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
SPRINGHOUSE INC C/O ROGERSON COMMUNITIES
Employer identification number
04-3152499
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.") ....
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
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.") .
160
0
0
2,575
0
2,735
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......
6,777,399
6,399,395
6,341,095
6,308,052
6,988,789
32,814,730
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.
6,777,559
6,399,395
6,341,095
6,310,627
6,988,789
32,817,465
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.
135,477
179,270
330,789
463,006
1,108,542
c
Add lines 7a and 7b..
135,477
179,270
330,789
463,006
1,108,542
8
Public support (Subtract line 7c from line 6.)
31,708,923
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...
6,777,559
6,399,395
6,341,095
6,310,627
6,988,789
32,817,465
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
237,897
172,544
137,365
186,872
172,002
906,680
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
237,897
172,544
137,365
186,872
172,002
906,680
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.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
7,015,456
6,571,939
6,478,460
6,497,499
7,160,791
33,724,145
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
94.024 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
93.230 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
2.688 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
3.460 %
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
SPRINGHOUSE INC C/O ROGERSON COMMUNITIES
Employer identification number
04-3152499
Identifier
Return Reference
Explanation
Operations
FORM 990, PART VI, SECTION A, LINE 3
DAY TO DAY OPERATIONS ARE MANAGED BY AN INDEPENDENT MANAGEMENT COMPANY.
Members
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATIONS SOLE MEMBER IS THE MOUNT PLEASANT HOME, A MASSACHUSETTS NONPROFIT CORPORATION.
Board of Directors
FORM 990, PART VI, SECTION A, LINE 7A
THE MOUNT PLEASANT HOME MAY APPOINT OR TERMINATE MEMBERS OF THE BOARD OF DIRECTORS.
Review of tax return
FORM 990, PART VI, SECTION B, LINE 11
THE 990 IS SUBMITTED TO THE TREASURER FOR REVIEW BEFORE ISSUANCE. THE TREASURER MAKES A COPY AVAILABLE TO ALL BOARD MEMBERS.
Conflicts of Interest
FORM 990, PART VI, SECTION B, LINE 12C
ANNUALLY THE BOARD IS REQUIRED TO REVIEW AND SIGN THE CONFLICT OF INTEREST POLICY.
Compensation
FORM 990, PART VI, SECTION B, LINE 15B
THE MANAGEMENT COMPANY ADVISES THE BOARD OF DIRECTORS CONCERNING PROPOSED COMPENSATION AND COMPARABILITY DATA WITH OTHER SIMILAR TOP MANAGEMENT POSITIONS IN THE MANAGEMENT COMPANYS PORTFOLIO. THE BOARD DOCUMENTS THE DECISION CONTEMPORANEOUSLY.
Available upon request
FORM 990, PART XI, SECTION C, LINE 19
THE FORM 990 AND FINANCIAL STATEMENTS ARE AVAILABLE ON THE MASSACHUSETTS ATTORNEY GENERALS WEBSITE. ALL INFORMATION IS AVAILABLE UPON REQUEST AT THE ORGANIZATION.
CHANGES IN NET ASSETS
FORM 990, PART XI, LINE 5
GAIN ON INTEREST RATE SWAP: 197,511.
Governance Decisions
Form 990, Part VI, Section A, Line 7B
The Member shall have all the authority of members provided under Massachusetts General Laws, Chapter 180, including the following reserved powers: i. approval of any merger, consolidation, restructuring, dissolution or liquidation of the Corporation, or sale or other disposition of all or substantially all of its assets; ii. approval of any amendment to the Articles of Organization or By-Laws of the Corporation; iii. approval of any change in the philosophy, mission and values of the Corporation, including, without limitation, approval of any strategic plan or initiative proposed by its governing Board; iv. approval of any auditor and annual audited financial statements of the Corporation; v. approval of any change in accounting period of the Corporation; vi. approval of any borrowing or significant changes in credit facilities in excess of ten percent (10%) of program services revenue for the most recently completed fiscal year; vii. approval of the creation of a controlling interest in any subsidiary or joint venture by or for the benefit of the Corporation; and viii. approval of transactions that involve a conflict of interest.
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:TAXES TOTAL EXPENSES:170883 MANAGEMENT AND GENERAL:170883
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:ACTIVITIES TOTAL EXPENSES:196657 PROGRAM SERVICES:196657
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:TRANSPORATION TOTAL EXPENSES:42464 PROGRAM SERVICES:42464
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:UTILITIES TOTAL EXPENSES:358981 PROGRAM SERVICES:358981
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:HOUSEKEEPING AND LAUNDRY TOTAL EXPENSES:164736 PROGRAM SERVICES:164736
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:LOSS ON EXTINGUISHMENT ON DEBT TOTAL EXPENSES:207079 MANAGEMENT AND GENERAL:207079
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:CONSULTING TOTAL EXPENSES:14898 MANAGEMENT AND GENERAL:14898
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:DUES AND SUBSCRIPTIONS TOTAL EXPENSES:12594 MANAGEMENT AND GENERAL:12594
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:TELEPHONE EXPENSES TOTAL EXPENSES:33109 MANAGEMENT AND GENERAL:33109
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:BAD DEBT EXPENSE TOTAL EXPENSES:2865 MANAGEMENT AND GENERAL:2865
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.