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
AMERICAN GOLD STAR MANOR
Employer identification number
23-7288650
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.") .
134,780
237,452
380,125
384,064
490,972
1,627,393
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......
1,894,565
1,830,418
1,890,351
1,977,611
2,001,212
9,594,157
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.
2,029,345
2,067,870
2,270,476
2,361,675
2,492,184
11,221,550
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
132,523
236,327
379,790
383,964
490,862
1,623,466
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..
132,523
236,327
379,790
383,964
490,862
1,623,466
8
Public support (Subtract line 7c from line 6.)
9,598,084
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...
2,029,345
2,067,870
2,270,476
2,361,675
2,492,184
11,221,550
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
25,446
7,074
3,213
5,235
4,328
45,296
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
25,446
7,074
3,213
5,235
4,328
45,296
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.)..
2,054,791
2,074,944
2,273,689
2,366,910
2,496,512
11,266,846
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
85.190 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
85.740 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.400 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.640 %
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
AMERICAN GOLD STAR MANOR
Employer identification number
23-7288650
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 4
AMERICAN GOLD STAR MANOR MADE THE FOLLOWING CHANGES TO ITS BY LAWS DURING FYE 5/31/14: - A REDEFINITION OF THE TIMING OF THE ANNUAL JOINT BOARD MEETING - A STANDARDIZATION OF THE TITLES OF THE BOARD OFFICERS TO MAKE THE AMERICAN GOLD STAR HOME AND MANOR TITLES CONSISTENT. - A REDEFINITION OF THE TERMS OF OFFICE FOR THE TRUSTEES - A REDEFINITION OF THE AUTHORITY AND RESPONSIBILITIES OF A TRUSTEE EMERITUS - AUTHORIZATION FOR THE BOARD TO ESTABLISH VARIOUS COMMITTEES
FORM 990, PART VI, SECTION B, LINE 11
A COPY OF THE FORM 990 IS PRESENTED TO THE BOARD OF TRUSTEES AT A MONTHLY MEETING. THE FORM 990 IS REVIEWED AND APPROVED AT THE AFOREMENTIONED MEETING. PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE, A COPY OF THE FINAL RETURN IS FORWARDED TO THE ENTIRE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C
THE ENTITY DISTRIBUTES AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE TO THE BOARD OF TRUSTEES. EACH TRUSTEE IS REQUIRED TO COMPLETE THE QUESTIONNAIRE TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY HAVE ARISEN DURING THE YEAR. IF ANY NEW CONFLICTS ARISE, THE PRESIDENT/CEO AND THE BOARD WILL DISCUSS HOW TO PROCEED IN THE MOST ETHICAL AND FAIR MANNER.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION AMOUNTS FOR THE CEO AND OFFICE MANAGER (BOTH OF WHICH ARE NOT ON THE BOARD OF DIRECTORS) ARE DETERMINED THROUGH THE USE OF A COMPENSATION SURVEY. THE BOARD OF DIRECTORS MUST APPROVE THE FINAL COMPENSATION AMOUNTS, WHICH ARE THEN DETAILED IN WRITTEN EMPLOYMENT CONTRACTS.
FORM 990, PART VI, SECTION C, LINE 19
THE DETERMINATION LETTER, FORM 1023 AND 990 ARE AVAILABLE FOR PUBLIC DISCLOSURE AT THE ENTITY'S OFFICE BY VERBAL OR WRITTEN REQUEST
FORM 990, PART IX
THE AMERICAN GOLD STAR HOME AND AMERICAN GOLD STAR MANOR SHARE COMMON OFFICES, EMPLOYEES, AND BOARD OF TRUSTEES. THE TOTAL COST OF SHARED EXPENSES IS ALLOCATED BETWEEN THE TWO ENTITIES. THE MANOR FURNISHES FACILITIES TO NEEDY AND DISTRESSED MEMBERS IN GOOD STANDING OF AMERICAN GOLD STAR MOTHERS, INC AND LOWER INCOME FAMILIES.
FORM 990, PART V, LINE 1A, 1B, 1C, 2A, AND 2B
THE ORGANIZATION HAS EMPLOYEES AND INDEPENDENT CONTRACTORS THAT CONTRACT WITH AMERICAN GOLD STAR MANOR AND RECEIVE PAYMENT FOR THEIR WORK FOR THE MANOR, WHICH IS REPORTED AS SALARIES AND PAYMENTS ON THE STATEMENT OF FUNCTIONAL EXPENSE. THESE EMPLOYEES/CONTRACTS, WHILE PAID BY THE MANOR, ARE ISSUED W-2S AND 1099S FROM AMERICAN GOLD STAR HOME, THE MANOR'S SUPPORTING ORGANIZATION. ALL SALARIES, BENEFITS AND PAYROLL RELATED EXPENSES FOR WORK PERFORMED FOR THE MANOR ARE PAID BY THE MANOR, WHILE THE W-2S AND 1099S ARE FILED UNDER THE EIN OF AMERICAN GOLD STAR HOME.
FORM 990, PART IX
THERE IS NO MONEY EXPENDED FOR FUNDRAISING PURPOSES DUE TO THE FACT THAT THE MAJORITY OF CONTRIBUTIONS RECEIVED ARE FROM A SUPPORTING ORGANIZATION -- AMERICAN GOLD STAR HOME.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.