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
Intergenerational Living & Health Care Inc
Employer identification number
41-1740311
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.") .
5,417,791
16,155
154,885
134,406
279,258
6,002,495
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......
24,423,523
24,641,155
25,390,548
25,506,604
25,178,103
125,139,933
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.
29,841,314
24,657,310
25,545,433
25,641,010
25,457,361
131,142,428
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.
5,365,000
5,365,000
c
Add lines 7a and 7b..
5,365,000
5,365,000
8
Public support (Subtract line 7c from line 6.)
125,777,428
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...
29,841,314
24,657,310
25,545,433
25,641,010
25,457,361
131,142,428
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
815,161
25,769
20,735
15,881
15,247
892,793
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
815,161
25,769
20,735
15,881
15,247
892,793
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.)..
30,656,475
24,683,079
25,566,168
25,656,891
25,472,608
132,035,221
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
95.260 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
94.360 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.680 %
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
Intergenerational Living & Health Care Inc
Employer identification number
41-1740311
Return Reference
Explanation
Form 990, Part VI, Section B, line 11
The Form 990 is prepared by an independent certified public accounting firm. It is then reviewed by the controller of the management company who is a CPA. The form 990 is given to each board member in advance of a scheduled meeting of the board for their review. There is discussion of the form 990 at the board meeting with the preparers and the management company's representative prior to board approval of the Form 990.
Form 990, Part VI, Section B, line 12c
Each member of the governing board annually completes a disclosure of conflict of interest questionnaire.
Form 990, Part VI, Section B, line 15
Compensation is based on experience and market salary surveys and is annualized every year.
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:
Gain on equity method of accounting for investment in outside project 56,867.
FORM 990, PART XII, LINE 2C - FINANCIAL STATEMENT PREPARATION:
The financial statements are prepared by an independent accounting firm. The statements are reviewed and approved by the board before being issued. This process was the same as last year.
Form 990, Part III, Line 4a, Program Service Accomplishments (continued)
Valley View Estates Health Care Center, Hamilton, Montana is a long-term care community that serves 98 older adults. A program where residents and children work side by side to create gift packages for disadvantaged children, is just one of many intergenerational programs that helped this community win several awards for its innovative care from the Montana Health Care Association. Other programs and charitable initiatives provided by Valley View Estates Health Care Center to support the mission of ILHC include: Ravalli County Council on Aging Loan Closet donations of furniture and equipment, Operation Christmas Child in which 25 gift boxes were made, school supplies for Washington Elementary School, food donations for the Bitterroot Winter Special Olympics, donation of auction items twice a year for the Bitterroot Valley Chamber of Commerce, donation of prize items and book bags for the Bitterroot Library Summer Reading Program. Additional charitable initiatives include donation of food and paper products to area food banks, Haven House, Darby Bread Box and Pantry Partners; donation of used eye glasses to the Lions Club and hosting-monthly group meetings for the Alzheimer's Support Group. The Inn on Westport, Sioux Falls, South Dakota, offers a full range of care and services including independent living, assisted living, and memory care in 133 residences in a beautiful, park-like environment. Our goal is to have every resident at The Inn on Westport enjoy each day with the maximum independence and the highest quality of life, health and well-being. At The Inn on Westport, our "Aging in Place" philosophy allows residents to remain in their apartment home with health services delivered directly to them. We are the only retirement community in Sioux Falls and the surrounding areas to offer this unique experience. To support the mission of ILHC at this senior living community, students of all ages gather for various activities hosted by the local day cares, schools and churches. The Inn on Westport also supports the mission of ILHC through other various charitable initiatives such as: Rent Reduction-a program that offers reduced rates for residents to live at The Inn on Westport due to income qualifications. (Value: 2013 - $52,495) (Estimated value 2014: $47,880). Monetary Donations-cash donations are collected every Sunday through chapel services and used towards the following: The Banquet (meals for homeless), Hope Prison Mission, Gospel Mission, World Vision (world-wide missionary outreach), Gideon Bible donations, Achieve (school and work for developmentally disabled), and Salvation Army (Value: $1,300). An Inn on Westport employee chairs the annual United Way drive for our building holding various fundraisers throughout the year (Value: $1,500). The senior living community supports Meals on Wheels-a program where an employee and a resident drive weekly to deliver noon meals to home bound elderly in the Sioux Fall community (Value: $1,800). Alzheimer's and Parkinson's Associations-The Inn on Westport hosts events for both agencies and sponsors and participates in their annual fundraisers (Value: $1,500). The Senior Concert Association (Value - $2,000). Holiday Clearing House-employees and residents adopt two families during the holidays and are given a list of needs and wants. Items are given or money is donated to purchase items and is presented in person (Non-cash value: $1,000) . Center for Active Generations-sponsor monthly bingo with prizes and an annual car show at the local center for seniors and a community taste-testing event (Value: $1,500). Goodwill Drive Donation-twice annually donations of clothing and household goods are promoted and gathered at The Inn on Westport. Employees, residents and family members all participate in this event (Value: $500) (Non-cash). Ronald McDonald House-The Inn on Westport participates in a campaign to collect pop tabs for the Ronald McDonald House, which they in turn are able to use to raise funds (Value: $150) (Non-cash). Kiwanis Club-employees are members of local service club and residents attend special events as fundraisers (Value: $500). Employee Scholarships- (Value: $3,000).
