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
SIMPSON HOUSE INC
Employer identification number
23-1352227
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.") .
711,983
476,345
454,790
510,018
416,833
2,569,969
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......
17,554,658
17,958,024
19,405,080
18,689,368
18,895,068
92,502,198
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.
18,266,641
18,434,369
19,859,870
19,199,386
19,311,901
95,072,167
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.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
95,072,167
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...
18,266,641
18,434,369
19,859,870
19,199,386
19,311,901
95,072,167
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
192,234
285,421
304,890
456,983
104,913
1,344,441
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
192,234
285,421
304,890
456,983
104,913
1,344,441
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.)
..
46,923
20,260
52,140
51,911
146,566
317,800
13
Total support. (Add lines 9, 10c, 11, and 12.)..
18,505,798
18,740,050
20,216,900
19,708,280
19,563,380
96,734,408
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
98.280 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
96.590 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
1.390 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.540 %
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
SIMPSON HOUSE INC
Employer identification number
23-1352227
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
GLORIA BORING IS THE EXECUTIVE DIRECTOR FOR SIMPSON HOUSE AND HER SON, ALEX BORING, ALSO WORKS FOR THE FACILITIY AS A MEDICAL SUPPLY MANAGER.
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE CORPORATE MEMBER OF THE CORPORATION SHALL BE SIMPSON SENIOR SERVICES.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBER SHALL HAVE RESERVED POWERS TO APPOINT AND REMOVE ALL MEMBERS OF THE BOARD OF DIRECTORS AT ANY TIME OTHER THAN THE BISHOP.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBER SHALL HAVE RESERVED POWERS TO APPOINT AND REMOVE ALL MEMBERS OF THE BOARD OF DIRECTORS AT ANY TIME OTHER THAN THE BISHOP, APPROVE ANY AMENDMENT TO THE ARTICLES OF INCORP. OR BY-LAWS, APPROVE ANNUAL CAPITAL BUDGET, APPROVE SALE, LEASE, OR TRANSFER OF ANY ASSETS, APPROVE INDEBTEDNESS GREATER THAN $50,000, AND APPROVE ANY MERGER, DISSOLUTION, ETC OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. ONCE APPROVED, THE FORM 990 IS SENT TO THE PRESIDENT AND CHIEF EXECUTIVE OFFICER FOR REVIEW AND APPROVAL. THE PRESIDENT AND CHIEF EXECUTIVE OFFICER WILL THEN FORWARD A COPY OF THE FORM 990 TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C
ALL OFFICERS AND MEMBERS OF THE BOARD ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. ALL SIGNIFICANT NEW CONTRACTS ARE SUBJECT TO BOARD APPROVAL. ONGOING CONTRACTS ARE REVIEWED FOR ANY KNOWN POTENTIAL CONFLICT OF INTEREST. IF A CONFLICT ARISES, LEVEL AT WHICH THE DETERMINATION OF A CONFLICT OF INTEREST EXISTS IS DETERMINED AT THE BOARD LEVEL. CONFLICTS OF INTERESTS ARE REVIEWED AT THE BOARD LEVEL. ANY INDIVIDUAL WITH A CONFLICT OF INTEREST IS ABSTAINED FROM BOARD DISCUSSIONS AND DECISIONS WHERE ANY CONFLICT WOULD BE PRESENT.
FORM 990, PART VI, SECTION B, LINE 15
A SUB-COMMITTEE OF THE BOARD OF DIRECTORS WHICH IS APPOINTED BY THE BOARD CHAIR HAS THE SPECIFIC DUTY OF ANNUALLY EVALUATING THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, INCLUDING DETERMINING HIS ANNUAL COMPENSATION. A COMPETENT SALARY SURVEY IS USED TO BENCHMARK COMPENSATION FOR THE POSITION UTILIZING PANPHA, AAHSA AND CEMO SALARY SURVEYS AND OTHER STUDIES. IN ADDITION, THE GUIDE STAR WEBSITE IS UTILIZED TO RESEARCH THE SALARY OF SIMILAR POSITIONS AT SIMILAR SIZED ORGANIZATIONS IN THE LOCAL MARKET AREA. THE CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, AND THE EXECUTIVE DIRECTORS SALARIES OF EACH COMMUNITY ARE DETERMINED BY THE PRESIDENT & CEO OF SSS ON AN ANNUAL BASIS. THE PRESIDENT & CEO REVIEWS THE ANNUAL PERFORMANCE OF THESE INDIVIDUALS RELATIVE TO THEIR POSITION DESCRIPTIONS. THE OPERATING BUDGETS, INCLUDING SALARY INCREASES, OF EACH COMMUNITY ARE PRESENTED TO THE BOARD FOR THEIR APPROVAL ON AN ANNUAL BASIS. THE PROCESS WAS LAST UNDERTAKEN IN 2012.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:
VALUATION CHANGE 589,024. PRIOR YEAR ADJUSTMENT DUE TO ACCOUNTING STANDARD UPDATE ASU 2012-01 -215,266.
FORM 990, PART XII LINES 2C
THE FINANCIAL STATEMENTS OF SIMPSON HOUSE, INC. WERE AUDITED BY INDEPENDENT AUDITORS ON A CONSOLIDATED BASIS WITH RELATED ORGANIZATIONS. ON LINE 2C, THE RELATED ORGANIZATIONS DO HAVE A COMMITTEE THAT ASSUMES RESPONSBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.