Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 16,155 | 154,885 | 134,406 | 279,258 | 70,595 | 655,299 |
| 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...... | 24,641,155 | 25,390,548 | 25,506,604 | 25,178,103 | 26,154,294 | 126,870,704 |
| 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. | 24,657,310 | 25,545,433 | 25,641,010 | 25,457,361 | 26,224,889 | 127,526,003 |
| 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. | 201,000 | 201,000 | ||||
| c | Add lines 7a and 7b.. | 201,000 | 201,000 | ||||
| 8 | Public support (Subtract line 7c from line 6.) | 127,325,003 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 24,657,310 | 25,545,433 | 25,641,010 | 25,457,361 | 26,224,889 | 127,526,003 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 25,769 | 20,735 | 15,881 | 15,247 | 15,005 | 92,637 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 25,769 | 20,735 | 15,881 | 15,247 | 15,005 | 92,637 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 24,683,079 | 25,566,168 | 25,656,891 | 25,472,608 | 26,239,894 | 127,618,640 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared by an independent certified public accounting firm. It is then reviewed by the controller and CPAs of the management company. The form 990 is given to each board member in advance of a scheduled meeting of the board for their review. There is discussion of the form 990 at the board meeting with the preparers and the management company's representative prior to board approval of the Form 990. |
| Form 990, Part VI, Section B, line 12c | Each member of the governing board annually completes a disclosure of conflict of interest questionnaire. |
| Form 990, Part VI, Section B, line 15 | Compensation is based on experience and market salary surveys and is annualized every year. |
| 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: | Loss on equity method of accounting for investment in outside project -119,285. |
| FORM 990, PART XII, LINE 2C - FINANCIAL STATEMENT PREPARATION: | The financial statements are prepared by an independent accounting firm. The statements are reviewed and approved by the board before being issued. This process was the same as last year. |
| Form 990, Part III, Line 4a, Program Service Accomplishments (continued) | Valley View Estates Health Care Center, Hamilton, Montana is a long-term care community that serves up to 98 older adults. A program where residents and children work side by side to create gift packages for disadvantaged children is just one of many intergenerational programs that helped this community win several awards for its innovative care from the Montana Health Care Association. Other programs and charitable initiatives provided by Valley View Estates Health Care Center to support the mission of ILHC include: Ravalli County Council on Aging Loan Closet donations of furniture and equipment, Operation Christmas Child in which 25 gift boxes were made, school supplies for Washington Elementary School, food donations for the Bitterroot Winter Special Olympics, donation of auction items twice a year for the Bitterroot Valley Chamber of Commerce, donation of prize items and book bags for the Bitterroot Library Summer Reading Program. Additional charitable initiatives include donation of food and paper products to area food banks, Haven House, Darby Bread Box and Pantry Partners; donation of used eye glasses to the Lions Club and hosting twice a month group meetings for the Alzheimer's Support Group. The Inn on Westport, Sioux Falls, South Dakota, offers a full range of care and services including independent living, assisted living, and memory care in 133 residences in a beautiful, park-like environment. Our goal is to have every resident at The Inn on Westport enjoy each day with the maximum independence and the highest quality of life, health and well-being. At The Inn on Westport, our "Aging in Place" philosophy allows residents to remain in their apartment home with health services delivered directly to them. We are the only retirement community in Sioux Falls and the surrounding areas to offer this unique experience. To support the mission of ILHC at this senior living community, students of all ages gather for various activities hosted by the local day cares, schools and churches. The Inn on Westport also supports the mission of ILHC through other various charitable initiatives such as: Rent Reduction-a program that offers reduced rates for residents to live at The Inn on Westport due to income qualifications. (Value: 2014 - $51,643) (Estimated value 2015: $47,580). Monetary Donations-cash donations were collected every Sunday through chapel services and used towards the following: The Banquet (meals for homeless), Hope Prison Mission, Gospel Mission, World Vision (world-wide missionary outreach), Gideon Bible donations, Achieve (school and work for developmentally disabled), and Salvation Army. (Value: $4,000). United Way Drive-an Inn on Westport employee chairs the annual drive for our building holding various fundraisers throughout the year. (Value: $2,000). Meals on Wheels-a program where an employee and a resident drive weekly to deliver noon meals to home bound elderly in the Sioux Fall community. (Value: $1,800). Alzheimer's and Parkinson's Associations-The Inn on Westport hosts events for both agencies and sponsors and participates in their annual fundraisers. (Value- $2,000)The Senior Concerrt Community Association (Value: $1,000). Holiday Clearing House-employees and residents adopt two families during the holidays and are given a list of needs and wants. Items are given or money is donated to purchase items and is presented in person. (Non-cash value: $1,000) (Non-cash). Center for Active Generations-sponsor monthly bingo with prizes and an annual quilt show at the local center for seniors and a community taste-testing event. (Value: $1,040). Goodwill Drive Donation-twice annually donations of clothing and household goods are promoted and gathered at IOW. Employees, residents and family members all participate in this event. (Value: $500) (Non-cash value) Ronald McDonald House-the Inn on Westport participates in a campaign to collect pop tabs for the Ronald McDonald House, which they in turn are able to use to raise funds. (Value: $150) (Non-cash). (Non-cash). Kiwanis Club-employees are members of local service club and residents attend special events as fundraisers. (Value: $200). Sponsor; Employee Scholarships- (Value- $3,000) |
