2013-10-07T12:15:26-05:00 2012-12-31 061009205 BLUM SHAPIRO & COMPANY PC CPAS 50 HOLDEN STREET PROVIDENCE RI 02908 990 2012-01-01 050275443 ST ANTOINE RESIDENCE SAIN 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 WENDY FARGNOLI 4017673500 2013-09-30 1 DONALD SULLIVAN P00059830 4012725600 2012 2016-02-25 16:41:14Z WENDY FARGNOLI 10 RHODES AVENUE NORTH SMITHFIELD RI 028966999 23442102 0 X WWW.STANTOINE.NET X 1913 RI THE MISSION OF SAINT ANTOINE RESIDENCE IS TO CARE FOR THE SICK AND ELDERLY IN ADDITION TO REFLECTING THE CHURCH'S COMMITMENT AND SUPPORT FOR ALL HUMAN LIFE AND AFFIRMATION OF THE VALUE OF EACH PERSON REGARDLESS OF AGE OR PHYSICAL CONDITION IN A COMPASSIONATE, CARING AND CHRISTIAN ENVIRONMENT. 6 5 462 65 0 0 369262 822098 21843385 22398207 94950 37113 86129 92991 22393726 23350409 0 0 0 0 13078932 13690168 0 0 0 8043912 8115705 21122844 21805873 1270882 1544536 18677883 19787469 9555696 9012374 9122187 10775095 X THE MISSION OF SAINT ANTOINE RESIDENCE IS TO CARE FOR THE SICK AND ELDERLY IN ADDITION TO REFLECTING THE CHURCH'S COMMITMENT AND SUPPORT FOR ALL HUMAN LIFE AND AFFIRMATION OF THE VALUE OF EACH PERSON REGARDLESS OF AGE OR PHYSICAL CONDITION IN A COMPASSIONATE, CARING AND CHRISTIAN ENVIRONMENT. 0 0 20019181 22276988 THE OPERATION OF A LONG-TERM CARE FACILITY FOR THE ELDERLY AND OTHER NEEDY INDIVIDUALS. DURING 2012 ST. ANTOINE'S PROVIDED A TOTAL 92,811 PATIENT BED DAY, INCLUDING 77,601 BED DAYS TO MEDICAID AND MEDICARE PATIENTS. 74410 121219 PROVISION OF MEALS TO ADULT DAY CARE PROGRAM OPERATED BY PACE, AN EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). 20093591 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 7 0 1 462 1 0 0 0 0 0 1 1 0 0 0 0 X 6 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 X MARIO MACERA 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 028966999 WENDY FARGNOLI 40.00 X X 125321 0 27881 MOST REV THOMAS J TOBIN 1.00 X X 0 0 0 REV MSGR GEORGE FRAPPIER 1.00 X 0 0 0 REV TIMOTHY D REILLY 1.00 X X 0 0 0 REV MSGR ALBERT A KENNEY 1.00 X X 0 0 0 JOHN J BARRY III 1.00 X 0 0 0 MARIO MACERA 40.00 X 103878 0 25918 229199 0 53799 2 0 1 0 0 250227 571871 822098 MEDICAID & MEDICARE RE 623000 16762850 16762850 NURSING HOME FEES 623000 5428738 5428738 MEALS REVENUE - PACE ADULT MEALS 621990 121219 121219 MANAGEMENT FEE INCOME 623000 85400 85400 22398207 37113 37113 12000 3571 8429 8429 8429 120537 88122 32415 32415 OTHER INCOME 900099 29778 29778 DISCOUNTS EARNED 900099 15958 15958 HAIRDRESSER REVENUE 900099 6411 6411 52147 23350409 22398207 0 130104 282998 16980 266018 9863370 9174540 688830 669532 629365 40167 2133416 1967530 165886 740852 673114 67738 62754 62754 9100 9100 83865 83865 39969 39969 20421 20421 52845 52845 441054 414591 26463 15876 15876 355021 333720 21301 693560 654350 39210 546927 528687 18240 PURCHASED SERVICES 2024131 2024131 MEDICAL & OTHER DIRECT 1329005 1329005 PROVIDER TAXES 1254814 1254814 FOOD 812818 812818 373545 217192 156353 21805873 20093591 1712282 0 2000 2000 4864031 6631991 2328612 1636771 650962 621251 90586 77666 117554 103304 19612596 9844358 9586733 9768238 327175 354168 710230 592080 18677883 19787469 1433117 1910264 7350000 6405000 772579 697110 9555696 9012374 X 8923168 10185330 167519 551015 31500 38750 9122187 10775095 18677883 19787469 X 1544536 32903 75469 X X 0 1 X 1 0 X 1257796 318059 434717 410451 457529 2878552 20949743 21097651 21359483 21843385 22323885 107574147 8122 6622 6370 5998 6411 33523 22215661 21422332 21800570 22259834 22787825 110486222 0 0 0 110486222 63775 61066 63113 55327 37113 280394 63775 61066 63113 55327 37113 280394 6670 3845 30260 14897 26762 82434 22286106 21487243 21893943 22330058 22851700 110849050 0.99670 0.99650 0.00250 0.00290 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 166000 166000 15363306 6645023 8718283 4019006 3199335 819671 64284 64284 9768238 INTEREST RATE SWAP 697110 697110 X 23179573 32903 79040 111943 23067630 282779 282779 23350409 21526665 3571 3571 21523094 282779 282779 21805873 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION HAS ADOPTED THE GUIDANCE IN ASC 740, INCOME TAXES, RELATING TO UNCERTAIN TAX POSITIONS. THIS GUIDANCE PRESCRIBES A TWO STEP PROCESS FOR THE MEASUREMENT OF UNCERTAIN TAX POSITIONS THAT HAVE BEEN TAKEN OR ARE EXPECTED TO BE TAKEN ON A TAX RETURN. THE FIRST STEP IS A DETERMINATION OF WHETHER THE TAX POSITION SHOULD BE RECOGNIZED IN THE FINANCIAL STATEMENTS. THE SECOND STEP DETERMINES THE MEASUREMENT OF THE TAX POSITION. ASC 740 ALSO PROVIDES GUIDANCE ON DE-RECOGNITION OF SUCH TAX POSITIONS, CLASSIFICATION, POTENTIAL INTEREST AND PENALTIES, AND DISCLOSURE. NO UNCERTAIN TAX POSITIONS WITHIN THE SCOPE OF ASC 740 EXIST AS OF DECEMBER 31, 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL PROPERTY DEPRECIATION 3,571. UNREALIZED GAIN ON INTEREST RATE SWAP CONTRACT 75,469. PART XI, LINE 4B - OTHER ADJUSTMENTS: UNITED WAY GRANT EXPENSES NETTED ON FINANCIAL STATEMENTS 208,369. EXPENSE FOR MEALS TO ADULT DAY CARE NETTED ON FINANCIAL STATEMENTS 74,410. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL PROPERTY DEPRECIATION 3,571. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNITED WAY GRANT EXPENSES NETTED ON FINANCIAL STATEMENTS 208,369. EXPENSE FOR MEALS TO ADULT DAY CARE NETTED ON FINANCIAL STATEMENTS 74,410. GOLF TOURNAMENT 100497 100497 73306 ANNUAL FUND 20040 20040 14816 120537 120537 88122 88122 32415 X X X 0 0 0 0 0 0 0 0 0 WENDY FARGNOLI 125321 0 0 0 0 0 0 0 27881 0 153202 0 0 0 A RHODE ISLAND HEALTH AND EDUCATIONAL BUILDING CORPORATION 521300173 762243ZA4 2009-11-12 9135000 BOND REFUNDING 0 0 0 A 9135000 345000 1994 1 0 1 1 A 0 0 0 0 1 1 BANK OF AMERICA MERRILL LYNCH 9.000000000000 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 MARIO MACERA, DIRECTOR OF FINANCE AND WENDY FARGNOLI, ASSISTANT TREASURER REVIEW THE FORM 990 PRIOR TO FILING. UPON REVIEW AND APPROVAL, THE RETURN IS SIGNED BY WENDY FARGNOLI AND FILED WITH THE IRS. IN THE EVENT THAT WENDY FARGNOLI IS NOT ABLE TO SIGN THE 990 INFORMATION RETURN, MARIO MACERA IS AUTHORIZED TO DO SO. A COPY IS SUBMITTED TO THE FISCAL OFFICE AT THE DIOCESE OF PROVIDENCE AND ONE IS KEPT AT THE BUSINESS OFFICE. FORM 990, PART VI, SECTION B, LINE 12C ALL KEY EMPLOYEES AND MEMBERS OF THE BOARD OF DIRECTORS ARE ASKED TO READ THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND ANNUALLY THEY ARE ASKED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. THE EXECUTIVE DIRECTOR AND THE FINANCE DIRECTOR REVIEW ALL POTENTIAL CONFLICTS OF INTEREST DISCLOSED BY KEY EMPLOYEES AND DETERMINE IF A TRUE CONFLICT EXISTS. IF AN INDIVIDUAL HAS A CONFLICT, THE EXECUTIVE DIRECTOR AND THE DIRECTOR OF FINANCE REPORT THIS INFORMATION TO THE BOARD OF DIRECTORS. ALL MEMBERS OF THE BOARD ARE ASKED TO DISCLOSE ANY CONFLICTS OF INTEREST, AND DEPENDING UPON THE CONFLICT, THEY ARE ASKED TO RECUSE THEMSELVES FROM DISCUSSIONS AND VOTING ON THE RELATED ISSUE. ALL DECISIONS ARE RECORDED IN THE MINUTES OF THE BOARD OF DIRECTORS' MEETING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS FUNCTIONS AS A COMPENSATION COMMITTEE IN DETERMINING SALARY FOR THE ADMINISTRATOR AND KEY EMPLOYEES. IN MAKING ITS DECISION ON COMPENSATION, IT TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR ADMINISTRATORS AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE AREA. THE COMMITTEE CONSIDERS THE PERFORMANCE OF THE ORGANIZATION DURING THE REVIEW PERIOD AND CONSIDERS THE ADMINISTRATOR'S SUCCESS IN ACHIEVING ORGANIZATIONAL GOALS. THE ADMINISTRATOR REVIEWS SALARY OF ALL OTHER EMPLOYEES. IN MAKING A DECISION ON THE AMOUNT OF COMPENSATION, SHE TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR EXECUTIVES, PERFORMING SIMILAR TYPES OF DUTIES, AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE RHODE ISLAND AREA. COMPENSATION RELATED DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ALL GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: UNREALIZED GAIN ON INTEREST RATE SW 75,469. FINANCIAL STATEMENTS AUDIT OVERSIGHT FORM 990 PART XII, LINE 2C THE FINANCE COMMITTEE IS RESPONSIBLE FOR OVERSIGHT OF THE COMPLETION OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE FINANCE COMMITTEE AND SUBMITTED TO THE ADVISORY BOARD AND CORPORATE BOARD. DAURAY LLC 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 050275443 REAL ESTATE RI 0 0 THE FRASSATI RESIDENCE DBA THE VILLA AT SAINT ANTOINE 400 MENDON ROAD NORTH SMITHFIELD RI 02896 050511505 OPERATION OF A 76-UNIT ASSISTED LIVING FACILITY. RI 501(C)(3) LINE 1 0 501(C)(3) 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0