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
Hebrew Rehabilitation Center
Employer identification number
04-2104298
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.") .
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.)
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...
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 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.).
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
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
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
Hebrew Rehabilitation Center
Employer identification number
04-2104298
Identifier
Return Reference
Explanation
Description of Negative Assets
Form 990, Part I, Line 22
THE DECREASE IN UNRESTRICTED NET ASSETS AND UNRESTRICTED NET DEFICIT AT HEBREW REHABILITATION CENTER ("HRC") FOR FISCAL YEAR 2012 REFLECTS THE INCLUSION OF EXPENSES THAT ARE SUPPORTED BY HRC'S PARENT, HEBREW SENIORLIFE ("HSL"). HSL BENEFITS FROM BOTH MANAGEMENT FEES AND PHILANTHROPIC INCOME THAT ARE AVAILABLE TO FUND HRC'S OPERATING, PENSION FUND AND OTHER EXPENSES. AS SUCH, HSL'S MANAGEMENT, BOARD OF DIRECTORS AND LENDERS VIEW THE ORGANIZATION'S FINANCIAL CONDITION AS HSL'S AND HRC'S COMBINED BALANCE SHEET, WITH $53.8 MILLION IN UNRESTRICTED NET ASSETS AT 9/30/2012. Description of Classes of Members or Stockholders Form 990, Part VI, Question 6 HEBREW SENIORLIFE, INC. IS THE SOLE CORPORATE MEMBER OF HEBREW REHABILITATION CENTER AND PROVIDES MANAGEMENT OVERSIGHT AND FUNDRAISING SERVICES TO HRC AND TO ITS OTHER AFFILIATES. MEMBERS WHO MAY ELECT ONE OR MORE OF THE GOVERNING BODY FORM 990, PART VI, QUESTION 7A THE HEBREW SENIORLIFE BOARD CHAIR APPOINTS THE MEMBERS OF THE HEBREW REHABILITATION CENTER BOARD OF DIRECTORS WITH THE ADVICE AND CONSENT OF THE HEBREW SENIORLIFE BOARD MEMBERS. Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights Form 990, Part VI, Question 7b DECISIONS INVOLVING MAJOR CHANGES IN ORGANIZATION, DEBT PLACEMENT, SALE OF ASSETS, ETC. ARE ALSO SUBJECT TO APPROVAL BY HEBREW SENIORLIFE'S BOARD. Ultimately, governance of the corporation rests with the Board of Directors of the company's sole corporate member, Hebrew SeniorLife, Inc. Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, Question 11 PREPARATION OF THE FORMS 990 AND 990T BEGIN INTERNALLY WITH HEBREW REHABILITATION CENTER STAFF AND ERNST & YOUNG PREPARES THE FORMS WITH INPUT PROVIDED BY HEBREW REHABILITATION CENTER. ALL FORMS 990 AND 990T OF THE AFFILIATES OF HEBREW SENIORLIFE, INC. (HSL IS THE SOLE CORPORATE MEMBER OF EACH AFFILIATE) WILL BE REVIEWED PRIOR TO FILING BY THE AUDIT COMMITTEE OF HEBREW SENIORLIFE, INC. SUBSEQUENT TO SUCH REVIEW AND PRIOR TO FILING COPIES WILL BE PROVIDED TO THE APPROPRIATE GOVERNING BOARD OF DIRECTORS FOR EACH AFFILIATE. THE GOVERNING BOARDS WILL HAVE 5 DAYS TIME IN WHICH TO REVIEW THE FULL AND ACCURATE RETURNS PRIOR TO THEIR FILING. Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Question 12c The conflicts of interest policy is rigorously monitored by the conflicts review committee of the Board of Directors. This involves annually mailing a conflicts disclosure form to all members of the Board of Directors, Board committees and senior management. This committee reviews signed disclosure forms and identifies potential conflicts. The committee discusses the potential conflict with the Interested Person and receives any additional information pertaining to the potential conflict. The Interested Person leaves the committee room, the committee deliberates and reaches