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
FOULKEWAYS AT GWYNEDD
Employer identification number
23-1657176
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.") .
429,408
416,995
556,984
240,738
273,777
1,917,902
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......
21,052,154
22,193,114
21,927,751
22,911,205
23,980,235
112,064,459
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
0
0
0
0
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
0
0
0
0
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
0
0
0
0
0
6
Total. Add lines 1 through 5.
21,481,562
22,610,109
22,484,735
23,151,943
24,254,012
113,982,361
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
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
0
0
0
0
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public support (Subtract line 7c from line 6.)
113,982,361
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...
21,481,562
22,610,109
22,484,735
23,151,943
24,254,012
113,982,361
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
546,386
1,156,704
1,277,718
1,630,498
1,877,927
6,489,233
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
0
0
0
0
0
c
Add lines 10a and 10b.
546,386
1,156,704
1,277,718
1,630,498
1,877,927
6,489,233
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
0
0
0
0
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
658,001
672,228
653,737
683,401
715,067
3,382,434
13
Total support. (Add lines 9, 10c, 11, and 12.)..
22,685,949
24,439,041
24,416,190
25,465,842
26,847,006
123,854,028
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
92.030 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
92.14 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
5.239 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
4.92 %
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:
13000241
Software Version:
v1.00
-
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
FOULKEWAYS AT GWYNEDD
Employer identification number
23-1657176
Return Reference
Explanation
Form 990, Part VI, Section A, Line 2
Rolland Henderson, Board Emeritus and Phillip Henderson, President are brothers. Ann T. Raper, Board Member and Neil Trueblood, Board Member are siblings
Form 990, Part VI, Section B, Line 11b
The Form 990 is prepared by the Chief Financial Officer using information obtained from electronic records of Foulkeways at Gwynedd and personal interviews with the Chief Executive Officer and various members of the management team. Upon completion of the document, the Form 990 is distributed in its entirety to the Board of Directors. At the next Board of Directors meeting any questions or comments not previously addressed are answered. After Board of Directors review, the Form 990 is filed electronically with the Internal Revenue Service as required.
Form 990, Part VI, Section B, Line 12c
At the Annual Meeting of the Board of Directors that is held each May, each board member is requested to complete a Conflict of Interest Statement disclosing any conflicts that may exist. The Conflict of Interest Statement is signed by the board member and then reviewed by the Board Chair and the Chief Executive Officer. If, during the year, any decision is proposed related to an area where there is a conflict, the board member with the conflict is expected to recuse themselves from the decision.
Form 990, Part VI, Section B, Line 15
The Foulkeways Board of Directors and the Chief Executive Officer (CEO) Evaluation Committee (comprised of the Board Chair, Vice Chair and Chair of the Pension/Personnel Committee) evaluate the CEO on an annual basis utilizing information from board members and other sources, including salary surveys from comparable organizations. The Board Chair gathers information both verbally and written from Board Members regarding the performance of the CEO and then obtains salary information from various salary surveys of comparable organizations from the Director of Human Resources. The Board Chair also receives a recap of the previous year's goals and the goals for the upcoming year from the CEO. The CEO Evaluation Committee meets and reviews all of the information. Subsequently a meeting is held with the CEO to review and discuss the information and to establish goals for the coming year. A recommendation for compensation is then presented to the next full Board of Directors meeting for final approval.
Form 990, Part VI, Section C, Line 19
Foulkeways makes available to those who inquire, the governing documents and conflict of interest policy. These are available from the Administrative Assistant to the Chief Executive Officer in the Administrative offices on the Foulkeways campus. Foulkeways produces an Annual Report each year that includes the complete audited financial statements. The Annual Report is distributed to all residents and priority list members. It is also given to employees and other interested parties as requested. The Annual Report is also included in the information packet that is given to those individuals requesting information about the community. The Financial Statements are posted to the NRMSIR for use by bondholders of the Community. They are also posted on Guidestar.com as part of the Form 990 posting for not-for-profit charitable organizations.
Form 990, Part XI, Line 9
Change in Pension Plan Assets and Benefit Obligations Other than Periodic Benefit Cost
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.