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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
WASHINGTON SENIOR CARE CORPORATION
Employer identification number
25-1849365
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
0
1,000
0
0
2,693
3,693
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......
6,098,213
6,229,878
6,403,832
6,623,279
6,883,504
32,238,706
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.
6,098,213
6,230,878
6,403,832
6,623,279
6,886,197
32,242,399
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.)
32,242,399
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
6,098,213
6,230,878
6,403,832
6,623,279
6,886,197
32,242,399
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
23,079
16,540
8,527
5,297
4,510
57,953
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
23,079
16,540
8,527
5,297
4,510
57,953
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.)..
6,121,292
6,247,418
6,412,359
6,628,576
6,890,707
32,300,352
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.821 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.702 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.179 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.298 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
WASHINGTON SENIOR CARE CORPORATION
Employer identification number
25-1849365
Return Reference
Explanation
Organizations Programs and Accomplishments
WASHINGTON SENIOR CARE CORPORATION EIN: 25-1849365 FISCAL YEAR ENDING JUNE 30, 2014 Form 990, Part III - Statement of Program Service Accomplishments The primary exempt purpose of Washington Senior Care Corporation is the ownership of two types of residential homes for the elderly: Independent Congregate Living Facilities (ICLs) and Assisted Living Facilities (ALFs). Washington Senior Care is a charitable, non-profit corporation founded in 1999 to provide for senior care housing and health and wellness programs through the establishment and operation of an assisted living facility and independent congregate living facility. Washington Senior Care Corporation operates an 81-unit Assisted Living Facility and a 123-unit Independent Congregate Living Facility. During fiscal year 2014, the two facilities had a combined average daily census of 214.6 residents. These facilities are a vital service to the elderly in the community because they provide this population with the continuing opportunity to have a range of independence during scenarios where some limited assistance may be needed. This creates a very positive and nurturing environment for the seniors to live in, while maintaining the highest level of dignity and independence for them. The two types of facilities are as follows: An ICL is a residential facility for the elderly who are ambulatory without assistance, able to self manage medications, and require no assistance with the activities of daily living. These residents are generally independent, but may need a little assistance in daily routines, including instrumental activities of daily living (IADLs) including meal preparation and transportation. In addition to enjoying all of the amenities of the facility, these residents are free to come and go as they please and enjoy the added-benefit of live-in resident managers who are available to provide them with a worry-free lifestyle in a safe and secure environment. An ALF is a residential facility for the elderly who require assistance with personal hygiene, bathing, grooming, and other activities of daily living, including the taking of medication. These residents are able to enjoy the independence and privacy of apartment living, but with the added benefit of receiving extra assistance with daily activities. Both of these facilities are designed to meet the physical, emotional, recreational, social, cultural, intellectual, and spiritual health-related needs of its residents. These facilities consist of residential units, all connected through a central core of dining, administrative and recreational space. Both of these facilities offer the following services to its residents: room, three meals a day, housekeeping, linen service, utilities, transportation, private dining room for family gatherings, indoor and outdoor recreation areas, daily activities, entertainment and supervision of social and recreational activities. In addition, the facilities facilitate health services through arrangements with its affiliated health care organizations-the University of Pittsburgh Medical Center (UPMC) and The Washington Hospital. Washington Senior Care Corporation has established a charitable relief policy whereby residents will have the ability to continue their residency even in light of financial inability to pay their monthly service fees.
Section A: Governing Body and Management
Question 2: Multiple UPMC Officers, Directors, and/or Key Employees have business relationships 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: Washington Senior Care Corporation has 2 memberS, the exempt entities UPMC Community Provider Services, Inc. AND the WASHINGTON HOSPITAL. Question 7A: The parent entities of Washington Senior Care Corporation, UPMC Community Provider Services, Inc. AND the WASHINGTON HOSPITAL have the abilty to appoint board members to WASHINGTON SENIOR CARE CORPORATION as stipulated in the by-laws of Washington Senior Care Corporation.
Section B: Policies
Question 12a-c: Washington Senior Care Corporation adheres to the Conflict of Interest policy of UPMC. 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 Washington Senior Care Corporation. Question 15a and b: UPMC has established a rigorous compensation review process for its top executives which applies to washington senior care corporation; it 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 Washington Senior Care Corporation.
Section C: Disclosure
Question 19: Upon request, management determines public disclosure applicability.
Financial Statements and Reporting
Question 2B: The organization's financial statements are audited by DeMarchi and Associates.
OTHER CHANGES IN NET ASSETS
Partner Distribution $(1,000,000) Special Purpose Fund Activity $90 TOTAL $999,904
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.