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 VILLAGE AT ORCHARD RIDGE INC
Employer identification number
26-3445374
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.") .
49,515
2,705
52,220
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
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.
49,515
2,705
52,220
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
875
875
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..
875
875
8
Public Support (Subtract line 7c from line 6.)
51,345
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...
49,515
2,705
52,220
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
4,885
855,394
748,797
1,609,076
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
4,885
855,394
748,797
1,609,076
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.).
54,400
855,394
751,502
1,661,296
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
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
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
THE VILLAGE AT ORCHARD RIDGE INC
Employer identification number
26-3445374
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 4
THE ORGANIZATION'S BY-LAWS WERE AMENDED IN JANUARY 2010 RESTATING SOME OF THE AUTHORITY OF THE DIRECTORS AND INCLUDING THE CHIEF EXECUTIVE OFFICER AS AN EX-OFFICIO BOARD MEMBER WITH FULL VOTING PRIVILEGES.
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION HAS A SINGLE CLASS OF CONSTITUENT MEMBERS WHICH SHALL CONSIST OF THOSE DULY ELECTED MEMBERS OF THE BOARD OF TRUSTEES OF NATIONAL LUTHERAN HOME FOR THE AGED, INC., THE PARENT ORGANIZATION TO THE FILING ENTITY.
FORM 990, PART VI, SECTION A, LINE 7A
THE ORGANIZATION'S BOARD HAS ROTATING 3 YEAR TERMS WITH THE POSSIBILITY OF 2 CONSECUTIVE TERMS BEING SERVED. THEN A BREAK OF ONE YEAR MUST OCCUR BEFORE AN INDIVIDUAL SERVES AS A BOARD MEMBER AGAIN. THE ONLY EXCEPTION TO THESE RULES ARE THE BISHOP'S DESIGNEES FROM EACH OF THE CHURCH SYNODS TO WHICH THE ORGANIZATION BELONGS. IF THE BISHOP CHOOSES NOT TO SERVE ON THE BOARD, THEN HE CAN ASSIGN AN INDIVIDUAL TO HIS/HER SEAT AS LONG AS HE/SHE IS BISHOP.
FORM 990, PART VI, SECTION A, LINE 7B
APPROVAL OF THE FOLLOWING MATTERS IS RESERVED EXCLUSIVELY TO THE MEMBERSHIP. A) APPROVE THE ROLE AND/OR MISSION STATEMENT, IF ANY B) APPROVE OPERATING AND CAPITAL BUDGETS C) APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS D) APPROVAL OF ALL EXPENDITURES, CONTRACTS OR THE INCURRENCE OF DEBT IN EXCESS OF $100,000 THAT HAVE NOT BEEN INCLUDED IN AN APPROVED OPERATING OR CAPITAL BUDGET E) APPROVAL OF AND RECOMMENDATIONS FOR THE FORMATION OF LEGAL ENTITIES, THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS, DIVESTITURES, DISSOLUTIONS, CLOSURES, MERGERS, CONSOLIDATIONS, OR CHANGES IN CORPORATE MEMBERSHIP F) LIQUIDATION, DISSOLUTION, WINDING UP OR ABANDONMENT OF THE CORPORATION G) APPROVAL OF STRATEGIC PLANS H) SELECTION OF THE CORPORATION'S EXECUTIVE DIRECTOR I) SELECTION OF THE AUDITOR FOR THE CORPORATION J) APPROVAL OF ALL DECISIONS REGARDING THE MANAGEMENT OF THE CORPORATION'S INVESTMENT PORTFOLIO
FORM 990, PART VI, SECTION B, LINE 11
THE EXECUTIVE COMMITTEE, ALONG WITH APPROPRIATE STAFF, PERFORMS AN INITIAL REVIEW OF THE FORM 990. UPON APPROVAL, THE FORM 990 IS MADE AVAILABLE TO EACH BOARD MEMBER FOR REVIEW PRIOR TO TRANSMISSION OF THE RETURN TO THE IRS. THE BOARD OF THE PARENT, NATIONAL LUTHERAN HOME FOR THE AGED, INC., WILL RECEIVE A COPY OF THE RETURN PRIOR TO THE IRS FILING AS WELL.
