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
COLLINGTON EPISCOPAL LIFE CARE COMMUNITY INC
Employer identification number
52-1281156
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.") .
95,958
370,626
181,677
162,291
390,559
1,201,111
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......
21,326,864
21,982,425
21,767,451
21,495,930
22,876,728
109,449,398
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.
21,422,822
22,353,051
21,949,128
21,658,221
23,267,287
110,650,509
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.)
110,650,509
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...
21,422,822
22,353,051
21,949,128
21,658,221
23,267,287
110,650,509
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
641,475
448,373
232,705
239,763
234,206
1,796,522
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
641,475
448,373
232,705
239,763
234,206
1,796,522
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.)
125,619
139,066
240,260
191,006
135,413
831,364
13
Total support (Add lines 9, 10c, 11 and 12.).
22,189,916
22,940,490
22,422,093
22,088,990
23,636,906
113,278,395
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
97.680 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
97.200 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
1.590 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
2.080 %
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
COLLINGTON EPISCOPAL LIFE CARE COMMUNITY INC
Employer identification number
52-1281156
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
THE ORGANIZATION ENTERED INTO AN AGREEMENT WITH LIFE CARE SERVICES LLC DATED OCTOBER 2, 2008 TO MANAGE, OPERATE AND MAINTAIN COLLINGTON EPISCOPAL LIFE CARE COMMUNITY, INC.
FORM 990, PART VI, SECTION A, LINE 7B
THE KENDAL CORPORATION SHALL HAVE THE RIGHT TO REVIEW COLLINGTON'S OPERATIONS, STRATEGIC AND OTHER PLANS, AND FINANCIAL PROJECTIONS AND PERFORMANCE. IF, IN THE JUDGMENT OF THE KENDAL CORPORATION, COLLINGTON IS NOT IN ACCORD WITH THE VALUES AND PRACTICES AND AFFILIATION AGREEMENT OF KENDAL AFFILIATES AS ESTABLISHED FROM TIME TO TIME BY THE KENDAL CORPORATION, TO THE EXTENT NOT PROHIBITED BY THE LAWS OF MARYLAND, THE KENDAL CORPORATION MAY REQUEST, AND REQUIRE IF NECESSARY, THE AFFILIATE TO TAKE APPROPRIATE ACTION TO ADDRESS THE SITUATION. WITH REGARDS TO VACANCIES, IF THE OFFICE OF ANY DIRECTOR BECOMES VACANT FOR ANY REASON, THEN THE REMAINING DIRECTORS MAY SELECT A PERSON TO HOLD OFFICE FOR THE REMAINING TERM SUBJECT TO THE APPROVAL OF THE KENDAL CORPORATION. SUBJECT TO THE APPROVAL OF THE KENDAL CORPORATION AS PROVIDED ABOVE, THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION MAY BE AMENDED BY AFFIRMATION OF THREE-FOURTHS OF THE DIRECTORS IN OFFICE AT ANY ANNUAL, REGULAR OR SPECIAL MEETING DULY CONVENED AFTER NOTICE OF SUCH PURPOSE.
FORM 990, PART VI, SECTION B, LINE 11
PRIOR TO FILING THE FORM 990 THE BOARD OF TRUSTEES WILL RECEIVE A COPY OF THE 990, THEY WILL REVIEW AND APPROVE IT.
FORM 990, PART VI, SECTION B, LINE 12C
A CONFLICT OF INTEREST IS DEFINED AS A PERSON WHO HAS AN "INTEREST" IN A CONTRACT OR OTHER TRANSACTION IF HE OR SHE IS THE PARTY (OR ONE OF THE PARTIES) CONTRACTING OR DEALING WITH THE CORPORATION, OR IS A DIRECTOR, TRUSTEE OR OFFICER OF, OR HAS A SIGNIFICANT FINANCIAL OR INFLUENTIAL INTEREST IN, THE ENTITY CONTRACTING OR DEALING WITH THE CORPORATION OTHER THAN CORPORATIONS, PARTNERSHIPS, JOINT VENTURES, OR OTHER ENTITIES OWNED, CONTROLLED, OR MANAGED BY THE CORPORATION. THE ORGANIZATION ENFORCES THE WRITTEN CONFLICT OF INTEREST POLICY BY ANNUALLY BEING REVIEWED AND EXECUTED BY THE BOARD MEMBERS AND SENIOR STAFF MEMBERS. THE INDIVIDUALS THAT ARE COVERED BY THIS POLICY ARE DIRECTORS, OFFICERS, KEY EMPLOYEES AND COMMITTEE MEMBERS. ANY DIRECTOR, OFFICER, KEY EMPLOYEE OR COMMITTEE MEMBER HAVING A INTEREST IN A CONTRACT OR OTHER TRANSACTION WITH THE CORPORATION SHALL DISCLOSE SUCH INTEREST TO THE BOARD OR A COMMITTEE THEREOF FOR CONSIDERATION, AUTHORIZATION, APPROVAL, OR RATIFICATION AND SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE OF HIS OR HER INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL INCLUDE ANY RELEVANT AND MATERIAL FACTS, KNOWN TO SUCH PERSON, ABOUT THE CONTRACT OR TRANSACTION, WHICH MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE OR POTENTIALLY ADVERSE TO THE CORPORATION'S INTEREST. THE BODY TO WHICH SUCH DISCLOSURE IS MADE SHALL THEREUPON DETERMINE, BY MAJORITY VOTE, WHETHER THE DISCLOSURE SHOWS THAT A CONFLICT OF INTEREST EXISTS OR CAN REASONABLY BE CONSTRUED TO EXIST. IF A CONFLICT IS DEEMED TO EXIST, SUCH PERSON SHALL NOT VOTE ON, NOR USE HIS OR PER PERSONAL INFLUENCE ON, NOR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION OR TO RESPOND TO QUESTIONS) IN THE DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO, SUCH CONTRACT OR TRANSACTION. SUCH PERSON MAY BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM AT ANY MEETING WHERE THE CONTRACT OR TRANSACTION IS UNDER DISCUSSION OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE THEREON AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION, AND THAT A QUORUM WAS PRESENT.
FORM 990, PART VI, SECTION B, LINE 15A
THE ORGANIZATION ENTERED INTO AN AGREEMENT WITH LIFE CARE SERVICES LLC TO MANAGE, OPERATE AND AND MAINTAIN COLLINGTON EPISCOPAL LIFE CARE COMMUNITY, INC. THE ORGANIZATION'S CEO AND HCA ARE LIFE CARE SERVICES EMPLOYEES. THEIR COMPENSATION IS PAID DIRECTLY BY LIFE CARE SERVICES AND NOT BY THE ORGANIZATION. LCS IS PAID A MANAGEMENT FEE BY CELCC.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 117,571. CHANGE IN FAIR VALUE OF INTEREST SWAP AGREEMENTS -57,661. INVESTMENT RETURN IN ASSETS HELD BY COLLINGTON FOUNDATION, INC. 446,251. TOTAL TO FORM 990, PART XI, LINE 5: 506,161.
FORM 990, PART XII, LINE 2C
THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.