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
HUBBARD HILL ESTATES INC
Employer identification number
35-1362157
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.") .
2,250,506
50,276
68,503
127,926
124,155
2,621,366
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......
10,766,476
10,858,863
10,562,140
11,097,819
11,208,374
54,493,672
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.
13,016,982
10,909,139
10,630,643
11,225,745
11,332,529
57,115,038
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
2,175,000
0
0
0
0
2,175,000
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.
0
0
0
0
0
0
c
Add lines 7a and 7b..
2,175,000
0
0
0
0
2,175,000
8
Public support (Subtract line 7c from line 6.)
54,940,038
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...
13,016,982
10,909,139
10,630,643
11,225,745
11,332,529
57,115,038
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
31,853
81,751
202,158
102,344
115,851
533,957
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
31,853
81,751
202,158
102,344
115,851
533,957
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
306
306
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
117,820
95,194
150,044
168,803
217,890
749,751
13
Total support. (Add lines 9, 10c, 11, and 12.)..
13,166,655
11,086,084
10,983,151
11,496,892
11,666,270
58,399,052
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
94.080 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
94.310 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.910 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.790 %
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:
13000248
Software Version:
2013v3.1
-
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
HUBBARD HILL ESTATES INC
Employer identification number
35-1362157
Return Reference
Explanation
FORM 990, PART III, LINE 4A, PROGRAM SERVICE DESCRIPTION
HUBBARD HILL ESTATES, INC. (HUBBARD HILL) IS A FULL-SERVICE RETIREMENT COMMUNITY DESIGNED AS A CONTINUING CARE CAMPUS. HUBBARD HILL PROVIDES RESIDENTS WITH A VARIETY OF LIVING ARRANGEMENTS RANGING FROM PRIVATE HOUSES TO A SKILLED MEDICARE CERTIFIED HEALTH CENTER WITH 24 HOUR PROFESSIONAL NURSING CARE. A FULL-TIME ACTIVITIES DIRECTOR AND STAFF PROVIDE A FULL RANGE OF RECREATIONAL AND WELLNESS PROGRAMS. SOCIAL WORKERS PROVIDE FOR SOCIAL SERVICES NEEDS. PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES ARE AVAILABLE IN THE HEALTHCARE CENTER'S FULLY EQUIPPED THERAPY CENTER FOR INPATIENT AND OUTPATIENT THERAPY SERVICES. RESIDENTS HAVE ACCESS TO A BEAUTY SALON AND MASSAGE THERAPY. A FULL-TIME CHAPLAIN IS ALSO AVAILABLE. HUBBARD HILL HAS A TOTAL OF 250 INDIVIDUAL LIVING UNITS WITHIN THE CONTINUUM OF CARE ACCOMMODATIONS. THERE ARE 87 INDIVIDUAL INDEPENDENT DWELLINGS THAT OFFER MAINTENANCE-FREE LIVING TO RESIDENTS AND PROVIDE OPTIONAL ACCESS TO ALL SERVICES PROVIDED