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
2012
Open to Public Inspection
Name of the organization
LAKEWOOD RESOURCE AND REFERRAL CENTER INC
Employer identification number
20-1324142
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
804,658
2,267,232
1,757,512
2,876,328
5,933,378
13,639,108
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
804,658
2,267,232
1,757,512
2,876,328
5,933,378
13,639,108
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.
13,639,108
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
804,658
2,267,232
1,757,512
2,876,328
5,933,378
13,639,108
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
1,522
1,683
1,995
5,200
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
13,644,308
12
Gross receipts from related activities, etc. (see instructions)
..................
12
8,950,790
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
99.960 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
99.890 %
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
SCHEDULE A, PART II, LINE 1E OPERATING GRANTS 3,296,631 CAPITAL DEVELOPMENT GRANTS 2,636,747 TOTAL 5,933,378
Schedule A (Form 990 or 990-EZ) 2012
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
2012
Open to Public Inspection
Name of the organization
LAKEWOOD RESOURCE AND REFERRAL CENTER INC
Employer identification number
20-1324142
Identifier
Return Reference
Explanation
DOING BUSINESS AS
FORM 990, PAGE 1, ITEM C
THE CENTER FOR HEALTH EDUCATION, MEDICINE & DENTISTRY (CHEMED)
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
THE LAKEWOOD RESOURCE & REFERRAL CENTER'S (LRRC) MISSION IS TO PROVIDE COMPREHENSIVE, ACCURATE AND EMPATHETIC SOCIAL SERVICES, INFORMATION, REFERRAL, ASSISTANCE, AND ADVOCACY, FOR GOVERNMENT ENTITLEMENT AND PRIVATE SECTOR PROGRAMS. ESTABLISHED IN MARCH 2005, THE LRRC WAS CREATED TO HELP NEW JERSEY RESIDENTS ACCESS, NAVIGATE, AND UNDERSTAND THE COMPLEX AND OFTEN CONFUSING GOVERNMENT ENTITLEMENT OFFICES, INFORMATION SOURCES AND APPLICATIONS. THE LRRC ASSISTS RESIDENTS IN ADDRESSING THE BARRIERS THEY FACE AS THEY ATTEMPT TO NEGOTIATE THE SOCIAL SERVICE AND HEALTH CARE SYSTEMS. WE SERVE AS A "ONE-STOP" SOCIAL SERVICES COMMUNITY AGENCY BY PROVIDING INFORMATION ABOUT THE MANY MEDICAL ASSISTANCE AND SOCIAL SERVICE PROGRAMS AVAILABLE TO LOW-INCOME RESIDENTS,EXPLAINING GUIDELINES AND SCREENING RESIDENTS FOR ELIGIBILITY, ASSISTING RESIDENTS WITH THE APPLICATION PROCESS, AND PROVIDING ADVOCACY AND INTERVENTION SERVICES TO ASSIST LAKEWOOD RESIDENTS IN RESOLVING PROBLEMS WITH BENEFITS AND SERVICES. THE CENTER FOR HEALTH EDUCATION, MEDICINE, & DENTISTRY (CHEMED) IS A FEDERALLY QUALIFIED HEALTH CENTER DEDICATED TO PROVIDING PRIMARY HEALTH CARE, DISEASE PREVENTION, HEALTH EDUCATION, CASE MANAGEMENT SERVICES, AND SOCIAL SERVICE REFERRAL TO ALL RESIDENTS OF OUR AREA IN ORDER TO PROMOTE AND MAINTAIN HEALTHIER LIFESTYLES. THESE SERVICES ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. CHEMED PARTICIPATES IN ALL MEDICAID AND MEDICARE PLANS AS WELL AS PRIVATE INSURANCE COVERAGE. A SLIDING FEE SCALE IS AVAILABLE FOR OUR UNINSURED PATIENTS. CHEMED CURRENTLY OFFERS SERVICES IN ADULT & PEDIATRIC MEDICINE, DENTISTRY, BEHAVIORAL HEALTH, AND A FULL SERVICE PHARMACY. WE ALSO HAVE ON-SITE SOCIAL SERVICE AND CASE MANAGEMENT STAFF TO ASSIST OUR PATIENTS WITH ANY OTHER NEEDS RELATED TO THEIR HEALTH CARE. OUR PHYSICIANS PROMOTE THE USE OF PREVENTIVE SERVICES AND COMPLIANCE WITH TREATMENT PLANS AND FOLLOW-UP APPOINTMENTS. CHEMED'S DELIVERY MODEL OF PROVIDING BOTH PRIMARY CARE MEDICAL AND DENTAL SERVICES IN ONE TREATMENT SETTING ENSURES COORDINATION OF CARE. OUR SOCIAL SERVICE DEPARTMENT ENSURES THAT OUR PATIENTS RECEIVE ACCESS TO AVAILABLE SERVICES THAT ASSIST WITH THE FINANCIAL NEEDS INHERENT IN THEIR MEDICAL CARE.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE TAX RETURN PREPARER SENDS THE CFO, AN EXPERIENCED CPA, A DRAFT COPY OF THE COMPLETED TAX RETURN. THE CFO REVIEWS THE TAX RETURN AND SENDS IT BACK TO THE TAX PREPARER WITH COMMENTS AS NEEDED. THE TAX PREPARER INCORPORATES THOSE COMMENTS INTO THE RETURN, AND SENDS A NEW DRAFT OF THE COMPLETED TAX RETURN TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENTS. AFTER THE BOARD OF DIRECTORS APPROVES THE RETURN THEY NOTIFY THE TAX RETURN PREPARER AND A FINAL VERSION OF THE TAX RETURN IS SENT TO THE EXECUTIVE DIRECTOR TO BE SIGNED AND MAILED.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST. FAILURE TO DISCLOSE A POTENTIAL CONFLICT OF INTEREST, OR ENGAGING IN A PRACTICE DETERMINED TO BE A CONFLICT OF INTEREST MAY RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
THE ORGANIZATION ENGAGED A COMPANY CALLED COMPENSATION RESOURCES INC. TO CONDUCT A MARKET STUDY OF THE BASE SALARY, TOTAL CASH COMPENSATION AND TOTAL COMPENSATION PACKAGE FOR THE CEO.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
THE ORGANIZATION ENGAGED A COMPANY CALLED COMPENSATION RESOURCES INC. TO CONDUCT A MARKET STUDY OF THE BASE SALARY, TOTAL CASH COMPENSATION AND TOTAL COMPENSATION PACKAGE FOR MANY KEY POSITIONS INCLUDING THE CFO, DIRECTOR OF STRATEGIC PLANNING, AND DIRECTOR OF HUMAN RESOURCES.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
UPON REQUEST THE PUBLIC MAY VIEW THE ORGANIZATION'S GOVERNING DOCUMENTS AND RELATED DOCUMENTS AT THE ADDRESS LOCATED ON PAGE 1 OF FORM 990.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.