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
2011
Open to Public Inspection
Name of the organization
CANTERBURY PLACE
Employer identification number
25-0965334
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
179,141
199,181
175,631
162,351
716,304
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......
8,855,599
9,122,448
8,962,175
8,813,163
35,753,385
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.
9,034,740
9,321,629
9,137,806
8,975,514
36,469,689
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.)
36,469,689
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
9,034,740
9,321,629
9,137,806
8,975,514
36,469,689
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
59,955
317,600
377,555
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
59,955
317,600
377,555
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.)
13
Total support (Add lines 9, 10c, 11 and 12.).
9,034,740
9,321,629
9,197,761
9,293,114
36,847,244
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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
98.975 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
100.000 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
1.025 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
0 %
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
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
2011
Open to Public Inspection
Name of the organization
CANTERBURY PLACE
Employer identification number
25-0965334
Identifier
Return Reference
Explanation
PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
ORGANIZATIONS PROGRAMS AND ACCOMPLISHMENTS
CANTERBURY PLACE EIN 25-0965334 DECEMBER 31, 2010 Form 990, Part III - Statement of Program Service Accomplishments History Canterbury Place, established in 1859 as the Church Home Association, was later renamed the Episcopal Church Home and had the distinction of being the first incorporated charity in the City of Pittsburgh to provide housing for the elderly and infirm. The organization has been at its present site since 1861. In 1988, the Episcopal Church Home affiliated with UPMC Presbyterian Shadyside (f/k/a Presbyterian University Hospital), and at the same time a new six-story building was constructed and the combined structure named Canterbury Place. In July 2007, Canterbury Place went through a reorganization, which resulted in UPMC Senior Communities becoming the sole Member of Canterbury Place. UPMC Senior Communities is a Pennsylvania not-for-profit corporation and a wholly owned subsidiary of UPMC. Mission and Values Sustained by a 150-year heritage of caring, Canterbury Place is a community where the physical, emotional, spiritual, and social needs of older adults are anticipated and fulfilled. Its mission is carried out through a unique combination of compassionate service and expert medical care directed toward achieving optimal levels of independence and encouraging growth throughout life. The values upon which the mission of Canterbury Place is based include: " responding to the changing needs of older adults and their families and caregivers " promoting the highest ethical standards " treating every person with dignity and respect " providing benevolent care and continuing a charitable mission supported by the people of the Episcopal Diocese of Pittsburgh and other organizations The mission is accomplished by: " provision of quality personal care; dementia care; and skilled nursing care " participation in geriatric medical education and research through its association with UPMC " outreach services to older adults beyond the Canterbury Place residential community, including residents of affordable housing Care and Services The name Canterbury Place is recognized and respected as a community where all the amenities of assisted living are available in a comfortable environment in an elegant city setting. As part of UPMC Senior Communities, Canterbury Place combines medical science and services that have made it one of the leaders in geriatric health care in western Pennsylvania. Canterbury Place offers a continuum of care, on either a temporary or permanent basis, to help residents maintain their independence and dignity in a secure, comfortable, and welcoming home that best suits their needs. With many options for care, Canterbury Place helps its personal care residents remain independent as long as possible. Personal care offers the best of both worlds for seniors who need ongoing assistance with daily activities yet who wish to retain their independence to the fullest extent possible. With support, Canterbury Place residents stay active, healthy, and independent in exceptional, home-like surroundings. Residents enjoy the freedom and privacy of apartment living while receiving help with daily needs, such as taking medications, bathing, and managing general hygiene. Before becoming a Canterbury resident, an evaluation is done to determine the level of assistance needed. The nursing staff is on duty 24 hours daily to assist with problems or emergencies. Canterbury Place has a dedicated chaplain to provide for the spiritual needs of the residents and their families. The chapel is available for all denominations and offers regular services for the Christian and Jewish faiths. Memory Support Services Canterbury Place's Renaissance Hall provides state of the art specialty care to residents in different stages of memory impairment. Whether a person is functioning at a high level despite mild cognitive deficits, or lives with moderate or severe dementia, accommodations and care programs are carefully planned to keep each person as independent as possible in secure and dignified surroundings. Residents live in private or semi-private rooms and benefit from a wide variety of goal-oriented activities that stimulate both mind and body. Activities are based on a sound knowledge of each person's previous and current interests such as exercise, music, expressive arts, entertainment, foods, pets, and social gatherings that are familiar, repetitive, and dignified. A secure outdoor courtyard and walking path, a year-round indoor gardening area and customized activities provide stimulation and enjoyment in a beautiful and safe setting. UPMC Senior Care - Benedum Center Canterbury also supports an outpatient satellite clinic of the Benedum Geriatric program. The Benedum clinic is staffed by nationally recognized geriatricians, geriatric psychiatrists, and health professionals experienced in older populations and the conditions that affect them. Services include ongoing primary care and specialty care for patients as well as health care education, counseling, and psychotherapy for patients and families. Through the Benedum Geriatric Center clinic at Canterbury Place, residents receive the professional services of board-certified geriatricians. In addition, dental, eye, audiology, podiatry, and psychiatry services are available. Skilled Nursing For those residents who require 24 hour nursing care, Canterbury Place offers specialized services on site such as IV therapy, physical therapy, occupational therapy, private/semi-private rooms, hyperalimentation (TPN), would care services, short-term rehabilitation, hospice care services, respite care, feeding tubes, and respiratory care. These services are provided regardless of a patient's ability to pay.
Part VI Governance, Management, and Disclosure
Section A: Governing Body and Management
Question 2: William Nigro, Deborah Brodine, Margaret Kimmel, and Jerome Shaffer all serve in officer or board member capacity in related (Parent or brother-sister) exempt entities. Question 6: Canterbury Place has one sole member, the exempt entity UPMC Senior Communities, Inc. Question 7a: The parent entity of Canterbury Place, UPMC Senior Communties, Inc., has the ability to appoint Board members to Canterbury Place as stipulated in the By-Laws of Canterbury Place.
Part VI Governance, Management, and Disclosure
Section B: Policies
Question 11(a): A full copy of the Form 990 was provided to each Board of Directors member prior to filing. Question 12c: UPMC requires all of its key employed and non-employed personnel to comply with its Conflict of Interest Policies when they engage in UPMC-related business. People covered by the policies include: -UPMC entity board members, board committee members, and corporate officers -UPMC physician and non-physician employees who hold a position of influence -Non-employed members of the UPMC medical staff who hold a position of influence or trust -Individuals conducting clinical research at UPMC, whether or not they are employed by UPMC These people are required to complete a questionnaire at least annually. An electronic form has been developed to capture the data from the questionnaire and to monitor completion. The information, along with other data, is used to capture individual and institutional relationships so that potential conflicts of interest can be identified. If a potential conflict is identified regarding a specific UPMC activity the Corporate Compliance Department, with the assistance of the Legal Department, evaluate the activity in relation to the potential conflict. If a perceived or actual conflict is determined to exist and a decision is made to proceed with the activity, a written plan designed to prevent the conflict from influencing decisions related to the activity is developed. The process is ultimately overseen by a Conflict of Interest Committee of the UPMC Board of Directors on behalf of all UPMC subsidiaries, including Canterbury Place. Question 15a and b : UPMC has established a rigorous compensation review process for its top executives which includes review by its Executive Compensation Committee in a process intended to satisfy the "rebuttable presumption of reasonableness" set forth in the regulations to Section 4958 of the Internal Revenue Code. UPMC gives authority to those executives to establish the compensation of executives of other subsidiaries and business units, including those of Canterbury Place.
Part VI Governance, Management, and Disclosure
Section C: Disclosure
Question 19: Upon request, management determines public disclosure applicability.
Reconciliation of Net Assets
PART XI, Reconcilation of Net Assets
Funds Released from Restriction $(106,959) Interest Income $170,206 Unrealized Investment Revenue $(7,747) Donations $14,172 Total Changes in Net Assets 69,672
Financial Statements and Reporting
Part XII, Financial Statements and Reporting
Question 2b : The organization's financial statements are part of a consolidated group financial statement audit performed by Ernst and Young for UPMC and all subsidiaries. The entire system financial statements, of which this organizations is part of, are posted on the UPMC website. (www.upmc.com)
Schedule R - Related Organizations and Unrelated Partnerships
Part II and III, Identification of Related Tax-Exempt and Taxable P-Ship
There are organizations included in the UPMC Group Form 990 tax return for fiscal year 2010 which are relate to Canterbury Place. These organizations are not required to be listed in Schedule R. The related organizations have direct and indirect control.
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:WILLIAM NIGRO TITLE:TREASURER HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:STEPHEN NIMMO TITLE:SECRETARY HOURS:40
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.