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
ARIZONA RETIREMENT HOME OF SCOTTSDALE INC
Employer identification number
86-0456124
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......
362,209
370,005
387,907
399,718
424,064
1,943,903
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.
362,209
370,005
387,907
399,718
424,064
1,943,903
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.
103,709
146,649
172,597
422,955
c
Add lines 7a and 7b..
103,709
146,649
172,597
422,955
8
Public Support (Subtract line 7c from line 6.)
1,520,948
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...
362,209
370,005
387,907
399,718
424,064
1,943,903
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
2,651
2,382
437
45
15
5,530
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
2,651
2,382
437
45
15
5,530
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.).
364,860
372,387
388,344
399,763
424,079
1,949,433
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
78.020 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
86.220 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.280 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.400 %
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
ARIZONA RETIREMENT HOME OF SCOTTSDALE INC
Employer identification number
86-0456124
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
THE BOARD OF THE ORGANIZATION HAS AGREED THAT ALL MANAGEMENT SERVICES AND OVERSIGHT OF THE ORGANIZATION SHALL BE DONE BY BILTMORE PROPERTIES, INC. BILTMORE PROPERTIES, INC. HAS AGREED TO MANAGE ALL RENTAL OPERATIONS FOR A SPECIFIC FEE PER MONTH.
FORM 990, PART VI, SECTION A, LINE 6
MEMBERSHIP IN THE CORPORATION IS LIMITED TO INDIVIDUALS WHO ARE EITHER (1) TRUSTEES (DIRECTORS) OF ARIZONA CHRISTIAN RETIREMENT HOME SOCIETY, INC. OR (2) MEMBERS OF ARIZONA CHRISTIAN RETIREMENT HOME SOCIETY, INC. AND WHO HAVE THE APPROVAL OF THE BOARD OF TRUSTEES (DIRECTORS) OF ARIZONA CHRISTIAN RETIREMENT HOME SOCIETY, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERS OF THE SOCIETY ELECT THE BOARD MEMBERS ON AN ANNUAL BASIS FOR A THREE YEAR TERM.
FORM 990, PART VI, SECTION A, LINE 8B
THE ORGANIZATION DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11
A COPY OF THE FORM 990 WILL BE PROVIDED TO BILTMORE PROPERTIES AND THE PRESIDENT OF THE BOARD FOR THE INITIAL REVIEW. ONCE THE FORM 990 IS IN FINAL DRAFT, EACH BOARD MEMBER WILL HAVE THE OPPORTUNITY TO REVIEW A COPY OF THE FORM 990 FOR SEVEN DAYS PRIOR TO FILING THE TAX RETURN.
FORM 990, PART VI, SECTION B, LINE 12C
OFFICERS AND DIRECTORS ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE ORGANIZATION DOES NOT HAVE ANY KEY EMPLOYEES. THE POLICY IS REVIEWED AT THE BOARD MEETING BY ALL BOARD MEMBERS TO DETERMINE IF A CONFLICT EXISTS. IF A CONFLICT WERE TO EXIST, A BOARD MEMBER MUST REFRAIN FROM VOTING WHEN THE MATTERS ARE BEING DISCUSSED AND VOTED UPON.
FORM 990, PART VI, SECTION B, LINE 15: AS THE ORGANIZATION DOES NOT HAVE A TOP MANAGEMENT OFFICIAL AND DOES NOT COMPENSATE INDIVIDUALS SERVING AS OFFICERS, THE BOARD DOES NOT HAVE A PROCESS FOR APPROVING COMPENSATION. THE BOARD DOES HAVE A PROCESS FOR ENGAGING A MANAGEMENT COMPANY TO OVERSEE THE OPERATIONS OF THE ORGANIZATION. THIS PROCESS INCLUDES EVALUATION AND APPROVAL OF A MANAGEMENT COMPANY THAT WILL MEET THE NEEDS OF THE ORGANIZATION. THE BOARD REVIEWS AND APPROVES THE RATES TO BE PAID TO THE MANAGEMENT COMPANY AND THE TIME PERIOD OF THE CONTRACT.
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 EMPLOYED BY AN OUTSIDE AGENCY. NO FEDERAL OR STATE REPORTING IS DONE BY THIS ORGANIZATION.
FORM 990, PART VII
OVERALL MANAGEMENT AND OVERSIGHT OF THE ORGANIZATION IS DONE BY BILTMORE PROPERTIES, INC. AS FEES PAID TO BILTMORE PROPERTIES, INC. ARE LESS THAN $100,000, DISCLOSURE OF RELATIONSHIP AND FEES FOR PART VII IS NOT NECESSARY.
FORM 990, PART VII, SECTION A
ALL OF THE BOARD MEMBERS LISTED FOR ARIZONA RETIREMENT HOME OF SCOTTSDALE, INC. SERVE A RELATED ORGANIZATION, ARIZONA RETIREMENT HOME OF SCOTTSDALE II, INC. AN ADDITIONAL 0.30 HOURS PER MONTH.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.