. ACCORDING TO THE CRITERIA, RESIDENTS WHO BECOME UNABLE TO FUNCTION WILL BE EVALUATED FOR ASSISTED LIVING. SERVICES PROVIDED INCLUDE MEALS, ACTIVITIES AND RELIGIOUS SERVICES. SAINT ANNE RETIREMENT COMMUNITY RESIDENTIAL LIVING UNITS PROVIDED 37,405 PATIENT DAYS DURING THE YEAR ENDED JUNE 30, 2013.Description
FieldValueIRS element (for citing)
Total Program Service Expense14198136TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109616NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees390NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Mike RorickBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2604845555TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11900 RANDALLIA DRIVEAddressLine1
CityFort WayneCity
StateINState
ZIP Code46805ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MONSIGNOR JOHN SUELZER
CORPORATE OFFICER1.0040.00XX0217010
MOST REVEREND KEVIN C RHOADES
CHAIRMAN/CORPORATE OFFICER1.0040.00XX0217010
MR DAVID KOHNEN
VICE PRESIDENT/TREASURER/SECRETARY1.00XX000
MR JIM FITZPATRICK
CORPORATE OFFICER1.00XX000
MR MICHAEL DAHM
PRESIDENT1.00XX000
BEN MILES
DIRECTOR1.00X000
DR DIANE HOPEN
DIRECTOR - PARTIAL YEAR1.00X000
DR MICHAEL ISENBERG
DIRECTOR1.00X000
FRED FORTE
DIRECTOR1.00X000
MARK ANDORFER
DIRECTOR1.00X000
MR BOB NICHOLAS
DIRECTOR1.00X000
MR ED WELLING
DIRECTOR1.00X000
MR JOSEPH RYAN
DIRECTOR1.005.00X0878420
MR MIKE FRIDLEY
DIRECTOR1.00X000
MR NICK CIOCCA
DIRECTOR1.00X000
MR TOM DIXON
DIRECTOR1.00X000
MS CATHERINE WILCOX
DIRECTOR - PARTIAL YEAR1.00X000
MS NANCY O'BRIEN
DIRECTOR1.00X000
SISTER CAROLE LANGHAUSER
DIRECTOR1.00X000
MARY HAVERSTICK
ADMINISTRATOR40.00X7242209935
FieldValueIRS element (for citing)
Total Reportable Comp From Org72422TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs131244TotalReportableCompFrmRltdOrgs
Total Other Compensation9935TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SELECT REHABILITATION
PO BOX 809056CHICAGOIL606809056THERAPY SERVICES465303
SCHENKEL & SONS INC
1120 ST MARYS AVEFORT WAYNEIN46808CONSTRUCTION291294
TECHNOLOGY CONTRACTING SERVICES
2802 CONGRESSIONAL PKWYFORT WAYNEIN46808TECHNOLOGY SERVICES143411
OTIS ELEVATOR
821 CONRAD STFORT WAYNEIN46808ELEVATOR SERVICE137079
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
All Other Contributions81559AllOtherContributions
Total Contributions81559TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NURSING AND MEDICAL SERVICES6230001006237910062379
ANCILLARY SERVICES62300028377332837733
RESIDENTIAL SERVICES62300026936512693651
ADULT DAY SERVICES6230006397563975
0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue15657738TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column17624TotalRevenueColumn
Exclusion$17,624ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities251944Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities194500Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities57444Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column57444TotalRevenueColumn
Exclusion$57,444ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
DINING/VENDING SERVICES722210236454$236,454
LAUNDRY/TELEPHONE SERVICES81230034037$34,037
BAD DEBT RECOVERY9000995989$5,989

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column86323TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$86,323ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue362803TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column16177168TotalRevenueColumn
Related Or Exempt Function Income15657738RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$437,871ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total652Total
Program Services652ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total82357Total
Program Services82357ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total11288Total
Program Services11288ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7918449Total
Program Services7392834ProgramServices
Management And General525615ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total460818Total
Program Services427231ProgramServices
Management And General33587ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1316888Total
Program Services1222607ProgramServices
Management And General94281ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total593080Total
Program Services555185ProgramServices
Management And General37895ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3074Total
Management And General3074ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total37852Total
Management And General37852ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total6125Total
Management And General6125ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1735509Total
Program Services1244006ProgramServices
Management And General491503ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total69736Total
Management And General69736ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total385899Total
