Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
THE COMMONS OF PROVIDENCE
Employer identification number
34-1826097
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
7,840
10,200
16,477
1,818
1,212
37,547
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3,078,550
2,986,409
3,421,480
3,503,594
3,727,137
16,717,170
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
3,086,390
2,996,609
3,437,957
3,505,412
3,728,349
16,754,717
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
307,501
346,946
363,790
403,056
273,494
1,694,787
c
Add lines 7a and 7b..
307,501
346,946
363,790
403,056
273,494
1,694,787
8
Public Support (Subtract line 7c from line 6.)
15,059,930
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
3,086,390
2,996,609
3,437,957
3,505,412
3,728,349
16,754,717
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
31,000
33,890
12,603
6,103
4,944
88,540
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
31,000
33,890
12,603
6,103
4,944
88,540
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
192,851
319,013
215,992
265,434
256,476
1,249,766
13
Total support (Add lines 9, 10c, 11 and 12.).
3,310,241
3,349,512
3,666,552
3,776,949
3,989,769
18,093,023
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
83.240 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
82.350 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.490 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.600 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A, Part IV, Supplemental Information: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: ANCILLARY/NURSING CAFETERIA REVENUE BEAUTY SHOP REVENUE OTHER REVENUE THERAPY REVENUE REIMBURSEMENT GRANT
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
THE COMMONS OF PROVIDENCE
Employer identification number
34-1826097
Identifier
Return Reference
Explanation
Form 990, Part VI, Section A, line 6
FRANCISCAN LIVING COMMUNITIES IS THE SOLE MEMBER OF FRANCISCAN CARE CENTER, SYLVANIA.
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 FRANCISCAN CARE CENTER, SYLVANIA.
Form 990, Part VI, Section A, line 7b
FRANCISCAN LIVING COMMUNITIES HAS THE RESERVED POWER TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF FRANCISCAN CARE CENTER, SYLVANIA.
Form 990, Part VI, Section B, line 11
THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING. GLORIA KATTOUAH, CONTROLLER, EMAILED THE FORM 990 TO EACH BOARD MEMBER INDIVIDUALLY FOR THEM TO REVIEW PRIOR TO FILING.
Form 990, Part VI, Section B, line 12c
THE ORGANIZATION REGULARY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY PROVIDING EACH BOARD MEMBER WITH A COPY OF THE POLICY AT THE JANUARY BOARD MEETING. EACH MEMBER IS ASKED TO READ THE POLICY AND SIGN A DISCLOSURE.
Form 990, Part VI, Section B, line 15a
THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR INCLUDES THE BOARD OF DIRECTORS REVIEWING AND DISCUSSING PAST COMPENSATION AND USING DATA COMPILED ON SIMILAR QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO MAKE A RECOMENDATION AS TO FUTURE COMPENSATION. THE DISCUSSION TAKES PLACE DURING THE EXECUTIVE SESSION AT THE BOARD OF DIRECTORS MEETING. THE LAST TIME THIS PROCESS TOOK PLACE WAS DECEMBER 2008. DELIBERATIONS AND DISCUSSIONS ARE INCLUDED IN THE BOARD MEETING MINUTES.
Form 990, Part VI, Section C, line 18
THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST.
Form 990, Part VI, Section C, line 19
THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
Changes in Net Assets or Fund Balances:
Form 990, Part XI, line 5:
EQUITY TRANSFER FROM PROVIDENCE CARE CENTERS 3,440. Total to Form 990, Part XI, Line 5: 3,440.
OVERSIGHT OF THE AUDIT
FORM 990, PART XI, LINE 2C
THE ORGANIZATION'S COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND FOR SELECTION OF THE INDEPENDENT ACCOUNTANTS CONSISTS OF THE BOARD MEMBERS. THE PROCESS USED IN THE OVERSIGHT AND SELECTION DID NOT CHANGE FROM THE PRIOR YEAR.
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
THE COMMONS OF PROVIDENCE IS A SUBSIDIARY OF PROVIDENCE CARE CENTERS. THE MISSION STATEMENT SHOWN IN PART III WAS ADOPTED BY THE ORGANIZATION'S GOVERNING BODY FOR PROVIDENCE CARE CENTERS AND SUBSIDIARIES.
TOTAL NUMBER OF EMPLOYEES
FORM 990, PAGE 1, PART 1, LINE 5
ALL W-2'S FOR THE COMMONS OF PROVIDENCE ARE PROCESSED OUT OF PROVIDENCE CARE CENTER, A RELATED PARTY. THE TOTAL NUMBER OF EMPLOYEES THAT WORK FOR THE COMMONS OF PROVIDENCE AS OF DECEMBER 31, 2010 ARE 70.
OFFICER WHO CANNOT BE REACHED AT THE ORGANIZATION'S MAILING ADDRESS
FORM 990, PART VI, LINE 9
NAME: RICK RYAN ADDRESS: 5942 RENAISSANCE PLACE, SUITE A, TOLEDO, OHIO 43623
REPORTABLE COMPENSATION
FORM 990, PART VII, SECTION A
THE EXECUTIVE DIRECTOR'S W-2 IS ISSUED THROUGH PROVIDENCE CARE CENTER. FOR FINANCIAL RECORDKEEPING PURPOSES, ALL COMPENSATION FOR THE EXECUTIVE DIRECTOR IS ALLOCATED BETWEEN PROVIDENCE CARE AND THE COMMONS OF PROVIDENCE.
PUBLIC CHARITY STATUS
FORM 990, SCHEDULE R, PART II, COLUMN E
THE PUBLIC CHARITY STATUS OF THE SISTERS OF ST. FRANCIS OF SYLVANIA, A RELATED PARTY, IS NOT APPLICABLE. THE ORGANIZATION IS CONSIDERED A CHURCH AND RECEIVED THE EXEMPT CODE STATUS OF 501(C)(3) AUTOMATICALLY.
OFFICER'S AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATION
FORM 990, PART VII, SECTION A
THE AVERAGE HOURS PER WEEK DEVOTED TO A RELATED ORGANIZATION FOR RICK G. RYAN, TRUSTEEE, IS APPROXIMATELY 35 HOURS PER WEEK. THE AVERAGE HOURS PER WEEK DEVOTED TO A RELATED ORGANIZATION FOR WENDY DOLYK, EXECUTIVE DIRECTOR, IS APPROXIMATELY 21 HOURS PER WEEK. THE AVERAGE HOURS PER WEEK DEVOTED TO A RELATED ORGANIZATION FOR GLORIA KATTOUAH, CONTROLLER, IS APPROXIMATELY 30 HOURS PER WEEK.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.