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
DELNOR COMMUNITY RESIDENTIAL LIVING INC
Employer identification number
36-4156211
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.") .
3,082
0
0
0
5,035,830
5,038,912
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......
4,955,284
5,120,100
4,749,330
4,509,999
3,795,974
23,130,687
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
4,958,366
5,120,100
4,749,330
4,509,999
8,831,804
28,169,599
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
0
0
0
0
0
8
Public Support (Subtract line 7c from line 6.)
28,169,599
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...
4,958,366
5,120,100
4,749,330
4,509,999
8,831,804
28,169,599
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
326,753
171,128
61,128
146,369
186,402
891,780
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
326,753
171,128
61,128
146,369
186,402
891,780
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
0
13
Total support (Add lines 9, 10c, 11 and 12.).
5,285,119
5,291,228
4,810,458
4,656,368
9,018,206
29,061,379
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
96.930 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
96.110 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
3.070 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
3.890 %
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:
10000128
Software Version:
v2010.1.0
-
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
DELNOR COMMUNITY RESIDENTIAL LIVING INC
Employer identification number
36-4156211
Identifier
Return Reference
Explanation
Significant changes to organizational documents
Form 990, Part VI, Section A, Line 4
ON MARCH 31, 2011, DELNOR-COMMUNITY HEALTH SYSTEM, THE FORMER SOLE MEMBER ORGANIZATION OF DELNOR-COMMUNITY RESIDENTIAL LIVING, MERGED WITH CENTRAL DUPAGE HEALTH. THE SURVIVING ENTITY WAS CENTRAL DUPAGE HEALTH, WHICH CHANGED ITS NAME TO CDH-DELNOR HEALTH SYSTEM AT THE MERGER. THE BYLAWS FOR DELNOR-COMMUNITY RESIDENTIAL LIVING WERE AMENDED AT THE TIME OF THE MERGER TO REFLECT THE NEW SOLE MEMBER ORGANIZATION. IN ADDITION, THE BYLAWS REFLECT THE CHANGE IN ACCOUNTING PERIOD TO A JUNE 30 FISCAL YEAR-END.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE SOLE MEMBER OF DELNOR-COMMUNITY RESIDENTIAL LIVING IS CDH-DELNOR HEALTH SYSTEM, A RELATED TAX-EXEMPT ORGANIZATION. MANAGEMENT DUTIES PROVIDED BY CDH-DELNOR HEALTH SYSTEM INCLUDE OPERATIONAL, STRATEGIC, BUDGETING AND LONG-RANGE PLANNING DUTIES, AS WELL AS FINANCE, INTERNAL AUDIT, PERSONNEL, TREASURY AND MARKETING SERVICES. THE INDIVIDUALS PROVIDING THESE SERVICES, INCLUDING THE CEO, CFO, AND OTHER SENIOR MANAGEMENT, ARE EMPLOYEES OF AND COMPENSATED BY CDH-DELNOR HEALTH SYSTEM.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
CDH-DELNOR HEALTH SYSTEM, THE SOLE MEMBER AND PARENT ORGANIZATION, HAS THE POWER TO ELECT OR REMOVE ALL OF THE DIRECTORS OF DELNOR-COMMUNITY RESIDENTIAL LIVING.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
