ASCENSION LIVING ALEXIAN VILLAGE TENNESEE: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ASCENSION LIVING ALEXIAN VILLAGE TENNESEE (EIN 62-1136742)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-03-25
- IRS object ID
- 201440849349300034
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-03-25T19:58:31-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 South Wacker Drive | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60606 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 621136742 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alexian Village of Tennessee | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ALEX | NameControl |
| Phone | 4238860100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 437 Alexian Way | AddressLine1 |
| City | Signal Mountain | City |
| State | TN | State |
| ZIP Code | 373771860 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Robin Baschnagel | Name |
| Title | Chief Executive Officer | Title |
| Phone | 4238860100 | Phone |
| Date Signed | 2014-03-25 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Laura Gillespie | Name |
| PTIN | P00855604 | PTIN |
| Phone | 3124861000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Robin Baschnagel | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 437 Alexian Way | AddressLine1 |
| City | Signal Mountain | City |
| State | TN | State |
| ZIP Code | 373771860 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 23083316 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.alexianbrothershealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | TN | StateLegalDomicile |
| Activity Or Mission Description | Continuing Care Retirement Center. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 488 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 64503 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 542841 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11453410 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 22454998 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 153636 | InvestmentIncomePriorYear |
| Investment Income Current Year | 85477 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11671549 | TotalRevenuePriorYear |
| Total Revenue Current Year | 23083316 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5677284 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8104509 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5061071 | OtherExpensePriorYear |
| Other Expenses Current Year | 13710097 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10738355 | TotalExpensesPriorYear |
| Total Expenses Current Year | 21814606 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 933194 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1268710 | RevenuesLessExpensesCY |
| Total Assets BOY | 54020259 | TotalAssetsBOY |
| Total Assets EOY | 58981417 | TotalAssetsEOY |
| Total Liabilities BOY | 33042145 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 33042069 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 20978114 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 25939348 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Alexian Village of Tennessee ("AVT") carries out the healing mission of the Catholic Church as an Alexian Brothers ministry by identifying and developing effective responses to the health and housing needs of those we are called to serve. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15385595 | Expense |
| Revenue | 19587401 | Revenue |
| Description | Alexian Village of Tennessee ("AVT") provides a continuum of services to residents of AVT (133,590 resident days served), assisted living services to residents of Alexian Inn (9,578 days served) and residents of the health care center (35,200 days served) that maximizes dignity and independence. Although reimbursement for services rendered is critical to the operation and stability for the continuum of services, as a charitable organization, it is recognized that not all persons served possess the ability to purchase essential services needed for care and our mission is to serve the community with respect to providing health care services. In 2013, over $43,000 was provided in charitable care at costs. AVT also serves the communities of Signal Mountain and Chattanooga by providing programs throughout the year. Meeting rooms are provided at no costs to local charitable organizations and community groups. As a religious organization, AVT also employs staff to provide chaplaincy services. There are multiple chapels at AVT, which have daily interdenominational services & programs. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1302596 | Expense |
| Revenue | 1902175 | Revenue |
| Description | Alexian Brothers Valley Residence ("ABVR") is a separate and distinct division of AVT. It exists to provide a secure environment to those suffering from dementia or Alzheimer's disease. On average, 40.4 residents were served each day of 2013. Such services include nursing assistance with activities of daily living, recreational activities, meal preparation and dining, and spiritual wellness. In addition, ABVR provides short term respite care and an adult day care program, also to serve those suffering from dementia or Alzheimer's disease. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 815088 | Expense |
| Revenue | 965422 | Revenue |
