2014-11-14T10:35:09-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC 1111 SUPERIOR AVENUE SUITE 1250 CLEVELAND OH 44114 990 2013-01-01 610654635 MADONNA MANOR INC MADO 8594266400 2344 AMSTERDAM ROAD VILLA HILLS KY 41017 MARK MULLAHY ADMINISTRATOR 8594266400 2014-11-13 1 JEREMY S HERMAN P00745789 2165231010 2013 2015-11-30 17:44:51Z MARK MULLAHY 2344 AMSTERDAM ROAD VILLA HILLS KY 41017 10020182 0 0928 X WWW.MADONNAMANOR.ORG X 1964 KY MADONNA MANOR IS A LONG TERM CARE COMMUNITY PROVIDING SERVICES TO MEET OUR SENIOR RESIDENTS APPROPRIATE LEVEL OF CARE. 13 11 274 11 0 0 96161 7905 7925820 9052084 336185 113022 61778 131731 8419944 9304742 0 76128 0 0 3822230 4066886 0 0 0 4067594 4344509 7889824 8487523 530120 817219 38462164 39322786 29672932 29311339 8789232 10011447 X MADONNA MANOR, A FRANCISCAN CATHOLIC LIVING COMMUNITY, PROVIDES PERSON CENTERED CARE TO SENIORS OF ALL FAITHS IN AN ENVIRONMENT OF BEAUTY, PRAYER AND PEACE, ENABLING THEM TO ACHIEVE THE HIGHEST LEVEL OF PERSONAL INDEPENDENCE. 0 0 4479487 76128 6130593 SKILLED NURSING UNIT - 60 BEDS. 20,878 RESIDENT DAYS IN 2013. OFFERING SKILLED REHABILITATION SERVICES AND LONG TERM CARE SERVICES. 930801 0 1295912 MEMORY CARE UNIT - 24 INDIVIDUAL ROOMS. 8,404 RESIDENT DAYS IN 2013. SPECIFICALLY DESIGNED FOR RESIDENTS WITH DEMENTIA OR OTHER MIND AFFECTING ILLNESSES AND RESIDENTS NEEDS MORE SERVICE THAN AVAILABLE IN ASSISTED LIVING, BUT NOT ABLE TO QUALIFY FOR LONG TERM OR SKILLED SERVICES. 1050482 0 1462537 ASSISTED LIVING ROOMS - 40 INDIVIDUAL ROOMS, CONSISTING OF STUDIO, ONE BEDROOM AND TWO BEDROOM APARTMENTS. 11,009 RESIDENT DAYS IN 2013. DESIGNED FOR RESIDENTS THAT NEED ASSISTANCE WITH SOME DAY TO DAY ACTIVITIES. SEVERAL LEVELS OF CARE ARE ALSO OFFERED IN THE ASSISTED LIVING AREA. 117107 0 163042 INDEPENDENT LIVING AND OTHER - ALL AREAS OFFER A WIDE VARIETY OF ACTIVITIES INLCUDING EXECUTIVE CHEF PREPARED MEALS AND SNACKS, PERSONAL EMERGENCY RESPONSE SYSTEMS, SCHEDULED TRANSPORTATION, HOUSEKEEPING AND LAUNDRY SERVICES, SPIRITUAL EDUCATION AND WIRELESS INTERNET. 117107 163042 6577877 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 33 0 1 274 1 0 0 0 0 0 1 1 0 0 0 0 X 13 11 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X STACEY L GRUBBS 5674550414 5942 RENAISSANCE PLACE TOLEDO OH 43623 RICK RYAN PRESIDENT/CEO EX-OFFICIO 1.00 49.00 X X 0 387330 52736 DIANE RAUSCH-HUFFMAN CHAIRPERSON 1.00 10.00 X X 0 0 0 SISTER MARY THILLOSF SECRETARY/TREASURER 1.00 10.00 X X 0 0 0 REVEREND DAVID W NUSS VICE CHAIRPERSON 1.00 10.00 X X 0 0 0 DARLENE M MINNICK TRUSTEE 1.00 10.00 X 0 0 0 NICK P ULRICH TRUSTEE 1.00 10.00 X 0 0 0 DONALD L TURNER TRUSTEE 1.00 10.00 X 0 0 0 JAMES W POPE EX-OFFICIO 1.00 40.00 X 0 780789 72652 CHARLES J EVERETT TRUSTEE 1.00 10.00 X 0 0 0 TERESA FITZPATRICK TRUSTEE 1.00 10.00 X 0 0 0 GARY SCANLON TRUSTEE 1.00 10.00 X 0 0 0 CARL E MCGOOKEY TRUSTEE 1.00 10.00 X 0 0 0 JOHN NIENABER JR TRUSTEE 1.00 10.00 X 0 0 0 MARK MULLAHY ADMINISTRATOR 40.00 0.00 X 0 117381 11200 THOMAS PILLE CONTROLLER 40.00 0.00 X 69629 0 16985 69629 1285500 153573 1 0 1 0 THERAPY PARTNERS 16600 SPRAGUE RD STE 365 MIDDLEBURG HEIGHTS OH 44130 THERAPIST SERVICES 328859 CONCEPT REHAB 7150 GRANITE CIRCLE TOLEDO OH 43617 REHAB SERVICES 179209 2 843 7062 7905 NURSING/PERSONAL CARE 623000 8889042 8889042 INDEPENDENT LIVING 623000 163042 163042 9052084 82097 82097 744865 1500 715440 0 29425 1500 30925 30925 0 843 0 0 MEAL INCOME 623110 37571 37571 HAIR SALON 623110 32993 32993 TRANSPORTATION INCOME 623110 24307 24307 36860 36860 131731 9304742 9052084 0 244753 X 76128 76128 215194 215194 3007263 2784323 222940 102408 92383 10025 490018 466779 23239 252003 227335 24668 155267 155267 40519 40519 67547 67547 1954 1954 903336 711392 191944 134315 121167 13148 334793 57674 277119 63891 57637 6254 356702 310687 46015 35056 18181 16875 2739 1420 1319 331504 331504 1035814 902194 133620 46180 40223 5957 MEDICAL SUPPLIES 352882 352882 FOOD 332780 332780 PROVISION FOR BAD DEBTS 101080 101080 FRANCHISE TAXES 24692 24692 23458 23458 8487523 6577877 1909646 0 300 300 2446178 4447521 9246 5988 1173151 796725 19185 19498 77780 21973 27497835 2468721 25695844 25029114 4239333 4758975 2823864 2242564 1011894 968170 965389 1031958 38462164 39322786 995359 689299 28440000 28440000 237573 182040 29672932 29311339 X 7970857 9193072 818375 818375 8789232 10011447 38462164 39322786 X 817219 529850 -124854 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 999142 103201 1102343 2546438 -28707 1518589 999142 2456322 90116 2546438 2292199 164123 2456322 2035932 273614 17347 2292199 0.25760 0.74240 0 0 2335000 2335000 21915030 1631877 20283153 3229215 836844 2392371 18590 18590 25029114 RESTRICTED FUNDS 1102343 F TRUSTEE HELD FUNDS 1140221 F 2242564 SECURITY DEPOSITS 63846 THIRD PARTY SETTLEMENT 9558 RESERVE FOR INSURANCE CLAIMS 66721 DUE TO RELATED PARTIES 41915 182040 X PART V, LINE 4: BENELOVENT CARE FUND PART X, LINE 2: THE COMBINED GROUP CONSISTS MOSTLY OF NONPROFIT ORGANIZATIONS AFFILIATED WITH THE SISTERS. EACH NONPROFIT MEMBER OF THE COMBINED GROUP HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OR SECTION 501(A) OF THE INTERNAL REVENUE CODE. ALLIANCE HEALTH PROVIDERS OF BRAZOS VALLEY, INC. IS A FOR-PROFIT CORPORATION AND FILES A FEDERAL INCOME TAX RETURN ON A SEPARATE-ENTITY BASIS. THERE IS PRESENTLY NO PREMIUM, INCOME, OR CAPITAL GAINS TAXES IMPOSED BY THE GOVERNMENT OF THE CAYMAN ISLANDS, AND IF ANY FORM OF TAXATION WERE TO BE ENACTED IN THE FUTURE, SFH ASSURANCE, LTD HAS BEEN GRANTED AN EXEMPTION UNTIL THE YEAR 2032. THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES OR UNCERTAIN TAX POSITIONS AT DECEMBER, 31, 2013 OR 2012. 1 FRANCISCAN LIVING COMMUNITIES 5942 RENAISSANCE PLACE SUITE A TOLEDO OH 43623 341892096 76128 FUNDING TO SUPPORT OPERATIONS 1 0 1 0 0 0 0 0 0 0 RICK RYAN PRESIDENT/CEO EX-OFFICIO 0 322340 0 32852 0 32138 0 26000 0 26736 0 440066 0 0 JAMES W POPE EX-OFFICIO 0 656090 0 0 0 124699 0 51000 0 21652 0 853441 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN UNDER SECTION 457(F). CURRENT YEAR PAYMENTS, REPORTED IN PART II, COLUMN (B)(III), ARE SUMMARIZED BELOW: RICK RYAN $28,810 JAMES POPE $108,634 A KENTUCKY ECONOMIC DEVELOPMENT FINANCE AUTHORITY 610600439 49126TAD4 2010-01-05 28440000 BUILDING PROJECT, ADDITIONAL BEDS 0 0 0 A 28440000 547600 2011 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE JANUARY 1, 2013, THE BOARD STRUCTURE FOR MADONNA MANOR, INC CHANGED FROM A SEPARATE BOARD TO AN ADVISORY COMMITTEE WITHOUT VOTING RIGHTS. THE BOARD MEMBERS OF FRANCISCAN LIVING COMMUNITIES REPLACED THE PREVIOUS BOARD AND ASSUMED THE CORRESPONDING RIGHTS AND RESPONSIBILITIES. FORM 990, PART VI, SECTION A, LINE 6 FRANCISCAN LIVING COMMUNITIES IS THE SOLE MEMBER OF MADONNA MANOR. FORM 990, PART VI, SECTION A, LINE 7A FRANCISCAN LIVING COMMUNITIES, AS THE SOLE MEMBER OF THE ORGANIZATION, HAS THE RESERVED POWERS TO ELECT THE TRUSTEES OF THE ORGANIZATION, AND TO ELECT AND REMOVE THE CHAIRPERSON AND PRESIDENT/CEO OF MADONNA MANOR. FORM 990, PART VI, SECTION A, LINE 7B FRANCISCAN LIVING COMMUNITIES HAS THE RESERVED POWER TO: 1) ADOPT OR CHANGE THE PHILOSOPHY, OBJECTIVES, PURPOSES OR ETHICAL OR RELIGIOUS STANDARDS OF THE CORPORATION; 2) REMOVE THE TRUSTEES AT WILL; 3) ELECT, APPOINT AND REMOVE ANY OFFICER AND CHAIRPERSON OF ANY COMMITTEE OF THE CORPORATION; 4) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION AND THE CODE OF REGULATIONS; 5) TO DISSOLVE OR TERMINATE THE EXISTENCE OF THE CORPORATION OR TO REVOKE ANY PROCEEDING FOR ITS VOLUNTARY DISSOLUTION AND TO DETERMINE THE DISTRIBUTION OF ASSETS UPON ANY APPROVED DISSOLUTION OR TERMINATION; 6) SATISFY ALL REQUIREMENTS APPLICABLE TO NONPROFIT CORPORATIONS UNDER STATE LAW; 7) TAKE ANY ACTION NECESSARY TO CONFORM THE PURPOSES AND ACTIVITIES OF THE CORPORATION WITH THE TRADITIONS, TEACHING AND CANON LAW OF THE ROMAN CATHOLIC CHURCH AS THEY MAY BE IN EFFECT FROM TIME TO TIME; 8) APPROVE ANY TRANSACTION, AGREEMENT, ARRANGEMENT OR CLAIM TO WHICH THE CORPORATION IS A PARTY THAT INVOLVES A POTENTIAL CONFLICT OF INTEREST; 9) TO APPROVE ANY MERGER OR CONSOLIDATION OF THE