2022-11-14T12:16:59-06:00 2021-12-31 FORVIS LLP 111 E Wayne St Suite 600 Fort Wayne IN 46802 990 2021-01-01 364390434 CATHERINE KASPER LIFE CENTER % CKLC CATH 5749351757 PO BOX 1 DONALDSON IN 46513 SR SHIRLEY BELL PROVINCIAL LEADER 5749351757 2022-11-15 true SR SHIRLEY BELL 999009999 Lauren R Denton P01571860 2604604000 2 2021 2022-09-23 18:48:47Z SR SHIRLEY BELL PO BOX 1 DONALDSON IN 46513 8024250 false 0928 X WWW.CKLC.POORHANDMAIDS.ORG X 2000 IN CKLC IS COMPOSED OF CKH, A LONG TERM CARE FACILITY, MARIA CENTER, AN APARTMENT COMPLEX FOR SENIORS, AND CATHERINE'S COTTAGE, OFFERING INDEPENDENT LIVING SERVICES FOR MEMBERS. 10 10 127 10 0 0 1477298 320957 8913722 7686964 9384 16329 0 0 10400404 8024250 0 0 0 0 5294478 4030291 0 0 0 4455882 3771214 9750360 7801505 650044 222745 1652159 1708998 895211 729305 756948 979693 X CKLC IS COMPOSED OF CATHERINE KASPER HOME (CKH), A STATE LICENSED AND CERTIFIED LONG TERM CARE FACILITY, MARIA CENTER, AN APARTMENT COMPLEX FOR SENIORS OFFERING SUPPORTIVE SERVICES, AND CATHERINE'S COTTAGE (THE COTTAGE) OFFERING INDEPENDENT LIVING SERVICES TO THE RELIGIOUS MEMBERS RESIDING THERE. false false 5678893 6887230 CATHERINE KASPER HOME (CKH) IS AN 82-BED LICENSED NURSING CARE FACILITY PROVIDING SKILLED SERVICES TO RESIDENTS. CKH PROVIDES ROUTINE CARE SERVICES MEETING THE NEEDS OF RESIDENTS RANGING FROM A LIGHT ACUITY LEVEL NURSING FACILITY COMPONENT TO A SKILLED NURSING UNIT. THE BASIC FEE INCLUDES 24-HOUR NURSING SERVICES, THREE MEALS PER DAY, AND AT LEAST ONE PLANNED NUTRITIONAL SNACK, LAUNDRY SERVICES FOR PERSONAL CLOTHING AND LINENS, ROUTINE MEDICAL SUPPLIES, LOCAL TRANSPORTATION FOR MEDICAL NECESSITY, ACTIVITIES, SOCIAL SERVICE CONSULTATION, PASTORAL CARE, DIETICIAN CONSULTATIONS AND GROUNDS SECURITY. ALL ROOM ACCOMMODATIONS ARE INDIVIDUAL PRIVATE ROOMS, OFFERING A PEACEFUL HOME-LIKE SETTING FOR RESIDENTS' FRIENDS AND FAMILY. 418593 650946 MARIA CENTER IS A NON-LICENSED APARTMENT COMPLEX FOR SENIORS OFFERING SUPPORTIVE SERVICES. A PART OF CKLC, MARIA CENTER IS HOUSED WITHIN THE MAIN POOR HANDMAIDS OF JESUS CHRIST MINISTRY CENTER BUILDING. A FULL-TIME DIRECTOR AND PART-TIME ACTIVITY DIRECTOR STAFF THE MARIA CENTER. MARIA CENTER IS COMPRISED OF 27 APARTMENTS. AN ACTIVITY ROOM PROVIDES EXERCISE EQUIPMENT, A FULL KITCHEN, SMALL LIBRARY, LARGE SCREEN TV AND MEETING AND ACTIVITY SPACE. MARIA CENTER PROVIDES THREE MEALS DAILY THROUGH THE MINISTRY CENTER'S DINING SERVICE. THE MONTHLY RENT INCLUDES ACCESS TO A LAUNDRY FACILITY, A LOCKED PERSONAL STORAGE UNIT, RESERVED PARKING AND TRANSPORTATION FOR SHOPPING. AS AN INDEPENDENT LIVING COMPLEX, ALL ACTIVITIES AND OFFERINGS ARE UTILIZED PER CHOICE OF THE RESIDENT. THERE ARE A WIDE VARIETY OF ACTIVITIES BOTH WITHIN AND OUTSIDE THE MARIA CENTER. 90599 148788 CATHERINE'S COTTAGE IS A PART OF CKLC THAT PROVIDES COMMUNAL LIVING SERVICES FOR RELIGIOUS MEMBERS OF ITS CONGREGATION. EACH RESIDENT RECEIVES STANDARD SERVICES THAT INCLUDE HEALTH AND MEDICAL, MEALS, HOUSEKEEPING, LAUNDRY, TRANSPORTATION, SECURITY, MAINTENANCE, AND WELLNESS ACTIVITIES FOR A MONTHLY RATE. 6188085 true true false false false false false false false false true true false false true false true false false false false false false false false false false false false false false false false false false false false false false false false false false true false false false true 12 0 127 true false false false false false false false false false false false false X 10 10 false true false false true true true true true false false true true true true true true true true false IN X CKLC 5749369936 9601 UNION ROAD PLYMOUTH IN 46563 X SR LINDA VOLK DIRECTOR 1.0 0.0 X 0 0 0 MERITA ALLSOP-BORTON DIRECTOR 1.0 0.0 X 0 0 0 REV SAM BOYS DIRECTOR 1.0 0.0 X 0 0 0 SR SHARON MARIE FOX DIRECTOR 1.0 0.0 X 0 0 0 RAY GIRRES DIRECTOR 1.0 0.0 X 0 0 0 SR JOETTA HUELSMANN PRES./CHAIRPERSON (END 08/21) 1.0 0.0 X X 0 0 0 DR JON KUBLEY DIRECTOR 1.0 0.0 X 0 0 0 SR CAROLE LANGHAUSER VICE PRESIDENT/SECRETARY 1.0 0.0 X X 0 0 0 KENNETH LUKENBILL DIRECTOR 1.0 0.0 X 0 0 0 DONNA SIKORSKI TREASURER 1.0 0.0 X X 0 0 0 SR SHIRLEY BELL PRES./CHAIRPERSON(START 08/21) 1.0 0.0 X X 0 0 0 0 0 0 0 false false false MELADJOY THERAPY SERVICES INC 51470 NORWICH DR GRANGER IN 46530 THERAPY SERVICES 814294 ROSEWOOD STAFFING INC 1022 S 250 W ALBION IN 46701 EMPLOYMENT SERVICES 610620 CSJI 3450 N ROCK ROAD STE 605 WICHITA KS 67226 MANAGEMENT SERVICES 875963 3 275566 45391 320957 CKH REVENUE 623000 6887230 6887230 MARIA CENTER REVENUE 623000 650946 650946 CATHERINE'S COTTAGE REVENUE 623990 148788 148788 7686964 16329 16329 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8024250 7686964 16329 X 0 0 0 0 0 0 3007333 2616380 390953 159419 138695 20724 650926 566306 84620 212613 184973 27640 728945 728945 14652 14652 59416 59416 0 0 0 1083361 942523 140838 490 490 170531 35829 134702 0 0 639565 639565 31434 27348 4086 0 680 592 88 0 0 72487 72487 187057 187057 PHARMACY 138277 138277 FOOD 492179 492179 REPAIRS & MAINTENANCE 48201 41935 6266 COVID EXPENSES 103939 103939 7801505 6188085 1613420 0 598961 553834 0 0 0 0 656229 819278 0 0 0 0 0 0 29281 5238 26544 30346 1173887 1021651 209407 152236 0 0 131737 148066 0 0 0 0 0 0 1652159 1708998 756490 608079 0 0 29861 14861 0 0 0 0 0 0 0 0 0 0 108860 