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
2012
Open to Public Inspection
Name of the organization
UPMC SENIOR COMMUNITIES INC
Employer identification number
25-1574736
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
350
0
8,150
500
500
9,500
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......
18,003,786
15,985,379
15,451,453
15,826,671
16,531,528
81,798,817
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
18,004,136
15,985,379
15,459,603
15,827,171
16,532,028
81,808,317
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.)
81,808,317
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
18,004,136
15,985,379
15,459,603
15,827,171
16,532,028
81,808,317
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
79,284
10,820
8,194
9,062
1,998
109,358
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
79,284
10,820
8,194
9,062
1,998
109,358
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
18,083,420
15,996,199
15,467,797
15,836,233
16,534,026
81,917,675
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
99.867 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
99.684 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.134 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
0.316 %
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
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
2012
Open to Public Inspection
Name of the organization
UPMC SENIOR COMMUNITIES INC
Employer identification number
25-1574736
Identifier
Return Reference
Explanation
Part III Statement of Program Service Accomplishments
Organizations Programs and Accomplishments
UPMC SENIOR COMMUNITIES, INC. EIN: 25-1574736 FISCAL YEAR ENDING JUNE 30, 2013 Form 990, Part III-Statement of Program Service Accomplishments The primary exempt purpose of UPMC Senior Communities is the ownership of two types of residential homes for the elderly: Independent Congregate Living Facilities (ICL) and Assisted Living Facilities (ALF). UPMC Senior Communities is also the parent entity of several federally tax exempt skilled nursing facilities. UPMC Senior Communities is a charitable, non-profit corporation founded in 1988 for the purpose of building, owning, operating and maintaining skilled nursing, assisted living, and independent living facilities specifically designed, planned and equipped to meet the physical, emotional, recreational, social, and spiritual needs of elderly or ill persons. UPMC Senior Communities, Inc. offers a variety of living options for Western Pennsylvania-area seniors to meet virtually every need. The goal is to fill a need for area seniors who want a worry-free and enjoyable lifestyle that is affordable and keeps them close to important family and hometown roots. Independent Living A home billed as an independent-living retirement residence is for seniors who are generally independent but who may need a little assistance in daily routines, or instrumental activities of daily living (IADL) including meal preparation and transportation. Residents at these retirement facilities access services including daily meals, housekeeping and laundry service, and scheduled van transportation to shopping and appointments. Live-in resident managers are available around the clock to provide an extra measure of safety and security. Residents can bring their own furniture, automobiles, and even pets, making UPMC Senior Communities' independent living facilities true homes. Independent living is also designed to promote an active lifestyle and offers a full program of activities and entertainment, which enable socialization and prevent the isolation and healthcare complications that can result from living alone. Every building is equipped with dining facilities, space for family and other social gatherings, game room, hair-styling salon, activities room, and library for the residents' enjoyment. Trips to concerts, shows, and luncheons are planned, and residents often make new friends who share common interests. Assisted Living Residents in assisted living facilities are able to enjoy the independence and privacy of apartment living but receive extra assistance with daily activities. Although self-reliance is important, help is available to residents who need it. Assisted living services, such as medication management, nutritional support, personal care services for assistance with dressing, bathing and other needs, and emergency response provide residents with care in the convenience and comfort of their own home. Personal care services provided are individualized to each resident's needs. As in the independent-living residences, assisted living facilities are designed with all the amenities that make them comfortable and welcoming homes. Indoor and outdoor recreation areas and a schedule of daily activities provide residents with an enjoyable setting that promotes functional independence and wellness, and meets needs. The facilities that comprise UPMC Senior Communities, Inc. are as follows: Independent Living Beatty Point Village Vanadium Woods Village Hampton Fields Village Assisted Living Facilities Seneca Manor Weatherwood Manor
Part VI Governance, Management, and Disclosure
Section A: Governing Body and Management
Question 2: Multiple UPMC Officers, Directors, and/or Key Employees have business realtionships by virtue of the fact that they are also Officers, Directors, and/or Key Employees of UPMC subsidiaries and affiliates, which are not separately disclosed below. Question 6: UPMC Senior Communities, Inc. has one sole member, the exempt entity UPMC. Question 7A: The parent entity of UPMC Senior Communities, Inc., UPMC, has the abilty to appoint board members to UPMC Senior Communities, Inc. as stipulated in the by-laws of UPMC Senior Communities, Inc.
Part VI Governance, Management, and Disclosure
Section B: Policies
Question 11: A full copy of the form 990 is provided to each board of directors member prior to filing. Question 12c: UPMC requires all of its key employees 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 physicians and non-physician employees who hold a position of influence -Non-employed members of the UPMC medical staff who hold a positon of influence of 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 UPMC Senior Communities, Inc. 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 others subsidiaries and business units, including those of UPMC Senior Communities, Inc.
Part VI Governance, Management, and Disclosure
Section C: Disclosure
Question 19: Upon request, management determines public disclosure applicability.
PART XI RECONCILIATION OF NET ASSETS
OTHER CHANGES IN NET ASSETS
ADDITIONAL CHANGES IN EQUITY $ 261,162 DONATION $ 300 NET RESTRICTED ASSET ACTIVITY $(1,320) TOTAL $260,142
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 related to UPMC Senior Communities, Inc. These organizations are not required to be listed in schedule R. The organization or related organizations are related through direct and indirect control.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.