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
THE HARRY AND JEANETTE WEINBERG village III
Employer identification number
20-4351501
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.") .
0
15,244
27,335
56,121
17,000
115,700
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......
622,141
624,163
621,481
625,644
627,986
3,121,415
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
622,141
639,407
648,816
681,765
644,986
3,237,115
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.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
3,237,115
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...
622,141
639,407
648,816
681,765
644,986
3,237,115
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,036
1,232
1,237
1,809
3,407
8,721
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
1,036
1,232
1,237
1,809
3,407
8,721
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
10,154
261
0
10,415
13
Total support. (Add lines 9, 10c, 11, and 12.)..
633,331
640,900
650,053
683,574
648,393
3,256,251
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
99.412 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
0 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.268 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0 %
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
THE HARRY AND JEANETTE WEINBERG village III
Employer identification number
20-4351501
Return Reference
Explanation
PART VI, SECTION C, #19
THE ORGANIZATION'S GOVERNING DOCUMENTS AND POLICIES ARE AVAILABLE FOR PUBLIC INSPECTION AT THE ORGANIZATION'S OFFICE DURING REGULAR BUSINESS HOURS UPON REQUEST.
PART VI, SECTION B, LINE 12
THE BOARD MEMBERS ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY AND CERTIFY THAT THEY HAVE NO CONFLICT OF INTERESTS.
PART VI, SECTION B, #11
A DRAFT OF FORM 990 IS REVIEWED & AUTHORIZED BY A MEMBER OF THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS
PART VI, SECTION A, #3
The Harry & Jeanette Weinberg VILLAGE III, Inc. has entered into a housing management agreement with Community Life Management, LLC to act as the exclusive agent for the management of the property.
PART VI, SECTION B, #15A
CHAI conducts a performance and salary review to determine the compensation for Executive director, MITCHELL POSNER, whose responsibility is to oversee the project.
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:ELDERLY CARE EXPENSES TOTAL EXPENSES:59161 PROGRAM SERVICES:59161 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:SUPPLIES TOTAL EXPENSES:16406 PROGRAM SERVICES:16406 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:TRASH REMOVAL TOTAL EXPENSES:4943 PROGRAM SERVICES:4943 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:REPAIRS & MAINTENANCE TOTAL EXPENSES:16475 PROGRAM SERVICES:16475 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:MISC. MAINTENANCE EXPENSES TOTAL EXPENSES:825 PROGRAM SERVICES:825 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:MISC. TAXES, LICENSES, PERMITS TOTAL EXPENSES:1046 PROGRAM SERVICES:1046 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:MISC. FINANCIAL EXPENSES TOTAL EXPENSES:883 PROGRAM SERVICES:883 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:BAD DEBT EXPENSE TOTAL EXPENSES:376 PROGRAM SERVICES:376 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:MISC. ADMIN. EXPENSE TOTAL EXPENSES:1256 PROGRAM SERVICES:1256 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:SNOW REMOVAL TOTAL EXPENSES:1201 PROGRAM SERVICES:1201 MANAGEMENT AND GENERAL:FUNDRAISING:
FORM 990 PART IX LINE 24 - OTHER EXPENSES
DESCRIPTION:OTHER RENTING EXPENSES TOTAL EXPENSES:61 PROGRAM SERVICES:61 MANAGEMENT AND GENERAL:FUNDRAISING:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.