2018-04-05T15:47:06-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2017-01-01 237271041 THE CHAPEL HILL RESIDENTIAL RETIREMENT CENTER INC CHAP 9199684511 750 WEAVER DAIRY ROAD CHAPEL HILL NC 27514 PATRICIA E SPRIGG PRESIDENT/CEO 9199684511 2018-04-04 1 JOHN NORMAN P01506766 7049985200 2018-03-26 2017 2022-09-23 18:48:47Z CAROL WOODS RETIREMENT COMMUNITY PATRICIA E SPRIGG 750 WEAVER DAIRY ROAD CHAPEL HILL NC 27514 48219001 0 X WWW.CAROLWOODS.ORG X 1972 NC OPERATION OF A CCRC PROVIDING HOUSING, HEALTHCARE, AND OTHER SERVICES TO SENIORS. 18 16 427 60 0 0 306295 402174 26171986 26578196 2202629 3596637 160728 159213 28841638 30736220 769430 757325 0 0 14271254 14414666 0 0 0 12992496 13206649 28033180 28378640 808458 2357580 116046164 123656483 97342523 96604423 18703641 27052060 X CAROL WOODS SHALL BE A CHARITABLE, NOT-FOR-PROFIT CORPORATION MEETING THE NEEDS OF OLDER ADULTS FOR HOUSING, HEALTH, WELL-BEING, AND PROTECTION OF FINANCIAL SECURITY. THE MISSION OF CAROL WOODS SHALL BE TO PROVIDE A SAFE, HEALTHFUL, AND SECURE ENVIRONMENT FOR PERSONS THROUGHOUT THEIR LATER YEARS, AS WELL AS ENGAGE IN COOPERATIVE RESEARCH, DEVELOPMENT AND EDUCATION IN AREAS ENCOMPASSED BY THE MISSION. HIGH QUALITY RESIDENTIAL LIVING AND HEALTH SERVICES SHALL BE PROVIDED ACCORDING TO INDIVDUAL NEEDS. RESIDENTS' ON-GOING NEEDS TO MAINTAIN AND PROMOTE HEALTH AND WELL-BEING SHALL BE SUPPORTED THROUGH THE PROVISION OF APPROPRIATE RESOURCES. CAROL WOODS SHALL ENCOURAGE DIVERSITY, RESIDENTS' LEADERSHIP, PARTICIPATION IN AND SERVICE TO CAROL WOODS AND THE LARGER COMMUNITY. CAROL WOODS SHALL ALSO FOSTER A HIGH QUALITY WORK EXPERIENCE FOR STAFF AND FACILITATE STAFF DEVELOPMENT THAT EMBODIES THE VALUES OF THE ORGANIZATION. 0 0 23963725 757325 26578196 PROVIDED HOUSING, HEALTHCARE AND OTHER RELATED SERVICES TO SENIOR RESIDENTS THROUGH OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) CONTAINING 313 INDEPENDENT LIVING APARTMENTS / COTTAGES, 59 ASSISTED LIVING ACCOMMODATIONS, AND A 60-BED HEALTH CENTER. SERVED AN AVERAGE OF 490 SENIORS UNDER LIFE CARE ARRANGEMENTS, INCLUDING AN AVERAGE OF 76 LIVING PERMANENTLY IN ASSISTED LIVING AND THE HEALTH CENTER. OFFER A CCRC WITHOUT LODGING PROGRAM APPROVED BY THE NC DEPARTMENT OF INSURANCE. SERVED AN AVERAGE OF 96 IN THE PROGRAM OVER THE COURSE OF THE YEAR. CONTINUED PROACTIVE AND INTENTIONAL CHARITABLE CARE AND COMMUNITY BENEFIT PROGRAM, INCLUDING: 1) PROVIDED $349,707 IN FINANCIAL ASSISTANCE TO RESIDENTS IN NEED; 2) MADE CHARITABLE GIFTS TO ORANGE COUNTY ($175,000), TOWN OF CHAPEL HILL ($50,000), AND THE LOCAL PUBLIC SCHOOLS ($30,000) TO SUPPORT VITAL SERVICES TO SENIORS IN THE COMMUNITY; AND 3) MADE $180,960 IN CHARITABLE GIFTS TO OTHER LOCAL NON-PROFIT ORGANIZATIONS PURSUING MISSIONS SIMILAR TO CAROL WOODS. CONTINUED