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 HOUSE OF THE HOLY COMFORTER
Employer identification number
22-1487578
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.") .
8,070
6,920
6,055
3,275
4,425
28,745
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......
1,706,185
1,817,123
1,963,415
1,984,018
2,365,811
9,836,552
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.
1,714,255
1,824,043
1,969,470
1,987,293
2,370,236
9,865,297
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.)
9,865,297
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...
1,714,255
1,824,043
1,969,470
1,987,293
2,370,236
9,865,297
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
3,288
1,960
1,063
611
267
7,189
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
3,288
1,960
1,063
611
267
7,189
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.)
..
638
327
965
13
Total support. (Add lines 9, 10c, 11, and 12.)..
1,718,181
1,826,003
1,970,533
1,987,904
2,370,830
9,873,451
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
99.920 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.860 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.070 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.130 %
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 HOUSE OF THE HOLY COMFORTER
Employer identification number
22-1487578
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
HEATH ALLIANCE FOR CARE EXECUTIVE COMMITTEE THE EXECUTIVE COMMITTEE SHALL CONSIST OF SEVEN (7) MEMBERS, INCLUDING THE PRESIDENT, VICE-PRESIDENT, SECRETARY, TREASURER, ASSISTANT SECRETARY, ASSISTANT TREASURER, AND IMMEDIATE PAST PRESIDENT. FIVE (5) MEMBERS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ALL BUSINESS. THE EXECUTIVE COMMITTEE SHALL MEET TO TRANSACT EMERGENCY BUSINESS BETWEEN BOARD MEETINGS AS IS NECESSARY. THE EXECUTIVE COMMITTEE SHALL HAVE ALL POWERS AND DUTIES OF THE BOARD EXCEPT IT SHALL NOT HAVE THE POWER TO REMOVE OR ELECT A TRUSTEE OR THE CEO OR TO APPROVE OR DISAPPROVE THE OPERATING OR CAPITAL EXPENSE BUDGETS. HOWEVER, IN TIMES DEEMED BY THEM TO BE OF EMERGENCY, THE EXECUTIVE COMMITTEE MAY APPROVE EXPENDITURES NOT IN THE BUDGETS BUT NOT TO EXCEED SUCH AMOUNTS AS CURRENTLY ESTABLISHED BY THE BOARD. THE SECRETARY OF THE BOARD SHALL KEEP MINUTES OF ALL MEETINGS OF THE EXECUTIVE COMMITTEE AND SEND COPIES OF SAID MINUTES TO ALL BOARD MEMBERS. THE EXECUTIVE COMMITTEE MEETS AT THE CALL OF THE PRESIDENT OR UPON WRITTEN REQUEST OF ANY OTHER TWO MEMBERS THEREOF.
FORM 990, PART VI, SECTION A, LINE 3
ARTHUR DUNSMORE, ADMINISTRATOR OF THE HOUSE OF THE HOLY COMFORTER, IS EMPLOYED BY HEATH CARE MANAGEMENT (A RELATED FOR PROFIT CORPORATION). THE HOUSE OF THE HOLY COMFORTER PAYS A MONTHLY FEE FOR HIS SERVICES. THE HOUSE OF THE HOLY COMFORTER ALSO PAYS A MONTHLY FEE TO HEATH CARE MANAGEMENT FOR MANAGEMENT OVERSIGHT AND ACCOUNTING SERVICES. THESE SERVICES ARE PERFORMED BY THE CEO (PATRICK BRADY), COO (MARY ELLEN BOVE), CONTROLLER (ANTHONY PUCCIO) AND BUSINESS OFFICE STAFF OF HEATH VILLAGE (A RELATED NON-PROFIT CORPORATION).
FORM 990, PART VI, SECTION A, LINE 6
THE CORPORATION SHALL HAVE ONE CORPORATE MEMBER (THE "MEMBER") WHICH SHALL CONSIST OF HEATH ALLIANCE FOR CARE, INC., A NEW JERSEY NOT-FOR-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBER, BY A VOTE OF ITS BOARD OF TRUSTEES OR DIRECTORS, SHALL APPOINT THE TRUSTEES OF THE CORPORATION. UNLESS OTHERWISE PROVIDED BY THE BYLAWS OF THE MEMBER, ANY TRUSTEE POSITION NOT FILLED AT THE MEMBER'S ANNUAL MEETING AND ANY VACANCY, HOWEVER CAUSED, OCCURRING IN THE CORPORATION'S BOARD OF TRUSTEES MAY BE FILLED BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THE EXECUTIVE COMMITTEE OF THE MEMBER OR THE FULL BOARD OF TRUSTEES OF THE MEMBER. ANY TRUSTEE POSITION TO BE FILLED BY REASON OF AN INCREASE IN THE NUMBER OF TRUSTEES SHALL BE FILLED BY THE MEMBER BY ELECTION AT AN ANNUAL MEETING OR AT A SPECIAL MEETING CALLED FOR THAT PURPOSE.
