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 UNITED METHODIST RETIREMENT HOMES INC
Employer identification number
56-0634527
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.") .
720,870
600,887
922,478
475,239
1,533,172
4,252,646
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......
33,410,086
34,773,766
41,872,553
43,093,483
58,317,877
211,467,765
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.
34,130,956
35,374,653
42,795,031
43,568,722
59,851,049
215,720,411
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.)
215,720,411
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...
34,130,956
35,374,653
42,795,031
43,568,722
59,851,049
215,720,411
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,057,816
1,165,812
1,506,339
1,263,769
1,734,543
6,728,279
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
1,057,816
1,165,812
1,506,339
1,263,769
1,734,543
6,728,279
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.)
..
5,816,315
5,801,463
291,865
166,400
-140,990
11,935,053
13
Total support. (Add lines 9, 10c, 11, and 12.)..
41,005,087
42,341,928
44,593,235
44,998,891
61,444,602
234,383,743
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
92.040 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
88.880 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.870 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
2.860 %
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 UNITED METHODIST RETIREMENT HOMES INC
Employer identification number
56-0634527
Return Reference
Explanation
FORM 990 PART IV
AT OCTOBER 1, 2013 CYPRESS GLEN RETIREMENT COMMUNITY(CYPRESS GLEN) EIN 56-1961935, IRC CODE SEC 501(C)(3) MERGED WITH THE UNITED METHODIST RETIREMENT HOMES, INC (UMRH), EIN 56-0634527, IRC CODE SEC 501(C)(3) . UMRH IS THE SURVIVING ENTITY. THE MERGED ENTITY, THE UNITED METHODIST RETIREMENT HOMES, INC CONTINUES WITH THE ARTICLES OF INCORPORATION AND BY-LAWS OF UMRH. THE CURRENT BOARD OF TRUSTEES IS COMPRISED OF THE FORMER TRUSTEES OF CYPRESS GLEN AND UMRH.
FORM 990, PART VI, SECTION A, LINE 2
JONATHAN ERICKSON (CORPORATE EXECUTIVE DIRECTOR) AND STACY DOBSON (CHIEF FINANCIAL OFFICER) SERVE AS OFFICERS OF UNITED METHODIST RETIREMENT HOMES AFFORDABLE HOUSING, INC. JONATHAN ERICKSON IS THE PRESIDENT OF UMRH AFFORDABLE HOUSING, INC. THE FOLLOWING MEMBERS OF THE BOARD OF TRUSTEES ARE ALSO MEMBERS OF THE BOARD OF TRUSTEES FOR UNITED METHODIST RETIREMENT HOMES FOUNDATION, INC., A RELATED ENTITY DISCLOSED ON SCHEDULE R: JONATHAN ERICKSON, STACY DOBSON, JD ADAMS, JOHN GRISSOM, CARL HAMILL, LEE HARRISS, DON METZGER, GARY WHALEY, ARTIE ROGERS, AND NANCY MARKS.
FORM 990, PART VI, SECTION A, LINE 4
THE ORGANIZATION ADOPTED AMENDED BYLAWS IN OCTOBER 2013. BYLAWS WERE AMENDED FOR THE MERGER OF CYPRESS GLEN RETIREMENT COMMUNITY INTO UMRH, INC.
FORM 990, PART VI, SECTION B, LINE 11
THE ORGANIZATION'S CHIEF FINANCIAL OFFICER REVIEWS THE 990.
FORM 990, PART VI, SECTION B, LINE 12C
THE UMRH, INC. BOARD FILLS OUT THE CONFLICT OF INTEREST POLICY FORM EACH SEPTEMBER NOTING ANY CONTINUED CONFLICTS OF INTEREST. NEW BOARD MEMBERS ARE ORIENTED TO THE POLICY AND SIGN THE FORM UPON BECOMING MEMBERS. EACH BOARD MEMBER IS REQUIRED TO DISCLOSE ANY CONFLICTS TO THE CHAIRMAN PRIOR TO A VOTE BEING TAKEN. THE MEMBER MUST ABSTAIN FROM VOTING. THE CONFLICT OF INTEREST POLICY IS ALSO REVIEWED FOR THE EMPLOYEES AT ORIENTATION AND AT ANNUAL REVIEW.
FORM 990, PART VI, SECTION B, LINE 15
THE ORGANIZATION ROUTINELY CONSULTS THE SERVICES OF AN OUTSIDE AGENCY TO EVALUATE THE ORGANIZATION'S WAGE SCALES AND PAY GRADES. THE RESULTING WAGE SCALE AND THE EMPLOYEE'S PERFORMANCE AND ACCOMPLISHMENTS ARE CONSIDERED IN THE ANNUAL REVIEW PROCESS. IN SOME INSTANCES, A SOFTWARE PROGRAM CALLED "PERFORMANCE NOW" IS USED TO SIMPLIFY THE COMMUNICATION OF THE REVIEW AND ITS RESULTS.
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 SPLIT INTEREST AGREEMENT 161,987. CHANGE IN VALUE OF PLEDGES -90,832. CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT 239,862. ACQUISITION OF CYPRESS GLEN RETIREMENT COMMUNITY NET ASSETS 13,821,488.
FORM 990, PART XII, LINE 2C
THE ORGANIZATION'S OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR.
FORM 990, PART VII, SECTION A
HOURS TO RELATED ORGANIZATION: JONATHAN ERICKSON - 1 HOUR PER WEEK TO UNITED METHODIST HOMES FOUNDATION, INC. AS A MEMBER OF THE BOARD OF TRUSTEES. THE FOLLOWING MEMBERS OF THE BOARD OF TRUSTEES ARE ALSO MEMBERS OF THE BOARD OF TRUSTEES FOR UNITED METHODIST RETIREMENT HOMES FOUNDATION, INC. AND PROVIDE 1 HOUR OF SERVICE PER WEEK: STACY DOBSON, JD ADAMS, JOHN GRISSOM, CARL HAMILL, LEE HARRISS, DON METZGER, ARTIE ROGERS, GARY WHALEY, AND NANCY MARKS.
FORM 990, PART VII, SECTION A, COLUMN F
THE ORGANIZATION, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN COLUMN F, PART VII AND NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.