TO PROVIDE IN-KIND BENEFITS TO THE OUTSIDE COMMUNITY, INCLUDING: 1) MAKING AVAILABLE CAROL WOODS' CAMPUS AND STAFF FOR A VARIETY OF EDUCATIONAL AND COMMUNITY SUPPORT PURPOSES -- PROVIDING INTERNSHIPS AND OTHER OPPORTUNITIES FOR STUDENTS TO LEARN OF AGING SERVICES OPPORTUNITIES IN DISCIPLINES RANGING FROM MEDICAL AND NURSE PRACTITIONER, TO NURSING, SOCIAL WORK AND CERTIFIED NURSING ASSISTANTS; 2) DONATED BUILDING MATERIALS TO THE HABITAT RESTORE. 23963725 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 32 0 1 427 1 0 0 0 0 0 0 0 0 0 1 0 X 18 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X KENNETH REEB CFO 9199684511 750 WEAVER DAIRY ROAD CHAPEL HILL NC 27514 NAPE BAKER RESIDENT, VOTING BOARD MEMBER 1.00 X 0 0 0 CHRIS BARNES TREASURER OF THE BOARD 1.00 X X 0 0 0 JACK BENJAMIN BOARD MEMBER 1.00 X 0 0 0 ROB BRUCE VICE CHAIR OF THE BOARD 1.00 X 0 0 0 ROBERT DUNHAM CHAIR OF THE BOARD 1.00 X X 0 0 0 JACK EVANS BOARD MEMBER 1.00 X 0 0 0 TOM HABER BOARD MEMBER 1.00 X 0 0 0 BRENDA JAMERSON BOARD MEMBER 1.00 X 0 0 0 JIM KITCHEN BOARD MEMBER 1.00 X 0 0 0 LARRY MCMANUS BOARD MEMBER 1.00 X 0 0 0 BRENDA MITCHELL BOARD MEMBER 1.00 X 0 0 0 PATTIE MOORE-BOYETTE SECRETARY OF THE BOARD 1.00 X X 0 0 0 RUTH OUIMETTE RESIDENT, EX OFFICIO BOARD MEMBER 1.00 X 0 0 0 MARLENE RIFKIN BOARD MEMBER 1.00 X 0 0 0 DINA ROUSSET BOARD MEMBER 1.00 X 0 0 0 MARK ROYSTER BOARD MEMBER 1.00 X 0 0 0 ROBERT SAUNDERS BOARD MEMBER 1.00 X 0 0 0 MARIAN STEPHENSON RESIDENT, VOTING BOARD MEMBER 1.00 X 0 0 0 DEBORAH STROMAN BOARD MEMBER 1.00 X 0 0 0 JIM WILDE RESIDENT, EX OFFICIO BOARD MEMBER 1.00 X 0 0 0 PATRICIA E SPRIGG PRESIDENT & CEO 40.00 X 383511 0 4707 KENNETH G REEB JR VP OF FINANCE / CFO 40.00 X 186724 0 25786 DAVID L WILKERSON VP OF OPERATIONS 40.00 X 178301 0 4707 748536 0 35200 3 0 1 0 ROSCO'S REMODELING 3301 CLANDON PARK DRIVE RALEIGH NC 27613 CARPENTRY, GENERAL BUILDING REPAIRS 927111 TRIANGLE ELECTRIC 12085 US HWY 15-501 N CHAPEL HILL NC 27517 LICENSED ELECTRIC SUBCONTRACTOR 484560 STANLEY'S CARPET 5509 SHADOWBROOK DR RALEIGH NC 27612 CARPET INSTALLATION 263366 WELLSMONT LANDSCAPING 1005 DIMMOCKS MILL RD HILLSBOROUGH NC 27278 LANDSCAPING SUBCONTRACTOR 240142 LEE AIR CONDITIONERS INC PO BOX 2895 DURHAM NC 27715 LICENSED HVAC SUBCONTRACTOR 214862 14 396453 5721 402174 RESIDENT CHARGES 623000 22683443 22683443 HEALTH CENTER 623000 3498988 3498988 GUEST MEALS AND LODGING 900099 286542 286542 MISC REVEUE 900099 109223 109223 26578196 1602979 1602979 151020 0 151020 151020 151020 18857904 618535 16931976 550805 1925928 67730 1993658 1993658 PRIVATE DUTY GARDENING 110000 8193 8193 8193 30736220 26578196 0 3755850 394760 394760 362565 362565 885738 81602 804136 10904597 8916446 1988151 397998 397998 1401466 1401466 824867 824867 1659 1659 64394 64394 486815 