| Description | Alexian Grove is a separate and distinct division of the AVT organization. It exists to provide independent, residential retirement living while promoting the well-being of all those served through a delivery of quality services. Alexian Grove is home to over 30 senior citizens in independent apartments (on average 30 persons served each day). In keeping with our commitment to serve all members of Chattanooga and the surrounding community, free or subsidized care and other activities and programs to support the community at large are considered and provided when appropriate. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 17503279 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 33 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 488 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | TN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tim Booth | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4237553437 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 East 10th St | AddressLine1 |
| City | Chattanooga | City |
| State | TN | State |
| ZIP Code | 37402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Matthew Fox end 712 | |||||||||
| Ex-Officio Member & President & CEO | 40.00 | 0.00 | X | X | 0 | 244310 | 68491 | ||
| Robin Baschnagel start 1012 | |||||||||
| Ex-Officio Member & President & CEO | 40.00 | 0.00 | X | X | 0 | 50945 | 1056 | ||
| Kathleen Puri RN MSN | |||||||||
| Director & Chairperson | 1.00 | 0.00 | X | X | 0 | 0 | 0 | ||
| Robert Main | |||||||||
| Director & Vice Chairperson | 1.00 | 0.00 | X | X | 0 | 0 | 0 | ||
| Linda Bennett | |||||||||
| Director & Secretary/Treasurer | 1.00 | 0.00 | X | X | 0 | 0 | 0 | ||
| Brother Andrew Thome CFA | |||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| John Turongian | |||||||||
| Director | 0.00 | 40.00 | X | 0 | 339442 | 50851 | |||
| Mark Frey | |||||||||
| Ex-Officio Member | 0.00 | 40.00 | X | 0 | 1434790 | 179527 | |||
| Donna Gauthier | |||||||||
| Assistant Secretary | 0.00 | 40.00 | X | 0 | 71007 | 15381 | |||
| Jim Lewandowski | |||||||||
| Vice President | 0.00 | 40.00 | 0 | 468370 | 805832 | X | |||
| Tim Booth | |||||||||
| Director of Finance | 40.00 | 0.00 | 0 | 120543 | 19824 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2729407 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1140962 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Anthem Blue Cross | |||||
| PO Box 105183 | Atlanta | GA | 303485183 | Health Insurance | 1304137 |
| Alexian Brothers Health System | |||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | Management Services | 852648 |
| New Blue Construction | |||||
| PO Box 15903 | Chattanooga | TN | 37415 | Construction Contractor | 443058 |
| Tennessee Lawn Care | |||||
| PO Box 264 | Signal Mountain | TN | 37377 | Lawn Care Service | 200550 |
| 2 Days Home Improvement | |||||
| 511 Landcaster Avenue | Chattanooga | TN | 37415 | Construction Contractor | 131456 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| All Other Contributions | 542841 | AllOtherContributions |
| Total Contributions | 542841 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Lifecare & Independent | 623000 | 12082853 | 12082853 |
| Skilled Nursing | 623000 | 3570135 | 3570135 |
| Assisted Living | 623000 | 3497775 | 3497775 |
| Medicare & Medicaid | 623000 | 2527882 | 2527882 |
| Adult Day Care | 624100 | 46354 | 46354 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 729999 | TotalRevenueColumn |
| Related Or Exempt Function Income | 729999 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 22454998 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 85477 | TotalRevenueColumn |
| Exclusion | $85,477 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23083316 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22454998 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $85,477 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6093006 | Total |
| Program Services | 5319367 | ProgramServices |
| Management And General | 773639 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119347 | Total |
| Program Services | 106555 | ProgramServices |
| Management And General | 12792 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1436147 | Total |
| Program Services | 1244391 | ProgramServices |
| Management And General | 191756 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 456009 | Total |
| Program Services | 413366 | ProgramServices |
| Management And General | 42643 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47497 | Total |
| Management And General | 47497 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26167 | Total |
| Management And General | 26167 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 428689 | Total |
| Program Services | 358366 | ProgramServices |
| Management And General | 70323 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96250 | Total |
| Program Services | 2910 | ProgramServices |
| Management And General | 93340 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 378948 | Total |
| Program Services | 312042 | ProgramServices |
| Management And General | 66906 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13372 | Total |
| Program Services | 290 | ProgramServices |
| Management And General | 13082 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1657747 | Total |
| Program Services | 1657747 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23907 | Total |
| Program Services | 9008 | ProgramServices |
| Management And General | 14899 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6683 | Total |
| Program Services | 5733 | ProgramServices |
| Management And General | 950 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 335926 | Total |
| Program Services | 324470 | ProgramServices |
