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
WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
Employer identification number
13-1740497
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.") .
902,321
965,638
680,410
855,474
759,699
4,163,542
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......
35,429,642
35,362,553
38,513,555
39,562,006
37,893,270
186,761,026
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.
36,331,963
36,328,191
39,193,965
40,417,480
38,652,969
190,924,568
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.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
190,924,568
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...
36,331,963
36,328,191
39,193,965
40,417,480
38,652,969
190,924,568
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
339,264
405,260
181,460
105,214
103,244
1,134,442
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
339,264
405,260
181,460
105,214
103,244
1,134,442
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.)
441,469
699,525
588,998
490,022
743,420
2,963,434
13
Total support (Add lines 9, 10c, 11 and 12.).
37,112,696
37,432,976
39,964,423
41,012,716
39,499,633
195,022,444
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
97.900 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
98.030 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.580 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.650 %
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 II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME PURCHASED SERVICES AGREEMENT
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
WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
Employer identification number
13-1740497
Identifier
Return Reference
Explanation
FORM 990, PART I, LINE 6
IN 2010 THERE WERE 83 VOLUNTEERS IN THE NURSING HOME, 14 AT ADULT DAY CARE, 2 IN FINANCE, 1 IN MARKETING AND 1 IN HR, TOTALING 101 VOLUNTEERS. THE VOLUNTEERS ARE MADE UP OF TEENS, PEOPLE LOOKING TO KEEP BUSY, STUDENTS WHO NEED INTERNSHIPS FOR COLLEGE OR PEOPLE WHO HAD A CHANGE IN CAREER. WE ALSO HAVE 12 VOLUNTEERS FROM THE MT. VERNON YOUTH SHELTER WHO COME 5 DAYS A WEEK. THIS GROUP OF BOYS IS ALWAYS CHANGING SO WE PROBABLY HAD ABOUT 25 DIFFERENT YOUNG MEN MAKE UP THE 12 WHO LIVE THERE. WE HAVE 6 YOUNG STUDENTS FROM BOCES MT. VERNON HS COME EVERY DAY AT LUNCH TIME TO ASSIST WITH DELIVERING THE TRAYS TO THE RESIDENTS IN THE NURSING HOME. MANY CHURCHES OF ALL FAITHS THROUGHOUT WESTCHESTER, MAINLY MT VERNON, COME TO VISIT RESIDENTS IN THE NURSING HOME. WE HAVE NUMEROUS GIRL SCOUT TROOPS COME THROUGHOUT THE SCHOOL YEAR SOME ON A MONTHLY BASIS AND SOME ONCE OR TWICE A YEAR. WE ALSO HAVE VOLUNTEER ENTERTAINERS COME IN FROM SCHOOLS, INDIVIDUALS OR GROUPS TO SING, DANCE OR PLAY INSTRUMENTS THROUGHOUT THE FACILITY. WE ALSO HAD 6 SWEDISH STUDENTS HELP IN THE NURSING DEPARTMENTS. THE VOLUNTEERS WHO GO TO THE NURSING HOME USUALLY ASSIST IN THERAPEUTIC RECREATION BUT ALSO WITH PT, OT, SPEECH THERAPY, MEDICAL RECORDS, CLERICAL, GIFT SHOP AND TRANSPORTING RESIDENTS. AT ADC AND IN MEADOWVIEW IT IS GENERALLY WITH RECREATION. IT IS DETERMINED USUALLY WHERE THEY WILL BE AFTER THEY ARE GIVEN A TOUR AND THEY HEAR THE DIFFERENT OPTIONS OF PROGRAMS THAT ARE AVAILABLE.
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE ORGANIZATION IS WARTBURG MT. VERNON INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE BOARD OF DIRECTORS OF THE CORPORATION SHALL BE ELECTED BY THE MEMBER AT THE ANNUAL MEETING OF THE MEMBER. IN ADDITION, VACANCIES OCCURRING ON THE BOARD OF DIRECTORS OF THE CORPORATION, FOR ANY REASON, MAY ONLY BE FILLED BY THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B
ACTION BY THE VOTE OF AT LEAST TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS OF THE CORPORATION AND BY THE CONCURRING VOTE OF TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS OF THE MEMBER AT THEIR ANNUAL MEETING, REGULAR MEETING OR SPECIAL MEETING HELD UPON NOTICE OF THE PROPOSED ACTION SHALL BE REQUIRED FOR: - AMENDMENT OF THE CERTIFICATE OF INCORPORATION OF THE CORPORATION - AMENDMENT OF THE BY-LAWS OF THE CORPORATION - THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION - MERGER OR CONSOLIDATION OF THE CORPORATION IN ACCORDANCE WITH ARTICLE IX OF THE NOT-FOR-PROFIT CORPORATION LAW - NON-JUDICIAL DISSOLUTION OF THE CORPORATION IN ACCORDANCE WITH ARTICLE X OF THE NOT-FOR-PROFIT CORPORATION LAW - AUTHORIZATION FOR AMENDMENT OF THESE BY-LAWS TO PROVIDE THAT THE QUORUM OR VOTING REQUIREMENT FOR THE TRANSACTION OF ANY ITEM OF BUSINESS BE GREATER THAN THAT WHICH IS REQUIRED BY THE NOT-FOR-PROFIT CORPORATION LAW
FORM 990, PART VI, SECTION B, LINE 11
WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD MEMBERS OF THE ORGANIZATION FOR ANY COMMENTS. ANY COMMENTS ARE THEN GROUPED, SUMMARIZED AND PROVIDED TO THE OUTSIDE ACCOUNTANTS. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED FOR FILING.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION HAS ADOPTED A CONFLICT OF INTEREST POLICY TO ASSURE A UNIFORM POLICY EXISTS FOR COVERED PERSONS AND THAT EFFECTIVE COMMUNICATION AND DECISION MAKING COURSE REGARDING POTENTIAL CONFLICTS OF INTEREST. COVERED PERSONS, AS DEFINED BY THE POLICY, REFERS TO DIRECTORS AND OFFICERS OF THE ORGANIZATION, AS WELL AS EMPLOYEES, CONSULTANTS AND OTHER PERSONS WHO MAY BE IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION'S AFFAIRS. ANNUALLY, COVERED PERSONS ARE REQUIRED TO COMPLETE A FORM "QUESTIONNAIRE CONCERNING FINANCIAL INTERESTS AND AFFIRMATION RE: CONFLICT OF INTEREST POLICY". POTENTIAL CONFLICTS ARE EVALUATED BY THE BOARD OF DIRECTORS OR AN APPROPRIATE COMMITTEE OF THE BOARD. PERSONS IDENTIFIED WITH A CONFLICT MAY BE EXCLUDED FROM VOTING ON/MAKING A DECISION REGARDING A TRANSACTION/ARRANGEMENT WHICH CREATES THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15
THE WARTBURG ALIGNS ITS COMPENSATION PHILOSOPHY WITH THE OVERALL MISSION AND BUSINESS STRATEGY OF THE ORGANIZATION. THE COMPENSATION PHILOSOPHY IS DESIGNED TO PROVIDE COMPETITIVE COMPENSATION POSITIONING COMPARED TO OTHER HEALTH ORGANIZATIONS SIMILAR IN SIZE AND PROGRAM OFFERINGS. MARKET DATA ANALYTICS USED ARE FROM COMMERCIALLY AVAILABLE, TOP-TIER AS WELL AS INDUSTRY AND ASSOCIATION SURVEYS. THE 50TH PERCENTILE IS USED AS A GUIDELINE WHILE ASCERTAINING INTERNAL EQUITY AND ALLOWING FOR SLIGHT ADJUSTMENTS BASED ON THE INCUMBENT'S EXPERIENCE, EDUCATION AND SKILL SETS. SALARY PROGRESSION OCCURS VIA INCREASED LEVEL OF PROFICIENCY, PROMOTIONS AND/OR THROUGH ANNUAL BOARD APPROVED SALARY INCREASES. UNDER THE DIRECTION OF THE PERSONNEL AND COMPENSATION COMMITTEE AND THE CHIEF EXECUTIVE OFFICER, THE EXECUTIVE VICE PRESIDENT OF HUMAN RESOURCES ASSURES THAT COMPENSATION CONSIDERATIONS ARE SOUND AND THAT INCREMENTAL SALARY ADJUSTMENTS TOWARD MID RANGE ARE ALIGNED WITH THE INCUMBENT'S LEVEL OF PROFICIENCY OVER TIME. SALARY INCREMENTS SHALL NOT EXCEED 10% OF AN EMPLOYEE'S BASE COMPENSATION UNLESS OTHERWISE REVIEWED, CONSIDERED, AND APPROVED BY THE BOARD COMMITTEE. EMPLOYEE COMPENSATION LEVELS ARE REVIEWED TWICE A YEAR FOR BUDGETARY AND ENACTMENT PURPOSES. THE LAST COMPENSATION REVIEW WAS COMPLETED IN OCTOBER OF 2010.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE BY POSTING IT ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST AT WARTBURG PLACE, MT. VERNON, NY 10552...OR BY CALLING THE ORGANIZATION DIRECTLY AT (914)-699-0800.
FORM 990, PART VII, SECTION A
THE FOLLOWING OFFICERS AND EMPLOYEES SPENT TIME WORKING FOR WARTBURG RESIDENTIAL COMMUNITY: - DAVID GENTNER, 2 HOURS PER WEEK - JOSEPH SESSA, 8 HOURS PER WEEK - SYLVIA MCTIGUE, 4 HOURS PER WEEK - FRANK TRIPODI, 2 HOURS PER WEEK - LARAINE FELLEGARA, 2 HOURS PER WEEK - SUSAN CADOFF, 20 HOURS PER WEEK - ROBERT WESSLER, 2 HOURS PER WEEK THE FOLLOWING OFFICERS AND EMPLOYEES SPENT TIME WORKING FOR WARTBURG SENIOR HOUSING: - DAVID GENTNER, 3 HOURS PER WEEK - JOSEPH SESSA, 8 HOURS PER WEEK - SYLVIA MCTIGUE, 4 HOURS PER WEEK - FRANK TRIPODI, 3 HOURS PER WEEK - LARAINE FELLEGARA, 3 HOURS PER WEEK - ROBERT WESSLER, 3 HOURS PER WEEK ALL OF THE BOARD MEMBERS SPENT AN AVERAGE OF .5 HOURS A WEEK WORKING FOR WARTBURG RESIDENTIAL COMMUNITY, WARTBURG MT. VERNON INC. AND WARTBURG SENIOR HOUSING.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 46,409. CHANGE IN VALUE OF TRUSTS HELD BY THIRD PARTIES AND POOLED INCOME DEFERRED 133,326. CHANGE IN VALUE OF TRUSTS HELD BY THIRD PARTIES 13,006. TOTAL TO FORM 990, PART XI, LINE 5: 192,741.
FORM 990, PART XII, LINE 2C
THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.