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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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 | 10,034,481 | 10,100,105 | 20,134,586 | |||
| 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 | 10,034,481 | 10,100,105 | 20,134,586 | |||
| 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.) | 20,134,586 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 10,034,481 | 10,100,105 | 20,134,586 | |||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 11 | 85 | 96 | |||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 11 | 85 | 96 | |||
| 11 | Net income from unrelated business activities not included on 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.) .. | 12,579 | 377 | 12,956 | |||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 10,047,071 | 10,100,567 | 20,147,638 | |||
| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2022 AMOUNT: $ 12,579. 2023 AMOUNT: $ 377. |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | WAVERLY HEIGHTS, A RELATED PUBLIC CHARITY, PROVIDED MANAGEMENT AND ADMINISTRATIVE SUPPORT SERVICES TO WAVERLY CARE FROM JANUARY 1 JUNE 30, 2023. THE MANAGEMENT FEE PAID DURING THAT PERIOD WAS $580,462. WAVERLY SENIOR SERVICES, A RELATED PUBLIC CHARITY, PROVIDED MANAGEMENT AND ADMINISTRATIVE SUPPORT SERVICES TO WAVERLY CARE BEGINNING JULY 1, 2023. THE MANAGEMENT FEE PAID DURING THAT PERIOD WAS $461,074. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS WERE AMENDED EFFECTIVE JULY 1, 2023. HERE IS A LIST OF THE SIGNIFICANT CHANGES: 1. THE SOLE MEMBER WAS CHANGED FROM WAVERLY HEIGHTS, LTD., TO WAVERLY SENIOR SERVICES. (ARTICLE II, SECTION 1) 2. APPROVAL OF THE SOLE MEMBER IS REQUIRED FOR ANY OF THESE ACTIONS (ARTICLE III, SECTION 2): A. THE ADOPTION OF THE CORPORATION'S OPERATING AND CAPITAL BUDGETS, INCLUDING ANY DEVIATIONS THEREFROM OR REVISIONS OR AMENDMENTS THERETO; B. THE INCURRENCE OF ANY MATERIAL INDEBTEDNESS THAT IS NOT INCLUDED IN THE CORPORATION'S OPERATING OR CAPITAL BUDGETS APPROVED BY THE MEMBER, OR ANY OTHER INDEBTEDNESS, WHETHER OR NOT INCLUDED IN SUCH BUDGETS, WHICH WOULD REQUIRE THE GUARANTY OR SURETY OF THE MEMBER; C. THE ELECTION OR REMOVAL OF TRUSTEES OF THE BOARD; D. THE AMENDMENT, ADOPTION, OR REPEAL OF THE ARTICLES OR THE BYLAWS; E. THE APPROVAL OF A PLAN OF MERGER OR CONSOLIDATION, CONVERSION, OR DIVISION, OR ANY OTHER TRANSACTION WITHIN THE SCOPE OF THE PENNSYLVANIA ENTITY TRANSACTIONS LAW, 15 PA. CONS. STAT. ANN. SEC. 311 ET SEQ.; THE CREATION OR ACQUISITION OF ANY SUBSIDIARY ORGANIZATION; THE ACQUISITION OF ALL, OR SUBSTANTIALLY ALL, OF THE ASSETS OR BUSINESS OF ANOTHER ENTITY; OR THE PARTICIPATION IN ANY ALLIANCE, JOINT VENTURE, AFFILIATION, OR OTHER RELATIONSHIP WITH ANOTHER ENTITY WHICH WOULD RESULT IN A CHANGE IN CONTROL OF THE CORPORATION OR SUCH ENTITY; F. THE SALE, PLEDGE, LEASE, RELINQUISHMENT, TRANSFER, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE CORPORATION'S ASSETS; AND ANY CHANGES TO THE CORPORATION'S ORGANIZATIONAL STRUCTURE OR CORPORATE PURPOSE; G. THE AUTHORIZATION AND DESIGNATION OF THE CORPORATION'S OFFICERS TO EXECUTE A DEED OF ASSIGNMENT FOR THE BENEFIT OF CREDITORS, FILE A VOLUNTARY PETITION IN BANKRUPTCY, FILE AN ANSWER CONSENTING TO THE APPOINTMENT OF A RECEIVER, OR FILE AN ANSWER TO AN INVOLUNTARY PETITION IN BANKRUPTCY; H. THE DETERMINATION TO INDEMNIFY A REPRESENTATIVE (AS THAT TERM IS DEFINED IN ARTICLE XII OF THE BYLAWS); I. THE ELECTION OR REMOVAL OF ANY OF THE CORPORATION'S BOARD OFFICERS THE PRESIDENT/CHIEF EXECUTIVE OFFICER OR THE CHIEF FINANCIAL OFFICER; OR, J. THE AUTHORIZATION, APPROVAL, AMENDMENT, OR TERMINATION OF ANY MANAGEMENT CONTRACT(S). 