Program Services326649ProgramServices
Management And General59250ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total13444Total
Management And General13444ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total63807Total
Management And General63807ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total581523Total
Program Services581523ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total25741Total
Program Services25741ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL & OTHER SUPPLIES1573892150319670696
PROVIDER TAXES824867824867
RESIDENT RELATIONS3914439144

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total22851Total
Program Services0ProgramServices
Management And General22851ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15766996Total
Program Services14198136ProgramServices
Management And General1568860ManagementAndGeneral
Fundraising0Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1300BOY
EOY1300EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1204455BOY
EOY1364102EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1926688BOY
EOY1227361EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY187098BOY
EOY209214EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY65453BOY
EOY67556EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis16601650LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9280542LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY7069769BOY
EOY7321108EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2066582BOY
EOY2260293EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY598317BOY
EOY604457EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY13119662BOY
EOY13055391EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1350920BOY
EOY1209841EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY2845000BOY
EOY2490000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY20057BOY
EOY12257EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY425043BOY
EOY305524EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4641020BOY
EOY4017622EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8478642BOY
EOY9037769EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8478642BOY
EOY9037769EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13119662BOY
EOY13055391EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses410172ReconcilationRevenueExpenses
Reconciliation Unrealized Invest124768ReconciliationUnrealizedInvest
Reconcilation Other Changes24187ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years95152CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years101105CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years127477CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year290030CurrentTaxYearMinus1Year
Current Tax Year81559CurrentTaxYear
Total695323Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14280838CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14275476CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14914596CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15067777CurrentTaxYearMinus1Year
Current Tax Year15663727CurrentTaxYear
Total74202414Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years241508CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years248538CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years309304CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year263282CurrentTaxYearMinus1Year
Current Tax Year362803CurrentTaxYear
Total1425435Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14617498CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14625119CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15351377CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15621089CurrentTaxYearMinus1Year
Current Tax Year16108089CurrentTaxYear
Total76323172Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total
FieldValueIRS element (for citing)
Public Support Total50976323172PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years35946CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years42290CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years31505CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year31524CurrentTaxYearMinus1Year
Current Tax Year17624CurrentTaxYear
Total158889Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years35946CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years42290CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years31505CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year31524CurrentTaxYearMinus1Year
Current Tax Year17624CurrentTaxYear
Total158889Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14653444CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14667409CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15382882CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15652613CurrentTaxYearMinus1Year
Current Tax Year16125713CurrentTaxYear
Total76482061Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99790PublicSupportPercentage509
