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
CATHOLIC CARE CAMPUS INC
Employer identification number
76-0760243
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.") .
67,083
81,606
0
0
0
148,689
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......
11,015,434
11,861,447
13,165,340
13,821,196
12,945,493
62,808,910
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.
11,082,517
11,943,053
13,165,340
13,821,196
12,945,493
62,957,599
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.)
62,957,599
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...
11,082,517
11,943,053
13,165,340
13,821,196
12,945,493
62,957,599
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
259,674
188,824
235,201
369,907
394,545
1,448,151
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
259,674
188,824
235,201
369,907
394,545
1,448,151
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
11,342,191
12,131,877
13,400,541
14,191,103
13,340,038
64,405,750
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
97.752 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
97.500 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.249 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
2.500 %
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
CATHOLIC CARE CAMPUS INC
Employer identification number
76-0760243
Return Reference
Explanation
FORM 990, PART III, LINE 1
IN A CATHOLIC ENVIRONMENT CONDUCIVE TO THE DIGNITY AND INDEPENDENCE OF THE ELDERLY WITHOUT CAUSING UNDUE FINANCIAL DISTRESS.
FORM 990, PART VI, SECTION A, LINE 3
GREYSTONE MANAGEMENT IS AN UNRELATED BUSINESS ORGANIZATION ENGAGED BY THE CATHOLIC CARE CAMPUS, INC. BOARD OF DIRECTORS TO PROVIDE MANAGEMENT SERVICES. CHESTER SURMACZEWICZ IS EMPLOYED BY GREYSTONE AND SERVES AS PRESIDENT OF CATHOLIC CARE CAMPUS. MANAGEMENT DUTIES INCLUDE HIRING AND RECRUITING QUALIFIED PERSONNEL, PREPARING ANNUAL OPERATING BUDGETS FOR SUBMISSION TO THE BOARD OF DIRECTORS, AND ASSISTING IN THE PREPARATION OF MONTHLY AND ANNUAL FINANCIAL REPORTING DISCLOSURES. THE BOARD OF DIRECTORS HAVE FINAL AUTHORITY OVER THE APPROVAL OF THE ANNUAL OPERATING BUDGET, APPROVAL OF MONTHLY AND ANNUAL FINANCIAL REPORTING DISCLOSURES, AND OVERSIGHT OF THE MANAGEMENT COMPANY.
FORM 990, PART VI, SECTION A, LINE 6
THE ROMAN CATHOLIC ARCHBISHOP AND THE VICARS GENERAL OF THE ARCHDIOCESE OF KANSAS CITY, KANSAS ARE MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERS ELECT THE BOARD OF DIRECTORS AT EACH ANNUAL MEETING OR AT A SPECIAL MEETING IF A VACANCY OCCURS.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBERS MUST PROVIDE WRITTEN APPROVAL FOR ACTIONS BY THE GOVERNING BODY INVOLVING: AMENDING THE ARTICLES OF INCORPORATION; TRANSACTIONS INVOLVING THE PURCHASE, EXCHANGE OR DISPOSITION OF REAL ESTATE OR ENCUMBERING REAL PROPERTY; ANY MERGER, CONSOLIDATION, DISSOLUTION, LIQUIDATION OR TERMINATION OF THE CORPORATION; OR MAKING ANY EXPENDITURE, INVESTMENT, PURCHASE OF PERSONAL PROPERTY OR BORROWING FUNDS IN EXCESS OF STATED AMOUNTS.
FORM 990, PART VI, SECTION B, LINE 11B
THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. MEMBERS OF THE ORGANIZATION'S FINANCE COMMITTEE REVIEW THE FORM 990 AND ASSOCIATED SCHEDULES FOR ACCURACY AND COMPLETENESS. THE ORGANIZATION'S BOARD MEMBERS WILL BE PROVIDED COPIES OF THE FORM 990. THIS WILL ALL OCCUR PRIOR TO THE FORM BEING FILED WITH THE IRS.
FORM 990, PART VI, SECTION A, LINE 12C
Each new Director, Trustee or Manager shall, upon joining his or her respective Board, AND ANNUALY THEREAFTER, be given a copy of the conflict of interest policy and shall acknowledge, in writing, receipt of the policy and compliance therewith. Any Director who believes he or she may be in violation or potential violation, has a duty to report that fact to the Chair of the Board immediately upon becoming aware of the relevant facts. Any Director may recuse himself or herself at any time from involvement in any decision or discussion in which the Director believes s/he has or may have a conflict of interest, without going through the process for determining whether a conflict of interest exists. Any action taken by the Santa Marta Board which involves an "interested Director" must, to be valid, meet the following tests: a. it must be for Santa Marta's benefit; and b. it must be fair and reasonable at the time Santa Marta entered into it; and c. it must be approved by a majority of the Board without considering the vote, if cast, of the interested Director and only after disclosure of all material facts by the interested Director; and d. prior to authorizing the action the Board must have determined, after reasonable investigation, that Santa Marta could not obtain a more advantageous arrangement with reasonable effort, than the arrangement being approved.
FORM 990, PART VI, SECTION C, LINE 19
CATHOLIC CARE CAMPUS, INC.'S FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON THE ELECTRONIC MUNICIPAL MARKET ACCESS'S WEBSITE AT HTTP://EMMA.MSRB.ORG/. NO OTHER DOCUMENTS MADE AVAILABLE TO THE PUBLIC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.