2013-11-15T08:12:15-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 1111 SUPERIOR AVENUE SUITE 1250 CLEVELAND OH 44114 990 2012-01-01 610654635 MADONNA MANOR INC MADO 8594266400 2344 AMSTERDAM ROAD VILLA HILLS KY 41017 MARK MULLAHY 8594266400 2013-11-13 1 JEREMY S HERMAN P00745789 2165231010 2012 2016-02-25 16:41:14Z MARK MULLAHY 2344 AMSTERDAM ROAD VILLA HILLS KY 41017 13007992 0 0928 X WWW.MADONNAMANOR.ORG X 1964 KY MADONNA MANOR IS A LONG TERM CARE COMMUNITY PROVIDING SERVICES TO MEET OUR SENIOR RESIDENTS APPROPRIATE LEVEL OF CARE. 8 6 277 6 0 0 65795 96161 4839509 7925820 -945721 336185 42190 61778 4001773 8419944 0 0 0 0 3111204 3822230 0 0 0 3386824 4067594 6498028 7889824 -2496255 530120 38071331 38462164 30031849 29672932 8039482 8789232 X MADONNA MANOR, A FRANCISCAN CATHOLIC LIVING COMMUNITY, PROVIDES PERSON CENTERED CARE TO SENIORS OF ALL FAITHS IN AN ENVIRONMENT OF BEAUTY, PRAYER AND PEACE, ENABLING THEM TO ACHIEVE THE HIGHEST LEVEL OF PERSONAL INDEPENDENCE. 0 0 4632619 5587587 SKILLED NURSING UNIT - 60 BEDS. 20,276 RESIDENT DAYS IN 2012. OFFERING SKILLED REHABILITATION SERVICES AND LONG TERM CARE SERVICES. 945135 1139965 MEMORY CARE UNIT - 24 INDIVIDUAL ROOMS. 6,748 RESIDENT DAYS IN 2012. SPECIFICALLY DESIGNED FOR RESIDENTS WITH DEMENTIA OR OTHER MIND AFFECTING ILLNESSES AND RESIDENTS NEEDS MORE SERVICE THAN AVAILABLE IN ASSISTED LIVING, BUT NOT ABLE TO QUALIFY FOR LONG TERM OR SKILLED SERVICES. 865471 1043879 ASSISTED LIVING ROOMS - 40 INDIVIDUAL ROOMS, CONSISTING OF STUDIO, ONE BEDROOM AND TWO BEDROOM APARTMENTS. 6,748 RESIDENT DAYS IN 2012. DESIGNED FOR RESIDENTS THAT NEED ASSISTANCE WITH SOME DAY TO DAY ACTIVITIES. SEVERAL LEVELS OF CARE ARE ALSO OFFERED IN THE ASSISTED LIVING AREA. 128002 154389 INDEPENDENT LIVING AND OTHER - ALL AREAS OFFER A WIDE VARIETY OF ACTIVITIES INLCUDING EXECUTIVE CHEF PREPARED MEALS AND SNACKS, PERSONAL EMERGENCY RESPONSE SYSTEMS, SCHEDULED TRANSPORTATION, HOUSEKEEPING AND LAUNDRY SERVICES, SPIRITUAL EDUCATION AND WIRELESS INTERNET. 128002 154389 6571227 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 29 0 1 277 1 0 0 0 0 0 1 1 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X TOM PILLE 8594266304 2344 AMSTERDAM ROAD VILLA HILLS KY 41017 RICK RYAN 1.00 40.00 X 0 347637 43887 JOSEPH NADER 1.00 X X 0 0 0 SR CAROLYN GIERA 1.00 X 0 0 0 JOHN R NIENABER 1.00 X X 0 0 0 EVA M BALLARD 1.00 X X 0 0 0 DAVID T ADAMS 1.00 X 0 0 0 GERALD WHITE 1.00 X 0 0 0 MARK MULLAHY 40.00 X X 105705 0 13408 THOMAS PILLE 40.00 X 67515 0 17025 173220 347637 74320 1 0 1 0 THERAPY PARTNERS 16600 SPRAGUE RD STE 365 MIDDLEBURG HEIGHTS OH 44130 THERAPIST SERVICES 467821 1 4855 91306 96161 NURSING/PERSONAL CARE 623000 7771431 7771431 INDEPENDENT LIVING 623000 154389 154389 7925820 212062 212062 7375 7375 4698858 4579913 2197 118945 -2197 116748 116748 5915 4855 5915 0 23 -23 -23 MEAL INCOME 623000 29397 29397 