2019-01-22T09:24:08-06:00 2018-03-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2017-04-01 560963926 MORAVIAN HOME INCORPORATED DBA SALEMTOWNE MORA 3367678130 1000 SALEMTOWNE DRIVE WINSTONSALEM NC 27106 BRIAN TUCKMANTEL CFO 3367678130 2019-01-22 1 AMY BIBBY P00445891 8282542254 24.241.144.70 2019-01-22 09:17:50 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3C4A73C7F70BFF54BAAC11A85090BDFB39FC8B01 2017 2019-02-21 02:37:17Z SALEMTOWNE MARK STEELE 1000 SALEMTOWNE DRIVE WINSTONSALEM NC 27106 24278738 0 X WWW.SALEMTOWNE.ORG X 1971 NC LONG TERM CARE FOR THE ELDERLY 17 17 360 0 0 0 880262 1036759 19932903 21670423 1018470 1033957 385676 533808 22217311 24274947 1245059 1312520 0 0 11129937 11666727 0 0 174339 11413720 15370428 23788716 28349675 -1571405 -4074728 116098430 112397128 89612428 89058448 26486002 23338680 X SALEMTOWNE IS A NON-PROFIT CONTINUING CARE RETIREMENT COMMUNITY THAT PROMOTES THE WELL-BEING OF ITS RESIDENTS BY PROVIDING A CARING ENVIRONMENT. SALEMTOWNE IS AN ECUMENICAL COMMUNITY THAT REFLECTS THE MORAVIAN VALUES OF INDIVIDUAL RESPECT, HOSPITALITY, LIFE-LONG LEARNING, AND LOVE OF THE ARTS. 0 0 22734147 82183 21670423 SALEMTOWNE PROVIDED SERVICES THROUGH LONG-TERM CARE FOR ELDERLY IN THE WINSTON-SALEM COMMUNITY AND SURROUNDING AREAS. IT IS THE MISSION OF THE SALEMTOWNE COMMUNITY OUTREACH PROGRAM TO PROVIDE RESOURCES FOR SERVICES, PROGRAMS AND EDUCATION THAT ENHANCE THE QUALITY OF LIVING AND CARE FOR SENIOR ADULTS OF PIEDMONT NORTH CAROLINA. SALEMTOWNE STRIVES TO SHARE ITS EXPERTISE IN THE AREA OF AGING BY OFFERING EDUCATION AND TRAINING TO SENIOR ADULTS, FAMILIES AND CAREGIVERS; BY UTILIZING ITS TIME, TALENTS, AND FACILITIES FOR PROGRAMS AND EDUCATION; AND BY SPONSORING AND/OR SUPPORTING PROGRAMS OF ORGANIZATIONS AND ASSOCIATIONS DEDICATED TO SENIOR ADVOCACY. 1230337 1230337 PROVIDED FINANCIAL ASSISTANCE FOR RESIDENTS MOVING THROUGH THE CONTINUUM OF CARE AT SALEMTOWNE. PROVIDED FINANCIAL ASSISTANCE FOR DIRECT ADMISSIONS TO INDEPENDENT LIVING, THE ASSISTED LIVING CENTER & THE HEALTH CARE CENTER AT SALEMTOWNE. 23964484 1 1 0 0 0 0 1 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 81 0 1 360 1 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME AK AZ OR NM MN MS GA ND CO FL KY OH NH SC UT WA WI X X BRIAN TUCKMANTEL 3367142141 1000 SALEMTOWNE DRIVE WINSTONSALEM NC 27106 DERON MABE CHAIRMAN 1.00 X X 0 0 0 KIM STOGNER VICE CHAIR 1.00 X X 0 0 0 DAVID SHAFFNER TREASURER 1.00 X X 0 0 0 CHRIS PERRY SECRETARY 1.00 X X 0 0 0 PEGGY CARTER BOARD MEMBER 1.00 X 0 0 0 MATTHEW DOLGE BOARD MEMBER 1.00 X 0 0 0 CAROL ANN ADCOCK BOARD MEMBER 1.00 X 0 0 0 JOHN GEIS BOARD MEMBER 1.00 X 0 0 0 DONALD FREY BOARD MEMBER 1.00 X 0 0 0 RICHARD GOTTLIEB BOARD MEMBER 1.00 X 0 0 0 EVELYN ACREE BOARD MEMBER 1.00 X 0 0 0 RICHARD HARRIS BOARD MEMBER 1.00 X 0 0 0 VALENE FRANCO BOARD MEMBER 1.00 X 0 0 0 GRAHAM RIGHTS BOARD MEMBER 1.00 X 0 0 0 BETTY PETREE BOARD MEMBER 1.00 X 0 0 0 EDWARD LEWIS BOARD MEMBER 1.00 X 0 0 0 PEGGY VALENTINE BOARD MEMBER 1.00 X 0 0 0 MARK STEELE CEO 40.00 X 184881 0 27861 BRIAN TUCKMANTEL CFO (BEGAN 