Prior Year Support Percentage0.99760PriorYearSupportPercentage
Investment Income Percentage0.00200InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00240PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

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)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$1,216OtherActivitiesAmount
Total Lobbying Expenditures IIB1216TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDescription of the activities reported on Lines 1a through 1iIdentifier
Return ReferenceSchedule C, Part II-B, Line 1ReturnReference
ExplanationTHE ORGANIZATION INDIRECTLY INFLUENCED LEGISLATION THOUGH ITS ANNUAL DUES PAID TO LEADINGAGE AND LEADINGAGE INDIANA. FOR THE YEAR ENDED JUNE 30, 2013, 3.3% OF LEADING AGE DUES, 11.2% OF LEADINGAGE INDIANA AND 3% OF CATHOLIC HEALTH ASSOCIATION DUES WERE USED FOR LOBBYING PURPOSES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Land Land

FieldValueIRS element (for citing)
Book Value0BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis13122609OtherCostOrOtherBasis
Depreciation7353901Depreciation
Book Value5768708BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis219872OtherCostOrOtherBasis
Depreciation123432Depreciation
Book Value96440BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3218603OtherCostOrOtherBasis
Depreciation1803209Depreciation
Book Value1415394BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis40566OtherCostOrOtherBasis
Book Value40566BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7321108TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value0BookValue

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value0BookValue

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionNORTHERN TRUST POOLED INVESTMENTSDescription
Book Value2260293BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities2260293TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
SECURITY DEPOSITS$232,500
FAIR VALUE ADJUSTMENT ON INTEREST RATE SWAP$63,000
OTHER LIABILITIES$6,512
RESIDENTS COUNCIL FUNDS$3,512
FieldValueIRS element (for citing)
Total Of Amounts305524TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt16333509TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments124768NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities19500DonatedSrvcAndUseOfFacilities
Other Revenues24187OtherRevenues
Revenue Not Rptd F990168455RevenueNotRptdF990
Revenue Subtotal16165054RevenueSubtotal
Investment Expenses Not Included6125InvestmentExpensesNotIncluded
Other Revenues Not Included5989OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt12114RevenueNotRptdOnFinStmt
Total Revenue Per Form99016177168TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt15774382TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities19500DonatedServicesUseOfFacilities
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F99019500ExpensesNotRptdF990
Expenses Subtotal15754882ExpensesSubtotal
Investment Expenses Not Included26125InvestmentExpensesNotIncluded2
Other Expenses Not Included5989OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt12114ExpensesNotRptdOnFinStmt
Total Expenses Per Form99015766996TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Explanation of escrow agreementSchedule D, Part IV, Line 2bRESIDENTS ARE ENCOURAGED TO MAINTAIN ONLY A MINIMAL AMOUNT OF MONEY IN THEIR POSSESSION. AN ESCROW ACCOUNT MAY BE USED FOR THE RESIDENT TO ACCESS MONEY MONDAY THROUGH FRIDAY, DURING BUSINESS HOURS, WHEN NEEDED. RESIDENTS WHO USE THE ESCROW ACCOUNT ARE REQUIRED TO SIGN A STATEMENT INDICATING THAT IF HE/SHE DEPOSITS FUNDS INTO THE RESIDENT ESCROW ACCOUNT, THE FUNDS WILL BE MANAGED BY SAINT ANNE HOME, AND THAT THE POWER-OF-ATTORNEY, GUARDIAN, OR RESPONSIBLE PARTY MAY MAKE WITHDRAWALS ON BEHALF OF THE RESIDENT.
FIN 48 (ASC 740) footnoteSchedule D, Part X, Line 2THE ORGANIZATION IS EXEMPT FROM INCOME TAXES ON INCOME FROM RELATED ACTIVITIES UNDER SECTION 501(C) (3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING STATE TAX LAW. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. CURRENT ACCOUNTING STANDARDS REQUIRE THE ORGANIZATION TO DISCLOSE THE AMOUNT OF POTENTIAL BENEFIT OR OBLIGATION TO BE REALIZED AS A RESULT OF AN EXAMINATION PERFORMED BY A TAXING AUTHORITY. FOR THE YEARS ENDED JUNE 30, 2013 AND 2012, MANAGEMENT HAS DETERMINED THAT THE ORGANIZATION DOES NOT HAVE ANY TAX POSITIONS THAT RESULT IN ANY UNCERTAINTIES REGARDING THE POSSIBLE IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE UNCERTAIN TAX POSITIONS ARE NOT EXPECTED TO CHANGE IN THE NEXT 12 MONTHS. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES RELATED TO THE UNRECOGNIZED TAX BENEFITS IN INTEREST AND INCOME TAXES, RESPECTIVELY. THE ORGANIZATION HAS NO AMOUNTS ACCRUED FOR INTEREST OR PENALTIES AS OF JUNE 30, 2013 AND 2012. THE ORGANIZATION HAS TAX RETURNS OPEN FOR FEDERAL AND STATE PURPOSES FOR 2009 AND AFTER.
