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.") . | ||||||
| 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...... | 5,965,839 | 5,842,357 | 6,442,132 | 5,623,043 | 4,777,950 | 28,651,321 |
| 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. | 5,965,839 | 5,842,357 | 6,442,132 | 5,623,043 | 4,777,950 | 28,651,321 |
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 28,651,321 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 5,965,839 | 5,842,357 | 6,442,132 | 5,623,043 | 4,777,950 | 28,651,321 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 71,471 | 70,788 | 71,555 | 71,738 | 62,114 | 347,666 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 71,471 | 70,788 | 71,555 | 71,738 | 62,114 | 347,666 |
| 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.) .. | 43,334 | 113,268 | 425,922 | 386,817 | 353,625 | 1,322,966 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 6,080,644 | 6,026,413 | 6,939,609 | 6,081,598 | 5,193,689 | 30,321,953 |
| 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 | ||||
| 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) |
||||
| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | MISCELLANEOUS - 2011 AMOUNT: $ 42,472. 2012 AMOUNT: $ 25,135. 2013 AMOUNT: $ 56,497. 2014 AMOUNT: $ 39,902. 2015 AMOUNT: $ -3,747. MEAL/VENDING - 2011 AMOUNT: $ 862. 2012 AMOUNT: $ 1,098. 2013 AMOUNT: $ 249,281. 2014 AMOUNT: $ 239,871. 2015 AMOUNT: $ 254,511. TRANSPORTATION - 2012 AMOUNT: $ 18,333. 2013 AMOUNT: $ 24,514. 2014 AMOUNT: $ 22,455. 2015 AMOUNT: $ 15,894. LAUNDRY - 2012 AMOUNT: $ 17,660. 2013 AMOUNT: $ 20,526. 2014 AMOUNT: $ 17,833. 2015 AMOUNT: $ 18,111. GUEST ROOM - 2012 AMOUNT: $ 11,770. 2013 AMOUNT: $ 17,935. 2014 AMOUNT: $ 20,135. 2015 AMOUNT: $ 22,220. BEAUTY BARBER - 2012 AMOUNT: $ 39,272. 2013 AMOUNT: $ 57,169. 2014 AMOUNT: $ 46,621. 2015 AMOUNT: $ 41,466. GIFT SHOP - 2015 AMOUNT: $ 2,741. INSURANCE PROCEEDS - 2015 AMOUNT: $ 2,429. |
| Software ID: | |
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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 VI, SECTION A, LINE 3 | ON AUGUST 1, 2008, THE FOUNDATION ENTERED INTO A TEN-YEAR MANAGEMENT AGREEMENT WITH LIFE CARE SERVICES, LLC (LCS). UNDER THE TERMS OF THE AGREEMENT, LCS ASSUMES RESPONSIBILITY TO IMPLEMENT THE POLICIES, BUDGET AND GOALS ESTABLISHED BY THE FOUNDATION. LCS WILL PROVIDE MARKETING SOFTWARE, TRAINING, ESTABLISH AND MAINTAIN FINANCIAL SOFTWARE AND ASSIST IN THE RELATED CONTROLS. THE FOUNDATION WILL PAY A MONTHLY MANAGEMENT FEE OF 3.75% OF THE CURRENT MONTH'S GROSS OPERATING REVENUE. THE FOUNDATION SHALL PAY LCS AN INCENTIVE FEE OF $1,000 FOR THE SALE OF EACH APARTMENT UPON CLOSING. THE FOUNDATION SHALL PAY LCS A SERVICE PROVIDER FEE FOR THE USE OF LCS ACCOUNTING, PAYROLL, AND BILLING TECHNOLOGY IN THE AMOUNT OF $600 PER MONTH. IN THE EVENT THIS AGREEMENT IS TERMINATED PRIOR TO FORTY-EIGHT MONTHS, THE REMAINING BALANCE OF THIS SERVICE PROVIDER FEE SHALL BE DUE AND PAYABLE. EITHER PARTY MAY TERMINATE THE AGREEMENT, WITHOUT CAUSE AT ANY TIME BY GIVING THE