2020-11-11T15:06:05-06:00 2019-12-31 560571159 BERNARD ROBINSON & COMPANY LLP PO BOX 19608 GREENSBORO NC 274199608 990 2019-01-01 560529956 MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA INC MASO 3362990031 700 S HOLDEN ROAD GREENSBORO NC 27407 MARK LEWIS EXECUTIVE DIRECTOR 3362990031 2020-11-11 1 OLGA OGANESOV P01279668 3362944494 2020-11-10 12.198.32.162 2020-11-11 12:28:41 ES P 7DF8874F36D9AEC8AA6D0C4CBFBA6DA170636135 4B57986F3EC26E545B9AC857E4A458960E2046A6 2019 2021-01-29 14:40:06Z WHITESTONE MARK LEWIS 700 S HOLDEN ROAD GREENSBORO NC 27407 23083090 0 X WWW.LIVEATWHITESTONE.ORG X 1912 NC AS A RETIREMENT COMMUNITY LEADER SINCE 1912, MASONIC AND EASTERN STAR HOME OF NC IS DEVOTED TO EXCELLENCE IN HOSPITALITY WITH TRADITIONAL VALUES PROMOTING FRATERNAL SERVICE, DIGNITY, DEPENDABILITY, AND CHOICE. 21 21 364 75 0 0 1489837 1555079 17287777 16775531 -145902 2383555 14939 22434 18646651 20736599 1445002 485834 0 0 8131947 8542813 0 0 0 8872544 9015312 18449493 18043959 197158 2692640 55768807 59527056 42579330 44116065 13189477 15410991 AS A RETIREMENT COMMUNITY LEADER SINCE 1912, MASONIC AND EASTERN STAR HOME OF NC IS DEVOTED TO EXCELLENCE IN HOSPITALITY WITH TRADITIONAL VALUES PROMOTING FRATERNAL SERVICE, DIGNITY, DEPENDABILITY, AND CHOICE. 0 0 15585018 485834 16797965 MASONIC AND EASTERN STAR HOME OF NC PROVIDES RESIDENTIAL, HEALTH CARE, AND OTHER RELATED SERVICES TO ELDERLY RESIDENTS. THE HOME OFFERS INDEPENDENT LIVNG, ASSISTED LIVING, AND SKILLED NURSING SERVICES. 15585018 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 59 0 1 364 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 21 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MARK LEWIS 3362990031 700 S HOLDEN ROAD GREENSBORO NC 27407 X GENE JERNIGAN CHAIRMAN 1.00 X X 0 0 0 LOUISE TAYLOR VICE CHAIR 1.00 X X 0 0 0 CUTLER DILLON SECRETARY 1.00 X X 0 0 0 WAYNE SOUTHERN TREASURER 1.00 X X 0 0 0 MIKE UNDERWOOD DIRECTOR 1.00 X 0 0 0 DWIGHT MACK SIGMON DIRECTOR 1.00 X 0 0 0 SHAUN BRADSHAW DIRECTOR 1.00 X 0 0 0 MICHAEL FISCHER DIRECTOR 1.00 X 0 0 0 JON CANUPP DIRECTOR 1.00 X 0 0 0 ROSS GELLER DIRECTOR 1.00 X 0 0 0 JOEY TRANSOU DIRECTOR 1.00 X 0 0 0 TOMMY MILLS JR DIRECTOR 1.00 X 0 0 0 ELLEN BROOKS DIRECTOR 1.00 X 0 0 0 LINDA BURRIS DIRECTOR 1.00 X 0 0 0 BRYANT WEBSTER DIRECTOR 1.00 X 0 0 0 DAVID WICKER JR DIRECTOR 1.00 X 0 0 0 LINDA HYATT DIRECTOR 1.00 X 0 0 0 ALLEN HUGHES DIRECTOR 1.00 X 0 0 0 DAVID GRIFFITH DIRECTOR 1.00 X 0 0 0 GILBERT BAILEY DIRECTOR 1.00 X 0 0 0 JAMES WOOLARD DIRECTOR 1.00 X 0 0 0 MARK LEWIS EXECUTIVE DIRECTOR 40.00 X 0 0 0 PHIL HUGHES FORMER FINANCIAL SERVICES DIRECTOR 40.00 X 23634 0 2376 DIANNE ARMSTRONG HEALTH CENTER ADMINISTRATOR 40.00 X 129672 0 11070 153306 0 13446 1 0 0 1 LIFE CARE SERVICES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 1250359 HERITAGE HEALTHCARE 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY SERVICES 788057 2 819072 736007 1555079 RESIDENT SERVICES 623000 16775531 16775531 16775531 250758 250758 4479288 2338491 8000 2140797 -8000 2132797 2132797 OTHER INCOME 623000 22434 22434 22434 20736599 16797965 0 2383555 485834 485834 7178487 6341326 837161 81948 69924 12024 610174 551879 58295 672204 628861 43343 722493 62985 659508 43881 43881 73174 73174 444716 352772 91944 1513051 1513051 73123 19169 53954 1075154 1075154 1734395 1734395 218368 218368 MEDICAL SERVICES 1274684 1274684 REPAIRS AND MAINTENANCE 629569 623719 5850 VARIOUS SUPPLIES 597626 539221 58405 MISCELLANEOUS 289438 115105 174333 325640 196939 128701 18043959 15585018 2458941 0 3532535 2714422 64635 634691 2155484 2250155 74634 87872 231567 222788 55885125 22802303 32361628 33082822 11408535 13714944 4804370 5350964 611526 1416862 523893 51536 55768807 59527056 2441738 2755574 12051470 13126389 23804754 23461248 4281368 4772854 42579330 44116065 X 3746570 4967858 9442907 10443133 13189477 15410991 55768807 59527056 2692640 461890 -933016 0 X 0 1 X 1 0 X 1852247 1096277 2250218 1489837 1555079 8243658 1852247 1096277 2250218 1489837 1555079 8243658 3809073 4434585 174266 199207 234794 245919 250758 1104944 6929 15940 8309 14939 22434 68551 9417153 83767880 0.47090 0.47220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6321789 464504 6786293 6867206 -545417 6321789 6387499 479707 6867206 6404560 -17061 6387499 6871104 -466544 6404560 0 0 175138 175138 48606289 20010217 28596072 2915075 2141607 773468 4188623 650479 3538144 33082822 ASSETS IN SPLIT INTEREST AGREEMENTS 5350964 F 5350964 REFUNDABLE ADVANCE FEES 4097045 DEPOSITS ON UNOCCUPIED UNITS 523491 RESIDENT TRUST FUNDS 112318 LONG TERM ACCOUNTS PAYABLE 40000 4772854 X 20712655 461890 461890 20250765 485834 485834 20736599 17558125 0 17558125 485834 485834 18043959 PART X, LINE 2: IT IS THE HOME'S POLICY TO EVALUATE ALL TAX POSITIONS TO IDENTIFY ANY THAT MAY BE CONSIDERED UNCERTAIN. ALL IDENTIFIED MATERIAL TAX POSITIONS ARE ASSESSED AND MEASURED BY A "MORE-LIKELY-THAN-NOT" THRESHOLD TO DETERMINE IF THE TAX POSITION IS UNCERTAIN AND WHAT, IF ANY, THE EFFECT OF THE UNCERTAIN TAX POSITION MAY HAVE ON THE FINANCIAL STATEMENTS. NO MATERIAL UNCERTAIN TAX POSITIONS WERE IDENTIFIED DURING 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: GRANTS MADE TO RESIDENTS 485,834. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANTS MADE TO RESIDENTS 485,834. 1 WAIVER OF FEES FOR INDIVIDUALS DUE TO HARDSHIPS 24 485834 FMV RESIDENTIAL AND HEALTH SERVICES PART I, LINE 2: THE ORGANIZATION PROVIDES GRANTS FOR RESIDENTS UNABLE TO AFFORD TO PAY FOR THEIR CARE. THE MAJORITY OF THE GRANT RECIPIENTS ALSO RECEIVE MEDICAID BENEFITS. EACH RESIDENT IS REQUIRED TO CONTRIBUTE AS MUCH AS THEY CAN AFFORD TOWARDS THE COST OF THEIR CARE. THE GRANTS ARE PAID DIRECTLY TO THE VENDORS PROVIDING THE CARE, TO ENSURE THE FUNDS ARE USED APPROPRIATELY. X 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 MARK LEWIS IS THE EXECUTIVE DIRECTOR OF MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA. HOWEVER, MARK LEWIS IS EMPLOYED BY LIFE CARE SERVICES, LLC (AN UNRELATED ORGANIZATION). MASONIC AND EASTERN STAR HOME OF NC PAYS LIFE CARE SERVICES, LLC. TO MANAGE OPERATIONS OF THE HOME. MARK LEWIS'S SALARY AND BENEFITS ARE PAID BY LIFE CARE SERVICES, LLC. FOR THE 2019 TAX YEAR, LIFE CARE SERVICES, LLC PAID MARK LEWIS MEDICARE WAGES IN THE AMOUNT OF $217,267. A PUBLIC FINANCE AUTHORITY 273866124 74444VAD2 2017-11-28 25023276 REFUND 2011A BONDS 0 0 0 A 25023276 24520225 500465 2586 2012 1 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 FORM 990, SCHEDULE K, PART I, COLUMN F THE BONDS WERE ISSUED TO PAY FOR CONSTRUCTION OF AN EXPANSION TO THE HOMES' EXISTING FACILITY, REFUNDING CERTAIN INDEBTEDNESS INCURRED TO FINANCE A PORTION OF THE EXPANSION, FUNDING A DEBT SERVICE RESERVE FUND AND PAYING CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE BONDS. FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF DIRECTORS HAS CONTRACTED WITH LIFE CARE SERVICES, LLC. TO MANAGE, OPERATE AND MAINTAIN THE RETIREMENT COMMUNITY. THE EXECUTIVE DIRECTOR, MARK LEWIS, IS AN EMPLOYEE OF LIFE CARE SERVICES, LLC. FORM 990, PART VI, SECTION A, LINE 7A THE GRAND MASTER APPOINTS THREE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS WILL REVIEW THE FORM 990 AS IT IS PRESENTED BY LIFE CARE SERVICES, LLC. THE BOARD OF DIRECTORS WILL ASK ANY PERTINENT QUESTIONS AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL MONITORING OF CONFLICT OF INTEREST IS PART OF THE DUTIES OF THE CORPORATE COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR CEO, CURRENT OFFICERS, ETC. IS REVIEWED AS A PART OF ANNUAL BUDGET BY THE BOARD OF DIRECTORS, FINANCE COMMITTEE AND PERSONNEL COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. THE AUDITED FINANCIALS ARE INCLUDED IN ANNUAL DISCLOSURE AS REQUIRED BY DEPARTMENT OF INSURANCE. GRAND LODGE OF THE AF AND AM OF NC PO BOX 6506 RALEIGH NC 27628 560228750 PROVIDE SUPPORT FOR NC MASONS NC 501(C)(10) 0 GRAND CHAPTER OF THE ORDER OF THE EASTERN STAR OF NC PO BOX 4730 WILMINGTON NC 28406 560239941 CHARITABLE, EDUCATIONAL AND FRATERNAL NC 501(C)(8) 0 NC MASONIC FOUNDATION INC PO BOX 6506 RALEIGH NC 27628 566049500 RECEIVE DONATIONS AND DISTRIBUTE ALL INCOME TO CHARITABLE ORGANIZATIONS NC 501(C)(3) LINE 12B, II 0 NC EASTERN STAR FOUNDATION INC PO BOX 2296 GARNER NC 27529 561974972 INVEST FUNDS RAISED TO PROVIDE PERPETUAL FUND TO EASTERN STAR HOME NC 501(C)(3) PF 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NORTH CAROLINA MASONIC AND EASTERN STAR HOME FOUNDATION LLC C 528739 GRAND CHAPTER OF THE ORDER OF THE EASTERN STAR OF NC C 290333 NC EASTERN STAR FOUNDATION INC C 186219