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
Presbyterian Homes in the Presbytery of Lake Erie
Employer identification number
25-0979369
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.") .
65,150
38,129
88,755
117,453
177,724
487,211
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......
21,313,539
21,595,933
21,770,167
21,034,273
22,160,844
107,874,756
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.
21,378,689
21,634,062
21,858,922
21,151,726
22,338,568
108,361,967
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.)
108,361,967
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...
21,378,689
21,634,062
21,858,922
21,151,726
22,338,568
108,361,967
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
174,020
193,599
200,853
196,871
192,869
958,212
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
174,020
193,599
200,853
196,871
192,869
958,212
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.)..
21,552,709
21,827,661
22,059,775
21,348,597
22,531,437
109,320,179
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
99.123 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.088 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.877 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.912 %
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
Presbyterian Homes in the Presbytery of Lake Erie
Employer identification number
25-0979369
Return Reference
Explanation
Form 990, Part VI, Section A, Line 3
Presbyterian Homes entered into an agreement with SeniorCare Network, Inc. (SCN), a management and consulting affiliate of Presbyterian Senior Care, to provide management services to Presbyterian Homes for a two-year period that began on January 1, 2012. This agreement was renewed on January 1, 2014 for another one-year period. The agreement stipulates monthly management fees in addition to certain direct expenses. Also, under the agreement, SCN provides a regional manager to oversee the daily operations of the Presbyterian Homes' communities. All associated expenses are reimburseable to SCN by Presbyterian Homes.
Form 990, Part VI, Section B, Line 11b
A copy of the Form 990 was provided directly or emailed to each director of the board prior to filing the Form 990. A ten day period is given for review. Any proposed changes or comments received are reviewed by the officers of the organization, after which the document is filed with the Internal Revenue Service.
Form 990, Part VI, Section B, Line 12c
The organization has a written conflict of interest policy. All officers, directors and key employees are required to complete a conflict of interest questionnaire annually. The questionnaires are then reviewed by the Corporate Compliance Officer who then reports back to the board with any findings and/or corrective actions. To date we have had no unresolved conflict of interest problems.
Form 990, Part VI, Section B, Line 15
Presbyterian Homes has a compensation program in place which covers all employees. A regional human resource and management consulting firm provides recommendations to update both the salary structure and adjustments to wages. These recommendations are incorporated into the annual budget which is reviewed and approved by both the finance committee and the board of directors. The compensation for officers is included in this process. Compensation for officers is specifically reviewed and established by the board's executive committee. The Senior Director is an employee of SeniorCare Network, Inc. (SCN), a managment and consulting affiliate of Presbyterian SeniorCare. SCN is currently under contract to provide management services to Presbyterian Homes. The compensation for the Senior Director is formulated by SCN and reviewed with the board of Presbyterian Homes. No independent board members are compensated in any way.
Form 990, Part VI, Section C, Line 19
The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. We will make copies of requested documents at IRS approved rates per page, or the requestor may come to the offices to review the documents.
Form 990, Part XI, Line 9
Other changes in net assets or fund balances: Change in Value of Assets Whose Use is Limited $158,921 and Interest Rate Swap Adjustment $691,946.
Form 990, Part XII, Line 2c
The organization uses BKD, LLC, a regional accounting firm, as their independent auditor. Presbyterian Homes has an audit committee that meets to review the annual audited financial statement with BKD, LLC. They also have a private session, without management present, with the auditors at that meeting. The committee chooses the auditing firm, and approves their fee. A management letter, if there are any managment comments, is prepared by BKD, LLC and reviewed with the committee. Corrective action is documented if needed.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.