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 | |||||
| (A)
HEATH VILLAGE INC |
221717575 | 10 | Yes | 0 | 0 | |
| (B)
THE HOUSE OF THE HOLY COMFORTER |
221487578 | 10 | Yes | 0 | 0 | |
|
Total 2
|
0 | 0 | ||||
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.") . | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 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 |
||||
|
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) |
||||
| 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 |
|---|---|
| FORM 990-EZ, PART I, LINE 8 - OTHER REVENUE | DESCRIPTION: MANAGEMENT FEE. AMOUNT: 13,200. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: BOARD EXPENSE. AMOUNT: 9,195. DESCRIPTION: MISCELLANEOUS EXPENSE. AMOUNT: 60. DESCRIPTION: COMPUTER SUPPORT. AMOUNT: 434. TOTAL TO FORM 990-EZ, LINE 16: 9,689. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: INVESTMENT IN SUB - CANTERBURY VILLAGE. BEG. OF YEAR AMOUNT: 53,834. END OF YEAR AMOUNT: 53,834. DESCRIPTION: PREPAID - OTHER. BEG. OF YEAR AMOUNT: 796. END OF YEAR AMOUNT: 362. DESCRIPTION: DUE FROM AFFILIATES. BEG. OF YEAR AMOUNT: 6,600. END OF YEAR AMOUNT: 0. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 5,130. END OF YEAR AMOUNT: 287. DESCRIPTION: ACCRUED EXPENSES. BEG. OF YEAR AMOUNT: 550. END OF YEAR AMOUNT: 600. DESCRIPTION: DUE TO AFFILIATES. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 550. |
| FORM 990-EZ, PART III, PRIMARY EXEMPT PURPOSE | THE GENERAL PURPOSE FOR WHICH HEATH ALLIANCE WAS FORMED IS TO PROMOTE AND ADVANCE CHARITABLE, HEALTH, SCIENTIFIC, SOCIAL AND EDUCATIONAL PURPOSES OF THE NATURE SET FORTH PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. THE SPECIFIC PURPOSES OF HEATH ALLIANCE ARE TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, AND TO CARRY OUT THE PURPOSES OF HEATH VILLAGE, INC., AND THE HOUSE OF THE HOLY COMFORTER (D/B/A CANTERBURY VILLAGE), BOTH OF WHICH ARE NEW JERSEY NONPROFIT CORPORATIONS HAVING HEATH ALLIANCE AS THE SOLE CORPORATE MEMBER AND BOTH OF WHICH ARE QUALIFIED AS FEDERALLY TAX-EXEMPT PUBLIC CHARITIES UNDER CODE SECTION 501(C)(3) AND 509(A) AND ANY OTHER NONPROFIT CORPORATION WHICH QUALIFIES AS A FEDERALLY TAX-EXEMPT PUBLIC CHARITY UNDER CODE SECTION 501(C)(3) AND 509(A), OR A CORRESPONDING PROVISION OF ANY APPLICABLE FUTURE STATUTE OR REGULATION, AND IN WHICH HEATH ALLIANCE IS THE SOLE CORPORATE MEMBER. HEATH VILLAGE IS A RETIREMENT COMMUNITY PROVIDING INDEPENDENT LIVING, RESIDENTIAL HEALTH CARE AND SKILLED NURSING CARE. HOUSE OF THE HOLY COMFORTER, ALSO KNOWN AS CANTERBURY VILLAGE, IS A RESIDENTIAL/ASSISTED LIVING HEALTH CARE FACILITY FOR THE AGED. |
