2019-11-15T15:11:34-06:00 2018-12-31 560571159 BERNARD ROBINSON & COMPANY LLP PO BOX 19608 GREENSBORO NC 274199608 990 2018-01-01 560529956 MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA INC MASO 3362990031 700 S HOLDEN ROAD GREENSBORO NC 27407 MARK LEWIS EXECUTIVE DIRECTOR 3362990031 2019-11-15 1 OLGA OGANESOV P01279668 3362944494 2019-11-15 12.198.32.162 2019-11-15 12:02:35 ES P AE8756E269BC3D028F5F1EE52092E27644DFACF0 770F105F5705FE37EB014741EDECC2FD4DE580F0 2018 2020-03-31 21:24:44Z WHITESTONE MARK LEWIS 700 S HOLDEN ROAD GREENSBORO NC 27407 19638948 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. 20 20 372 100 0 0 2250218 1489837 16678448 17287777 1620294 -145902 8309 14939 20557269 18646651 1271315 1445002 0 0 8108909 8131947 0 0 0 9079138 8872544 18459362 18449493 2097907 197158 82496467 55768807 63770091 42579330 18726376 13189477 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 16189457 1445002 17302716 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. 16189457 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 63 0 1 372 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 20 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 JAMES H WOOLARD DIRECTOR 1.00 X 0 0 0 REX EVANS SECRETARY 1.00 X X 0 0 0 LINDA HYATT DIRECTOR 1.00 X 0 0 0 WAYNE SOUTHERN TREASURER 1.00 X X 0 0 0 SHAUN BRADSHAW 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 BRYANT WEBSTER DIRECTOR 1.00 X 0 0 0 GILBERT BAILEY DIRECTOR 1.00 X 0 0 0 DON ALDERMAN DIRECTOR 1.00 X 0 0 0 BILLY L PRICE JR MD DIRECTOR 1.00 X 0 0 0 STEVEN A GREEN DIRECTOR 1.00 X 0 0 0 MICHAEL J FISCHER DIRECTOR 1.00 X 0 0 0 HELEN LENTZ VICE CHAIR 1.00 X X 0 0 0 SPEED HALLMAN DIRECTOR 1.00 X 0 0 0 DWIGHT SIGMON DIRECTOR 1.00 X 0 0 0 JON CANUPP DIRECTOR 1.00 X 0 0 0 DEBBIE OWEN DIRECTOR 1.00 X 0 0 0 WILLIAM HORNE DIRECTOR 1.00 X 0 0 0 MARK LEWIS EXECUTIVE DIRECTOR 40.00 X 0 0 0 PHIL HUGHES FINANCIAL SERVICES DIRECTOR 40.00 X 110335 0 5566 DIANNE ARMSTRONG HEALTH CENTER ADMINISTRATO 40.00 X 121328 0 11029 231663 0 16595 2 0 0 1 LIFE CARE SERVICES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 1226512 HERITAGE HEALTHCARE 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY SERVICES 783788 2 839117 650720 1489837 RESIDENT SERVICES 623000 17287777 17287777 17287777 245919 245919 600476 992297 -391821 -391821 -391821 OTHER INCOME 623000 14939 14939 14939 18646651 17302716 0 -145902 1445002 1445002 6786266 6037682 748584 78238 70797 7441 657049 583286 73763 610394 571768 38626 713592 58526 655066 43715 5670 38045 66089 66089 146119 64422 81697 1517542 1517542 63345 20769 42576 1426395 1426395 1717254 1717254 199111 199111 MEDICAL SERVICES 1267003 1267003 VARIOUS SUPPLIES 576759 513020 63739 REPAIRS AND MAINTENANCE 510177 505715 4462 MISCELLANEOUS 258029 111631 146398 367414 272975 94439 18449493 16189457 2260036 0 26465816 3532535 47858 64635 2240069 2155484 68582 74634 237111 231567 53429537 21067909 31633726 32361628 12197237 11408535 5425285 4804370 3399313 611526 781470 523893 82496467 55768807 2059971 2441738 12090856 12051470 45258302 23804754 4360962 4281368 63770091 42579330 X 8594406 3746570 3264764 3121118 6867206 6321789 18726376 13189477 82496467 55768807 197158 -1267156 -4466901 0 X 0 1 X 1 0 X 1165145 1852247 1096277 2250218 1489837 7853724 1165145 1852247 1096277 2250218 1489837 7853724 3642912 4210812 139750 174266 199207 234794 245919 993936 23631 6929 15940 8309 14939 69748 8917408 82525275 0.47220 0.49430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6867206 -545417 6321789 6387499 479707 6867206 6404560 -17061 6387499 6871104 -466544 6404560 6958944 -87840 6871104 0 0 123290 123290 47764777 18548078 29216699 2812454 1901634 910820 2729016 618197 2110819 32361628 ASSETS IN SPLIT INTEREST AGREEMENTS 4804370 F 4804370 REFUNDABLE ADVANCE FEES 3994271 DEPOSITS ON UNOCCUPIED UNITS 169535 RESIDENT TRUST FUNDS 117562 4281368 X 15934493 -1267156 -1267156 17201649 1445002 1445002 18646651 17004491 0 17004491 1445002 1445002 18449493 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 2018. PART XI, LINE 4B - OTHER ADJUSTMENTS: GRANTS MADE TO RESIDENTS 1,445,002. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANTS MADE TO RESIDENTS 1,445,002. 1 WAIVER OF FEES FOR INDIVIDUALS DUE TO HARDSHIPS 50 1445002 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 2018 TAX YEAR, LIFE CARE SERVICES, LLC PAID MARK LEWIS MEDICARE WAGES IN THE AMOUNT OF $119,664. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YJN7 2011-04-28 26642514 SEE PART VI 0 0 0 A 26642514 1971475 2234840 3874001 532850 12196700 5832648 2012 1 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 A 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 606890 GRAND CHAPTER OF THE ORDER OF THE EASTERN STAR OF NC C 232227