| Form 990, Part III, Line 4a, Program Service Accomplishments (continued) | The Commons on Marice, Eagan, Minnesota is a gracious senior living community that offers 147 residences where seniors choose independent living, assisted living and care suites with around-the-clock staffing and personal and health-related services. The memory care c community cares for individuals with Alzheimer's disease and is designed with a residential feel to familiarize residents with their surroundings to maximize independence while maintaining a safe environment. The Commons on Marice offers what few other senior communities can, an opportunity to interact in meaningful ways with children. The Intergenerational Learning Center, located one block away, provides both children and older adults with extraordinary opportunities for sharing and learning where children six weeks to eight years of age, not only develop confidence, skills and self-esteem, they also build meaningful relationships with the residents of The Commons on Marice. In addition to the Intergenerational Learning Center, The Commons on Marice also supports the mission of ILHC through other various charitable initiatives such as: Elderly Waiver Program-the elderly waiver program is the Minnesota state Medicaid program for licensed assisted living facilities that choose to participate. The Commons on Marice discounted care services a total of $593,344 under the state Medicaid program in 2014. In 2015, The Commons on Marice will likely discount an estimated $510,000 for residents who live with us and receive elderly waiver services (Value: $528,000). Operation Christmas Child-a ministry of Samaritan's Purse whose headquarters are in South Carolina. We started participating in this program in 2008. In 2014, we packed 100 boxes. The value of each box is about $10-15. This year, boxes were packed with a variety of school supplies, clothing items (hats, gloves, and socks), personal hygiene items, and toys. Materials are purchased with offering money designated to Operation Christmas Child and residents help with shipping costs. This is our biggest outreach of the year with 40 residents participating (Value: $1500). Feed My Starving Children (FMSC) in Eagan, Minnesota-We go to FMSC three times a year. This is an organization that packs bags of a special highly nutritional rice and protein recipe and works with ministries around the world to serve hungry children. We have packed food and also gone to put labels on the bags. FMSC requests that volunteers make a donation when they volunteer to help cover costs. We don't do this but have supported this organization with money (Value: $1,500). We have also bundled and given cards that were made by our card making club. Supplies for the cards were purchased through the Activity budget (Value: $100). Community Education-The Commons on Marice does quarterly events for community education on various topics such as estate planning, insurance, coping with loss, etc. (Value: $400) (Non-cash). The Commons on Marice's residents braided tug toys for rescue dogs. The facility made 50 of these toys to benefit the animals helping others. (Value: $50). The Commons on Marice's made 100 laundry packets to benefit the Eagan Food Shelf. (Value: $75). The residents also assembled and delivered 100 lunch bags containing the following food items: meat and cheese sandwich; apple; small package of cookies; and bottle of water which was delivered to the Dorothy Day Center in St. Paul and the Eagan Women's Shelter. (Value: $100). The Eagan Resource Center benefitted from the resident's time and talents by double-bagging grocery bags, over 500 of them! (Value $50). St. Stephen's Human Services in Minneapolis received 50 pairs of tube socks stuffed with deodorant, toothbrush and toothpaste, bath gel and wash cloth for St. Stephen's to distribute to the area homeless. (Value $300). In addition to this project, the residents stuffed 50 2-gallon Ziploc bags with hygiene itmes: tube socks, boxer briefs, shampoo, comb, toothbrush/holder, toothpaste, washcloth, bar soap and deodorant for distribution to the area homeless men. (Value $300). The Commons on Marice's residents also benefited Dakota Woodlands Shelter in Eagan by sorting and assembling bags of six varieties of re-made greeting cards, with stamps for each of them. In addition to that, the resident's participated in a project called Birthday-in-a-bag filling 10 2-gallon Ziploc bags consisting of cake mix, birthday candles, balloons, paper plates/cups, napkins, birthday pencils, crayon, and a table centerpiece. (Value: $155). The residents and staff collected empty toilet paper rolls and made cat toys out of them, putting 4 cat treats inside each toy. This benefitted the "Saved by a Whisker" cat rescue program in Eagan. (Value: $35). The Open Door Pantry in Eagan was a food drive held at The Commons on Marice that collected 166 pounds of non-perishable food items. (Value: $250) Staff and residents assembled tote bags for toddler-age children for the Dakota Woodlands Shelter in Eagan. Each reusable bag contained 10 diapers, one package of baby wips, a sippy cup and a story book. (Value $125). Residents assembled Ziploc bags with feminine products, panties and socks to address an ongoing need at Simpson Housing Services. (Value $75) Arizona Grand Senior Living Community, Phoenix Arizona, is an independent living, assisted living, and skilled nursing facility. Arizona Grand Senior Living Community supports the mission of ILHC through charitable initiatives such as: Alzheimer's Association-fundraising events throughout the year (Estimated value: $200). Just Three Things (J3T) Foundation--Arizona Grand collects food items to be donated to area foster children and youth in transition programs for teens that would otherwise go without food. Just Three Things contacts Arizona Grand on a routine basis to update recommended "Just Three Things" donation items list and arrange pickup of donated items to distribute (estimated value $1,500). Donations in the way of furniture, walkers, televisions and other medical equipment were made to St. Vincent De Paul (Estimated value: $3,000). Arizona Grand also worked with a new charity called UMOM (woman's shelter) to donate Christmas gifts and backpacks (estimated value $700) for children residing in the shelter. |
| Related Organization Compensation: | Made an effort to obtain information on compensation, if any were paid from a related organization. No other compensation or transactions noted other than board compensation as listed on Form 990, Part VII Line 1a. |
| Form 990, Part VI, Section A, Line 1b - INDEPENDENT BOARD MEMBERS: | Denise Gustafson is compensated as an officer of the entity and an employee,therefore is not considered an independent board member. |
| Form 990, Part X, Line 12 - CLOSELY HELD COMPANY: | The entity owes a 50% equity in Northern Arizona Senior Living Community, LLC valued by the equity method. This investment does not meet the 5% of total assets threshold to be included on the Schedule D, Part X, but is considered a closely held company. |
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