FORM 990, PART VI, SECTION B, LINE 12C
BOARD MEMBERS AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT EVERY YEAR. IF A CONFLICT IS IDENTIFIED, IT IS 1) IDENTIFIED AND DISCUSSED WITH THE BOARD AND 2) REVIEWED AND DOCUMENTED BY MANAGEMENT. IF AN ACTUAL OR POTENTIAL CONFLICT IS IDENTIFIED, THE BOARD MEMBER, OFFICER, OR EMPLOYEE WILL RECUSE HIM OR HERSELF FROM ANY CONVERSATIONS, DECISIONS, OR OTHER ACTIVITIES AND DISCUSSIONS INVOLVING THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD DETERMINES THE COMPENSATION FOR THE CEO THROUGH THE COMBINED USE OF SEVERAL METHODS. BOARD MEMBERS SERVE AS A COMPENSATION COMMITTEE WHICH OVERSEES THE PROCESS. COMPENSATION SURVEYS ARE PERFORMED BY AN OUTSIDE HR CONSULTING FIRM, PRM, USING LOCAL MARKET DATA AND WRITTEN EMPLOYMENT CONTRACTS ARE DRAWN. THE CEO, EXECUTIVE DIRECTOR AND DIRECTOR OF HUMAN RESOURCES USE SALARY SURVEYS TO DETERMINE THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES TO ASSURE THEY ARE WITHIN THE LOCAL MARKET RANGE. THE SERVICES THE INDIVIDUAL PROVIDES TO THE ORGANIZATION AND THE TENURE OF THE OFFICER ARE ALSO FACTORS CONSIDERED IN SALARY DETERMINATIONS.
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.
HOURS WORKED FOR RELATED ORGANIZATIONS
FORM 990, PART VII
LARRY BRADSHAW IS THE CEO OF THE VILLAGE AT ORCHARD RIDGE AND ITS RELATED ENTITIES. MR. BRADSHAW'S TIME IS ALLOCATED 25% TO NATIONAL LUTHERAN HOME AND VILLAGE AT ROCKVILLE, 25% TO THE VILLAGE AT ORCHARD RIDGE, AND 50% TO NATIONAL LUTHERAN HOME FOR THE AGED. MICHAEL BRADY IS THE DIRECTOR OF FINANCE AT THE VILLAGE AT ORCHARD RIDGE. MR. BRADY'S TIME IS ALLOCATED 65% TO NATIONAL LUTHERAN HOME AND VILLAGE AT ROCKVILLE, 25% TO THE VILLAGE AT ORCHARD RIDGE, AND 10% TO NATIONAL LUTHERAN HOME FOR THE AGED.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 4,080,836.
AUDIT OVERSIGHT:
FORM 990, PART XII, LINE 2C
THE ROLE OF THE AUDIT COMMITTEE, WHICH CONSISTS OF THE FINANCE COMMITTEE, IS TO SELECT THE AUDITOR. THE AUDITORS ALSO PRESENT THEIR FINDINGS TO THE AUDIT COMMITTEE IN A FORMAT WHICH ENCOURAGES DIALOGUE AND QUESTIONS WITH THE AUDITORS.
DOCUMENT RETENTION AND DESTRUCTION:
FORM 990, PART VI, QUESTION 14
THE ORGANIZATION DOES NOT CURRENTLY HAVE A DOCUMENT RETENTION AND DESTRUCTION POLICY IN PLACE. HOWEVER, THEY HAVE THE FRAMEWORK FOR A POLICY WHICH IS IN THE PROCESS OF BEING APPROVED BY CORPORATE COMPLIANCE.
DEBT FORGIVENESS:
FORM 990, PART VIII, LINE 11A
THE DEBT FORGIVENESS IS FROM THE AFFILIATED ORGANIZATION, NATIONAL LUTHERAN HOME AND VILLAGE AT ROCKVILLE. THE TRANSFER OF ASSETS HAS BEEN REPORTED ON SCHEDULE R, PART V, LINE 1R. AS THE FILING ORGANIZATION IS NOT THE CONTROLLING ORGANIZATION, NO AMOUNT HAS BEEN REPORTED ON SCHEDULE R, PART V, LINE 2 PER IRS INSTRUCTIONS. THE DEBT FORGIVENESS HAS BEEN REPORTED ON PART VIII, LINE 11 INSTEAD OF PART VIII, LINE 1 BECAUSE IT WAS NEITHER A CASH CONTRIBUTION OR A NON-CASH CONTRIBUTION OF TANGIBLE ITEMS OR SECURITIES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.