3. THE MINIMUM NUMBER OF TRUSTEES WAS INCREASED FROM 3 TO 5. (ARTICLE III, SECTION 4) 4. TRUSTEES ARE ELECTED BY THE MEMBER. PREVIOUSLY, DIRECTORS WERE ELECTED BY THE BOARD. (ARTICLE III, SECTION 5). 5. THE MEMBER SHALL HAVE THE POWER TO REMOVE ANY TRUSTEE. PREVIOUSLY, THE BOARD HAD THE POWER TO REMOVE TRUSTEES. (ARTICLE III, SECTION 10). 6. THE ELECTION OF THE CHAIR AND VICE CHAIR IS SUBJECT TO THE APPROVAL OF THE SOLE MEMBER. (ARTICLE IV, SECTION 1) 7. THE PRESIDENT, VICE PRESIDENT AND DIRECTOR OF OPERATIONS, TREASURER, AND SECRETARY POSITIONS ARE NOW DEFINED AS CORPORATE OFFICERS RATHER THAN BOARD OFFICERS. THE CORPORATION'S CHIEF FINANCIAL OFFICER IS DEFINED AS A CORPORATE OFFICER. ALL CORPORATE OFFICERS ARE ELECTED BY THE BOARD; THE ELECTION OF THE PRESIDENT AND CHIEF FINANCIAL OFFICER ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER. AN INDIVIDUAL MAY HOLD MULTIPLE OFFICES, EXCEPT THAT THE PRESIDENT, THE CHIEF FINANCIAL OFFICER, AND THE SECRETARY SHALL BE SEPARATE PERSONS. (ARTICLE V, SECTION 1). 8. UNLESS ANOTHER DATE IS SPECIFIED BY THE BOARD AT THE TIME OF ELECTION, EACH BOARD OFFICER SHALL SERVE FOR A TERM OF ONE (1) YEAR BEGINNING ON JANUARY 1 FOLLOWING ELECTION AND UNTIL A SUCCESSOR IS ELECTED OR UNTIL HIS OR HER EARLIER DEATH, DISABILITY, RESIGNATION OR REMOVAL. OFFICERS SHALL BE ELIGIBLE FOR RE-ELECTION. THE TERM OF ANY OFFICER WHO IS AN EMPLOYEE OF THE CORPORATION SHALL NOT EXTEND BEYOND SUCH OFFICER'S EMPLOYMENT BY THE CORPORATION. (ARTICLE V, SECTION 2) 9. ANY OFFICER MAY BE REMOVED BY THE BOARD. REMOVAL OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER. (ARTICLE V, SECTION 3). |
| FORM 990, PART VI, SECTION A, LINE 6 | WAVERLY HEIGHTS, A RELATED PUBLIC CHARITY, WAS THE SOLE MEMBER FROM JANUARY 1 - JUNE 30, 2023. WAVERLY SENIOR SERVICES, A RELATED PUBLIC CHARITY, IS THE SOLE MEMBER EFFECTIVE JULY 1, 2023. |
| FORM 990, PART VI, SECTION A, LINE 7A | TRUSTEES ARE ELECTED BY THE SOLE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BYLAWS MAY BE AMENDED OR REPEALED, IN WHOLE OR IN PART, OR NEW BYLAWS MAY BE ADOPTED, EITHER (A) BY THE SOLE MEMBER OR (B) EXCEPT WITH RESPECT TO MATTERS THAT ARE BY STATUTE COMMITTED EXCLUSIVELY TO THE SOLE MEMBER, BY THE BOARD OF DIRECTORS, SUBJECT TO THE AUTHORITY OF THE SOLE MEMBER TO CHANGE ANY SUCH ACTION BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND THEN REVIEWED BY THE CFO AND CONTROLLER. THE AUDIT COMMITTEE OF THE BOARD OF WAVERLY SENIOR SERVICES PERFORMS A FINAL REVIEW WITH THE INDEPENDENT ACCOUNTING FIRM AND THEN A COPY IS PROVIDED TO ALL MEMBERS OF THE WAVERLY CARE BOARD OF TRUSTEES BEFORE FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | WAVERLY CARE'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 THE GOVERNING BOARD MEMBERS IS REQUIRED TO BE TIMELY DISCLOSED UPON REALIZATION OF THE POTENTIAL CONFLICT TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD WHEN THE CONFLICT BECOMES A MATTER OF BOARD ACTION. THE BOARD MAKES THE DECISION AS TO WHETHER A POTENTIAL CONFLICT IS AN ACTUAL CONFLICT. ANY GOVERNING BOARD MEMBERS HAVING A CONFLICT OF INTEREST SHALL NOT VOTE OR USE THEIR PERSONAL INFLUENCE ON THE MATTER, 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 | WAVERLY CARE DOES NOT COMPENSATE ANY INDIVIDUAL THAT MEETS THE IRS DEFINITION OF TOP MANAGEMENT OFFICIAL, OFFICER, OR KEY EMPLOYEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER TO WAVERLY HEIGHTS -1,200,000. |
| Software ID: | |
| Software Version: |