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
Edgewood Summit Inc
Employer identification number
55-0701159
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.") .
14,900
20
4,668,763
4,683,683
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......
5,829,860
5,881,393
5,977,581
6,143,514
6,519,655
30,352,003
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.
5,844,760
5,881,413
5,977,581
6,143,514
11,188,418
35,035,686
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
8
Public Support (Subtract line 7c from line 6.)
35,035,686
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...
5,844,760
5,881,413
5,977,581
6,143,514
11,188,418
35,035,686
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
239,712
259,910
328,907
264,288
222,482
1,315,299
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
239,712
259,910
328,907
264,288
222,482
1,315,299
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.).
6,084,472
6,141,323
6,306,488
6,407,802
11,410,900
36,350,985
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
96.380 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
95.800 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
3.620 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
4.200 %
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
Edgewood Summit Inc
Employer identification number
55-0701159
Identifier
Return Reference
Explanation
Form 990, Part VI, Section A, line 3
Edgewood Summit, Inc. (the community) has delegated management duties to a management company experienced in senior living. The executive director is an employee of the management company contracted to provide management oversight at the community. In addition, the executive director and community staff are supported by various team members of the management company that provide operations, marketing and financial support services.
Form 990, Part VI, Section B, line 11
The Executive Director, the Board of Directors, and a representative of the organization's management company review the 990 before it is filed with the IRS.
Conflict of Interest policy
Form 990, Part VI, Section B, Line 12b
The organization has the following conflict of interest policy. 1. The members of the Board of Directors shall refrain, directly and indirectly, both themselves and through their immediate family members, from acquiring any financial interest in a transaction in which Edgewood Summit is involved, in any real or personal property which Edgewood Summit may acquire, or deal or contract with UNLESS the Director makes a full and complete disclosure to the Board so to permit the Board to fully consider all relevant facts before making a decision. 2. Any Director who believes a potential conflict of interest may exist has a duty to immediately report the facts to the President of the Board upon becoming aware of the relevant facts. 3. No Director shall receive any payment for serving as a member of the Board of Directors of Edgewood Summit which is not directly related to that Directors services to the Board. 4. A Director has a duty to act at all times in good faith and to perform his or her duties as a Director in such a manner as the Director believes to be in the best interest of Edgewood Summit, and to act with such care, including reasonable inquiry, as an ordinarily prudent person in a like position would act in the same or similar circumstances. 5. Any action taken by Edgewood Summit which involves an interested Director must meet the following tests to be valid and not in violation of the policy. a. It must benefit Edgewood Summit; and b. It must be fair and reasonable at the time it is entered into; and c. It must be approved by a majority of the Board after all material facts have been disclosed by the interested Director and the interested Director's vote is not considered; and d. Prior to authorizing the action, the Board has determined Edgewood Summit could not obtain a more advantageous position than the arrangement approved. 6. Each Director shall be given a copy of the Conflict of Interest Policy upon joining the Board and acknowledge receipt and list any potential disclosures.
Form 990, Part VI, Section B, line 12c
The organization constantly monitors the conflict of interest policy.
Form 990, Part VI, Section B, line 15
The executive director is an employee of the management company, contracted to provide management oversight at the community. The executive director's initial compensation was based on industry market survey comparisons and initial compensation and annual wage adjustments are approved by the board of directors during review and approval of the annual operating budget.
Form 990, Part VI, Section C, line 19
Edgewood Summit, Inc. makes its governing documents and financial statements available to the public through the West Virginia Secretary of State's office and The West Virginia Economic Development Authority.
Changes in Net Assets or Fund Balances:
Form 990, Part XI, line 5:
Net unrealized gains on investments: 1,488,682.
Whistleblower policy
Form 990, Part VI, Section B, Line 13
Although the organization does not have a policy labeled as a whistleblower policy, we do have policies on reporting suspected or alleged abuse, neglect or exploitation and on resident rights. Both policies encourage residents and staff to report irregularities, complaints, concerns, etc. promptly and without fear of reprisal. Residents and staff are notified of these policies upon move-in or hire and annually thereafter. Other aids to the policy include forms available for use in reporting and feature articles in monthly newsletters reminding and encouraging people to come forward with information. The Board is in the process of developing a formal Whistleblower Policy.
Document retention and destruction policy
Form 990, Part VI, Section B, Line 14
The Board is in the process of developing a formal document retention and destruction Policy.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.