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
COVENANT WOODS
Employer identification number
54-0524902
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.") .
100,520
91,720
1,921,651
137,740
468,389
2,720,020
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......
9,945,828
10,500,712
11,168,887
11,681,199
13,374,643
56,671,269
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
217,375
245,214
340,426
307,159
387,943
1,498,117
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.
10,263,723
10,837,646
13,430,964
12,126,098
14,230,975
60,889,406
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
10,000
10,000
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.
1,708,445
51,152
1,759,597
c
Add lines 7a and 7b..
1,708,445
51,152
10,000
1,769,597
8
Public support (Subtract line 7c from line 6.)
59,119,809
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...
10,263,723
10,837,646
13,430,964
12,126,098
14,230,975
60,889,406
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,146,980
1,288,224
826,287
1,278,958
1,503,041
6,043,490
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
14,353
3,794
18,147
c
Add lines 10a and 10b.
1,146,980
1,288,224
826,287
1,293,311
1,506,835
6,061,637
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.)..
11,410,703
12,125,870
14,257,251
13,419,409
15,737,810
66,951,043
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
88.300 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
87.800 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
9.050 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
9.460 %
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
COVENANT WOODS
Employer identification number
54-0524902
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF ALL OFFICERS OF THE CORPORATION WHO ARE DIRECTORS AND THE CHAIRMEN OF FINANCE, DEVELOPMENT, BUILDING/GROUNDS, NOMINATIONS/RESOURCES, ADMISSIONS AND COMMUNITY INVOLVEMENT COMMITTEES, IF SUCH COMMITTEE(S) THEN EXISTS, TO PROVIDE THE EXECUTIVE COMMITTEE WITH AT LEAST 9 MEMBERS. IF AT ANY TIME THE EXECUTIVE COMMITTEE HAS FEWER THAN 9 MEMBERS, THE EXECUTIVE COMMITTEE SHALL MAKE SUCH RECOMMENDATION TO THE BOARD OF DIRECTORS AS TO ADDITIONAL MEMBERS AS IT SHALL DETERMINE, AND THE BOARD OF DIRECTORS SHALL BY A RESOLUTION APPOINT SUCH ADDITIONAL MEMBERS AS IT MAY DETERMINE FOR A TERM OF NO MORE THAN TWO YEARS. THE CHAIRMAN OF THE CORPORATION SHALL BE CHAIRMAN OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE MAY MEET AND MAKE RECOMMENDATIONS AS IT SHALL DEEM ADVISABLE TO THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL BE VESTED WITH FULL AND COMPLETE AUTHORITY WITH RESPECT TO THE BUSINESS AND AFFAIRS OF THE CORPORATION EXCEPT THAT IT SHALL NOT WITHOUT THE APPROVAL OF THE BOARD OF DIRECTORS: (1) FILL VACANCIES ON THE BOARD OR ON ANY OF ITS COMMITTEES; (2) AMEND THE ARTICLES OF INCORPORATION PURSUANT TO VIRGINIA CODE SECTION 13.1-885 (ALLOWING AMENDMENT OF THE ARTICLES OF INCORPORATION BY THE BOARD OF DIRECTORS); (3) ADOPT, AMEND, OR APPEAL THE BYLAWS; (4) APPROVE A PLAN OF MERGER; (5) SELL THE ASSETS OF THE CORPORATION OTHER THAN IN THE REGULAR COURSE OF BUSINESS; (6) DISSOLVE THE CORPORATION; OR ANY OTHER ACTIONS SPECIFIED IN VIRGINIA CODE SECTIONS 13.1-869, 13.1-885, 13.1-895, 13.1-900, 13.1-903 (OR THE EQUIVALENT SECTION OF ANY CODE OF LAW SUBSEQUENTLY ENACTED BY THE COMMONWEALTH OF VIRGINIA) OR ANY ACTION OTHERWISE PROHIBITED BY LAW.
FORM 990, PART VI, SECTION B, LINE 11
A COPY WAS SENT TO EACH BOARD MEMBER, WHICH INCLUDES FINANCE COMMITTEE MEMBERS, REQUESTING COMMENTS OR QUESTIONS TO BE DIRECTED TO THE CFO WITHIN 10 DAYS. THE 990 WAS FILED WITH THE IRS AFTER SUCH TIME.
FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD IS POLLED ANNUALLY AND SURVEYS ARE COLLECTED BY THE EXECUTIVE SECRETARY AND CHECKED FOR COMPLIANCE WITH THE POLICY.
FORM 990, PART VI, SECTION B, LINE 15
THE CEO IS EVALUATED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD. EACH COMMITTEE MEMBER DOES AN INDEPENDENT EVALUATION, AND THE COMMITTEE CHAIRMAN COMPILES THE SCORE. THE CEO EVALUATES THE CFO WITH FEEDBACK FROM THE BOARD. THE BOARD CHAIR REQUESTS COMPARATIVE SALARY DATA THAT THE HR DIRECTOR ACQUIRES FROM VARIOUS LONG-TERM CARE GROUPS, WHICH IS USED TO DETERMINE BASE WAGE INCREASES. BONUS AMOUNTS ARE DETERMINED BASED ON HOW WELL THE CEO AND CFO EXECUTE THE STRATEGIC PLAN FOR THE YEAR - MEETING BUDGET, SATISFACTION, DEVELOPMENT, ETC. BONUS AMOUNTS ARE CAPPED AT 10% OF BASE SALARY.
FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION'S RECENT FORMS 990 ARE AVAILABLE AT WWW.GUIDESTAR.ORG AND UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE FOR PUBLIC INSPECTION AT THIS TIME. FINANCIAL STATEMENTS ARE PROVIDED TO WWW.EMMA.ORG.
FORM 990, PART XI, LINE 9:
CHANGE IN FAIR VALUE OF PERPETUAL TRUSTS -404,939.
FORM 990, PART XII, LINE 2C:
THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.