Other revenues in audited financial statements not in form 990Schedule D, Part XI, Line 2dUNREALIZED GAIN/(LOSS) ON INTEREST RATE SWAP AGREEMENT - 24187;
Other revenues in form 990 not in audited financial statementsSchedule D, Part XI, Line 4bBAD DEBT RECOVERY - 5989;
Other expenses in form 990 not in audited financial statementsSchedule D, Part XII, Line 4bBAD DEBT RECOVERY - 5989;

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ANNE NICHOLASBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipSPOUSE (BOB NICHOLAS) IS A BOARD MEMBERRelationship
Amount Of Transaction11288AmountOfTransaction
Description Of TransactionEMPLOYEE COMPENSATIONDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSION (CONTINUED FROM PART III)FORM 990, PART III, LINE 1SAINT ANNE HOME IS A NOT-FOR-PROFIT CHARITABLE CORPORATION ORGANIZED UNDER THE ROMAN CATHOLIC CHURCH, DIOCESE OF FORT WAYNE - SOUTH BEND TO PROVIDE NONSECTARIAN SERVICES TO MEET HUMAN NEEDS. SAINT ANNE HOME PROVIDES THE HIGHEST QUALITY CARE TO ALL THOSE ENTRUSTED TO US. THIS IS DONE IN A CHRISTIAN ATMOSPHERE WITH LOVE AND CONCERN FOR THE INDIVIDUAL, AND WHERE THE SPECIAL NEEDS OF EACH RESIDENT ARE RESPECTED AND MET. SINCE ITS OPENING, SAINT ANNE HOME HAS BECOME THE BENCHMARK FOR HIGH-QUALITY HEALTHCARE IN FORT WAYNE. STARTING AS A NURSING HOME, OVER THE YEARS, SAINT ANNE HOME HAS ADDED 103 APARTMENTS TO ITS CAMPUS AND 16 REHAB SUITES. CURRENTLY, WE HAVE THE ABILITY TO SERVE 165 NURSING HOME RESIDENTS AND 168 RESIDENTIAL CARE RESIDENTS. WHEN YOU WALK IN ANY ENTRANCE TO SAINT ANNE'S, A WARM FEELING OF HOME EMBRACES YOU. WE TREAT EACH OF OUR RESIDENTS AS FAMILY, AND WE WANT TO MEET THE NEEDS AND EXPECTATIONS OF EACH RESIDENT.
NURSING, MEDICAL, AND ANCILLARY SERVICES (CONTINUED FROM PART III)FORM 990, PART III, LINE 4ASAINT ANNE HOME ALSO PROVIDES ADULT DAY SERVICES FOR OLDER ADULTS WHO ARE UNABLE OR UNCOMFORTABLE STAYING HOME ALONE THROUGHOUT THE DAY. THESE PROGRAMS INCORPORATE A SOCIAL MODEL AND MEDICAL SUPPORT FOR THE ADULTS WE SERVE. THE ATMOSPHERE PROVIDES A SAFE, CARING ENVIRONMENT WHERE PARTICIPANTS CAN SOCIALIZE, PARTICIPATE IN THERAPEUTIC ACTIVITIES AND RECEIVE SUPPORT SERVICES AND HEALTH MONITORING. THESE PROGRAMS OFFER FAMILIES AND CAREGIVERS DAILY RESPITE FOR THE DEMANDS OF 24-HOUR CARE.
