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
ST ANNE'S HOME FOR THE ELDERLY MILWAUKEE INC
Employer identification number
39-0985045
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.") .
379,564
183,855
274,167
392,577
292,188
1,522,351
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......
11,158,111
11,354,605
11,215,952
10,779,728
10,897,217
55,405,613
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
87,721
136,831
89,512
151,222
140,644
605,930
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.
11,625,396
11,675,291
11,579,631
11,323,527
11,330,049
57,533,894
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.
8,758
8,758
c
Add lines 7a and 7b..
8,758
8,758
8
Public support (Subtract line 7c from line 6.)
57,525,136
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...
11,625,396
11,675,291
11,579,631
11,323,527
11,330,049
57,533,894
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
2,447
21,630
22,568
21,757
19,618
88,020
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
2,447
21,630
22,568
21,757
19,618
88,020
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.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
11,627,843
11,696,921
11,602,199
11,345,284
11,349,667
57,621,914
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
99.830 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.880 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.150 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.120 %
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
ST ANNE'S HOME FOR THE ELDERLY MILWAUKEE INC
Employer identification number
39-0985045
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION HAS ONE MEMBER, THE SISTERS OF THE DIVINE SAVIOR SPONSORSHIP CORPORATION, REFERRED TO AS THE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A
THE MISSION OF THE SISTERS OF THE DIVINE SAVIOR (SDS) SPONSORSHIP CORPORATION IS TO EXERCISE SPONSOR-LEVEL AUTHORITY OVER SIGNIFICANT DECISIONS MADE BY THE BOARD OF DIRECTORS, BUT NOT TO REPLACE DECISION-MAKING AUTHORITY OF THE BOARD OF DIRECTORS REGARDING DAY-TO-DAY OPERATIONS. THE CORPORATE MEMBER SHALL HAVE THE EXCLUSIVE POWER TO: A. APPOINT AND REMOVE ALL DIRECTORS OF THE CORPORATION. B. APPROVE ALL BUDGETS AND BUDGET REVISIONS OF THE CORPORATION. C. APPROVE THE ACQUISITION, LEASE, SALE, TRANSFER, ASSIGNMENT, OR ENCUMBRANCE OF THE ASSETS OF THE CORPORATION, OR THE INCURRENCE OF DEBT BY THE CORPORATION, IF THE AMOUNT INVOLVED IN ANY SUCH TRANSACTION IS IN EXCESS OF AN AMOUNT SPECIFIED FROM TIME TO TIME BY THE CORPORATE MEMBER. D. APPROVE ALL STRATEGIC PLANS FOR THE CORPORATION. E. APPOINT THE AUDITORS FOR THE CORPORATION. F. APPROVE THE ESTABLISHMENT OF ANY NEW AFFILIATE OR SUBSIDIARY OR THE ACQUISITION BY THE CORPORATION OF A NEW FACILITY OR LINE OF BUSINESS. G. APPROVE THE CLOSURE OF ANY INSTITUTION OR MAJOR MINISTRY OR WORK CONDUCTED BY THE CORPORATION. H. APPROVE THE APPOINTMENT, RETENTION AND REMOVAL BY THE BOARD OF THE PRESIDENT OF THE CORPORATION. I. APPROVE THE ADOPTION OF ANY PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION. J. APPROVE THE ADOPTION OR CHANGE OF THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION. K. APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B
SEE EXPLANATION ON SCHEDULE O FOR PART VI, SECTION A, LINE 7A.
FORM 990, PART VI, SECTION B, LINE 11
THE FINANCE COMMITTEE PERFORMS AN IN-DEPTH REVIEW OF THE FORM 990, FOLLOWED BY A REVIEW BY THE OTHER BOARD MEMBERS BEFORE IT IS APPROVED FOR SUBMISSION TO THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
EMPLOYEES AND MEMBERS OF THE BOARD OF DIRECTORS HAVE AN OBLIGATION TO CONDUCT BUSINESS WITHIN GUIDELINES THAT PROHIBIT ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. BUSINESS DEALINGS WITH OUTSIDE FIRMS SHOULD NOT RESULT IN UNUSUAL GAINS FOR THOSE FIRMS. AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST OCCURS WHEN AN EMPLOYEE OR BOARD MEMBER IS IN A POSITION TO INFLUENCE A DECISION THAT MAY RESULT IN A PERSONAL GAIN FOR THAT EMPLOYEE OR FOR A RELATIVE AS A RESULT OF ST. ANNE'S SALVATORIAN CAMPUS SASC INC.'S BUSINESS DEALINGS. FOR THE PURPOSE OF THIS POLICY, A RELATIVE IS ANY PERSON WHO IS A RELATED BY BLOOD OR MARRIAGE, OR WHOSE RELATIONSHIP WITH THE EMPLOYEE OR BOARD MEMBER IS SIMILAR TO THAT OF PERSON WHO ARE RELATED BY BLOOD OR MARRIAGE. IF EMPLOYEES HAVE ANY INFLUENCE ON TRANSACTIONS INVOLVING PURCHASES, CONTRACTS, OR LEASES, IT IS IMPERATIVE THAT THEY DISCLOSE TO AN OFFICER OF ST. ANNE'S SALVATORIAN CAMPUS SASC INC. AS SOON AS POSSIBLE THAT EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST SO THAT SAFEGUARDS CAN BE ESTABLISHED TO PROTECT ALL PARTIES. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION IS ESTABLISHED WITH THE USE OF INDEPENDENT COMPENSATION SURVEYS. THE EXECUTIVE DIRECTOR COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS. THE EXECUTIVE DIRECTOR APPROVES OTHER TOP MANAGEMENT'S COMPENSATION. DECISIONS ARE DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION BELIEVES CERTAIN GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART XII, LINE 2C
THE COMBINED FINANCIAL STATEMENTS OF ST. ANNE'S SALVATORIAN CAMPUS AND SASC, INC. ARE AUDITED BY AN INDEPENDENT ACCOUNTANT. THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT AUDITOR. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.