HAIR SALON 623000 23587 23587 COMMUNITY CENTER INCOME 623000 3251 3251 5566 5566 61801 8419944 7925820 0 397963 210390 210390 2877303 2660721 216582 112474 96921 15553 396934 342044 54890 225129 193998 31131 43939 43939 35406 35406 94823 94823 729985 662704 67281 72487 62463 10024 244220 46446 197774 60552 52179 8373 323713 281954 41759 16258 6326 9932 4669 2939 1730 656084 571449 84635 64041 64041 1013359 882637 130722 28303 24652 3651 FOOD 325155 325155 MEDICAL SUPPLIES 294349 294349 FRANCHISE TAXES 20351 20351 DUES AND LICENSE FEES 12104 12104 27796 27796 7889824 6571227 1318597 0 400 300 2614500 2446178 9246 813539 1173151 22302 19185 36469 77780 27191093 1495249 25864011 25695844 2727929 4239333 4045015 2823864 1055617 1011894 891549 965389 38071331 38462164 1454378 995359 28440000 28440000 137471 237573 30031849 29672932 X 7221107 7970857 818375 818375 8039482 8789232 38071331 38462164 X 530120 -98405 318035 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2546438 -28707 1518589 999142 2456322 90116 2546438 2292199 164123 2456322 2035932 273614 17347 2292199 2739287 -684627 18728 2035932 0.18090 0.81910 0 0 2335000 2335000 21706974 991488 20715486 3031548 503761 2527787 117571 117571 25695844 RESTRICTED FUNDS 999142 F TRUSTEE HELD FUNDS 1824722 F 2823864 SECURITY DEPOSITS 62005 THIRD PARTY SETTLEMENT 50429 RESERVE FOR INSURANCE CLAIMS 125139 237573 X 8292718 -98405 -28821 -127226 8419944 0 8419944 7861003 0 7861003 28821 28821 7889824 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: BENELOVENT CARE FUND DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES AT DECEMBER 31, 2012 OR 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSE -28,821. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSE 28,821. 0 1 0 0 0 0 0 0 0 RICK RYAN 0 313233 0 0 0 34404 0 22490 0 21397 0 391524 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN UNDER SECTION 457(F). CURRENT YEAR PAYMENTS, REPORTED IN PART II, COLUMN (B)(III), ARE SUMMARIZED BELOW: RICK RYAN $33,737 A KENTUCKY ECONOMIC DEVELOPMENT FINANCE AUTHORITY 610600439 49126TAD4 2010-01-05 28440000 BUILDING PROJECT, ADDITIONAL BEDS 0 0 0 A 28440000 547600 2011 0 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 FRANCISCAN LIVING COMMUNITIES IS THE SOLE MEMBER OF MADONNA MANOR. FORM 990, PART VI, SECTION A, LINE 7A FRANCISCAN LIVING COMMUNITIES, AS THE SOLE MEMBER OF THE ORGANIZATION, HAS RESERVED POWERS TO ELECT THE TRUSTEES OF THE ORGANIZATION, AND TO ELECT AND REMOVE THE CHAIRPERSON AND PRESIDENT/CEO OF MADONNA MANOR. FORM 990, PART VI, SECTION A, LINE 7B FRANCISCAN LIVING COMMUNITIES HAS THE RESERVED POWER TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF MADONNA MANOR. FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. THE BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990, INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE IS ENFORCED BY THE