2016-08-09T11:28:05-05:00 2015-09-30 593070669 MOORE STEPHENS LOVELACE PA 311 PARK PLACE BLVD SUITE 100 CLEARWATER FL 33759 990 2014-10-01 592867652 WATERMAN COMMUNITIES INC D/B/A WATERMAN VILLAGE OF MT DORA WATE 3523830051 2250 BROOKFIELD AVENUE MOUNT DORA FL 32757 ANDREW DUJON PRESIDENT/CEO 3523830051 2016-08-09 1 MICHAEL D MEADE JD LLM P01079860 7275314477 2014 2016-12-15 16:53:06Z WATERMAN VILLAGE OF MT DORA ANDREW DUJON 2250 BROOKFIELD AVENUE MOUNT DORA FL 32757 28479029 0 X WWW.WATERMANVILLAGE.COM X 1987 FL TO PROVIDE HOUSING, HEALTHCARE AND OTHER SERVICES TO THE ELDERLY. 7 7 496 10 0 0 160458 110587 25833426 27622698 38153 36023 625181 653165 26657218 28422473 0 0 0 0 11959649 12293344 0 0 0 14406220 15508473 26365869 27801817 291349 620656 28362420 28783335 37807750 37620339 -9445330 -8837004 X AS A COMMUNITY CENTERED ORGANIZATION, WATERMAN COMMUNITIES, INC. MAKES IT POSSIBLE FOR ALL RESIDENTS TO AGE SUCCESSFULLY, LIVING THEIR BEST LIFE WITH MAXIMUM WELLNESS AND INDEPENDENCE THROUGH A BROAD RANGE OF SERVICES DELIVERED IN A SPIRIT OF CARING, INTEGRITY AND PROFESSIONALISM. 0 0 12532445 14881747 EDGEWATER HEALTH CARE AND REHABILITATION CENTER: THIS SKILLED NURSING FACILITY SERVES APPROXIMATELY 120 RESIDENTS IN ITS REHABILITATION THERAPY SUB-ACUTE AND SECURED DEMENTIA UNITS, AND LONG-TERM CARE NURSING FACILITY BEDS. 7861403 9335084 INDEPENDENT LIVING RETIREMENT UNITS: THE INDEPENDENT LIVING UNITS SERVE APPROXIMATELY 305 ELDERLY RESIDENTS BY PROVIDING ONE MEAL PER DAY, TRANSPORTATION TO MEDICAL APPOINTMENTS, SHOPPING, ACTIVITIES, WEEKLY HOUSEKEEPING, MAINTENANCE, BASIC CABLE TELEVISION AND SOME UTILITIES. 2868201 3405867 BRIDGEWATER ASSISTED LIVING FACILITY: THE ASSISTED LIVING FACILITIES SERVE APPROXIMATELY 150 ELDERLY RESIDENTS WITH ASSISTANCE IN CERTAIN ACTIVITIES OF DAILY LIVING, INCLUDING A 24-HOUR NURSING STAFF; THREE MEALS DAILY; HOUSEKEEPING AND MAINTENANCE; TRANSPORTATION TO MEDICAL APPOINTMENTS AND SHOPPING ACTIVITIES; BASIC CABLE TELEVISION AND ALL UTILITIES. 550054 653165 GENERAL REVENUE AND EXPENSES 550054 653165 23812103 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 1 33 0 1 496 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 X ANDREW DUJON 3523830051 250 BROOKFIELD AVENUE MOUNT DORA FL 32757 KEVIN W MCEWEN CHAIRMAN 2.00 X X 0 0 0 JOHN J COFFEY VICE CHAIRMAN 2.00 X X 0 0 189 KIM Y STEWART TREASURER 2.00 X X 0 0 0 THOMAS POPIESKI SECRETARY 2.00 X X 0 0 0 RICHARD A LEIGH DIRECTOR 2.00 X 0 0 0 GUSTAV SCHEUNEMAN DIRECTOR 2.00 X 0 0 0 GARY SKILTON DIRECTOR 2.00 X 0 0 1661 WILLIAM MORRIS RESIDENT LIAISON 2.00 X 0 0 0 DAVID BURLINGAME RESIDENT LIAISON 2.00 X 0 0 0 ANDREW DUJON CHIEF FINANCIAL OFFICER 39.00 1.00 X 169536 0 7339 JEANNE DE PRADA VICE PRESIDENT & COO 40.00 X 135415 0 5647 GARY SCHULTZ VICE PRESIDENT-STRATEGIC PLANNIN 40.00 X 126620 0 2448 HEARDLEY MURDOCK DIRECTOR OF FINANCE 40.00 X 99285 0 6454 MICHAEL RAY VP/CHIEF OPERATING OFFICER 40.00 X 0 0 0 JACK WILBURN VP-INFORMATION TECHNOLOGY 40.00 X 137011 0 6676 SANDRA VAN SYCKEL RISK MANAGER 40.00 X 115992 0 1887 783859 0 32301 5 0 1 0 SODEXO INC & AFFILIATES P O BOX 905374 CHARLOTTE NC 282905374 CULINARY MANAGEMENT 2003470 HERITAGE HEALTHCARE LLC 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY MANAGEMENT 1760761 OMNICARE