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
HUBBARD HILL ESTATES INC
Employer identification number
35-1362157
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.") .
29,315
29,124
52,671
2,250,506
50,276
2,411,892
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......
7,867,147
9,009,970
10,645,440
10,766,476
10,858,863
49,147,896
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
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.
7,896,462
9,039,094
10,698,111
13,016,982
10,909,139
51,559,788
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
2,175,000
0
2,175,000
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..
0
0
0
2,175,000
0
2,175,000
8
Public Support (Subtract line 7c from line 6.)
49,384,788
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...
7,896,462
9,039,094
10,698,111
13,016,982
10,909,139
51,559,788
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
33,319
60,973
38,457
31,853
81,751
246,353
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
33,319
60,973
38,457
31,853
81,751
246,353
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
4,805
4,805
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
117,213
112,614
117,820
95,194
442,841
13
Total support (Add lines 9, 10c, 11 and 12.).
7,929,781
9,217,280
10,849,182
13,166,655
11,090,889
52,253,787
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
94.510 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
94.190 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.470 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.490 %
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
OTHER INCOME, SCHEDULE A, PART III, DESCRIPTION: MISCELLANEOUS REVENUE 2006: NONE 2007: 117,213 2008: 112,614 2009: 117,820 2010: 95,194 TOTAL: 442,841,
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000128
Software Version:
v2010.1.0
-
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
2010
Open to Public Inspection
Name of the organization
HUBBARD HILL ESTATES INC
Employer identification number
35-1362157
Identifier
Return Reference
Explanation
PROGRAM SERVICE DESCRIPTION
FORM 990 PART III LINE 4A
HUBBARD HILL ESTATES, INC. (HUBBARD HILL) IS A FULL-SERVICE RETIREMENT COMMUNITY DESIGNED AS A CONTINUING CARE CAMPUS. HUBBARD HILL PROVIDES RESIDENTS WITH A VARIETY OF LIVING ARRANGEMENTS RANGING FROM PRIVATE HOUSES TO A SKILLED MEDICARE CERTIFIED HEALTH CENTER WITH 24 HOUR PROFESSIONAL NURSING CARE. HUBBARD HILL HAS A TOTAL OF 205 INDIVIDUAL LIVING UNITS WITHIN THE CONTINUUM OF CARE ACCOMMODATIONS. THERE ARE 85 INDIVIDUAL INDEPENDENT DWELLINGS THAT OFFER MAINTENANCE-FREE LIVING TO RESIDENTS AND PROVIDE OPTIONAL ACCESS TO ALL SERVICES PROVIDED AT HUBBARD HILL INCLUDING MEALS. THE ROUTINE MAINTENANCE FEE INCLUDES LAWN CARE, SNOW REMOVAL, TRASH COLLECTION, AND CITY WATER. OTHER SERVICES ARE ALSO AVAILABLE. HUBBARD HILL PROVIDED 44,428 RESIDENT DAYS OF SERVICE TOWARD INDEPENDENT CARE DURING THE YEAR ENDED JUNE 30, 2011. THE RESIDENTIAL HALLS, LICENSED BY THE STATE FOR RESIDENTIAL CARE, HAVE 104 APARTMENTS DESIGNED FOR RESIDENTS REQUIRING SOME ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. HUBBARD HILL PROVIDES RESIDENTS NEEDING SOME ASSISTANCE WITH SERVICES SUCH AS DRESSING, BATHING, MEDICATION MANAGEMENT, AND OTHER LIMITED NURSING SERVICES. MONTHLY OPTIONAL SERVICES AVAILABLE INCLUDE THREE MEALS PER DAY FROM A SELECTIVE MENU, HOUSEKEEPING SERVICES, MAINTENANCE SERVICES, BED AND BATH LINEN SERVICES, AND PERSONAL LAUNDRY SERVICES. WASHERS AND DRYERS ARE AVAILABLE IN EACH HALL FOR RESIDENTS DESIRING TO DO THEIR OWN PERSONAL LAUNDRY. ADDITIONAL ASSISTED LIVING SERVICES ARE AVAILABLE TO ANY RESIDENT IN ANY APARTMENT IN THE RESIDENCE HALLS FOR AN ADDITIONAL FEE. A LICENSED PRACTICAL NURSE AND CERTIFIED AIDES ARE ON DUTY 24 HOURS A DAY FOR ASSESSMENT, EVALUATION, AND SUPERVISION OF RESIDENTS' NEEDS. AN RN SERVES AS DIRECTOR OF NURSING AND LICENSED NURSES ALSO PROVIDE OVERSIGHT THROUGHOUT THE WEEK. HUBBARD HILL PROVIDED 31,063 RESIDENT DAYS OF SERVICE TOWARD ASSISTED LIVING CARE DURING THE YEAR ENDED JUNE 30, 2011. HUBBARD HILL ALSO OPERATES A 66 BED SKILLED NURSING FACILLITY THAT ALSO PROVIDES DEDICATED REHABILITATION CARE. ALL HEALTHCARE ROOMS ARE CERTIFIED FOR MEDICARE SERVICES. DURING THE YEAR ENDED JUNE 30, 2011, 10 BEDS ARE ALSO CERTIFIED FOR MEDICAID SERVICES. A FULL-TIME ACTIVITIES DIRECTOR PROVIDES A FULL RANGE OF RECREATIONAL PROGRAMS. TWO LICENSED SOCIAL WORKERS PROVIDE FOR SOCIAL SERVICES NEEDS. NURSING CARE IS PROVIDED 24 HOURS PER DAY. PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES ARE AVAILABLE IN THE HEALTHCARE CENTER'S FULLY EQUIPPED THERAPY CENTER FOR INPATIENT AND OUTPATIENT THERAPY SERVICES. THE DIRECTOR OF NURSING HEADS A STAFF THAT INCLUDES REGISTERED NURSES, LICENSED PRACTICAL NURSES & CERTIFIED NURSING ASSISTANTS. SEVERAL CONSULTANTS, INCLUDING A DIETITIAN, PHARMACISTS, PHYSICIANS, AND THERAPISTS ARE ALSO ON STAFF. HUBBARD HILL PROVIDED 21,723 RESIDENT DAYS FOR HEALTHCARE INCLUDING 8,001 MEDICARE DAYS, 1,825 MEDICAID DAYS, AND 11,897 PRIVATE PAY DAYS DURING THE YEAR ENDED JUNE 30, 2011.
FAMILY AND BUSINESS RELATIONSHIPS
FORM 990, PART IV, PAGE 4, LINE 28A AND SCHEDULE L, PART IV
THE ORGANIZATION USES AN INDEPENDENT CONTRACTOR, INTERWIZE, TO ASSIST IN FINANCIAL MANAGEMENT, BILLING SERVICES, AND CONSULTING. INTERWIZE PROVIDES THREE FINANCIAL CONSULTANTS TO HUBBARD HILL ESTATES --LORI FARKAS, BILL QUIG, AND DAVID NULL. BILL QUIG AND DAVID NULL ARE OWNERS OF INTERWIZE; THEY ARE NOT INDIVIDUALLY COMPENSATED BY HUBBARD HILL ESTATES IN THEIR CAPACITY AS FINANCIAL CONSULTANTS, BUT RATHER, INTERWIZE IS PAID FOR THE SERVICES THEY PROVIDE TO HUBBARD HILL ESTATES. BILL QUIG AND DAVID NULL ARE INDIVIDUALLY COMPENSATED BY INTERWIZE FOR SERVICES PROVIDED TO HUBBARD HILL ESATES, AS WELL AS FOR SERVICES PROVIDED TO OTHER UNRELATED ORGANIZATIONS. LORI FARKAS IS THE OWNER OF MORGANROTH CONSULTING SERVICES, A COMPANY THAT SUBCONTRACTS TO INTERWIZE TO PROVIDE FINANCIAL CONSULTING TO HUBBARD HILL ESTATES. LORI FARKAS IS NOT INDIVIDUALLY COMPENSATED BY HUBBARD HILL ESTATES IN HER CAPACITY AS A FINANCIAL CONSULTANT, BUT RATHER, HUBBARD HILL ESTATES PAYS INTERWIZE FOR SERVICES PROVIDED, AND INTERWIZE PAYS MORGANROTH CONSULTING SERVICES FOR THE SUBCONTRACT WORK. LORI FARKAS IS INDIVIDUALLY COMPENSATED BY MORGANROTH CONSULTING SERVICES FOR HER SERVICES PROVIDED TO INTERWIZE AND HUBBARD HILL ESTATES, AS WELL AS FOR SERVICES PROVIDED TO OTHER UNRELATED ORGANIZATIONS. HUBBARD HILL ESTATES PAID INTERWIZE FOR FINANCIAL MANAGEMENT AND CONSULTING SERVICES IN THE AMOUNT OF $155,221 FOR THE FISCAL YEAR ENDED JUNE 30, 2011. SEE SCHEDULE L, PART IV.
