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
PRESBYTERIAN HOMES MANAGEMENT & SERVICES
Employer identification number
41-1499595
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
AVALON SQUARE INC
311662044
9
Yes
Yes
Yes
256,753
(2)
CASTLE RIDGE CARE CENTER INC
510171801
9
Yes
Yes
Yes
170,183
(3)
CROIXDALE
410843106
9
Yes
Yes
Yes
184,391
(4)
CENTRAL TOWERS
411859139
1065
Yes
Yes
Yes
75,299
(5)
GIDEON POND HOUSING CORPORATION
411428336
9
Yes
Yes
Yes
40,827
(6)
GIDEON POND WEST INC
311608246
9
Yes
Yes
Yes
27,594
(7)
GRANDVIEW CHRISTIAN HOME
410844893
9
Yes
Yes
Yes
330,784
(8)
GRANDVIEW WEST INC
311608246
9
Yes
Yes
Yes
163,894
(9)
KIRKLAND CROSSING INC
311662039
9
Yes
Yes
Yes
246,311
(10)
MARANATHA CONSERVATIVE BAPTIST HOME
410855713
9
Yes
Yes
Yes
181,061
(11)
MILL RIDGE COMMONS
363545892
9
Yes
Yes
Yes
40,524
(12)
NOAHS ARK AFFORDABLE HOUSING INC
411777250
9
Yes
Yes
Yes
68,993
(13)
PHS MONTICELLO INC
411819439
9
Yes
Yes
Yes
27,811
(14)
PHSBEACON HILL INC
300093682
9
Yes
Yes
Yes
200,107
(15)
PHSCHANHASSEN INC
311725630
9
Yes
Yes
Yes
271,509
(16)
PHSCOTTAGE GROVE INC
300227875
9
Yes
Yes
Yes
264,288
(17)
PHSEAGLE CREST INC
311604817
9
Yes
Yes
Yes
469,491
(18)
PHSINVER GROVE INC
311725017
9
Yes
Yes
Yes
420,858
(19)
PHSOAKDALE INC
411832098
9
Yes
Yes
Yes
64,392
(20)
PHSSHOREVIEW INC
311631264
9
Yes
Yes
Yes
56,124
(21)
PHSWOODBURY INC
311630828
9
Yes
Yes
Yes
276,379
(22)
PRESBYTERIAN HOMES & SERVICES
410758756
9
Yes
Yes
Yes
470,593
(23)
PRESBYTERIAN HOMES BLOOMINGTON CARE CENTER INC
411862259
9
Yes
Yes
Yes
650,279
(24)
PRESBYTERIAN HOMES CARE CENTERS INC
411500288
9
Yes
Yes
Yes
425,609
(25)
PRESBYTERIAN HOMES FOUNDATION
411465334
7
Yes
Yes
Yes
1,215,228
(26)
PRESBYTERIAN HOMES HOUSING & ASSISTED LIVING INC
411463801
9
Yes
Yes
Yes
938,454
(27)
PRESBYTERIAN HOMES MILL POND APARTMENTS INC
311581710
9
Yes
Yes
Yes
38,446
(28)
PRESBYTERIAN HOMES MILL POND CARE CENTER INC
311581714
9
Yes
Yes
Yes
199,261
(29)
PRESBYTERIAN HOMES OF ANOVERI NC
411891862
9
Yes
Yes
Yes
235,893
(30)
PRESBYTERIAN HOMES OF ARDEN HILLS INC
411482075
9
Yes
Yes
Yes
786,706
(31)
PRESBYTERIAN HOMES OF BLOOMINGTON INC
411871732
9
Yes
Yes
Yes
75,205
(32)
PRESBYTERIAN HOMES OF NORTH OAKS INC
300054296
9
Yes
Yes
Yes
743,609
(33)
VALLEY SENIOR SERVICE ALLIANCE
411915023
9
Yes
Yes
Yes
1,030,441
(34)
WILLIAMSBURG RETIREMENT COMMUNITY
753033211
9
Yes
Yes
Yes
218,114
Total
10,865,411
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.") .
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
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.
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.)
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...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.).
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
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
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
PRESBYTERIAN HOMES MANAGEMENT & SERVICES
Employer identification number
41-1499595
Identifier
Return Reference
Explanation
CHANGES IN PROGRAM SERVICES
FORM 990, PART III, LINE 3
PHS MANAGEMENT & SERVICES DISCONTINUED ITS OPERATION AND TRANSFERRED ALL OF ITS ASSETS TO PHS MANAGEMENT, LLC, A DISREGARDED ENTITY OF PRESBYTERIAN HOMES HOUSING & ASSISTED LIVING.
FORM 990, PART VI, SECTION A, LINE 6
PRESBYTERIAN HOMES AND SERVICES IS THE SOLE MEMBER OF PRESBYTERIAN HOMES MANAGEMENT & SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERS OF THE ORGANIZATION ELECT THE MEMBERS OF THE GOVERNING BODY, BUT NOT IF THE PERSONS ON THE GOVERNING BODY ARE THE ORGANIZATION'S ONLY MEMBERS OR THEIR DELEGATES.
FORM 990, PART VI, SECTION B, LINE 11
THE ORGANIZATION'S FORM 990 IS PROVIDED TO VOTING MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE IRS. OFFICERS AND MANAGEMENT OF THE ORGANIZATION HAVE BEEN INVOLVED IN THE PREPARATION OF THE FORM 990 AND HAVE REVIEWED IT THROUGHOUT THE PROCESS.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION OBTAINS ANNUALLY WRITTEN DISCLOSURES FROM GOVERNING BODY MEMBERS, OFFICERS, AND KEY EMPLOYEES. MANAGEMENT AND OFFICERS REVIEW THESE DISCLOSURES AND EVALUATE WHETHER THE INTEREST COULD RESULT IN A CONFLICT AND THEN TAKE THE NECESSARY STEPS TO REMEDIATE ANY SUCH CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15
THE PRESBYTERIAN HOMES & SERVICES BOARD OF DIRECTORS IS RESPONSIBLE FOR THE GOVERNANCE AND STRUCTURE OF COMPENSATION PLANS AND FOR ENSURING REGULATORY COMPLIANCE OF THESE PLANS. CEO, SENIOR MANAGEMENT, EXECUTIVES AND OFFICERS' COMPENSATION SYSTEMS ARE MANAGED BY THE EXECUTIVE COMMITTEE AND PRESBYTERIAN HOMES & SERVICES BOARD OF DIRECTORS. SYSTEMS ARE REVIEWED MANUALLY AND THE ORGANIZATION ENGAGES AN EXTERNAL INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE A FAIR MARKET VALUE OPINION. THE TARGET FOR TOTAL COMPENSATION FOR EXECUTIVE STAFF WHO MEET PERFORMANCE EXPECTATIONS IS SET AT 105% OF THE MIDPOINT IN EACH RESPECTIVE MARKET PRICE PAY RANGE.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
SHARING OF HOURS
FORM 990, PART VIII, SECTION A
OFFICERS & KEY EMPLOYEES SHARE THEIR HOURS BETWEEN THE FILING ORGANIZATION AND ITS RELATED ORGANIZATIONS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.