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 CROSS ROAD REST & RETIREMENT CENTER INC
Employer identification number
58-1491011
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.") .
131,699
57,847
15,026
95,713
12,364
312,649
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......
4,785,144
4,820,210
5,081,180
5,118,087
4,765,870
24,570,491
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
839
417
353
348
505
2,462
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.
4,917,682
4,878,474
5,096,559
5,214,148
4,778,739
24,885,602
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
24,885,602
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...
4,917,682
4,878,474
5,096,559
5,214,148
4,778,739
24,885,602
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
4,138
3,874
6,406
5,155
5,146
24,719
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
4,138
3,874
6,406
5,155
5,146
24,719
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
10,965
15,500
2,792
2,290
31,547
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
24,947
24,386
523
460
47,951
98,267
13
Total support. (Add lines 9, 10c, 11, and 12.)..
4,957,732
4,922,234
5,106,280
5,222,053
4,831,836
25,040,135
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
99.380 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.320 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
1.000 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.000 %
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 CROSS ROAD REST & RETIREMENT CENTER INC
Employer identification number
58-1491011
Return Reference
Explanation
FORM 990 - ORGANIZATION'S MISSION
CROSS ROAD REST & RETIREMENT CENTER IS DEDICATED TO PROVIDING EXCEPTIONAL RESIDENTIAL, HEALTH AND OUTREACH SERVICES. OUR QUALIFIED AND CARING TEAM SERVES OUR RESIDENTS WITH RESPECT AND DIGNITY IN AN ATMOSPHERE OF LOVE. AS A NON-PROFIT CHRISTIAN MINISTRY, WE ARE COMMITTED TO THE CHANGING NEEDS OF SENIORS AND THEIR FAMILIES.
FORM 990, PAGE 2, PART III, LINE 3
THE BOND ISSUANCE EXECUTED IN OCTOBER, 2006 WAS REFINANCED VIA BANK FINANCING ON DECEMBER 19, 2013. AS A RESULT OF THE EARLY EXTINGUISHMENT OF THE BONDS A LOSS WAS INCURRED OF 116,509 WHICH IS REFLECTED AS AN "OTHER CHANGE IN NET ASSETS" PER THE AUDITED FINANCIAL STATMENTS AND REPORTED ON PART XI OF THIS FORM 990.
FORM 990, PART VI
RE: PART VI, QUESTION 9: SEE REFERENCE TO FINANCE DIRECTOR TRANSITION UNDER SCH. O, PART VII
FORM 990, PAGE 6, PART VI, LINE 9
LEANNE SAUNDERS
FORM 990, PAGE 6, PART VI, LINE 11B
A COPY OF A DRAFT VERSION OF THE RETURN IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT DURING A PERIODIC BOARD MEETING. AS PART OF THE REVIEW PROCESS, DIRECTORS ARE PROVIDED AN OPPORTUNTIY TO POSE QUESTIONS AND REQUEST ADDITIONAL DETAILS OR CLARIFICATION FROM THE ORGANIZATION'S OFFICERS AS WELL AS EXTERNAL ACCOUNTANTS.
FORM 990, PAGE 6, PART VI, LINE 12C
THE CONFLICT OF INTEREST POLICY FOR THE ORGANIZATION IS COMMUNICATED TO EACH EMPLOYEE DURING THE ORIENTATION. IN ADDITION, MONTHLY MANAGEMENT MEETINGS ARE HELD WHERE AN OPPORTUNITY IS PROVIDED FOR DISCUSSION OF NEW PROFESSIONAL OR PERSONAL RELATIONSHIPS THAT MAY REPRESENT POTENTIAL CONFLICTS OF INTEREST FOR THE ORGANIZATION OR ITS EMPLOYEES. ALSO, THE ORGANIZATION'S HUMAN RESOURCE FUNCTION PROVIDES OVERSIGHT AS TO ONGOING ADHERENCE WITH THE CONFLICT OF INTEREST POLICY.