ORGANIZATIONS THAT MAY RECEIVE DEDUCTIBLE CONTRIBUTIONS:
FORM 990, PART V, PAGE 5, LINE 7G AND 7H
THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY, CARS, BOATS, AIRPLANES, OR OTHER VEHICLES DURING THE YEAR ENDED JUNE 30, 2011; THEREFORE, THESE QUESTIONS DO NOT APPLY AND BEEN LEFT INTENTIONALLY BLANK.
Delegation of management duties
Form 990, Part VI, Section A, Line 3
THE ORGANIZATION USES AN INDEPENDENT CONTRACTOR, INTERWIZE, TO ASSIST IN FINANCIAL MANAGEMENT. DUTIES INCLUDE FINANCIAL REPORTING AND ANALYSIS, BOARD REPORTING ON FINANCIAL RELATED MATTERS, AUDIT COMPLIANCE, AND OTHER FINANCIAL MATTERS. INTERWIZE REGULARLY MEETS WITH THE EXECUTIVE DIRECTOR ON ALL FINANCIAL MATTERS. FINAL AUTHORITY AND DECISIONS ON ALL FINANCIAL MATTERS REMAINS WITH THE EXECUTIVE DIRECTOR. INTERWIZE PROVIDES INPUT TO FINANCIAL STAFF EVALUATIONS AND SUPERVISION, BUT IS NOT RESPONSIBLE FOR THOSE ACTIVITIES.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
THE CONFERENCE OF THE MISSIONARY CHURCH, NORTH CENTRAL DISTRICT, INC., A RELATED PARTY, HAS AUTHORITY TO APPROVE 2/3 OF THE GOVERNING BODY.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11a
A FINAL DRAFT OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY PRIOR TO ITS FILING WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE ORGANIZATION REQUIRES ALL OFFICERS AND DIRECTORS OF THE BOARD, AS WELL AS KEY EMPLOYEES AND OTHER INTERESTED PERSONS, TO ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND TO DOCUMENT IN WRITING ANY POTENTIAL CONFLICTS. A DETAILED QUESTIONNAIRE IS ALSO COMPLETED BY EACH BOARD MEMBER. EXECUTIVE AND FINANCIAL MANAGEMENT REVIEW THE QUESTIONNAIRES FOR ANY POTENTIAL CONFLICTS. IF A CONFLICT DOES EXIST, THAT PERSON MUST NOTIFY THE BOARD AND/OR EXCUSE HIM OR HERSELF FROM THE BOARD MEETING PRIOR TO DISCUSSION ON THE CONFLICTING TOPIC. THAT PERSON WILL NOT BE PERMITTED TO VOTE ON ANY DECISIONS REGARDING THE CONFLICTING ISSUE.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE EVALUATION COMMITTEE, WHICH IS MADE UP OF INDIVIDUALS FROM THE GOVERNING BOARD. THIS COMMITTEE COMPARES CURRENT COMPENSATION TO COMPENSATION DATA FOR SIMILAR CONTINUING CARE RETIREMENT COMMUNITY (CCRC) INSTITUTIONS. THE COMMITTEE LOOKS AT SIZE, STATE, AND OTHER TRENDS TO ENSURE THAT COMPENSATION IS ALIGNED WITH SIMILAR ORGANIZATIONS. ONCE THE EVALUATION COMMITTEE REVIEWS PERFORMANCE AND COMPARABLE COMPENSATION DATA, A COMPENSATION PACKAGE WHICH INCLUDES RANGES IS SUBMITTED TO THE FULL BOARD OF DIRECTORS. ONCE APPROVED BY THE FULL BOARD, THE PACKAGE IS THEN SENT TO THE FINANCE COMMITTEE, WHO LOOKS AT THE RANGE OF COMPENSATION APPROVED IN THE PACKAGE AND DETERMINES A FINAL PACKAGE NUMBER. THIS REVIEW PROCESS WAS LAST COMPLETED DURING FISCAL YEAR 2010 AND WAS DOCUMENTED IN THE BOARD MEETING MINUTES.
Public Disclosure
Form 990, Part VI, Section C, Line 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
FAMILY AND BUSINESS RELATIONSHIPS
FORM 990, PART VI, SECTION A, PAGE 6, LINE 2
SHIRLEY MARKS, A CURRENT BOARD MEMBER, AND J.R. ROHRER, A CURRENT BOARD MEMBER, HAVE A FAMILY RELATIONSHIP. OFFICERS DAVE NULL, BILL QUIG, AND LORI FARKAS HAVE A BUSINESS RELATIONSHIP THROUGH INTERWIZE. SEE FURTHER DISCLOSURE IN SCH O PART IV 28A AND VI SECTION A LINE 3.
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -21922; GAIN ON INTEREST RATE SWAP - 150559;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.