2011-10-12T13:04:48-05:00 2010-12-31 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2010-01-01 381789460 LOURDES INC LOUR 2486742241 2300 WATKINS LAKE ROAD WATERFORD MI 48328 SR MAUREEN COMER OP 2486742241 2011-09-30 1 2483522500 2010 2016-03-07 17:11:31Z LOURDES NURSING HOME SR MAUREEN COMER OP 2300 WATKINS LAKE ROAD WATERFORD MI 48328 10609721 0 0928 X WWW.LOURDESSENIORCOMMUNITY.ORG X 1965 MI OPERATION OF A 108-BED SKILLED NURSING FACILITY 21 21 172 54 0 0 24301 105368 9586166 10456443 25570 47910 43302 0 9679339 10609721 0 0 0 0 6714773 6762952 0 0 118393 3506624 3963209 10221397 10726161 -542058 -116440 6689701 7210714 786374 1384525 5903327 5826189 FULL CONTINUUM CARE FOR SENIORS REGARDLESS OF RACE, CREED, OR RELIGION. THOSE WHO MINISTER ARE COMMITTED TO GOSPEL VALUES AND STRIVE TO PROVIDE HUMAN WHOLENESS RECOGNIZING THE UNIQUENESS OF EACH PERSON WITH COMPASSION, LOVE, RESPECT, AND DIGNITY. 0 0 8649438 10456443 OPERATION OF A 108-BED SKILLED NURSING FACILITY. 8649438 1 1 0 0 0 0 0 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 172 1 0 0 0 0 0 0 0 0 0 0 X 21 21 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X SR MAUREEN COMER OP CEO 2486742241 2300 WATKINS LAKE ROAD WATERFORD MI 48328 X ROBERT RINEY 1.00 X X 0 0 0 J EDWARD HANNAN 1.00 X 0 0 0 BRIAN CONDIT 1.00 X 0 0 0 FRANK MACDONELL 1.00 X 0 0 0 S GENE POORE 1.00 X X 0 0 0 SISTER TERSITA LIPAR OP 1.00 X 0 0 0 SISTER DIANE TRAFFAS OP 1.00 X X 0 0 0 BARBARA MENDELSON 1.00 X X 0 0 0 BETH CAFARO 1.00 X 0 0 0 DAN CALLAN 1.00 X 0 0 0 MICHAEL CIANCIOLO 1.00 X 0 0 0 TIM GRAJEWSKI 1.00 X 0 0 0 ROGER HOWARD MD 1.00 X 0 0 0 HENRIETTA JURAS MD 1.00 X 0 0 0 LYNNE LEPISTO-FOLLING RN MSN 1.00 X 0 0 0 RONALD MCGUIRE 1.00 X 0 0 0 JOSEPH MENDELSON SR 1.00 X 0 0 0 JAMES NOTEMAN 1.00 X 0 0 0 JUITH SMITH 1.00 X 0 0 0 DANIEL WALLAS 1.00 X 0 0 0 ARCHBISHOP VIGNERON 1.00 X X 0 0 0 S MAUREEN COMER OP 10.00 X 0 0 0 DON MISENER 10.00 X 95090 0 7175 RONALD DELASKO 40.00 X 98041 0 18551 SHELA MYRICK 40.00 X 106564 0 6524 201654 0 13699 1 0 0 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 63150 RESIDENT THERAPY 617677 DOMINICAN SISTERS OF ADRIAN 1257 EAST SIENA HEIGHTS DRIVE ADRIAN MI 49221 MANAGEMENT SERVICES 167833 2 105368 105368 MEDICARE/MEDICAID PAY. 623000 7097445 7097445 RESIDENT SERVICE/ROOM 623000 3342267 3342267 RESIDENT SERVICES 623000 16731 16731 10456443 43298 43298 4612 4612 4612 4612 10609721 10456443 0 47910 102265 102265 5252771 4182091 999620 71060 64650 51472 12303 875 869188 692020 165409 11759 474078 377446 90219 6413 10026 10026 34650 34650 758527 603916 144350 10261 35407 35407 1056847 841428 201122 14297 8355 8355 275597 219422 52447 3728 19000 19000 364262 364262 56267 56267 MEDICAID - BED TAX 724024 724024 BAD DEBT EXPENSE 593357 593357 26890 26890 10726161 8649438 1958330 118393 700 800 377158 358865 1491119 2809340 38184 33105 5018 41803 8263719 5210731 3264012 3052988 1455907 913813 57603 0 6689701 7210714 786374 1384525 786374 1384525 X 5054551 4949577 848776 876612 5903327 5826189 6689701 7210714 X -116440 39302 X X 0 1 1 X 0 X 106981 502599 234778 65605 105368 1015331 8351940 9970551 10248997 9597908 10456443 48625839 8458921 10473150 10483775 9663513 10561811 49641170 390000 130302 520302 31160 49260 80420 390000 130302 31160 49260 600722 49040448 216142 75571 55110 48080 43298 438201 216142 75571 55110 48080 43298 438201 8675063 10548721 10538885 9711593 10605109 50079371 0.97930 0.92960 0.00880 0.00930 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: RESIDENT SERVICES, INTERCOMPANY, AND INVESTMENT INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 345 248 231 362 0 848776 60410 30014 2560 876612 797621 94230 40675 2400 848776 1.00000 0 1 1 6028369 3617824 2410545 1564284 1190486 373798 671066 402421 268645 3052988 10609721 10726161 -116440 39302 39302 -77138 PART IV, LINE 1B: ORGANIZATION IS CUSTODIAN FOR RESIDENT TRUST ACCOUNT TO HOLD SPENDING MONEY FOR NURSING HOME RESIDENTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION INTENDS TO USE THE FUNDS IN VARIOUS WAYS IN SUPPORT OF THE CARE OF THE DOMINICAN SISTERS OF PEACE. FORM 990, PART VI, SECTION A, LINE 2 BARBARA AND JOSEPH MENDELSON - PERSONAL RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE CORPORATION SHALL BE LIMITED TO TWENTY-ONE PERSONS, TO BE APPOINTED BY THE DOMINICAN HEALTH CARE CORPORATION. AMONG THESE MEMBERS SHALL BE THREE MEMBERS OF THE ORDER OF THE DOMINICAN SISTERS OF PEACE, KENTUCKY ("DOMINICAN SISTERS") WHOSE NAMES ARE TO BE SUBMITTED TO THE DOMINICAN HEALTH CARE CORPORATION BY THE PRIORESS OF THE DOMINICAN SISTERS. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF THE ADMINISTRATOR IS SUBJECT TO APPROVAL OF THE BOARD OF DIRECTORS. ALL MEMBERS OF THE CORPORATION, AND ONLY SUCH MEMBERS, SHALL BE MEMBERS OF THE BOARD OF DIRECTORS. THE MEMBERSHIP OF THE CORPORATION SHALL BE LIMITED TO TWENTY-ONE PERSONS, TO BE APPOINTED BY THE DOMINICAN HEALTH CARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS ARE THE BOARD OF DIRECTORS. DECISIONS ARE SUBJECT TO THE APPROVAL OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE CEO, CONTROLLER, AND AUDIT AND COMPLIANCE COMMITTEE REVIEW THE FORM 990 AND PROVIDE TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C SR. MAUREEN COMER, OP, CEO, THE PRESIDENT OF THE DOMINICAN HEALTH CARE BOARD, AND THE GOVERNANCE AND NOMINATING COMMITTEE REVIEW THE CONFLICT OF INTEREST STATEMENTS SUBMITTED BY BOARD MEMBERS AND KEY EMPLOYEES ON AN ANNUAL BASIS. IN THE EVENT A CONFLICT ARISES, IT IS DISCUSSED WITH THE AUDIT/COMPLIANCE COMMITTEE TO EVALUATE APPROPRIATENESS AND DETERMINATION OF RESTRICTIONS. THE MONITORING OF TRANSACTIONS IS REPORTED TO THE AUDIT/COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE HUMAN RESOURCES/COMPENSATION COMMITTEE, COMPRISED OF INDEPENDENT BOARD MEMBERS AND NON-BOARD MEMBERS, MEETS ANNUALLY TO DETERMINE RAISES FOR THE CEO AND THE EXECUTIVE GROUP. COMPENSATION BENCHMARKING AND PERFORMANCE DATA IS REVIEWED IN ORDER TO SUBSTANTIATE COMPENSATION. 2010 WAS THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART VII: SISTER MAUREEN COMER HAS MET THE REQUIREMENTS DESCRIBED IN REV. RULING 77-290 TO NOT BE LIABLE FOR FEDERAL INCOME OR EMPLOYMENT TAXES. ACCORDINGLY, PAYMENT FOR HER SERVICES ARE MADE DIRECTLY TO THE DOMINICAN SISTERS OF ADRIAN, AN IRC SEC. 501(C)(3) ORGANIZATION. WE HAVE DISCLOSED THIS TRANSACTION ON FORM 990, PART VII, SECTION B, INDEPENDENT CONTRACTORS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 39,302. FORM 990, PART XI, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. DOMINICAN SISTERS OF PEACE 2320 AIRPORT ROAD COLUMBUS OH 432192098 263550703 RELIGIOUS KY 501(C)(3) LINE 1 VATICAN - CATHOLIC CHURCH 0 LOURDES ALZHEIMERS SPECIAL CARE CENTER 2300 WATKINS LAKE ROAD WATERFORD MI 48328 383077328 ALZHEIMERS CARE MI 501(C)(3) LINE 9 LOURDES INC 1 LOURDES ASSISTED LIVING CORPORATION 2300 WATKINS LAKE ROAD WATERFORD MI 48328 383431154 ASSISTED LIVING MI 501(C)(3) LINE 9 PRIORESS DOMINICAN SISTERS OF PEACE 1 FOX MANOR INC 2300 WATKINS LAKE ROAD WATERFORD MI 48328 382906665 SENIOR CARE MI 501(C)(3) LINE 9 PRIORESS DOMINICAN SISTERS OF PEACE 1 ARCHDIOCESE OF DETROIT 1234 WASHINGTON BLVD DETROIT MI 48226 381359274 RELIGIOUS MI 501(C)(3) LINE 1 VATICAN - CATHOLIC CHURCH 0 DOMINICAN HEALTH CARE CORPORATION 2300 WATKINS LAKE ROAD WATERFORD MI 48328 383575700 RELIGIOUS MI 501(C)(3) LINE 1 ARCHBISHOP ARCHDIOCESE OF DETROIT 1 LOURDES CAMPUS FUND 2300 WATKINS LAKE ROAD WATERFORD MI 48328 383576730 FUNDING TO SUPPORT LOURDES, INC. AND AFFILIATES MI 501(C)(3) LINE 1 ARCHBISHOP ARCHDIOCESE OF DETROIT 1 0 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 DOMINICAN SISTERS OF PEACE J 57800 COST LOURDES ALZHEIMERS SPECIAL CARE CENTER N 237128 ALLOCATED COST OF COMPENSATION FOX MANOR N 272168 ALLOCATED COST OF COMPENSATION LOURDES ASSISTED LIVING N 372596 ALLOCATED COST OF COMPENSATION LOURDES CAMPUS FUND K 242972 COST