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
PITTSBURGH LIFETIME CARE COMMUNITY
Employer identification number
25-1335247
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.") .
827,971
5,000
290,462
458,061
11,691
1,593,185
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......
14,777,014
15,807,469
16,231,524
16,904,711
18,007,153
81,727,871
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.
15,604,985
15,812,469
16,521,986
17,362,772
18,018,844
83,321,056
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.)
83,321,056
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...
15,604,985
15,812,469
16,521,986
17,362,772
18,018,844
83,321,056
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
299,753
173,755
171,974
155,397
94,954
895,833
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
299,753
173,755
171,974
155,397
94,954
895,833
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.)..
15,904,738
15,986,224
16,693,960
17,518,169
18,113,798
84,216,889
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
98.936 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
98.549 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
1.064 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
1.451 %
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
PITTSBURGH LIFETIME CARE COMMUNITY
Employer identification number
25-1335247
Identifier
Return Reference
Explanation
Part III Statement of Program Service Accomplishments
Organizations programs and accomplishments
Pittsburgh Lifetime Care Community d/b/a Sherwood Oaks EIN 25-1335247 Fiscal Year Ending June 30, 2013 Form 990, Part III - Statement of Program Service Accomplishments The mission of Pittsburgh Lifetime Care Community (Sherwood Oaks) is to operate a continuing care retirement community for people over age 62 which fosters independence, health, physical and financial security, while preserving a quality and dignity of life in which residents realize their fullest potential. In fulfillment of this mission, Sherwood Oaks provides housing and supportive services to older adults on its 85 acre campus in Cranberry Township, PA. The services provide support that allows residents to live independently as long as feasible and offers more support in personal care, a secured dementia unit or a skilled nursing facility if necessary. Sherwood Oaks is accredited by the Continuing Care Accreditation Commission (CCAC), an independent commission sponsored by the Commission on Accreditation of Rehabilitation Facilities (CARF). In order to gain this distinction, the organization's programs and services have met consumer-focused, state-of-the-art international standards of performance in areas such as leadership, strategic planning, human resources, technology practices, and performance improvement. Sherwood Oaks is a member of Leading Age PA, a non-profit association of home and services for seniors in Pennsylvania, and also Leading Age, a national association that was previously named AAHSA, the American Association of Homes and Services for the Aging. What sets Sherwood Oaks apart from other retirement communities is their guarantee of personal care and skilled care whenever it is needed by a resident. This is the Lifecare program, and there is no limit on the number of nursing or personal care days a resident can receive. Additionally there are other service options providing residents with choices fitting their lifestyle needs. Sherwood Oaks offers a comprehensive package of health and wellness programs, including: " Fitness center to foster wellness and health promotion " In-home care provided by Community Nursing " Fully licensed 42-room personal care " Fully licensed 43-bed nursing home " Fully licensed 30-room personal care facility for residents with memory loss " Transportation services " Fully licensed home care agency For the year ended June 30, 2013, Sherwood Oaks provided services in the aggregate of 150,131 resident days for its skilled nursing, personal care, and retirement living residents. Sherwood Oaks provides a wide range of programs and services that address many aspects of a resident's life. These programs and services address the emotional, intellectual, social, physical, spiritual, and vocational aspects of life. The fitness center offers an array of exercise machines that promote strength and flexibility, along with equipment that promotes cardiovascular health. There is also a wellness manager to assist residents in achieving their health and wellness goals. Residents organize and participate in social, spiritual and educational programs that promote wellness. Some of the features/amenities at Sherwood Oaks include: Sound-proof and fire-rated construction Community nursing Meals served daily Fully-equipped kitchens Weekly housekeeping Utilities Weekly flat laundry service Maintenance of buildings Bathroom with safety aids Maintenance of grounds Security personnel on duty 24 hours/day Twenty-four hour emergency call system Smoke detectors Health Center Services: Sherwood Oaks has a state-licensed Medicare and Medicaid-approved health care center on site. A resident's continuing care contract guarantees unlimited nursing care. Additional health related services and facilities include: " Community nurse " Personal care studio apartments and suites " Regular doctor's office hours " Recreational, occupational and physical therapies " Specialty dementia unit There is a registered nurse on duty 24 hours a day, and physicians are on call.
Part VI Governance, Management, and Disclosure
Section A: Governing Body and Management
Question 2: Deborah Brodine and Jerome Shaffer both serve in officer or board member capacity in related (parent or brother-sister) exempt entities. Question 6: Pittsburgh Lifetime Care Community has one sole member, the exempt entity UPMC Senior Communities, Inc. Question 7A: The parent entity of Pittsburgh Lifetime Care Community, UPMC Senior Communities, Inc., has the abilty to appoint board members to Pittsburgh Lifetime Care Community as stipulated in the by-laws of Pittsburgh Lifetime Care Community. Question 7B: UPMC, as the parent entity of the sole member of Pittsburgh Lifetime Care, UPMC Senior Communities, has the right to approve certain actions and transactions of Pittsburgh Lifetime Care. The specific transactions that are subject to UPMC approval are stipulated in the By-laws of Pittsburgh Lifetime Care.
Part VI Governance, Management, and Disclosure
Section B: Policies
Question 11: 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 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 sussidiaries, including Pittsburgh Lifetime Care Community. 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 sections 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 Pittsburgh Lifetime Care Community.
Part VI Governance, Management, and Disclosure
Section C: Disclosure
Question 19: Upon request, management determines public disclosure applicability.
PART VII COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES
HIGHEST COMPENSATED EMPLOYEES AND INDEPENDENT CONTRACTORS
ALL SALARIES AND BENEFITS REPORTED ARE BASED ON INDIVIDUALS' OPERATIONAL POSITIONS AND ARE NOT FOR SERVICES PERFORMED AS DIRECTORS OR BOARD MEMBERS. BOARD POSITIONS ARE ALL VOLUNTEER AND UNPAID. INDIVIDUALS ARE COMPENSATED FOR OPERATIONAL ROLES ONLY, NOT FOR DUTIES PERFORMED AS DIRECTORS OR BOARD MEMBERS.
Part XI, Financial Statements and Reporting
Financial Statements and Reporting
Question 2b: The organization's financial statements are audited separately by Ernst & Young for Pittsburgh Lifetime Care Community, as well as being included in the Audited Financial Statements of UPMC and subsidiaries.
Part XI, Other Changes in Net Assets
Changes in Net Assets
UNREALIZED LOSS ON INVESTMENT $440,967 CHANGE IN VALUE OF CHARITABLE GIFT ANNUITIES $928 CHANGES IN BENEFICIALS INTEREST $(659,741) CHANGE IN RESTRICTED FUNDS $(116,720) TOTAL............................... $(334,565)
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 2013 which are related to Pittsburgh Lifetime Care Community. These organizations are not required to be listed in schedule R. These related organizations have direct and indirect control.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.