Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 139,728 | 352,559 | 207,189 | 332,420 | 362,337 | 1,394,233 |
| 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 | 2,817,741 | 2,865,154 | 2,955,187 | 2,546,953 | 1,572,252 | 12,757,287 |
| 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 | 2,957,469 | 3,217,713 | 3,162,376 | 2,879,373 | 1,934,589 | 14,151,520 |
| 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.) | 14,151,520 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 2,957,469 | 3,217,713 | 3,162,376 | 2,879,373 | 1,934,589 | 14,151,520 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 12,693 | 10,947 | 7,354 | 3,588 | 492 | 35,074 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 12,693 | 10,947 | 7,354 | 3,588 | 492 | 35,074 |
| 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.).. | 2,970,162 | 3,228,660 | 3,169,730 | 2,882,961 | 1,935,081 | 14,186,594 |
| 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) |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| 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 - ORGANIZATION'S MISSION | WE PROVIDE RESIDENTIAL FACILITIES FOR THE AGED WHICH ARE DESIGNED TO MEET THE NEEDS OF AGED PERSONS - SUITABLE HOUSING, PHYSICAL AND MENTAL HEALTH CARE CIVIC, CULTURAL AND RECREATIONAL ACTIVITIES, AND AN OVERALL ENVIRONMENT CONDUCIVE TO DIGNITY AND INDEPENDENCE. |
| FORM 990, PAGE 2, PART III, LINE 3 | ON OCTOBER 2, 2020, THE MAIN PROGRAM OF PROVIDING PHYSICAL CARE, MENTAL HEALTH CARE, AND CIVIC, RECREATIONAL AND CULTURAL ACTIVITIES FOR THE ELDERLY OF 121 RESIDENTIAL UNITS CEASED AS THE PROPERTY WAS SOLD TO AN OUTSIDE THIRD PARTY. |
| FORM 990, PAGE 6, PART VI, LINE 3 | MANAGEMENT SERVICES FOR THE ORGANIZATION ARE PROVIDED BY NEWBURY MANAGEMENT COMPANY. |
| FORM 990, PAGE 6, PART VI, LINE 4 | THE BYLAWS WERE AMENDED DURING FEBRUARY OF 2020 TO ADD THE FOLLOWING PARAGRAPH ABOUT THE AUTHORITY TO CALL SPECIAL MEETINGS. SPECIAL MEETINGS OF THE MEMBERS, FOR ANY PURPOSE OR PURPOSES, UNLESS OTHERWISE PRESCRIBED BY STATUTE, MAY BE CALLED BY THE PRESIDENT OR BY THE BOARD OF DIRECTORS, AND SHALL BE CALLED BY THE PRESIDENT AT THE REQUEST OF NOT LESS THAN ONE-THIRD (1/3) OF ALL MEMBERS ENTITLED TO VOTE AT THE MEETING. THE BYLAWS WERE ALSO AMENDED TO UPDATE THE NUMBER, ELECTION AND TERM OF OFFICE. THE BOARD OF DIRECTORS SHALL CONSIST OF THE FOLLOWING DIRECTORS, WHICH NUMBER MAY BE ALTERED FROM TIME TO TIME BY THE AMENDMENT OF THESE BYLAWS, BUT NO DECREASE IN THE NUMBER OF DIRECTORS SHALL HAVE THE EFFECT OF SHORTENING THE TERM OF ANY INCUMBENT DIRECTOR. THE DIRECTORS SHALL BE DETERMINED AS FOLLOWS: (A) A MINIMUM OF TWO (2) AND A MAXIMUM OF THREE (3) DIRECTORS SHALL BE MEMBERS, ELECTED BY A MAJORITY VOTE OF THE MEMBERS. EXCEPT IN CASE OF DEATH, RESIGNATION, RETIREMENT, DISQUALIFICATION, OR REMOVAL, ALL OF SUCH DIRECTORS SHALL SERVE FOR A TERM OF (3) YEARS AND IN NO CASE SHALL SUCH DIRECTORS SERVE LONGER THAN TWO, CONSECUTIVE THREE-YEAR TERMS. IF NO CANDIDATE IS AVAILABLE UPON THE EXPIRATION OF THEIR TERM, THE DIRECTOR WHOESE TERM HAS EXPIRED SHALL CONTINUE TO SERVE UNTIL THEIR SUCCESSOR OR SUCCESSORS SHALL HAVE BEEN ELECTED AND QUALIFIED. THESE DIRECTORS SHALL BE ELECTED ONE (1) PER YEAR SO AS TO EFFECT A STAGGERED BOARD. (B) TWO (2) DIRECTORS SHALL SERVE IN AN EX OFFICIO CAPACITY, HAVING ALL RIGHTS OF BOARD MEMBERSHIP EXCEPT THE RIGHT TO VOTE. ONE (1) SUCH DIRECTOR SHALL BE APPOINTED BY THE PROPERTY MANAGER WHO AT ALL TIMES SHALL BE AN EMPLOYEE OF THE PROPERTY MANAGER. ONE (1) SUCH DIRECTOR SHALL BE THE CHAIR OF THE RESIDENT ADVISORY COMMITTEE ("RAC"). EXCEPT IN CASE OF DEATH, RESIGNATION, RETIREMENT, DISQUALIFICATION, OR REMOVAL THESE DIRECTORS SHALL SERVE UNTIL THEIR SUCCESSOR OR SUCCESSORS HAVE BEEN APPOINTED. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THERE SHALL BE TWO CLASSES OF MEMBERSHIP, BOTH OF WHICH CLASSES SHALL CONSIST OF VOTING MEMBERS: (A) SPONSOR MEMBER - THE SPONSOR MEMBER OF THE CORPORATION SHALL, FROM TIME TO TIME, ASSIST IN ARRANGING WELLNESS PROGRAMS AND OTHER SERVICES FOR THE CARE AND TREATMENT OF PERSONS RESIDING WITHIN THE CORPORATION'S RETIREMENT CENTER IN URBANDALE, IOWA, AND SUCH OTHER ADDITIONAL SUPPORT AND GUIDANCE AS SHALL BE REQUIRED BY THE CORPORATION FROM TIME TO TIME. THE SPONSOR MEMBER SHALL BE APPOINTED BY THE BOARD OF DIRECTORS. (B) RESIDENTIAL MEMBERS - ALL PERSONS WHO HAVE SIGNED APPLICATION AGREEMENTS WITH THE CORPORATION, HAVE BEEN ACCEPTED AS RESIDENTIAL MEMBERS ("MEMBERS") IN THE CORPORATION, HAVE PAID ALL AMOUNTS DUE UNDER THE APPLICATION AGREEMENT, ARE NOT IN DEFAULT THEREUNDER, AND WHO HAVE NOT TRANSFERRED THEIR MEMBERSHIP IN THE CORPORATION WITH THE APPROVAL OF THE BOARD OF DIRECTORS, SHALL BE MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE BOARD OF DIRECTORS SHALL CONSIST OF THE FOLLOWING DIRECTORS, WHICH NUMBER MAY BE ALTERED FROM TIME TO TIME BY THE AMENDMENT OF THESE BYLAWS, BUT NO DECREASE IN THE NUMBER OF DIRECTORS SHALL HAVE THE EFFECT OF SHORTENING THE TERM OF ANY INCUMBENT DIRECTOR. THE DIRECTORS SHALL BE DETERMINED AS FOLLOWS: (A) A MINIMUM OF TWO (2) AND A MAXIMUM OF THREE (3) DIRECTORS SHALL BE MEMBERS, ELECTED BY A MAJORITY VOTE OF THE MEMBERS. EXCEPT IN CASE OF DEATH, RESIGNATION, RETIREMENT, DISQUALIFICATION, OR REMOVAL, ALL OF SUCH DIRECTORS SHALL SERVE FOR A TERM OF (3) YEARS AND IN NO CASE SHALL SUCH DIRECTORS SERVE LONGER THAN TWO, CONSECUTIVE THREE-YEAR TERMS. IF NO CANDIDATE IS AVAILABLE UPON THE EXPIRATION OF THEIR TERM, THE DIRECTOR WHOESE TERM HAS EXPIRED SHALL CONTINUE TO SERVE UNTIL THEIR SUCCESSOR OR SUCCESSORS SHALL HAVE BEEN ELECTED AND QUALIFIED. THESE DIRECTORS SHALL BE ELECTED ONE (1) PER YEAR SO AS TO EFFECT A STAGGERED BOARD. (B) TWO (2) DIRECTORS SHALL SERVE IN AN EX OFFICIO CAPACITY, HAVING ALL RIGHTS OF BOARD MEMBERSHIP EXCEPT THE RIGHT TO VOTE. ONE (1) SUCH DIRECTOR SHALL BE APPOINTED BY THE PROPERTY MANAGER WHO AT ALL TIMES SHALL BE AN EMPLOYEE OF THE PROPERTY MANAGER. ONE (1) SUCH DIRECTOR SHALL BE THE CHAIR OF THE RESIDENT ADVISORY COMMITTEE ("RAC"). EXCEPT IN CASE OF DEATH, RESIGNATION, RETIREMENT, DISQUALIFICATION, OR REMOVAL THESE DIRECTORS SHALL SERVE UNTIL THEIR SUCCESSOR OR SUCCESSORS HAVE BEEN APPOINTED. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE FORM 990 PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE ORGANIZATION'S DIRECTORS CERTIFY IN WRITING, ANNUALLY, THAT THEY HAVE RECEIVED AND HAVE READ THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, AND THEY ARE NOT IN INVOLVED WITH ANY OF THE CONFLICTS LISTED IN THE POLICY. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION PROVDES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. |
| Software ID: | |
| Software Version: |