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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 99,266 | 150,585 | 141,777 | 154,800 | 152,078 | 698,506 |
| 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 | 99,266 | 150,585 | 141,777 | 154,800 | 152,078 | 698,506 |
| 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. | 698,506 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 99,266 | 150,585 | 141,777 | 154,800 | 152,078 | 698,506 |
| 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 | 698,506 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part II, Line 1 | During the tax year, the organization received a single $161,000 contribution that meets the IRS definition of an unusual grant under Reg. 1.509(a)-3(c)(3) and (4). The grant was: (1) substantial in size relative to the organization's normal level of contributions, (2) attracted because of the publicly supported nature of the organization, (3) unexpected and nonrecurring, and (4) large enough that including it in the public support calculation would distort the organization's normal public support percentage. Accordingly, the organization has excluded the $161,000 amount from Schedule A, Part II, Line 1(e) and has reported it in Schedule A, Part VI as an unusual grant, as permitted by the regulations. The grant remains included in Form 990, Part VIII as contribution revenue consistent with IRS reporting requirements. |
| Software ID: | 24021167 |
| Software Version: | v1.00 |
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section B, Line 11b | The Board Chair, Treasurer & Executive Director review the tax documents prior to filing and the documents are made available to all board members either pre or post filing upon request. |
| Form 990, Part VI, Section B, Line 12c | The conflict of interest policy is included in the governing documents and is periodically reviewed. Board members are required to report any conflicts that may arise when they occur. The member would be excused from any discussions and votes regarding the conflict in question. |
| Form 990, Part VI, Section B, Line 15 | The Director of the home receives compensation that has been reviewed and approved by the board of directors. The compensation package is based on reviews of similar position in the local area. |
| Form 990, Part VI, Section C, Line 19 | Upon request the governing documents, Form 990 and financial information are made available to the public for review. Additionally the Form 990 is available on Guidestar. |
| Form 990, Part VIII, Line 1c | All voluntary contributions, gifts, and grants received during the year were reported on Lines 1c and 1f. Contributions collected at fundraising events (for example, donations made at the annual banquet) were reported on Line 1c. All other recurring donations, memorial gifts, corporate grants, and general support contributions were reported on Line 1f. A one-time $161,000 gift received to retire the mortgage was treated as an unusual grant and therefore excluded from Schedule A per instructions. |
| Form 990, Part VIII, Line 1f | All voluntary contributions, gifts, and grants received during the year were reported on Lines 1c and 1f. Contributions collected at fundraising events (for example, donations made at the annual banquet) were reported on Line 1c. All other recurring donations, memorial gifts, corporate grants, and general support contributions were reported on Line 1f. A one-time $161,000 gift received to retire the mortgage was treated as an unusual grant and therefore excluded from Schedule A per instructions. |
| Form 990, Part VIII, Line 8a | Gross receipts from fundraising events were reported on Line 8a. |
| Form 990, Part VIII, Line 8b | Direct event costs (for meals, green fees, venue rental, prizes, and related supplies) were reported on Line 8b. |
| Form 990, Part VIII, Line 8c | The difference (Line 8c) represents the organization's net fundraising event income. Because the events were occasional activities conducted primarily to raise funds for exempt purposes, the entire amount of Line 8c is reported in Column (D) - Excluded Revenue under IRC §§ 512-514. |
| Form 990, Part IX, Line 22 | The depreciation reported on Form 990, Part IX, Line 22 reflects the organization's book depreciation from its fixed-asset schedule, totaling $16,179 for the tax year. The organization's internal Profit and Loss statement reflected a smaller depreciation and amortization amount because it did not include all items required by the tax-year fixed-asset rollforward. Schedule D, Part VI reports the complete accumulated depreciation reconciliation, and the amount reported in Part IX properly follows the organization's books and records maintained on the accrual basis of accounting. |
| Form 990, Part X, Line 23 | The organization's long-term mortgage was fully paid off during the tax year. The outstanding mortgage liability (approximately $154,699 at the beginning of the year) was eliminated as part of the normal course of business when the loan was satisfied. The mortgage principal repayment is a balance sheet transaction and is therefore not reported as an expense in Part IX. The corresponding unusual grant revenue used to fund the payoff is reported in Part VIII. As a result, the removal of the mortgage liability appears as a change in net assets in Part X but does not appear in Part IX expenses. |
| Form 990, Part XI | The organization's long-term mortgage was fully paid off during the tax year. The outstanding mortgage liability (approximately $154,699 at the beginning of the year) was eliminated as part of the normal course of business when the loan was satisfied. The mortgage principal repayment is a balance sheet transaction and is therefore not reported as an expense in Part IX. The corresponding unusual grant revenue used to fund the payoff is reported in Part VIII. As a result, the removal of the mortgage liability appears as a change in net assets in Part X but does not appear in Part IX expenses. |
| Form 990, Part XI, Line 9 | Part XI, Line 9 includes a net adjustment of $10,722 to reconcile the organization's change in net assets on a book basis to the change reported on Form 990. This adjustment reflects the combined effect of non-expense balance sheet transactions, including the removal of the mortgage liability following its full payoff during the year, corrections to beginning balance sheet accounts, and differences between book depreciation and depreciation reported for Form 990 purposes based on the organization's fixed-asset schedule. These items affect the organization's net assets but are not reported as revenue or expenses in Part I. The reconciling amount ensures that ending net assets reported in Part XI agree with the ending net assets reported in Part X of the Form 990. |
| Software ID: | 24021167 |
| Software Version: | v1.00 |