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
RIDDLE VILLAGE
Employer identification number
23-2613942
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.") .
50,526
47,426
1,138,619
103,398
121,058
1,461,027
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......
24,321,791
25,513,077
26,083,204
26,415,152
26,349,671
128,682,895
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.
24,372,317
25,560,503
27,221,823
26,518,550
26,470,729
130,143,922
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.)
130,143,922
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...
24,372,317
25,560,503
27,221,823
26,518,550
26,470,729
130,143,922
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
297,917
138,153
104,166
147,744
79,363
767,343
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
297,917
138,153
104,166
147,744
79,363
767,343
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.)..
24,670,234
25,698,656
27,325,989
26,666,294
26,550,092
130,911,265
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
99.410 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.990 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.590 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.010 %
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
RIDDLE VILLAGE
Employer identification number
23-2613942
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD, TO THE EXTENT PERMITTED BY APPLICABLE LAW, BETWEEN MEETINGS OF THE BAORD. MEETINGS OF THE EXECUTIVE COMMITTEE MAY BE CALLED AT ANY TIME BY THE CHAIR OF COMMITTEE, BY THE CHAIR OF THE BOARD OR BY ANY TWO MEMBERS OF THE COMMITTEE. NOTICE OF SPECIAL MEETINGS OF THE EXECUTIVE COMMITTEE SHALL BE GIVEN AT LEAST TWO DAYS BEFORE SUCH MEETING, BUT WRITTEN NOTICE SHALL NOT BE REQUIRED.
FORM 990, PART VI, SECTION A, LINE 7A
ONE DIRECTOR SHALL BE NOMINATED BY THE RIDDLE HEALTH CARE FOUNDATION, AND PROVIDED THAT SUCH NOMINEE IS OTHERWISE QUALIFIED UNDER THESE BYLAWS AND APPLICABLE LAW, SUCH NOMINEE SHALL BE ELECTED BY THE BOARD TO SERVE FOR A TERM OF ONE YEAR, AND SHALL BE ELIGIBLE FOR SUCCEEDING ONE-YEAR TERMS WITHOUT LIMIT. AT ALL TIMES, A MAJORITY OF ALL OF THE DIRECTOS SHALL BE NON-RESIDENTS OF RIDDLE VILLAGE. NO DIRECTOR, EXCEPT THE DIRECTOR NOMINATED BY THE RIDDLE HEALTH CARE FOUNDATION, MAY SERVE MORE THAN TWO CONSECUTIVE FULL TERMS.
FORM 990, PART VI, SECTION B, LINE 11
ALL MEMBERS OF THE BOARD REVIEW THE FORM PRIOR TO THE FILING THEREOF.
FORM 990, PART VI, SECTION B, LINE 12C
CURRENTLY, ALL MEMBERS OF THE BOARD REVIEW THE CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. THEY CONFIRM THAT THEY HAVE NO SUCH CONFLICT IF APPROPRIATE. IF CONFLICT WERE TO EXIST, THE BOARD AS A WHOLE WOULD REVIEW EACH POTENTIAL CONFLICT AND DETERMINE THE APPROPRIATENESS OF THE ACTION. ANY BOARD MEMBER INVOLVED IN A CONFLICT WOULD BE UNABLE TO VOTE ON ANY ACTION, PURCHASE OR DECISION BEING MADE. IN ADDITION, EACH SENIOR MANAGEMENT REPRESENTATIVE SIGNS A SIMILAR STATEMENT. DIRECTORS WITH A POTENTIAL CONFLICT ARE EXCLUDED FROM DECISION MAKING IN THAT AREA.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION IS MAINLY DETERMINED BASED ON EXTERNAL SALARY SURVEYS. WORK PERFORMANCE AND EXPANDED JOB RESPONSIBLITIES ARE ALSO CONSIDERED. THE PRESIDENT/CEO USES THE TOOLS MENTIONED ABOVE TO DETERMINE THE SALARIES OF KEY EMPLOYEES. THE INFORMATION IS THEN SHARED WITH THE COMPENSATION COMMITTEE FOR DISCUSSION.
FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE ORGANIZATIONS FINANCIAL STATEMENTS ARE DISTRIBUTED TO RESIDENTS & FILED WITH THE PA INSURANCE DEPARTMENT. THEY ARE ALSO MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:
CHANGE IN FAIR VALUE OF SWAP AGREEMENT -1,857.
FORM 990, PART XI, LINE 2C
THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART XI, LINE 8
IN JULY 2012, THE FINANCIAL REPORTING ACCOUNTING STANDARDS BOARD (FASB)ISSUED ACCOUNTING STANDARDS UPDATE (ASU) 2012-01 HEALTH CARE ENTITIES: CONTINUING CARE RETIREMENT COMMUNITIES REFUNDABLE ADVANCE FEES. THE AMENDMENTS IN THIS ASU CLARIFY THAT AN ENTITY SHOULD CLASSIFY AN ADVANCE FEE AS DEFERRED REVENUE WHEN A CONTINUING CARE RETIREMENT COMMUNITY HAS A RESIDENT CONTRACT THAT PROVIDES FOR PAYMENT OF THE REFUNDABLE ADVANCE FEE UPON REOCCUPANCY BY A SUBSEQUENT RESIDENT, WHICH IS LIMITED TO THE PROCEEDS OF REOCCUPANCY BY A SUBSEQUENT RESIDENT. THE AMENDMENTS ALSO CLARIFY THAT REFUNDABLE ADVANCE FEES THAT ARE CONTINGENT UPON REOCCUPANCY BY A SUBSEQUENT RESIDENT BUT ARE NOT LIMITED TO THE PROCEEDS OF REOCCUPANCY SHOULD BE ACCOUNTED FOR AND REPORTED AS A LIABILITY. THE AMENDMENTS IN THE ASU ARE EFFECTIVE FOR FISCAL PERIODS BEGINNING AFTER DECEMBER 15, 2012 FOR PUBLIC ENTITIES, AS DEFINED, WITH EARLY ADOPTION PERMITTED. DURING THE FISCAL YEAR ENDED JUNE 30, 2014, THE CORPORATION ADOPTED ASU 2012-01. THE ADOPTION REQUIRES A RETROSPECTIVE APPLICATION TO THE EARLIEST PERIOD PRECEDING AND RESULTS IN AN INCREASING THE LIABILITY FOR REFUNDABLE ENTRANCE FEES BY $2,283,139, REDUCING THE ENTRANCE FEE AMORTIZATION BY $302,831, AND DECREASING THE NET ASSETS BY $1,980,308 FOR THE YEAR ENDED JUNE 30, 2013.
RELATED PARTY EXPLANATION
RIDDLE VILLAGE LEASES THE LAND ON WHICH THEIR FACILITY IS SITUATED FROM RIDDLE HEALTHCARE FOUNDATION. THESE ENTITIES ALSO HAVE A BOARD MEMBER IN COMMON. RIDDLE HEALTHCARE FOUNDATION DOES NOT HAVE CONTROL OR AN ABILITY TO ELECT A MAJORITY OF THE BOARD MEMBERS OF RIDDLE VILLAGE. THEREFORE, THESE TWO PARTIES ARE NOT CONSIDERED RELATED.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.