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
EXTENDED HOUSING INC
Employer identification number
34-1400918
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.") ....
1,381,787
1,398,736
1,663,348
1,501,872
3,756,564
9,702,307
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
1,381,787
1,398,736
1,663,348
1,501,872
3,756,564
9,702,307
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)..
0
6
Public support. Subtract line 5 from line 4.
9,702,307
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..
1,381,787
1,398,736
1,663,348
1,501,872
3,756,564
9,702,307
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
267
464
178
191
555
1,655
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
22,816
20,517
29,341
14,776
12,792
100,242
11
Total support (Add lines 7 through 10).
9,804,204
12
Gross receipts from related activities, etc. (see instructions)
..................
12
2,153,516
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
98.961 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
98.168 %
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.") .
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......
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.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
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...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
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
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
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
EXTENDED HOUSING INC
Employer identification number
34-1400918
Identifier
Return Reference
Explanation
Review of Form 990
page 6, part vi, section b, #11b
Form 990 for 2012 was reviewed and approved by the Agency's board of Directors prior to filing.
Conflict of Interest Policy
page 6, part vi, section b, #12c
All board members are required to review the agency's Conflict of Interest Policy upon acceptance to the Board of Directors, and annually thereafter. Any conflicts are required to be disclosed to the Agency's management and other Board members.
Compensation Policy
page 6, part vi, section b, #15b
The Executive Committee of the Agency's Board of Directors reviews and approves the compensation of upper management periodically.
Disclosure Policy
page 6, part vi, section c, #19
The Agency's governing documents, conflict of interest policy, and financial statements are available upon request.
Program Service Accomplishments
page 2, part iii, #4
Housing Coordinators/Support Workers provided 4,739 hours of service to 258 households with severe and persistent mental illness as listed below: 1) Housed 73 persons (19 persons are in families) in Supportive Housing (Including Permanent Supportive Housing) in Extended Housing owned units, via properties located throughout Lake County (does not include persons housed in two group homes and one transitional group home). - 3.5% vacancy rate for these units - Member of Painesville Crime Free Housing & Northeast Ohio Apartment Association 2) ProvideD 164 households with rental subsidies/vouchers to obtain or maintain housing throughout Lake County ( including Permanent Supportive Housing). - HUD's Shelter + Care provided rental vouchers to 81 homeless and disabled households. Mental Health services provided from Beacon Health and Signature Health. - Lake County ADAMHS Board funded rental assistance to 70 households (part of Rental Subsidy Program) - Housed 2 families and 11 veterans through HOME funding from the Lake County Board of Commissioners. Funds are targeted for veterans (Part of Rental Subsidy Program). 3) Provided 44 households received "no interest" loans. This loan program is for one-time rental assistance or security deposits to help persons/families obtain or maintain housing. - 1 Housing Loan was paid off 4) number of households successfully transferring off of Extended Housing assistance: - 29 households received a Housing Choice Voucher - 6 households were able to gain enough income to no longer need a Housing Subsidy - 2 households reunited with family or friends and no longer needed housing assistance - 1 household moved into public housing Homeless Outreach Workers (PATH Program) provided aggressive outreach to 176 homeless persons in Lake County. Of these: 1) 141 homeless persons were linked with mental health services and resources in the community, such as case management with other mental health agencies. - 81 engaged in mental health services - 37 accessed housing and were no longer homeless - 52 homeless persons attended the Homeless Outreach Picnic at Painesville's Recreation Park. - The Homeless Advisory Council had 6 members throughout the year. Extended Housing owns & manages 19 properties. Two of these are group homes operated by Northcoast Behavioral Healthcare and one is a transitional group home operated by Beacon Health, Inc. Our 19th property, McKinley Grove,is our first permanent supportive housing property, which started housing tenants June of 2013. FY 2013 Major Property & Unit Improvements 1) During the past fiscal year, Extended Housing was the Recipient of an ODMH Pilot grant which enabled us to completely remodel 7 kitchens, which included new cabinets, flooring, painting, sinks and faucets. In addition, we were able to remodel or update 7 bathrooms according to their need. Seven refrigerators and two stoves were replaced, as well as an air conditioner unit. Five units received new flooring, two units completely painted and a set of concrete steps were installed in a 9-unit building. 2) Volunteer Projects Extended Housing's properties benefited from over 400 Hours of service, primarily through businesses volunteering through Lake County's United Way Day of Caring and the Western Reserve Junior Service League Service Project at McKinley Grove. Extended Housing staff members volunteered over 100 hours during the fiscal year 2013.
NEW PROGRAM SERVICE
PAGE 2, PART III, #2
Extended Housing, Inc. ADDED THE NEW MCKINLEY GROVE PROJECT IN FISCAL YEAR 2013. McKinley Grove Apartments is a 17-bed apartment complex located in Painesville, Ohio. Construction of the apartment complex was completed in 2013 with tenants housing beginning on June 28, 2013. This is the Agency's first supportive housing with services available on-site. The Agency's property maintenance and management department relocated their office to McKinley Grove.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.