| Management And General | 11456 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1883037 | Total |
| Program Services | 1841777 | ProgramServices |
| Management And General | 41260 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122298 | Total |
| Management And General | 122298 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Food and Env. Services | 4782394 | 4782394 | |
| Management Fees - ABHS | 1656109 | 1656109 | |
| Property & Bed Taxes | 827348 | 827348 | |
| Medical Supplies | 418388 | 418388 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1005337 | Total |
| Program Services | 706475 | ProgramServices |
| Management And General | 298862 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21814606 | Total |
| Program Services | 17503279 | ProgramServices |
| Management And General | 4311327 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 223636 | BOY |
| EOY | 371410 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1944883 | BOY |
| EOY | 1335163 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108273 | BOY |
| EOY | 90563 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 125814 | BOY |
| EOY | 97602 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 56685106 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 2790306 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46333647 | BOY |
| EOY | 53894800 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2982927 | BOY |
| EOY | 816742 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2301079 | BOY |
| EOY | 2375137 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54020259 | BOY |
| EOY | 58981417 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2467072 | BOY |
| EOY | 2434901 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 919651 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29655422 | BOY |
| EOY | 30607168 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33042145 | BOY |
| EOY | 33042069 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18714820 | BOY |
| EOY | 23445913 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1798102 | BOY |
| EOY | 2034619 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 465192 | BOY |
| EOY | 458816 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20978114 | BOY |
| EOY | 25939348 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54020259 | BOY |
| EOY | 58981417 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1268710 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 82346 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 3610178 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 244922 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 169787 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 78402 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 64503 | CurrentTaxYearMinus1Year |
| Current Tax Year | 542841 | CurrentTaxYear |
| Total | 1100455 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 21471012 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 22074021 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 22598336 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 11453410 | CurrentTaxYearMinus1Year |
| Current Tax Year | 22454998 | CurrentTaxYear |
| Total | 100051777 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 21715934 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 22243808 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 22676738 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 11517913 | CurrentTaxYearMinus1Year |
| Current Tax Year | 22997839 | CurrentTaxYear |
| Total | 101152232 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 101152232 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 128476 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 277269 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 181137 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 153636 | CurrentTaxYearMinus1Year |
| Current Tax Year | 85477 | CurrentTaxYear |
| Total | 825995 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 128476 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 277269 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 181137 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 153636 | CurrentTaxYearMinus1Year |
| Current Tax Year | 85477 | CurrentTaxYear |
| Total | 825995 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 21844410 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 22521077 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 22857875 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 11671549 | CurrentTaxYearMinus1Year |
| Current Tax Year | 23083316 | CurrentTaxYear |
| Total | 101978227 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99190 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99620 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00810 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00380 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
| General Explanation | Schedule A, Part IV, Supplemental Information: Schedule A, Part IV: For the year ended 6/30/12, the organization filed a short period return due to a change of accounting period. Thus, the amounts in column 2011 of Schedule A reflect the tax year 1/1/2012 6/03/2012 activity. Prior balances have been rolled backward. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 465192 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -6376 | InvestmentEarningsOrLosses |
| End Of Year Balance | 458816 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 464231 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 961 | InvestmentEarningsOrLosses |
