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
WAVERLY HEIGHTS LTD
Employer identification number
23-2212842
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.") .
295,608
10,244
33,325
13,292
281,614
634,083
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......
18,606,352
18,702,033
19,573,916
21,328,729
22,641,897
100,852,927
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.
18,901,960
18,712,277
19,607,241
21,342,021
22,923,511
101,487,010
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.)
101,487,010
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...
18,901,960
18,712,277
19,607,241
21,342,021
22,923,511
101,487,010
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
647,513
505,560
483,281
458,967
452,035
2,547,356
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
438,063
416,493
758,592
721,074
2,334,222
c
Add lines 10a and 10b.
647,513
943,623
899,774
1,217,559
1,173,109
4,881,578
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.)
..
1,416,556
1,246,792
1,472,377
1,175,353
1,841,948
7,153,026
13
Total support. (Add lines 9, 10c, 11, and 12.)..
20,966,029
20,902,692
21,979,392
23,734,933
25,938,568
113,521,614
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
89.400 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
89.750 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
4.300 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
4.240 %
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
WAVERLY HEIGHTS LTD
Employer identification number
23-2212842
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS PREPARED AND REVIEWED BY THE VP OF FINANCE,THE CONTROLLER AND THE INDEPENDENT ACCOUNTANT. THE FINANCE COMMITTEE PERFORMS A FINAL REVIEW BEFORE FILING AND A COPY IS PROVIDED TO ALL MEMBERS OF THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C
WAVERLY HEIGHTS LTD'S CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY TO PROVIDE GUIDANCE TO GOVERNING BOARD MEMBERS. ALL NEW MEMBERS SIGN OFF ON THIS POLICY UPON APPOINTMENT TO THE BOARD. ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF GOVERNING BOARD MEMBERS IS DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD WHEN THE CONFLICT BECOMES A MATTER OF BOARD ACTION. ANY GOVERNING BOARD MEMBERS HAVING A CONFLICT OF INTEREST SHALL NOT VOTE OR USE THEIR PERSONAL INFLUENCE ON THE MATTER, AND THEY SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE, ABSTENTION, AND THE QUORUM.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION FOR THE CEO AND SENIOR MANAGEMENT OF WAVERLY HEIGHTS LTD IS DETERMINED BY THE BOARD HUMAN RESOURCES COMMITTEE BASED ON RECOMMENDATIONS FROM AN INDEPENDANT CONSULTANT. THE CONSULTANT BASES THEIR INFORMATION ON SURVEY DATA FROM SIMILAR RETIREMENT COMMUNITIES AND EXTERNAL DATA. ADDITIONALLY, ANY SIGNIFICANT ADJUSTMENTS FOR CHANGE AND ANNUAL ADJUSTMENTS ARE REVIEWED AND RECOMMENDED BY THE HUMAN RESOURCES COMMITTEE TO THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION C, LINE 19
ALL INFORMATION IS AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:
NET ASSETS RELEASED FROM RESTRICTION -179,917. OTHER -90,028. NET ASSETS RELEASED FROM RESTRICTION 135,293.
FORM 990, PART XII, LINE 2C:
THE BOARD HAS AN AUDIT COMMITTEE THAT APPOINTS THE INDEPENDENT AUDITOR ON AN ANNUAL BASIS.
FORM 5471 SCHEDULE B, SECTION (B):
NO U.S. PERSON OWNED (AT ANY TIME DURING THE ANNUAL ACCOUNTING PERIOD), DIRECTLY OR INDIRECTLY, 10% OR MORE IN VALUE OR VOTE OF THE CLASS OF THE CORPORATION'S OUTSTANDING STOCK.
FORM 5471, SCHEDULE O, PART II, SECTION C & D:
CHURCHILL CASUALTY, LTD. 29-FEB-13 EIN: 98-0177773 ACQUISITIONS AND DISPOSITIONS: THE TAXPAYER NEITHER ACQUIRED NOR DISPOSED OF STOCK IN THE FOREIGN CORPORATION, CHURCHILL CASUALTY, LTD., DURING THE YEAR ENDED FEBRUARY 29, 2013. THE TAXPAYER IS CLASSIFIED AS A CATEGORY 3 FILER FOR FORM 5471 PURPOSES BECAUSE THE TAXPAYER IS TREATED AS A U.S. SHAREHOLDER OF CHURCHILL CASUALTY, LTD. UNDER INTERNAL REVENUE CODE 953(C), AND IS THEREFORE REQUIRED TO COMPLETE SCHEDULE O.
FORM 5471, SCHEDULE O, PART II, SECTION F:
CHURCHILL CASUALTY, LTD. 29-FEB-13 EIN: 98-0177773 ADDITIONAL INFORMATION CHURCHILL CASUALTY, LTD. FILED FORM 1120-F, U.S. INCOME TAX RETURN OF A FOREIGN CORPORATION, FOR ITS TAX YEARS ENDED FEBRUARY 28, 2011, 2012 AND 2013. THE COMPANY HAD NO TAXABLE INCOME AND NO TAX DUE ON THE RETURN.
FORM 5471, ADDITIONAL FILING REQUIREMENTS FOR CATEGORY 3 FILERS:
CHURCHILL CASUALTY, LTD. 29-FEB-13 EIN: 98-0177773 ADDITIONAL FILING REQUIREMENTS FOR CATEGORY 3 FILERS: 1. THE AMOUNT AND TYPE OF ANY INDEBTEDNESS THE FOREIGN CORPORATION HAS WITH THE RELATED PERSONS DESCRIBED IN REGULATIONS 1.6046-1(B)(11). N/A - THERE IS NO INDEBTEDNESS BETWEEN CHURCHILL CASUALTY, LTD. AND RELATED PARTIES. 2. THE NAME, ADDRESS, IDENTIFYING NUMBER AND NUMBER OF SHARES SUBSCRIBED TO BY EACH SUBSCRIBER TO THE FOREIGN CORPORATION'S STOCK. N/A - THERE ARE CURRENTLY NO SUBSCRIPTIONS FOR ANY OF CHURCHILL CASUALTY, LTD.'S STOCK.
FORM 990, SCHEDULE K, PART I, LINE A, COLUMN (F):
PAY OFF $17,105,000 OF OUTSTANDING 1996 BONDS & TO PAY BOND ISSUANCE COSTS.
FORM 990, SCHEDULE K, PART I, LINE B, COLUMN (F):
THE PROCEEDS OF THE 2009 BONDS WERE USED TO: (I) FINANCE THE EXPANSION AND RECONFIGURATION OF THE CORPORATION'S HEALTH CARE CENTER FROM 60 SKILLED NURSING BEDS AND 15 PERSONAL CARE UNITS TO 49 SKILLED NURSING BEDS AND 49 PERSONAL CARE UNITS, (II) FINANCE THE CONSTRUCTION OF EIGHT INDEPENDENT LIVING VILLAS ON THE CORPORATION'S CAMPUS, (III) FINANCE THE COSTS OF OTHER CAPITAL ACQUISITIONS, ADDITIONS, AND IMPROVEMENTS TO BE INCURRED BY THE CORPORATION, (IV) PAY INTEREST ON THE 2009 BONDS DURING THE PERIOD OF CONSTRUCTION OF THE NEW FACILITIES, AND (V) PAY CERTAIN COSTS OF ISSUING THE 2009 BONDS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.