Delegate broad authority to a committeeForm 990, Part VI, Section A, Line 1aBYLAWS ARTICLE VI, COMMITTEES: 6.02(B) EXECUTIVE COMMITTEE: THERE SHALL BE AN EXECUTIVE COMMITTEE OF THE BOARD CONSISTING OF THE PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER AND THREE (3) ADDITIONAL PERSONS, ONE OF WHOM SHALL BE A MEMBER OF THE CORPORATION. THE DUTIES OF THE EXECUTIVE COMMITTEE SHALL BE: 1) TO HANDLE ANY ADMINISTRATIVE MATTER DELEGATED TO THE COMMITTEE BY THE BOARD. 2) TO EXERCISE THE AUTHORITY OF THE BOARD BETWEEN MEETINGS AND TO REPORT BACK TO THE BOARD AT THE NEXT MEETING ON ALL CONSIDERATIONS, DECISION AND RECOMMENDATIONS. 3) TO BE RESPONSIBLE FOR THE ANNUAL EVALUATION OF THE ST. ANNE HOME ADMINISTRATOR.
Classes of members or stockholdersForm 990, Part VI, Section A, Line 6THE ORGANIZATION HAS THREE MEMBERS, THE DIOCESAN BISHOP OF THE DIOCESE OF FORT WAYNE-SOUTH BEND, INC., AND TWO OTHER PERSONS DESIGNATED BY THE DIOCESAN BISHOP. THE THREE MEMBERS ARE EX-OFFICIO MEMBERS OF THE BOARD OF DIRECTORS; THESE EX-OFFICIO MEMBERS HAVE THE RIGHT TO VOTE AS DIRECTORS.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aTHE DIRECTORS (WHO ARE NOT ALSO MEMBERS OF THE ORGANIZATION) ARE ELECTED BY A MAJORITY VOTE OF THE MEMBERS AND SERVE AT THE SOLE DISCRETION OF THE MEMBERS. ANY DIRECTOR MAY BE REMOVED WITH OR WITHOUT CAUSE OR NOTICE BY A MAJORITY VOTE OF THE MEMBERS AT ANY TIME.
Decisions requiring approval by members or stockholdersForm 990, Part VI, Section A, Line 7bTHE ORGANIZATION'S MEMBERS HAVE THE FOLLOWING POWERS: APPROVAL BY MAJORITY VOTE OF THE BOARD OF DIRECTORS' PROPOSAL TO DISSOLVE THE ORGANIZATION; AMENDMENT OR REPEAL OF BYLAWS AND ADOPTION OF AMENDED BYLAWS; AUTHORIZATION OF ANY OFFICER, THE ADMINISTRATOR, OR OTHER CORPORATE AGENTS TO ENTER INTO CONTRACTS OR TO EXECUTE ANY CONTRACTS IN THE NAME OF AND ON BEHALF OF THE ORGANIZATION; AND CONSULTATION WITH THE BOARD OF DIRECTORS CONCERNING THE APPOINTMENT, RETENTION, AND TERMINATION OF THE ADMINISTRATOR.
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11bA FINAL DRAFT OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS REVIEWED BY MANAGEMENT PRIOR TO FILING WITH THE IRS. A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS THEN PROVIDED TO EACH MEMBER OF THE GOVERNING BODY PRIOR TO ITS FILING WITH THE IRS.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cANNUAL DISCLOSURE IS PROVIDED TO EACH BOARD MEMBER AND ADMINISTRATIVE STAFF. EACH PERSON COMPLETES AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. ONCE THE QUESTIONNAIRES ARE COMPLETED, THE ADMINISTRATIVE ASSISTANT REVIEWS THE RESPONSES AND DETERMINES WHETHER OR NOT THERE ARE ANY POTENTIAL CONFLICTS OF INTEREST. IF THERE IS A POTENTIAL CONFLICT OF INTEREST, THE PRESIDENT, TREASURER AND ADMINISTRATOR REVIEW THE CORRESPONDING ISSUE AND DETERMINE IF THERE IS AN ACTUAL CONFLICT OF INTEREST. IF AN ACTUAL CONFLICT OF INTEREST IS DETERMINED TO EXIST, THAT PERSON IS EXCLUDED FROM ANY DISCUSSIONS CONCERNING THE CONFLICTING ISSUE AND IS NOT PERMITTED TO VOTE ON ANY DECISIONS REGARDING THE CONFLICTING ISSUE. ANY PURCHASES AND/OR BIDDING PROPOSALS ARE ALSO REVIEWED FOR ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO SUBMITTING BIDS OR MAKING PURCHASES. THE CONTROLLER ATTENDS THE BOARD MEETINGS AS A GUEST TO ENSURE THAT COMPLIANCE WITH THESE GUIDELINES IS FOLLOWED.
