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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
GALLOWAY RIDGE INC
Employer identification number
56-2277623
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
129,035
245,423
156,549
194,438
375,390
1,100,835
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......
17,944,731
19,092,296
19,204,552
20,962,036
22,060,908
99,264,523
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
85,795
94,882
142,084
153,047
475,808
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.
18,073,766
19,423,514
19,455,983
21,298,558
22,589,345
100,841,166
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
234,909
166,826
8,780
9,550
388,367
808,432
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..
234,909
166,826
8,780
9,550
388,367
808,432
8
Public support (Subtract line 7c from line 6.)
100,032,734
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
18,073,766
19,423,514
19,455,983
21,298,558
22,589,345
100,841,166
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
188,974
97,794
106,768
108,757
104,403
606,696
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
188,974
97,794
106,768
108,757
104,403
606,696
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.)
..
53,933
35,839
8,863
88,336
21,451
208,422
13
Total support. (Add lines 9, 10c, 11, and 12.)..
18,316,673
19,557,147
19,571,614
21,495,651
22,715,199
101,656,284
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
98.400 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.060 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.600 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.630 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
GALLOWAY RIDGE INC
Employer identification number
56-2277623
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
THE PRIMARY FUNCTION OF THE EXECUTIVE COMMITTEE WILL BE TO EXECUTE THE POLICIES PRESCRIBED BY THE BOARD AND CARRY OUT THE RESPONSIBILITIES ASSIGNED TO IT BY THE BOARD AND THESE BYLAWS, INCLUDING, WITHOUT LIMITATION, CONDUCTING STRATEGIC PLANNING FOR THE CORPORATION, ESTABLISHING CRITERIA TO EVALUATE THE EXECUTIVE DIRECTION AND OTHER OFFICERS AND EMPLOYEES OF THE CORPORATION, AND OVERSEEING RELATIONSHIPS WITH THE CORPORATION'S OUTSIDE SERVICE PROVIDERS. THE BOARD MANAGEMENT COMMITTEE WILL ALSO BE RESPONSIBLE FOR REVIEWING AND MAKING RECOMMENDATIONS REGARDING CONFLICTS OF INTEREST OF DIRECTORS, OFFICERS, EMPLOYEES AND INDEPENDENT CONTRACTORS AND THEIR EMPLOYEES ASSOCIATED WITH THE CORPORATION. DURING THE INTERVALS BETWEEN THE MEETINGS OF THE BOARD, THE EXECUTIVE COMMITTEE WILL HAVE AND EXERCISE ALL OF THE POWERS OF THE BOARD THAT MAY BE LAWFULLY DELEGATED IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION. THE EXECUTIVE COMMITTEE WILL BE COMPRISED OF THE FOLLOWING: (1) SUCH OFFICERS OF THE CORPORATION AS MAY HOLD OFFICE FROM TIME TO TIME; (2) THE CHAIRPERSONS OF SUCH COMMITTEES OF THE CORPORATION AS MAY EXIST FROM TIME TO TIME; AND (3) SUCH OTHER DIRECTORS AS MAY BE NOMINATED BY THE PRESIDENT AND APPOINTED BY THE BOARD FROM TIME TO TIME. THE PRESIDENT OF THE CORPORATION WILL BE THE CHAIRPERSON OF THE EXECUTIVE COMMITTEE. EACH MEMBER OF THE EXECUTIVE COMMITTEE WILL HOLD OFFICE FOR THE DURATION OF SUCH PERSON'S TERM IN AN OFFICE THAT QUALIFIES SUCH PERSON FOR MEMBERSHIP ON THE EXECUTIVE COMMITTEE.
FORM 990, PART VI, SECTION A, LINE 3
THE ORGANIZATION CONTRACTS ITS EXECUTIVE DIRECTOR FROM CRSA/LCS MANAGEMENT, LLC. UNDER THE TERMS OF A MANAGEMENT AGREEMENT, MANAGEMENT SERVICES ARE PROVIDED TO THE ORGANIZATION BY COOPERATIVE RETIREMENT SERVICES OF AMERICA (CRSA). THESE SERVICES INCLUDE THE SUPERVISION OF ALL ASPECTS OF NORMAL OPERATIONS INCLUDING BUDGETING, HIRING OF EMPLOYEES, BILLING, PAYROLL, ACCOUNTS PAYABLE, AND OTHER MANAGEMENT RESPONSIBILITIES. HEATHER RUSNAK FULLFILLS THE ROLL OF EXECUTIVE DIRECTOR UNDER THE TERMS OF THE AGREEMENT. HER COMPENSATION RECEIVED FROM CRSA FOR THESE SERVICES TO GALLOWAY RIDGE ARE: REPORTABLE COMPENSATION: $171,570 DEFERRED COMPENSATION & NONTAXABLE BENEFITS: $21,132
FORM 990, PART VI, SECTION B, LINE 11
THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DISTRIBUTED ELECTRONICALLY TO THE MEMBERS OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS WERE GIVEN TIME TO REVIEW, DISCUSS, AND COMMENT PRIOR TO THE FORM BEING ELECTRONICALLY FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY IS REVIEWED BY ALL BOARD MEMBERS ANNUALLY. EACH BOARD MEMBER SIGNS A STATEMENT INDICATING THE UNDERSTANDING OF AND COMPLIANCE WITH THE POLICY. THE CONFLICT OF INTEREST POLICY IS BASED UPON THE IRS MODEL CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15
THE COMPENSATION OF EXECUTIVE DIRECTOR IS REVIEWED BY THE MANAGEMENT COMPANY (CRSA) AND THE PRESIDENT (I.E. CHAIRPERSON OF THE BOARD) ANNUALLY USING INDUSTRY DATA FOR COMPARISON. OTHER KEY EMPLOYEES HAVE ANNUAL REVIEWS BY THE EXECUTIVE DIRECTOR AND COMPARABILITY DATA IS REVIEWED ON A REGULAR BASIS.
FORM 990, PART VI, SECTION C, LINE 18
PHOTOCOPIES OF THE ORGANIZATION'S FORM 1023, FORM 990 AND FORM 990-T ARE AVAILABLE UPON REQUEST. RECENT FILINGS OF THE FORM 990 CAN BE ACCESSED THROUGH GUIDESTAR.ORG, A NON-PROFIT WEBSITE.
FORM 990, PART VI, SECTION C, LINE 19
BYLAWS, WITH ANY CHANGES OR UPDATES, ARE MAINTAINED IN THE RESIDENT LIBRARY AND ARE ALSO AVAILABLE BY REQUEST. THE CONFLICT OF INTEREST POLICY IS INCLUDED IN THE ANNUAL DISCLOSURE STATEMENT. FINANCIAL STATEMENTS ARE PROVIDED MONTHLY TO THE PRIMARY CREDITOR, BOARD AUDIT & FINANCE COMMITTEE, AND THE RESIDENT FINANCE COMMITTEE AND PROVIDED QUARTERLY TO THE BOARD. THE ANNUAL AUDIT IS PROVIDED ANNUALLY IN THE DISCLOSURE STATEMENT.
FORM 990, PART XII, LINE 2C:
THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.