FORM 990, PAGE 6, PART VI, LINE 15A
ANNUALLY THE BOARD OF DIRECTORS INDEPENDENTLY REVIEWS THE COMPENSATION LEVEL FOR THE EXECUTIVE DIRECTOR. THE BOARD STRIVES TO MAINTAIN A REASONABLE COMPENSATION LEVEL FOR ITS EXECUTIVE DIRECTOR, RELYING ON THEIR COLLECTIVE AND INDIVIDUAL EXPERIENCE IN THE INDUSTRY, KNOWLEDGE OF COMPENSATION AMOUNTS FOR SIMILAR ORGANIZATIONS, SUBSTANTIVE SALARY CRITERIA, PERFORMANCE EVALUATION AND OTHER DISCRETIONARY FACTORS.
FORM 990, PAGE 6, PART VI, LINE 15B
THE EXECUTIVE DIRECTOR IS RESPONSIBLE FOR SETTING THE COMPENSATION LEVEL FOR THE FINANCE DIRECTOR AND OTHER DEPARTMENT MANAGERS. THE EXECUTIVE DIRECTOR STRIVES TO MAINTAIN REASONABLE COMPENSATION BY GIVING CONSIDERATION TO PERSONAL KNOWLEDGE OF THE CURRENT COMPENSATION ARRANGEMENTS IN THE NOT-FOR-PROFIT WORKPLACE, SUBSTANTIVE SALARY CRITERIA, PERFORMANCE EVALUATION AND BENCHMARKS, AND OTHER RELEVANT DISCRETIONARY FACTORS.
FORM 990, PAGE 6, PART VI, LINE 19
REQUESTS FOR COPIES OF PUBLIC INFORMATION MAY BE MADE TO THE ORGANIZATION'S FINANCE DEPARTMENT. ALL REQUESTS ARE HONORED WITHIN A REASONABLE PERIOD OF TIME.
FORM 990, PART VII
TRANSITION OF FINANCE DIRECTOR POSITION: LEANNE SAUNDERS IS LISTED AS A "FORMER" OFFICER AS SHE VOLUNTARILY TERMINATED HER EMPLOY IN DECEMBER, 2012 AND RECEIVED HER FINAL FORM W-2 IN 2013. SHE WAS SUCCEEDED BY JOE DEATON, WHO WAS SUBSEQUENTLY REPLACED BY BY THE CURRENT FINANCE DIRECTOR BOBBIE TORAIN IN JANUARY 2014
FORM 990, PART XI, LINE 9
EXPENSES RELATED TO RENTAL PROPERTY 49,768 EXPENSES RELATED TO VENDING MACHINE SALES 2,201 EXPENSES RELATED TO GENERAL STORE 61,491 EXPENSES RELATED TO RENTAL PROPERTY -49,048 EXPENSES RELATED TO VENDING MACHINE REPORTED WITH REVENUES -2,201 EXPENSES RELATED TO GENERAL STORE -61,491
FORM 990, PART XI, LINE 9
LOSS ON REFINANCING OF LONG-TERM DEBT 116,509 AN ADJUSTMENT IS INCLUDED REFLECTING A DEPRECIATION DIFFERENCE BETWEEN TAX RETURN AND BOOK ATTRIBUTABLE TO THE DAYCARE RENTAL IN ORDER TO PROPERLY ROLLFORWARD NET ASSETS BALANCE AT END OF YEAR. A 7 ADJUSTMENT TO THE BEGINNING OF YEAR NET ASSETS IS ALSO INCLUDED TO ACCOUNT FOR ROUNDING BETWEEN THE PRIOR YEAR TAX RETURN AND AUDITED FINANCIAL STATEMENTS IN ORDER TO PROPERLY RECONCILE NET ASSETS PER THE CURRENT YEAR TAX RETURN AND YEAR-END AUDITED FINANCIAL STATEMENTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.