INC PO BOX 715268 COLUMBUS OH 432715268 PHARMACY SERVICES 590294 3 110587 105181 110587 SKILLED NURSING 623000 14881747 14881747 INDEPENDENT LIVING 623990 9335084 9335084 ASSISTED LIVING 623000 3405867 3405867 27622698 92579 92579 56556 -56556 -56556 -56556 OTHER REVENUE 623000 653165 653165 653165 28422473 28275863 0 36023 511791 511791 10758728 9231004 1527724 204987 138709 66278 817838 674146 143692 2698137 2698137 44497 44497 48457 48457 510072 267631 242441 185905 8002 177903 662213 511280 150933 1052569 886843 165726 57881 34453 23428 1304703 1304703 2083151 1755162 327989 2481805 2091047 390758 FOOD AND DIETARY USAGE 1499371 1460188 39183 MEDICAL SUPPLIES 903493 903493 REPAIRS AND MAINTAINANC 733115 619661 113454 QUALITY ASSESSMENT FEE 632186 632186 610918 595458 15460 27801817 23812103 3989714 0 1418383 2120516 1999609 1610059 15672 15672 85839 78821 316833 322364 61461435 40268368 21030073 21193067 387884 393845 3108127 3048991 28362420 28783335 3239695 3055228 13631152 14074405 19541907 18505041 1203517 1421581 191479 564084 37807750 37620339 X -9445330 -8837004 -9445330 -8837004 28362420 28783335 X 620656 -825 -11505 X X 0 1 X 1 0 X 57780 126543 67601 160458 110587 522969 27485076 27544110 26756538 25833426 27622698 135241848 27542856 27670653 26824139 25993884 27733285 135764817 0 0 0 135764817 107188 105904 114207 95487 92579 515365 107188 105904 114207 95487 92579 515365 527664 585089 638687 625181 653165 3029786 28177708 28361646 27577033 26714552 28479029 139309968 0.97460 0.97460 0.00370 0.00350 X 1 11184 1207 12391 0 3711303 3711303 38294711 25846912 12447799 12506349 9585715 2920634 6949072 4835741 2113331 21193067 DEFERRED FINANCING COSTS, NET 323880 DEPOSITS 93960 DEPOSITS FOR PURCHASE OF WATERMAN COVE 99583 ASSETS LIMITED IN USE 2478122 OTHER ASSETS 3103 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 50343 3048991 OTHER LIABILITIES 220084 DEPOSITS 344000 564084 28410143 -825 -825 28410968 11505 11505 28422473 27801817 0 27801817 0 27801817 PART IV, LINE 1B: THE ORGANIZATION PROVIDES A CASH MANAGEMENT SERVICE TO ITS RESIDENTS. THESE FUNDS REMAIN THE SOLE PROPERTY OF EACH RESIDENT, TO BE DISBURSED ONLY AS REQUESTED. THE ORGANIZATION HAS A FIDUCIARY DUTY OF ACCOUNTABILITY FOR THESE FUNDS. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN NET INTEREST IN WATERMAN COMMUNITIES FOUNDATION 11,505. X X 0 1 0 0 0 1 0 0 0 ANDREW DUJON CHIEF FINANCIAL OFFICER 169536 0 0 0 0 0 0 0 7339 0 176875 0 0 0 PART I, LINE 4B ALL MANAGING DIRECTORS ARE ELIGIBLE TO PARTICIPATE IN THE NON-QUALIFED DEFERRED COMPENSATION PLAN ESTABLISHED BY THE ORGANIZATION. ALL COMPENSATED INDIVIDUALS LISTED ON PART VII PARTICIPATE IN THE PLAN, AND NONE OF THESE INDIVIDUALS WITHDREW MONIES FROM THE PLAN DURING THE REPORTING YEAR. NO WITHDRAWALS CAN BE MADE FROM THE PLAN EXCEPT UNDER THE FOLLOWING CIRCUMSTANCES, (1) RETIREMENT - AGE 65, (2) TERMINATION OF EMPLOYMENT, (3) DEATH, (4) UNFORESEEABLE EMERGENCY, (5) DE MINIMIS EXCEPTION, OR (6) AGE 70 1/2 REQUIRED MINIMUM DISTRIBUTION. AFTER FIVE YEARS OF SERVICE, THE EARNED OWNERSHIP INTEREST (VESTING) OF THE EMPLOYER CONTRIBUTIONS BECOMES 100%. PART I, LINE 6 CEO, CFO AND COO BONUSES ARE BASED ON OPERATIONAL PROFIT, NOT INCLUDING EXTRAORDINARY ITEMS SUCH AS THE DISPOSITION OF THE