Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 6,922,906 | 6,428,495 | 6,100,714 | 6,114,381 | 6,898,864 | 32,465,360 |
| 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 | 2,381,599 | 3,890,653 | 3,876,064 | 2,913,114 | 2,733,703 | 15,795,133 |
| 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 | 9,304,505 | 10,319,148 | 9,976,778 | 9,027,495 | 9,632,567 | 48,260,493 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 4,668,703 | 4,393,763 | 4,283,306 | 4,121,945 | 4,461,156 | 21,928,873 |
| 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.. | 4,668,703 | 4,393,763 | 4,283,306 | 4,121,945 | 4,461,156 | 21,928,873 |
| 8 | Public support. (Subtract line 7c from line 6.) | 26,331,620 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 9,304,505 | 10,319,148 | 9,976,778 | 9,027,495 | 9,632,567 | 48,260,493 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,095,159 | 410,568 | 837,344 | 669,148 | 710,109 | 3,722,328 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 1,095,159 | 410,568 | 837,344 | 669,148 | 710,109 | 3,722,328 |
| 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.) .. | 332,606 | 236,264 | 82,210 | 204,557 | 239,319 | 1,094,956 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 10,732,270 | 10,965,980 | 10,896,332 | 9,901,200 | 10,581,995 | 53,077,777 |
| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| DOCUMENTS AVAILABLE TO PUBLIC | PAGE 6, PART VI, SECTION C, #19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY | PAGE 6, PART VI, SECTION B, #12C THE ORGANIZATION DISTRIBUTES CONFLICT OF INTEREST STATEMENTS THAT THE BOARD MEMBERS AND OFFICERS SIGN AND RETURN ON AN ANNUAL BASIS. IN ADDITION, ALL STAFF ARE REQUIRED TO SIGN THE ORGANIZATION'S CORPORATE COMPLIANCE STATEMENT ANNUALLY AS PART OF ITS CORPORATE COMPLIANCE PROGRAM. |
| FORM 990 REVIEW PROCESS | PAGE 6, PART VI, SECTION B, #11B THE FORM 990 WILL BE FORWARDED TO ALL BOARD MEMBERS AT THE BOARD MEETING PRECEEDING THE FILING DATE. AT THAT TIME, A REVIEW OF THE FORM 990 WILL COMMENCE AND ANY RECOMMENDED CHANGES WILL BE MADE PRIOR TO FILING WITH THE IRS. |
| PROCESS FOR DETERMINING COMPENSATION | PAGE 6, PART VI, SECTION B, #15A & 15B The HUMAN RESOURCES department provides the board chair with salary INFORMATION from similar organizations. The chair then reviews this INFORMATION with the board'S executive committee when implementing annual salary and benefit increases for the president and CEO. The president and CEO reviews THE data and makes recommendations to the board chair for the remaining executive management staff, which includes officers and key employees. ALL PROCESSES ARE DOCUMENTED AT THE TIME THE DECISIONS ARE MADE. |
| DESCRIPTION OF OTHER PROGRAM SERVICE ACTIVITIES | PAGE 2, PART III, #4D Program Service Activity #4 Charity Care: The Benjamin Rose Institute provides patient care to those who meet the criteria of its Charity Care policy without charge or at amounts less than its established rates. Under its charitable endowment program, if services provided within the scope of the Eldercare Services Institute LLC are not billable under an entitlement program (e.g. Medicare Medicaid, and/or other third party payer) the fee for service is based on a sliding scale. When third party reimbursement has been explored and found lacking, and no other revenue source is available for assessed needs, Benjamin Rose underwrites the cost of these services. Services include social work/case management/counseling, mental health case management and counseling, home health services provided by the Eldercare Services Institute LLC. The endowment program manual places high standards on the social work endowment program that symbolizes the importance placed on Eldercare Services Institute's service delivery of the highest order. Program Service Activity #5 The Center for Consumer Education and Benefits Enrollment, as part of its advocacy efforts, helps older populations understand and access benefits from more than 1300 federal, state and local public benefit programs in addition to helping Medicare beneficiaries under the Medicare Part D program. An online benefits checkup questionnaire is completed for callers that helps them enroll in Medicaid, the Supplementation Nutrition Assistance Program, telephone discount programs, low income heating and assistance program, and the Medicare Savings program. The Center has helped Medicare beneficiaries and people age 55 and older in Northeast Ohio and beyond. Benjamin Rose capitalizes on its unique ability to integrate clinical services with evidence-based research on services outcomes, the findings of which are used as the basis for educating and informing the public on policies to improve the well-being of older adults and those who care for them. |
| RECONCILIATION OF NET ASSETS | PAGE 12, PART XI, #9 Other changes in net assets or fund balances: BENEFICIAL INTEREST IN CHARITABLE PERPETUAL TRUSTS $ (10,852,370) ASSETS RELEASED FROM RESTRICTIONS (68,814) -------------- $ (10,921,184) |
| SIGNIFCANT CHANGES TO GOVERNING DOCUMENTS | Page 6, Part VI, #4 Effective July 16, 2017, the Organization merged with existing non-profit 501(c)3 organizations, East Side Organizing Project, Inc and ESOP Realty Inc which became wholly-owned subsidiaries of the institute. East Side Organizing Project, Inc was formally renamed "Empowering and Strengthening Ohio's People, Inc". |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:2161757 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:NURSING/HHA TOTAL FEES:27573 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:GRANT PURCHASED SERVICES TOTAL FEES:33637 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:TRANSPORTATION PURCHASED SERV. TOTAL FEES:200302 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES I.T. TOTAL FEES:318829 |
| Software ID: | |
| Software Version: |