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.") .. | ||||||
| 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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 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.") . | 524,979 | 570,209 | 546,636 | 1,038,274 | 622,971 | 3,303,069 |
| 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 | 30,315,823 | 32,968,065 | 33,216,989 | 32,733,888 | 33,103,865 | 162,338,630 |
| 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 | 30,840,802 | 33,538,274 | 33,763,625 | 33,772,162 | 33,726,836 | 165,641,699 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 9,547 | 9,547 | ||||
| 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.. | 9,547 | 9,547 | ||||
| 8 | Public support. (Subtract line 7c from line 6.) | 165,632,152 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 30,840,802 | 33,538,274 | 33,763,625 | 33,772,162 | 33,726,836 | 165,641,699 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 763,484 | 898,852 | 1,275,931 | 855,884 | 910,851 | 4,705,002 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 763,484 | 898,852 | 1,275,931 | 855,884 | 910,851 | 4,705,002 |
| 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.) .. | 210,359 | 185,011 | 623,383 | 636,047 | 394,060 | 2,048,860 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 31,814,645 | 34,622,137 | 35,662,939 | 35,264,093 | 35,031,747 | 172,395,561 |
| 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 III, LINE 12, EXPLANATION OF OTHER INCOME: | VENDOR REBATES - 2017 AMOUNT: $ 169,704. 2018 AMOUNT: $ 153,554. 2019 AMOUNT: $ 200,743. 2020 AMOUNT: $ 325,320. 2021 AMOUNT: $ 70,636. POSTAGE - 2017 AMOUNT: $ 29,668. 2018 AMOUNT: $ 30,572. 2019 AMOUNT: $ 28,215. 2020 AMOUNT: $ 33,757. 2021 AMOUNT: $ 26,911. MISCELLANEOUS INCOME - 2017 AMOUNT: $ 1,747. 2018 AMOUNT: $ 885. 2019 AMOUNT: $ 19,670. 2020 AMOUNT: $ 15,795. 2021 AMOUNT: $ 9,527. INSURANCE RECOVERY - 2017 AMOUNT: $ 9,240. DINING SERVICES - 2019 AMOUNT: $ 1,081. 2020 AMOUNT: $ 35,682. 2021 AMOUNT: $ 2,826. BAD DEBT - 2019 AMOUNT: $ 4,007. BEAUTY SHOP - 2019 AMOUNT: $ 193,732. 2020 AMOUNT: $ 90,013. 2021 AMOUNT: $ 144,784. LAUNDRY - 2019 AMOUNT: $ 53,250. 2020 AMOUNT: $ 55,890. 2021 AMOUNT: $ 54,428. REPAIRS - 2019 AMOUNT: $ 43,025. 2020 AMOUNT: $ 17,479. 2021 AMOUNT: $ 27,254. VILLAGE STORE - 2019 AMOUNT: $ 79,660. 2020 AMOUNT: $ 60,641. 2021 AMOUNT: $ 57,694. REFUNDS - 2020 AMOUNT: $ 1,470. |
| 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 VI, SECTION A, LINE 1A | THE BOARD ESTABLISHED AN EXECUTIVE COMMITTEE THAT MAY EXERCISE ALL OF THE POWERS AND AUTHORITY OF THE BOARD BETWEEN BOARD MEETINGS, EXCEPT IT SHALL NOT HAVE ANY POWER OR AUTHORITY AS TO THE FOLLOWING: (A) THE FILLING OF VACANCIES ON THE BOARD, (B) THE ADOPTION, AMENDMENT OR REPEAL OF THE BYLAWS, (C) THE AMENDMENT OR REPEAL OF ANY RESOLUTION OF THE BOARD, (D) ACTION ON MATTERS COMMITTED BY THE BYLAWS OR BY RESOLUTION OF THE BOARD TO ANOTHER COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIR, VICE-CHAIR, SECRETARY AND TWO OTHER MEMBERS OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, THEN THE ORGANIZATION'S FINANCE COMMITTEE RECEIVES A DRAFT COPY