Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
WESLEY RETIREMENT SERVICES INC
Employer identification number
42-0680440
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
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.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
1,141,678
1,614,381
1,587,221
1,464,130
5,973,231
11,780,641
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......
32,627,228
34,647,494
36,384,006
38,609,917
54,554,100
196,822,745
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.
33,768,906
36,261,875
37,971,227
40,074,047
60,527,331
208,603,386
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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..
0
8
Public Support (Subtract line 7c from line 6.)
208,603,386
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
33,768,906
36,261,875
37,971,227
40,074,047
60,527,331
208,603,386
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,406,795
2,036,426
1,236,904
1,812,329
1,759,701
8,252,155
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
1,406,795
2,036,426
1,236,904
1,812,329
1,759,701
8,252,155
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
734
61,601
40,761
15,261
3,356
121,713
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
337,325
-79,937
257,388
13
Total support (Add lines 9, 10c, 11 and 12.).
35,176,435
38,697,227
39,248,892
41,901,637
62,210,451
217,234,642
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
96.030 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
95.550 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
3.800 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
3.770 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME REIMBURSED ADMINISTRATIVE EXPENSES LOSS ON REFINANCING
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
WESLEY RETIREMENT SERVICES INC
Employer identification number
42-0680440
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
THE EXECUTIVE COMMITTEE IS COMPOSED OF THE OFFICERS OF THE BOARD AND THE CHAIRS OF THE COMMITTEES. ALL MEMBERS ARE ON THE GOVERNING BOARD. THE EXECUTIVE COMMITTEE HAS ALL THE AUTHORITY OF THE BOARD (EXCEPT AS NOTED BELOW) BUT LIMITS ITSELF TO MATTERS THAT REQUIRE IMMEDIATE ACTION AND CANNOT WAIT UNTIL THE NEXT SCHEDULED BOARD MEETING. THE EXECUTIVE COMMITTEE SHALL HAVE NO AUTHORITY TO AMEND THE ARTICLES OF INCORPORATION, THE BYLAWS, OR ADOPT A PLAN OF MERGER OR CONSOLIDATION.
FORM 990, PART VI, SECTION A, LINE 4
ARTICLES OF INCORPORATION WAS AMENDED TO INCLUDE TO INCLUDE WESLEYLIFE AS SOLE MEMBER OF WESLEY RETIREMENT SERVICES, INC. & WESLEY COMMUNITY SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF WESLEY RETIREMENT SERVICES, INC. IS WESLEYLIFE.
FORM 990, PART VI, SECTION A, LINE 7A
WESLEYLIFE ELECTS THE BOARD MEMBERS OF WESLEY RETIREMENT SERVICES, INC. AND IF THERE ARE ANY VACANCIES IN THE BOARD OF DIRECTORS OF THEY ARE FILLED BY WESLEYLIFE.
FORM 990, PART VI, SECTION A, LINE 7B
APPROVAL OF THE FOLLOWING MATTERS ARE RESERVED EXCLUSIVELY TO THE MEMBER: 1. APPROVAL OF CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS; 2. APPOINTMENT OF, OR REMOVAL OF, WITH OR WITHOUT CAUSE, THE MEMBERS OF THE BOARD OF DIRECTORS; 3. APPROVAL OF THE INCURRENT OF DEBT; 4. THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS, DIVESTITURES, DISSOLUTIONS, CLOSURES, MERGERS, CONSOLIDATIONS, OR CHANGES IN CORPORATE MEMBERSHIP; 5. APPROVAL OF THE TRANSFER OR ENCUMBRANCE OF THE ASSETS; AND 6. APPROVAL OF THE ANNUAL OPERATING BUDGET AND CAPITAL PLAN.
FORM 990, PART VI, SECTION B, LINE 11
THE CEO, CFO AND VP OF FINANCIAL PLANNING REVIEWED THE DOCUMENT INTERNALLY. THE 990 WAS THEN DISTRIBUTED TO THE FINANCE COMMITTEE FOR DISCUSSION WITH MANAGEMENT AND APPROVAL FOR SUBMISSION WITH THE IRS. ONCE APPROVED BY THE FINANCE COMMITTEE, THE 990 WILL BE POSTED TO THE BOARD'S WEBSITE FOLLOWED BY AN EMAIL TO THE FULL BOARD STATING THAT IT CAN BE REVIEWED THERE.
FORM 990, PART VI, SECTION B, LINE 12C
THE CORPORATION REQUIRES FROM BOARD MEMBERS AND MANAGING EMPLOYEES AN ANNUAL STATEMENT DESCRIBING ACTUAL OR PERCEIVED CONFLICTS OF INTEREST. WITH RESPECT TO THE BOARD MEMBERS, A PERSON WHO HAS A CONFLICT OF INTEREST IS DEEMED AN INTERESTED DIRECTOR. THE INTERESTED DIRECTOR SHALL NOT PARTICIPATE IN THE VOTE REGARDING HIS/HER POTENTIAL CONFLICT AND, DEPENDING UPON THE CIRCUMSTANCES, MAY NOT BE PERMITTED TO PARTICIPATE IN THE DISCUSSION REGARDING THE ISSUE. NO INTERESTED DIRECTOR SHALL BE PERMITTED TO VOTE IN MATTERS IN WHICH HE/SHE HAS A CONFLICT OF INTEREST. WITH RESPECT TO EMPLOYEES, THE PRESIDENT, IN CONSULTATION WITH OTHER UNBIASED MANAGERS, SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. AFTER EXERCISING DUE DILIGENCE, INCLUDING INVESTIGATING ALTERNATIVES TO A TRANSACTION OR ARRANGEMENT THAT GIVES RISE TO A CONFLICT OF INTEREST, THE PRESIDENT SHALL DETERMINE WHETHER THE CORPORATION IS ABLE TO OBTAIN WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM ANOTHER INDIVIDUAL OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT AVAILABLE, THE ARRANGEMENT OR TRANSACTION MAY GO FORWARD IF THE PRESIDENT DETERMINES THAT THE TRANSACTION IS FAIR AND IN THE BEST INTEREST OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 15A
THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IS EMPOWERED BY THE BOARD OF DIRECTORS ACCORDING TO ARTICLE VII OF THE ORGANIZATION'S BY-LAWS, TO DETERMINE PERFORMANCE GOALS AND MONITOR AND EVALUATE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE INCLUDES IN ITS EVALUATION, FEEDBACK FROM OTHER BOARD MEMBERS AND OTHERS NOT ASSOCIATED WITH THE COMMITTEE OR THE BOARD. THE COMMITTEE MONITORS PERFORMANCE OF THE ORGANIZATION AND CEO THROUGHOUT THE YEAR AND PROVIDES ONGOING ASSESSMENTS TO THE CEO USING AN EVALUATION AND RATING TOOL. THE COMMITTEE UTILIZES AN ANNUAL INDEPENDENT COMPENSATION SURVEY TO ASSIST IN DETERMINING COMPENSATION. THE ORGANIZATIONS OF CHIEF EXECUTIVE OFFICERS OF MULTI-SITE ORGANIZATIONS AND THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGANG PROVIDE AN ANNUAL SURVEY OF COMPENSATION FOR CEOS AND OTHER OFFICERS. (WESLEY HAS SEARCHED FOR OTHER SURVEYS TO SUPPLEMENT THIS ONE BUT NO OTHER SURVEY PROVIDES THE SAME DEGREE OF COMPARABILITY.) THE SURVEY INCLUDES ONLY SENIOR LIVING ORGANIZATIONS AND IS SORTED BY GEOGRAPHIC REGIONS, REVENUE VOLUME, FULL-TIME EQUIVALENT EMPLOYEES, AND ASSET SIZE. THE EXECUTIVE COMMITTEE DISCLOSES TO THE FULL BOARD OF DIRECTORS, IN CLOSED SESSION, THE RESULTS OF THE PERFORMANCE EVALUATION AND COMPENSATION DECISIONS. MINUTES OF MEETINGS ARE MAINTAINED AND THE BOARD CHAIRMAN PROVIDES WRITTEN NOTIFICATION TO BOTH THE CEO AND THE CORPORATE FINANCE DEPARTMENT REGARDING COMPENSATION DECISIONS. THE EVALUATION AND COMPENSATION SETTING PROCESS IS MUCH THE SAME FOR THE OTHER OFFICERS AS FOR THE CEO WITH SOME EXCEPTIONS. THE CEO DETERMINES THE PERFORMANCE GOALS AND MONITORS RESULTS. THE SAME SURVEY AS DESCRIBED ABOVE IS USED TO ASSIST IN DETERMINING COMPENSATION. THE CEO DISCLOSES ANNUALLY TO THE EXECUTIVE COMMITTEE THE COMPENSATION DECISIONS AND REASONS FOR THOSE DECISIONS IN REGARD TO OTHER OFFICERS. THE LAST REVIEW PROCESS WAS CONDUCTED IN 2010 AND IS DONE ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 976,945. FAIR VALUE INTEREST RATE SWAP -1,344,390. CHANGE IN VALUE OF EFFECTIVE CASH FLOW HEDGE SWAPS -31,218. CHANGE IN VALUE OF SPLIT INTEREST GIFTS 15,249. CHANGE IN VALUE OF PERPETUAL TRUST HELD BY THIRD PARTY 118,442. TOTAL TO FORM 990, PART XI, LINE 5: -264,972.
SHARING OF HOURS
FORM 990, PART VII, SECTION A
OFFICERS AND HIGHEST PAID EMPLOYEES SHARE THEIR HOURS WITH THE RELATED ORGANIZATIONS AS FOLLOWS: WESLEY RETIREMENT SERVICES, INC: 34 HOURS WESLEY COMMUNITY SERVICES, INC: 6 HOURS WESLEYLIFE: 1 HOUR
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.