| FORM 990-EZ, PART V, LINE 34 | THE PURPOSE DEFINED IN ARTICLE II WAS REWRITTEN AS FOLLOWS: THE GENERAL PURPOSE FOR WHICH HEATH ALLIANCE IS FORMED IS TO PROMOTE AND ADVANCE CHARITABLE, HEALTH, SCIENTIFIC, SOCIAL AND EDUCATIONAL PURPOSES OF THE NATURE SET FORTH PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED (THE "CODE"). THE SPECIFIC PURPOSES OF HEATH ALLIANCE ARE TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, AND TO CARRY OUT THE PURPOSES OF (I) HEALTH VILLAGE, INC., ("HEATH VILLAGE") AND THE HOUSE OF THE HOLY COMFORTER ("CANTERBURY VILLAGE"), BOTH OF WHICH ARE NEW JERSEY NONPROFIT CORPORATIONS HAVING HEALTH ALLIANCE AS THE SOLE CORPORATE MEMBER AND BOTH OF WHICH ARE QUALIFIED AS FEDERALLY TAX-EXEMPT PUBLIC CHARITIES UNDER CODE SECTION 501(C)(3) AND 509(A) AND (II) ANY OTHER NONPROFIT CORPORATION WHICH QUALIFIES AS A FEDERALLY TAX-EXEMPT PUBLIC CHARITY UNDER CODE SECTION 501(C)(3) AND 509(A), OR A CORRESPONDING PROVISION OF ANY APPLICABLE FUTURE STATUTE OR REGULATION, AND IN WHICH HEATH ALLIANCE IS THE SOLE CORPORATE MEMBER. THE ORGANIZATIONS DESCRIBED IN PART (I) AND (II) OF THE FOREGOING SENTENCE SHALL BE REFERRED TO HEREIN AS A "SUBSIDIARY". THE MINIMUM NUMBER OF MEMBERS ON THE BOARD OF TRUSTEES, DEFINED IN ARTICLE IV, WAS CHANGED FROM 9 TO 3. THE FIRST PARAGRAPH OF ARTICLE IV, PARAGRAPH 4 REGARDING DUTIES OF TRUSTEES WAS REWRITTEN IN PART AS FOLLOWS: THE BOARD OF TRUSTEES SHALL EXERCISE IN THE NAME OF AND ON BEHALF OF HEATH ALLIANCE ALL OF THE RIGHTS AND PRIVILEGES LEGALLY EXERCISABLE UNDER THE NEW JERSEY NONPROFIT CORPORATION ACT (THE "ACT"), INCLUDING, BUT NOT LIMITED TO CARRYING OUT THE SPECIFIC DUTIES AND RESPONSIBILITIES DESCRIBED IN THESE BYLAWS. THE BOARD OF TRUSTEES SHALL CONTRACT, FOR NOT MORE THAN ONE YEAR AT A TIME, WITH A FIRM OF CERTIFIED PUBLIC ACCOUNTANTS FOR AN AUDIT EACH YEAR OF ALL BOOKS OF ACCOUNT AFFECTING HEATH ALLIANCE, ITS SUBSIDIARIES AND ITS BUSINESS TRANSACTIONS. THE BOARD OF TRUSTEES SHALL NOMINATE AND ELECT THE TRUSTEES OF THE BOARD OF EVERY SUBSIDIARY; PROVIDED THAT A MAJORITY OF THE TRUSTEES OF HEATH VILLAGE SHALL SIMULTANEOUSLY BE TRUSTEES OF HEATH ALLIANCE AND PROVIDED FURTHER THAT THE CEO OF HEATH ALLIANCE SHALL BE A TRUSTEE OF EACH SUBSIDIARY. THE BOARD SHALL ALSO APPOINT THE CHAIRPERSON OF THE CANTERBURY VILLAGE BOARD. IN ADDITION, THE BOARD SHALL EMPLOY THE EXECUTIVE DIRECTOR OF HEATH VILLAGE. THE FOLLOWING SPECIFIC DUTIES WERE ADDED TO ARTICLE IV UNDER DUTIES OF TRUSTEES: -ANY CONTRACT OR TRANSACTION THAT INVOLVES AN AMOUNT IN EXCESS OF THE LIMITS CURRENTLY ESTABLISHED BY THE BOARD SHALL BE PRESENTED TO THE PROPER STANDING COMMITTEE AND THEN, THE BOARD SHALL REVIEW THAT COMMITTEE'S RECOMMENDATION AND MAKE A DECISION -AMENDMENTS TO THE SUBSIDIARY BYLAWS ARTICLE IV REGARDING VACANCIES WAS UPDATED TO INCLUDE VACANCIES IN THE BOARD OF ANY SUBSIDIARY. SUCH VACANCIES SHALL ALSO BE FILLED BY A MAJORITY VOTE OF THE REMAINING TRUSTEES. THE DUTIES OF THE PRESIDENT DEFINED IN ARTICLE V WERE REVISED TO STATE THAT THE PRESIDENT IS THE EX-OFFICIO MEMBER OF THE STANDING COMMITTEES, OTHER THAN THE EXECUTIVE COMMITTEE, RATHER THAN ALL COMMITTEES. THE PRESIDENT'S DUTIES WERE ALSO UPDATED TO ADD THAT THE PRESIDENT SHALL ALSO APPOINT THE CHAIRPERSON AND VICE-CHAIRPERSON OF THE HEATH VILLAGE BOARD OF TRUSTEES FROM AMONG THE HEATH VILLAGE TRUSTEES. THE DUTIES OF THE SECRETARY IN ARTICLE V WERE UPDATED TO INCLUDE THE FOLLOWING: THE SECRETARY SHALL ALSO BE RESPONSIBLE FOR NOTIFYING EACH NEW TRUSTEE OF A SUBSIDIARY OF HIS/HER