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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 10,000 | 6,178 | 1,500 | 2,518 | 159,831 | 180,027 |
| 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 | 10,000 | 6,178 | 1,500 | 2,518 | 159,831 | 180,027 |
| 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) .. | 6,154 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 173,873 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 10,000 | 6,178 | 1,500 | 2,518 | 159,831 | 180,027 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 113 | 2,273 | 280 | 2,666 | ||
| 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.).. | 87 | 7,539 | 2,000 | 9,626 | ||
| 11 | Total support. Add lines 7 through 10 | 192,319 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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) |
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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): |
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| 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2019 AMOUNT: $ 87. 2020 AMOUNT: $ 7,539. 2021 AMOUNT: $ 2,000. |
| PART II, SHORT YEAR EXPLANATION | THE ORGANIZATION CHANGED THE ACCOUNTING PERIOD, AS SUCH, THE TAX YEAR ENDING JUNE 30, 2021 IS A SHORT TAX YEAR. |
| 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, PART V, LINES 1A AND 2A | THERE ARE NO W-2S OR 1099S REPORTED DUE TO THE FACT THAT THE ENTITY IS FILING A SHORT-PERIOD RETURN THAT DOES NOT INCLUDE A CALENDAR YEAR-END. |
| FORM 990, PART VI, SECTION A, LINE 3 | MANAGEMENT OF TWELVE OAKS SENIOR LIVING IS CONDUCTED BY EPISCOPAL COMMUNITIES AND SERVICES, THE SOLE MEMBER OF TWELVE OAKS. ECS'S MANAGEMENT AND EMPLOYEES ARE RESPONSIBLE FOR OPERATING THE RESIDENCE. THEY INTERVIEW, HIRE, TRAIN AND SUPERVISE STAFF, MARKET THE FACILITIES AND SERVICES, AND IMPLEMENT ALL OF THE NECESSARY SYSTEMS NEEDED FOR OPERATION OF THE PROPERTY, INCLUDING PAYROLL, ACCOUNTS PAYABLE, BILLING AND ACCOUNTING, FOOD SERVICE MANAGEMENT AND PHYSICAL PLANT MAINTENANCE. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZATION UPDATED IS ARTICLES OF INCORPORATION AND BYLAWS IN JANUARY 2021 TO REFLECT THE AFFILIATION BETWEEN TWELVE OAK FOUNDATION ("TOF") AND EPISCOPAL COMMUNITIES AND SERVICES ("ECS"). THE BYLAWS WERE AMENDED AND RESTATED IN WHOLE, BUT SIGNIFICANT CHANGES INCLUDE THE FOLLOWING: - ECS, A PUBLIC CHARITY UNDER IRC 501(C)(3), BECAME THE SOLE STATUTORY MEMBER OF TWELVE OAKS FOUNDATION. THE FUNCTION OF THE MEMBER SHALL BE TO ELECT THE BOARD AND TO PERFORM OTHER DUTIES AS THE BOARD MAY FROM TIME TO TIME ASSIGN OR ESTABLISH WITH THE PRIOR APPROVAL OF THE MEMBER. - UPON THE DISSOLUTION OR WINDING UP OF THE CORPORATION, ITS ASSETS REMAINING AFTER PAYMENT, OR PROVISION FOR PAYMENT, OF ALL DEBTS AND LIABILITIES OF THE CORPORATION SHALL BE DISTRIBUTED TO EPISCOPAL COMMUNITIES & SERVICES FOR SENIORS, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION AND A 501(C)(3) CORPORATION, PROVIDED THAT SUCH ORGANIZATION IS THEN AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND, IF IT IS NOT, TO A NONPROFIT FUND, FOUNDATION OR CORPORATION WHICH IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES AND WHICH HAS ESTABLISHED ITS TAX EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE CODE, SUCH ORGANIZATIONS TO BE SELECTED BY THE BOARD OF DIRECTORS OF THIS CORPORATION. - LAY OUT THE APPROVALS REQUIRED BY THE STATUTORY MEMBER FOR ACTIONS OF THE TWELVE OAKS FOUNDATION BOARD - UPDATE THE NUMBER OF BOARD MEMBERS TO BE BETWEEN 4 AND 13 - ELECTION OF BOARD: DIRECTORS SHALL BE APPOINTED BY THE MEMBER AT THE ANNUAL MEETING OF THE MEMBER FROM THE LIST OF QUALIFIED CANDIDATES SUBMITTED BY THE MEMBER'S JOINT BOARDS' GOVERNANCE & COMPENSATION COMMITTEE. DIRECTORS SHALL BE DIVIDED INTO FOUR (4) CLASSES, EACH CLASS HAVING APPROXIMATELY ONE-FOURTH OF THE ELECTED DIRECTORS. THE BYLAWS LAY OUT THE TERMS OF THE BOARD MEMBERS (4 YEAR TERMS, WITH NO MORE THAN 2 CONSECUTIVE TERMS) - THE STRUCTURE AND FREQUENCY OF THE BOARD MEETINGS HAS BEEN UPDATED TO REQUIRE AN ANNUAL BOARD MEETING WITH REGULAR MEETINGS TO BE SCHEDULED AT A TIME AND PLACE AS DETERMINED BY THE BOARD. - OFFICER POSITIONS HAVE BEEN UPDATED TO HAVE A CHAIRPERSON, VICE CHAIRPERSON AND TREASURER OF THE BOARD, AS WELL AS THE CEO AND CFO. |