BOARD PRESIDENT, THE EXECUTIVE DIRECTOR, AND HUMAN RESOURCE DIRECTOR. THE ORGANIZATION PROVIDES AN ANNUAL QUESTIONNAIRE TO ALL BOARD MEMBERS WHICH REQUIRES DISCLOSURE OF ANY CONFLICTS OF INTEREST THE BOARD MEMBER MAY HAVE WITH THE ORGANIZATION. THIS IS REVIEWED BY THE ORGANIZATION AND REPORTED TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR IS DONE BY THE BOARD OF DIRECTORS. IN SETTING THE WAGES, THE BOARD COMPARES VARIOUS SALARIES FROM LIKE POSITIONS IN SIMILAR ORGANIZATIONS. THE BOARD REVIEWS AND APPROVES THE SALARY ON AN ANNUAL BASIS AND DOCUMENTS IN BOARD MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 219,122. EQUITY TRANSFER 98,913. FORM 990, PART XII, LINE 2C THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS FROM THE PRIOR YEAR. FORM 990, PART VII, AVERAGE HOURS PER WEEK RICK RYAN IS AN OFFICER OF THE PARENT ORGANIZATION. ONE OF THE RESPONSIBILITIES OF HIS POSITION IS TO SERVE AS OFFICER FOR MANY OF THE SUBSIDIARY ORGANIZATIONS. THE AVERAGE WORK WEEK FOR THIS INDIVIDUAL IS 40+ HOURS. THIS TIME IS ALLOCATED TO HIS POSITION WITH THE VARIOUS SUBSIDIARIES AS WELL AS HIS RESPONSIBILITIES OF THE PARENT ORGANIZATION. IT IS ESTIMATED THAT HE DEDICATES AT LEAST ONE HOUR PER WEEK TO HIS RESPONSIBILITIES AS OFFICER OF THE SUBORDINATE ORGANIZATIONS. JOSEPH BERNADINE RESIDENCE LLC 8400 ST FRANCIS DRIVE CENTERVILLE OH 45458 461614594 LOW INCOME RENTAL RESIDENTIAL OH 0 0 ST LEONARD ST JOSEPH SERVICES CORPORATION 2801 FRANCISCAN DRIVE BRYAN TX 77802 742455161 GOVERNANCE TX 501(C)3 LINE 11A, I SYLVANIA FRANCISCAN HEALTH 0 ST JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 741282696 HEALTH CARE TX 501(C)3 LINE 3 ST JOSEPH SERVICES CORP 0 BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HEALTH CARE TX 501(C)3 LINE 3 ST JOSEPH SERVICES CORP 0 MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742761145 HEALTH CARE TX 501(C)3 LINE 3 ST JOSEPH SERVICES CORP 0 ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742847594 NURSING CARE TX 501(C)3 LINE 9 ST JOSEPH SERVICES CORP 0 BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 NURSING CARE TX 501(C)3 LINE 9 ST JOSEPH SERVICES CORP 0 ST JOSEPH FOUNDATION 2801 FRANCISCAN DRIVE BRYAN TX 77802 742351158 FUNDRAISING TX 501(C)3 LINE 11A, I ST JOSEPH SERVICES CORP 0 ST JOSEPH PHYSICIAN ASSOCIATES 2801 FRANCISCAN DRIVE BRYAN TX 77802 203159302 PHYSICIAN PRACTICE TX 501(C)3 LINE 3 ST JOSEPH SERVICES CORP 0 SOPHIA CENTER 6832 CONVENT BLVD SYLVANIA OH 43560 341761656 MENTAL HEALTH OH 501(C)3 LINE 9 SYLVANIA FRANCISCAN HEALTH 0 SISTERS OF ST FRANCIS 6832 CONVENT BLVD SYLVANIA OH 43560 344450609 RELIGIOUS OH 501(C)3 LINE 1 N/A 0 SYLVANIA FRANCISCAN HEALTH 3231 CENTRAL PARK WEST SUITE 106 TOLEDO OH 43617 341412964 CHURCH ORG OH 501(C)3 LINE 1 N/A 0 FRANCISCAN LIVING COMMUNITIES 5942 RENAISSANCE PLACE SUITE A TOLEDO OH 43623 341892096 MANAGEMENT SUPPORT OH 501(C)3 LINE 11A, I