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
HATTIE LARLHAM COMMUNITY SERVICES
Employer identification number
34-1863723
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.") .
6,923
6,472
6,965
6,960
42,416
69,736
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......
7,178,415
6,938,312
6,940,966
6,849,761
7,479,787
35,387,241
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.
7,185,338
6,944,784
6,947,931
6,856,721
7,522,203
35,456,977
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.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
35,456,977
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...
7,185,338
6,944,784
6,947,931
6,856,721
7,522,203
35,456,977
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
159
75
234
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
159
75
234
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.)
..
40,386
65,689
39,235
30,220
69,116
244,646
13
Total support. (Add lines 9, 10c, 11, and 12.)..
7,225,883
7,010,548
6,987,166
6,886,941
7,591,319
35,701,857
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
99.310 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.490 %
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 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.010 %
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
HATTIE LARLHAM COMMUNITY SERVICES
Employer identification number
34-1863723
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE CORPORATION IS HATTIE LARLHAM CARE GROUP. THERE IS ONLY ONE CLASS OF MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7A
ACTION BY THE MEMBER OF THE CORPORATION SHALL BE REQUIRED, AND SHALL BE SUFFICIENT, FOR THE FOLLOWING MATTERS A) TO ELECT THE MEMBERS OF THE BOARD OF DIRECTORS (THE "DIRECTORS") AND TO REMOVE THE DIRECTORS, B) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR THE CODE OF REGULATIONS, C) TO DISSOLVE OR TERMINATE THE EXISTENCE OF THE CORPORATION. THE DIRECTORS SHALL BE RELIEVED FROM LIABILITY FOR MANAGERIAL ACTS OR OMISSIONS IMPOSED UPON DIRECTORS BY LAW, TO THE EXTENT THAT, AND AS LONG AS, ANY DISCRETIONARY POWER IN THE MANAGEMENT OF CORPORATE AFFAIRS OF THE CORPORATION IS EXERCISED BY THE MEMBER PURSUANT TO THE CODE OF REGULATIONS, THE ARTICLES OR INCORPORATION, OR APPLICABLE LAW.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBER MUST APPROVE THE FOLLOWING ACTIONS OF THE BOARD OF DIRECTORS BEFORE SUCH ACTIONS BECOME EFFECTIVE A) ANY MERGER OR CONSOLIDATION OF THE CORPORATION AND ANY SALE OF SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS, B) THE CREATION OF ANY SUBSIDIARY ORGANIZATION OR THE AFFILIATION OF THE CORPORATION WITH ANY OTHER ENTITY FOR THE PURPOSE OF THE JOINT CONDUCT OF BUSINESS OR OTHER PROGRAMS, WHETHER IN THE FORM OF PARTICIPATION IN A CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY, JOINT VENTURE, CO-TENANCY OR ANY OTHER FORM OF OWNERSHIP OR CONTROL, C) THE APPROVAL OF THE ANNUAL BUDGET OF THE CORPORATION, D) THE ADOPTION OF ANY NEW OR MATERIALLY REVISED SERVICES TO BE PROVIDED BY THE CORPORATION, E) ANY REQUESTS FOR FUNDING FROM HATTIE LARLHAM FOUNDATION, AND F) ANY OTHER ACT FOR WHICH MEMBERSHIP APPROVAL IS REQUIRED UNDER APPLICABLE LAW, THE ARTICLES OF INCORPORATION, OR THE CODE OF REGULATIONS.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 IS REVIEWED BY THE CFO AND PRESENTED TO THE TREASURER'S (FINANCE) COMMITIEE BY THE TAX ACCOUNTANT/PREPARER AND CFO FOR REVIEW AND APPROVAL. THE BOARD OF DIRECTORS THEN RECEIVES A COPY OF FORM 990 TO REVIEW/COMMENT PRIOR TO THE TAX RETURN BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12C
EACH MEMBER OF THE BOARD OF DIRECTORS RECEIVES TRAINING ON ETHICAL CONDUCT BY THE DIRECTOR OF CORPORATE COMPLIANCE DURING THEIR ORIENTATION TO THE BOARD AND ON AN ANNUAL BASIS. HATTIE LARLHAM DISTRIBUTES TO THE BOARD OF DIRECTORS AT THE ANNUAL MEETING AND DURING ORIENTATION THE CONFLICT OF INTEREST POLICY EACH BOARD MEMBER HAS AN OBLIGATION TO MAKE FULL DISCLOSURE OF CONFLICTS OF INTEREST. EACH YEAR THEY RECEIVE THE CONFLICT OF INTEREST POLICY AND A DECLARATION STATEMENT TO READ AND SIGN. IF A CONFLICT OF INTEREST IS REPORTED, THE DISCLOSURE IS PLACED ON THE AGENDA OF A BOARD MEETING WHERE A MOTION IS MADE TO ACKNOWLEDGE THE DISCLOSURE AND VOTE TO DETERMINE IF THE SERVICES ARE APPROPRIATE TO THE NEEDS OF THE ORGANIZATION. HATTIE LARLHAM HAS SPECIFIC POLICIES IN REGARDS TO GIFTS AND GRATUITIES AND EMPLOYMENT OF RELATIVES. THE EXECUTIVE STAFF OF HL AGENCIES MUST ALSO REPORT ANY CONFLICT OF INTEREST TO THE CEO IN REGARDS TO GIFTS, GRATUITIES, AND RELATIVES EMPLOYED AT HL UNDER AN EXECUTIVES SPAN OF CONTROL. IF A CONFLICT OF INTEREST IS REPORTED TO THE CEO, HE/SHE WILL FOLLOW THE SAME POLICY AS IT APPLIES TO THE BOARD OF DIRECTORS UNDER THE CONFLICT OF INTEREST POLICY. HL HAS A CORPORATE COMPLIANCE COMMITIEE WHICH MEETS MONTHLY TO MONITOR ALL CORPORATE COMPLIANCE ACTIVITIES. A CORPORATE COMPLIANCE EVALUATION IS COMPLETED ON AN ANNUAL BASIS BY THE DIRECTOR OF CORPORATE COMPLIANCE, A VICE PRESIDENT OF ONE OF THE HL AGENCIES, AND THE QUALITY IMPROVEMENT COORDINATOR TO DETERMINE WHICH ACTIVITIES NEED TO BE ADDRESSED.
FORM 990, PART VI, SECTION B, LINE 15
HATTIE LARLHAM CARE GROUP, A RELATED ORGANIZATION, COMPENSATES ORGANIZATION'S CEO, VICE PRESIDENTS, TOP MANAGEMENT AND KEY EMPLOYEES. THE PROCESS OF DETERMINING THE COMPENSATION FOR THE ORGANIZATION'S CEO, VICE PRESIDENTS, TOP MANAGEMENT AND KEY EMPLOYEES INCLUDES A MEETING OF THE COMPENSATION COMMITIEE WITH THE CEO WHERE THE COMMITIEE IS PRESENTED WITH SALARY RECOMMENDATIONS COMPARED TO PRIOR YEAR COMPENSATION AND COMPENSATION SURVEYS/STUDYS WHICH WOULD THEN LEAD TO AN APPROVAL BY THE COMMITIEE OF THE COMPENSATION TO BE PAID.
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 XII, LINE 2C:
THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.