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
SILVER KEY SENIOR SERVICES INC
Employer identification number
23-7109922
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.") ....
1,635,701
2,602,387
1,878,814
2,043,383
1,963,738
10,124,023
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
1,635,701
2,602,387
1,878,814
2,043,383
1,963,738
10,124,023
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.
10,124,023
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..
1,635,701
2,602,387
1,878,814
2,043,383
1,963,738
10,124,023
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
82,854
72,476
155,955
163,702
164,276
639,263
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.)..
403
3,378
25,050
10,765
39,596
11
Total support (Add lines 7 through 10).
10,802,882
12
Gross receipts from related activities, etc. (see instructions)
..................
12
2,547,693
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
93.720 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
93.990 %
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 (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
SILVER KEY SENIOR SERVICES INC
Employer identification number
23-7109922
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
SERVICES ARE PROVIDED WITH THE GOALS OF PROMOTING INDEPENDENCE, SELF SUFFICIENCY, INDEPENDENT LIVING IN THE HOME, FULFILLING BASIC AND SOCIAL NEEDS, RELIEVING THE MANY BURDENS OF OLD AGE AND PRESERVING THE DIGNITY OF SELF RESPECT OF THE ELDERLY PERSON.
SECOND ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
SUPPLEMENTAL FOOD PROGRAM (CSFP) AND THE EMERGENCY FOOD ASSISTANCE PROGRAM (TEFAP) AS WELL AS OPERATED A FOOD PANTRY TO DISTRIBUTE EMERGENCY FOOD AND SUPPLEMENTAL FOOD TO THE FEDERAL PROGRAMS RECIPIENTS. THE FOOD PANTRY ACCOMMODATES CLIENTS WHO HAVE DIETARY RESTRICTIONS. SENIORS WHO ARE HOMEBOUND RECEIVE THEIR COMMODITIES THROUGH OUR HOME DELIVERY SERVICES. THESE SERVICES ARE PROVIDED WITH COMPASSION AND RESPECT, WITH SENSITIVITY TO ALLOW FOR DIGNITY AND UNDERSTANDING TO OLDER INDIVIDUALS WHO MUST RELY ON OTHERS FOR THEIR BASIC NEEDS. WE WORK CLOSELY WITH CARE AND SHARE TO ENSURE OUR CLIENTS HAVE ACCESS TO AS MUCH FRESH FRUITS AND VEGETABLES AND DAIRY PRODUCTS AS AVAILABLE. A TOTAL OF 1,166 CLIENTS WERE SERVED, RECEIVING 1,096 PANTRY BAGS, 5,298 CSFP FOOD BOXES, 1,022 TEFAP BAGS AND 1,280 EMERGENCY PANTRY FOOD BAGS. A TOTAL OF 2,100 HOURS WERE DONATED IN CONJUNCTION WITH ASSISTING SENIORS RECEIVE FOOD PANTRY ITEMS AND FOOD DRIVES.
THIRD ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4C
SERVICE TO THESE LOW INCOME INDIVIDUALS. THE CARE MANAGERS ASSIST SENIORS IN RESOLVING ISSUES RELATED TO MEDICAID ENROLLMENT AND BENEFITS, FINDING AFFORDABLE HOUSING, UTILITIES ASSISTANCE, AND OTHER HEALTH AND WELFARE NEEDS. DURING 2012, SILVER KEY CARE MANAGERS SAW 1,299 SENIORS. NEED BASED FINANCIAL ASSISTANCE WAS PROVIDED TO 522 INDIVIDUALS. WITHOUT INTERVENTION, MANY OF THESE SENIORS WOULD BE IN SHELTERS, HOSPITALS, AND COSTLY NURSING FACILITIES. A TOTAL OF 4,700 HOURS OF SERVICE WERE DONATED IN CARE MANAGEMENT DURING THIS PERIOD.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
RETAIL SERVICES: THIS PROGRAM PROVIDES SUPPORT VIA HEALTH & VISION EQUIPMENT AND A THRIFT STORE. HEALTH AND VISION EQUIPMENT IS PROVIDED TO SENIORS TO ASSIST WITH MOBILITY AND VISION NEEDS. THE THRIFT STORE IS STAFFED BY VOLUNTEERS AND RESELLS ITEMS THAT HAVE BEEN DONATED TO SILVER KEY. VOLUNTEERS DONATED 2,500 HOURS IN THESE AREAS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE RETURN IS EMAILED TO THE ENTIRE BOARD FOR THEIR REVIEW PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
ANNUALLY, THE BOARD AND EMPLOYEES FILL OUT A CONFLICT OF INTEREST FORM. ANY ITEMS OF MAJOR CONCERN ARE ADDRESSED AND IF SERIOUS ENOUGH, APPROPRIATE ACTION IS TAKEN, INCLUDING DISMISSAL. ANY ITEMS THAT REQUIRE A BOARD VOTE AND THERE IS A CONFLICT OF INTEREST WITH A PARTICULAR BOARD MEMBER, THAT MEMBER WILL EXCUSE HIM/HERSELF FROM THE VOTE.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
DURING THE PROCESS OF THE BUDGET REVIEW WITH THE EXECUTIVE COMMITTEE, FINANCE COMMITTEE, AND THE BOARD, THE CEO COMPENSATION IS REVIEWED UTILIZING COMPARABILITY DATA. THE COMPARABILITY DATA IS UTILIZED TO ASCERTAIN THAT THE LEVEL OF COMPENSATION IS NOT EXCESSIVE. THE ORGANIZATION UTILIZES COMPENSATION SURVEYS BY MOUNTAIN STATES EMPLOYERS COUNCIL. IN YEARS WHERE THERE ARE NO SALARY INCREASES,THIS DATA IS RELIED UPON FROM THE YEAR BEFORE.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
DURING THE PROCESS OF THE BUDGET REVIEW WITH THE EXECUTIVE COMMITTEE, FINANCE COMMITTEE, AND THE BOARD, THE SALARIES AND WAGES OF OTHER OFFICERS AND KEY EMPLOYEES ARE REVIEWED UTILIZING COMPARABILITY DATA. THE ORGANIZATION UTILIZES COMPENSATION SURVEYS BY MOUNTAIN STATES EMPLOYERS COUNCIL. IN YEARS WHERE THERE ARE NO SALARY INCREASES, THIS DATA IS RELIED UPON FROM THE YEAR BEFORE.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE TAX RETURN IS AVAILABLE ON THE GUIDESTAR WEBSITE. THE FINANCIAL AUDIT,TAX RETURN AS WELL AS THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST.
RECONCILIATION OF CHANGES - OTHER
FORM 990, PART XI, LINE 9
CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE TRUST 193,175 SPECIAL EVENT EXPENSES 10,765 RECLASSIFICATION OF SP. EVENT EXPENSES -10,765
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.