2019-11-14T14:29:19-06:00 2018-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-01-01 562103741 THE CYPRESS OF CHARLOTTE CLUB INC CYPR 7047145500 3442 CYPRESS CLUB DR CHARLOTTE NC 28210 VICTORIA DUVALL EXECUTIVE DIRECTOR 7047145500 2019-11-14 1 AMY BIBBY P00445891 8282542254 2019-11-14 24.241.144.70 2019-11-14 12:05:11 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 48FB394F9AA065459641371F168D9F2AFFFBB473 2018 2020-03-31 21:24:44Z MARC PUNTERERI 3442 CYPRESS CLUB DR CHARLOTTE NC 28210 18071339 0 X WWW.THECYPRESSOFCHARLOTTE.COM X 1998 NC THE CYPRESS OF CHARLOTTE CLUB, INC WAS ESTABLISHED AS A NON-PROPIETARY, NON-SHAREHOLDER, NOT-FOR-PROFIT MUTUAL BENEFIT CORPORATION UNDER THE LAWS OF NC, EXCLUSIVELY TO MAINTAIN HOUSING FOR ELDERLY, TO DIRECTLY PROVIDE HEALTHCARE FOR THE PHYSICAL AND MENTAL WELL-BEING OF ITS RESIDENTS, TO PROVIDE FINANCIAL SECURITY FOR ITS RESIDENTS WITH POLICIES PERMITTING RESIDENTS TO REMAIN AT THE CYPRESS EVEN THOUGH THEY MAY RUN OUT OF FUNDS, AND TO OPERATE THE FACILITY AT ITS LOWEST FEASIBLE AND ACCEPTABLE COST. 5 3 514 12 0 0 0 0 17434214 18036472 4578 5401 17079 29466 17455871 18071339 0 0 0 0 10956471 11572236 0 0 15278 6392974 6468362 17349445 18040598 106426 30741 5394267 5316093 3384348 2880294 2009919 2435799 THE CYPRESS OF CHARLOTTE, CHARLOTTE'S PREMIER CONTINUING CARE RETIREMENT COMMUNITY, IS COMMITTED TO ENHANCING THE LIVES OF OUR MEMBERS BY PROVIDING EXCEPTIONAL SERVICE AND PEACE OF MIND IN AN UPSCALE ENVIRONMENT. 0 0 15894348 18036472 THE CYPRESS OF CHARLOTTE CLUB PROVIDES SERVICES TO ELDERLY RESIDENTS LIVING IN 310 PRIVATELY OWNED RESIDENTIAL UNITS. RESIDENTS RECEIVED ASSISTED LIVING, INCLUDING HEALTHCARE, FOR PHYSICAL AND MENTAL WELL BEING. 15894348 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 71 0 1 514 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X VICTORIA DUVALL 7047145500 3442 CYPRESS CLUB DR CHARLOTTE NC 28210 X X JAMES P COLEMAN PRESIDENT 5.00 X X 0 0 0 VICTORIA DUVALL EXEC DIR/TREASURER/SECRETARY 40.00 X X 0 0 0 MICHELLE FISH DIRECTOR 1.00 X 0 0 0 MICHAEL J HARRISON DIRECTOR 1.00 X 0 0 0 DR ROBERT HIGGINS DIRECTOR 1.00 X 0 0 0 TRACY RIVERS DIRECTOR OF HUMAN RESOURCES 40.00 X 111493 0 0 ANN HEINTEL DIRECTOR OF FINANCE 40.00 X 101214 0 9004 212707 0 9004 2 0 0 0 LIFE CARE COMPANIES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 1373647 THE CYPRESS OF CHARLOTTE LLC 20 LADY SLIPPER LANE HILTON HEAD ISLAND SC 29926 CONTRACT SERVICES 1091955 HERITAGE HEALTHCARE 536 OLD HOWELL ROAD GREENVILLE SC 29615 REHABILITATION SERVICES 569858 LANDMARK LANDSCAPE INC 7319 IVY HILL LANE WAXHAW NC 28173 LANDSCAPING SERVICES 417632 FRANCISCO ANARIVA 2828 COCHRANE DR CHARLOTTE NC 28269 RENOVATION SERVICES 193200 6 MEMBER FEES 623000 9435086 9435086 HOME HEALTH SERVICES 621610 4372686 4372686 HEALTH CENTER SERVICES 623000 4228700 4228700 18036472 5026 5026 375 0 375 375 375 MISCELLANEOUS REVENUE 900099 29466 29466 29466 18071339 18036472 0 34867 208055 52014 145638 10403 8923817 8222228 701589 72989 64991 7850 148 1687938 1504012 180528 3398 679437 607484 70624 1329 935474 935474 37867 37867 93479 93479 909519 794246 115273 786706 570069 216637 121354 121354 249211 225524 23687 35387 12692 22695 37038 20352 