COVE. A MOUNT DORA HEALTH FACILITIES AUTHORITY 621233DD4 2004-09-15 14015000 SEE SUPPLEMENTAL INFORMATION 0 0 0 A 7250000 14002184 28240 13693644 280300 2005 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 1 A 1 SCHEDULE K, PART I (F) IN SEPTEMBER 2004, THE VILLAGE ISSUED MOUNT DORA HEALTH FACILITIES AUTHORITY REFUNDING REVENUE BONDS, SERIES 2004, IN THE AMOUNT OF $14,015,000, TO FINANCE THE REDEMPTION OF THE SERIES B PORTION OF THE SERIES 1996 BOND ISSUE AND TO PAY A PORTION OF THE COST OF ISSUING THE SERIES 2004 BONDS. THE 2004 BONDS INCLUDE SERIES A AND SERIES B BONDS ISSUED IN THE PRINCIPAL AMOUNTS OF $10,515,000 AND $3,500,000, RESPECTIVELY. SCHEDULE K, PART I (C) THE SERIES 2004A BOND ISSUE CONSISTS OF THE FOLLOWING: CUSIP NO. 621233CW3, $20,000 3.75% TERM BONDS DUE AUGUST 15, 2006 CUSIP NO. 621233CX1, $670,000 3.75% TERM BONDS DUE AUGUST 15, 2007 CUSIP NO. 621233CY9, $690,000 4.25% TERM BONDS DUE AUGUST 15, 2008 CUSIP NO. 621233CZ6, $720,000 4.50% TERM BONDS DUE AUGUST 15, 2009 CUSIP NO. 621233DA0, $755,000 4.75% TERM BONDS DUE AUGUST 15, 2010 CUSIP NO. 621233DB8, $2,500,000 5.25% TERM BONDS DUE AUGUST 15, 2013 CUSIP NO. 621233DC6, $5,160,000 5.75% TERM BONDS DUE AUGUST 15, 2018 THE SERIES 2004B BOND ISSUE CONSISTS OF THE FOLLOWING: CUSIP NO. 621233DD4, $3,500,000 5.00% TERM BONDS DUE AUGUST 15, 2021 SCHEDULE K, PART II, LINE 3 THE TOTAL PROCEEDS FOR SERIES 2004 BOND ISSUE ARE NOT IDENTICAL TO THE ISSUE PRICE LISTED IN PART I, COLUMN (E), THE DIFFERENCES ARE AS FOLLOWS: AN UNDERWRITER'S DISCOUNT OF $(157,475), A $116,410 TRANSFER FROM DEBT SERVICE FUND FOR THE REFUNDED BONDS AND ACCRUED INTEREST OF $28,249. HILLCREST INSURANCE ENTITY IS OWNED BY BOARD MEMBER, KEVIN MCEWEN. 187428 INSURANCE 0 0 X LEASEHOLD IMPROVEMENT CONTRIBUTIONS 34 105181 COST 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S CHIEF FINANCIAL OFFICER CONDUCTS A COMPREHENSIVE REVIEW OF THE FORM 990 BEFORE IT IS FILED. A COPY OF THE RETURN, AS ULTIMATELY FILED, IS PROVIDED TO EACH VOTING MEMBER OF THE BOARD OF DIRECTORS BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S BOARD OF DIRECTORS MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ANNUALLY. THE BOARD REVIEWS ACTUAL CONFLICTS THAT ARE IDENTIFIED BY THE ANNUAL DISCLOSURE PROCESS AND PROHIBITS OFFICERS AND DIRECTORS FROM VOTING ON MATTERS WHERE ACTUAL CONFLICTS OF INTEREST EXIST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES THE COMPENSATION AND BENEFITS OF THE CHIEF EXECUTIVE OFFICER. THE CEO DETERMINES THE COMPENSATION AND BENEFITS OF OTHER OFFICERS AND KEY EMPLOYEES. THE BOARD AND CEO ARE INDEPENDENT WITH RESPECT TO THE COMPENSATION ARRANGEMENTS BEING CONSIDERED. THE BOARD UTILIZES COMPARABILITY SURVEYS PROVIDED BY THE ORGANIZATION'S CPA FIRM. THE REVIEW AND APPROVAL PROCESS IS DOCUMENTED IN BOARD MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF WATERMAN VILLAGE FOUNDATION -11,505. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS HAS RESPONSIBILITY FOR OVERSIGHT OF AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. WATERMAN COMMUNITIES FOUNDATION INC 250 BROOKFIELD AVENUE MOUNT DORA FL 32757 030386001 RAISES FUNDS FOR THE BENEFIT OF WATERMAN COMMUNITIES, INC. FL 501(C)(3) LINE 11A, I N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0