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 CAPSTONE GROUP INC
Employer identification number
43-1821821
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.") .
969,653
3,537,132
22,355
4,529,140
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......
6,518,812
5,696,591
4,013,336
16,228,739
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.
6,518,812
6,666,244
3,537,132
4,035,691
20,757,879
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.
256,803
21,603
278,406
c
Add lines 7a and 7b..
256,803
21,603
278,406
8
Public support (Subtract line 7c from line 6.)
20,479,473
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...
6,518,812
6,666,244
3,537,132
4,035,691
20,757,879
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
20,593
743,586
2,720
17,358
9,824
794,081
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
20,593
743,586
2,720
17,358
9,824
794,081
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.)
..
1,495
10,463
56
18,032
30,046
13
Total support. (Add lines 9, 10c, 11, and 12.)..
6,540,900
7,420,293
3,539,908
17,358
4,063,547
21,582,006
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
94.890 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
95.480 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
3.680 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
3.310 %
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 CAPSTONE GROUP INC
Employer identification number
43-1821821
Return Reference
Explanation
FORM 990, PART III, LINE 2
IN 2012 THERE WERE NO OPERATIONS. IN 2013 AN EXISITNG LONG-TERM HEALTH CARE FACILITY WAS PURCHASED AND BEGAN OPERATIONS ON MARCH 1. OPERATIONS INCLUDE RENTAL OF INDEPENDENT, ASSISTED AND SKILLED NURSING UNITS/BEDS.
FORM 990, PART VI, SECTION A, LINE 3
MANAGEMENT OF FINANCIAL DUTIES WERE CONTRACTED OUT TO PIVOTAL HEALTH CARE, LLC
FORM 990, PART VI, SECTION A, LINE 6
THE BOARD OF DIRECTORS CONSTITUTE THE MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A
A MAJORITY OF THE MEMBERS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS AT ANY MEETINGS OF THE MEMBERS; PROVIDED, HOWEVER THAT IF LESS THAN A MAJORITY OF THE MEMBERS ARE PRESENT AT SAID MEETING, A MAJORITY OF THE MEMBERS PRESENT MAY ADJOURN THE MEETING FROM TIME TO TIME WITHOUT FURTHER NOTICE. EACH MEMBER PRESENT SHALL BE ENTITLED TO ONE VOTE UPON EACH MATTER SUBMITTTED TO A VOTE AT ANY SUCH MEETING. MEMBERS MAY BE REMOVED, FOR CAUSE, UPON THE AFFIRMATIVE VOTE OF A MAJORITY OF THE REMAINING MEMBERS. IN THE EVENT OF THE REMOVAL OF A MEMBERS, THE REMAINING MEMBERS MAY FILL SUCH VACANCY OR VACANCIES UPON THE AFFIRMATIVE VOTE OF A MAJORITY OF THE REMAINING MEMBERS.
FORM 990, PART VI, SECTION A, LINE 8B
THERE ARE NO MINUTES KEPT OF COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY BECAUSE THERE ARE NO OTHER COMMITTEES THAT CAN ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11
THE BOARD OF DIRECTORS OF THE ORGANIZATION DETERMINED THAT A COPY OF FORM 990 WOULD BE PROVIDED TO A COMMITTEE OF THE BOARD SO THAT THE COMMITTEE COULD REVIEW THE 990 IN DETAIL AND THEN ADVISE THE ENTIRE BOARD REGARDING ANY ISSUES THAT NEED TO BE DETERMINED BY, OR DISCLOSED TO, THE ENTIRE BOARD OF DIRECTORS. IN ADDITION, THE ENTIRE FORM 990 WAS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS SUFFICIENTLY PRIOR TO FILING THE FORM SO THAT ANY COMMENTS COULD BE PROVIDED TO THE ORGANIZATION IN TIME TO PERMIT ANY NECESSARY REVISIONS.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT REQUIRES ANNUAL EXECUTION OF A CERTIFICATION WITH RESPECT TO CONFLICTS AND ROUTINE DISCLOSURE IF THERE IS A CONFLICT IN CONNECTION WITH A MATTER THAT COMES BEFORE THE BOARD. THE BOARD MONITORS AND ENFORCES COMPLIANCE WITH THIS POLICY BY REQUIRING THE ANNUAL CERTIFICATION AND MY REMINDING BOARD MEMBERS OF THEIR OBLIGATIONS WITH RESPECT TO CONFLICTS ON AN ON-GOING BASIS. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEN THEY WILL NOT VOTE ON THE CONFLICTING ISSUE AT HAND.
FORM 990, PART VI, SECTION B, LINE 15A
THE BOARD MET IN PRIVATE JANUARY 10, 2012 TO DISCUSS COMPENSATION FOR THE PRESIDENT/EXECUTIVE DIRECTOR, WHO WAS ABSENT DURING THE DISCUSSION. THE BOARD REVIEWED THE REQUIREMENTS OF THE POSITION, THE PRESIDENT/EXECUTIVE DIRECTOR'S QUALIFICATIONS, AND A COMPENSATION ANALYSIS BASED ON THE POSITION AS PREPARED BY AN INDEPENDENT CONSULANT IN KANSAS CITY, MO. THE BOARD THEN DETERMINED THE PRESIDENT/EXECUTIVE DIRECTOR'S SALARY TO BE REASONABLE AND CONSISTENT WITH THE COMPANY'S EXECUTIVE COMPENSATION POLICY.
FORM 990, PART VI, SECTION C, LINE 19
THE GOVERNING DOUCMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.