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
2011
Open to Public Inspection
Name of the organization
INDIANAPOLIS JEWISH HOME INC
Employer identification number
35-6041299
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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.
Section B. Total Support
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..
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—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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.") .
1,015,328
797,646
752,660
640,252
684,655
3,890,541
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......
11,594,766
11,740,251
12,283,749
13,007,188
13,568,803
62,194,757
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
49,156
50,474
50,556
52,227
65,663
268,076
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.
12,659,250
12,588,371
13,086,965
13,699,667
14,319,121
66,353,374
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
100,000
100,000
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..
100,000
0
0
0
0
100,000
8
Public Support (Subtract line 7c from line 6.)
66,253,374
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
12,659,250
12,588,371
13,086,965
13,699,667
14,319,121
66,353,374
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
120,702
5,428
1,277
54
811
128,272
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
120,702
5,428
1,277
54
811
128,272
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.)
7,443
11,828
28,757
45,713
34,174
127,915
13
Total support (Add lines 9, 10c, 11 and 12.).
12,787,395
12,605,627
13,116,999
13,745,434
14,354,106
66,609,561
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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
99.470 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
99.310 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
0.190 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
0.370 %
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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
OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - OTHER INCOME, COLUMN A - 7443, COLUMN B - 11828, COLUMN C - 28757, COLUMN D - 45713, COLUMN E - 34174, COLUMN F - 127915;,
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000230
Software Version:
v2011.1.0
-
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
2011
Open to Public Inspection
Name of the organization
INDIANAPOLIS JEWISH HOME INC
Employer identification number
35-6041299
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
(CONTINUED FROM PART III) HOOVERWOOD, A NON-PROFIT, NON-SECTARIAN ORGANIZATION, GOVERNED BY A DEDICATED BOARD OF DIRECTORS, IS A CONSTITUENT AGENCY OF THE JEWISH FEDERATION OF GREATER INDIANAPOLIS. WITH THE VALUES AND TRADITIONS OF JUDAISM AS ITS FOUNDATION, HOOVERWOOD'S MISSION STATEMENT IS BASED ON FOUR CORE VALUES THAT TOGETHER CONTINUE HOOVERWOOD'S TRADITION OF HEALTHCARE EXCELLENCE. DIGNITY- TO RECOGNIZE, RESPECT, AND VALUE INDIVIDUALS FOR THEIR UNIQUE QUALITIES AND CONTRIBUTIONS, WHILE PROVIDING OPPORTUNITIES FOR GROWTH, INDEPENDENCE, AND FEELINGS OF SELF WORTH. SPIRITUALITY- TO UPHOLD THE BELIEFS AND TRADITIONS OF JUDAISM, AND TO PROVIDE FOR THE SPIRITUAL WELL BEING OF ALL RESIDENTS THROUGH WORSHIP, SERVICE, AND CELEBRATION. COMMUNITY- TO PROVIDE A NURTURING, HOME-LIKE ENVIRONMENT TO ALL WHO RECEIVE AND PROVIDE CARE. VISION- TO PREPARE FOR THE FUTURE OF THE AGING POPULATION THROUGH A COMMITMENT TO EDUCATION, RESEARCH, AND QUALITY CARE.
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4A
(CONTINUED FROM PART III, LINE 4A) THE ADULT DAY SERVICE PROGRAM AT HOOVERWOOD IS DESIGNED TO BENEFIT FAMILIES IN THE COMMUNITY WHO ARE LIVING WITH OLDER ADULTS WHO NEED A RESPITE FROM THE EVERYDAY CHALLENGES OF CARING FOR A LOVED ONE. FLEXIBLE HOURS ARE OFFERED MONDAY THROUGH FRIDAY, AND WEEKEND/SHORT TERM STAYS ARE ALSO OFFERED BASED ON ROOM AVAILABILITY IN THE NURSING HOME. TRANSPORTATION IS PROVIDED FOR THOSE PARTICIPANTS LIVING WITHIN A FIVE-MILE RADIUS OF THE CENTER. A SPECIALIZED PLAN OF CARE IS DESIGNED FOR EACH PARTICIPANT. MEDICAL/NURSING SERVICES INCLUDING BATHING, GROOMING, VITAL SIGN MONITORING, AND MEDICATION ADMINISTRATION ARE AVAILABLE TO PATIENTS ALONG WITH OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES. HOOVERWOOD'S MEDICAL DIRECTORS ARE BOARD-CERTIFIED GERIATRICIANS WHO HAVE BEEN WITH THE ORGANIZATION FOR OVER 20 YEARS. THE MEDICAL DIRECTORS VISIT OUR RESIDENTS REGULARLY ALONG WITH A GERIATRIC NURSE PRACTITIONER. A PSYCHIATRIC NURSE SPECIALIST, UNDER THE SUPERVISION OF A GERIATRIC PSYCHIATRIST, PROVIDES EVALUATION AND TREATMENT OF RESIDENTS WITH MENTAL ILLNESSES AND ASSISTS THE RESIDENTS AS THEY COPE WITH CHANGES AND LOSSES RELATED TO AGING. HOOVERWOOD OFFERS A FULL SERVICE ON-SITE DENTAL CLINIC WITH WEEKLY VISITS FROM A DENTIST ALONG WITH MONTHLY VISITS FROM A PODIATRIST. IN 2011, HOOVERWOOD PROVIDED 62,741 DAYS OF NURSING, REHABILITATION, MEDICAL AND DENTAL CARE, SOCIAL SERVICES AND ACTIVITIES TO APPROXIMATELY 300 CLIENTS IN A SPIRITUAL ENVIRONMENT.
Delegate broad authority to a committee
Form 990, Part VI, Section A, Line 1a
THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE CORPORATION PLUS THE PRESIDENT OF THE HOOVERWOOD GUILD. ALSO A MAXIMUM OF TWO (2) OTHER BOARD MEMBERS MAY BE APPOINTED BY THE PRESIDENT TO THE EXECUTIVE COMMITTEE IN HIS/HER SOLE DISCRETION, BUT NOTHING HEREIN SHALL REQUIRE THE PRESIDENT TO APPOINT SUCH ADDITIONAL MEMBERS TO SAID COMMITTEE. THE IMMEDIATE PAST PRESIDENT AND THE CHAIRMAN OF THE HOOVERWOOD FOUNDATION COMMITTEE SHALL ALSO SERVE ON THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL MEET WHEN DETERMINED NECESSARY BY THE PRESIDENT AND THE EXECUTIVE DIRECTOR/ADMINISTRATOR. A MAJORITY OF THE EXECUTIVE COMMITTEE MUST BE PRESENT TO CONSTITUTE A QUORUM. THE EXECUTIVE COMMITTEE SHALL ACT, WHEN NECESSARY, IN BETWEEN REGULAR MEETINGS OF THE BOARD. ALL ACTION OF THE EXECUTIVE COMMITTEE SHALL BE REPORTED TO THE BOARD OF DIRECTORS AT THE BOARD'S NEXT MEETING, EITHER IN REGULAR OR EXECUTIVE SESSION. THE EXECUTIVE COMMITTEE SHALL SPECIFICALLY HANDLE TOP MANAGEMENT LEVEL ISSUES, ADMINISTRATIVE COMPENSATION, SENSITIVE POLITICAL/COMMUNITY ISSUES, SENSITIVE LEGAL ISSUES, AND OTHER SUCH TYPE OF CONFIDENTIAL OR SENSITIVE ISSUES.
JILL BURNETT/JANIE MAURER - FAMILY RELATIONSHIP, BARBARA GURWITZ/BARBARA LEVENTHAL - FAMILY RELATIONSHIP, IRVING FREEMAN/EDWARD FREEMAN - FAMILY RELATIONSHIP, HEATHER KULWIN/SHIRLEY KULWIN - FAMILY RELATIONSHIP
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
THE JEWISH FEDERATION OF GREATER INDIANAPOLIS, INC., THE JEWISH COMMUNITY CENTER ASSOCIATION, PARK REGENCY, THE JEWISH COMMUNITY RELATIONS COUNCIL, AND THE BUREAU OF JEWISH EDUCATION HAVE THE RIGHT TO APPOINT ONE VOTING MEMBER TO THE BOARD.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
THE FORM 990 IS REVIEWED IN DETAIL BY MANAGEMENT. THEN COPIES ARE PROVIDED TO EVERY MEMBER OF THE GOVERNING BODY BEFORE IT IS FILED WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
ALL DIRECTORS AND OFFICERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE STATEMENTS ARE REVIEWED BY THE CHIEF FINANCIAL OFFICER. IF ANY CONFLICTS OF INTEREST ARE NOTED, THE EXECUTIVE DIRECTOR AND PRESIDENT OF THE BOARD ARE NOTIFIED. THE PRESIDENT OF THE BOARD ENSURES THAT ANY BOARD MEMBER WITH AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST ABSTAINS FROM VOTING ON DECISIONS RELATED TO THE CONFLICT.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
EACH YEAR, THE COMPENSATION COMMITTEE IS SCHEDULED TO DISCUSS THE COMPENSATION OF THE EXECUTIVE DIRECTOR. THE COMPENSATION COMMITTEE CONSISTS OF MEMBERS FROM THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE USES CURRENT COMPENSATION & FRINGE BENEFIT INFORMATION ALONG WITH OTHER COMPARATIVE DATA, AND PERFORMANCE EVALUATIONS TO ANALYZE COMPENSATION FOR THE EXECUTIVE DIRECTOR. THE DELIBERATION AND DECISION IS CONTEMPORANEOUSLY DOCUMENTED IN THE COMMITTEE MINUTES. AFTER A CONSENSUS IS REACHED, THE DECISION IS DISCUSSED WITH THE EXECUTIVE DIRECTOR. THIS PROCESS LAST TOOK PLACE IN 2011.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
EACH YEAR, THE COMPENSATION COMMITTEE IS SCHEDULED TO DISCUSS THE COMPENSATION OF THE CHIEF FINANCIAL OFFICER. THE COMPENSATION COMMITTEE CONSISTS OF MEMBERS FROM THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE USES CURRENT COMPENSATION & FRINGE BENEFIT INFORMATION ALONG WITH OTHER COMPARATIVE DATA, AND PERFORMANCE EVALUATIONS TO ANALYZE COMPENSATION FOR THE CHIEF FINANCIAL OFFICER. THE DELIBERATION AND DECISION IS CONTEMPORANEOUSLY DOCUMENTED IN THE COMMITTEE MINUTES. AFTER A CONSENSUS IS REACHED, THE DECISION IS DISCUSSED WITH THE EXECUTIVE DIRECTOR AND CHIEF FINANCIAL OFFICER. THIS PROCESS LAST TOOK PLACE IN 2011.
Governing documents, conflict of interest policy and financial statements available to the public
Form 990, Part VI, Section C, Line 19
THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -165471;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.