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
Ozanam Hall of Queens Nursing Home Inc
Employer identification number
11-2167809
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.") .
167,920
1,054,866
754,475
294,813
217,538
2,489,612
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......
47,605,692
49,783,218
53,198,432
51,081,690
49,869,262
251,538,294
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.
47,773,612
50,838,084
53,952,907
51,376,503
50,086,800
254,027,906
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.)
254,027,906
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...
47,773,612
50,838,084
53,952,907
51,376,503
50,086,800
254,027,906
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
71,919
63,671
54,008
39,790
72,566
301,954
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
30,841
28,653
31,257
30,614
29,444
150,809
c
Add lines 10a and 10b.
102,760
92,324
85,265
70,404
102,010
452,763
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.)
..
307,867
453,844
515,504
653,086
716,186
2,646,487
13
Total support. (Add lines 9, 10c, 11, and 12.)..
48,184,239
51,384,252
54,553,676
52,099,993
50,904,996
257,127,156
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
98.790 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.770 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.180 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.290 %
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
Ozanam Hall of Queens Nursing Home Inc
Employer identification number
11-2167809
Return Reference
Explanation
Form 990, Part VI, Section A, line 6
There shall be six (6) Members of the Corporation. The Members of this Corporation shall consist of the following individuals: The Superior General of the Community of Carmelite Sisters for the Aged and Infirm; the Ordinary of the Roman Catholic Diocese of Brooklyn, New York; two (2) members of the General Council of Carmelite Sisters to be selected by the Superior General of the Community; and two (2) member priests of the Brooklyn Diocese to be selected by the Ordinary of the Diocese of Brooklyn.
Form 990, Part VI, Section A, line 7a
(Governing Body and management) The Board of Directors of Ozanam Hall of Queens Nursing Home, Inc shall be elected by the Members at each annual meeting of the Members of the Corporation, except that the Superior General of the Community of Carmelite Sisters and the Ordinary of the Roman Catholic Diocese of Brooklyn may each appoint two (2) Members of the Corporation to be Directors of the Corporation(Member-Directors). Except as otherwise expressly provided herein, all standards applicable to Directors in the By-laws shall also apply to Member-Directors.
Form 990, Part VI, Section A, line 7b
The following powers are reserved exclusively to the Members of the Corporation: 1-Any amemdment of the By-laws as specified in Article XIII(The By-laws and/or the Certificate of Incorporation may be amended in whole or in part by a two-thirds vote of the whole of the Membership at a meeting called for such purpose, provided that written notice of such amendment has been given to the Membership no less than ten (10) days nor more than fifty (50) days prior to the meeting) 2-Amemdments of the Corporation's Certificate of Incorporation; 3-Approval or the appointment of the Administrator; 4-The approval of individuals eligible to be Officers of the Corporation; 5-The approval of individuals eligible to be members of the Executive, Finance and Nominating Committees; 6-The formulation and/or change from time to time of the philosophy, objectives and purposes of the Corporation as well as any change in the general character of the Corporation as a voluntary health facility for the aged under the auspices of the Roman Catholic Church; 7-The purchase, sale, mortgage or lease of real property of the Corporation, or the sale of all or substantially all of its assets; 8-Consolidation of the Corporation with another not-for-profit corporation organized for similar purposes; 9-the approval of any plan for the dissolution of the Corporation.
Form 990, Part VI, Section B, line 11
(Policies) Form 990 is presented to the Finance Committee for review. The Finance Committee reports to the Board of Directors regarding the review, and a copy of form 990 is provided to the Board before it is filed.
Form 990, Part VI, Section B, line 12c
(Policies) The organization is strongly committed to a policy of compliance with all conflict of interest provisions under the law. Such compliance is of critical importance to the non-profit, charitable mission and activities of Ozanam Hall. Ozanam Hall requires that any Board Members, Officers, Directors, key employees or trustees must disclose his/her relationship or interest to the full Board of Directors who will be acting upon or considering any contract or transaction with the business in which the member, director, officer, trustee or key employee holds an interest. No director so interested shall participate in the discussions and deliberations regarding such contract or transaction, nor vote on such contract or transaction. Disclosure shall be made as soon as the board member becomes aware of the potential for a conflict. Such disclosure shall be provided to the Executive Committee and recorded in the minutes of the first scheduled board meeting after the disclosure is made. Any decisions as to imposing restrictions on persons with any conflict of interests which could potentially prohibit them from participating in the governing body's delibrations and decisions will be determined by the Board of Directors. Each Board Member or officer signs a disclosure statement annually.
Form 990, Part VI, Section B, line 15
(Compensation Committee) A compensation policy was developed by the Board to govern compensation arrangements between the organization and covered individuals, defined as those in a position to exercise substantial influence over the affairs of the organization. The compensation committee consists of at least three independent individuals appointed by the Boards, who themselves are members of the Board of Directors. The committee meets yearly and recommends to the Board the compensation for covered individuals based on relevant data including comparability compensation for similarly situated entities and independent compensation surveys compiled by independent firms as deemed necessary.
Form 990, Part VI, Section C, line 18
Part VI, Section C, Line 19: (Public Access)The organization makes its governing documents; conflict of interest policy, financial statements, and tax filings available to the public upon request. The organization also files reports with various governmental agencies as a requirement for participation in government programs, which the agencies may make available to the public. The organization's Form 990 is available to the public on Guidestar's website and other similar websites
Form 990, Part VI, Section C, line 19
Part VI, Section B, Line 12: (Conflict of Interest Policy) The conflict of interest disclosure policy requires all Officers and Board Members to complete an annual disclosure statement. In addition, should an officer or Board member assume new external interests that potentially conflict with his or her role with the organization, such individual is required to disclose in writing the nature of such external interests. The disclosure statement is provided to the Board Chair for review. Conflicts are resolved by making a required disclosure, and may result in restricting the Officer or Board Member in any related activity or process as determined appropriate to the circumstances of the conflict. Failure to disclose a conflict on interest is in violation of the adopted policy and can result in disciplinary action or removal.
Form 990, Part XII, Line 2c:
Part XII, Line 2c: (Oversight of Audit and Selection of Independent Accountant) The Board of Directors has designated a committee to manage the process of selection and oversight of the Audit and Indepedent Accountant. The committee meets with management and the independent auditors to review the engagement proposal; results of the audit; draft audit report; management letter. The committee may meet with the independent auditors in executive session before concluding its review and acceptance of the annual audit report. The committee reports its findings and makes its recommendation to the Board of Directors.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.