486815 933056 923156 9900 111466 111466 1960496 1542001 418495 42060 42060 1680252 1528453 151799 71659 31771 39888 20 20 1855405 1855405 3466692 3466692 160543 160543 MISC EXPENSES 2236543 2236543 BAD DEBT EXPENSE 89239 89239 RECRUITMENT 30134 30134 BOND ADMIN FEE 16216 16216 28378640 23963725 4414915 0 852550 293402 2968208 3002395 0 1709588 1675727 237100 255515 294962 401256 96144573 41864266 54327957 54280307 55655799 63747881 116046164 123656483 3135237 2987210 44585064 46944557 43255920 41205412 220567 304555 6145735 5162689 97342523 96604423 X 18479834 26828254 223807 223806 18703641 27052060 116046164 123656483 2357580 5990839 0 X X 0 1 X 1 0 X 433400 318650 232835 306295 402174 1693354 21077150 25415595 25097344 26171986 26578196 124340271 21510550 25734245 25330179 26478281 26980370 126033625 483759 604153 697112 382250 158580 2325854 0 483759 604153 697112 382250 158580 2325854 123707771 1574423 1954015 1761042 1771367 1753999 8814846 1574423 1954015 1761042 1771367 1753999 8814846 351690 416824 8193 776707 23436663 28105084 27091221 28249648 28742562 135625178 0.91210 0.90490 0.06500 0.06560 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 569 569 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID BY THE ORGANIZATION TO VARIOUS TRADE ASSOCIATIONS IS ATTRIBUTABLE TO LOBBYING PERFORMED BY THOSE TRADE ASSOCIATIONS ON BEHALF OF THE ORGANIZATION AND OTHER MEMBER ORGANIZATIONS. 833077 833077 78519696 36717813 41801883 9637660 3723810 5913850 7154140 1422643 5731497 54280307 LT DEBT INTEREST SWAP 5162689 5162689 X PART X, LINE 2: THE FOLLOWING IS THE FOOTNOTE FROM THE CONSOLIDATED FINANCIAL STATEMENTS FOR CAROL WOODS AND THE CHARITABLE FUND: CAROL WOODS AND THE CHARITABLE FUND ARE NOT-FOR-PROFIT ORGANIZATIONS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). CAROL WOODS AND THE CHARITABLE FUND FILE AS TAX-EXEMPT ORGANIZATIONS. MANAGEMENT IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE TAX-EXEMPT STATUS OF CAROL WOODS OR THE CHARITABLE FUND. MANAGEMENT IS NOT AWARE OF ANY SIGNIFICANT ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES FOR CAROL WOODS OR THE CHARITABLE FUND. 1 ORANGE COUNTY 200 SOUTH CAMERON STREET HILLSBOROUGH NC 27278 566000327 GOV'T 175000 GENERAL SUPPORT, SENIOR SERVICES TOWN OF CHAPEL HILL 405 MARTIN LUTHER KING BLVD CHAPEL HILL NC 27514 566001199 GOV'T 50000 GENERAL SUPPORT, SENIOR SERVICES CHAPEL HILL CARRBORO SCHOOLS 750 S MERRITT MILL ROAD CHAPEL HILL NC 27516 566001004 501(C)(3) 30000 PROMOTE CAREERS IN AGING SERVICES MEDICAL FOUNDATION OF NC 880 MARTIN LUTHER KING BLVD CHAPEL HILL NC 27514 566057494 501(C)(3) 20000 SUPPORT FOR NEW HOSPICE FACILITY UNC SCHOOL OF NURSING FOUNDATION CARRINGTON HALL CAMPUS BOX 7460 CHAPEL HILL NC 27599 581508175 501(C)(3) 15000 GERIATRIC NURSING