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.") . | 1,950 | 252,724 | 125,885 | 850 | 6,273 | 387,682 |
| 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...... | 13,246,858 | 13,290,561 | 13,779,791 | 13,765,753 | 13,758,196 | 67,841,159 |
| 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. | 13,248,808 | 13,543,285 | 13,905,676 | 13,766,603 | 13,764,469 | 68,228,841 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 84,159 | 85,775 | 90,063 | 55,823 | 0 | 315,820 |
| 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 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 84,159 | 85,775 | 90,063 | 55,823 | 0 | 315,820 |
| 8 | Public support (Subtract line 7c from line 6.) | 67,913,021 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 13,248,808 | 13,543,285 | 13,905,676 | 13,766,603 | 13,764,469 | 68,228,841 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 416,224 | 121,699 | 134,763 | 137,457 | 184,919 | 995,062 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 10a and 10b. | 416,224 | 121,699 | 134,763 | 137,457 | 184,919 | 995,062 |
| 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.) .. | 46,788 | 46,526 | 83,739 | 107,401 | 107,376 | 391,830 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 13,711,820 | 13,711,510 | 14,124,178 | 14,011,461 | 14,056,764 | 69,615,733 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 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 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 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) |
||||
| 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) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
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 |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12 Other Income | DESCRIPTION - MISCELLANEOUS INCOME, COLUMN A - 10788.0, COLUMN B - 10526.0, COLUMN C - 27565.0, COLUMN D - 39888.0, COLUMN E - 46729.0, COLUMN F - 135496.0; DESCRIPTION - MANAGEMENT FEE, COLUMN A - 36000.0, COLUMN B - 36000.0, COLUMN C - 28501.0, COLUMN D - 36000.0, COLUMN E - 36000.0, COLUMN F - 172501.0; DESCRIPTION - GUEST APARTMENT, COLUMN A - , COLUMN B - , COLUMN C - 26719.0, COLUMN D - 31057.0, COLUMN E - 23257.0, COLUMN F - 81033.0; DESCRIPTION - VENDING REVENUE, COLUMN A - , COLUMN B - , COLUMN C - 954.0, COLUMN D - 456.03, COLUMN E - 1390.0, COLUMN F - 2800.03; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
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 III, Line 4d Description of other program services | (Expenses $ 1,008,906 including grants of $)(Revenue $ 1,090,649) THE ASSISTED LIVING PROGRAM PROVIDES THE OPPORTUNITY FOR RESIDENTS TO LIVE LIFE AS INDEPENDENTLY AS POSSIBLE, ON THEIR OWN TERMS, IN THEIR OWN PRIVATE APARTMENTS. RESIDENTS SET THEIR OWN SCHEDULES AND ENJOY THEIR OWN LIFESTYLE WITH THE CONFIDENCE THAT COMES FROM KNOWING HELP IS THERE IF EVER NEEDED. |
| Form 990, Part VI, Line 15b PROCESS USED TO DETERMINE COMPENSATION FOR OTHER OFFICERS | THE EXECUTIVE DIRECTOR CONDUCTS ANNUAL PERFORMANCE REVIEWS OF THE ORGANIZATION'S OTHER OFFICERS (ADMINISTRATOR & FINANCE DIRECTOR ). THE BOARD THEN DETERMINES COMPENSATION FOR THESE OFFICERS BASED IN PART UPON THE REVIEW PERFORMED BY THE EXECUTIVE DIRECTOR AS WELL AS COMPARABILITY DATA. THE DETERMINATION AND APPROVAL OF THE COMPENSATION IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE ORGANIZATION, INDEPENDENT OF THE BOARD OF DIRECTORS. IN DETERMINING THE OFFICER'S COMPENSATION PACKAGE, THE EXECUTIVE DIRECTOR USED AHSA. THESE TABLES WERE USED AS REFERENCE POINTS TO THE SALARIES OF THE SENIOR MANAGEMENT AND RAISES WERE CALCULATED BASED ON THESE FACTORS. THE INFORMATION WAS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AT THE JANUARY BOARD MEETING WITH THE DIRECTION THAT THE SENIOR MANAGEMENT WILL FORGO ANY COMPENSATION ADJUSTMENT TO BE CONSISTENT WITH ACTIONS TAKEN WITH THE STAFF OF MONTGOMERY PLACE. THE DECISION TO FORGO COMPENSATION ADJUSTMENTS WAS PRESENTED TO THE BOARD DURING THE BUDGET PRESENTATION. |