PROCESS USED TO ESTABLISH COMPENSATION FOR TOP MANAGEMENT OFFICIALFORM 990, PART VI, LINE 15AANNUALLY, THE ADMINISTRATOR'S PERFORMANCE AND COMPENSATION ARE REVIEWED BY THE PRESIDENT AND VICE PRESIDENT OF THE BOARD OF DIRECTORS. DURING THE REVIEW PROCESS, THE EXECUTIVE COMMITTEE COMPLETES AN EVALUATION WITH INPUT FROM THE DIOCESE OF FORT WAYNE-SOUTH BEND DIRECTORS THAT SIT ON THE SAINT ANNE HOME AND RETIREMENT COMMUNITY BOARD. THE EXECUTIVE COMMITTEE LOOKS AT THE PAY STRUCTURE OF THE DIOCESE OF FORT WAYNE-SOUTH BEND, A SIMILAR ORGANIZATION, AND ALSO SPEAKS WITH OUR INDEPENDENT AUDITORS FOR INFORMATION REGARDING INDUSTRY TRENDS. THEY ALSO BASE THEIR FINAL DECISION ON THE RATE OF INCREASE SET BY THE BOARD OF DIRECTORS FOR SAINT ANNE HOME. A COPY OF THE ADMINISTRATOR'S REVIEW, ALONG WITH A LETTER FROM THE BOARD PRESIDENT, IS GIVEN TO HUMAN RESOURCES AND THE CONTROLLER AT THE DIOCESE. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MEETING MINUTES AND WAS LAST COMPLETED DURING FY 2012.
PROCESS USED TO ESTABLISH COMPENSATION FOR OTHER OFFICERSFORM 990, PART VI, LINE 15BTHE ORGANIZATION DOES NOT HAVE ANY OTHER COMPENSATED OFFICERS; THEREFORE, THIS QUESTION HAS BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS.
Governing documents, conflict of interest policy and financial statements available to the publicForm 990, Part VI, Section C, Line 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
Other ExpensesForm 990, Part IX, Line 11gMEDICAL DIRECTOR - TOTAL EXPENSE: 15729, PROGRAM SERVICE EXPENSE: 15729, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONSULTANTS - TOTAL EXPENSE: 15793, PROGRAM SERVICE EXPENSE: 15793, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; LAB SERVICES - TOTAL EXPENSE: 289331, PROGRAM SERVICE EXPENSE: 289331, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; THERAPY SERVICES - TOTAL EXPENSE: 932078, PROGRAM SERVICE EXPENSE: 923153, MANAGEMENT AND GENERAL EXPENSES: 8925, FUNDRAISING EXPENSES: ; CONTRACT LABOR - TOTAL EXPENSE: 346462, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 346462, FUNDRAISING EXPENSES: ; PROFESSIONAL FEES - TOTAL EXPENSE: 90858, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 90858, FUNDRAISING EXPENSES: ; OTHER - TOTAL EXPENSE: 45258, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 45258, FUNDRAISING EXPENSES: ;
Other changes in net assets or fund balancesForm 990 , Part XI, Line 9UNREALIZED GAIN/(LOSS) ON INTEREST RATE SWAP AGREEMENT - 24187;

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DIOCESE OF FORT WAYNE-SOUTH BENDBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 390AddressLine1
CityFORT WAYNECity
StateINState
ZIP Code46801ZIPCode
FieldValueIRS element (for citing)
Primary ActivitiesRELIGIOUS ORDERPrimaryActivities
Legal Domicile StateINLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status1PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg