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
PORTER COUNTY COUNCIL OF CHURCH WOMEN INC
Employer identification number
35-6035944
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.") .
75,873
799,084
51,440
50,820
31,529
1,008,746
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......
7,810,631
10,108,794
9,647,071
9,474,557
10,201,321
47,242,374
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
23,633
30,931
33,896
36,915
125,375
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.
7,910,137
10,907,878
9,729,442
9,559,273
10,269,765
48,376,495
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
0
0
0
0
0
8
Public Support (Subtract line 7c from line 6.)
48,376,495
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...
7,910,137
10,907,878
9,729,442
9,559,273
10,269,765
48,376,495
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
60,123
30,322
14,188
3,071
3,545
111,249
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
60,123
30,322
14,188
3,071
3,545
111,249
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.)
4,493
151,362
0
5,215
4,904
165,974
13
Total support (Add lines 9, 10c, 11 and 12.).
7,974,753
11,089,562
9,743,630
9,567,559
10,278,214
48,653,718
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
99.430 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
99.200 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
0.230 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
0.380 %
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 - MISCELLANEOUS INCOME, COLUMN A - 4493, COLUMN B - 151362, COLUMN C - , COLUMN D - 5215, COLUMN E - 4904, COLUMN F - 237978;,
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
PORTER COUNTY COUNCIL OF CHURCH WOMEN INC
Employer identification number
35-6035944
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
(CONTINUED FROM PART III) OWNED AND OPERATED SINCE 1964 BY THE PORTER COUNTY COUNCIL OF CHURCH WOMEN, WHISPERING PINES HEALTH CARE CENTER (WHISPERING PINES) IS A NOT-FOR-PROFIT ORGANIZATION COMMITTED TO THE CARE OF THE ELDERLY. WHISPERING PINES OFFERS FULL 24-HOUR CARE RANGING FROM REHABILITATIVE THERAPY SERVICES TO RESTORATIVE NURSING AND ALZHEIMER'S CARE IN A SECURE HOME-LIKE ENVIRONMENT. WHISPERING PINES IS LOCATED WITHIN TWO MILES OF A LARGE HOSPITAL AND NEAR SHOPPING, PARKS, AND RESTAURANTS FOR CONVENIENCE AND EXCURSION. OUR ONSITE SERVICES INCLUDE PHYSICIAN SERVICES, NURSING SERVICES, PHARMACY SERVICES, OCCUPATIONAL THERAPY, PHYSICAL THERAPY, SPEECH-LANGUAGE SERVICES, LAB SERVICES, DIAGNOSTIC X-RAY, QUALIFIED ACTIVITIES PROFESSIONAL, QUALIFIED SOCIAL WORKERS, CHAPLAIN, DENTISTRY SERVICES, PODIATRY SERVICES, MENTAL HEALTH SERVICES, DIETARY SERVICES, AND HOUSEKEEPING SERVICES. THERE WERE 40,871 PATIENT DAYS SERVED DURING 2011. SERVICES INCLUDE A SPECIALIZED AND STRUCTURED ALZHEIMER'S PROGRAM, SKILLED AND INTERMEDIATE CARE, SHORT TERM RESPITE, AND THERAPY REHABILITATION. 44 PERCENT OF REHAB RESIDENTS WERE DISCHARGED TO HOME, 17 PERCENT WERE TRANSFERRED TO IN-HOUSE LONG-TERM CARE, WITH A 13 PERCENT CENSUS ON SKILLED CARE UNIT. THE 150 LICENSED BEDS IN THE FACILITY WERE OCCUPIED 74.65 PERCENT OF THE TIME, FOR AN AVERAGE DAILY CENSUS OF 112 RESIDENTS.
