2012-11-09T12:52:31-06:00 2011-12-31 061470257 SULLIVAN & COMPANY CPAS LLP 50 HOLDEN STREET PROVIDENCE RI 02908 990 2011-01-01 050275443 ST ANTOINE RESIDENCE SAIN 4017673500 10 RHODES AVENUE NORTH SMITHFIELD RI 02896 WENDY FARGNOLI 4017673500 2012-11-06 1 DONALD SULLIVAN P00059830 4012725600 X 2011 2016-02-24 21:20:13Z WENDY FARGNOLI 10 RHODES AVENUE NORTH SMITHFIELD RI 028966999 22495931 0 0928 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 5 442 85 0 0 389282 369262 21359483 21843385 51113 94950 106303 86129 21906181 22393726 0 0 0 0 12809896 13078932 0 0 0 7688752 8043912 20498648 21122844 1407533 1270882 18884073 18677883 10872261 9555696 8011812 9122187 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 19440636 21739995 THE OPERATION OF A LONG-TERM CARE FACILITY FOR THE ELDERLY AND OTHER NEEDY INDIVIDUALS. DURING 2011 ST. ANTOINE'S PROVIDED A TOTAL 93,573 PATIENT BED DAY, INCLUDING 76,125 BED DAYS TO MEDICAID AND MEDICARE PATIENTS. 51013 103390 PROVISION OF MEALS TO ADULT DAY CARE PROGRAM OPERATED BY PACE, AN EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3) 19491649 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 0 1 0 0 442 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 121244 0 17129 MOST REV THOMAS TOBIN 1.00 X X 0 35754 19921 REV MSGR GEORGE FRAPPIER 1.00 X X 0 0 0 REV TIMOTHY D REILLY 1.00 X X 0 30608 19921 REVEREND ALBERT KENNEY 1.00 X X 0 34885 19921 JOHN BARRY 1.00 X 0 145842 25343 MARIO MACERA 40.00 X 100377 0 23492 221621 247089 125727 2 0 1 0 0 279495 89767 369262 MEDICAID & MEDICARE RE 623000 15750506 15750506 NURSING HOME FEES 623000 5904089 5904089 MEALS REVENUE-PACE ADU 621990 103390 103390 MANAGEMENT FEE INCOME 623000 85400 85400 21843385 55327 55327 12000 3572 8428 8428 8428 39623 0 39623 39623 39623 139822 98633 41189 41189 DISCOUNTS EARNED 900099 15617 15617 OTHER INCOME 900099 14897 14897 HAIRDRESSER REVENUE 900099 5998 5998 36512 22393726 21843385 0 181079 262442 15747 246695 9474208 8871539 602669 637043 601242 35801 1996836 1844404 152432 708403 647786 60617 68630 68630 10241 10241 67425 67425 45504 45504 20957 20957 94892 94892 661598 621902 39696 13064 13064 375512 352982 22530 663638 626076 37562 533370 515808 17562 PURCHASED SERVICES 1888363 1888363 PROVIDER TAXES 1171086 1171086 MEDICAL & OTHER DIRECT 1149517 1149517 FOOD 832052 832052 448063 284515 163548 21122844 19491649 1631195 0 2000 2000 4956968 4864031 2079595 2328612 648754 650962 57678 90586 155735 117554 18777823 9191090 9892285 9586733 356341 327175 734717 710230 18884073 18677883 1970248 1433117 8260000 7350000 642013 772579 10872261 9555696 X 7711875 8923168 268437 167519 31500 31500 8011812 9122187 18884073 18677883 X 1270882 -160507 X X 0 1 1 X 0 X 212620 1257796 318059 434717 410451 2633643 20290845 20949743 21097651 21359483 21843385 105541107 6327 8122 6622 6370 5998 33439 20509792 22215661 21422332 21800570 22259834 108208189 0 0 0 108208189 74081 63775 61066 63113 55327 317362 74081 63775 61066 63113 55327 317362 7689 6670 3845 30260 14897 63361 20591562 22286106 21487243 21893943 22330058 108588912 0.99650 0.99610 0.00290 0.00310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 166000 166000 14649655 6252793 8396862 3872377 2938297 934080 89791 89791 9586733 INTEREST RATE SWAP 772579 772579 22393726 21122844 1270882 -29941 -130566 -160507 1110375 21954384 -29941 3572 -26369 21980753 412973 412973 22393726 20844009 3572 3572 20840437 282407 282407 21122844 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: UNREALIZED LOSS ON INTEREST RATE SW -130,566. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL PROPERTY DEPRECIATION 3,572. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNREALIZED LOSS ON INTEREST RATE SWAP CONTRACT 130,566. UNITED WAY GRANT EXPENSES NETTED ON FINANCIAL STATEMENTS 163,548. BAD DEBT RECOVERY NETTED WITH EXPENSE ON FINANCIAL STATEMENTS 7,198. EXPENSE FOR MEALS TO ADULT DAY CARE NETTED ON FINANCIAL STATEMENTS 51,013. GRANT EXPENSES NETTED AGAINST REVENUE ON FINANCIAL STATEMENTS 60,648. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL PROPERTY DEPRECIATION 3,572. PART XIII, LINE 4B - OTHER ADJUSTMENTS: UNITED WAY GRANT EXPENSES NETTED ON FINANCIAL STATEMENT 163,548. BAD DEBT RECOVERY NETTED ON FINANCIAL STATEMENTS 7,198. EXPENSE FOR MEALS TO ADULT DAY CARE NETTED ON FINANCIAL STATEMENTS 51,013. GRANT EXPENSES NETTED AGAINST REVENUE ON FINANCIAL STATEMENTS 60,648. GOLF TOURNAMENT 112802 112802 85517 ANNUAL FUND 27020 27020 13116 139822 139822 98633 98633 41189 X X X 0 0 0 0 0 0 0 0 0 JOHN BARRY 0 145842 0 0 0 0 0 0 0 25343 0 171185 0 0 RHODE ISLAND HEALTH AND EDUCATIONAL BUILDING CORPORATION 521300173 762243ZA4 2009-11-12 9135000 BOND REFUNDING 0 0 0 9135000 345000 1994 1 0 1 1 0 0 0 0 1 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 5: NET UNREALIZED LOSSES ON INVESTMENTS: -29,941. UNREALIZED LOSS ON INTEREST RATE SW -130,566. TOTAL TO FORM 990, PART XI, LINE 5: -160,507. 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 ROMAN CATHOLIC DIOCESE OF PROVIDENCE 1 CATHEDRAL SQUARE PROVIDENCE RI 02905 050258960 ROMAN CATHOLIC ORGANIZATION RI 501(C)(3) LINE 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0