11/17) 40.00 X 16748 0 0 JAMES KONISZEWSKI CFO (THROUGH 10/17) 40.00 X 116972 0 6902 KATHY WILSON DIRECTOR OF HR & COMPLIANCE 40.00 X 104682 0 7116 JAMES MATTHEWS ADMIN. OF HEALTH CARE 40.00 X 117060 0 12211 ELWIN MELTON DIRECTOR OF DEVELOPMENT 40.00 X 104224 0 11542 644567 0 65632 5 0 1 0 HEALTH PRO HERITAGE LLC 536 OLD HOWELL RD GREENVILLE SC 29615 THERAPY 491993 THERAPY PARTNERS LLC 1032 TRADERS TRAIL WAKE FOREST NC 27587 THERAPY 405268 LEADERSTAT 1322 B MANNING PKWY POWELL OH 43065 RECRUITING 347418 WOMBLE BOND DICKINSON ONE WEST FOURTH STREET WINSTONSALEM NC 27101 LEGAL 112783 DIXON HUGHES GOODMAN LLP PO BOX 602828 CHARLOTTE NC 28260 ACCOUNTING SERVICES 109155 5 1036759 147547 1036759 RESIDENT SERVICES 623000 18406021 18406021 AMORT. OF ADVANCE FEES 623000 2991368 2991368 NAVIGATION REVENUE 623000 273034 273034 21670423 295800 295800 741948 0 3791 741948 -3791 738157 738157 MISCELLANEOUS INCOME 900099 276367 276367 BEAUTY SHOP 812900 114963 114963 FOOD SERVICE 722210 109076 109076 33402 33402 533808 24274947 21670423 0 1567765 X 82183 82183 1230337 1230337 341288 273030 68258 9224964 7556632 1560099 108233 166196 119996 41754 4446 1192452 982442 203542 6468 741827 615624 118302 7901 46406 46406 3864655 3217357 644079 3219 288830 222340 60363 6127 787718 449025 324944 13749 807105 135 797286 9684 982643 980517 2126 46032 35718 10314 1877430 1877430 4527401 4527401 259405 259405 FOOD 1190102 1127995 62107 HEALTHCARE SUPPLIES & S 537788 537788 BAD DEBT 66706 66706 MISC 57458 43965 2928 10565 30749 17863 8939 3947 28349675 23964484 4210852 174339 566235 162068 39848 41047 1060759 1633570 44690 70467 174156 185947 126355452 42280082 77320969 84075370 35715191 24740226 1176582 1488433 116098430 112397128 3968615 2813951 14010574 14821946 67592808 66135200 250000 4040431 5037351 89612428 89058448 X 14739385 19790144 630363 620999 11116254 2927537 26486002 23338680 116098430 112397128 X -4074728 536215 391191 X X 0 1 X 1 0 X 518858 1291873 608667 880262 1036759 4336419 18096731 18928825 18779046 18791815 21670423 96266840 484477 348152 423823 385676 533808 2175936 19100066 20568850 19811536 20057753 23240990 102779195 58484 30178 115409 346000 330845 880916 0 58484 30178 115409 346000 330845 880916 101898279 398839 327464 290707 234811 295800 1547621 398839 327464 290707 234811 295800 1547621 19498905 20896314 20102243 20292564 23536790 104326816 0.97670 0.97850 0.01480 0.01560 X X 1 25.00 1 1 1 0.00 0 0 11746617 798252 486860 2207212 10824517 11992952 628463 159386 1034184 11746617 11865131 383504 92140 347823 11992952 11740234 235920 152156 263179 11865131 11624873 308351 237824 430814 11740234 0.67220 0.27040 0.05740 0 0 3468962 3468962 108842701 38778748 70063953 8350418 2975108 5375310 5693371 526226 5167145 84075370 DEPOSITS 1615865 REFUNDABLE ADVANCE FEES 1793312 BOND INTEREST PAYABLE 1628174 5037351 X 23958334 536215 396996 933211 23025123 1249824 1249824 24274947 27105656 5805 5805 27099851 1249824 1249824 28349675 PART II, LINE 9: THE CONSERVATION EASEMENT IS REPORTED IN THE ORGANIZATION'S FINANCIAL STATEMENTS AS