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
ELDER CARE ALLIANCE OF CAMARILLO
Employer identification number
94-3351613
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.") .
7,480
1,297
6,945
15,722
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......
3,550,536
3,566,133
3,612,905
4,044,316
4,623,586
19,397,476
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.
3,550,536
3,573,613
3,614,202
4,044,316
4,630,531
19,413,198
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.
723,465
721,724
773,774
727,465
493,121
3,439,549
c
Add lines 7a and 7b..
723,465
721,724
773,774
727,465
493,121
3,439,549
8
Public Support (Subtract line 7c from line 6.)
15,973,649
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...
3,550,536
3,573,613
3,614,202
4,044,316
4,630,531
19,413,198
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
2,000
2,700
2,775
2,700
10,175
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
2,000
2,700
2,775
2,700
10,175
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.).
3,550,536
3,575,613
3,616,902
4,047,091
4,633,231
19,423,373
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
82.239 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
80.101 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.052 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.041 %
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
ELDER CARE ALLIANCE OF CAMARILLO
Employer identification number
94-3351613
Identifier
Return Reference
Explanation
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINES 4A, 4B, 4C & 4D
AS PART OF THE ELDER CARE ALLIANCE FAMILY OF ASSISTED LIVING SENIOR COMMUNITIES, ALMAVIA OF CAMARILLO IS DEDICATED TO PROVIDING CARE SERVICES TO MEET THE NEEDS OF OLDER ADULTS. WE ARE A NON-PROFIT, FAITH-BASED ORGANIZATION THAT CELEBRATES AND RESPECTS THE DIGNITY AND INHERENT WORTH OF EACH PERSON. LINE 4A A CUSTOM CARE APPROACH THAT ALLOWS RESIDENTS, STAFF, AND OTHER HEALTH CARE PROFESSIONALS TO DEVELOP A SERVICE PLAN FOR EACH RESIDENT'S INDIVIDUAL NEEDS. SERVICES INCLUDE ASSISTANCE WITH PERSONAL CARE, MEDICATION MANAGEMENT, ESCORTS TO DINING AND SOCIAL PROGRAMS, TRANSPORTATION, CLEANING AND MAINTENANCE OF EACH LIVING UNIT, AND COORDINATION OF HEALTHCARE NEEDS. LINE 4B THE GARDENS RESTORES DIGNITY TO THOSE SUFFERING FROM MEMORY LOSS IN AN ATMOSPHERE OF KINDNESS AND RESPECT. WE HAVE CREATED A FAITH BASED, LOVING ATMOSPHERE OF CARING, SUPPORT AND COMPASSION FOR THE RESIDENTS THROUGH EVERY STAGE OF THEIR MEMORY LOSS. LINE 4C AVC ALSO OFFERS AFFORDABLE RESPITE STAYS DESIGNED TO GIVE CAREGIVERS AT HOME A BREAK FROM THE DAY-TO-DAY CHALLENGES OF CARING FOR A LOVED ONE. THIS CAN BE A RESPONSIBLE OPTION FOR FAMILY CAREGIVERS GOING ON VACATION. AT ALMAVIA OF CAMARILLO, RESIDENTS ARE THE HEART OF THE COMMUNITY.
DELEGATION OF MANAGEMENT DUTIES
FORM 990, PART VI, SECTION A, LINE 3
ALMAVIA OF CAMARILLO HAS A MANAGEMENT CONTRACT WITH ELDER CARE ALLIANCE, A NON-PROFIT PUBLIC BENEFIT CORPORATION THAT IS THE SOLE CORPORATE MEMBER OF ALMAVIA OF CAMARILLO, TO PROVIDE MANAGEMENT SERVICES INCLUDING, BUT NOT LIMITED TO, MARKETING, HUMAN RESOURCES, ACCOUNTING, INFORMATION TECHNOLOGY SERVICES, CLINICAL OVERSIGHT AND INSURANCE.
