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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
EASTERN STAR HOMES OF CALIFORNIA
Employer identification number
94-1196188
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
3,607,452
3,982,817
3,576,689
2,592,993
2,424,546
16,184,497
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
3,607,452
3,982,817
3,576,689
2,592,993
2,424,546
16,184,497
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)..
0
6
Public support. Subtract line 5 from line 4.
16,184,497
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
3,607,452
3,982,817
3,576,689
2,592,993
2,424,546
16,184,497
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
270,491
255,698
282,392
283,205
305,999
1,397,785
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
11
Total support (Add lines 7 through 10).
17,582,282
12
Gross receipts from related activities, etc. (see instructions)
..................
12
1,946,296
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
92.050 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
92.792 %
16a
33 1/3% support test—2012.
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—2011.
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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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......
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.
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.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)..
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to 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) 2012
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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
EASTERN STAR HOMES OF CALIFORNIA
Employer identification number
94-1196188
Identifier
Return Reference
Explanation
FORM 990, PART I, LINE 1 & PART III, LINE 1
MISSION STATEMENT:
EASTERN STAR HOMES WAS ORGANIZED FOR THE PURPOSE OF OPERATING A HOME FOR THE CARE OF AGED MEMBERS OF THE ORDER OF THE EASTERN STAR.
FORM 990, PART VI, SECTION A, LINE 7A
GOVERNING BODY AND MANAGEMENT:
The Order of the Eastern Star has members who elect the Trustees of the Senior Living Community Board of Trustees at their annual session. If a Board member leaves office, the replacement is appointed by the Worthy Grand Matron who is an elected officer in Eastern Star.
FORM 990, PART VI, SECTION B, LINE 11B
POLICIES:
FORM 990 IS GIVEN TO THE ORGANIZATION'S VARIOUS COMMITTEES AND BOARDS IN DRAFT FORM TO BE REVIEWED. COMMENTS PROVIDED BY THE COMMITTEES/BOARDS ARE ADDRESSED AND, IF APPROPRIATE, INCORPORATED INTO THE RETURN BEFORE IT IS FINALIZED.
FORM 990, PART VI, SECTION B, LINE 12C
POLICIES:
A CONFLICT OF INTEREST REVIEW IS PERFORMED ANNUALLY AT OFFICERS' RENEWAL AND DIRECTOR'S REVIEW. KEY EMPLOYEES ARE NOT REQUIRED TO DISCLOSE ANNUALLY INTEREST THAT COULD GIVE RISE TO CONFLICTS, ONLY OFFICERS AND DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15A
POLICIES:
COMPENSATION OF THE EXECUTIVE DIRECTOR IS CONSIDERED ON AN ANNUAL BASIS; FACTORS CONSIDERED IN DETERMINING COMPENSATION ARE ANNUAL REVIEW, BUDGET AND COMPATIBILITY WITH EXISTING POSITIONS IN SIMILAR ORGANIZATIONS.
FORM 990, PART VI, SECTION C, LINE 19
DISCLOSURE:
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5
OTHER CHANGES IN NET ASSETS OR FUND BALANCES:
INCREASE IN OBLIGATION TO PROVIDE FUTURE SERVICES $281,470
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:MINOR EQUIP/SUPPLIES TOTAL EXPENSES:93091 PROGRAM SERVICES:77502 MANAGEMENT AND GENERAL:15589 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:RESIDENT ALLOWANCES TOTAL EXPENSES:78441 PROGRAM SERVICES:78441 MANAGEMENT AND GENERAL:FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:RESIDENT ACTIVITIES TOTAL EXPENSES:74190 PROGRAM SERVICES:74190 MANAGEMENT AND GENERAL:FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:OTHER EMPLOYEE EXPENSES TOTAL EXPENSES:40673 PROGRAM SERVICES:33202 MANAGEMENT AND GENERAL:7471 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:PUBLICATIONS TOTAL EXPENSES:28748 PROGRAM SERVICES:14374 MANAGEMENT AND GENERAL:14374 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:LICENSES AND TAXES TOTAL EXPENSES:25682 PROGRAM SERVICES:21402 MANAGEMENT AND GENERAL:4280 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:EQUIPMENT RENTAL AND MAINTENAN TOTAL EXPENSES:15820 PROGRAM SERVICES:8701 MANAGEMENT AND GENERAL:7119 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:BOARD MEMBER EXPENSES TOTAL EXPENSES:15633 PROGRAM SERVICES:3127 MANAGEMENT AND GENERAL:12506 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:RESIDENT ADMISSION EXPENSES TOTAL EXPENSES:15359 PROGRAM SERVICES:15359 MANAGEMENT AND GENERAL:FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:TELEPHONE TOTAL EXPENSES:14542 PROGRAM SERVICES:11634 MANAGEMENT AND GENERAL:2908 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:DUES AND SUBSCRIPTIONS TOTAL EXPENSES:11490 PROGRAM SERVICES:5745 MANAGEMENT AND GENERAL:5745 FUNDRAISING:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:HOLIDAY GIFTS - RESIDENTS TOTAL EXPENSES:3417 PROGRAM SERVICES:3417 MANAGEMENT AND GENERAL:FUNDRAISING:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.