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
BRETHREN VILLAGE
Employer identification number
23-1425014
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.") .
1,548,638
1,014,533
1,010,179
919,746
1,804,564
6,297,660
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......
25,967,575
28,836,627
31,908,041
33,795,740
34,844,554
155,352,537
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.
27,516,213
29,851,160
32,918,220
34,715,486
36,649,118
161,650,197
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
325,000
720,000
133,500
185,000
155,000
1,518,500
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..
325,000
720,000
133,500
185,000
155,000
1,518,500
8
Public support (Subtract line 7c from line 6.)
160,131,697
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...
27,516,213
29,851,160
32,918,220
34,715,486
36,649,118
161,650,197
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
523,705
617,665
746,031
720,297
969,188
3,576,886
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
523,705
617,665
746,031
720,297
969,188
3,576,886
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
-36,387
-13,130
-49,517
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
219,875
1,044,441
209,817
248,980
305,405
2,028,518
13
Total support. (Add lines 9, 10c, 11, and 12.)..
28,223,406
31,500,136
33,874,068
35,684,763
37,923,711
167,206,084
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
95.770 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
95.650 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.140 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
2.000 %
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
BRETHREN VILLAGE
Employer identification number
23-1425014
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
MANAGEMENT SUBMITS INFORMATION NECESSARY FOR TAX CONSULTANT TO PREPARE TAX RETURNS. MANAGEMENT PARTICIPATES IN THE REVIEW PROCESS PRIOR TO PRESENTING TO THE FINANCE COMMITTEE OF BRETHREN VILLAGE FOR FINAL REVIEW AND APPROVAL. RETURNS ARE THEN MADE AVAILABLE TO ALL BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 12C
ALL OF THE ORGANIZATION'S EXPENDITURES ARE SUBJECT TO APPROPRIATE APPROVALS THROUGH THE ORGANIZATION'S PURCHASING POLICY. ADDITIONALLY, TRANSACTIONS WITH ANY COMPANIES AFFILIATED WITH BOARD MEMBERS ARE MONITORED AND ANALYZED BY THE ACCOUNTING DEPARTMENT AND REPORTED IN OUR ANNUAL DISCLOSURE STATEMENT, IF APPLICABLE. BRETHREN VILLAGE HAS A CONFLICT OF INTEREST POLICY WHICH IS DIRECTED NOT ONLY TO DIRECTORS AND OFFICERS, BUT TO ALL TEAM MEMBERS WHO CAN INFLUENCE THE ACTIONS OF BRETHREN VILLAGE. DISCLOSURE OF CONFLICTS SHOULD BE MADE TO THE PRESIDENT (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE BOARD OR DULY CONSTITUTED COMMITTEE THEREOF. DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE BOARD CHAIR (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD VICE-CHAIR), WHO SHALL BRING THE MATTER TO THE BOARD OR A DULY CONSTITUTED COMMITTEE THEREOF. ANY BOARD OF DIRECTOR MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE PERSONAL INFLUENCE ON THE MATTER, AND SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. EACH MEMBER OF THE BOARD, CORPORATE OFFICERS, AND MEMBERS OF THE BOARD COMMITTEES SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, (B) HAS READ AND UNDERSTANDS THE POLICY, (C) HAS AGREED TO COMPLY WITH THE POLICY, AND (D) UNDERSTANDS THAT BRETHREN VILLAGE IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THE EXECUTIVE ASSISTANT IS RESPONSIBLE FOR ENSURING THAT EVERYONE COMPLETES A STATEMENT ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15
EXECUTIVE COMMITTEE OF BRETHREN VILLAGE BOARD ESTABLISHES COMPENSATION FOR PRESIDENT AND VICE PRESIDENTS. THE COMMITTEE RELIES ON EXTERNAL DATA INCLUDING AN EXECUTIVE WAGE SURVEY, SPECIFIC FOR THE SENIOR LIVING INDUSTRY, AS WELL AS OTHER COMPARABLE WAGE INDICATORS (ECONOMIC OUTLOOK, ETC.). COMPENSATION FOR OTHER POSITIONS (POSSIBLY KEY EMPLOYEES) WITHIN THE ORGANIZATION ARE ESTABLISHED USING INTERNALLY DEVELOPED DATA (COMPENSATION RANGES) AND EXTERNAL SURVEY DATA FROM STATE ASSOCIATION AND OTHER SIMILAR GROUPS. SALARIES ARE REVIEWED ANNUALLY. MINUTES OF THE COMMITTEE MEETINGS ARE RECORDED AND FILED. SALARY ADJUSTMENTS ARE FORWARDED TO THE HR DEPARTMENT BY THE PRESIDENT WITH THE PROPER DOCUMENTATION/AUTHORIZATION.
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.
FORM 990, PART XI, LINE 9:
CHANGE IN VALUE OF SPLIT-INTEREST ADJUSTMENT -23,668. PENSION LIABILITY ADJUSTMENT -121,732. VALUATION GAIN ON BENEFICIAL INTEREST IN PERPETUAL TRUSTS 116,699. CHANGE IN VALUE OF FUTURE SERVICE OBLIGATION 8,929,000.
FORM 990, PART XII, QUESTION 2C:
THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE REVIEW OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.