MEMBERS
FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B
THE ORGANIZATION'S SOLE CORPORATE MEMBER IS ELDER CARE ALLIANCE. APPOINTMENT, TERM OF OFFICE AND QUALIFICATION OF DIRECTORS: A. ALL DIRECTORS SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF ELDER CARE ALLIANCE, EXCEPT FOR THE EX OFFICIO DIRECTOR AND THE INITIAL DIRECTORS APPOINTED BY THE INCORPORATOR. B. THE PRESIDENT/CHIEF EXECUTIVE OFFICER (OR ACTING PRESIDENT/CHIEF EXECUTIVE OFFICER) OF ELDER CARE ALLIANCE SHALL SERVE ON THE BOARD AS AN EX OFFICIO DIRECTOR WITH FULL VOTING RIGHTS FOR AS LONG AS HE OR SHE HOLDS THE OFFICE OF PRESIDENT/CHIEF EXECUTIVE OFFICER OF ELDER CARE ALLIANCE. SUCH EX OFFICIO DIRECTOR SHALL CEASE TO BE A DIRECTOR AS OF THE DATE SUCH EX OFFICIO DIRECTOR CEASES TO BE PRESIDENT/CHIEF EXECUTIVE OFFICER OF ELDER CARE ALLIANCE. C. EXCEPT FOR THE INITIAL DIRECTORS APPOINTED BY THE INCORPORATOR AND THE EX OFFICIO DIRECTOR, THE TERM OF OFFICE FOR EACH DIRECTOR SHALL BE AS FOLLOWS. ANY DIRECTOR APPOINTED TO THE BOARD FOR THE FIRST TIME OR AFTER HAVING BEEN OFF THE BOARD FOR THE HIATUS PERIOD (AS HEREINAFTER DEFINED) SHALL SERVE FOR A TERM OF ONE (1) YEAR. THEREAFTER, A DIRECTOR WILL BE ELIGIBLE FOR APPOINTMENT FOR UP TO TWO (2) CONSECUTIVE THREE-YEAR TERMS; PROVIDED, HOWEVER, THAT AT THE ELECTION OF THE BOARD OF DIRECTORS OF ELDER CARE ALLIANCE, ANY SUCH TERM MAY BE FOR LESS THAN THREE (3) YEARS TO ALLOW FOR THE STAGGERING OF TERMS OR TO PERMIT A DIRECTOR TO SERVE THE MAXIMUM NUMBER OF CONSECUTIVE YEARS ALLOWED HEREUNDER. NO DIRECTOR MAY SERVE MORE THAN A MAXIMUM OF SEVEN (7) CONSECUTIVE YEARS ON THE BOARD; HOWEVER, HE OR SHE WILL AGAIN BE ELIGIBLE FOR APPOINTMENT UNDER THE PROVISIONS HERE OF ONE (1) YEAR AFTER THE CONCLUSION OF SUCH A SEVEN-YEAR PERIOD (THE "HIATUS PERIOD"). D. APPOINTMENT OF DIRECTORS APPOINTED BY ELDER CARE ALLIANCE SHALL TAKE PLACE ANNUALLY AT A REGULAR MEETING OR A SPECIAL MEETING OF THE CORPORATION. RESERVED RIGHTS OF CORPORATE MEMBER: THE FOLLOWING ACTIONS OF ELDER CARE ALLIANCE OF CAMARILLO (THE "CORPORATION") SHALL NOT BE IMPLEMENTED WITHOUT THE APPROVAL OF THE CORPORATE MEMBER: (A) ADOPTION OR AMENDMENT OF PHILOSOPHY AND MISSION OF THE CORPORATION; (B) APPROVAL OF STRATEGIC AND LONG RANGE PLANS OF THE CORPORATION; (C) REORGANIZATION, MERGER, CONSOLIDATION OR CHANGE OF CONTROL OF THE CORPORATION; (D) ANY CHANGE IN THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (E) ADOPTION OF AND ANY CHANGE IN THE MISSION STATEMENT OR VALUES STATEMENT OF THE CORPORATION; (F) ADOPTION OF AND ANY CHANGE IN CHARITABLE CARE POLICIES OF THE CORPORATION; (G) SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (H) DISSOLUTION OF THE CORPORATION; (I) ADOPTION OR APPROVAL OF OPERATING AND CAPITAL BUDGETS OF THE CORPORATION, AND ANY CAPITAL EXPENDITURES OR BORROWINGS IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY; (J) CREATION OF A NEW CORPORATION, OR PARTICIPATION IN A JOINT VENTURE REQUIRING CAPITAL COMMITMENTS IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY; OR (K) ANY UNBUDGETED ACQUISITION OF ASSETS WITH A PURCHASE PRICE IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY.
FORM 990 REVIEW PROCESS
FORM 990, PART VI, SECTION B, LINE 11B
THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. ELDER CARE ALLIANCE'S AUDIT COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE FORM 990 BEFORE FILING. ALSO, THE CEO AND CFO REVIEW THE FORM 990 BEFORE FILING. THE FINAL FORM 990 IS THEN PROVIDED BY E-MAIL TO ALL MEMBERS OF THE BOARD OF DIRECTORS BEFORE FILING.
CONFLICT OF INTEREST POLICY COMPLIANCE
FORM 990, PART VI, SECTION B, LINE 12C
ANNUALLY, THE ASSISTANT SECRETARY OF ELDER CARE ALLIANCE REQUESTS UPDATED CONFLICT OF INTEREST DISCLOSURE FORMS FROM THE BOARD OF DIRECTORS, OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED AUTHORITY. THE ASSISTANT SECRETARY PREPARES A TABLE SUMMARIZING THE DISCLOSURES MADE AND PRESENTS THE TABLE TO THE BOARD OF DIRECTORS FOR THEIR INFORMATION. IF AN APPARENT CONFLICT OF INTEREST IS IDENTIFIED, THE MATTER IS REFERRED TO A COMMITTEE OF THE BOARD FOR REVIEW AND ACTION, IF DEEMED NECESSARY, SUCH AS REQUIRING AN INTERESTED DIRECTOR TO RECUSE HIMSELF OR HERSELF FROM A VOTE ON THE MATTER, OR TERMINATING A BUSINESS RELATIONSHIP ENTERED INTO IN VIOLATION OF THE POLICY.
COMPENSATION DETERMINATION
FORM 990, PART VI, SECTION B, LINES 15A & 15B
ALMAVIA OF CAMARILLO HAS A MANAGEMENT CONTRACT WITH ELDER CARE ALLIANCE. INCLUDED IN THE SERVICES PROVIDED UNDER THIS MANAGEMENT CONTRACT ARE THE SERVICES OF THE CEO AND CFO. THE COMPENSATION REVIEW OF THE EXECUTIVE DIRECTORS AND KEY EMPLOYEES WAS DONE IN FY 2011 BY THE FINANCE COMMITTEE OF ELDER CARE ALLIANCE AS PART OF THE BUDGET REVIEW PROCESS. THE COMPENSATION FOR THE CEO AND CFO WAS REVIEWED AGAINST COMPARABLES PROVIDED BY THE VICE PRESIDENT OF HUMAN RESOURCES OF LIFE CARE SERVICES, ELDER CARE ALLIANCE'S MANAGEMENT COMPANY.
GOVERNING DOCUMENT AVAILABILITY
FORM 990, PART VI, SECTION C, LINE 19
THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON WRITTEN REQUEST TO ELDER CARE ALLIANCE, ALMAVIA OF CAMARILLO'S MANAGEMENT COMPANY. DOCUMENTS WILL BE PROVIDED VIA EMAIL, US MAIL, OR BY FAX IF SO REQUESTED.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.