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
Sun Dial Manor Inc
Employer identification number
46-6016762
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.") .
50,000
50,000
59,330
161,000
114,000
434,330
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......
2,324,441
2,314,803
2,403,108
2,409,791
2,493,899
11,946,042
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
6,197
8,880
11,276
6,808
3,231
36,392
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.
2,380,638
2,373,683
2,473,714
2,577,599
2,611,130
12,416,764
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.
864,101
1,071,079
1,078,541
873,531
964,700
4,851,952
c
Add lines 7a and 7b..
864,101
1,071,079
1,078,541
873,531
964,700
4,851,952
8
Public support (Subtract line 7c from line 6.)
7,564,812
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...
2,380,638
2,373,683
2,473,714
2,577,599
2,611,130
12,416,764
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
14,427
15,871
15,635
11,329
10,586
67,848
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
14,427
15,871
15,635
11,329
10,586
67,848
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.)..
2,395,065
2,389,554
2,489,349
2,588,928
2,621,716
12,484,612
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
60.590 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
59.870 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.540 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.630 %
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
Sun Dial Manor Inc
Employer identification number
46-6016762
Return Reference
Explanation
Form 990, Part VI, Section A, line 1
The investment oversight committee consists of the President, Secretary, and Executive Director. The investment oversight committee has broad authority to act on behalf of the governing body. The investment oversight committee does not have full authority to adjust salaries, approve the budget, or adopt bylaw amendments.
Form 990, Part VI, Section A, line 6
Contributors can choose to become members by making a donation and indicating their desire to become members. Once a member, they are members for lifetime.
Form 990, Part VI, Section A, line 7a
Eighteen members constitute a quorum for the annual meeting. Members select the Board of Directors. No one person can elect the governing body.
Form 990, Part VI, Section B, line 11
A copy of the draft Form 990 will be given to the board members to review and approve at a board meeting held prior to the filing of the Form 990.
Form 990, Part VI, Section B, line 12c
Each board member completes a Conflict of Interest Information Form. This form is to be renewed annually. If a potential conflict of interest arises, the governing board will discuss the issue in the absence of the interested person and vote upon the determination of whether a conflict of interest exists. Depending on the circumstances, the interested person might be precluded from voting on the proposed transaction or arrangement.
Form 990, Part VI, Section B, line 15a
The Executive Director's compensation is determined by utilizing performance evaluations by the Board, compensation surveys and studies, and board approval. This procedure is conducted annually.
Form 990, Part VI, Section C, line 19
Available upon request
Form 990, Part IX, line 11g
Contracted Nursing Labor: Program service expenses 180,876. Management and general expenses 0. Fundraising expenses 0. Total expenses 180,876. Contracted Activity Labor: Program service expenses 630. Management and general expenses 0. Fundraising expenses 0. Total expenses 630. Title 19 OTC Medications: Program service expenses 6,407. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,407. Dietary Consultant: Program service expenses 3,796. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,796. Social Services Consultant: Program service expenses 665. Management and general expenses 0. Fundraising expenses 0. Total expenses 665. Medical Director: Program service expenses 1,100. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,100. Medicare Consultant: Program service expenses 3,628. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,628. Billable Physical Therapy Part B: Program service expenses 26,303. Management and general expenses 0. Fundraising expenses 0. Total expenses 26,303. Billable Occupational Therapy Part: Program service expenses 28,660. Management and general expenses 0. Fundraising expenses 0. Total expenses 28,660. Billable Speech Services: Program service expenses 26,459. Management and general expenses 0. Fundraising expenses 0. Total expenses 26,459. Billable Laboratory: Program service expenses 3,226. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,226. Billable Radiology: Program service expenses 481. Management and general expenses 0. Fundraising expenses 0. Total expenses 481. Billable Out-Patient PT: Program service expenses 22,164. Management and general expenses 0. Fundraising expenses 0. Total expenses 22,164. Billable Out-Patient OT: Program service expenses 3,462. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,462. Other fees: Program service expenses 2,062. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,062. Professional Fees: Program service expenses 0. Management and general expenses 18,071. Fundraising expenses 0. Total expenses 18,071.
Form 990, Part XII, Line 2c:
The entire board is responsible for selection and oversight of the independent accountant.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.