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.") . | 71,545 | 61,031 | 46,054 | 48,111 | 68,469 | 295,210 |
| 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 | 27,104,740 | 25,550,017 | 26,866,566 | 27,154,157 | 26,846,806 | 133,522,286 |
| 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 | 27,176,285 | 25,611,048 | 26,912,620 | 27,202,268 | 26,915,275 | 133,817,496 |
| 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.) | 133,817,496 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 27,176,285 | 25,611,048 | 26,912,620 | 27,202,268 | 26,915,275 | 133,817,496 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 991,062 | 1,206,119 | 1,981,261 | 2,261,838 | 1,677,799 | 8,118,079 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 991,062 | 1,206,119 | 1,981,261 | 2,261,838 | 1,677,799 | 8,118,079 |
| 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 VI.) .. | 434,740 | 469,691 | 479,382 | 509,014 | 473,062 | 2,365,889 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 28,602,087 | 27,286,858 | 29,373,263 | 29,973,120 | 29,066,136 | 144,301,464 |
| 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) |
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| 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): |
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| 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 |
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| 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, Explanation of Other Income: | GUEST ROOM INCOME - 2015 Amount: $ 86,347. 2016 Amount: $ 105,428. 2017 Amount: $ 107,289. 2018 Amount: $ 113,603. 2019 Amount: $ 115,398. CORNER CAFE - 2015 Amount: $ 36,080. 2016 Amount: $ 25,328. 2017 Amount: $ 24,061. 2018 Amount: $ 23,724. 2019 Amount: $ 21,392. GUEST MEALS - 2015 Amount: $ 106,980. 2016 Amount: $ 49,741. 2017 Amount: $ 40,771. 2018 Amount: $ 37,407. 2019 Amount: $ 41,207. CATERING - 2015 Amount: $ 21,006. 2016 Amount: $ 21,925. 2017 Amount: $ 13,907. 2018 Amount: $ 4,984. 2019 Amount: $ 4,272. GENERAL STORE - 2015 Amount: $ 7,690. 2016 Amount: $ 5,176. 2017 Amount: $ 5,733. 2018 Amount: $ 5,191. 2019 Amount: $ 6,300. beauty shop - 2015 Amount: $ 112,676. 2016 Amount: $ 110,324. 2017 Amount: $ 115,138. 2018 Amount: $ 123,475. 2019 Amount: $ 114,586. housekeeping/laundry - 2015 Amount: $ 5,438. 2016 Amount: $ 6,024. 2017 Amount: $ 7,518. 2018 Amount: $ 6,196. 2019 Amount: $ 5,491. parking/transportation - 2015 Amount: $ 61,975. 2016 Amount: $ 63,950. 2017 Amount: $ 64,912. 2018 Amount: $ 68,461. 2019 Amount: $ 62,643. miscellaneous - 2015 Amount: $ -14,542. 2016 Amount: $ 23,652. 2017 Amount: $ 8,011. 2018 Amount: $ 49,585. 2019 Amount: $ 33,049. supplies/postage - 2015 Amount: $ 11,090. 2016 Amount: $ 10,533. 2017 Amount: $ 10,519. 2018 Amount: $ 10,154. 2019 Amount: $ 7,777. Maintenance Revenue - 2016 Amount: $ 47,610. 2017 Amount: $ 81,523. 2018 Amount: $ 66,234. 2019 Amount: $ 60,947. |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 1 | The LVL Board may have Advisory Committees, each of which shall have a Resident Facilitator, the relevant Department Director, up to six Resident members and at least one LVL Board Director. Each committee, to the extent provided in a resolution of the LVL Board, in the Articles of Incorporation, or in the bylaws of the LVL Board, shall have and exercise all the authority of the LVL Board. The designation of any such committee and the delegation thereto of authority shall not operate to relieve the LVL Board, or any member thereof, of any responsibility imposed by law. The Committees shall report to the LVL Board at regular meetings of the LVL Board. |
| Form 990, Part VI, Section A, line 6 | Haverland Carter Lifestyle Group, a 501(c)(3), is the sole member. |
| Form 990, Part VI, Section A, line 7a | THE ORGANIZATIONS NOMINATING COMMITTEE ELECTS MEMBERS OF THE BOARD. IT IS THE COMMITTEE'S INTENT, WHEN POSSIBLE THAT AT LEAST (8) OF THE DIRECTORS AT ANY GIVEN TIME SHALL BE INDIVIDUALS WHO ARE MEMBERS OF THE DEMOMINATIONS REPRESENTING THE FOUR FOUNDING CHURCHES: UNITED METHODIST CHURCH OF AMERICA, PRESBYTERIAN CHURCH USA, EPISCOPAL CHURCH IN THE US AND THE EVANGELICAL LUTHERAN CHURCH OF AMERICA. |
| Form 990, Part VI, Section A, line 7b | Haverland Carter Lifestyle Group, as the sole member, retains the rights to all business decisions greater than $10,000. |
| Form 990, Part VI, Section B, line 11b | A copy of the IRS Form 990 will be made available upon request. The form 990 was reviewed by the organization's board which was documented in the board's most recent meeting minutes and approved by the executive committee of Haverland Carter Lifestyle Group at their board meeting prior to being filed. |
| Form 990, Part VI, Section B, line 12c | Each year the directors on the board and organization officers complete a conflict of interest statement. New employees are required to complete a conflict of interest statement at the new hire orientation. If a conflict of interest situation that would involve a board member, officer, or key employee is contemplated, the Executive/Financial committee of the Board of Directors is informed and the committee then decides if a conflict exists. If a conflict does exist, it is then voted on by the Board of Directors. |
| Form 990, Part VI, Section B, line 15 | THE EXECUTIVE COMMITTEE WHICH IS COMPOSED OF HCLG BOARD MEMBERS WITH NO CONFLICTS OF INTEREST WITH RESPECT TO THESE COMPENSATION ARRANGEMENTS DETERMINES THE CEO AND CFO SALARY BASED ON THE CONTINUING CARE ACCREDITATION COMMISSION'S CONTINUING CARE RETIREMENT COMMUNITY SALARY GUIDELINES. IN 2016 THE HCLG BOARD CHAIR REQUESTED HR CONDUCT A COMPENSATION REVIEW ON THE HCLG CEO POSITION. HR USED SALARY BENCHMARKS OBTAINED THROUGH WWW.GUIDESTAR.ORG FROM SIMILARLY SIZED CCRC COMMUNITES, AND FROM WWW.NONPROFITTIMES.COM. THE DATA WAS PROVIDED TO HCLG BOARD FOR REVIEW AND RECOMMENDATION. THE HCLG BOARD MET TO REVIEW DATA AND FACTORS SUCH AS INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE, AND ORGANIZATIONAL RESOURCES AND NEEDS. THE HCLG BOARD DETERMINED A NEW SALARY AND COMMUNICATED IT TO HR VERBALLY. HR OUTLINED THE HCLG BOARD DIRECTIONS IN EMAIL AND SENT IT TO THE HCLG BOARD CHAIR FOR FINAL VERIFICATION AND THE NEW COMPENSATION WAS COMMUNICATED TO THE HCLG BOARD VIA EMAIL. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING FOR THE DELIBERATIONS AND DECISIONS MADE REGARDING THESE COMPENSATION ARRANGEMENTS. |
| Form 990, Part VI, Section C, line 19 | Although not required, the Organization provides copies of it governing documents,conflict of interest policy, and financial statements to all who request one or more of the above items. |
| Form 990, Part XI, line 9: | Net Assets transferred to affiliate -950,007. |
| Form 990, Page 12, Part XII, Line 2C | The process is consistent with prior years. |
| Schedule K, Part I | 2019 bonds were issued by the parent entity, Haverland Carter Lifestyle Group |
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