SYLVANIA FRANCISCAN HEALTH 0 ST LEONARD 8100 CLYO ROAD CENTERVILLE OH 45458 341940863 LONG TERM CARE FACILITY OH 501(C)3 LINE 9 FRANCISCAN LIVING COMMUNITIES 0 ST LEONARD FOUNDATION 8100 CLYO ROAD CENTERVILLE OH 45458 320102715 FUNDRAISING OH 501(C)3 LINE 7 ST LEONARD 0 PROVIDENCE CARE CENTER 2025 HAYES ROAD SANDUSKY OH 44870 341658625 LONG TERM CARE FACILITY OH 501(C)3 LINE 9 FRANCISCAN LIVING COMMUNITIES 0 THE COMMONS OF PROVIDENCE 5000 PROVIDENCE DRIVE SANDUSKY OH 44870 341826097 ASSISTED LIVING FACILITY OH 501(C)3 LINE 9 PROVIDENCE CARE CENTER 0 PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY OH 44870 341896807 INDEPENDENT LIVING FACILITY OH 501(C)3 LINE 9 PROVIDENCE CARE CENTER 0 PROVIDENCE CARE CENTERS 2025 HAYES ROAD SANDUSKY OH 44870 341826099 FINANCIAL SUPPORT OH 501(C)3 LINE 7 PROVIDENCE CARE CENTER 0 FRANCISCAN CARE CENTER 4111 HOLLAND SYLVANIA ROAD TOLEDO OH 43623 341931806 LONG TERM CARE FACILITY OH 501(C)3 LINE 9 FRANCISCAN LIVING COMMUNITIES 0 ST CLARE COMMONS 5942 RENAISSANCE PLACE SUITE A TOLEDO OH 43623 270163752 LONG TERM CARE FACILITY OH 501(C)3 LINE 9 FRANCISCAN LIVING COMMUNITIES 0 ROSARY CARE CENTER 6832 CONVENT BLVD SYLVANIA OH 43560 341931795 LONG TERM CARE FACILITY OH 501(C)3 LINE 9 SYLVANIA FRANCISCAN HEALTH 0 FRANCISCAN PROPERTIES INC 6600 CONVENT ROAD SYLVANIA OH 43560 341412966 SENIOR HOUSING OH 501(C)3 LINE 9 FRANCISCAN LIVING COMMUNITIES 0 TRINITY HOSPITAL TWIN CITY 819 NORTH FIRST STREET DENNISON OH 44621 275401105 HEALTH CARE OH 501(C)3 LINE 3 SYLVANIA FRANCISCAN HEALTH 0 FRANCISCAN SERVICES SELF INSURANCE TRUST FUND (DSLVD IN 2012) 6832 CONVENT BLVD SYLVANIA OH 43560 346895492 SELF INSURANCE TRUST OH 501(C)3 LINE 11A, I SYLVANIA FRANCISCAN HEALTH 0 SYLVANIA FRANCISCAN HEALTH FOUNDATION 3231 CENTRAL PARK WEST SUITE 106 TOLEDO OH 43617 455357161 FUNDRAISING OH 501(C)3 LINE 7 SYLVANIA FRANCISCAN HEALTH 0 FRANCISCAN SHELTERS 6832 CONVENT BLVD SYLVANIA OH 43560 341612437 DOMESTIC VIOLENCE SHELTER OH 501(C)3 LINE 7 SYLVANIA FRANCISCAN HEALTH 0 ST JOSEPH REGIONAL HEALTH PARTNERS 2801 FRANCISCAN DRIVE BRYAN TX 77802 454088170 PHYSICIAN SUPPORT TX 501(C)3 LINE 3 ST JOSEPH SERVICES CORP 0 ST LEONARD LIMITED PARTNERSHIP 88 E BROAD ST STE 1800 CENTERVILLE OH 45458 311481761 LOW INCOME RENTAL RESIDENTIAL OH N/A INVESTMENT 0 1 ALLIANCE HEALTH PROVIDERS OF BRAZOS VALLEY 2801 FRANCISCAN DR BRYAN TX 77802 742466914 PHYSICIAN HOSPITAL ORGANIZATION TX ST JOSEPH SERVICE CORPORATION C 0 TAU ENTERPRISES (DISSOLVED IN 2012) 2801 FRANCISCAN DR BRYAN TX 77802 742544009 OFFICE BUILDING RENTAL TX ST JOSEPH SERVICE CORPORATION C 0 ST LEONARD CENTER 1 INC 8100 CLYO RD CENTERVILLE OH 45458 311481764 LOW INCOME RENTAL RESIDENTIAL OH ST LEONARD C 0 SFH ASSURANCE LTD SUITE 6 GRAND PAVILION COMMERCIAL GRAND CAYMAN KY1- CJ 981056892 INSURANCE CJ SYLVANIA FRANCISCAN HEALTH C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0