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
UNITED ZION RETIREMENT COMMUNITY
Employer identification number
23-1365176
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.") .
186,166
61,229
51,388
65,066
38,728
402,577
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......
7,197,622
7,218,296
7,625,826
7,827,301
8,132,726
38,001,771
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
13,168
13,168
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.
7,396,956
7,279,525
7,677,214
7,892,367
8,171,454
38,417,516
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
100
125
25
150
400
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..
100
125
25
150
400
8
Public support (Subtract line 7c from line 6.)
38,417,116
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...
7,396,956
7,279,525
7,677,214
7,892,367
8,171,454
38,417,516
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
185,956
252,637
257,385
266,781
291,967
1,254,726
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
185,956
252,637
257,385
266,781
291,967
1,254,726
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.)
..
10,815
228,502
220,044
222,541
681,902
13
Total support. (Add lines 9, 10c, 11, and 12.)..
7,582,912
7,542,977
8,163,101
8,379,192
8,685,962
40,354,144
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
95.200 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
95.140 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
3.110 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
3.090 %
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
UNITED ZION RETIREMENT COMMUNITY
Employer identification number
23-1365176
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 7A
BOARD MEMBERS ARE ELECTED AT THE GENERAL CONFERENCE OF THE UNITED ZION CHURCH.
FORM 990, PART VI, SECTION B, LINE 11
AN ELECTRONIC COPY OF THE FORM 990 IS SENT TO EACH VOTING BOARD MEMBER AND OFFICER IN ADVANCE OF A SCHEDULED BOARD MEETING. THE RETURN REVIEWED IN ADVANCE AND ANY QUESTIONS/COMMENTS/CONCERNS ARE BROUGHT TO THE MEETING. A VOTE TO ACCEPT THE REVIEWED REPORT IS THEN TAKEN AND DOCUMENTED IN THE MINUTES. THE REVIEW PROCESS IS COMPLETE BEFORE THE TRANSMITTAL OF THE RETURN TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C
ALL EMPLOYEES OF THE UNITED ZION RETIREMENT COMMUNITY RECEIVE A CORPORATE COMPLIANCE INTEGRITY PLAN. THE ORGANIZATION'S CORPORATE COMPLIANCE OFFICER MONITORS ALL POTENTIAL CONFLICTS AS HEAD OF THE CORPORATE COMPLIANCE COMMITTEE. NUMEROUS AUDITS AND CHECKS ARE PERFORMED TO ENSURE COMPLIANCE. THE CORPORATE COMPLIANCE OFFICER REPORTS DIRECTLY AND INDEPENDENTLY TO THE BOARD OF DIRECTORS. BOARD MEMBERS ALSO RECEIVE CORPORATE COMPLIANCE HANDBOOKS AND MONITOR COMPLIANCE AS A GROUP. AT THE BOARD LEVEL, POTENTIAL CONFLICTS ARE DISCUSSED IN BOARD MEETINGS AND DOCUMENTED IN MINUTES. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE BOARD MEMBER OR OFFICER ABSTAINS FROM VOTES RELATED TO THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15
A PERFORMANCE ASSESSMENT IS COMPLETED ANNUALLY ON THE EXECUTIVE DIRECTOR BY THE BOARD OF DIRECTORS' EXECUTIVE COMMITTEE. THE COMMITTEE REVIEWS WAGE DATA FROM THE STATE TRADE ASSOCIATION, LEADINGAGE PA, TO CONFIRM THAT ANY COMPENSATION DECISIONS WILL BE WITHIN FAIR MARKET RANGE FOR THE INDUSTRY AND LOCATION. UPON COMPLETION OF THE REVIEW, THE BOARD APPROVES THE EXECUTIVE DIRECTOR'S COMPENSATION. UNITED ZION MAINTAINS A JOB DESCRIPTION AND PERFORMANCE ASSESSMENT FORM FOR EACH STAFF POSITION. A PERFORMANCE ASSESSMENT IS COMPLETED ANNUALLY BY THE EMPLOYEE'S MANAGER AND COMPENSATION INCREASES ARE INCORPORATED INTO THE ANNUAL BUDGET, WHICH IS APPROVED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G
PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 24,581. MANAGEMENT AND GENERAL EXPENSES 41,903. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,484. OTHER CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 9,492. MANAGEMENT AND GENERAL EXPENSES 223. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,715. THERAPISTS & OTHER SERVICES : PROGRAM SERVICE EXPENSES 32,723. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,723. OTHER MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 623,465. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 623,465. CONTRACTED BUILDING SERVICES : PROGRAM SERVICE EXPENSES 140,953. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,953. ANNUAL BOND FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,890. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,890. PAYROLL SERVICE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,556. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,556.
FORM 990, PART XI, LINE 9:
CHANGE IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUST 7,543. UNREALIZED GAIN/LOSS ON INTEREST RATE SWAPS 133,875.
FORM 990, PART XII, LINE 2C
THE ORGANIZATION DOES NOT HAVE A SPECIFIED AUDIT COMMITTEE. THE FINANCE COMMITTEE AND/OR THE BOARD IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF THE AUDITIED FINANCIAL STATEMENTS. THE EXECUTIVE DIRECTOR WILL RECOMMEND AN INDEPENDENT AUDITOR TO THE BOARD. ONCE THE RECOMMENDATION IS MADE, THE FINANCE COMMITTEE AND/OR BOARD HAS THE FINAL APPROVAL OVER THE RECOMMENDATION.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.