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
MONTGOMERY PLACE
Employer identification number
36-3582046
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.") .
271,375
355,020
533,461
1,950
1,161,806
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......
9,263,436
9,440,370
10,464,338
12,181,115
13,246,858
54,596,117
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.
9,263,436
9,711,745
10,819,358
12,714,576
13,248,808
55,757,923
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
68,599
84,159
152,758
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
68,599
84,159
152,758
8
Public Support (Subtract line 7c from line 6.)
55,605,165
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...
9,263,436
9,711,745
10,819,358
12,714,576
13,248,808
55,757,923
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
437,806
352,161
115,750
289,545
416,224
1,611,486
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
56,627
35,665
0
92,292
c
Add lines 10a and 10b.
437,806
352,161
172,377
325,210
416,224
1,703,778
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.)
350,547
41,058
66,527
44,105
46,788
549,025
13
Total support (Add lines 9, 10c, 11 and 12.).
10,051,789
10,104,964
11,058,262
13,083,891
13,711,820
58,010,726
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
95.850 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
95.230 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
2.940 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
2.540 %
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
OTHER INCOME, PART III - LINE 12, 2006 MISCELLANEOUS INCOME =350,547 2007 MISCELLANEOUS INCOME =41,058 2008 MISCELLANEOUS INCOME = 66,527 2009 MANAGEMENT FEE= $36,000 MISCELLANEOUS INCOME = $8,105 2010 MANAGEMENT FEE= $36,000 MISCELLANEOUS REVENUE = $10,788,
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
MONTGOMERY PLACE
Employer identification number
36-3582046
Identifier
Return Reference
Explanation
Description of other program services
Form 990, Part III, Line 4d
ASSISTED LIVING PROGRAM PROVIDES THE OPPORTUNITY FOR RESIDENTS TO LIVE LIFE AS INDEPENDENTLY AS POSSIBLE, ON THEIR OWN TERMS, IN THEIR OWN PRIVATE APARTMENTS. RESIDENTS SET THEIR OWN SCHEDULES AND ENJOY THEIR OWN LIFESTYLE WITH THE CONFIDENCE THAT COMES FROM KNOWING HELP IS THERE IF EVER NEEDED.
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
MONTGOMERY PLACE CELEBRATES THE DIVERSITY OF ITS RESIDENTS WHILE REFLECTING ITS EPISCOPAL HERITAGE. MONTGOMERY PLACE PROVIDES A SETTING OFFERING THE RESOURCES OF THE CITY AND A UNIVERSITY NEIGHBORHOOD FOR A STIMULATING AND ENRICHING LIFE.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS REVIEWED BY THE ORGANIZATION'S MANAGEMENT AND MEMBERS OF THE FINANCE COMMITTEE OF THE MONTGOMERY PLACE BOARD OF DIRECTORS. SUBSEQUENT TO THIS REVIEW, A COPY OF THE FINAL FORM 990 IS DISTRIBUTED TO EACH MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ALL OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES (INTERESTED PERSONS). IF IT IS DETERMINED THAT AN INTERESTED PERSON HAS A CONFLICT OF INTEREST WITH THE ORGANIZATION, THE INTERESTED PERSON WILL BE ASKED TO EXCUSE THEMSELVES FROM THE DISCUSSIONS AND DECISIONS THAT ARE MADE IN REGARDS TO THE TRANSACTION WHERE A CONFLICT EXISTS.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
THE EXECUTIVE DIRECTOR'S COMPENSATION AND BONUS IS DETERMINED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S INDEPENDENT BOARD OF DIRECTORS. IN DETERMINING THE EXECUTIVE DIRECTOR'S COMPENSATION PACKAGE, THE EXECUTIVE COMMITTEE USES COMPENSATION SURVEYS OF COMPARABLE ENTITIES. THE DETERMINATION AND APPROVAL OF THE COMPENSATION PACKAGE PROVIDED TO THE EXECUTIVE DIRECTOR IS DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMMITTEE MEETING. THE EXECUTIVE DIRECTOR'S THE 2011 COMPENSATION INCREMENT WAS REVIEWED BY THE BOARD IN DECEMBER 08, 2011 AFTER THE ANNUAL REVIEW OF THE FINANCIAL AUDIT. UPON APPROVAL BY THE BOARD, THE COMPENSATION INCREMENT WAS PAID TO THE EXECUTIVE DIRECTOR.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
THE EXECUTIVE DIRECTOR CONDUCTS ANNUAL PERFORMANCE REVIEWS OF THE ORGANIZATION'S OTHER OFFICERS (ADMINISTRATOR & CFO). THE BOARD THEN DETERMINES COMPENSATION FOR THESE OFFICERS BASED IN PART UPON THE REVIEW PERFORMED BY THE EXECUTIVE DIRECTOR AS WELL AS COMPARABILITY DATA. THE DETERMINATION AND APPROVAL OF THE COMPENSATION IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE ORGANIZATION INDEPENDENT OF THE BOARD OF DIRECTORS. THE PROCESS FOR DETERMINING COMPENSATION FOR THE ORGANIZATIONS OTHER OFFICERS WAS LAST UNDERTAKEN IN MARCH 2011 FOR FOR JULY 1, 2010 TO JUNE 30, 2011 FISCAL YEAR.
Public Disclosure
Form 990, Part VI, Section C, Line 19
FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
HOURS DEVOTED TO RELATED ORGANIZATIONS
FROM 990, PART VII
MARILYN HELMHOZ, VICE PRESIDENT, DANIEL SHANNON, SECRETARYAND VARIOUS BOARD MEMBERS EACH DEVOTED 1 HOUR A WEEK TO THE RELATED ORGANIZATION REPORTED IN SCH R.
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 165236; CHANGE IN TEMPORARY RESTRICTED NET ASSETS - -1640;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.