PART OF PERMANENTLY RESTRICTED NET ASSETS. PART V, LINE 4: SUPPORT FOR RESIDENTS IN FINANCIAL NEED, PERSONNEL RECRUITING AND OTHER GENERAL OBLIGATIONS. PART X, LINE 2: THE COMMUNITY IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE COMMUNITY HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF MARCH 31, 2018. IN ADDITION, THE COMMUNITY QUALIFIED FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND IS CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 391,191. GAIN/LOSS ON FIXED ASSETS 5,805. PART XI, LINE 4B - OTHER ADJUSTMENTS: INDIVIDUAL ASSISTANCE INCLUDED IN INCOME 1,230,337. REVENUES IN EXPENSES 19,487. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN/LOSS ON FIXED ASSETS 5,805. PART XII, LINE 4B - OTHER ADJUSTMENTS: INDIVIDUAL ASSISTANCE INCLUDED IN INCOME 1,230,337. REVENUES IN EXPENSES 19,487. 1 SENIOR SERVICES INC 2895 SHOREFAIR DRIVE WINSTONSALEM NC 27105 561085968 501(C)(3) 74683 FMV FOOD PROVIDED MEALS TO ORGANIZATIONS SUPPORTING ELDERLY POPULATION BOOKMARKS PO BOX 11867 WINSTONSALEM NC 27116 542152610 501(C)(3) 7500 FMV PROVIDED DONATION TO ORGANIZATION 2 BENEVOLENT ASSISTANCE 10 1230337 FMV SCHEDULE I, PART I, LINE 2: RESIDENTS - RESIDENTS MUST APPLY FOR FINANCIAL ASSISTANCE AND PROVIDE VERIFICATION OF ASSETS AND INCOME. APPLICANTS APPROVED FOR FINANCIAL ASSISTANCE MUST SIGN A FINANCIAL ASSISTANCE AGREEMENT OUTLINING THE TERMS AND CONDITIONS OF THE PROGRAM. FINANCIAL ASSISTANCE TOTALS ARE LISTED AS PART OF THE FINANCIAL STATEMENT PACKAGE FOR THE BOARD OF TRUSTEES AND OFFICERS OF THE ORGANIZATION. OUTSIDE ORGANIZATIONS - SALEMTOWNE CHOOSES TO GIVE TO WELL ESTABLISHED NON-PROFIT ORGANIZATIONS IN GOOD STANDING WITH THE IRS WHO SUPPORT AND/OR ENHANCE OUR MISSION AND VALUES. IT IS THE MISSION OF SALEMTOWNE AND ITS OUTREACH PROGRAM TO PROVIDE HOUSING AND SERVICES FOR RESIDENTS WHO HAVE OUTLIVED THEIR RESOURCES, RESOURCES FOR SERVICES, PROGRAMS AND EDUCATION THAT ENHANCE THE QUALITY OF LIVING AND CARE FOR THE SENIOR CITIZENS OF PIEDMONT NORTH CAROLINA. SALEMTOWNE STRIVES TO SHARE ITS EXPERTISE IN THE AREA OF AGING BY OFFERING EDUCATION AND TRAINING TO SENIORS, FAMILIES AND CARE GIVERS; BY UTILIZING ITS TIME, TALENTS, AND FACILITIES FOR PROGRAMS AND EDUCATION; AND BY SPONSORING PROGRAMS OF ORGANIZATIONS AND ASSOCIATIONS DEDICATED TO SENIOR ADVOCACY. X 0 0 X X X X 0 0 0 0 0 0 0 0 0 MARK STEELE CEO 184881 0 0 0 0 0 10743 0 17118 0 212742 0 0 0 PART I, LINE 1A THE FOLLOWING INDIVIDUAL'S RECEIVED A HOUSING ALLOWANCE DURING THE YEAR: MARK STEELE - $39,077 THE HOUSING ALLOWANCE WAS INCLUDED IN THEIR TAXABLE WAGES. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YMA1 2016-09-07 25807298 REFUND 2006 BOND 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YLG9 2015-08-18 42180601 RETIREMENT FACILITIES FIRST MORTGAGE REVENUE BONDS SERIES 2015 0 0 0 A 1225000 23480124 2328525 516146 22963978 2016 0 1 1 1 B 42620309 2337282 843600 7957819 31047391 2045 0 0 1 1 A 0 0 0 1 0 0 1 BANK OF AMERICA NA 13.000000000000 1 0 1 B 0 1 0 1 0 0 0 0 1 A 1 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2016 