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 | |||||
| (A)
MESSIAH HOME DBA MESSIAH VILLAGE |
231458000 | 9 | Yes | 0 | 0 | |
| Total 1 | 0 | 0 | ||||
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.") . | ||||||
| 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...... | ||||||
| 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. | ||||||
| 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 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.).. | ||||||
| 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 | ||||
| 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 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 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) |
||||
| 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) |
||||
|
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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| 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 III, LINE 3 | CAPITAL AREA HEALTH ASSOCIATES BEGAN OPERATING IN 2005 AND, OVER THE PAST DECADE, THEY HAVE OFFERED GREAT CONTINUITY OF CARE FOR MESSIAH VILLAGE RESIDENTS. HOWEVER, IN THOSE 10 YEARS, THE PHYSICIAN PRACTICE INDUSTRY HAS CHANGED DRAMATICALLY. THE REGULATORY STANDARDS, QUALITY REPORTING MEASURES, AND BILLING AND REIMBURSEMENT PRACTICES ARE VASTLY DIFFERENT FROM THOSE IN THE SENIOR LIVING INDUSTRY. ON DECEMBER 15, 2015, THE MESSIAH LIFEWAYS BOARD OF DIRECTORS VOTED TO CEASE OPERATIONS OF CAHA. THE BOARD DETERMINED THAT THE BEST COURSE FOR ALL PARTIES IS TO FORM ALLIANCES OR PARTNERSHIPS THAT WILL BRING PHYSICIAN SERVICES TO THE MESSIAH VILLAGE CAMPUS. THE INTENT WAS THAT THE PARTNERSHIP WOULD EASE THE BURDEN OF TWO PHYSICIANS SHARING RESPONSIBILITY FOR ROUND-THE-CLOCK CARE OF 700 RESIDENTS, HELP MINIMIZE OPERATING LOSS, AND ALLOW MESSIAH LIFEWAYS TO FOCUS ON OUR PRIMARY MODE OF PROVIDING OUTSTANDING SENIOR CARE IN EXISTING CORE SERVICE AREAS. OPERATIONS OFFICIALLY CEASED ON APRIL 1, 2016. ADMINISTRATIVE RESPONSIBILITIES RELATED TO COLLECTION OF ACCOUNTS RECEIVABLE AND PAYMENT OF LIABILITIES CONTINUE. THE BOARD ANTICIPATES IT WILL VOTE TO DISSOLVE THE ENTITY DURING FISCAL 2017. |
| FORM 990, PART VI, SECTION A, LINE 1B: | CAPITAL AREA HEALTH ASSOCIATES ("CAHA") HAD TWO (2) INDEPENDENT BOARD MEMBERS THROUGHOUT FISCAL YEAR 2016. AT YEAR END, THERE WERE NO INDEPENDENT BOARD MEMBERS. CAHA CEASED OPERATIONS DURING FISCAL YEAR 2016. CAHA WILL BE OVERSEEN BY ITS PARENT ENTITY MESSIAH LIFEWAYS AT MESSIAH VILLAGE ("MESSIAH VILLAGE") AND BY MESSIAH VILLAGE'S PARENT MESSIAH LIFEWAYS. |
| FORM 990, PART VI, SECTION A, LINE 3 | THERE IS A MANAGEMENT AGREEMENT BETWEEN CAHA AND ITS AFFILIATE, MESSIAH LIFEWAYS, FOR CERTAIN MANAGEMENT FUNCTIONS, INCLUDING ACCOUNTING, HR, ADMINISTRATION, INFORMATION SERVICES, ETC. |
| FORM 990, PART VI, SECTION A, LINE 6 | MESSIAH HOME D/B/A MESSIAH LIFEWAYS AT MESSIAH VILLAGE ("MESSIAH VILLAGE") IS THE SOLE MEMBER OF CAPITAL AREA HEALTH ASSOCIATES. |
| FORM 990, PART VI, SECTION A, LINE 7A | IN ACCORDANCE WITH THE BYLAWS OF CAPITAL AREA HEALTH ASSOCIATES (CAHA), THE MEMBER (MESSIAH VILLAGE) SHALL HOLD AN ANNUAL MEETING TO ELECT THE DIRECTORS OF CAHA. |