CORPORATION AND ANY SALE OF SUBSTANTIALLY ALL OF ITS ASSETS; 10) TO AUTHORIZE THE CREATION OF ANY SUBSIDIARY ORGANIZATION OR THE AFFILIATION OF THE CORPORATION WITH ANY OTHER ENTITY FOR THE PURPOSE OF THE JOINT CONDUCT OF BUSINESS OR OTHER PROGRAMS, WHETHER IN THE FORM OF PARTICIPATION IN A CORPORATION, PARTNERSHIP, JOINT VENTURE, CO-TENANCY OR ANY OTHER FORM OF OWNERSHIP OR CONTROL; 11) APPROVE THE CONVEYANCE OF REAL PROPERTY OR THE GRANTING OF MORTGAGES OR TRUST DEED OR THE CREATION OF OTHER LIENS UPON ANY REAL PROPERTY OWNED BY THE CORPORATION; 12) APPROVE CONVEYING ANY TANGIBLE PERSONAL PROPERTY, INCURRING ANY DEBT OR SERIES OF DEBTS, GUARANTEEING OF ANY DEBT OR SERIES OF DEBTS, OR THE GRANTING OF ANY SECURITY INTEREST OR OTHER LIEN IN THE PROPERTY OF THE CORPORATION IN EXCESS OF THE AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBER; 13) APPROVE ANY CAPITAL EXPENDITURE OR GRANT; 14) APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; 15) APPROVE THE ADDITION OR TERMINATION OF SERVICES; 16) APPROVE THE CORPORATION'S AUDITOR; 17) APPROVE THE CORPORATION'S STRATEGIC PLAN; 18) APPROVE THE POWER OF APPROVAL RESERVED BY THE CORPORATION OVER ACTIONS OF THE GOVERNING BODIES OF ITS SUBSIDIARY ORGANIZATIONS OR AFFILIATED ENTITIES; AND 19) APPROVE ANY OTHER ACT FOR WHICH MEMBERSHIP APPROVAL IS REQUIRED UNDER APPLICABLE CANON OR CIVIL LAW, THE ARTICLES OF INCORPORATION, OR THE CODE OF REGULATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. THE GOVERNING BODY RECEIVES AN ELECTRONIC COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EVERY YEAR, EACH BOARD MEMBER, DEPARTMENT DIRECTOR, AND KEY EMPLOYEE IS GIVEN A QUESTIONNAIRE TO BE FILLED OUT AND SENT TO THE EXECUTIVE DIRECTOR. THE FORM IS REVIEWED AND ACTIONS ARE TAKEN IF A CONFLICT IS IDENTIFIED. A "DESIGNATED PERSON" MEANS ANY MEMBER OF THE BOARD OF THE CORPORATION, ANY MEMBER OF A COMMITTEE OF THE CORPORATION THAT IS AUTHORIZED TO APPROVE TRANSACTIONS OR ASSERT CLAIMS ON BEHALF OF THE CORPORATION, ANY OFFICER OF THE CORPORATION, AND ANY EMPLOYEE OR AGENT OF THE CORPORATION WHO IS AUTHORIZED TO APPROVE TRANSACTIONS OF ASSERT CLAIMS ON BEHALF OF THE CORPORATION. ANY DESIGNATED PERSON WHO HAS A CONFLICT OF INTEREST SHALL DISCLOSE THE CONFLICT OF INTEREST WHEN IT ARISES, AND BEFORE ACTION ON THE TRANSACTION OR CLAIM IN QUESTION. CONFLICTS OF INTEREST INVOLVING THE PRESIDENT OR MEMBERS OF THE BOARD OF THE CORPORATION SHALL BE REPORTED TO THE BOARD, AND CONFLICTS OF INTEREST CONCERNING OTHER DESIGNATED PERSONS SHALL BE REPORTED TO THE PRESIDENT, IN WHICH CASE THE PRESIDENT WILL MAKE THE CONFLICT OF INTEREST KNOWN TO THE BOARD AND ANY APPLICABLE COMMITTEE AT THE NEXT REGULARLY SCHEDULED MEETING. A DESIGNATED PERSON WHO HAS A CONFLICT OF INTEREST ARISING OUT OF OR RELATED TO A TRANSACTION OR CLAIM SHALL BE EXCUSED FROM THE BOARD OR COMMITTEE MEETING BEFORE ANY DELIBERATIONS OR VOTING CONCERNING THE AUTHORIZATION OF THE TRANSACTION OR ASSERTION OF THE CLAIM. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR'S COMPENSATION IS PAID BY A RELATED ORGANIZATION, FRANCISCAN LIVING COMMUNITIES. ANNUALLY, AN OUTSIDE CONSULTANT IS HIRED TO COMPLETE AN EXECUTIVE COMPENSATION ANALYSIS FOR THE POSITION OF EXECUTIVE DIRECTOR. THE ANALYSIS COMPARES COMPENSATION OF SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. DURING AN EXECUTIVE SESSION AT A BOARD MEETING, THE BOARD, EXCLUDING THE PRESIDENT, REVIEWS THE ANALYSIS AND THE PRESIDENT'S PERFORMANCE APPRAISAL AND DETERMINES FAIR COMPENSATION FOR THE PRESIDENT. 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 GENERAL PUBLIC UPON REQUEST. THE DOCUMENTS ARE LOCATED IN THE ADMINISTRATIVE OFFICES DURING REGULAR BUSINESS HOURS. FORM 990, PART IX, LINE 11G MEDICAL CONSULTING: PROGRAM SERVICE EXPENSES 52,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 52,200. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 605,937. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 605,937. MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 24,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,000. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 29,255. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,255. MAINTENANCE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 64,298. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,298. ADMINISTRATIVE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 127,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,646. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -124,854. FORM 990, PART XII, LINE 2C: THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS FROM THE PRIOR YEAR. FORM 990, SCHEDULE R, PART II: THE RELATED TAX EXEMPT ORGANIZATIONS ARE ALL MEMBERS OF GROUP EXEMPTION # 0928. ST LEONARD LIMITED PARTNERSHIP (MERGED WITH JBR LLC IN 2013) 88 E BROAD ST STE 1800 CENTERVILLE OH 45458 311481761 LOW INCOME RENTAL RESIDENTIAL OH N/A ALLIANCE HEALTH PROVIDERS OF BRAZOS VALLEY 2801 FRANCISCAN DR BRYAN TX 77802 742466914 PHYSICIAN HOSPITAL ORGANIZATION TX N/A C 0 ST LEONARD CENTER 1 INC (DISSOLVED IN 2013) 8100 CLYO RD CENTERVILLE OH 45458 311481764 LOW INCOME RENTAL RESIDENTIAL OH N/A C 0 SFH ASSURANCE LTD SUITE 6 GRAND PAVILION COMMERCIAL GRAND CAYMAN KY1- CJ 981056892 INSURANCE CJ N/A C 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SYLVANIA FRANCISCAN HEALTH E 28440000 FAIR MARKET VALUE FRANCISCAN LIVING COMMUNITIES B 76128 ACTUAL AMOUNTS PAID