106365 895211 729305 X 741395 979693 15553 0 756948 979693 1652159 1708998 222745 X false true X true false X X 1 ANCILLA DOMINI SISTERS 350867952 1 true 0 0 1 0 0 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 128701 114834 13867 0 1045186 906817 138369 152236 INVESTMENTS - OTHER SECURITIES 148066 F 148066 0 OTHER LIABILITY 106365 106365 8024250 8024250 8024250 7801505 7801505 7801505 ASC 740 FOOTNOTE MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH THE CONGREGATION OF ST. JOSEPH INITIATIVES (CSJI) ON DECEMBER 1, 2019. THE AGREEMENT CALLS FOR CSJI TO PROVIDE MANAGEMENT SERVICES FOR THE LONG-TERM CARE FACILITY MAINLY IN THE AREAS OF CLINICAL OPERATIONS, HUMAN RESOURCES, ACCOUNTS RECEIVABLE MANAGEMENT, AND FINANCIAL OVERSIGHT. FINANCIAL OVERSIGHT ENCOMPASSES THE PROCESSING AND RECORDING OF BILLINGS/CASH RECEIPTS AND ACCOUNTS PAYABLES/CASH DISBURSEMENTS, AS WELL AS THE PREPARATIONS OF MONTHLY FINANCIAL STATEMENTS AND ANNUAL COST REPORTS. THE AGREEMENT WAS EXTENDED FOR A TERM OF THREE YEARS. FORM 990, PART VI, SECTION A, LINE 6 THE PROVINCIAL OF THE AMERICAN PROVINCE OF THE POOR HANDMAIDS OF JESUS CHRIST, THE TREASURER OF THE AMERICAN PROVINCE OF POOR HANDMAIDS OF JESUS CHRIST AND THE INDIVIDUALS HOLDING MEMBERSHIP POSITION IN THE PROVINCIAL COUNCIL OF THE AMERICAN PROVINCE OF THE POOR HANDMAIDS OF JESUS CHRIST ARE THE VOTING MEMBERS OF THE CATHERINE KASPER LIFE CENTER (CKLC). FORM 990, PART VI, LINE 7A THE MEMBERS OF CKLC APPOINT THE BOARD OF DIRECTORS. FORM 990, PART VI, LINE 7B THE APPROVAL OF THE MEMBERS OF CKLC IS REQUIRED WITH RESPECT TO THE FOLLOWING: 1.) ANY MODIFICATIONS OF THE PHILOSOPHY OF CKLC. 2.) ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS. 3.) THE MERGER OR CONSOLIDATION OF CKLC WITH OR INTO ANY OTHER ENTITY. 4.) THE VOLUNTARY DISSOLUTION OF CKLC. 5.) THE LEASE, SALE, TRANSFER, ASSIGNMENT, MORTGAGE OR ENCUMBRANCE OF ANY KIND OF FIXED CAPITAL, REAL ESTATE OR BUILDINGS HAVING A BOOK VALUE IN EXCESS OF ONE MILLION. 6.) THE INCURRENCE OF DEBT IN EXCESS OF $100,000 OTHER THAN INCURRED IN THE ORDINARY COURSE OF BUSINESS. 7.) THE SELECTION OF CERTIFIED PUBLIC ACCOUNTANTS. 8.) THE ACCEPTANCE OF ANY DONATION, GIFT, DEVISE OR BEQUEST WHICH IMPOSES AN ONGOING OR CONTINUING OBLIGATION UPON CKLC. FORM 990, PART VI, LINE 11B THE FORM 990 WAS PREPARED BY THE INDEPENDENT AUDITORS OF CKLC, AND WAS REVIEWED BY CSJI AND ANCILLA DOMINI SISTERS, INC., BOTH OF WHICH PROVIDED ACCOUNTING SERVICES TO CKLC DURING 2021. A DRAFT OF THE FORM 990 WAS PROVIDED TO ALL DIRECTORS VIA EMAIL FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, LINE 12C EACH OFFICER AND DIRECTOR ARE