WORKFORCE DEVELOPMENT SENIOR CARE OF ORANGE COUNTY 515 MEADOWLANDS DRIVE SUITE 400 HILLSBOROUGH NC 27278 562460614 501(C)(3) 27000 SUPPORT FOR ADULT DAY HEALTH CENTER TOWN OF CARRBORO 301 WEST MAIN STREET CARRBORO NC 27510 562275038 GOV'T 5000 GENERAL SUPPORT, SENIOR SERVICES 7 ASSISTANCE TO RESIDENTS WHOSE ASSETS HAVE BEEN DEPLETED 6 351270 TUITION ASSISTANCE FOR ELIGIBLE FT EMPLOYEES 12 11195 PART I, LINE 2: EACH GRANT RECIPIENT IS ASKED TO PROVIDE AN ANNUAL REPORT ON THE USE OF THE FUNDS THAT HAD BEEN DONATED BY CAROL WOODS. EACH YEAR GRANT RECIPIENTS ARE INVITED TO A MEETING OF THE CAROL WOODS RESIDENT ASSOCIATION WHERE THEY ARE ASKED TO REPORT BRIEFLY ON THE OUTCOMES FROM THE FUNDS THAT WERE GRANTED. TWO GROUPS OF INDIVIDUALS MAY RECEIVE FINANCIAL SUPPORT FROM CAROL WOODS. FIRST, CAROL WOODS PROVIDES FINANCIAL ASSISTANCE TO RESIDENTS WHO ARE UNDER CONTRACT SHOULD THEY OUTLIVE THEIR ASSETS. IF ASSETS ARE DEPLETED TO A DEFINED LEVEL, CAROL WOODS WILL PROVIDE A MONTHLY CREDIT TO THEIR STATEMENT IN AN AMOUNT INTENDED TO STOP FURTHER DETERIORATION OF ASSETS. SECOND, CAROL WOODS OFFERS A TUITION ASSISTANCE PROGRAM THROUGH ITS HUMAN RESOURCES DEPARTMENT FOR FULL TIME EMPLOYEES WHO ARE TAKING COURSES IN AN ACCREDITED SCHOOL TOWARD A DEGREE OR CERTIFICATE RELATED TO CAROL WOODS' MISSION. X X X X X 0 0 0 0 0 0 0 0 0 PATRICIA E SPRIGG PRESIDENT & CEO 301844 0 76485 0 5182 0 0 0 4707 0 388218 0 0 0 KENNETH G REEB JR VP OF FINANCE / CFO 171073 0 0 0 15651 0 21079 0 4707 0 212510 0 0 0 DAVID L WILKERSON VP OF OPERATIONS 173133 0 0 0 5168 0 0 0 4707 0 183008 0 0 0 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2010-10-22 30000000 REFINANCING, ADDITIONAL CONSTRUCTION 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2012-07-18 22000000 CAPITAL ACQUISITION, CONSTRUCTION 0 0 0 A 6435000 30000882 266032 4717553 25017297 2012 1 0 1 1 B 3805000 22000000 248454 315078 21369444 2015 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 1 1 DEUTSCHE BANK 20.583333300000 0 0 0 0 1 B 0 0 0 1 1 1 1271 COUNTERPARTY LLC 20.583333300000 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 01/22/2015 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 02/03/2017 FORM 990, PART VI, SECTION A, LINE 1 TWO RESIDENTS SERVE AS EX OFFICIO WITHOUT VOTING RIGHTS. TWO OTHER RESIDENTS SERVE AS VOTING MEMBERS. PRESIDENT & CEO SERVES AS EX OFFICIO WITH NO VOTING RIGHTS. THE CORPORATION HAS AN EXECUTIVE COMMITTEE OF THE BOARD COMPRISED ENTIRELY OF MEMBERS OF THE GOVERNING BOARD. IN THE MONTHS THAT THE FULL BOARD DOES NOT MEET, THE EXECUTIVE COMMITTEE OF THE BOARD MEETS. THE SCOPE OF THE EXECUTIVE COMMITTEE IS ALMOST AS BROAD AS THE FULL BOARD, BUT FOR MOST SIGNIFICANT ACTIONS, SUCH AS RESOLUTIONS TO INCUR ADDITIONAL DEBT, ADOPTION OF THE ANNUAL