2020-11-13T16:59:53-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 501 GRANT STREET SUITE 425 PITTSBURGH PA 15219 990 2019-01-01 420760833 KAHL HOME FOR THE AGED AND INFIRM KAHL 5633241621 6701 JERSEY RIDGE ROAD DAVENPORT IA 52807 KIMBERLY HUFSEY ADMINISTRATOR 5633241621 2020-11-11 1 RYAN SANTARELLA P02069285 4124856700 2020-11-11 67.137.57.251 2020-11-11 20:12:10 ES P B5C6689AE7AF5414E27E4467F9AB971DF3B0FBE3 142F3DE39B0754EF86483173A7FF9CFB696D9CF0 2019 2021-01-29 14:40:06Z KIMBERLY HUFSEY 6701 JERSEY RIDGE ROAD DAVENPORT IA 52807 13816930 0 0928 X WWW.KAHLHOMEDAV.COM X 1957 IA PROVIDE CARE AND SERVICES TO THE COMMUNITY IN CONFORMANCE WITH THE THEOLOGY; PHILOSOPHY; TEACHINGS AND DOCTRINES OF THE ROMAN CATHOLIC CHURCH, RESPECTING AND BUILDING ON THE MISSION, PHILOSOPHY AND VALUES OF THE CARMELITE SISTERS FOR THE AGED AND INFIRM. 14 14 325 115 0 0 66070 189638 11452056 12786981 268787 698885 140105 141426 11927018 13816930 0 0 0 0 6681468 8166801 0 0 0 7478178 6428946 14159646 14595747 -2232628 -778817 48310345 48644419 23363878 22962543 24946467 25681876 PROVIDE CARE AND SERVICES TO THE COMMUNITY IN CONFORMANCE WITH THETHEOLOGY, PHILOSOPHY, TEACHINGS AND DOCTRINES OF THE ROMAN CATHOLICCHURCH. RESPECTING AND BUILDING ON THE MISSION, PHILOSOPHY AND VALUESOF THE CARMELITE SISTERS FOR THE AGED AND INFIRM. 0 0 12811554 0 12928407 THE HOME PROVIDES PROFESSIONAL AND PERSONAL SERVICES IN A COMPASSIONATE AND CARING MANNER TO SERVE MEMBERS OF THE DAVENPORT AND SURROUNDING COMMUNITIES. DURING THE YEAR, THE HOME PROVIDED APPROXIMATELY 40,000 PATIENT DAYS OF CARE TO OUR NEIGHBORS AND THEIR FAMILIES WITHOUT REGARD TO THEIR ETHNIC BACKGROUND, RELIGION, AND FINANCIAL CIRCUMSTANCES. 12811554 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 325 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JUDITH NADERHOFF 5185377500 646 WOODS ROAD GERMANTOWN NY 12526 SR MARY ROSE HEERY PRESIDENT 1.00 10.00 X X 0 0 0 SR PATRICIA MARGARET RAWDON VICE PRESIDENT 1.00 7.00 X X 0 0 0 MRS MARY REHMANN SECRETARY 1.00 0.00 X X 0 0 0 MIKE MCCARTHY CHAIRMAN OF THE BOARD 1.00 0.00 X 0 0 0 MR ROBERT MCCABE MEMBER 1.00 0.00 X 0 0 0 MR THOMAS SUNDERBRUCH PHD MEMBER 1.00 0.00 X 0 0 0 SR JEANNE FRANCIS HALEY MEMBER 1.00 9.00 X 0 0 0 SR ALICE WEBSTER MEMBER 1.00 2.00 X 0 0 0 SR TERESA KATHLEEN DOMINICK MEMBER 1.00 2.00 X 0 0 0 SR ANN ELIZABETH BROWN MEMBER 1.00 3.00 X 0 0 0 SR ANTHONY DE LOURDES VEILLEUX MEMBER 1.00 1.00 X 0 0 0 MR JOSEPH POLASCHEK MEMBER 1.00 0.00 X 0 0 0 MRS JUDY PRANGER MEMBER 1.00 0.00 X 0 0 0 MR JOSEPH LOHMULLER MEMBER 1.00 0.00 X 0 0 0 MS KIMBERLY HUFSEY TREASURER, ADMINISTRATOR 40.00 0.00 X 112433 0 127 112433 0 127 1 0 0 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 HOUSEKEEPING CONTRACT LABOR 502290 CONSONUS REHAB PO BOX 4800 UNIT 12 PORTLAND OR 972084800 THERAPY CONTRACT LABOR 426806 GRAPETREE MEDICAL STAFFING INC 2501 BOJI BEND DRIVE SUITE 100 MILFORD IA 51351 NURSING CONTRACT LABOR 267359 MEDLINE INDUSTRIES INC PO BOX 382075 PITTSBURGH PA 152518075 NURSING CONTRACT LABOR 126230 4 189638 189638 RESIDENT SERVICES REVENUE 623000 12786981 12786981 12786981 330609 330609 368276 0 368276 368276 368276 OTHER OPERATING INCOME 623000 141426 141426 141426 13816930 12928407 0 698885 X 112560 112560 6371189 5983117 388072 23990 23990 952281 778895 173386 706781 526657 180124 148142 148142 29204 29204 23211 23211 11366 11366 1826754 1610888 215866 49964 49964 40792 40792 246657 46700 199957 383722 383722 12477 