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
EDENDALE RESIDENCE INC
Employer identification number
41-1458930
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.") .
89,000
42,050
131,050
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......
566,852
583,094
638,328
691,639
702,880
3,182,793
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.
655,852
583,094
680,378
691,639
702,880
3,313,843
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.
149,071
269,860
317,184
222,181
250,082
1,208,378
c
Add lines 7a and 7b..
149,071
269,860
317,184
222,181
250,082
1,208,378
8
Public Support (Subtract line 7c from line 6.)
2,105,465
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...
655,852
583,094
680,378
691,639
702,880
3,313,843
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
2,236
1,563
549
263
305
4,916
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
2,236
1,563
549
263
305
4,916
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.).
658,088
584,657
680,927
691,902
703,185
3,318,759
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
63.440 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
63.040 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.150 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.160 %
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
EDENDALE RESIDENCE INC
Employer identification number
41-1458930
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
TWIN CITY CHRISTIAN HOMES SERVICES CO. IS THE MANAGEMENT AGENT.
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE ORGANIZATION IS TWIN CITY CHRISTIAN HOMES, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE NUMBER OF DIRECTORS SHALL BE NOT LESS THAN THREE (3) AND NOT MORE THAN FIVE (5). THE DIRECTORS SHALL BE APPOINTED BY THE MEMBER. EACH DIRECTOR SHALL BE A NATURAL PERSON AND SHALL HOLD OFFICE UNTIL THE ANNUAL MEETING OF THE MEMBERS IN THE THIRD YEAR FOLLOWING HIS OR HER APPOINTMENT, OR UNTIL HIS OR HER DEATH, RESIGNATION OR REMOVAL AS HEREINAFTER PROVIDED. DIRECTORS MAY BE APPOINTED FOR LESS THAN A THREE-YEAR TERM.
FORM 990, PART VI, SECTION A, LINE 8B
THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11
PRIOR TO THE FORM 990 BEING FILED, IT WILL BE PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR THEIR REVIEW. IT WILL ALSO BE PROVIDED TO THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE. SUFFICIENT TIME WILL BE ALLOWED FOR THEM TO REVIEW THE FORM 990 AND FOR THEM TO RAISE QUESTIONS OR CONCERNS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY REQUIRES THAT ALL BOARD MEMBERS, OFFICERS, OTHER VOLUNTEERS AND EMPLOYEES MUST FULLY DISCLOSE ALL AREAS OF INTEREST WHERE POTENTIAL CONFLICT(S) MAY EXIST AND THAT THIS DISCLOSURE SHOULD TAKE PLACE PRIOR TO ANY TRANSACTIONS BEING CONSUMMATED. TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST DOES EXIST, MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: 1.THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; 2.A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS; AND 3.THE BOARD, EXECUTIVE DIRECTOR OR DIRECTOR OF FINANCE HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. TO HELP ENSURE COMPLIANCE WITH THIS POLICY, ALL BOARD MEMBERS AND ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT, WHICH ARE REVIEWED BY THE EXECUTIVE DIRECTOR OR DIRECTOR OF FINANCE FOR INDICATION OF ANY POTENTIAL CONFLICTS OF INTEREST. IF ANY MATERIAL CONFLICTS OF INTEREST ARE DETERMINED TO EXIST, THEY ARE DEALT WITH ON A CASE BY CASE BASIS AND ARE BROUGHT TO THE BOARD OF DIRECTOR'S ATTENTION, AS APPROPRIATE.
FORM 990, PART VI, SECTION B, LINE 15: COMPENSATION FOR THE EXECUTIVE DIRECTOR AND ALL OTHER OFFICERS AND KEY EMPLOYEES ARE DETERMINED BY A RELATED ORGANIZATION THAT HAS POLICIES IN PLACE FOR DETERMINING COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19
THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY MAY BE MADE AVAILABLE ON A CASE BY CASE BASIS IF REQUESTED.
FORM 990, PART XI, LINE 2C:
THE BOARD OF DIRECTORS OF TWIN CITY CHRISTIAN HOMES INC., THE SOLE MEMBER, ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT.
FORM 990, PART VII, SECTION A:
THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO THESE RELATED ORGANIZATIONS. TWIN CITY CHRISTIAN HOMES, INC. HALGEIR GRODAHL ONE HALF HOURS PER WEEK LINDA NELSON ONE HALF HOURS PER WEEK JOHN KANTKE ONE HALF HOURS PER WEEK JEFF JONSWOLD ONE HALF HOURS PER WEEK JOHN BERGESON ONE HALF HOURS PER WEEK JEAN CHERRY ONE HALF HOURS PER WEEK NANCY STARR ONE HOUR PER WEEK CHRIS SCHMIDT ONE HOUR PER WEEK TWIN CITY CHRISTIAN HOMES SERVICES CO. HALGEIR GRODAHL ONE HALF HOURS PER WEEK LINDA NELSON ONE HALF HOURS PER WEEK JOHN KANTKE ONE HALF HOURS PER WEEK JEFF JONSWOLD ONE HALF HOURS PER WEEK JOHN BERGESON ONE HALF HOURS PER WEEK JEAN CHERRY ONE HALF HOURS PER WEEK NANCY STARR 40 HOURS PER WEEK CHRIS SCHMIDT 40 HOURS PER WEEK TWIN CITY CHRISTIAN HOMES FOUNDATION HALGEIR GRODAHL ONE HALF HOURS PER WEEK LINDA NELSON ONE HALF HOURS PER WEEK JOHN KANTKE ONE HALF HOURS PER WEEK JEFF JONSWOLD ONE HALF HOURS PER WEEK JOHN BERGESON ONE HALF HOURS PER WEEK JEAN CHERRY ONE HALF HOURS PER WEEK NANCY STARR ONE HOUR PER WEEK CHRIS SCHMIDT ONE HOUR PER WEEK RICHFIELD SENIOR HOUSING, INC. D/B/A MAINSTREET VILLAGE SENIOR HOUSING HALGEIR GRODAHL ONE HALF HOURS PER WEEK LINDA NELSON ONE HALF HOURS PER WEEK JOHN KANTKE ONE HALF HOURS PER WEEK JOHN BERGESON ONE HALF HOURS PER WEEK NANCY STARR ONE HOUR PER WEEK CHRIS SCHMIDT ONE HOUR PER WEEK WESTRIDGE SENIOR HOUSING, INC. HALGEIR GRODAHL ONE HALF HOURS PER WEEK LINDA NELSON ONE HALF HOURS PER WEEK JOHN KANTKE ONE HALF HOURS PER WEEK JOHN BERGESON ONE HALF HOURS PER WEEK NANCY STARR ONE HOUR PER WEEK CHRIS SCHMIDT ONE HOUR PER WEEK SHOREVIEW SENIOR RESIDENCE D/B/A SCANDIA SHORES HALGEIR GRODAHL ONE HALF HOURS PER WEEK LINDA NELSON ONE HALF HOURS PER WEEK JOHN KANTKE ONE HALF HOURS PER WEEK JOHN BERGESON ONE HALF HOURS PER WEEK NANCY STARR ONE HOUR PER WEEK CHRIS SCHMIDT ONE HOUR PER WEEK
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.