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
CHRISTIAN CARE COTTONWOOD VI INC
Employer identification number
86-1002178
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.") .
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......
38,394
47,557
53,548
56,741
61,421
257,661
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.
38,394
47,557
53,548
56,741
61,421
257,661
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.
2,363
5,620
10,415
18,398
c
Add lines 7a and 7b..
2,363
5,620
10,415
18,398
8
Public Support (Subtract line 7c from line 6.)
239,263
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...
38,394
47,557
53,548
56,741
61,421
257,661
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
159
142
59
21
25
406
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
159
142
59
21
25
406
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.)
13
Total support (Add lines 9, 10c, 11 and 12.).
38,553
47,699
53,607
56,762
61,446
258,067
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
92.710 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
96.480 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.160 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.180 %
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 (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
CHRISTIAN CARE COTTONWOOD VI INC
Employer identification number
86-1002178
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
THE CEO, CFO AND EXECUTIVE DIRECTOR ARE COMPENSATED BY CHRISTIAN CARE MANAGEMENT, INC. FOR PROVIDING OVERSIGHT OF THE DAILY MANAGEMENT OF THE ORGANIZATION. THE CORPORATION AND MANAGEMENT ENTERED INTO A MANAGEMENT AGREEMENT ON A MONTH-TO-MONTH BASIS UNDER WHICH THE CORPORATION IS TO PAY MANAGEMENT AND BOOKKEEPING FEES IN AN AMOUNT SPECIFIED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 6
THE MEMBERSHIP OF THE CORPORATION IS COMPOSED OF AND LIMITED TO THE INDEPENDENT CHRISTIAN CHURCHES OF ARIZONA.
FORM 990, PART VI, SECTION A, LINE 7B
THE FEDERAL HOUSING COMMISSIONER INSURES THE DEED OF TRUST AND MUST APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION. THE ORGANIZATION MAY NOT SELL OR OTHERWISE DISPOSE OF MORE THAN $200,000 OR REAL PROPERTY OVER THE OBJECTION OF 51% OR MORE OF THE MEMBERS EXCEPT IN THE ORDINARY COURSE OF BUSINESS AND ON SUCH TERMS AND CONDITIONS AS ARE CONSISTENT WITH THE BEST INTEREST AND PURPOSES OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11
THE CEO AND CFO WILL REVIEW COMPLETED FORM 990 AND PROVIDE A FINAL DRAFT TO THE GOVERNING BOARD ALLOWING FOR A COMMENT PERIOD BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C
ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, HIGHEST COMPENSATED INDEPENDENT CONTRACTORS AND ANY OTHER PERSON WITH SUBSTANTIAL INFLUENCE ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST DISCLOSURE STATEMENT. PART OF THIS STATEMENT REQUIRES THEM TO SIGN AND CONFIRM THAT THEY HAVE READ AND UNDERSTOOD THE COMPANY'S CONFLICT OF INTEREST POLICY. THEY ALSO AGREE TO NOTIFY THE CHAIR OF THE BOARD OR PRESIDENT AND/OR THE CEO IMMEDIATELY IF THEY BECOME AWARE OF ANY POTENTIAL CONFLICTS. IF AN INDIVIDUAL HAS A CONFLICT, THEY ARE REQUIRED TO EXCUSE THEMSELVES FROM DISCUSSION OF THE ISSUE AND THE VOTING PROCESS.
FORM 990, PART VI, SECTION B, LINE 15
THE CEO IS NOT COMPENSATED BY CHRISTIAN CARE COTTONWOOD VI, INC. THE CEO IS COMPENSATED BY CHRISTIAN CARE MANAGEMENT, INC. FOR HIS SERVICES PROVIDED TO ALL RELATED CHRISTIAN CARE COMPANIES. THE COMPENSATION IS DETERMINED BY LOOKING AT COMPARABILITY DATA THROUGH REVIEW OF FORM 990 OF OTHER ORGANIZATIONS AND COMPENSATION SURVEY AND STUDY. THE CEO'S COMPENSATION IS REVIEWED BY THE PERSONNEL COMMITTEE AND RATIFIED BY THE INDEPENDENT GOVERNING BOARD. THE COMPENSATION ARRANGEMENT IS DOCUMENTED IN A WRITTEN EMPLOYMENT CONTRACT. THIS DOCUMENTATION IS PREPARED IN JANUARY OF EACH YEAR. THE CFO, ADMINISTRATOR, AND HUMAN RESOURCE OFFICER ARE NOT COMPENSATED BY CHRISTIAN CARE COTTONWOOD VI, INC. THE CFO AND HUMAN RESOURCE OFFICER ARE COMPENSATED BY CHRISTIAN CARE MANAGEMENT, INC. FOR SERVICES TO MULTIPLE CHRISTIAN CARE RELATED ENTITIES. THE ADMINISTRATOR IS COMPENSATED BY CHRISTIAN CARE MANAGEMENT, INC. FOR HER SERVICES PROVIDED TO CHRISTIAN CARE COTTONWOOD VI, INC. THEIR COMPENSATION IS DETERMINED BY LOOKING AT COMPARABILITY DATA THROUGH REVIEW OF FORM 990 OF OTHER ORGANIZATIONS AND COMPENSATION SURVEYS AND STUDY. THEY DO NOT HAVE WRITTEN EMPLOYMENT CONTRACTS. THEIR COMPENSATION IS ALSO REVIEWED ANNUALLY ON THEIR ANNIVERSARY DATE.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART V, LINE 2A: EMPLOYEES ARE EMPLOYEES OF CHRISTIAN CARE MANAGEMENT, INC. NO FEDERAL OR STATE PAYROLL REPORTING IS DONE BY CHRISTIAN CARE COTTONWOOD VI, INC.
FORM 990, PART VII: THE CEO AND CFO ARE COMPENSATED BY CHRISTIAN CARE MANAGEMENT, INC. FOR THEIR SERVICES PROVIDED TO CHRISTIAN CARE COTTONWOOD VI, INC. AND ALL 20 OTHER RELATED CHRISTIAN CARE COMPANIES. THE CEO SERVES EACH RELATED ORGANIZATION AN AVERAGE OF 1 HOUR PER WEEK. THE CFO SERVES EACH RELATED ORGANIZATION AN AVERAGE OF 1 HOUR PER WEEK. THE ADMINISTRATOR AND HUMAN RESOURCE DIRECTOR ARE BOTH COMPENSATED BY CHRISTIAN CARE MANAGEMENT, INC. FOR THIER SERVICES PROVIDED TO CHRISTIAN HOUSING COTTONWOOD, INC., CHRISTIAN CARE COTTONWOOD, INC., CHRISTIAN CARE COTTONWOOD III, INC., CHRISTIAN CARE COTTONWOOD IV, INC., CHRISTIAN CARE COTTONWOOD V, INC., CHRISTIAN CARE COTTONWOOD VI, INC., CHRISTIAN CARE COTTONWOOD VII, INC., CHRISTIAN CARE COTTONWOOD VIII, INC., CHRISTIAN CARE NURSING CENTER, INC., CHRISTIAN CARE ASSISTED LIVING, INC., CHRISTIAN CARE RETIREMENT APARTMENTS, INC., CHRISTIAN CARE MANOR I, INC., CHRISTIAN CARE MANOR II, INC., AND CHRISTIAN CARE MANOR III, INC. THE ADMINISTRATOR AND HUMAN RESOURCE DIRECTOR SERVES EACH RELATED ORGANIZATION AN AVERAGE OF 2 AND 1 HOURS PER WEEK, RESPECTIVELY. THE GOVERNING BOARD MEETS TEN TIMES ANNUALLY ON BEHALF OF ALL CHRISTIAN CARE COMPANIES DEVOTING AN AVERAGE OF ONE HOUR PER WEEK.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.