AT HUBBARD HILL INCLUDING MEALS. THE ROUTINE MAINTENANCE FEE INCLUDES LAWN CARE, SNOW REMOVAL, TRASH COLLECTION, AND CITY WATER. OTHER SERVICES ARE ALSO AVAILABLE. HUBBARD HILL PROVIDED 46,801 RESIDENT DAYS OF SERVICE TOWARD INDEPENDENT CARE DURING THE YEAR ENDED JUNE 30, 2014. THE RESIDENTIAL HALLS, LICENSED BY THE STATE FOR RESIDENTIAL CARE, HAVE 98 APARTMENTS DESIGNED FOR RESIDENTS REQUIRING SOME ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. HUBBARD HILL PROVIDES ASSISTANCE SUCH AS DRESSING, BATHING, MEDICATION MANAGEMENT, AND OTHER LIMITED NURSING SERVICES TO RESIDENTS WHO NEED ASSISTANCE. MONTHLY SERVICES AVAILABLE INCLUDE THREE MEALS PER DAY FROM A SELECTIVE MENU, HOUSEKEEPING SERVICES, MAINTENANCE SERVICES, BED AND BATH LINEN SERVICES, AND PERSONAL LAUNDRY SERVICES. WASHERS AND DRYERS ARE AVAILABLE IN EACH HALL FOR RESIDENTS DESIRING TO DO THEIR OWN PERSONAL LAUNDRY. ADDITIONAL ASSISTED LIVING SERVICES ARE AVAILABLE TO ANY RESIDENT IN ANY APARTMENT IN THE RESIDENCE HALLS FOR AN ADDITIONAL FEE. UTILITIES, PHONES WITH LOCAL CALL ACCESS AND TRANSPORTATION TO LOCAL APPOINTMENTS ARE ALSO PROVIDED. A LICENSED NURSE IS ON DUTY 24 HOURS A DAY FOR ASSESSMENT, EVALUATION, AND SUPERVISION OF RESIDENTS' NEEDS. AN RN SERVES AS DIRECTOR OF NURSING WHO PROVIDES OVERSIGHT THROUGHOUT THE WEEK, ALONG WITH AN ADMINISTRATOR. HUBBARD HILL PROVIDED 36,711 RESIDENT DAYS OF SERVICE TOWARD ASSISTED LIVING CARE DURING THE FISCAL YEAR ENDED JUNE 30, 2014. HUBBARD HILL ALSO OPERATES A 66 BED SKILLED NURSING FACILITY THAT PROVIDES DEDICATED REHABILITATION AND LONG TERM CARE. ALL HEALTHCARE ROOMS ARE CERTIFIED FOR MEDICARE SERVICES. 10 BEDS ARE ALSO CERTIFIED FOR MEDICAID SERVICES. NURSING CARE IS PROVIDED 24 HOURS PER DAY. THE DIRECTOR OF NURSING HEADS A STAFF THAT INCLUDES REGISTERED NURSES, LICENSED PRACTICAL NURSES & CERTIFIED NURSING ASSISTANTS. SEVERAL CONSULTANTS, INCLUDING A DIETITIAN, PHARMACISTS, PSYCHIATRIST, PHYSICIANS, AND THERAPISTS ARE ALSO ON STAFF. HUBBARD HILL PROVIDED 21,335 RESIDENT DAYS FOR HEALTHCARE INCLUDING 8,069 MEDICARE DAYS, 1,806 MEDICAID DAYS, AND 11,460 PRIVATE PAY DAYS DURING THE FISCAL YEAR ENDED JUNE 30, 2014.
FORM 990, PART IV, LINE 28A, BUSINESS TRANSACTIONS
THE ORGANIZATION USES AN INDEPENDENT CONTRACTOR, MORGANROTH CONSULTING, TO PROVIDE FINANCIAL MANAGEMENT AND CONSULTING. MORGANROTH PROVIDES LORI FARKAS, WHO RECEIVES COMPENSATION FROM HER ENTITY FOR HER WORK PERFORMED NOT ONLY FOR HUBBARD HILL ESTATES, BUT ALSO FOR WORK PROVIDED FOR OTHER UNRELATED ORGANIZATIONS. MS. FARKAS IS NOT COMPENSATED DIRECTLY BY HUBBARD HILL ESTATES.
FORM 990, PART V, LINE 7G, ORGANIZATIONS THAT MAY RECEIVE DEDUCTIBLE CONTRIBUTIONS:
THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY DURING THE YEAR ENDED JUNE 30, 2014; THEREFORE, THIS QUESTION DOES NOT APPLY AND HAS BEEN LEFT INTENTIONALLY BLANK.