REQUIRED TO ANNUALLY COMPLETE A DISCLOSURE STATEMENT WHICH IDENTIFIES CONFLICTS OF INTEREST. THE FILING OFFICER REVIEWS THE DISCLOSURE STATEMENTS AND REPORTS ANY POTENTIAL CONFLICTS OF INTEREST TO THE BOARD CHAIR WHO WOULD SUBSEQUENTLY DISCLOSE THE POTENTIAL CONFLICT OF INTEREST TO THE BOARD. IN 2021, NO POTENTIAL CONFLICTS OF INTEREST WERE NOTED. FORM 990, PART VI, LINE 15A & 15B THE DIRECTOR OF HUMAN RESOURCES OF ANCILLA DOMINI SISTERS, INC., WHICH PROVIDES HUMAN RESOURCE SERVICES TO CKLC, GATHERS DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AS SIMILARLY SITUATED ORGANIZATIONS AND MAKES A RECOMMENDATION AS TO ANNUAL ADJUSTMENTS FOR EACH EMPLOYEE. THE MEMBERS OF CKLC REVIEW AND APPROVE THE COMPENSATION. FORM 990, PART VI, LINE 19 CKLC DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC EXCEPT TO THE EXTENT THAT THEY ARE IN A PUBLICLY AVAILABLE DOCUMENT SUCH AS FORM 990 OR 1023. FORM 990 PART IX LINE 11G DESCRIPTION:AGENCY STAFFING TOTAL FEES:273031 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:59410 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICAL THERAPY SERVICES TOTAL FEES:213538 FORM 990 PART IX LINE 11G DESCRIPTION:SPEECH THERAPY SERVICES TOTAL FEES:22669 FORM 990 PART IX LINE 11G DESCRIPTION:OCCUPATIONAL THERAPY SERVICES TOTAL FEES:190551 FORM 990 PART IX LINE 11G DESCRIPTION:DIAGNOSTIC SERVICES TOTAL FEES:844 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:73697 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:231723 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER TOTAL FEES:17898 THE LINDEN HOUSE OF GARY INC 566 WEST LAKE STREET CHICAGO IL 60661 351954576 SR. HOUSING IN 501(C)(3) 10 ANCILLA SYS false THE LINDEN HOUSE OF MISHAWAKA 566 WEST LAKE STREET CHICAGO IL 60661 351968002 SR. HOUSING IN 501(C)(3) 10 ANCILLA SYS false WEST TOWER SENIOR RESIDENCE INC 566 WEST LAKE STREET CHICAGO IL 60661 363768578 SR. HOUSING IL 501(C)(3) 10 ANCILLA SYS false SOJOURNER TRUTH HOUSE INC 1419 S LAKE PARK AVENUE HOBART IN 46342 270296707 SOCIAL SVS. IN 501(C)(3) 7 ANCILLA SYS false CATHERINE KASPER PLACE 347 W BERRY SUITE 101 FORT WAYNE IN 46802 273213747 SOCIAL SVS. IN 501(C)(3) 7 SJ HEALTH FN false PHJC FOUNDATION INC 1419 S LAKE PARK AVENUE HOBART IN 46342 271688707 FUND. FDN IN 501(C)(3) 7 ANCILLA SIS false THE LINDEN HOUSE OF HOBART INC 566 WEST LAKE STREET CHICAGO IL 60661 352006008 SR. HOUSING IN 501(C)(3) 10 ANCILLA SYS false false false false false true false false false false true true true false false false false false false ANCILLA DOMINI SISTERS INC K 392343 FMV ANCILLA DOMINI SISTERS INC L 352294 FMV ANCILLA DOMINI SISTERS INC M 15174 FMV