ALZHEIMERS PROGRAM (TIMBRE)
FORM 990, PART III, LINE 4A
(CONTINUED FROM PART III) "ELM" IS THE FIRST STAGE OF THE PROGRAM FOR PATIENTS IN THE EARLY STAGE ASSISTANCE. DURING THE EARLY STAGES, THE RESIDENT EXPERIENCES SOME FORGETFULNESS OF THE PLACEMENT OF ITEMS, NAMES, DATES, ETC. ASSISTING OUR ELM RESIDENTS FINDS US HELPING BRING THESE ITEMS BACK TO COGNITIVE MEMORY. WITH ASSISTANCE, ELM RESIDENTS CAN LEAD A NEAR NORMAL LIFE STYLE. "MAPLE" IS THE MIDDLE STAGE OF THE PROGRAM. MID-STATE ALZHEIMER'S RESIDENTS BEGIN TO EXPERIENCE CHALLENGES WITH MATHEMATICAL FUNCTIONS, I.E. COUNTING BACKWARDS, PLANNING EVENTS, REMEMBERING PERSONAL OR FAMILY HISTORY, AND DRESSING APPROPRIATELY FOR THE WEATHER. WORKING WITH OUR MAPLE RESIDENTS REQUIRES AN INCREASED LEVEL OF CARE IN ORDER TO MAINTAIN A NEAR NORMAL LIFE STYLE. FINALLY, "LINDEN" IS THE LATE STAGE ALZHEIMER'S CARE PROGRAM. RESIDENTS WITH LATE STAGE ALZHEIMER'S FACE THE GREATEST CHALLENGES. IN THIS STAGE, OUR WORK IS THE MOST INTENSIVE AS WE WORK TO PROVIDE QUALITY CARE FOR THESE INDIVIDUALS. ALTHOUGH THEIR PREVIOUS LIFE STYLE HAS BECOME A THING OF THE PAST, OUR TEAM OF SKILLED PROFESSIONALS PROVIDES UNPARALLELED CARE THAT MAXIMIZES THE QUALITY OF LIFE THESE INDIVIDUALS CAN LEAD. STAGING THE DISEASE IN THIS MANNER IS AN IMPERFECT SCIENCE. HOWEVER, ALZHEIMER'S IS ARGUABLY ONE OF THE LESS THAN PERFECT EVENTS IN ONE'S LIFE. THROUGH OUR SUCCESS IN TIMBRE, WE STRIVE TO RICHLY ESTEEM EACH PHASE OF THE DISEASE TO MAKE OUR PATIENTS' LIVES AS NEAR TO PERFECT AS IS HUMANLY POSSIBLE.
SKILLED CARE AND THERAPY REHABILITATION
FORM 990, PART III, LINE 4C
(CONTINUED FROM PART III) AS THESE PATIENTS RECOVER, THEIR HEALING CAN BE EXPEDITED THROUGH THE SERVICES PROVIDED AT WHISPERING PINES. THROUGH THE GUIDED REHABILITATION SERVICES OF WHISPERING PINES STAFF, SENIOR CITIZENS CAN RECOVER IN A SECURE ENVIRONMENT THAT MEETS THEIR EVERY NEED. REHABILITATION THERAPY SERVICES ARE PROVIDED IN: PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, AND RESPIRATORY THERAPY.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
THE COMPLETED FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS REVIEWED BY THE BOARD OF DIRECTORS AND THE ORGANIZATION'S OUTSIDE TAX ADVISORS PRIOR TO FILING THE RETURN WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT ALL EMPLOYEES AND MANAGEMENT STAFF SIGN UPON HIRING, AND ALL BOARD MEMBERS SIGN UPON JOINING THE BOARD OF DIRECTORS. THE POLICY IS INCLUDED IN THE "EMPLOYEE HANDBOOK" THAT ALL NEW EMPLOYEES SIGN INDICATING THAT HE/SHE IS AWARE OF OUR POLICIES. ANNUAL DISCLOSURE IS PROVIDED TO EACH OFFICER AND DIRECTOR. THE EXECUTIVE DIRECTOR REVIEWS THE ANNUAL DISCLOSURE STATEMENTS FOR POTENTIAL CONFLICTS. ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND MONITORED BY THE BOARD OF DIRECTORS; UPON NOTIFICATION OF A POTENTIAL OR ACTUAL CONFLICT, THE BOARD DETERMINES APPROVAL OR REQUEST FOR RESIGNATION. IN ADDITION, ANY PURCHASES AND/OR BIDDING PROPOSALS ARE REVIEWED FOR ANY CONFLICTS OF INTEREST PRIOR TO SUBMITTING BIDS OR MAKING PURCHASES.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
THE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY INCLUDED A REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS, WHICH CONSISTED OF INDEPENDENT PERSONS. THE POLICY USES THE AAHSA SALARY AND BENEFITS REPORT, WHICH IS UPDATED ANNUALLY, 25TH PERCENTILE AND STATE AVERAGE TO COMPARE COMPENSATION OF ALL MANAGEMENT POSITIONS, INCLUDING THE EXECUTIVE DIRECTOR AND CONTROLLER. THE DECISION AND APPROVAL OF THE COMPENSATION AMOUNTS AND THE PROCESS USED WAS DOCUMENTED IN THE BOARD MEETING MINUTES, AND WAS LAST UNDERTAKEN IN NOVEMBER 2011.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
SEE NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A.
Governing documents, conflict of interest policy and financial statements available to the public
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.
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
CHANGE IN VALUE OF CCRRG INVESTMENT - 13568;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.