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 05/08/2015 SCHEDULE K, PART I, DESCRIPTION OF PURPOSE: THE BONDS WERE ISSUED FOR THE PURPOSE OF (1) REFUNDING PRIOR ISSUES DATED OCTOBER 20, 1999 AND APRIL 26, 2001; (2) PAYING THE COSTS OF ISSUING THE SERIES 2006 BONDS; AND (3) FUNDING A DEBT SERVICE RESERVE FUND. SCHEDULE K, PART II, LINE 3, TOTAL PROCEEDS: THE AMOUNT OF TOTAL PROCEEDS ON PART II, LINE 3 INCLUDES $6,649,229 INVESTMENT EARNINGS OF BOND PROCEEDS. SCHEDULE K, PART II, LINE 11, OTHER SPENT PROCEEDS: THE AMOUNT PRESENTED ON PART II, LINE 11 REPRESENTS AMOUNTS USED TO PAY AT MATURITY OR REDEEM THE REFUNDED PRIOR ISSUES DATED OCTOBER 20, 1999 AND APRIL 26, 2001. SCHEDULE K, PART III: BECAUSE THE ISSUE IS AN ADVANCE REFUNDING FOR PRIOR BONDS ISSUED BEFORE JANUARY 1, 2003, AND CONTAINED NO NEW CAPITAL PROJECT BORROWINGS, PART III IS NOT REQUIRED. X 5 97180 FMV X GIFTS IN KIND 10 50368 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A THE QUADRENNIEL MEETING OF THE MORAVIAN CHURCH IN AMERICA, SOUTHERN PROVINCE (KNOWN AS SYNOD) ELECTS FOUR MEMBERS TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 WAS PROVIDED TO EACH BOARD MEMBER BEFORE THE RETURN WAS FILED. PRIOR TO FILING, THE BOARD REVIEWED AND APPROVED THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY UPON INITIALLY JOINING THE BOARD. BEFORE EACH BOARD MEETING, THE MEMBERS ARE ASKED TO DISCLOSE ANY POTENTIAL CONFLICTS. CHANGES IN CONFLICTS OF INTEREST ARE MAINTAINED BY THE CFO. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS PULLED FROM GUIDESTAR FOR CCRCS IN NORTH CAROLINA OF COMPARABLE SIZE AND FROM THE LEADING AGE SALARY SURVEY. THIS INFORMATION IS PROVIDED TO THE BOARD ALONG WITH HISTORY OF COMPENSATION FOR THE CEO AND CFO. THE BOARD THEN REVIEWS AND APPROVES THE COMPENSATION FOR ALL OFFICERS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 1023, 990, AND 990-T ARE AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE MADE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO MADE AVAILABLE ON THE NC DEPARTMENT OF INSURANCE WEBSITE. FORM 990, PART IX, LINE 11G CONTRACT PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,313,317. MANAGEMENT AND GENERAL EXPENSES 273,752. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,587,069. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 157,309. MANAGEMENT AND GENERAL EXPENSES 240,478. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 397,787. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 670,535. MANAGEMENT AND GENERAL EXPENSES 125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 670,660. MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 37,120. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,120. SERVICE FEES: PROGRAM SERVICE EXPENSES 3,796. MANAGEMENT AND GENERAL EXPENSES 129,724. FUNDRAISING EXPENSES 3,219. TOTAL EXPENSES 136,739. THERAPY FEES: PROGRAM SERVICE EXPENSES 1,035,280. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,035,280. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 391,191. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.