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
THE ADMIRAL AT THE LAKE
Employer identification number
36-2171730
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.") .
117,681
1,880,683
884,726
1,168,803
1,088,793
5,140,686
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......
1,924,439
1,584,238
1,227,977
1,760,701
7,353,973
13,851,328
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.
2,042,120
3,464,921
2,112,703
2,929,504
8,442,766
18,992,014
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
256,901
42,648
299,549
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..
256,901
42,648
299,549
8
Public support (Subtract line 7c from line 6.)
18,692,465
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...
2,042,120
3,464,921
2,112,703
2,929,504
8,442,766
18,992,014
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
56,433
43,043
48,868
729,035
714,548
1,591,927
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
56,433
43,043
48,868
729,035
714,548
1,591,927
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.)
..
6,368
58,294
311,455
376,117
13
Total support. (Add lines 9, 10c, 11, and 12.)..
2,098,553
3,514,332
2,161,571
3,716,833
9,468,769
20,960,058
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
89.180 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
91.510 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
7.600 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
6.010 %
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
THE ADMIRAL AT THE LAKE
Employer identification number
36-2171730
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE ADMIRAL SHALL HAVE A SINGLE CLASS OF VOTING MEMBERS, AND THE SOLE MEMBER OF THAT CLASS SHALL BE THE OLD PEOPLE'S HOME OF THE CITY OF CHICAGO, AN ILLINOIS NOT-FOR-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A
THE TRUSTEES OF THE ADMIRAL SHALL BE ELECTED OR APPOINTED BY THE MEMBER AT THE ANNUAL MEETING OF THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B
THE ADMIRAL MUST HAVE APPROVAL FROM THE MEMBER BEFORE COMPLETING THE FOLLOWING ACTIONS: - ELECTION AND REMOVAL OF TRUSTEES AND OFFICERS - AMENDMENT OF THE ARTICLES OF INCORPORATION OF THE ADMIRAL - AMENDMENT OF THE BYLAWS OF THE ADMIRAL - MERGER, CONSOLIDATIONS OR DISSOLUTION OF THE ADMIRAL - THE CREATION OF ANY SUBSIDIARIES OR AFFILIATES OF THE ADMIRAL - ADOPTION OF THE BUSINESS PLAN PREPARED ANNUALLY BY THE BOARD OF TRUSTEES OF THE ADMIRAL - ADOPTION OF THE ANNUAL BUDGET PREPARED BY THE ADMIRAL - THE SELECTION OF BANKING AFFILIATIONS, ACCOUNTING FIRMS OR LEGAL COUNSEL, AS WELL AS APPROVAL OF THE ENGAGEMENT OF ANY CONSULTANTS NOT SPECIFICALLY PROVIDED IN AN APPROVED BUDGET. - THE SELECTION AND RETENTION OF THE EXECUTIVE DIRECTOR OF THE ADMIRAL - THE MAKING OF CAPITAL EXPENDITURES OR SALE OF ANY CAPITAL BY THE ADMIRAL IN EXCESS OF $50,000 - THE SELECTION OF THE MANNER AND LOCATION OF INVESTMENT OF ANY FUNDS - THE EXTENSION OF ANY LOANS BY OR ANY BORROWING BY THE ADMIRAL
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS REVIEWED FOR ACCURACY AND COMPLETENESS BY THE CEO AND THE AUDIT COMMITTEE CHAIR. A COPY OF THE FORM IS THEN PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO READ AND SIGN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ALL EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY RELATED PART TRANSACTIONS PRIOR TO ENGAGING IN SAID TRANSACTIONS, AND ARE REQUIRED TO DISCLOSE ANY RELATED PARTY TRANSACTIONS ANNUALLY AS PART OF THE ANNUAL CONFLICT OF INTEREST DISCLOSURE. THE RESPONSES ARE REVIEWED BY THE CEO AND CHAIRPERSON. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND MAY BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE TRUSTEES AND COMMITTEE MEMBERS WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE INTERESTED PERSON SHALL THEN BE EXCUSED FROM THE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OF TRUSTEES OR DESIGNATED COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF THE ADMIRAL, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT.
FORM 990, PART VI, SECTION B, LINE 15
THE ADMIRAL AT THE LAKE COMPENSATION COMMITTEE COMPARES COMPENSATION TO INDUSTRY AND COMPETITOR STANDARDS. THE COMMITTEE THEN DECIDES IF THE CEO'S COMPENSATION IS REASONABLE AND CONSISTENT WITH INDUSTRY STANDARDS AND DOCUMENTS ITS FINDINGS. THE FINDINGS ARE THEN PRESENTED TO AND APPROVED BY THE EXECUTIVE COMMITTEE. THE CEO'S COMPENSATION WAS LAST REVIEWED IN DECEMBER 2012.
FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION MAKES ITS FORM 1023 AND 990 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19
THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:
DECREASE IN OBLIGATION TO PROVIDE FUTURE SERVICES TO CURRENT RESIDENTS 8,629,771. PENSION RELATED GAINS 1,011,446. VALUATION CHANGE IN ASSETS HELD IN TRUST 112,868.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.