OTHER PARTY AT LEAST SIX MONTHS WRITTEN NOTICE OF ITS DESIRE TO TERMINATE, AND USING A SCHEDULED SEVERANCE AGREEMENT. THE EXECUTIVE DIRECTOR AND THE HEALTH CENTER ADMINISTRATOR SHALL BE EMPLOYEES OF LCS, AND THE FOUNDATION SHALL REIMBURSE LCS FOR THE EXECUTIVE DIRECTOR'S AND ADMINISTRATOR'S COMPENSATION AND RELATED EXPENSES. THE FOUNDATION PAID MANAGEMENT FEES, THE EXECUTIVE DIRECTOR'S AND ADMINISTRATOR'S COMPENSATION AND EMPLOYEE BENEFITS AND OTHER RELATED EXPENSES TO LCS TOTALING $516,386 AND $537,632 FOR THE YEARS ENDED AUGUST 31, 2016 AND 2015, RESPECTIVELY. DURING THE 2015 CALENDAR YEAR, THE FOLLOWING INDIVIDUALS WERE COMPENSATED FOR PROVIDING SERVICES TO THE FOUNDATION IN THE FOLLOWING AMOUNTS: SUE FOWLER, EXECUTIVE DIRECTOR: $164,462 PAIGE WHEELER, EXECUTIVE DIRECTOR: $113,948 KRISTEN KALLAS, HEALTH CENTER ADMINISTRATOR: $55,297 |
| FORM 990, PART VI, SECTION B, LINE 11 | THE EXECUTIVE DIRECTOR AND ACCOUNTING DIRECTOR REVIEW FORM 990 AND THEN A COMPLETE COPY IS PROVIDED TO ALL BOARD MEMBERS BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS AND DIRECTORS ARE REQUIRED TO ANNUALLY DISCLOSE CONFLICTS OF INTEREST TO THE FOUNDATION. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE ORGANIZATION'S EXECUTIVE DIRECTOR AND TOP MANAGEMENT OFFICIALS ARE EMPLOYEES OF LIFE CARE SERVICES CORP. LIFE CARE SERVICES IS A MANAGER OF SENIOR LIVING COMMUNITIES. LIFE CARE SERVICES DETERMINES THE COMPENSATION FOR THE CEO AND HEALTH CARE ADMINISTRATOR. LCS USES COMPARABILITY DATA AND THE EMPLOYEES ANNUAL REVIEW INFORMATION TO DETERMINE COMPENSATION. THE BOARD OF DIRECTORS HAS FINAL APPROVAL OF ANY COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OUTSIDE SERVIES: PROGRAM SERVICE EXPENSES 347,210. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 347,210. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 293,486. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 293,486. CONSULTING: PROGRAM SERVICE EXPENSES 46,481. MANAGEMENT AND GENERAL EXPENSES 195. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,676. |
| FORM 990, PAGE 12 PART XII LINE 2C | PROCESSES HAVE NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990 PAGE 7 PART VII | THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF LIFE CARE SERVICES CORP. AND THE FOUNDATION REIMBURSES LIFE CARE SERVICES CORP. FOR THE EXECUTIVE DIRECTOR'S COMPENSATION AND RELATED EXPENSES FOR THEIR MANAGEMENT SERVICES, BUT LIFE CARE SERVICES CORP ISSUES THE W-2S, NOT THE FOUNDATION, SO NO COMPENSATION IS LISTED. |
| FORM 990, PAGE 10, PART IX, LINE 5 | THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF LIFE CARE SERVICES CORP. AND THE FOUNDATION REIMBURSES LIFE CARE SERVICES CORP. FOR THE EXECUTIVE DIRECTOR'S COMPENSATION AND RELATED EXPENSES FOR THEIR MANAGEMENT SERVICES, BUT LIFE CARE SERVICES CORP ISSUES THE W-2S, NOT THE FOUNDATION, SO NO COMPENSATION IS LISTED ON PAGE 7 OF FORM 990 ALTHOUGH FISCAL YEAR COMPENSATION IS SHOWN ON PAGE 10, LINE 5 FOR THE REIMBURSED EXPENSE AMOUNT. |
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