BUDGET, ETC. THESE ACTIONS ARE GENERALLY DONE WITH THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HAS A POLICY THAT STATES THAT PAPER AND/OR ELECTRONIC COPIES OF FORM 990 WILL BE PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO ITS FILING WITH THE IRS. THE FORM 990 WAS PROVIDED TO BOARD MEMBERS FOR THEIR PERSONAL REVIEW. THE FORM 990 WAS FORMALLY ACCEPTED BY THE BOARD OF DIRECTORS AT ITS MARCH, 2018 BOARD MEETING, AUTHORIZING MANAGEMENT TO SUBMIT THE FORM TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY 1)DISCUSSING THE POLICY INITIALLY WITH BOARD OF DIRECTORS CANDIDATES PRIOR TO BEING NOMINATED TO THE BOARD, 2)REVIEWING THE POLICY ANNUALLY WITH EACH BOARD MEMBER, 3)ASKING EACH BOARD MEMBER TO ANNUALLY SIGN A STATEMENT INDICATING THAT HE OR SHE HAS READ AND UNDERSTANDS THE POLICY, AND 4)ASKING EACH BOARD MEMBER TO ALSO DISCLOSE IN WRITING ANY ORGANIZATIONAL RELATIONSHIP OR OTHER ACTIVITY OR INTEREST THAT MIGHT POSSIBLY CONSTITUTE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE EXECUTIVE COMMITTEE OF THE ORGANIZATION WILL REVIEW THE OFFICERS (PRESIDENT/CEO, VP OF FINANCE/CFO, AND VP OF OPERATIONS) AS WELL AS KEY DEPARTMENT DIRECTOR POSITIONS. THIS IS DOCUMENTED IN THE ORGANIZATION'S MINUTES EVERY THREE TO FOUR YEARS. THE EXECUTIVE COMMITTEE OF THE ORGANIZATION'S BOARD RETAINS AN OUTSIDE CONSULTING FIRM TO ASSESS THE SALARIES OF ITS CORPORATE OFFICERS AS WELL AS KEY DEPARTMENT DIRECTOR POSITIONS. A REPORT IS PREPARED AND PRESENTED TO THE EXECUTIVE COMMITTEE FOR REVIEW. THIS INDEPENDENT, EXTERNAL PROCESS WAS LAST COMPLETED IN 2017. FORM 990, PART VI, SECTION C, LINE 19 1)ARTICLES OF INCORPORATION ARE AVAILABLE ON THE WEBSITE OF THE NC SECRETARY OF STATE, 2)BYLAWS ARE AVAILABLE FOR INSPECTION UPON REQUEST, 3)ANNUAL DISCLOSURE STATEMENT IS AVAILABLE ONLINE THROUGH THE NC DEPT OF INSURANCE AND INCLUDES, IN APPENDICES, COPIES OF THE DOI CCRC LICENSE, DHSR NURSING FACILITY LICENSE, ANNUAL AUDITED FINANCIAL STATEMENTS, 5-YEAR FINANCIAL PROJECTIONS, CONFLICT OF INTEREST POLICY, CCRC CONTRACT, AND OTHER CORPORATE INFORMATION INCLUDING CURRENT LISTING OF BIOS ON BOARD OF DIRECTORS, 4)CORPORATE CODE OF CONDUCT AND PRIVACY POLICY ARE AVAILABLE VIA CAROL WOODS' WEBSITE. PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR CANOPY OF CAROL WOODS LLC 750 WEAVER DAIRY ROAD CHAPEL HILL NC 27514 SUPPORT OF THE CHAPEL HILL RESIDENTIAL RETIREMENT COMMUNITY NC 0 0 THE CHAPEL HILL RESIDENTIAL RETIREMENT COMMUNITY THE CAROL WOODS CHARITABLE FUND INC 750 WEAVER DAIRY ROAD CHAPEL HILL NC 27514 204262143 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 12B, II THE CHAPEL HILL RESIDENTIAL RETIREMENT CENTER INC 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 THE CAROL WOODS CHARITABLE FUND INC C 396454 ACTUAL AMOUNTS TRANSFERRED