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
Chicagoland Methodist Senior Services
Employer identification number
36-2210011
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.
0
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...
0
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
0 %
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.") .
16,000
2,500
18,500
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......
10,279,866
9,512,539
8,670,381
7,540,930
7,615,614
43,619,330
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.
10,279,866
9,512,539
8,686,381
7,540,930
7,618,114
43,637,830
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
43,637,830
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...
10,279,866
9,512,539
8,686,381
7,540,930
7,618,114
43,637,830
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,662
195
1,857
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
1,662
195
1,857
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.)
..
387,711
373,008
1,021,358
1,163,326
1,116,132
4,061,535
13
Total support. (Add lines 9, 10c, 11, and 12.)..
47,701,222
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
91.480 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
93.340 %
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:
13000178
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
Chicagoland Methodist Senior Services
Employer identification number
36-2210011
Return Reference
Explanation
Pt VI, Line 1a
VOTING MEMBERS:
Pt VI, Line 1a
Three voting members of the governing body are not
Pt VI, Line 1a
independent because they are compensated in excess
Pt VI, Line 1a
of the threshold amount by this organization or
Pt VI, Line 1a
a related organization.
Pt VI, Line 11b
990 BOARD REVIEW PROCESS:
Pt VI, Line 11b
Form 990 is completed by the CFO, then reviewed by
Pt VI, Line 11b
the CEO and the tax department of our external CPA
Pt VI, Line 11b
firm. Prior to filing, a copy is provided to each
Pt VI, Line 11b
Board member for their review and comment.
Pt VI, Line 12c
CONFLICT OF INTEREST POLICY:
Pt VI, Line 12c
Conflict of Interest disclosure is regularly
Pt VI, Line 12c
reviewed, once a year, at a Board of Directors
Pt VI, Line 12c
meeting. The review covers all members of the Board.
Pt VI, Line 12c
Should a conflict exist, that Board member is
Pt VI, Line 12c
restricted from voting on any specific matters
Pt VI, Line 12c
related to the conflict.
Pt VI, Line 15a
COMPENSATION PROCESS:
Pt VI, Line 15a
The Compensation Committee, consisting of specific
Pt VI, Line 15a
Board of Director members, established a compensation
Pt VI, Line 15a
process which includes a review of all staff members
Pt VI, Line 15a
of the organization who are at a certain level or
Pt VI, Line 15a
higher. The review takes place on an annual basis,
Pt VI, Line 15a
with the last one being completed in 2013. The
Pt VI, Line 15a
process includes the CEO,
Pt VI, Line 15b
and other officers and key employees of our
Form 990, Part IX, Line 24f
BAD DEBT EXPENSE 85994. 85994. 0. 0.
Pt VI, Line 15b
organization.
Pt VI, Line 15b
The specifics are as follows:
Pt VI, Line 15b
1. The committee determines which employees meet the
Pt VI, Line 15b
criteria of disqualified employees.
Pt VI, Line 15b
2. For each disqualified employee, their base salary
Pt VI, Line 15b
is compared to the 50th percentile for their
Pt VI, Line 15b
respective position on the Life Services Network
Pt VI, Line 15b
annual salary survey. CMSS endeavors to pay at the
Pt VI, Line 15b
50th percentile for our region.
Pt VI, Line 15b
3. The benefit package is compared to the industry
Pt VI, Line 15b
average to be sure we are competitive and consistent
Pt VI, Line 15b
with the market place.
Pt VI, Line 15b
4. A bonus plan is developed for employees at the vice
Pt VI, Line 15b
president level and above wherein both corporate
Pt VI, Line 15b
and individual goals are established.
Pt VI, Line 15b
The committee insures that the goals are both
Pt VI, Line 15b
relevant and measurable.
Pt VI, Line 15b
5. Total compensation (base plus bonus) is intended
Pt VI, Line 15b
to approximate the 75th percentile from the LSN survey.
Pt VI, Line 19
PUBLIC DISCLOSURE:
Pt VI, Line 19
The organization makes its governing documents,
Pt VI, Line 19
conflict of interest policy and financial statements
Pt VI, Line 19
available to the general public by providing copies
Pt VI, Line 19
of the documents, upon request.
Pt XI
OTHER CHANGES IN NET ASSETS (Line 9):
Pt XI
Equity Transfer from related organization - $450,000.
Pt III, Line 1
ORGANIZATION'S MISSION - continued (Line 1):
Pt III, Line 1
Wesley Place - is a 108-bed Medicare licensed
Pt III, Line 1
nursing facility featuring a warm, comfortable
Pt III, Line 1
setting with private and semi-private accomodations.
Pt III, Line 1
Wesley Place prides itself on creating a sense of
Pt III, Line 1
community, where all residents can count on feeling