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
WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
Employer identification number
13-1740497
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.") .
855,474
759,699
4,631,583
12,018,731
23,288,981
41,554,468
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......
39,562,006
37,893,270
38,359,833
36,821,995
32,588,450
185,225,554
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.
40,417,480
38,652,969
42,991,416
48,840,726
55,877,431
226,780,022
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
15,622
14,672
12,867
24,516
30,905
98,582
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
c
Add lines 7a and 7b..
15,622
14,672
12,867
24,516
30,905
98,582
8
Public support (Subtract line 7c from line 6.)
226,681,440
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...
40,417,480
38,652,969
42,991,416
48,840,726
55,877,431
226,780,022
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
105,214
103,244
159,515
396,251
364,174
1,128,398
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
105,214
103,244
159,515
396,251
364,174
1,128,398
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.)
..
490,022
743,420
1,081,331
210,335
230,786
2,755,894
13
Total support. (Add lines 9, 10c, 11, and 12.)..
41,012,716
39,499,633
44,232,262
49,447,312
56,472,391
230,664,314
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
98.270 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.070 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.490 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.440 %
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
WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
Employer identification number
13-1740497
Return Reference
Explanation
FORM 990, PART I, LINE 6
IN 2013 THERE WERE A TOTAL OF 192 VOLUNTEERS. 96 IN THE NURSING HOME, MEADOWVIEW ARE 29 AND ADC IS 26. THE DEVELOPMENT, HOMECARE AND VOLUNTEER OFFICE HAD 21 VOLUNTEERS. THERE HAVE BEEN 20 WESTCHESTER SHELTER YOUNG MEN WHO WORKED THROUGHOUT THE CAMPUS.
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE ORGANIZATION IS WARTBURG MT. VERNON INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE BOARD OF DIRECTORS OF THE CORPORATION SHALL BE ELECTED BY THE MEMBER AT THE ANNUAL MEETING OF THE MEMBER. IN ADDITION, VACANCIES OCCURRING ON THE BOARD OF DIRECTORS OF THE CORPORATION, FOR ANY REASON, MAY ONLY BE FILLED BY THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B
ACTION BY THE VOTE OF AT LEAST TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS OF THE CORPORATION AND BY THE CONCURRING VOTE OF TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS OF THE MEMBER AT THEIR ANNUAL MEETING, REGULAR MEETING OR SPECIAL MEETING HELD UPON NOTICE OF THE PROPOSED ACTION SHALL BE REQUIRED FOR: - AMENDMENT OF THE CERTIFICATE OF INCORPORATION OF THE CORPORATION - AMENDMENT OF THE BY-LAWS OF THE CORPORATION - THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION - MERGER OR CONSOLIDATION OF THE CORPORATION IN ACCORDANCE WITH ARTICLE IX OF THE NOT-FOR-PROFIT CORPORATION LAW - NON-JUDICIAL DISSOLUTION OF THE CORPORATION IN ACCORDANCE WITH ARTICLE X OF THE NOT-FOR-PROFIT CORPORATION LAW - AUTHORIZATION FOR AMENDMENT OF THESE BY-LAWS TO PROVIDE THAT THE QUORUM OR VOTING REQUIREMENT FOR THE TRANSACTION OF ANY ITEM OF BUSINESS BE GREATER THAN THAT WHICH IS REQUIRED BY THE NOT-FOR-PROFIT CORPORATION LAW
FORM 990, PART VI, SECTION B, LINE 11
WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE BOARD MEMBERS OF THE ORGANIZATION FOR ANY COMMENTS. ANY COMMENTS ARE THEN GROUPED, SUMMARIZED AND PROVIDED TO THE OUTSIDE ACCOUNTANTS. EACH ISSUE IS DOCUMENTED AND ADDRESSED UNTIL THE RETURN IS FINALIZED AND APPROVED FOR FILING.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION HAS ADOPTED A CONFLICT OF INTEREST POLICY TO ASSURE A UNIFORM POLICY EXISTS FOR COVERED PERSONS AND THAT EFFECTIVE COMMUNICATION AND DECISION MAKING COURSE REGARDING POTENTIAL CONFLICTS OF INTEREST. COVERED PERSONS, AS DEFINED BY THE POLICY, REFERS TO DIRECTORS AND OFFICERS OF THE ORGANIZATION, AS WELL AS EMPLOYEES, CONSULTANTS AND OTHER PERSONS WHO MAY BE IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION'S AFFAIRS. ANNUALLY, COVERED PERSONS ARE REQUIRED TO COMPLETE A FORM " QUESTIONNAIRE CONCERNING FINANCIAL INTERESTS AND AFFIRMATION RE: CONFLICT OF INTEREST POLICY". POTENTIAL CONFLICTS ARE EVALUATED BY THE BOARD OF DIRECTORS OR AN APPROPRIATE COMMITTEE OF THE BOARD. PERSONS IDENTIFIED WITH A CONFLICT MAY BE EXCLUDED FROM VOTING ON/MAKING A DECISION REGARDING A TRANSACTION/ARRANGEMENT WHICH CREATES THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15
