efile Public Visual Render
ObjectId: 201432179349301508 - Submission: 2014-08-05
TIN: 22-3080006
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public
Inspection
Name of the organization
ORCHARD COVE INC
Employer identification number
22-3080006
Part I
Bond Issues
(a)
Issuer name
(b)
Issuer EIN
(c)
CUSIP #
(d)
Date issued
(e)
Issue price
(f)
Description of purpose
(g)
Defeased
(h)
On
behalf of
issuer
(i)
Pool
financing
Yes
No
Yes
No
Yes
No
A
MASSACHUSETTS DEVELOPMENT FINANCE AUTHORITY
04-3431814
57583RLP8
05-01-2007
36,577,442
SEE PART VI
X
X
X
Part II
Proceeds
A
B
C
D
1
Amount of bonds retired
.
.
.
.
.
.
.
.
.
.
.
.
.
.
31,951,080
2
Amount of bonds legally defeased
.
.
.
.
.
.
.
.
.
.
.
0
3
Total proceeds of issue
.
.
.
.
.
.
.
.
.
.
.
.
.
.
39,332,705
4
Gross proceeds in reserve funds
.
.
.
.
.
.
.
.
.
.
.
.
2,801,613
5
Capitalized interest from proceeds
.
.
.
.
.
.
.
.
.
.
.
0
6
Proceeds in refunding escrows
.
.
.
.
.
.
.
.
.
.
.
.
0
7
Issuance costs from proceeds
.
.
.
.
.
.
.
.
.
.
.
.
717,500
8
Credit enhancement from proceeds
.
.
.
.
.
.
.
.
.
.
.
0
9
Working capital expenditures from proceeds
.
.
.
.
.
.
.
.
.
0
10
Capital expenditures from proceeds
.
.
.
.
.
.
.
.
.
.
.
3,862,512
11
Other spent proceeds
.
.
.
.
.
.
.
.
.
.
.
.
.
.
0
12
Other unspent proceeds
.
.
.
.
.
.
.
.
.
.
.
.
.
.
0
13
Year of substantial completion
.
.
.
.
.
.
.
.
.
.
.
.
2009
Yes
No
Yes
No
Yes
No
Yes
No
14
Were the bonds issued as part of a current refunding issue?
.
.
.
.
.
X
15
Were the bonds issued as part of an advance refunding issue?
.
.
.
.
.
X
16
Has the final allocation of proceeds been made?
.
.
.
.
.
.
.
.
X
17
Does the organization maintain adequate books and records to support the final allocation of proceeds?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
X
Part III
Private Business Use
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds?
.
.
.
.
.
.
.
X
2
Are there any lease arrangements that may result in private business use of bond-financed property?
.
.
.
.
.
.
.
.
.
X
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Page 2
Schedule K (Form 990) 2012
Page
2
Part III
Private Business Use
(Continued)
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
3a
Are there any management or service contracts that may result in private business use of bond-financed property?
.
.
.
.
.
.
.
.
.
.
.
.
X
b
If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed
property?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
c
Are there any research agreements that may result in private business use of bond-financed property?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
X
d
If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
.
4
Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government
.
.
0
%
%
%
%
5
Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government
.
.
.
.
.
.
.
%
%
%
%
6
Total of lines 4 and 5
.
.
.
.
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.
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.
.
.
.
.
%
%
%
%
7
Does the bond issue meet the private security or payment test?
.
.
.
.
.
X
8a
Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were
issued?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
X
b
If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.
%
%
%
%
c
If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2?
.
.
.
.
.
.
.
.
.
.
.
.
.
X
9
Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X
Part IV
Arbitrage
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Has the issuer filed Form 8038-T?
.
.
.
.
.
X
2
If "No" to line 1, did the following apply?
.
.
.
.
a
Rebate not due yet?
.
.
.
.
.
.
.
.
b
Exception to rebate?
.
.
.
.
.
.
.
.
c
No rebate due?
.
.
.
.
.
.
.
.
.
.
X
If you checked "No rebate due" in line 2c, provide in Part VI
the date the rebate computation was performed
3
Is the bond issue a variable rate issue?
.
.
.
.
X
4a
Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?
X
b
Name of provider
.
.
.
.
.
.
.
.
.
0
c
Term of hedge
.
.
.
.
.
.
.
.
.
.
d
Was the hedge superintegrated?
.
.
.
.
.
.
e
Was a hedge terminated?
.
.
.
.
.
.
.
Schedule K (Form 990) 2012
Page 3
Schedule K (Form 990) 2012
Page
3
Part IV
Arbitrage
(Continued)
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
5a
Were gross proceeds invested in a guaranteed investment contract (GIC)?
.
.
.
.
.
.
.
.
.
X
b
Name of provider
.
.
.
.
.
.
.
.
.
0
c
Term of GIC
.
.
.
.
.
.
.
.
.
.
d
Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied?
.
.
.
.
.
6
Were any gross proceeds invested beyond an available temporary period?
.
.
.
.
.
.
.
.
X
7
Has the organization established written procedures to monitor the requirements of section 148?
.
.
.
X
Part V
Procedures To Undertake Corrective Action
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?
X
Part VI
Supplemental Information.
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier
Return Reference
Explanation
PURPOSE OF BOND
FORM 990, SCHEDULE K, PART 1, LINE A, COLUMN F
FIRST MORTGAGE REVENUE BONDS ORCHARD COVE - SERIES 2007 THE 2007 BONDS ARE ISSUED PURSUANT TO A MORTGAGE LOAN AND TRUST AGREEMENT DATED AS OF MAY 1, 2007 (THE LOAN AND TRUST AGREEMENT") BY AND AMONG MASSACHUSETTS DEVELOPMENT FINANCE AGENCY ("THE AGENCY"), ORCHARD COVE, INC. (THE "CORPORATION") AND WELLS FARGO BANK, NATIONAL ASSOCIATION, AS TRUSTEE (THE "TRUSTEE"). THE PROCESS OF THE 2007 BONDS, TOGETHER WITH OTHER AVAILABLE FUNDS, WILL BE USED: (I) TO REFUND THE AGENCY'S $31,770,000 OF OUTSTANDING FIRST MORTGAGE REVENUE REFUNDING BONDS (ORCHARD COVE - SERIES 1996A AND FIRST MORTGAGE REVENUE REFUNDING BONDS (ORCHARD COVE - SERIES 199B) WHICH WERE ISSUED TO REFINANCE BONDS PREVIOUSLY ISSUED BY THE AGENCY TO FINANCE THE ORIGINAL CONSTRUCTION OF THE CORPORATION'S CONTINUING CARE RETIREMENT COMMUNITY; (II) TO ESTABLISH A DEBT SERVICES RESERVE FUND FOR THE 2007 BONDS; (III) TO FINANCE THE COSTS OF CONSTRUCTION EQUIPPING AND FURNISHING OF A TWO-STORY ADDITION OF APPROXIMATELY 5,000 SQUARE FEET TO BE BUILT ABOVE A PORTION OF THE EXISTING BUILDING, CREATING APPROXIMATELY FIVE ROOMS FOR SKILLED NURSING BED AND APPROXIMATELY FIVE ROOMS FOR SKILLED NURSING BEDS AND APPROXIMATELY FOUR ASSISTANCE-IN-LIVING UNITS; (IV) THE REHABILITATION OF THE CORPORATION'S HEALTH CARE CENTER; AND (V) TO PAY COSTS OF ISSUANCE OF THE 2007 BONDS. Rebate Calculation Orchard Cove performed a rebate calculation on April 30, 2014. Written policies and procedures Schedule K, Part IV, Line 7 and Schedule K, Part V Hebrew SeniorLife (HSL), parent of Orchard Cove, is in the process of updating its bond compliance policies to include procedures for maintaining compliance with the arbitrage requirements under Section 148 and the use of the voluntary closing agreement program if self-remediation is not available.
Schedule K (Form 990) 2012
Additional Data
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