ELECTION. THE DUTIES OF THE TREASURER IN ARTICLE V WERE UPDATED TO REMOVE THE DUTIES AS THE PRINCIPAL FINANCIAL OFFICER OF HEATH ALLIANCE AND THE BOARD. THE DUTIES WERE REWRITTEN AS FOLLOWS: THE TREASURER IS RESPONSIBLE FOR PERIODIC BOARD OVERSIGHT OF THE FINANCIAL FUNCTIONS OF HEATH ALLIANCE, WHICH INCLUDES INDEPENDENT DISCUSSIONS WITH AUDITORS IF REQUESTED BY THE TREASURER. THE TREASURER SHALL BE RESPONSIBLE FOR PERIODICALLY REVIEWING THE FINANCIAL CONDITION OF HEATH ALLIANCE TO INSURE THAT HEATH ALLIANCE CAN ADEQUATELY SATISFY ITS CASH FLOW AND BUDGETARY NEEDS. THE TREASURER SHALL SERVE AS A MEMBER OF THE FINANCE & CORPORATE DEVELOPMENT COMMITTEE WITH THE DUTIES AND RESPONSIBILITIES SET FORTH AT SECTION 7.3. THE TREASURER SHALL PERFORM SUCH OTHER DUTIES AS MAY, FROM TIME TO TIME, BE ASSIGNED TO HIM OR HER BY THE BOARD OF TRUSTEES. THE RECIPIENTS OF ALL ASSETS TO BE DISTRIBUTED UPON DISSOLUTION WERE REDEFINED AS: A NONPROFIT ORGANIZATION OR ORGANIZATIONS IN WHICH HEATH ALLIANCE IS A CORPORATE MEMBER, INCLUDING BUT NOT LIMITED TO, HEATH VILLAGE AND CANTERBURY VILLAGE, AS LONG AS SUCH ORGANIZATION OR EACH OF SUCH ORGANIZATIONS SHALL QUALIFY AS AN ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3); AND/OR A NONPROFIT ORGANIZATION OR ORGANIZATIONS HAVING SIMILAR AIMS AND OBJECTS TO HEATH ALLIANCE WHICH MAY BE SELECTED AS AN APPROPRIATE RECIPIENT OF SUCH ASSETS, AS LONG AS SUCH ORGANIZATION OR EACH SUCH ORGANIZATION SHALL QUALIFY AS AN ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3). THE FOLLOWING DUTIES WERE REVISED REGARDING THE FINANCE AND CORPORATE DEVELOPMENT COMMITTEE: - REPLACED "ASSIST ADMINISTRATION OF HEATH VILLAGE AND CANTERBURY VILLAGE OR OTHER SUBSIDIARY IN THE PREPARATION OF ITS OPERATING BUDGET FOR THE COMING FISCAL YEAR AND A FINANCIAL PLAN TO IMPLEMENT ITS CAPITAL BUDGET" WITH "REVIEW AND APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF EACH SUBSIDIARY. - ADDED "REVIEW AND APPROVE THE SELECTION OF THE AUDITOR AND FINANCIAL ADVISOR." - REPLACED "MONITOR THE VARIOUS ACCOUNTS, INVESTMENTS AND FINANCIAL REPORTS OF THE TREASURER AND ADMINISTRATION OF HEATH VILLAGE AND CANTERBURY VILLAGE AND OTHER SUBSIDIARIES TO ASSURE THAT THEIR FINANCIAL POLICIES ARE ENFORCED AND THAT ITS FINANCIAL STATUS IS PROTECTED" WITH "REVIEW PERIODICALLY THE FINANCIAL RESULTS FOR HEATH ALLIANCE AND EACH SUBSIDIARY." - REPLACED "DEVELOP A FINANCIAL PLAN WHICH SHALL SERVE AS A GUIDE TO THE HEATH VILLAGE AND CANTERBURY VILLAGE BOARD AND OTHER SUBSIDIARIES IN ITS DELIBERATIONS OF AND RECOMMENDATIONS FOR NEW FACILITIES OR SERVICES AND FOR FINANCING ANY FACILITIES OR SERVICES APPROVED FOR IMPLEMENTATION BY THE HEATH ALLIANCE BOARD OF TRUSTEES" WITH "REVIEW MANAGEMENT'S FINANCIAL PLAN WHICH SHALL SERVE AS A GUIDE TO THE EACH SUBSIDIARY'S BOARD IN ITS DELIBERATIONS OF AND RECOMMENDATIONS FOR NEW FACILITIES OR SERVICES AND FOR FINANCING ANY FACILITIES OR SERVICES APPROVED FOR IMPLEMENTATION BY THE HEATH ALLIANCE BOARD." - REMOVED "SET THE FINANCIAL LIMITS REFERRED TO IN THESE BYLAWS.) |
| Software ID: | |
| Software Version: |