THE WARTBURG ALIGNS ITS COMPENSATION PHILOSOPHY WITH THE OVERALL MISSION AND BUSINESS STRATEGY OF THE ORGANIZATION. EMPLOYEES ARE COMPENSATED FAIRLY WITHOUT REGARD TO AGE, SEX, RACE, COLOR, RELIGION, CREED, NATIONAL ORIGIN, DISABILITY (INCLUDING PREGNANCY DISABILITY), VETERAN OR MILITARY STATUS, MARITAL STATUS, SEXUAL ORIENTATION, CITIZENSHIP STATUS, IN ACCORDANCE WITH ALL APPLICABLE LAWS AND REGULATIONS, AND AS OUTLINED IN HUMAN RESOURCE POLICY. THE COMPENSATION PHILOSOPHY IS DESIGNED TO PROVIDE COMPETITIVE COMPENSATION POSITIONING COMPARED TO PEER GROUPS/OTHER HEALTHCARE ORGANIZATIONS SIMILAR IN SIZE AND PROGRAM OFFERING. IT CONSIDERS EXTERNAL MARKET DATA AGAINST INTERNAL STRUCTURE, RECOGNIZES THE UNIQUE RELATIVE VALUE OF EACH FUNCTION, REWARDS, INDIVIDUAL PERFORMANCE, WHILE BEING FINANCIALLY SUSTAINABLE OVER TIME. IT IS REVIEWED ON AN AS NEEDED BASIS BY WARTBURG'S PERSONNEL & COMPENSATION COMMITTEE OF THE BOARD AND IS SUBJECT TO SUCH BUDGETARY CONSIDERATIONS AS BUSINESS CONDITIONS MAY CREATE. SINCE 2007, THE WARTBURG HAS ENGAGED THE SERVICES OF SIBSON CONSULTING, A NATIONAL EMPLOYEE COMPENSATION AND BENEFITS FIRM, TO REVIEW EXECUTIVE AND SENIOR MANAGEMENT COMPENSATION. DATA USED IN DETERMINING MARKET MID RANGE IS DERIVED FROM REPORTS ISSUED BY SIBSON USING REPUTABLE TOP-TIER SURVEY HOUSES AS WELL AS LOCAL, INDUSTRY, AND ASSOCIATION SPECIFIC SOURCES. WORLD AT WORK STANDARDS ARE FOLLOWED IN THE SELECTION AND USE OF THE COMPENSATION SURVEYS TO ASSURE RELIABILITY AND VALIDITY OF DATA SOURCES. IN ADDITION, MARKET DATA IS MATCHED AGAINST JOB CONTENT AND DESCRIPTIONS, NOT JOB TITLES, AND BY THE USE OF WARTBURG'S JOB FACTOR ANALYSIS TOOL. EXEMPTION DECISIONS ARE MADE IN ACCORDANCE WITH FAIR LABOR STANDARD ACT REQUIREMENTS. IT IS OUR ORGANIZATION'S DESIRE TO PAY A COMPETITIVE BASE SALARY ALIGNED TO MARKET VALUE AND TO OFFER A COMPENSATION PACKAGE WHICH INTEGRATES OTHER TOTAL COMPENSATION OFFERINGS SUCH AS PAID TIME OFF, HEALTH COVERAGE, TUITION REIMBURSEMENT, ETC. "COMPETITIVE" IS DEFINED AS MARKET 50TH PERCENTILE. MARKET PARITY/MID RANGE DECISIONS ARE BASED ON FACTORS SUCH AS EDUCATION, SUBJECT EXPERTISE, LEVEL OF PERFORMANCE, AS WELL AS LEVEL OF STRATEGIC IMPACT/VALUE TO THE LONG-TERM GOALS OF THE ORGANIZATION. AS BUSINESS CONDITIONS WARRANT AND BASED ON THE STRATEGIC NEEDS OF THE ORGANIZATION, WITH BOARD APPROVAL, AN EMPLOYEE'S BASE SALARY MAY BE SUPPLEMENTED WITH INCENTIVE-BASED PAY AND/OR OTHER TOTAL COMPENSATION ARRANGEMENTS.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS FORM 990 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS POSTED ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION FORM 990, FORM 1023, AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST OR BY CALLING THE ORGANIZATION DIRECTLY.
FORM 990, PART IX, LINE 11G
THERAPISTS: PROGRAM SERVICE EXPENSES 363,803. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 363,803. CONSULTANTS: PROGRAM SERVICE EXPENSES 730,833. MANAGEMENT AND GENERAL EXPENSES 451,444. FUNDRAISING EXPENSES 37,798. TOTAL EXPENSES 1,220,075. RNS & LPNS: PROGRAM SERVICE EXPENSES 150,199. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,199. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 102,756. MANAGEMENT AND GENERAL EXPENSES 16,776. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 119,532. PCA FEES: PROGRAM SERVICE EXPENSES 992,636. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 992,636. HHA FEES: PROGRAM SERVICE EXPENSES 2,623,941. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,623,941. RESPIRATORY THERAPY: PROGRAM SERVICE EXPENSES 156,336. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156,336. SOCIAL SERVICES: PROGRAM SERVICE EXPENSES 31,020. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,020. PAYROLL SERVICE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 112,799. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 112,799. EMPLOYMENT AGENCY FEES: PROGRAM SERVICE EXPENSES 11,962. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,962. PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 130,203. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130,203.
FORM 990, PART XI, LINE 9:
CHANGE IN VALUE OF TRUSTS HELD BY THIRD PARTIES AND POOLED INCOME DEFERRED 10,235. CHANGE IN VALUE OF TRUSTS HELD BY THIRD PARTIES 24,098. FEES, SUPPLIES AND OTHER DIRECT EXPENSE -103,335.
FORM 990, PART XII, LINE 2C
THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.