Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 0 | 0 | 0 | 0 |
| 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 | 24,186,050 | 26,612,203 | 27,781,745 | 27,432,235 | 27,050,877 | 133,063,110 |
| 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 | 24,186,050 | 26,612,203 | 27,781,745 | 27,432,235 | 27,050,877 | 133,063,110 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | 0 | 0 | 0 | 0 | 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 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public support. (Subtract line 7c from line 6.) | 133,063,110 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 24,186,050 | 26,612,203 | 27,781,745 | 27,432,235 | 27,050,877 | 133,063,110 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 276,671 | 1,445,568 | 1,905,412 | 880,813 | 881,025 | 5,389,489 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 276,671 | 1,445,568 | 1,905,412 | 880,813 | 881,025 | 5,389,489 |
| 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 VI.) .. | 0 | 0 | 0 | 0 | 24,627 | 24,627 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 24,462,721 | 28,057,771 | 29,687,157 | 28,313,048 | 27,956,529 | 138,477,226 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12 Other Income | DESCRIPTION - MEALS & DIETARY, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 24627.0, COLUMN F - 24627.0; |
| Software ID: | 19010655 |
| Software Version: | 2019v5.0 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 15 Process Used to Establish Compensation | The organization does not compensate its top management official or any other officers/key employees. All are compensated by Riverside Medical Center, a related tax exempt organization. Form 990, Part VI, Lines 15a and 15b have been answered no, in accordance with the instructions to the Form 990. |
| Form 990, Part VI, Line 1a Material differences in voting rights | The Executive Committee membership will be the Chair of the RHC Board, the Vice Chair of the RHC Board, and 2 members at large from the RHC Board, and Chairman of the Finance Committee. Each Committee member has been determined by the Board not to have a conflict of interest with respect to the compensation transaction(s) to be reviewed. At the start of the year, each member will review the organization's conflict of interest policy to ensure he or she has no conflict of interest. If a real, potential, or perceived conflict of interest is identified, the member will review the issue with the Executive Committee Chair and legal counsel to determine the appropriate action. Except where prohibited by law, the Executive Committee may transact all regular business of the Corporation during the interim between the meetings of the Board of Directors, provided that any action taken shall not conflict with the policies and express wishes of the Board of Directors and it shall report all matters of major importance to the Board. The Committee may also review annually the performance of the president of the Corporation and report to the Board of Directors the conclusions of this report. The Executive Committee, acting in its role as the Executive Compensation Committee and in accordance with the Corporate Bylaws, is authorized to act on the Board's behalf in (i) determining appropriate compensation for RHC executives and other disqualified persons; (ii) evaluating executives' and other disqualified persons' compensation plans, policies, and programs; (iii) reviewing benefit plans for executives and other disqualified persons; and (iv) verifying that compensation information is appropriately and fully disclosed. In discharging its role, the Executive Committee is empowered to investigate any matter brought to its attention with access to all RHC books, records, facilities, and personnel. It has the authority to retain outside counsel, compensation consultants, and/or other experts and will receive adequate funding from RHC to engage such advisors. It shall have sole authority to retain, compensate, terminate, and oversee the advisors, who shall be accountable ultimately to the health system board. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The sole corporate member of Riverside Senior Living Center is Riverside Health System, a related tax exempt organization. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | As the sole corporate member, Riverside Health System has the authority to appoint or remove members of the governing body. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | The power and authority of the Member concerning the affairs of the Corporation shall consist of those reserved powers as set forth in this Section. The Corporation may, at its option, initiate or make recommendations to the Member with respect to any of the following matters: (a) Elect and remove, with or without cause, the Directors of the Corporation; (b) Elect and remove the president of the Corporation; (c) Adopt, amend, restate or repeal the Articles of Incorporation and Bylaws of the Corporation; (d) Authorize the Corporation to engage in, or enter into any transaction providing for the sale, lease, exchange or other disposition of assets of the Corporation outside the Riverside Health System d/b/a Riverside Healthcare corporate structure in excess of five percent (5%) of its assets, as defined in the Corporate bond indenture, in any twelve (12) month period; (e) Adopt a plan of dissolution or liquidation of the Corporation and distribution of its assets; (f) Adopt a plan of merger, consolidation or corporate reorganization involving the Corporation other than in the ordinary course of health care operations; (g) Authorize any transaction which would result in a change in ownership or control of the Corporation; (h) Approve the appointment of an independent auditor or the adoption of accounting policies and investment guidelines; (i) Adopt capital and operating budgets of the Corporation; (j) Adopt and execute a strategic plan of the Corporation; (k) Incur indebtedness in excess of the limits established by the Member from time to time; (l) Authorize the Corporation to make loans in excess of the limits established by the Member from time to time; (m) Authorize any capital expenditures in excess of limits established by the Member from time to time; (n) Authorize any donation of assets of the Corporation in excess of limits established by the Member from time to time; (o) Authorize the sale, transfer, encumbrance or otherwise dispose of any real property or interest therein or the purchase of any real estate; (p) Organize or acquire, or authorize the organization or acquisition of any subsidiary or affiliate of the Corporation ("affiliate" shall include any corporation, association, partnership, trust, joint venture, or other entity directly or indirectly controlling, controlled by, or under common control with the Corporation); (q) Establish policy guidelines and criteria for implementation of the Corporation's mission and periodically review and amend the mission statement; (r) Approve any policy by the Corporation or any action taken by the Corporation as to initiation, defense, or settlement of legal or administrative actions in excess of such amounts as shall be established pursuant to corporate policy; (s) Modify compensation and benefit policies, with the exception of those involving the president/chief executive officer, which are solely the responsibility of the Member's executive committee. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The form 990 is reviewed in detail by the organization's management. Subsequent to this review, the form 990 is supplied to all board members prior to filing with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The conflict of interest questionnaires are mailed to all board members, officers and key employees (as applicable) annually. Each member must read and sign the form to disclose any potential conflicts for the year. If a conflict arises with a board member, the board member is made aware that they must abstain from voting on any issue related to the conflict. The process is monitored by the assistant to the CEO of Riverside Medical Center. |
| Form 990, Part VI, Line 19 Required documents available to the public | Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | All Other - Total Revenue: 48918, Related or Exempt Function Revenue: 48918, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part X, Line 20 Tax-Exempt Bonds | Riverside Senior Living Center is part of an obligated group that has been issued various tax exempt bonds since December 2002. The liabilities reported on the organization's balance sheet have been allocated specifically to this organization but the Schedule K is filed by the sole corporate member, Riverside Medical Center, a related tax-exempt organization. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Equity Transfer From Affiliate - 103202; Change in Fair Value of Derivatives - 5306; |
| Software ID: | 19010655 |
| Software Version: | 2019v5.0 |