12477 2280 2280 987289 888560 98729 1139043 1025139 113904 124129 111716 12413 SUPPLIES 586586 586586 FOOD 435479 435479 REPAIRS AND MAINTENANCE 167469 167469 BED TAX/ASSESSMENT 62638 62638 151744 151744 14595747 12811554 1784193 0 535537 174155 1593778 1092818 1577750 43513 46864 54564 49898 36693159 8841746 28790618 27851413 17443210 17226160 350085 124401 48310345 48644419 1198813 854329 21687408 21140589 12941 11738 464716 955887 23363878 22962543 X 24910718 25569213 35749 112663 24946467 25681876 48310345 48644419 X -778817 2007844 -493618 X X 0 1 X 1 0 X 175979 170555 94411 66070 189638 696653 12672455 12462460 11597469 11592161 12928407 61252952 12848434 12633015 11691880 11658231 13118045 61949605 17012 17012 0 17012 17012 61932593 196388 205112 226798 268787 330609 1227694 196388 205112 226798 268787 330609 1227694 13044822 12838127 11918678 11927018 13448654 63177299 0.98030 0.98210 0.01940 0.01730 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2553016 2553016 31218519 7972893 23245626 2903037 868853 2034184 18587 18587 27851413 DUE TO RELATED PARTY 169025 ACCRUED PENSION OBLIGATION 18488 SWAP AGREEMENTS 768374 955887 X PART IV, LINE 2B: MEDICAID RESIDENTS CAN REQUEST, AND IN CERTAIN CASES, KAHL HOME FOR THE AGED AND INFIRM IS REQUIRED TO MAINTAIN THEIR PERSONAL FUNDS IN A CUSTODIAN ACCOUNT. THESE CUSTODIAL ACCOUNTS ARE ACCOUNTED FOR SEPARATELY AND ARE MAINTAINED BY THE NURSING FACILITY ON THE RESIDENTS BEHALF. THE CUSTODIAL ACCOUNTS ARE LISTED ON THE BALANCE SHEET OF FORM 990, PART X, LINE 21 AS CUSTODIAL ACCOUNT LIABILITIES. PART X, LINE 2: THE CARMELITE SYSTEM, INC. AND ITS AFFILIATES ARE NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. IT IS THE ORGANIZATION'S POLICY TO ACCOUNT FOR ANY INTEREST OR PENALTIES ASSESSED RELATING TO UNCERTAIN TAX POSITIONS, IF ANY, AS ADMINISTRATIVE EXPENSES. THE ORGANIZATION DID NOT INCUR ANY INTEREST OR PENALTIES FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018. THE APPLICATION OF THESE PROVISIONS HAS NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. A IOWA FINANCE AUTHORITY 521699886 2014-11-12 24895000 TO REFINANCE SERIES 2011 REVENUE BONDS 0 0 0 A 3165862 24895000 569854 24325146 2011 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 0 0 0 1 A 1 FORM 990, SCHEDULE K, PART 1: THE BONDS WERE ISSUED AT THE SAME TIME AS THE $14,430,000 COUNTY OF FRANKLIN, OH REVENUE REFUNDING BONDS, SERIES 2014 (MOTHER ANGELINE MCCRORY MANOR, INC. PROJECT), THE $7,040,000 COUNTY OF FRANKLIN OHIO REVENUE BONDS, SERIES 2014 (THE VILLAS AT SAINT THERESE PROJECT), AND THE $17,300,000 PALM BEACH COUNTY REVENUE REFUNDING BONDS, SERIES 2014 (LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE, INC. PROJECT), (COLLECTIVELY THE "OBLIGATED GROUP BONDS"). THE BONDS AND THE OBLIGATED GROUP BONDS CONSITITUE A SINGLE ISSUE FOR PURPOSES OF TREASURY REGULATIONS SECTION 1 150-1(C). EACH SERIES OF THE OBLIGATED GROUP BONDS WILL BE REPORTED ON THE SCHEDULE K OF THE APPLICABLE MEMBER OF THE OBLIGATED GROUP. FORM 990, PART VI, SECTION A, LINE 1 THERE SHALL BE AN "EXECUTIVE COMMITTEE," WHICH SHALL BE A COMMITTEE OF THE CORPORATION AND SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, THE PRESIDENT, THE VICE-PRESIDENT, THE SECRETARY, THE TREASURER, AND SUCH OFFICERS OF THE CORPORATION AS MAY BE APPOINTED BY THE MEMBER. THE EXECUTIVE COMMITTEE SHALL MEET AS NEEDED AND SHALL HAVE AUTHORITY TO TRANSACT REGULAR BUSINESS OF THE CORPORATION BETWEEN MEETINGS OF THE BOARD. HOWEVER, THE EXECUTIVE COMMITTEE IS NOT EMPOWERED TO ACT WITH RESPECT TO ANY RESERVE POWERS DESCRIBED IN THE BY-LAWS, SHALL NOT TAKE ANY ACTION BEYOND THE AUTHORITY OF THE BOARD OR IN CONFLICT WITH THE EXPRESSED POLICIES OF THE BOARD. A MAJORITY OF THE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS FOR ANY MEETING. ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE REPORTED TO THE BOARD AT THE NEXT MEETING OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS THE CARMELITE SYSTEM, INC. THE MEMBERS OF THE CARMELITE SYSTEM, INC.'S INCLUDE FIVE MEMBERS CONSISTING OF THE PRIORESS GENERAL AND FOUR MEMBERS OF THE GENERAL COUNCIL OF THE CARMELITE SISTERS FOR THE AGED AND INFIRM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER, THE CARMELITE SYSTEM, INC., RETAINS THE RIGHT TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS OF THE ORGANIZATION RESERVE THE FOLLOWING MANAGEMENT POWERS: A) TO APPROVE AND INTERPRET THE CORPORATION'S PURPOSES, MISSION, PHILOSOPHY AND VALUES AND TO REQUIRE THAT THE CORPORATION OPERATES IN CONFORMANCE WITH SAME; B) TO APPROVE AND AMEND THE CERTIFICATE OF INCORPORATION AND BY-LAWS OF THE CORPORATION C) TO APPROVE ANY PLAN OF MERGER, CONSOLIDATION, OR REORGANIZATION OF THE CORPORATION; D) TO APPROVE ANY PLAN OF DISSOLUTION OF THE CORPORATION AND THE DISTRIBUTION OF THE ASSETS OF THE CORPORATION UPON DISSOLUTION; E) TO APPROVE THE ESTABLISHMENT, MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF ANY ORGANIZATIONAL RELATIONSHIP OF THE CORPORATION, INCLUDING SUBSIDIARY CORPORATIONS, PARTNERSHIPS, JOIN VENTURES, AND LIKE RELATIONSHIPS; F) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION; G) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION; H) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE VICE-PRESIDENT OF MISSION OF THE CORPORATION; I) TO RATIFY ANY DEBT OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE MEMBERS, EXCEPT FOR ANY DEBT NECESSARY TO FINANCE THE COST OF COMPLIANCE WITH OPERATIONAL OR PHYSICAL PLANT STANDARDS REQUIRED BY APPLICABLE LAW; J) TO RATIFY THE SALE, ACQUISITION, LEASE, TRANSFER, MORTGAGE, PLEDGE OR OTHER ALIENATION OF REAL OR PERSONAL PROPERTY OF THE CORPORATION IN EXCESS OF AN AMOUNT TO BE FIXED FROM TIME TO TIME BY THE MEMBERS; K) TO RATIFY SETTLEMENTS OF CLAIMS AND LITIGATION WHEN SUCH CLAIMS OR SETTLEMENTS EXCEEDS APPLICABLE INSURANCE COVERAGE OR THE AMOUNT OF ANY APPLICABLE SELF-INSURANCE FUND; L) TO APPOINT FISCAL AUDITORS, UPON THE RECOMMENDATION OF THE AUDIT COMMITTEE; AND M) TO APPOINT LEGAL COUNSEL FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE REPORTS TO THE BOARD OF DIRECTORS REGARDING THE REVIEW OF THE FORM 990. A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST DISCLOSURE POLICY REQUIRES ALL OFFICERS AND BOARD MEMBERS TO COMPLETE AN ANNUAL DISCLOSURE STATEMENT. IN ADDITION, SHOULD AN OFFICER OR BOARD MEMBER ASSUME NEW EXTERNAL INTERESTS THAT POTENTIALLY CONFLICT WITH HIS/HER ROLE WITH THE ORGANIZATION SUCH INDIVIDUALS IS REQUIRED TO DISCLOSE IN WRITING THE NATURE OF SUCH EXTERNAL INTERESTS. THE DISCLOSURE STATEMENT IS PROVIDED TO THE CHAIR OF THE BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION POLICY WAS DEVELOPED BY THE BOARD TO GOVERN COMPENSATION ARRANGEMENTS BETWEEN THE ORGANIZATION AND COVERED INDIVIDUALS, DEFINED AS THOSE IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. THE COMPENSATION COMMITTEE CONSISTS OF AT LEAST THREE INDEPENDENT INDIVIDUALS APPOINTED BY THE BOARD, WHO THEMSELVES ARE MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE RECOMMENDS TO THE BOARD THE COMPENSATION FOR A COVERED INDIVIDUAL BASED ON RELEVANT DATA INCLUDING COMPARABILITY OF COMPENSATION FOR SIMILARLY SITUATE ENTITIES AND COMPENSATION SURVEYS COMPLIED BY INDEPENDENT FIRMS AS REQUIRED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FORM 990 IS ALSO AVAILABLE TO THE PUBLIC ON GUIDESTAR'S WEBSITE. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,610,888. MANAGEMENT AND GENERAL EXPENSES 215,866. TOTAL EXPENSES 1,826,754. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -493,618. FORM 990, PART XII, LINE 2C: THE CARMELITE SYSTEM, INC. APPROVES THE ENGAGEMENT OF THE INDEPENDENT AUDITORS FOR THE CORPORATION. THE SYSTEM AUDIT COMMITTEE MEETS WITH THE SYSTEM'S MANAGEMENT AND THE INDEPENDENT AUDITORS TO REVIEW THE ENGAGEMENT PROPOSAL, RESULTS OF THE AUDIT, DRAFT AUDIT REPORT AND MANAGEMENT LETTERS. THE AUDIT COMMITTEE MAY MEET WITH THE INDEPENDENT AUDITORS IN AN EXECUTIVE SESSION BEFORE CONCLUDING ITS REVIEW AND ACCEPTANCE OF THE ANNUAL AUDIT REPORT. THE AUDIT COMMITTEE REPORTS ITS FINDINGS AND MAKES ITS RECOMMENDATION TO THE BOARD OF DIRECTORS. CARMELITE SISTERS FOR THE AGED AND INFIRM INC 600 WOODS ROAD GERMANTOWN NY 12526 141369151 LONG TERM HEALTHCARE MINISTRY NY 501(C)(3) LINE 10 N/A 0 CARMEL MANOR INC 100 CARMEL MANOR ROAD FT THOMAS KY 41075 610523290 SKILLED NURSING FACILITY KY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 CARMEL TERRACE INC 933 CENTRAL STREET FRAMINGHAM MA 01701 043210051 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 LOURDES FOUNDATION INC 315 SOUTH FLAGLER DRIVE WEST PALM BEACH FL 33401 592632080 FUNDRAISING FL 501(C)(3) LINE 12A, I CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE INC 315 SOUTH FLAGLER DRIVE WEST PALM BEACH FL 33401 590879342 SKILLED, ASSISTED AND INDEPENDENT LIVING FACILITY FL 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 MARIAN MANOR FOR THE AGED AND INFIRM INC 130 DORCHESTER STREET BOSTON MA 02127 042173054 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 MOTHER ANGELINE MCCRORY MANOR INC 5199 EAST BROAD STREET COLUMBUS OH 43213 912134683 SKILLED NURSING FACILITY OH 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 MOUNT CARMEL CARE CENTER INC 320 PITTSFIELD ROAD LENOX MA 01240 383902709 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 OZANAM HALL OF QUEENS NURSING HOME INC 42-41 201ST STREET BAYSIDE NY 11361 112167809 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST MARGARET HALL INC 1960 MADISON ROAD CINCINNATI OH 45206 310655031 SKILLED AND ASSISTED LIVING FACILITY OH 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST PATRICK'S HOME FOR THE AGED AND INFIRM INC 66 VAN CORTLAND PARK SOUTH BRONX NY 10463 131740033 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST PATRICK'S MANOR INC 863 CENTRAL STREET FRAMINGHAM MA 01701 042157057 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST PATRICK'S RESIDENCE 1400 BROOKDALE ROAD NAPERVILLE IL 60563 362527011 SKILLED NURSING FACILITY IL 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 THE CARMELITE SYSTEM INC 646 WOODS ROAD GERMANTOWN NY 12526 141810368 MANAGEMENT NY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 VILLAS AT ST THERESE INC 5253 EAST BROAD STREET COLUMBUS OH 43213 472021696 INDEPENDENT LIVING & ASSISTED LIVING FACILITY OH 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 1 1 1 0 0