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
TEL HAI SERVICES INC
Employer identification number
23-2630672
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.") .
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......
725,486
1,229,425
1,296,845
1,224,583
1,282,682
5,759,021
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.
725,486
1,229,425
1,296,845
1,224,583
1,282,682
5,759,021
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.)
5,759,021
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...
725,486
1,229,425
1,296,845
1,224,583
1,282,682
5,759,021
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)
..
1,240
1,060
1,074
35,628
1,300
40,302
13
Total support. (Add lines 9, 10c, 11, and 12.)..
726,726
1,230,485
1,297,919
1,260,211
1,283,982
5,799,323
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
99.310 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.240 %
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 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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
TEL HAI SERVICES INC
Employer identification number
23-2630672
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
TEL HAI SERVICES, INC SHALL CONSIST OF MEMBERS WHO ARE IN GOOD STANDING IN A MENNONITE CHURCH OR OTHER EVANGELICAL CONGREGATION WHO ARE IN SYMPATHY WITH THE STANDARDS ADOPTED BY THE CORPORATION. POTENTIAL MEMBERS ARE REVIEWED BY THE BOARD OF DIRECTORS OF THE CORPORATION, APPROVED BY THE ASSOCIATION, AND HAVE CONTRIBUTED AT LEAST THE SUM OF $150.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERS OF TEL HAI SERVICES, INC VOTE ON A SLATE OF BOARD MEMBERS RECOMMENDED BY THE GOVERNANCE BOARD.
FORM 990, PART VI, SECTION A, LINE 7B
MEMBERS OF TEL HAI SERVICES, INC. APPROVE ANY BY-LAW MODIFICATIONS.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 IS FIRST REVIEWED BY THE CEO AND CFO. ONCE THEY HAVE APPROVED THE INITIAL DRAFT, THE RETURN IS PRESENTED TO THE FINANCE COMMITTEE. THE FINANCE COMMITTEE REVIEWS AND APPROVES THE FORM, THEN REPORTS TO THE BOARD OF DIRECTORS. A FINAL COPY OF THE RETURN IS PROVIDED TO EACH BOARD MEMBER BEFORE THE RETURN IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C
ALL BOARD MEMBERS AND THE EXECUTIVE TEAM ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. THE PRESIDENT REVIEWS ALL STATEMENTS AND ANY POTENTIAL CONFLICT IS BROUGHT TO THE ATTENTION OF THE CHAIRMAN OF THE BOARD. IF A CONFLICT EXISTS FOR A BOARD MEMBER, THE MEMBER IS ASKED TO ABSTAIN FROM ANY VOTE ASSOCIATED WITH THE CONFLICT. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED IN THE CONFLICT OF INTEREST POLICY WHEN ADDRESSING WHO IS AN INTERESTED PERSON.
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD'S EXECUTIVE COMMITTEE REVIEWS THE LEADINGAGE PA ANNUAL WAGE SURVEY TO BENCHMARK THE EXECUITVE TEAM'S SALARIES AGAINST INDUSTRY STANDARDS AND ENSURE SALARIES ARE WITHIN FAIR MARKET RANGE FOR THE INDUSTRY. THE BOARD PRESIDENT REVIEWS ALL SALARY RECOMMENDATIONS AND DECISIONS REGARDING COMPENSATION ARE SUBJECT TO BOARD APPROVAL. ALL EXECUTIVE COMMITTEE DISCUSSIONS ON COMPENSATION ARE RECORDED IN EXECUTIVE MINUTES. ALL OTHER SALARIES ARE DETERMINED BY THE HUMAN RESOURCES DEPARTMENT AND WITH THE APPROPRIATE DIRECTORS OF VICE PRESIDENTS AND ARE DETERMINED AFTER VARIOUS WAGE STUDIES ARE CONSULTED TO AFFIRM SALARIES ARE WITHIN FAIR MARKET VALUE FOR THE INDUSTRY.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PAGE 10, PART IX
TEL HAI SERVICES, INC. PURCHASES SERVICES FROM ITS SUBSIDIARY, TEL HAI RETIREMENT COMMUNITY. ALL EXPENSES ARE REPORTED ON THE APPROPRIATE LINE OF THE SUBSIDIARY'S STATEMENT OF FUNCTIONAL EXPENSES AND ARE ALLOCATED BACK TO TEL HAI SERVICES, INC. THE PURCHASED SERVICES HAVE BEEN REPORTED ON PART IX, THE STATEMENT OF FUNCTIONAL EXPENSES, IN COMPLIANCE WITH THE FORM 990 INTERNAL REVENUE INSTRUCTIONS, PAGE 36, LINE 21 - PAYMENTS TO AFFILIATES, WHICH STATES THAT PURCHASES OF GOODS AND SERVICES FROM AFFILIATES ARE NOT REPORTED ON LINE 21 BUT ARE REPORTED AS EXPENSES IN THE USUAL MANNER.
FORM 990, PAGE 5, PART V, LINE 2A
ALL EMPLOYEES OF TEL HAI DEVELOPMENT ARE PAID BY TEL HAI RETIREMENT COMMUNITY (EIN: 23-2039189), A COMMON PAYMASTER. AS A RESULT, NO FORMS W-3 WERE FILED FOR TEL HAI DEVELOPMENT. HOWEVER, THERE ARE 6 EMPLOYEES WHO WERE PAID THROUGH THE COMMON PAYMASTER AND HAVE THEIR SALARIES AND BENEFITS RECORDED ON THE TEL HAI DEVELOPMENT FORM 990.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.