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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 0 | 0 | 0 | 0 |
| 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...... | 358,617 | 369,064 | 371,184 | 362,170 | 381,775 | 1,842,810 |
| 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. | 358,617 | 369,064 | 371,184 | 362,170 | 381,775 | 1,842,810 |
| 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. | 112,543 | 112,957 | 225,500 | |||
| c | Add lines 7a and 7b.. | 112,543 | 112,957 | 225,500 | |||
| 8 | Public support. (Subtract line 7c from line 6.) | 1,617,310 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 358,617 | 369,064 | 371,184 | 362,170 | 381,775 | 1,842,810 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 400 | 146 | 114 | 83 | 40 | 783 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 400 | 146 | 114 | 83 | 40 | 783 |
| 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 VI.) .. | 4,423 | 4,450 | 4,692 | 13,565 | ||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 359,017 | 369,210 | 375,721 | 366,703 | 386,507 | 1,857,158 |
| 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) |
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| 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): |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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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 I, LINE 1 | PROVIDE ELDERLY AND HANDICAPPED PERSONS WITH FACILITIES AND SERVICES DESIGNED TO MEET THEIR PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS, AND PROMOTE HEALTH, SECURITY, HAPPINESS AND USEFULNESS IN LONGER LIVING. FORM 990, PART III, LINE 3 HICKORY HOMES, INC. WAS DISSOLVED INTO KIDRON, INC. WITH A FINAL DATE OF DECEMBER 31, 2015. BOTH ENTITIES WERE DESIGNED FOR PERSONS AGE 62 AND OLDER AND THOSE WITH DEVELOPMENTAL OR PHYSICAL DISABILITIES, EACH OF WHICH MEET LOW INCOME LEVEL QUALIFICATIONS. THE LOAN AGREEMENT WITH HUD REQUIRES COMPLIANCE WITH CERTAIN REGULATORY REQUIREMENTS INCLUDING DEPOSITS FOR RESIDUAL RECEIPTS AND RESERVE FOR REPLACEMENTS. THE ENTITIES SHARE COMMON MANAGEMENT AND HAVE OVERSIGHT PROVIDED BY THE SAME BOARD OF DIRECTORS. FORM 990, PART V, LINE 2A THE CONTRACT LABOR AMOUNTS INCLUDED IN FORM 990, PART IX, LINE 11G ARE A REIMBURSEMENT TO BLUESTEM COMMUNITIES MANAGEMENT, INC., A 501(C)(3) RELATED ORGANIZATION, FOR EMPLOYEES PERFORMING SERVICES ON BEHALF OF THE MANAGEMENT COMPANY. BCMI REPORTS ALL OF THE SALARIES AND BENEFITS AND ISSUES ALL W-2'S FOR THE EMPLOYEES. FORM 990, PART VI, SECTION A, LINE 2 ALL OFFICERS AND DIRECTORS HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES TO BLUESTEM COMMUNITIES MANAGEMENT, INC, A RELATED 501(C)(3) ORGANIZATION. THESE DUTIES INCLUDE: 1) THE AUTHORITY TO HIRE, DISCHARGE, OR PAY ANY EMPLOYEES, 2) THE ABILITY TO CARRY OUT MARKETING ACTIVITIES, 3) THE ABILITY TO OFFER FOR RENT THE DWELLING UNITS, COMMERCIAL SPACE AND OTHER RENTAL FACILITIES AND CONCESSIONS IN THE PROJECT, 4) THE ABILITY TO COLLECT ALL RENTS, CHARGES, AND OTHER AMOUNTS RECEIVABLE ON THE OWNER'S ACCOUNT IN CONNECTION WITH THE MANAGEMENT AND OPERATION OF THE PROJECT, 5) THE AUTHORITY TO SECURE FULL COMPLIANCE BY EACH TENANT WITH THE TERMS OF HIS/HER LEASE, 6) THE ABILITY TO PREPARE ANNUAL OPERATING BUDGETS FOR THE PROJECT AND APPROVED BY THE OWNER. |
| FORM 990, PART VI, SECTION A, LINE 6 | BLUESTEM COMMUNITIES, INC., A NOT-FOR-PROFIT 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF HICKORY HOMES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | BLUESTEM COMMUNITIES, INC., AS THE SOLE MEMBER OF HICKORY HOMES, INC. HAS THE POWER TO ELECT OR APPOINT THE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | BLUESTEM COMMUNITIES, INC., AS THE SOLE MEMBER OF HICKORY HOMES, INC. HAS THE POWER TO MAKE GOVERNANCE DECISIONS OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE FORM 990 IS THEN REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD. THE CFO OF THE RELATED ORGANIZATION IS AVAILABLE TO ANSWER ANY QUESTIONS OR PROVIDE CLARIFICATION. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS ANNUALLY REVIEW AND SIGN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ACTUAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO THE BOARD. AFTER DISCLOSURE AND DISCUSSION OF THE CONFLICT, THE INTERESTED PERSON MUST LEAVE THE MEETING WHILE THE REMAINING BOARD MEMBERS DISCUSS AND VOTE ON WHETHER A CONFLICT EXISTS. IF A CONFLICT DOES EXIST, THE BOARD WILL DETERMINE WHETHER THEY CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF THAT IS NOT REASONABLY POSSIBLE, THE DISINTERESTED MEMBERS WILL VOTE TO DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE, IN THE ORGANIZATION'S BEST INTEREST, A TO THE ORGANIZATION'S BENEFIT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE SUBCOMMITTEE OF THE BOARD OF BLUESTEM COMMUNITIES, INC., THE CONTROLLING ORGANIZATION, ANNUALLY REVIEWS THE CEO'S COMPENSATION, USING THE LEADING AGE KANSAS WAGE AND SALARY SURVEY REPORT AND THEN PRESENTS THEIR RECOMMENDATION TO THE FULL BOARD. THIS REVIEW WAS LAST PERFORMED IN 2015 AND WAS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15B THE CEO ANNUALLY REVIEWS COMPENSATION FOR THE CFO AND COO USING THE SAME LEADING AGE KANSAS WAGE AND SALARY SURVEY REPORT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE NOT TYPICALLY AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9 | TRANSFER OF FIXED ASSETS (48,207) |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MANAGER & OFFICE SALARIES TOTAL FEES:48287 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:JANITOR & CLEANING CONTRACT TOTAL FEES:23845 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER CONTRACTS TOTAL FEES:13397 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:GROUNDS CONTRACT TOTAL FEES:10924 |
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