| FORM 990, PART VI, SECTION A, LINE 6 | EPISCOPAL COMMUNITIES AND SERVICES WILL OPERATE AS THE SOLE STATUTORY MEMBER OF TWELVE OAKS FOUNDATION |
| FORM 990, PART VI, SECTION A, LINE 7A | EPISCOPAL COMMUNITIES AND SERVICES WILL OPERATE AS THE SOLE STATUTORY MEMBER OF TWELVE OAKS FOUNDATION |
| FORM 990, PART VI, SECTION A, LINE 7B | THE APPROVAL OF THE MEMBER SHALL BE REQUIRED ON THE FOLLOWING MATTERS: (I) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR THESE BYLAWS; (II) PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE OR ENCUMBRANCE OF ANY INTEREST IN REAL OR PERSONAL PROPERTY IN ACCORDANCE WITH THE ESTABLISHED POLICIES FOR SUCH MATTERS APPROVED FROM TIME TO TIME BY THE MEMBER; (III) APPOINTMENT OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; (IV) APPROVAL OF AN INDEBTEDNESS TO BE INCURRED BY THE CORPORATION; "INDEBTEDNESS" MEANS (A)ALL INDEBTEDNESS FOR BORROWED MONEY, (B) ALL OBLIGATIONS FOR THE DEFERRED PURCHASE PRICE OF PROPERTY OR SERVICES (EXCLUDING TRADE PAYABLES ARISING IN THE ORDINARY COURSE OF BUSINESS), (C) ALL OBLIGATIONS EVIDENCED BY NOTES, BONDS, DEBENTURES OR OTHER SIMILAR INSTRUMENTS, (D) ALL INDEBTEDNESS CREATED OR ARISING UNDER ANY CONDITIONAL SALE OR OTHER TITLE RETENTION AGREEMENT WITH RESPECT TO PROPERTY ACQUIRED BY THE CORPORATION (EVEN THOUGH THE RIGHTS AND REMEDIES OF THE SELLER OR LENDER UNDER SUCH AGREEMENT IN THE EVENT OF DEFAULT ARE LIMITED TO REPOSSESSION OR SALE OF SUCH PROPERTY), (E) ALL OBLIGATIONS OF THE CORPORATION AS LESSEE UNDER LEASES THAT HAVE BEEN OR SHOULD BE, IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, RECORDED AS CAPITALIZED LEASES, OR (F) ALL LIABILITIES AND OBLIGATIONS OF OTHERS OF THE KIND DESCRIBED IN THE PRECEDING CLAUSES THAT THE CORPORATION HAS GUARANTEED OR PROVIDED CREDIT SUPPORT OR THAT IS OTHERWISE ITS LEGAL LIABILITY OR THAT ARE SECURED BY ANY ASSETS OR PROPERTY OF THE CORPORATION; (V) ANY CHANGE IN THE FORMAL OR INFORMAL EXPRESSIONS OF THE PHILOSOPHY OR PURPOSE OF THE CORPORATION; (VI) ANY CHANGE IN THE MISSION STATEMENT OR LONG-RANGE PLAN OF THE CORPORATION; (VII) APPROVAL OR ADOPTION OF NEW PROGRAMS OR PROJECTS OF THE CORPORATION; (VIII) MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION; (IX) APPROVAL OF THE CREATION OF A SUBSIDIARY ORGANIZATION OR ACQUISITION OF A CONTROLLING INTEREST IN ANOTHER ENTITY; (X) DISPOSITION OF ALL OR SUBSTANTIALLY ALL ASSETS OF THE CORPORATION; (XI) APPROVAL OF ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT AND ADMINISTRATION OF THE CORPORATION, AND ANY CHANGES TO SUCH MANAGEMENT AGREEMENT; AND (XI) APPOINTMENT OF AN INDEPENDENT AUDITOR AND A CORPORATE COUNSEL. THE MEMBER SHALL HAVE THE POWER TO TERMINATE THE EMPLOYMENT OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND ANY OTHER OFFICERS OF THE CORPORATION, SUBJECT TO ARTICLE VI, SECTION 4 OF THESE BYLAWS. THE MEMBER SHALL ALSO HAVE THE POWER TO REMOVE THE INVESTMENT MANAGER OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN OUTSIDE CPA FIRM AND PRESENTED TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS REVIEW THE FORM 990 AND APPROVE THE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH OFFICER (CEO AND VICE PRESIDENTS) AND MEMBERS OF THE BOARD OF DIRECTORS COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY AND SUBMIT IT TO THE AUDIT COMMITTEE. THE AUDIT COMMITTEE REVIEWS CONFLICT OF INTEREST STATEMENTS PROVIDED BY THE OFFICERS AND DIRECTORS AS THE NEED ARISES BUT NOT LESS THAN ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | PART VI, LINE 15(A) AND 15(B) WERE ANSWERED NO AS THERE ARE NO OFFICERS OR KEY EMPLOYEES AS DEFINED IN FORM 990 INSTRUCTIONS THAT RECEIVED COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE FOR PROPERTY MARKED TO MARKET 3,338,244. |
| Software ID: | |
| Software Version: |