CERTAIN DECISIONS OF THE DELNOR-COMMUNITY RESIDENTIAL LIVING'S GOVERNING BODY ARE SUBJECT TO APPROVAL BY CDH-DELNOR HEALTH SYSTEM, AS THE SOLE MEMBER OF THE FILING ORGANIZATION. THE MEMBER'S AUTHORITY INCLUDES THE POWER TO AMEND, ALTER, RESTATE OR REPEAL THE BYLAWS OF THE CORPORATION; TO NEGOTIATE AND EXECUTE CONTRACTS ON BEHALF OF THE CORPORATION; TO ADOPT A PLAN OF MERGER, CONSOLIDATION OR CORPORATE REORGANIZATION INVOLVING THE CORPORATION; TO ADOPT A PLAN OF DISSOLUTION OR LIQUIDATION OF THE CORPORATION AND DISTRIBUTION OF ITS ASSETS; AND, TO AMEND, ALTER, RESTATE OR REPEAL THE ARTICLES OF INCORPORATION OF THE CORPORATION. ACTIONS BY THE BOARD OF DIRECTORS REQUIRING THE APPROVAL OF THE SOLE MEMBER INCLUDE: ADOPTION OF CAPITAL AND OPERATING BUDGETS; ADOPTION AND EXECUTION OF A STRATEGIC PLAN; AND, AUTHORIZATION OF A CAPITAL EXPENDITURE IN EXCESS OF THE LIMITS ESTABLISHED BY THE SOLE MEMBER FROM TIME TO TIME.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11a
PRIOR TO FILING, A DRAFT OF THE COMPLETED FORM 990 IS REVIEWED BY OUTSIDE TAX ADVISORS AND INTERNAL MANAGEMENT. AFTER THAT REVIEW IS COMPLETE, THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS OF CDH-DELNOR HEALTH SYSTEM (SOLE MEMBER OF FILING ORGANIZATION) FOR ADDITIONAL REVIEW AND COMMENT.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
ALL OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST PAID EMPLOYEES ARE REQUIRED TO FILL OUT A QUESTIONNAIRE DOCUMENTING ANY POTENTIAL CONFLICTS OF INTEREST. THIS INCLUDES, BUT IS NOT LIMITED TO OUTSIDE INTERESTS AND BUSINESS TRANSACTIONS, INVESTMENTS, FAMILY OR BUSINESS RELATIONSHIPS, COMPENSATION ARRANGEMENTS, GRANTS, LOANS, AND GIFTS.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
A NATIONAL COMPENSATION CONSULTANT HIRED BY THE BOARD OF DIRECTORS HAS REVIEWED THE COMPENSATION, INCLUDING BENEFITS PROVIDED TO THE ORGANIZATION'S EXECUTIVES, AND DETERMINED THAT THE COMPENSATION PACKAGES ARE REASONABLE ACCORDING TO THE PROVISION OF TREASURY REGULATION SECTION 53.4958-6(C)(2) AND SECTION 53.4958-1(D)(4)(III).
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
SEE NARRATIVE FOR PART VI LINE 15A
Public Disclosure
Form 990, Part VI, Section C, Line 19
VARIOUS PUBLIC AND PRIVATE ENTITIES MAY REQUIRE THE FILING OF SUCH DOCUMENTS AS PART OF A REGULATORY OR CONTRACTUAL COMMITMENT, AND AS A RESULT OF SUCH OBLIGATIONS, CERTAIN OF THESE MATERIALS MAY, IN FACT, BE AVAILABLE TO THE PUBLIC. OUTSIDE OF SUCH DISCLOSURES, THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT ROUTINELY MADE AVAILABLE BY THE ORGANIZATION TO THE PUBLIC. NOTABLY, FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED TO BE DISCLOSED TO THE PUBLIC PURSUANT TO IRC SECTION 6104.
COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, ETC.
FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B)
THE EMPLOYED OFFICERS LISTED ON PART VII, LINE 1A PROVIDE LEADERSHIP AND MANAGEMENT JOINTLY TO THE FILING ORGANIZATION AND TO OTHER RELATED ORGANIZATIONS WITHIN THE CDH-DELNOR HEALTH SYSTEM OF HEALTHCARE ORGANIZATION (SEE SCHEDULE R, PART II). THE COMPENSATION INFORMATION REPORTED IN PART VII REFLECTS THE INDIVIDUALS' FULL COMPENSATION FOR SERVICE PROVIDED TO ALL RELATED ORGANIZATIONS. CDH-DELNOR HEALTH SYSTEM, AS PARENT AND SOLE MEMBER OF THESE RELATED ORGANIZATIONS, PROVIDES MANAGEMENT SERVICES TO ALL. DUE TO THE OVERLAP OF MANAGEMENT OF THESE ORGANIZATIONS, THERE IS NO MEANINGFUL METHOD BY WHICH TO ESTIMATE THE HOURS DEVOTED SPECIFICALLY TO ANY ONE OF THE RELATED ORGANIZATIONS. THEREFORE AN ESTIMATE OF 1 HOUR PER WEEK IS REPORTED AS BEING DEVOTED TO THIS FILING ORGANIZATION BY THESE INDIVIDUALS.
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 155000; CHANGE IN INTEREST OF NET ASSETS OF FOUNDATION - 74128;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.