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
PIONEER VALLEY LIVING CARE CENTER AT AMHERST INC
Employer identification number
22-2777127
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.") .
7,887
52,931
18,402
11,782
9,349
100,351
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......
4,505,844
4,576,548
4,775,062
4,868,276
5,141,936
23,867,666
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.
4,513,731
4,629,479
4,793,464
4,880,058
5,151,285
23,968,017
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.)
23,968,017
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...
4,513,731
4,629,479
4,793,464
4,880,058
5,151,285
23,968,017
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
87,166
263,866
90,793
51,602
11,503
504,930
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
87,166
263,866
90,793
51,602
11,503
504,930
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 IV.)
92,535
96,759
113,202
106,772
83,335
492,603
13
Total support (Add lines 9, 10c, 11 and 12.).
4,693,432
4,990,104
4,997,459
5,038,432
5,246,123
24,965,550
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
96.000 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
95.700 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
2.020 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
2.240 %
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 (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
PIONEER VALLEY LIVING CARE CENTER AT AMHERST INC
Employer identification number
22-2777127
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THERE ARE 93 MEMBERS OF THE CORPORATION, KNOWN AS CORPORATORS (PER THE BYLAWS, THERE IS NO LIMIT TO THE POTENTIAL NUMBER OF CORPORATORS).
FORM 990, PART VI, SECTION A, LINE 7A
THE CORPORATORS ELECT THE BOARD OF DIRECTORS AT THE ANNUAL MEETING OF THE CORPORATION EACH MAY. THERE IS 1 MEMBER OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B
THE BOARD OF DIRECTORS HAVE DECISION-MAKING AND VOTING AUTHORITY ON ISSUES INCLUDING BUT NOT LIMITED TO THE FOLLOWING: HIRING OR TERMINATING THE CEO; ESTABLISHING SALARY AND BENEFITS FOR THE CEO; APPROVING OPERATING AND CAPITAL BUDGETS AND EXPENDITURES; ENGAGING AN INDEPENDENT AUDITOR TO CONDUCT AN ANNUAL AUDIT; REVIEWING AND APPROVING THE AUDIT; ESTABLISHING, REVIEWING, AND APPROVING POLICIES; ESTABLISHING AND APPROVING STRATEGIC PLANS; AND CONDUCTING ALL OTHER BUSINESS AS IS DEEMED APPROPRIATE FOR THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11
THE COMPLETED FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. ANY PERTINENT COMMENTS OR RECOMMENDATIONS ARE PRESENTED BY THOSE COMMITTEES TO THE FULL BOARD. EACH MEMBER OF THE BOARD RECEIVES A COPY OF THE FORM 990; AND IT IS POSTED ON THE ORGANIZATION'S WEB SITE FOR ACCESS BY MEMBERS OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 12C
IN MAY OF EACH YEAR, FOLLOWING THE ANNUAL MEETING, EACH MEMBER OF THE BOARD OF DIRECTORS RECEIVES A COPY OF THE CONFLICT OF INTEREST POLICY, AND A FORM ON WHICH TO INDICATE ANY KNOWN OR POTENTIAL CONFLICTS OR DUALITIES OF INTEREST. BOARD MEMBERS ARE ASKED TO SIGN THE POLICY ITSELF, AND TO COMPLETE THE FORM REQUESTING ANY CONFLICTS OR DUALITIES. AT THE BOARD OF DIRECTORS MEETING IN JUNE OF EACH YEAR, EACH BOARD MEMBER RECEIVES A COPY OF EVERY OTHER BOARD MEMBER'S SIGNED FORMS; IF THERE ARE ANY CONFLICTS OR DUALITIES, THEY ARE DISCLOSED TO THE FULL BOARD. IF THERE IS A BOARD MEMBER WITH A CONFLICT RELATED TO A PARTICULAR DISCUSSION OR VOTE, THAT BOARD MEMBER EXCUSES HIM OR HERSELF FROM THE MEETING.
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL REVIEW OF THE CEO, BOTH FOR PERFORMANCE AND FOR COMPENSATION. THE CEO SUBMITS A SELF-EVALUATION AND REPORTS ON ACHIEVEMENT OF GOALS ESTABLISHED FOR THE PRIOR YEAR; ALL BOARD MEMBERS PROVIDE FEEDBACK. THE COMPENSATION COMMITTEE CONDUCTS A REVIEW OF SALARIES AND BENEFITS FOR POSITIONS COMPARABLE TO THE CEO. SOURCES FOR THE INFORMATION INCLUDE, BUT ARE NOT LIMITED TO: WAGE SURVEYS FROM THE ORGANIZATION'S STATE AND NATIONAL MEMBERSHIP ORGANIZATIONS; LOCAL EMPLOYERS' ASSOCIATION WAGE SURVEYS; PRIVATE WAGE SURVEYS FROM CONSULTANTS AND COLLEAGUES; WAGES AS REPORTED ON OTHER ORGANIZATIONS' FORM 990S; INFORMATION FROM INDEPENDENT AUDITOR. THE COMPENSATION COMMITTEE PRESENTS ITS RECOMMENDATION FOR CEO SALARY AND BENEFITS TO THE FULL BOARD FOR DISCUSSION AND VOTE. THE CEO PRESENTS ANNUALLY TO THE FULL BOARD OF DIRECTORS A SPREADSHEET WITH THE CURRENT SALARIES AND BENEFITS OF EACH MEMBER OF SENIOR MANAGEMENT: CFO, DIRECTOR OF OPERATIONS, DIRECTOR OF MARKETING, DIRECTOR OF DEVELOPMENT, AND THE ADMINISTRATORS OF THE ORGANIZATIONS, ALONG WITH RECOMMENDATIONS FOR ANY CHANGES IN SALARIES AND BENEFITS. COMPARABLE SALARIES FOR THESE POSITIONS ARE INCLUDED, OBTAINED FROM INFORMATION AS DESCRIBED ABOVE. THE FULL BOARD OF DIRECTORS VOTES TO APPROVE THESE SALARIES AND BENEFITS.
FORM 990, PART VI, SECTION C, LINE 19
FINANCIAL STATEMENTS, FORM 990, CONFLICT OF INTEREST POLICY, GOVERNANCE POLICIES AND PROCEDURES AND OTHER APPROPRIATE GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, THE ORGANIZATION'S FORM 990 IS AVAILABLE VIA GUIDESTAR AND THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE.
FORM 990, PART VII, SECTION A:
CAROL C. KATZ IS COMPENSATED FOR SERVICES PROVIDED TO LOOMIS COMMUNITIES, INC. AND AFFILIATES AS PRESIDENT & CEO. CAROL WORKS AN AVERAGE OF 40 HOURS PER WEEK IN HER POSITION AS PRESIDENT & CEO FOR LOOMIS COMMUNITIES, INC. AND AFFILIATES. MARGARET R. MANTONI IS COMPENSATED FOR SERVICES PROVIDED TO LOOMIS COMMUNITIES, INC. AND AFFILIATES AS CFO. MARGARET WORKS AN AVERAGE OF 40 HOURS PER WEEK IN HER POSITION AS CFO FOR LOOMIS COMMUNITIES, INC. AND AFFILIATES.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 5,939. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -2,850. UNREALIZED LOSSES ON INVESTMENTS -6,761. TOTAL TO FORM 990, PART XI, LINE 5: -3,672.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.