FOR REVIEW PRIOR TO FILING. THE ORGANIZATION'S FULL BOARD WILL RECEIVE A COPY OF THE FORM 990 BEFORE THE RETURN IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY ALL BOARD MEMBERS AND MANAGEMENT STAFF RECEIVE COPIES OF THE CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY EXIST. THIS WOULD INCLUDE CONFLICTS DUE TO FAMILY OR OTHER RELATIONSHIPS. ALL COPIES ARE REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND THE HUMAN RESOURCES DIRECTOR. COPIES OF THE SIGNED ACKNOWLEDGEMENTS FOR STAFF ARE RETAINED IN THE HUMAN RESOURCES OFFICE AND FOR BOARD MEMBERS IN THE CHIEF EXECUTIVE OFFICER'S OFFICE. SHOULD ANY BOARD MEMBER HAVE A CONFLICT, HE OR SHE WOULD RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS AND/OR DECISION RELATED TO THE CONFLICT. MONITORING OF PROPOSED OR ONGOING TRANSACTIONS FOR POTENTIAL CONFLICTS IS UNDERTAKEN THROUGH INTERNAL CONTROLS ESTABLISHED IN THE FINANCE DEPARTMENT. SPENDING AUTHORITY POLICIES EXIST TO CONTROL WHO HAS THE AUTHORITY TO ENCUMBER PENNSWOOD VILLAGE AND THE EXTENT TO WHICH THEY ARE ABLE TO DO SO. STAFF WITH SPENDING AUTHORITY ARE REQUIRED TO ANNUALLY COMPLETE CONFLICT OF INTEREST STATEMENTS AND TO DISCLOSE ANY CONFLICTS THAT MAY EXIST. STAFF MONITOR PROPOSED AND COMPLETED TRANSACTIONS TO DETERMINE IF A CONFLICT MAY EXIST. ANY CONCERNS ARE BROUGHT TO THE ATTENTION OF THE CFO FOR REVIEW AND ACTION, IF NECESSARY. IF A CONFLICT IS DETERMINED TO EXIST, THEN THE CONFLICTING PARTIES WILL BE NOTIFIED AND THE TRANSACTION HALTED. GROSS VIOLATIONS OF THE CONFLICT OF INTEREST MAY RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD CONDUCTS AN ANNUAL REVIEW OF THE CHIEF EXECUTIVE OFFICER (CEO) AND SETS COMPENSATION BASED ON PERFORMANCE THAT IS CONSISTENT WITH COMPETITIVE SALARY DATA. ANNUAL SALARY SURVEYS ARE COMPLETED BY HUMAN RESOURCES, A COMPENSATION CONSULTANT IS UTILIZED AS NEEDED AND THE FORM 990 OF OTHER SIMILAR ORGANIZATIONS ARE ALL USED IN THE SALARY DECISIONS. THE ANNUAL REVIEW PROCESS AND FINAL DECISIONS ARE TIMELY DOCUMENTED AND PUT INTO HUMAN RESOURCE FILES. OTHER OFFICER AND KEY EMPLOYEE COMPENSATION, SUCH AS THE CFO AND COO, ARE APPROVED BY THE CEO DURING THE ANNUAL REVIEW PROCESS, WHICH IS TIMELY DOCUMENTED AND PUT INTO HUMAN RESOURCE FILES. ANNUAL SALARY SURVEYS ARE COMPLETED BY HUMAN RESOURCES WHICH ARE USED IN THE SALARY DECISIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND GOVERNING DOCUMENTS ARE PLACED FOR PUBLIC VIEW IN THE ORGANIZATION'S LIBRARY OR ADMINISTRATIVE OFFICES AND ARE ALSO AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT -44,400. |
| FORM 990, PAGE 5, PART V, LINE 2 | THE FILING ENTITY IS THE PARENT IN A GROUP OF NON-PROFIT ENTITIES FOR WHICH IT IS CONSIDERED A COMMON PAY AGENT FOR W-2 REPORTING. PENNSWOOD VILLAGE REPORTS ALL EMPLOYEES ON ITS FORM W-3, HOWEVER, EACH AFFILIATE HAS EMPLOYEES ALLOCATED TO THAT ENTITY. PER IRS INSTRUCTIONS, EMPLOYEES LISTED ON PART V, LINE 2A ARE THOSE WHO HAVE BEEN DEEMED TO BE EMPLOYEES OF THIS ORGANIZATION. THE FOLLOWING AFFILIATE HAS W-2 EMPLOYEES LISTED ON THEIR FORM 990 THAT HAVE BEEN REPORTED ON THE FILING ORGANIZATION'S W-3: HOSPICE CARE BY PENNSWOOD 47-1563338 |
| Software ID: | |
| Software Version: |