FORM 990, PART VI, SECTION A, LINE 7B
ASIDE FROM APPOINTING TRUSTEES AND THE CHAIRPERSON, HEATH ALLIANCE FOR CARE, AS THE CORPORATE MEMBER, SHALL ALSO DETERMINE BY RESOLUTION THE TERM OF EACH NEW TRUSTEE WHO IS APPOINTED TO THE BOARD OF TRUSTEES OF THE HOUSE OF THE HOLY COMFORTER. THE MEMBER MAY ALSO REMOVE ANY OFFICER BY A SIXTY-SIX AND TWO-THIRDS VOTE OF THE MEMBER'S TRUSTEES. ANY CHANGES TO THE BYLAWS ARE CONDITIONED UPON APPROVAL OF THE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11
THE SENIOR ACCOUNTANT, CONTROLLER, AND SECRETARY/TREASURER REVIEW THE FORM PRIOR TO FILING. THE HEATH ALLIANCE FOR CARE FINANCE AND CORPORATE DEVELOPMENT COMMITTEE REVIEWS THE FORM AT A BOARD MEETING. THEN THE FINAL FORM IS DISTRIBUTED TO ALL MEMBERS OF THE HOUSE OF THE HOLY COMFORTER BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
ALL BOARD MEMBERS AND OFFICERS ARE REQUIRED TO COMPLETE THE DISCLOSURE OF POSSIBLE CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. THE PERSONNEL AND POLICY COMMITTEE IS RESPONSIBLE FOR DISTRIBUTING, COLLECTING AND REVIEWING ALL DISCLOSURE STATEMENTS ON AN ANNUAL BASIS. BOARD MEMBERS ARE REQUIRED TO REFRAIN FROM DISCUSSING, AS WELL AS VOTING ON, SUCH MATTERS IN WHICH A CONFLICT OF INTEREST EXISTS. IN SOME INSTANCES, THE INDIVIDUAL HAS BEEN RESPECTFULLY ASKED TO RESIGN FROM THEIR POSITION ON THE BOARD AS A RESULT OF A DISCLOSED CONFLICT. IN INSTANCES WHERE A CONFLICT OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE BOARD OF TRUSTEES MUST DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES PRESENT, THAT THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND THAT THE ORGANIZATION CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS. THE CEO ALSO REVIEWS THE COMPLETED FORMS AND RETAINS A FILE OF COMPLETED FORMS AFTER THE PROCESS OF COLLECTING AND REVIEWING THEM IS COMPLETED EACH YEAR.
FORM 990, PART VI, SECTION B, LINE 15
THE HEATH ALLIANCE FOR CARE BOARD OF TRUSTEES EMPLOYS A CHIEF EXECUTIVE OFFICER WHO IS RESPONSIBLE FOR THE MANAGEMENT AND OPERATION OF ALL AFFILIATES, INCLUDING THIS ENTITY, AND HE IS COMPENSATED ANOTHER AFFILIATE. THE CEO'S COMPENSATION IS DETERMINED AS FOLLOWS PER AN EXECUTED EMPLOYMENT AGREEMENT: "EMPLOYEE'S BASE SALARY IN EACH SUBSEQUENT YEAR OF THE PERIOD OF EMPLOYMENT SHALL BE REASONABLY ADJUSTED AND THE REASONABILITY OF SUCH ADJUSTMENT SHALL BE MADE WITH REFERENCE TO THE ANNUAL COMPENSATION SURVEYS PRODUCED BY THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING AND THE NEW JERSEY HOSPITAL ASSOCIATION FOR LIKE ORGANIZATIONS IN THE NORTHERN NEW JERSEY AREA, AND SUCH OTHER RELEVANT SALARY SURVEYS THAT MAY BE AVAILABLE FROM TIME TO TIME FROM OTHER INDEPENDENT INDUSTRY AND PROFESSIONAL ORGANIZATIONS. UPON CONSIDERATION OF RELEVANT SALARY DATA OF EMPLOYEES PERFORMING SERVICES COMMENSURATE WITH THOSE PERFORMED BY EMPLOYEE AND THE PERCENTAGE INCREASE GIVEN TO VILLAGE MANAGEMENT, THE PERSONNEL AND POLICY COMMITTEE, OR ANY SUCCESSOR COMMITTEE OF THE ALLIANCE BOARD, IN ITS SOLE DISCRETION, SUBJECT TO APPROVAL BY THE ALLIANCE BOARD, MAY ADJUST SUCH BASE SALARY INCREASES." IN ADDITION, HIS INCENTIVE BONUS IS ALSO COMPARED IN THE SAME MANNER. THE DIRECTOR OF HUMAN RESOURCES ALSO PROVIDES THE BOARD WITH INFORMATION FOR SIMILAR FACILITIES FROM GUIDESTAR. THIS WAS LAST PROVIDED TO THE BOARD ON 4/4/14 FOR THE CEO'S LAST ANNUAL REVIEW COMPLETED AT A BOARD MEETING ON 7/15/14. THE ORGANIZATION CONTRACTS WITH A RELATED ENTITY FOR MANAGEMENT SERVICES AND PAYS A MANAGEMENT FEE. THE RELATED ENTITY DETERMINES THE COMPENSATION OF THE INDIVIDUALS PERFORMING SERVICES FOR THIS ENTITY. THERE ARE NO MANAGEMENT LEVEL OR KEY EMPLOYS WHO ARE EMPLOYED AND COMPENSATED DIRECTLY BY THIS ENTITY.
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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.