a conclusion regarding the potential conflict and makes a recommendation to the Board. The recommendation of the committee shall be determined given (i) that a more advantageous transaction or arrangement is not reasonably attainable under circumstances not giving rise to a conflict of interest, (ii) that the transaction or arrangement is in the best interest of the Organization and for its own benefit, and (iii) that the transaction or arrangement is fair and reasonable to the Organization. Based on these recommendations made by the conflicts review committee, the entire Board, excluding the Interested Person, will make the final determination to authorize the transaction giving rise to the potential conflict of interest. If either the conflicts review committee or the Board of Directors has reasonable cause to believe an Interested Person has failed to disclose actual or possible conflicts of interest, the Interested Person shall be notified and allowed an opportunity to explain the alleged failure to disclose. Following such discussion, the committee or board shall deliberate and determine if a failure to disclose has occurred and shall take appropriate corrective action. Offices & Positions for Which Process was Used, & Year Process was Begun Form 990, Part VI, Question 15a and 15b THE COMPENSATION COMMITTEE OF THE Hebrew Seniorlife BOARD, WITH THE ASSISTANCE OF INDEPENDENT, EXPERT CONSULTANTS, HAS REVIEWED THE CEO'S TOTAL COMPENSATION, THE PRESIDENT'S TOTAL COMPENSATION AND THE COMPENSATION OF ALL OFFICERS AND KEY EMPLOYEES AS WELL AS HIGHLY COMPENSATED (>$150,000) EMPLOYEES OF HSL AND ITS AFFILIATES. THIS PROCESS WAS LAST PERFORMED DURING THE FISCAL YEAR 2011. THE FULL HSL BOARD FURTHER REVIEWED AND APPROVED THE COMPENSATION OF THE OFFICERS, KEY EMPLOYEES AND HIGHLY COMPENSATED EMPLOYEES OF HSL AND ITS AFFILIATES. ALL OF THESE COMMITTEE MEMBERS ARE INDEPENDENT DIRECTORS. DOCUMENTATION AND RECORDS OF COMPENSATION COMMITTEE MEETINGS ARE MAINTAINED WITH RESPECT TO DELIBERATIONS AND COMPENSATION DECISIONS. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 19 GOVERNING DOCUMENTS ARE AVAILABLE AT THE COMM OF MASS WEBSITE. THESE AND CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST AT THE OFFICES OF HSL AT 1200 CENTRE ST. BOSTON, MA 02131. WE HAVE ALSO RESPONDED TO TELEPHONE AND EMAIL REQUESTS FOR DOCUMENTS. AVERAGE HOURS PER WEEK DEVOTED TO THIS ORGANIZATION AND RELATED COMPANIES Form 990, Part VII, SECTION A NAME THIS ORGANIZATION OTHER AFFILIATES TOTAL ALESSANDRA DE VACA 29 21 50 JAMES D. HART 15 35 50 LEN FISHMAN 20 30 50 LOUIS J. WOOLF 15 35 50 MARY MOSCATO 40 10 50 JENIQUE LEBLOND 20 10 30 FRANCIS X. HINCKLEY 15 35 50 JAY L. WEBBER 1 3.5 4.5 JENNIFER SILVER 1 3.5 4.5 HOWARD COHEN 1 1 2 THOMAS ALPERIN 1 1 2
OTHER CHANGE IN NET ASSETS
FORM 990, PART XI, LINE 5
UNREALIZED GAINS $ 91,967 CHANGE IN PENSION $(5,071,496) NET ASSETS RELEASED, TRANSFERRED FROM AFFILIATE $ 373,513 ____________ OTHER CHANGES IN NET ASSETS $(4,606,016)
DESCRIPTION OF BONDS
SCHEDULE K, PART I
Variable Rate Demand Revenue Bonds Hebrew Rehabilitation Center Issue Series D (2007). The Proceeds of the 2007 Bonds will be applied, together with other available moneys: (i) to advance refund $9,081,387 of the outstanding amount of the Authority Bonds, Hebrew Rehabilitation Center for Aged, Series C; (ii) to repay the Authority's outstanding Pool M Loan to the Institution of approximately $5,357,000; and (iii) to letter of credit fees and other costs of the 2007 Bonds.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.