| FORM 990, PART VI, SECTION A, LINE 7B | MESSIAH VILLAGE, THE SOLE MEMBER OF THE CORPORATION, MUST APPROVE THE FOLLOWING: - BORROWINGS OVER $10,000; - ENTERING INTO ANY LEASES WHICH WOULD OBLIGATE THE CORPORATION TO MAKE RENTAL PAYMENTS IN EXCESS OF $10,000/YEAR; - UNDERTAKING ANY CAPITAL EXPENDITURES IN EXCESS OF $5,000; - AMENDING THE CORPORATION'S ARTICLES OF INCORPORATION OR THE BYLAWS; - SELLING, RELINQUISHING OR OTHERWISE AUTHORIZING A CHANGE IN CONTROL OF MORE THAN 10% OF THE ASSETS OF THE CORPORATION; - AUTHORIZING FUNDAMENTAL CHANGES TO THE CORPORATION, INCLUDING THE ADOPTION OF A PLAN OF DISSOLUTION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | MANAGEMENT REVIEWED THE FORM 990 IN DETAIL. THE FORM 990 WAS THEN POSTED ON THE BOARD WEBSITE FOR MEMBER ACCESS AND REVIEW. DURING THEIR NOVEMBER MEETING OF THE FINANCE & SHARED SERVICES COMMITTEE OF THE MESSIAH LIFEWAYS BOARD, THE FORMS 990 OF MESSIAH LIFEWAYS AND EACH OF ITS CONTROLLED ENTITIES WERE REVIEWED BEFORE BEING FILED WITH THE IRS. THE REVIEW WAS LED BY THE CFO. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY BOARD MEMBERS AND EXECUTIVE TEAM AFFIRM IN WRITING THEIR AWARENESS AND COMPLIANCE WITH THE CODE OF ETHICS AND CONDUCT POLICY AND CONFLICT OF INTEREST POLICY. ALL ARE ASKED TO DISCLOSE ANY CONFLICTS OF INTEREST AND AGREE TO REFRAIN FROM PARTICIPATING IN ANY DELIBERATIONS, DECISIONS, OR VOTING RELATING TO THE MATTER. THE POLICY IS MONITORED BY MANAGEMENT OF MESSIAH LIFEWAYS (KARL BRUMMER, VP OF HR, CSS & ENRICHMENT) BY VERIFYING ALL FORMS ARE COMPLETED AND SIGNED ANNUALLY. ANY VIOLATIONS OF THE POLICY WILL BE HANDLED AS DEEMED NECESSARY IN ACCORDANCE WITH THE POLICY. ANY MEMBER WHO INTENTIONALLY VIOLATES THE POLICY MAY BE REMOVED FROM THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE MESSIAH LIFEWAYS BOARD OF DIRECTORS HAS A "PRESIDENTIAL RELATIONS COMMITTEE" WHICH CONDUCTS AN ANNUAL REVIEW OF THE PRESIDENT. THIS COMMITTEE HAS THE SAME COMPOSITION AS THE EXECUTIVE COMMITTEE. IN ADDITION TO ESTABLISHING THIS COMMITTEE THE BOARD HAS ESTABLISHED A POLICY TO GUIDE THE WORK OF THE COMMITTEE. THE PURPOSE OF THE COMMITTEE IS TO CONDUCT THE ANNUAL PERFORMANCE EVALUATION OF THE PRESIDENT, REVIEW PAST GOALS AND ESTABLISH FUTURE GOALS, SHARE A SUMMARY OF THE EVALUATION WITH THE FULL BOARD, AND RECOMMEND TERMS OF COMPENSATION TO THE FULL BOARD. IN DETERMINING COMPENSATION, THE BOARD REVIEWS SALARY DATA FROM VARIOUS SOURCES SUCH AS TRADE ASSOCIATION AND HEALTHCARE ALLIANCES. REGARDING OTHER OFFICERS OF THE ORGANIZATION, THE PRESIDENT CONDUCTS AN ANNUAL PERFORMANCE EVALUATION. IN DETERMINING THE OFFICERS' COMPENSATION, THE PRESIDENT REVIEWS SALARY DATA FROM APPROPRIATE TRADE ASSOCIATIONS AND ALLIANCES. THE BOARD OF DIRECTORS GIVES FINAL APPROVAL OF THE COMPENSATION OF THESE OFFICERS INDIRECTLY THROUGH REVIEW AND APPROVAL OF THE ANNUAL BUDGET. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE FOR INSPECTION UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON ITS WEBSITE (WWW.MESSIAHLIFEWAYS.ORG), AND UPON REQUEST. ADDITIONALLY THE FINANCIAL STATEMENTS ARE INCORPORATED INTO THE DISCLOSURE STATEMENT PREPARED FOR MESSIAH HOME AND MESSIAH FAMILY SERVICES, AS REQUIRED BY THE DEPARTMENT OF INSURANCE. MESSIAH ALSO POSTS THE AUDITED STATEMENTS OUT TO THE EMMA WEBSITE (WWW.EMMA.MSRB.ORG) |
| FORM 990, PART XI, LINE 9: | TRANSFER OF EQUITY - AFFILIATE 500,000. |
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