Form 990, Part VI, Sec A, Line 2, Family/business relationships amongst interested persons
BOARD MEMBERS: SHIRLEY MARKS AND J.R. ROHRER - FAMILY RELATIONSHIP
Form 990, Part VI, Sec A, Line 3, Delegation of management duties
THE ORGANIZATION USES INDEPENDENT CONTRACTOR, MORGANROTH TO ASSIST IN FINANCIAL MANAGEMENT. DUTIES INCLUDE FINANCIAL REPORTING AND ANALYSIS, BOARD REPORTING ON FINANCIAL RELATED MATTERS, AUDIT COMPLIANCE, AND OTHER FINANCIAL MATTERS. THIS CONTRACTOR REGULARLY MEETS WITH THE EXECUTIVE DIRECTOR/CEO ON ALL FINANCIAL MATTERS. FINAL AUTHORITY AND DECISIONS ON ALL FINANCIAL MATTERS REMAINS WITH THE EXECUTIVE DIRECTOR. THIS CONTRACTOR PROVIDES INPUT TO FINANCIAL STAFF EVALUATIONS AND SUPERVISION, BUT ARE NOT RESPONSIBLE FOR THOSE ACTIVITIES.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders
THE CONFERENCE OF THE MISSIONARY CHURCH, NORTH CENTRAL DISTRICT, INC., A RELATED PARTY, HAS AUTHORITY TO APPROVE 2/3 OF THE GOVERNING BODY.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body
A FINAL DRAFT OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY PRIOR TO ITS FILING WITH THE IRS.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
THE ORGANIZATION REQUIRES ALL OFFICERS AND DIRECTORS OF THE BOARD, AS WELL AS KEY EMPLOYEES AND OTHER INTERESTED PERSONS, TO ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND TO DOCUMENT IN WRITING ANY POTENTIAL CONFLICTS. A DETAILED QUESTIONNAIRE IS ALSO COMPLETED BY EACH BOARD MEMBER. EXECUTIVE AND FINANCIAL MANAGEMENT REVIEW THE QUESTIONNAIRES FOR ANY POTENTIAL CONFLICTS. IF A CONFLICT DOES EXIST, THAT PERSON MUST NOTIFY THE BOARD AND/OR EXCUSE HIM OR HERSELF FROM THE BOARD MEETING PRIOR TO DISCUSSION ON THE CONFLICTING TOPIC. THAT PERSON WILL NOT BE PERMITTED TO VOTE ON ANY DECISIONS REGARDING THE CONFLICTING ISSUE.
Form 990, Part VI, Sec B, Line 15a, Process to establish compensation of top management official
THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE EVALUATION COMMITTEE, WHICH IS MADE UP OF INDIVIDUALS FROM THE GOVERNING BOARD. THIS COMMITTEE COMPARES CURRENT COMPENSATION TO COMPENSATION DATA FOR SIMILAR CONTINUING CARE RETIREMENT COMMUNITY (CCRC) INSTITUTIONS. THE COMMITTEE LOOKS AT SIZE, STATE, AND OTHER TRENDS TO ENSURE THAT COMPENSATION IS ALIGNED WITH SIMILAR ORGANIZATIONS. ONCE THE EVALUATION COMMITTEE REVIEWS PERFORMANCE AND COMPARABLE COMPENSATION DATA, A COMPENSATION PACKAGE WHICH INCLUDES RANGES IS SUBMITTED TO THE FULL BOARD OF DIRECTORS. ONCE APPROVED BY THE FULL BOARD, THE PACKAGE IS THEN SENT TO THE FINANCE COMMITTEE, WHO LOOKS AT THE RANGE OF COMPENSATION APPROVED IN THE PACKAGE AND DETERMINES A FINAL PACKAGE NUMBER. THIS REVIEW PROCESS WAS LAST COMPLETED DURING FISCAL YEAR 2014 AND WAS DOCUMENTED IN THE BOARD MEETING MINUTES.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
FORM 990, PART VII, SECTION A, LINE 1A, COMPENSATION OF OFFICERS,ETC
CHRISTOPHER KNIGHT AND JOE WENGER, BOTH BOARD MEMBERS, DEVOTED APPROX 40 HOURS PER WEEK FOR PART OF THE YEAR TO MISSIONARY CHURCH, A RELATED TAX-EXEMPT ORGANIZATION
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.