Form 990, Part III, Line 4a, Program Service Accomplishments (continued)
The Commons on Marice, Eagan, Minnesota is a gracious senior living community that offers 147 residences where seniors choose independent living, assisted living and care suites with around-the-clock staffing and personal and health-related services. The memory care c community cares for individuals with Alzheimer's disease and is designed with a residential feel to familiarize residents with their surroundings to maximize independence while maintaining a safe environment. The Commons on Marice offers what few other senior communities can, an opportunity to interact in meaningful ways with children. The Intergenerational Learning Center, located one block away, provides both children and older adults with extraordinary opportunities for sharing and learning where children six weeks to eight years of age, not only develop confidence, skills and self-esteem, they also build meaningful relationships with the residents of The Commons on Marice. In addition to the Intergenerational Learning Center, The Commons on Marice also supports the mission of ILHC through other various charitable initiatives such as: Elderly Waiver Program-the elderly waiver program is the Minnesota state Medicaid program for licensed assisted living facilities that choose to participate. The Commons on Marice discounted care services a total of $552,810 under the state Medicaid program in 2013. In 2014, The Commons on Marice will likely discount an estimated $510,000 for residents who live with us and receive elderly waiver services (Value: $510,000). Operation Christmas Child-a ministry of Samaritan's Purse whose headquarters are in South Carolina. We started participating in this program in 2008. In 2012, we packed 120 boxes. The value of each box is about $10-15. This year, boxes were packed with a variety of school supplies, clothing items (hats, gloves, and socks), personal hygiene items, and toys. Materials are purchased with offering money designated to Operation Christmas Child and residents help with shipping costs. This is our biggest outreach of the year with 40 residents participating (Value: $2,000). Feed My Starving Children (FMSC) in Eagan, Minnesota-We go to FMSC three times a year. This is an organization that packs bags of a special highly nutritional rice and protein recipe and works with ministries around the world to serve hungry children. We have packed food and also gone to put labels on the bags. FMSC requests that volunteers make a donation when they volunteer to help cover costs. We don't do this but have supported this organization with money (Value: $1,500). We have also bundled and given cards that were made by our card making club. Supplies for the cards were purchased through the Activity budget (Value: $500). Global Health Ministries (GHM) in Fridley, Minnesota-This is an organization that sends out medical supplies to relief organizations in countries where medical supplies are either hard to come by or very expensive. One of the ways we support them is rolling bandages from old white sheets. We have done this project several times this year. The sheets have been donated from an individual donor and the Hyatt Regency, Downtown Minneapolis. The bandage rollers that we use (made of wood) were donated by a church youth group. We have made 350 bandages over the last year and are hoping to expand this activity with our Memory Care community (Value: $175) (Non-cash). Community Education-The Commons on Marice does quarterly events for community education on various topics such as estate planning, insurance, coping with loss, etc. (Value: $400) (Non-cash). The Family Partnership (Minneapolis, Minnesota)-an agency working to respond to a variety of concerns with children and families. In 2012, we made play-dough for them to use in therapy situations with children. We also made 40 snack packs for their after school program and 100 laundry packets (Value $110). Soles4Souls-The Commons on Marice collected shoes from staff and residents for the Soles4Souls/Shoe Drive, collecting 210 pairs of gently worn shoes for people living in impoverished areas (Value: $630). People Serving People-Staff and residents pooled their spare change together and collected $150, which went to relief efforts for a mission trip to Africa. The Commons on Marice also sent care packages to homeless shelters in the area valued at $300. The residents also made dog toys through purchased materials ($50) for the Animal Park Shelter. The Lewis House women's shelter benefitted by receiving 25 gift packages for Mother's Day valued at $75.00, through materials purchased. The Urban Ventures Center for Fathering received 60 gift packages for Father's Day through materials purchased and put together by our residents valued at $120. The residents and staff members donated new toys to the Shriner's hospital valued at $300. The residents and staff members collected non-perishable food items in the amount of $200 that were donated to the Eagan Resource Center. Arizona Grand Senior Living Community, Phoenix Arizona, is an independent living, assisted living, and skilled nursing facility. Arizona Grand Senior Living Community supports the mission of ILHC through charitable initiatives such as: Alzheimer's Association-fundraising events throughout the year and the annual Alzheimer's walk every November (Estimated value: $200). Just Three Things (J3T) Foundation--Arizona Grand collects food items to be donated to area foster children and youth in transition programs for teens that would otherwise go without food. Just Three Things contacts Arizona Grand on a routine basis to update recommended "Just Three Things" donation items list and arrange pickup of donated items to distribute (estimated value $1,200). Donations in the way of furniture, walkers, televisions and other medical equipment were made to St. Vincent De Paul (Estimated value: $2,500).
Related Organization Compensation:
Made an effort to obtain information on compensation, if any were paid from a related organization. No other compensation or transactions noted other than board compensation as listed on Form 990, Part VII Line 1a.
Form 990, Part VI, Section A, Line 1b - INDEPENDENT BOARD MEMBERS:
Denise Gustafson is compensated as an officer of the entity and an employee,therefore is not considered an independent board member.
Form 990, Part X, Line 12 - CLOSELY HELD COMPANY:
The entity owes a 50% equity in Northern Arizona Senior Living Community, LLC valued by the equity method. This investment does not meet the 5% of total assets threshold to be included on the Schedule D, Part X, but is considered a closely held company.
Changes in presentation:
The following line items have been presented separately in the 2013 Form 990: 1) Investment held for deferred compensation = $88,353 (prior year balance included in prepaid expenses) 2) Tenant/patient funds held in trust = $24,667 (prior year balance included in cash - non-interest bearing) 3) Deferred revenue = $101,582 (prior year balance netted against accounts receivable) 4) Deferred compensation payable = $88,353 (prior year balance included in accounts payable and accrued expenses)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.