| Form 990, Part VI, Line 15a PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL | IN DETERMINING THE EXECUTIVE DIRECTOR'S COMPENSATION PACKAGE, THE EXECUTIVE COMMITTEE USED AN AHSA SURVEY . THESE TABLES WERE USED AS REFERENCE POINTS TO THE SALARIES OF THE SENIOR MANAGEMENT AND RAISES WERE CALCULATED BASED ON THESE FACTORS. THE INFORMATION WAS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AT THE JANUARY BOARD MEETING WITH THE DIRECTION THAT THE CEO WILL FORGO ANY COMPENSATION ADJUSTMENT TO BE CONSISTENT WITH ACTIONS TAKEN WITH THE STAFF OF MONTGOMERY PLACE. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | THE BOARD SHALL HAVE THE RIGHT TO CREATE AN EXECUTIVE COMMITTEE COMPRISED OF BOARD MEMBERS SUBJECT TO THE FOLLOWING: A. THE EXECUTIVE COMMITTEE WOULD BE CHARGED WITH ALL DUTIES AND RESPONSIBILITIES OF THE BOARD AND WOULD BE AUTHORIZED AND EMPOWERED TO ACT ON BEHALF OF THE BOARD BETWEEN ITS REGULAR OR SPECIAL MEETINGS. THE EXECUTIVE COMMITTEE, HOWEVER, WOULD NOT BE PERMITTED TO ADOPT A PLAN FOR DISTRIBUTION OF CORPORATION ASSETS OR FOR DISSOLUTION; APPROVE OR RECOMMEND TO THE BOARD OF DIRECTORS ANY ACT REQUIRING APPROVAL BY THE BOARD OF DIRECTORS PURSUANT TO THE ILLINOIS GENERAL NOT FOR PROFIT CORPORATION ACT OF 1986, AS MAY BE AMENDED FROM TIME TO TIME; FILL VACANCIES ON THE BOARD; ADOPT A PLAN OF MERGER OR CONSOLIDATION; AUTHORIZE THE SALE, LEASE, EXCHANGE, OR MORTGAGE OF ALL OR SUBSTANTIALLY OF THE PROPERTY OR ASSETS OF THE CORPORATION; ALTER, AMEND, RESTATE OR REPEAL THE BY-LAWS; OR BORROW FUNDS ON BEHALF OF THE CORPORATION; AND B. ANY ACTION OF THE EXECUTIVE COMMITTEE HEREIN AUTHORIZED WOULD BE REQUIRED TO BE REPORTED TO THE BOARD AT ITS NEXT MEETING. THE COMMITTEE WOULD MEET UPON CALL OF ITS CHAIRPERSON OR A MAJORITY OF ITS MEMBERS. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The full Form 990, including all applicable schedules, is reviewed by the organization's management and members of the finance committee of the Montgomery place board of directors. Subsequent to this review, a copy of the final form 990 is distributed to each member of the organization's board of directors prior to filing with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The organization's conflict of interest policy covers all officers, directors, trustees and key employees (interested persons). The board annually reviews the policy on conflicts of interests and asks all interested persons to disclose any conflicts that might exist. If it is determined that an interested person has a conflict of interest with the organization, the interested person will be asked to excuse themselves from the discussions and decisions that are made in regards to the transaction where a conflict exists. |
| Form 990, Part VI, Line 19 Required documents available to the public | Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | activities and services rrelated to residents - Total Revenue: 46729, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 46729; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |