STRATEGY STUDIO / PUBLIC DATA EXPLORER

VALDESE NURSING HOME INC COLLEGE PINES NURSING CENTER: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
VALDESE NURSING HOME INC COLLEGE PINES NURSING CENTER (EIN 58-1978560)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-09
IRS object ID
202133139349303593
Schema version
2020v4.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-09T13:39:21-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1227 WEST TRADE STREET SUITE 800AddressLine1Txt
CityCHARLOTTECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28202ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN581978560EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1VALDESE NURSING HOME INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlVALDBusinessNameControlTxt
Phone8285805000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line195 LOCUSTAddressLine1Txt
CityCONNELLY SPRINGSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28612ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPATRICIA MOLLPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone8285805000PhoneNum
Signature2021-11-03SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstPATRICIAPersonFirstNm
Person LastMOLLPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOHN NORMANPreparerPersonNm
PTINP01506766PTIN
Phone7049985200PhoneNum
Preparation2021-11-03PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKATHY BAILEYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line195 LOCUSTAddressLine1Txt
CityCONNELLY SPRINGSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28612ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$737,572GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BLUERIDGEHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1993FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO PROVIDE HEALTHCARE TO THE ELDERLY AND AGING.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers12TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$4,587,210PYProgramServiceRevenueAmt
CY Program Service Revenue$737,572CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$4,587,210PYTotalRevenueAmt
CY Total Revenue$737,572CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,059,909PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid-$945CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,361,659PYOtherExpensesAmt
CY Other Expenses$171,028CYOtherExpensesAmt
PY Total Expenses$4,421,568PYTotalExpensesAmt
CY Total Expenses$170,083CYTotalExpensesAmt
PY Revenues Less Expenses$165,642PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$567,489CYRevenuesLessExpensesAmt
Total Assets BOY$1,264,875TotalAssetsBOYAmt
Total Assets EOY$1,124,943TotalAssetsEOYAmt
Total Liabilities BOY$4,259,734TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,552,313TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$2,994,859NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$2,427,370NetAssetsOrFundBalancesEOYAmt
MissionVALDESE NURSING HOME, INC. IS DEDICATED TO PROVIDING EXCELLENT CARE AND HELPING EACH RESIDENT ACHIEVE AN OPTIMAL QUALITY OF LIFE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$157,304ExpenseAmt
Revenue$737,572RevenueAmt
DescVALDESE NURSING HOME, INC. PROVIDES INTERMEDIATE AND ASSISTED LIVING, AND PROVIDES COMPLETE REHABILITATION SERVICES WITH A FOCUS ON FOSTERING INDEPENDENCE WITHIN THE FACILITY. VALDESE NURSING HOME PROVIDES A COMPLETE RANGE OF THERAPY SERVICES UTILIZING BOTH CONTRACTED AND LICENSED THERAPISTS; THESE SERVICES INCLUDE: OCCUPATIONAL, PHYSICAL, RESPIRATORY AND SPEECH THERAPY. VALDESE NURSING HOME OPERATES A 104 BED FACILITY TO MEET THE LONG-TERM AND SHORT-TERM CARE NEEDS OF ITS RESIDENTS.ON 7/1/19 SANSTONE HEALTH & REHABILITATION TOOK OVER OPERATIONS OF THE FACILITY. VALDESE NURSING CENTER LEASES THE BUILDING AND EQUIPMENT TO SANSTONE.Desc
Total Program Service Expenses$157,304TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PATRICIA MOLLBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8285805003PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12201 S STERLING STAddressLine1Txt
CityMORGANTONCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28655ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
CLAY RICHARDSON MD
MEMBER AT LARGE1.0050.00Yes (X)Yes (X)$0$200,016$51,708
PATRICIA MOLL
INTERIM CFO1.0050.00Yes (X)$0$35,762$2,047
J MICHAEL BRIDGES
CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
M H MCCRARY
VICE-CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
SHERROD SALSBURY
SECRETARY1.00Yes (X)Yes (X)$0$0$0
JEFF CARSWELL
TREASURER1.00Yes (X)Yes (X)$0$0$0
JENNIFER BRADY MD
BOARD MEMBER1.00Yes (X)$0$0$0
JOHN BRANSTROM
BOARD MEMBER1.00Yes (X)$0$0$0
FRIEDA CLARK
BOARD MEMBER1.00Yes (X)$0$0$0
ALAN GRIFFIN
BOARD MEMBER1.00Yes (X)$0$0$0
BRIAN GWYN
BOARD MEMBER1.00Yes (X)$0$0$0
SUSAN HAIRE
BOARD MEMBER1.00Yes (X)$0$0$0
ALLEN VANNOPPEN
BOARD MEMBER1.00Yes (X)$0$0$0
FELICIA SIMMONS
BOARD MEMBER1.00Yes (X)$0$0$0
KATHY BAILEY
PRESIDENT & CEO1.0050.00Yes (X)$0$0$0
ROBERT G FRITTS
SENIOR VP OF FINANCE/CFO1.0050.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$235,778TotReportableCompRltdOrgAmt
Total Other Compensation$53,755TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
OTHER900099$688,498$688,498
RESIDENT REVENUE623000$49,074$49,074
FieldValueIRS element (for citing)
Total Program Service Revenue$737,572TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$737,572TotalRevenueColumnAmt
Related Or Exempt Func Income$737,572RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total-$359TotalAmt
Program Services-$269ProgramServicesAmt
Management And General-$90ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total-$559TotalAmt
Program Services-$559ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total-$27TotalAmt
Program Services-$27ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,743TotalAmt
Management And General$7,743ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,511TotalAmt
Program Services$7,830ProgramServicesAmt
Management And General$681ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,811TotalAmt
Management And General$1,811ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$140,776TotalAmt
Program Services$140,776ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,269TotalAmt
Management And General$3,269ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
INTERCOMPANY EXPENSE$11,064$11,064
SUPPLIES-$1,353-$1,353

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total-$793TotalAmt
Program Services-$158ProgramServicesAmt
Management And General-$635ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$170,083TotalAmt
Program Services$157,304ProgramServicesAmt
Management And General$12,779ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$5,179BOYAmt
EOY$3,611EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,007,840LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,886,512LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,259,694BOYAmt
EOY$1,121,328EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$2BOYAmt
EOY$4EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,264,875BOYAmt
EOY$1,124,943EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,187BOYAmt
EOY$6,189EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,258,547BOYAmt
EOY$3,546,124EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,259,734BOYAmt
EOY$3,552,313EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$2,994,859BOYAmt
EOY-$2,427,370EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$2,994,859BOYAmt
EOY-$2,427,370EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,264,875BOYAmt
EOY$1,124,943EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$567,489ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$4,258CurrentTaxYearMinus3YearsAmt
Total$4,258TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,542,624CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,363,902CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,576,888CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,587,210CurrentTaxYearMinus1YearAmt
Current Tax Year$737,572CurrentTaxYearAmt
Total$30,808,196TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,542,624CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,368,160CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,576,888CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,587,210CurrentTaxYearMinus1YearAmt
Current Tax Year$737,572CurrentTaxYearAmt
Total$30,812,454TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$30,812,454PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$30CurrentTaxYearMinus4YearsAmt
Total$30TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$30CurrentTaxYearMinus4YearsAmt
Total$30TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,542,654CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,368,160CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,576,888CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,587,210CurrentTaxYearMinus1YearAmt
Current Tax Year$737,572CurrentTaxYearAmt
Total$30,812,484TotalAmt
FieldValueIRS element (for citing)
Public Support CY5091.00000PublicSupportCY509Pct
Public Support PY5091.00000PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,347OtherCostOrOtherBasisAmt
Book Value$6,347BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,893,918OtherCostOrOtherBasisAmt
Depreciation$1,778,937DepreciationAmt
Book Value$1,114,981BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,005,333OtherCostOrOtherBasisAmt
Depreciation$1,005,333DepreciationAmt
Book Value$0BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$102,242OtherCostOrOtherBasisAmt
Depreciation$102,242DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,121,328TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescINTERCOMPANY LIABILITIESDesc
Amt$3,546,124Amt
FieldValueIRS element (for citing)
Total Liability$3,546,124TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE FILING ORGANIZATION IS A TAX-EXEMPT ORGANIZATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE FILING ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE FILING ORGANIZATION ADOPTED THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THIS STANDARD HAD NO IMPACT ON THE FILING ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED DECEMBER 31, 2020 OR DECEMBER 31, 2019.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonCLAY RICHARDSON MDPersonNm
TitleMEMBER AT LARGETitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$181,001CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$19,015BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$8,415DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$43,293NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$251,724TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1AALL BENEFITS PROVIDED TO OFFICERS FACILITATE BUSINESS RELATIONSHIPS. DURING THE YEAR, A RELATED ORGANIZATION PAID FOR THE CLUB DUES FOR KATHY BAILEY AND INCLUDED THE AMOUNT OF DUES PAID IN HER TAXABLE INCOME.
PART I, LINE 3UNCHECKED ITEMS ARE CONDUCTED BY ATRIUM HEALTH (FORMERLY CAROLINAS HEALTHCARE SYSTEM) AS PART OF THE MANAGEMENT AGREEMENT. THE ORGANIZATION COMPENSATION COMMITTEE REVIEWS AND APPROVES.
PART I, LINE 6BONUSES ARE PAID IF THE ORGANIZATION'S RESULTS MET CERTAIN PERFORMANCE INDICATORS.
PART IICOMPENSATION FOR KATHY BAILEY AND ROBERT FRITTS IS PAID BY ATRIUM HEALTH THROUGH A MANAGEMENT SERVICE CONTRACT.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3IN 1999, THE ORGANIZATION ENTERED INTO A MANAGEMENT SERVICES CONTRACT WITH ATRIUM HEALTH. THE TERMS OF THE CONTRACT CALL FOR THE ORGANIZATION TO PAY ATRIUM HEALTH AN ANNUAL MANAGEMENT FEE BASED UPON THE ORGANIZATION'S NET OPERATING REVENUES. IN ADDITION, ATRIUM HEALTH IS REQUIRED TO FURNISH THE ORGANIZATION WITH A CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. THE ORGANIZATION REIMBURSES ATRIUM HEALTH FOR THE SALARY AND BENEFITS' COST OF THESE INDIVIDUALS.
FORM 990, PART VI, SECTION B, LINE 11BTHE CHIEF FINANCIAL OFFICER, THE BOARD AND THE EXECUTIVE COMMITTEE WILL REVIEW THE PREPARED FORM 990 BEFORE IT IS FILED WITH THE IRS. A DRAFT OF FORM 990 WAS POSTED FOR ACCESS BY THE GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CCORPORATE COUNSEL, WHO REVIEWS ALL ANNUAL CONFLICT OF INTEREST DISCLOSURES, IS PRESENT AT EVERY BOARD MEETING TO ENSURE THAT ANY POTENTIAL CONFLICTS ARE APPROPRIATELY HANDLED BY MEMBERS ABSTAINING FROM VOTES AS APPROPRIATE.
FORM 990, PART VI, SECTION B, LINE 15SUCH A PROCESS WAS PERFORMED FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT/CEO AND CFO DURING 2020.
FORM 990, PART VI, SECTION C, LINE 19BY-LAWS ARE AVAILABLE UPON REQUEST THROUGH CORPORATE COUNSEL. ARTICLES OF INCORPORATION ARE FILED WITH THE NORTH CAROLINA SECRETARY OF STATE AND ARE AVAILABLE ON THEIR WEBSITE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
PART VIIDESCRIPTION OF HOURS -- FOR RELATED ORGANIZATIONS, OFFICERS AND KEY EMPLOYEES LISTED ON PART VII WORK AN AVERAGE OF 40 TO 50 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND OTHER RELATED ENTITIES LISTED ON SCHEDULE R.
FORM 990, PART XII, LINE 2CNO CHANGES FOR APPROVING AUDITED FINANCIAL STATEMENTS OR SELECTION OF INDEPENDENT ACCOUNTANTS HAVE OCCURRED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
BLUE RIDGE HEALTHCARE HOSPITALS INC
2201 SOUTH STERLING STREETMORGANTONNC28655560529976HEALTHCARENC501(C)(3)LINE 3N/A0
GRACE LIFECARE INC
500 LENOIR ROADMORGANTONNC28655561722754HEALTHCARENC501(C)(3)LINE 10N/A0
GRACE PROPERTIES INC
500 LENOIR ROADMORGANTONNC28655561727514HEALTHCARENC501(C)(3)LINE 12A, IN/A0
BLUE RIDGE FOUNDATION INC
2201 SOUTH STERLING STREETMORGANTONNC28655582063920HEALTHCARENC501(C)(3)LINE 7N/A0
BLUE RIDGE HEALTHCARE MEDICAL GROUP INC
2201 SOUTH STERLING STREETMORGANTONNC28655020777195HEALTHCARENC501(C)(3)LINE 10N/A0
BLUE RIDGE HEALTHCARE SYSTEM INC
2201 SOUTH STERLING STREETMORGANTONNC28655562150313HEALTHCARENC501(C)(3)LINE 12B, IIN/A0
GRACE NURSING CENTER INC
109 FOOTHILLS DRIVEMORGANTONNC28655561838369HEALTHCARENC501(C)(3)LINE 10N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1GRACE HEALTH VENTURES INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12201 SOUTH STERLING STREETAddressLine1Txt
CityMORGANTONCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28655ZIPCd
FieldValueIRS element (for citing)
EIN561581317EIN
Primary ActivitiesRELATEDPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BLUE RIDGE HEALTHCARE SYSTEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd