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
HOMESTEAD VILLAGE INC
Employer identification number
23-2010104
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.") .
241,143
859,671
206,868
136,221
131,448
1,575,351
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......
12,100,832
11,469,167
12,308,056
13,828,978
14,348,552
64,055,585
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
137,866
118,126
132,265
129,890
144,083
662,230
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.
12,479,841
12,446,964
12,647,189
14,095,089
14,624,083
66,293,166
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
10,887
124,406
10,000
5,000
150,293
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..
10,887
124,406
10,000
5,000
150,293
8
Public support (Subtract line 7c from line 6.)
66,142,873
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...
12,479,841
12,446,964
12,647,189
14,095,089
14,624,083
66,293,166
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
185,960
295,889
312,842
291,658
287,476
1,373,825
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
185,960
295,889
312,842
291,658
287,476
1,373,825
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
166,915
42,127
42,753
53,306
77,479
382,580
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
1,966
2,203
96
1,513
5,123
10,901
13
Total support. (Add lines 9, 10c, 11, and 12.)..
12,834,682
12,787,183
13,002,880
14,441,566
14,994,161
68,060,472
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
97.180 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
97.150 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.020 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.900 %
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
HOMESTEAD VILLAGE INC
Employer identification number
23-2010104
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
ALL DIRECTORS HAVE THE SAME VOTING RIGHTS. THE BYLAWS GIVE THE EXECUTIVE COMMITTEE THE POWER TO ACT WITH THE FULL AUTHORITY OF THE BOARD BETWEEN MEETINGS. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE MUST BE REPORTED AT THE NEXT BOARD OF DIRECTORS MEETING.
FORM 990, PART VI, SECTION B, LINE 11
HOMESTEAD VILLAGE'S CFO PERFORMS THE INITIAL COMPANY REVIEW OF THE FORM 990 PREPARED BY INDEPENDENT ACCOUNTANTS. THE FORM 990 IS THEN PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW. AFTER THE FINANCE COMMITTEE'S REVIEW, EVERY MEMBER OF THE BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 FOR REVIEW BEFORE THE RETURN IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
ARTICLE III, SECTION 13 OF HOMESTEAD VILLAGE'S BY-LAWS DEALS WITH CONFLICT OF INTEREST FOR BOARD MEMBERS. ALL MEMBERS OF THE BOARD OF DIRECTORS SHALL BE APPRISED OF THE FIDUCIARY OBLIGATIONS OF THEIR POSITION AS A MEMBER OF THE BOARD AND OF THEIR RESPONSIBILITY TO THE CORPORATION TO REFRAIN FROM PARTICIPATING IN ANY ACTION THAT IS A CONFLICT OF INTEREST IN THEIR DIRECTOR RELATIONSHIP TO THE CORPORATION. EACH MEMBER OF THE BOARD SHALL BE REQUIRED TO EXECUTE ANNUALLY A CONFLICT OF INTEREST STATEMENT IN A FORM TO BE PREPARED AND MAINTAINED BY THE OFFICE OF THE PRESIDENT OF THE CORPORATION. DIRECTORS ARE REQUIRED TO DISCLOSE ANY RELATIONSHIPS THEY MAY HAVE WITH OTHER DIRECTORS, OFFICERS, AND ENTITIES THAT DO BUSINESS WITH HOMESTEAD VILLAGE, ETC. ANY DIRECTOR OR OFFICER WITH A CONFLICT WILL ABSTAIN FROM VOTING ON ANY MATTER THAT INVOLVES THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15
THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE PERFORMANCE OF HOMESTEAD VILLAGE'S CEO. IT USES THE LEADING AGE SALARY SURVEY AS A GUIDE WHEN DETERMINING THE RATE OF INCREASE IN THE CEO'S COMPENSATION. INCREASES ARE MERIT-BASED AND THE PROCESS INCLUDES A REVIEW BY THE EXECUTIVE COMMITTEE OF THE GOALS SET FOR THE PRESIDENT FOR THE PAST YEAR AND THE PROGRESS MADE TOWARD ACHIEVING THOSE GOALS. NEW GOALS FOR THE UPCOMING YEAR ARE ESTABLISHED AS PART OF THE REVIEW PROCESS. THE CHAIRMAN OF THE BOARD OF DIRECTORS COMMUNICATES IN WRITING TO THE CHIEF FINANCIAL OFFICER ANY INCREASE IN COMPENSATION FOR THE PRESIDENT. THE CHIEF FINANCIAL OFFICER SHARES THE COMMUNICATION WITH HOMESTEAD VILLAGE'S DIRECTOR OF HUMAN RESOURCES. ALL OTHER EMPLOYEES OF HOMESTEAD VILLAGE HAVE THEIR PERFORMANCE REVIEWED ANNUALLY BY THEIR SUPERVISORS. PAY INCREASES ARE DETERMINED BY THE RESULTS OF THAT REVIEW. ANY PAY INCREASE OR DECREASE VARYING FROM THE COMPANY MEDIAN MUST BE APPROVED BY THE CEO. THE DIRECTOR OF HUMAN RESOURCES ALSO EXAMINES THE ANNUAL PERFORMANCE REVIEWS. THE CEO AND DIRECTOR OF HUMAN RESOURCES COMPARE WAGE AND SALARY LEVELS ANNUALLY TO INDUSTRY AVERAGES USING A TRADE ASSOCIATION SALARY SURVEY. A NEW BOARD COMMITTEE HAS BEEN FORMED TO DEAL WITH HUMAN RESOURCE ISSUES AND WILL BECOME INVOLVED IN SALARY DECISIONS FOR KEY EMPLOYEES. THE OCCURRENCE OF THEIR MEETING IS RECORDED IN THE MINUTES OF THE SUBSEQUENT MEETING OF THE FULL BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19
THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G
TEMPORARY PERSONNEL: PROGRAM SERVICE EXPENSES 59,374. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,374. CONSULTING FEES: PROGRAM SERVICE EXPENSES 1,652,222. MANAGEMENT AND GENERAL EXPENSES 35,515. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,687,737. AMBULANCE SERVICES: PROGRAM SERVICE EXPENSES 4,220. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,220. BEAUTY/BARBER: PROGRAM SERVICE EXPENSES 93,256. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,256. LABORATORY AND RADIOLOGY: PROGRAM SERVICE EXPENSES 69,302. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 69,302. OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 121,406. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 121,406. PHARMACY FEES: PROGRAM SERVICE EXPENSES 165,534. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,534. PHYSICAL AND SPEACH THERAPY: PROGRAM SERVICE EXPENSES 460,674. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 460,674.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.