16686 79314 67292 12022 257192 257192 275516 275516 FOOD 1714030 1714030 SUPPLIES 564467 538942 25525 ACTIVITIES 200229 200229 MEDICAL SUPPLIES 88295 88295 83284 19282 64002 18040598 15894348 2130972 15278 633801 698141 1284546 1022348 72313 95012 272197 236684 3488616 2709182 789157 779434 2312624 2358283 29629 126191 5394267 5316093 3319072 2649610 65276 230684 3384348 2880294 X 2009919 2435799 2009919 2435799 5394267 5316093 X 30741 395139 X X 0 1 X 1 0 3488616 2709182 779434 779434 X 18071339 0 18071339 0 18071339 18040598 0 18040598 0 18040598 PART X, LINE 2: THE CLUB IS A NONPROFIT ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. MANAGEMENT HAS EVALUATED THE CLUB'S TAX POSITIONS AND CONCLUDED THAT THE CLUB HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THE CLUB FILES AS A TAX-EXEMPT ORGANIZATION. BECAUSE MANAGEMENT HAS NOT IDENTIFIED UNRELATED BUSINESS INCOME IN PAST YEARS, THE CLUB HAS NOT FILED FORM 990-T, EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS. MANAGEMENT IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE TAX-EXEMPT STATUS OF THE CLUB. MANAGEMENT IS NOT AWARE OF ANY SIGNIFICANT ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES FOR THE CLUB. FORM 990, PART VI, SECTION A, LINE 3 THE CYPRESS OF CHARLOTTE CLUB ("CLUB") HAS CONTRACTED WITH LIFE CARE SERVICES, LLC TO PROVIDE SERVICES, INCLUDING MANAGEMENT SERVICES AND EMPLOYEES, TO THE CLUB. THE CLUB HAS AN AGREEMENT WITH THE CYPRESS OF CHARLOTTE, LLC ("COMPANY") TO PROVIDE SUPERVISION AND OVERSIGHT OF THOSE CONTRACTED ACTIVITIES AND EMPLOYEES. THE BOARD IS STILL ULTIMATELY RESPONSIBLE FOR THE CLUB AND MAY TERMINATE THE MANAGEMENT AGREEMENT WITH THE COMPANY SHOULD THE COMPANY BE IN DEFAULT. THE ORGANIZATION'S EXECUTIVE DIRECTOR IS COMPENSATED BY THE MANAGEMENT COMPANY AND RECEIVED $208,055 FOR SERVICES RENDERED IN 2018. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY MANAGEMENT PRIOR TO SUBMISSION. THE ORGANIZATION MADE THE FORM 990 AVAILABLE TO BOARD MEMBERS FOR THEIR PERSONAL REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE CLUB REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCY WITH THE POLICY THROUGH THEIR CORPORATE COMPLIANCE PROGRAM. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS OF DETERMINING COMPENSATION FOR THE EXECUTIVE DIRECTOR AND HEALTHCARE ADMINISTRATION IS CONDUCTED BY THE ORGANIZATION'S MANAGEMENT COMPANY, LIFE CARE SERVICES, LLC OF DES MOINES, IOWA, SUBJECT TO THE APPROVAL OF THE BOARD. THE EXECUTIVE DIRECTOR AND HEALTHCARE ADMINISTRATOR ARE LIFE CARE SERVICES, LLC EMPLOYEES (I.E. THEY ARE NOT EMPLOYEES OF THE CYPRESS OF CHARLOTTE). FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990 PART VII THE ORGANIZATION ACTS AS A PAYROLL PROCESSING AGENT FOR OTHER ENTITIES. THE FILING ORGANIZATION DOES NOT ISSUE ANY W-2S IN EXCESS OF $100,000 TO EMPLOYEES WHO ARE PROVIDING SERVICES TO THE FILING ORGANIZATION. FORM 990, PART XI, LINE 9: EQUITY TRANSFER FROM ASSOCTIATION 395,139. FORM 990 PART XII; LINE 2C NO CHANGE FROM PRIOR YEAR. THE CYPRESS OF CHARLOTTE OWNERS' ASSOCIATION 3442 CYPRESS CLUB DRIVE CHARLOTTE NC 28210 562205827 HOME OWNERS' ASSOCIATION NC C 5667317 14262906 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1