| End Of Year Balance | 465192 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 511922 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 2309 | InvestmentEarningsOrLosses |
| Other Expenditures | 50000 | OtherExpenditures |
| End Of Year Balance | 464231 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 517303 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 14232 | InvestmentEarningsOrLosses |
| Other Expenditures | 19613 | OtherExpenditures |
| End Of Year Balance | 511922 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | 504858 | Contributions |
| Investment Earnings Or Losses | 12445 | InvestmentEarningsOrLosses |
| End Of Year Balance | 517303 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1930000 | OtherCostOrOtherBasis |
| Book Value | 1930000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 50896095 | OtherCostOrOtherBasis |
| Depreciation | 2127984 | Depreciation |
| Book Value | 48768111 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3859011 | OtherCostOrOtherBasis |
| Depreciation | 662322 | Depreciation |
| Book Value | 3196689 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 53894800 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Unamortized Life Entry Fees | $30,480,814 |
| Resident Security Deposits | $88,020 |
| Reserve for Outstanding Ins Losses | $36,072 |
| Resident Personal Funds | $2,262 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 30607168 | TotalOfAmounts |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Part X Line 2: Alexian Village Of Tennessee does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. There is no ASC 740 (fka FIN 48) footnote for the current year. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Matthew Fox end 712 | ||||||||||||||
| Ex-Officio Member & President & CEO | 0 | 123136 | 0 | 37574 | 0 | 83600 | 0 | 29978 | 0 | 38513 | 0 | 312801 | 0 | 15963 |
| John Turongian | ||||||||||||||
| Director | 0 | 273039 | 0 | 55523 | 0 | 10880 | 0 | 22993 | 0 | 27858 | 0 | 390293 | 0 | 10880 |
| Mark Frey | ||||||||||||||
| Ex-Officio Member | 0 | 1110138 | 0 | 263024 | 0 | 61628 | 0 | 137956 | 0 | 41571 | 0 | 1614317 | 0 | 44628 |
| Jim Lewandowski | ||||||||||||||
| Vice President | 0 | 328372 | 0 | 88552 | 0 | 51446 | 0 | 779279 | 0 | 26553 | 0 | 1274202 | 0 | 33988 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Part I, Line 3: Alexian Brothers Health System, a related organization of Alexian Village Of Tennessee, uses all of the items in Schedule J, Part I, Line 3 to establish the compensation of the organization's CEO. Part I, Line 4a: The following individual listed in Schedule J was paid the referenced amount of severance in calendar 2012: Matthew Fox - $67,637 Part I, Line 4b: Alexian Brothers Health System offers a Supplemental Employee Retirement Plan to all employees who participate in the executive benefits program and whose compensation exceeds the IRS allowable limit for a qualified pension plan. The purpose of the plan is to restore retirement benefits that are restricted because of compensation limits for the executives. The amount paid in calendar 2012 was included in income in Schedule J for the following individual: Jim Lewandowski - $19,123 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | John Turongian, Matthew Fox, Donna Gauthier, Mark Frey, Robin Baschnagel, and Jim Lewandowski have a business relationship due to joint employment by a common health system entity. | |
| Form 990, Part VI, Section A, line 6 | Alexian Village of Tennesse has two members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Senior Ministries (the "Area Member"). | |
| Form 990, Part VI, Section A, line 7a | Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Village of Tennessee. | |
| Form 990, Part VI, Section A, line 7b | All decisions that have a material impact to Alexian Village of Tennessee's financial information or corporation as a whole are subject to approval by the National Member, Alexian Brothers Health System. | |
| Form 990, Part VI, Section B, line 11 | Alexian Village of Tennessee is an affiliate of Alexian Brothers Health System ("ABHS" or "the System"), which is a Catholic not for profit health system. ABHS is the National Member for each entity within the System. Alexian Village of Tennessee's Form 990 goes through an intensive review process at the System's Corporate level prior to being filed with the IRS. The entire Form 990 is reviewed by Alexian Village of Tennessee's financial officer and the CEO. The Form 990 is also reviewed at the System Corporate level by the Chief Accounting Officer for the System. The Vice President, General Counsel for the System reviews all sections of the Form 990 with the exception of the compensation disclosures. The Vice President of Human Resources for ABHS reviews all compensation disclosures for each entity within ABHS. These reviews were conducted before the Form 990 was signed and filed with the IRS. In addition, there is also a Compensation Committee that reports to the ABHS Board of Governors. This Committee reviews the Compensation disclosures for all entities within the System. Alexian Village of Tennessee's board reports to the ABHS Board of Governors, which has ultimate oversight of the activities of all entities within the System. The Audit Committee of the ABHS Board of Governors has responsibility for and oversight of the Tax Compliance process. The Audit Committee provides oversight for the Form 990 process for the entire System and reviews detailed Forms 990 for the System as requested. It then reports back to the ABHS Board of Governors on the results of these activities. The Forms 990 not reviewed by the Audit Committee are available to the Audit Committee members upon request. The Audit Committee did not review the 2012 Form 990 for Alexian Village Tennessee. | |
| Form 990, Part VI, Section B, line 12c | The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. | |
| Form 990, Part VI, Section B, line 15 | In determining compensation of the organization's CEO, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Compensation Committee of the Board of Governors of Alexian Brothers Health System, a related organization, reviewed and approved the compensation. In the review of the compensation, the CEO, was compared to individuals at other similarly situated organizations that hold the same or a similar title. During the review and approval of the compensation, the documentation of the decision was recorded in the Compensation Committee minutes. The individual was not present when his compensation was decided. In determining compensation of other officers or key employees of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were compared to other similarly situated organizations' employees who hold the same or similar title. During the review and approval of the compensation by the Compensation Committee, documentation of the decision was recorded in the minutes. | |
| Form 990, Part VI, Section C, line 19 | The financial statements of Alexian Village of Tennessee are available through the National Reporting Municipal Services Information Repository (NRMSIR). Conflicts of Interest statements and the governing documents of Alexian Village of Tennessee are not made available to the public. | |
| Form 990, Part VII, Section A: | Officers and certain key employees for Alexian Village of Tennessee provide services to Alexian Brothers Health System (the National Member) and its subsidiaries. Hours worked are not tracked on an entity by entity basis, and a 40 hour work week is used as a proxy for all individuals listed on Part VII if employed by the filing organization or a related organization (even though more hours may be worked on average). Therefore, all officers, directors, trustees, and key employee hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employee, Highest Compensated Employee represent aggregate hours for worked per week for all entities. | |
| Form 990, Part VII, Section A: | Compensation amount for John Turongian represents payment for services rendered to Alexian Brothers Senior Ministries, a related entity and compensation amounts for Mark Frey, Donna Gauthier and Jim Lewandowski represent payment for services rendered to Alexian Brothers Health System, a related entity. The amounts are not for services as a board member of Alexian Village of Tennessee. | |
| Form 990, Part XI, line 9: | Equity Transfer from Affiliate 3,810,203. Transfers for Operating Purposes -200,025. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2b - Audit Disclosure: | The financial statements of Alexian Village of Tennessee were audited on a consolidated basis. The Audit Committee of the Board of Governors of Alexian Brothers Health System has been delegated the responsibility to oversee the audited financial statements and the selection of the independent accountants that audits the financial statements. | |
| Form 990 Part VIII, Line 3; Part X, Line 12: | The amount reflected as dividends and interest reflects Alexian Village of Tennessee's share of interest, dividends and realized gains/losses from Alexian Village Of Tennessee's beneficial share in the Alexian Brothers Health System, Inc. Investment Trust (ABHSIT). ABHSIT is a related entity whose purpose is to pool the investments of the not-for-profit entities in ABHS and acts as an internal mutual fund. Details of gains and losses are shown on the Form 990 of ABHSIT. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (22 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Ascension Health | ||||||||||
| PO Box 45998 | St Louis | MO | 63145 | 311662309 | National Health System | MO | Section 501(c)(3) | Schedule A, Line 11a | Ascension Health Alliance | 0 |
| Alexian Brothers Health System | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363260495 | Supports provision of healthcare services for related corporations | IL | Section 501(c)(3) | Schedule A, Line 11c | Ascension Health | 0 |
| Alexian Brothers Bonaventure House | ||||||||||
| 825 Wellington Avenue | Chicago | IL | 60657 | 363527899 | Housing and supportive care services for persons with HIV/AIDS | IL | Section 501(c)(3) | Schedule A, Line 9 | Alexian Brothers Health System | 1 |
| Alexian Brothers Health System Inc Investment Trust | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363801585 | Manages pooled investments of related not-for-profit entities | IL | Section 501(c)(3) | Schedule A, Line 11c | Alexian Brothers Health System | 1 |
| Alexian Brothers Specialty Group | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 800710751 | Specialty physician practice group | IL | Section 501(c)(3) | Schedule A, Line 3 | Alexian Brothers Health System | 1 |
| Alexian Brothers of San Jose Inc | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 941530037 | Acute care hospital (sold in 1998) | TX | Section 501(c)(3) | Schedule A, Line 11c | Alexian Brothers Health System | 1 |
| Alexian Brothers Services Inc | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 431295333 | HUD housing | MO | Section 501(c)(3) | Schedule A, Line 9 | Alexian Brothers Health System | 1 |
| Alexian Village of Milwaukee Inc | ||||||||||
| 9301 N 76th Street | Milwaukee | WI | 53223 | 391351584 | Continuing care retirement community | WI | Section 501(c)(3) | Schedule A, Line 9 | Alexian Brothers Health System | 1 |
| Alexian Brothers Community Services | ||||||||||
| 425 Cumberland Street Suite 110 | Chattanooga | TN | 37404 | 364344423 | Provides comprehensive & coordinated community based services | IL | Section 501(c)(3) | Schedule A, Line 9 | Alexian Brothers Health System | 1 |
| Alexian Brothers Senior Neighbors | ||||||||||
| 250 East 10th Street | Chattanooga | TN | 37402 | 620646376 | Supports the provision of community services for senior citizens | TN | Section 501(c)(3) | Schedule A, Line 7 | Alexian Brothers Health System | 1 |
| Alexian Brothers Senior Ministries | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 364484290 | Supports the provision of healthcare services for related corporations | IL | Section 501(c)(3) | Schedule A, Line 11c | Alexian Brothers Health System | 1 |
| Alexian Elderly Services Inc | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 392039667 | Community outreach | WI | Section 501(c)(3) | Schedule A, Line 9 | Alexian Brothers Health System | 1 |
| Alexian Brothers Lansdowne Village | ||||||||||
| 4624 Lansdowne | St Louis | MO | 63116 | 431470362 | Skilled nursing facility | MO | Section 501(c)(3) | Schedule A, Line 9 | Alexian Brothers Health System | 1 |
| Alexian Brothers Sherbrooke Village | ||||||||||
| 4005 Ripa Avenue | St Louis | MO | 63125 | 431592502 | Skilled nursing facility | MO | Section 501(c)(3) | Schedule A, Line 9 | Alexian Brothers Health System | 1 |
| Alexian Brothers of St Louis Inc | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 430653236 | Acute care hospital (sponsorship transferred in 1997) | MO | Section 501(c)(3) | Schedule A, Line 11c | Alexian Brothers Health System | 1 |
| Alexian Brothers Hospital Network | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363276552 | Supports the provision of healthcare services for related corporations | IL | Section 501(c)(3) | Schedule A, Line 11c | Alexian Brothers Health System | 1 |
| Savelli Properties Inc | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363308965 | Owns or leases properties where healthcare services are delivered | IL | Section 501(c)(2) | N/A | Alexian Brothers Health System | 1 |
| Alexian Brothers Center for Mental Health | ||||||||||
| 3436 N Kennicott Avenue | Arlington Heights | IL | 60004 | 363045007 | Outpatient community mental health services | IL | Section 501(c)(3) | Schedule A, Line 7 | Alexian Brothers Health System | 1 |
| Alexian Brothers Behavioral Health Hospital | ||||||||||
| 1650 Moon Lake Blvd | Hoffman Estates | IL | 60194 | 364251848 | Behavioral health hospital | IL | Section 501(c)(3) | Schedule A, Line 3 | Alexian Brothers Health System | 1 |
| St Alexius Medical Center | ||||||||||
| 1555 Barrington Road | Hoffman Estates | IL | 60194 | 364251846 | Acute care hospital | IL | Section 501(c)(3) | Schedule A, Line 3 | Alexian Brothers Health System | 1 |
| Alexian Brothers Ambulatory Group | ||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 364336931 | Physician services | IL | Section 501(c)(3) | Schedule A, Line 3 | Alexian Brothers Health System | 1 |
| Alexian Brothers Medical Center | ||||||||||
| 800 Biesterfield Road | Elk Grove Village | IL | 60007 | 362596381 | Acute care hospital | TX | Section 501(c)(3) | Schedule A, Line 3 | Alexian Brothers Health System | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| Alexian Rehabilitation Services LLC | |||||||
| 935 Beisner Road | Elk Grove Village | IL | 60007 | 300221481 | Rehabilitation hospital | IL | N/A |
| Illinois NeuroMeg Center LLC | |||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 870783164 | Provision of NeuroMeg services | IL | N/A |
| Elk Grove MOB Limited Partnership | |||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363853289 | Medical office building | IL | N/A |
| Workplace Solutions LLC | |||||||
| 1100 E Woodfield Road | Schaumburg | IL | 60173 | 364095007 | Provision of EAP services | IL | N/A |
| Bonaventure Medical Foundation LLC | |||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363978153 | Manages managed care contracts | DE | N/A |
| Neurosciences Equipment LLC | |||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 861115516 | Ownership of Gamma Knife | IL | N/A |
| St Alexius Center for Sleep Health LLC | |||||||
| 1300 S Main Street | Lombard | IL | 60148 | 205876371 | Operation of sleep lab | IL | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| Thelen Corporation | |||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363266316 | Owns/leases property; joint venture partner | IL | N/A | C | 0 |
| Alexian Brothers Health Providers Association Inc | |||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 363853286 | Messenger model IPA | IL | N/A | C | 0 |
| Alexian Brothers Corpus Christi Housing Project LLC | |||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 943465394 | Tax credit financed housing | IL | N/A | C | 0 |
| Alexian Village of Elk Grove | |||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 352211303 | Tax credit financed housing | IL | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Alexian Brothers Health System | ||
| P | 1408711 | FMV |
| Alexian Brothers Health System | ||
| R | 2142327 | FMV |
| Alexian Brothers Health System | ||
| S | 3810203 | FMV |
| Alexian Brothers Senior Ministries | ||
| P | 113482 | FMV |