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
The Guardian Foundation Inc-Affiliates
Employer identification number
91-1842720
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.") .
91,578
590,896
36,224
9,622
5,778
734,098
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......
136,747,086
135,783,454
140,590,943
133,261,263
129,109,930
675,492,676
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.
136,838,664
136,374,350
140,627,167
133,270,885
129,115,708
676,226,774
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..
8
Public Support (Subtract line 7c from line 6.)
676,226,774
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...
136,838,664
136,374,350
140,627,167
133,270,885
129,115,708
676,226,774
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
876,952
847,622
622,577
587,594
631,489
3,566,234
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
876,952
847,622
622,577
587,594
631,489
3,566,234
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.)
1,048,000
686,791
1,734,791
13
Total support (Add lines 9, 10c, 11 and 12.).
137,715,616
137,221,972
142,297,744
134,545,270
129,747,197
681,527,799
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
99.220 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.200 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.520 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.540 %
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:
10000105
Software Version:
2010v3.2
-
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
The Guardian Foundation Inc-Affiliates
Employer identification number
91-1842720
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
The organization does not make its governing documents, conflict of interest policy, and financial statements available to the public.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
The conflict of interest policy is reviewed with the Directors annually. The organization monitors transactions and arrangements that could result in a conflict. If evidence suggests a conflict of interest, the organization performs due diligence procedures to and determines, by a majority vote of the governing board, whether or not a conflict exists. Outside advisors may be used.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
Prior to filing, a draft Form 990 is reviewed by senior management. A final draft Form 990 is emailed to the Board of Directors with an indication of an anticipated filing date. The Directors are given the opportunity to raise any issues of concern. These issues are discussed and incorporated in the final Form 990 as necessary. The Form 990 is filed after Board approval.
Form 990, Part VI, Line 8
Form 990, Part VI, Line 8 : Explanation of No Contemporaneously Documentation of Meetings
The affiliate organizations do not have committees to act on behalf of the governing body.
Form 990, Part VI, Line 6
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder
The Guardian Foundation, Inc. is the sole member of all the affiliate organizations.
Form 990, Part VI, Line 3
Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company
Some of the affiliates organizations have delegated operational control to a management company.
Client Note 1 - NOTE 1Form 990, Part III, Line 4a:The corporations are organized and operate exclusively for charitable uses and purposes. Their long-term charitable mission is to provide care for the elderly and developmentally delayed individuals.CARE OF THE ELDERLY:Guardian Center, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Massachusetts. They own and operate a 120-bed nursing facility located in Brockton, MA.Guardian Hospice of MA, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Massachusetts. They provide hospice and palliative care for patients and residents of MA.Lighthouse of Revere, Inc. in a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Massachusetts. They own and operate a 123-bed nursing facility located in Revere, MA.Naamans Creek Care, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Pennsylvania. They own and operate a 90-bed nursing facility located in Garnet Valley, PA.Rolling Meadows, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Pennsylvania. They own and operate a 121-bed nursing facility located in Waynesburg, PA.Somerset Care, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Pennsylvania. They own and operate a 150-bed nursing facility and an 11-unit independent living facility located in Berlin, PA.Pennsylvania LTC, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Pennsylvania. They own and operate Linwood Nursing and Rehabilitation Center, a 102-bed nursing facility located in Scranton, PA, and Edgehill Nursing and Rehabilitation Center, a 60-bed nursing faciltiy located in Glenside, PA.PS Atlanta, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of Georgia. They own and operate Plantation South of Duluth, a 62-bed assisted living facility located in Duluth, GA and Plantation South of Dunwoody, a 40-bed assisted living facility located in Dunwoody, GA.RBRC, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of Kentucky. They own and operate a senior housing community consisting of a 40-bed skilled nursing facility, along with 26 personal care beds, 18 assisted living facilities, an adult day care center, and a child day care center located in Kuttawa, KY.The overall aggregate patient mix in facilities operated by these affiliates is characterized by a high level of indigent patients, and the cost of caring for these patients is primarily paid for through the Medicaid and Medicare programs.CARE OF DEVELOPMENTALLY DISABLED:Central Florida Communities, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of Florida. They own and operate three intermediate care facilities for the developmentally disabled and 17 group homes located in central Florida.Florida Care Properties, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of Florida. They own and operate five day program service facilities for the developmentally disabled in Florida and Mississippi. They provide services to approximately 600 individuals.Nassau Care Centers, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of Florida. They own and operate three intermediate care homes for the developmentally disabled from three sites located in Nassau County, FL.AICC, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of Florida. They own a facility in Nassau County, FL, where services are provided to the developmentally disabled.The services provided by these facilities include room and board (except Florida Care Properties), supervision, and training activities for developmentally disabled individuals. Maximum effort is devoted to teaching these individuals basic skills such as dressing and personal hygiene, and, where possible, vocation skills that will allow the individual to become gainfully employed in some capacity.ADMINISTRATIVE SERVICES:Health Systems, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of Georgia. Health Systems was organized and operates to consult, advise, and assist the management of nonprofit nursing homes, hospice, and retirement facilities.AFFILIATION TERMINATED:Founders Pavilion, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the State of New York. They own and operate a 120-bed nursing facility located in Corning, NY. Founders Pavilion, Inc. became a stand along nonprofit organization no longer affiliated with Guardian Foundation in December, 2010.Quaside, Inc. is a nonprofit corporation created under the nonprofit corporation laws of the Commonwealth of Massachusetts. They own and operate Quaboag on the Common, a 141-bed nursing facility located in West Brookfield, MA, and Springside at Pittsfield, a 112-bed nursing facility located in Pittsfield, MA. Quaside, Inc. became a stand alone nonprofit organization no longer affiliated with Guardian Foundation in March, 2011.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.