Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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 | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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. | 0 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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.. | 0 | |||||
| 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). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 572,538 | 535,409 | 527,335 | 172,713 | 1,807,995 | |
| 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...... | 468,989 | 507,827 | 544,555 | 184,486 | 1,705,857 | |
| 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. | 1,041,527 | 1,043,236 | 1,071,890 | 357,199 | 3,513,852 | |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| 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. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | 3,513,852 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,041,527 | 1,043,236 | 1,071,890 | 357,199 | 3,513,852 | |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 118,417 | 78,904 | 92,770 | 24,657 | 314,748 | |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 118,417 | 78,904 | 92,770 | 24,657 | 314,748 | |
| 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.) | 12,867 | 35,311 | 36,610 | 4,872 | 89,660 | |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 3,918,260 | |||||




| Facts And Circumstances Test |
|---|
| OTHER INCOME PART III, LINE 12; DESCRIPTION: MISCELLANEOUS REVENUE; 2007: 12867.; 2008: 35311.; 2009: 36610.; 2010: 2284.; DESCRIPTION: LAUNDRY INCOME; 2010: 2588.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | The review process is as follows: The 990 is prepared by the management | |
| company and approved by the secretary/treasurer | ||
| of the organization. -John P. Stoner | ||
| Pt VI, Line 19 | Financial statements and governing doctrines are available to the | |
| public upon request. Copies are located at the housing | ||
| facility and the corporate office of United Church Homes, Inc., sole | ||
| member and Management Company of the corporation. | ||
| Pt VI, Line 12c | The Parent Organization, United Church Homes, regularly and consistently monitors | |
| and enforces compliance with its conflict of Interest Policy as follows: | ||
| 1. The Organization's corporate Bylaws require that each of the Board | ||
| of Director members disclose annually, in writing, interests that could be | ||
| construed as a conflict of interest. | ||
| 2. On November 1, 1999, the Organization adopted a Corporate Compliance | ||
| Policy and Program applicable to Directors, Officers, | ||
| Key Employees, and all other employees, which is inclusive of a | ||
| Conflict of Interest Policy. The purpose of the | ||
| policy provides that the Organization is committed to | ||
| conducting its business ethically and in conformance with all | ||
| applicable laws, regulations, rules and standards. | ||
| Pt VI, Line 15 | United Church Homes participates in the annual AAHSA-CEMO Leadership | |
| Leadership Compensation Survey. The Executive | ||
| Committee of the BOD requests copies of the annual survey report to | ||
| consider in setting the compensation package of the President & CEO. | ||
| In turn, the President & CEO normally relies on this | ||
| same survey report to determine to compensation package | ||
| of the Vice President positions. | ||
| Form 990, Part IX, Line 24f | MISCELLANEOUS TAX | |
| Pt VI, Line 4 | Same as above. Sold business assets. |
| Software ID: | 11000175 |
| Software Version: |