2018-02-12T14:34:03-06:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 130 TURNBERRY WAY PINEHURST NC 28374 990 2016-10-01 560729010 PENICK VILLAGE INC PENI 9106920300 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 JEFFREY I HUTCHINS CEO 9106920300 2018-02-09 1 SCOTT BREWER P00004789 9106928555 204.15.98.225 2018-02-09 09:56:31 ES P 6BF442AC2BCEB61A48DD69F3D2F5C8C1449B953C 6BF442AC2BCEB61A48DD69F3D2F5C8C1449B953C 2016 2021-01-29 14:40:06Z PENICK VILLAGE JEFFREY I HUTCHINS 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 19761383 0 X WWW.PENICKVILLAGE.ORG X 1957 NC OPERATES A LIFE PLANNING COMMUNITY, SEE ALSO PT III, LN 1. 13 13 361 78 0 0 240170 304186 15050652 16197265 2497077 430531 138927 -6241 17926826 16925741 0 0 0 0 8304076 8325105 0 0 0 7755144 7958253 16059220 16283358 1867606 642383 53689027 55464548 48104174 48869185 5584853 6595363 X PENICK VILLAGE'S MISSION IS TO BE A FAMILY THAT CREATES A LOVING COMMUNITY BY MAKING EVERY DAY GREAT FOR ONE ANOTHER. THE MISSION INCLUDES PROVIDING HOUSING, SERVICES, AND LONG-TERM CARE TO OVER 200 RESIDENTS DURING FISCAL YEAR 2017. THE SERVICES AND CARE ARE PROVIDED IN INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING AREAS. PENICK VILLAGE ALSO CONTRIBUTES TO THE GREATER SOUTHERN PINES COMMUNITY AND MOORE COUNTY IN WHICH IT IS LOCATED BY DONATING TIME AND RESOURCES TO , AMOUNG OTHERS, THE MOORE COUNTY CHAMBER OF COMMERCE, FIRSTHEALTH HOSPITAL, LEADINGAGE NC, EPISCOPAL DAY SCHOOL, RED CROSS, MEALS ON WHEELS OF THE SANDHILLS, STOP HUNGER NOW, AND THE SOUTHERN PINES FIRE AND POLICE DEPARTMENTS. THE PENICK VILLAGE COMMUNITY ALSO PROVIDES FINANCIAL ASSISTANCE TO THOSE RESIDENTS IN NEED. 0 0 3248506 0 DINING SERVICES IS ONE OF PENICK VILLAGE'S ESSENTIAL SERVICES. DINING SERVICES STRIVES TO PROVIDE A WONDERFUL DINING EXPERIENCE IN ALL LEVELS OF CARE FOR THE RESIDENTS AND THEIR FAMILY AND FRIENDS. THERE ARE SEVERAL DINING OPPORTUNITIES ON THE CAMPUS, INCLUDING THE CAFE EXPERIENCE, A PRIVATE DINING ROOM, CATERING IN ONE'S APARTMENT OR COTTAGE, INDIVIDUALIZED MENUS, AND MORE. DINING SERVICES ALSO PREPARES THE MEALS FOR MEALS ON WHEELS OF THE SANDHILLS ALONG WITH HOSTING EVENTS FOR OTHER SPECIAL COMMUNITY GROUPS SUCH AS KIWANIS. AS AN EMPLOYEE BENEFIT, THE STAFF ALSO ENJOYS WONDERFUL MEALS AT A GENEROUS DISCOUNT. 688593 0 HOUSEKEEPING IS ANOTHER ONE OF PENICK VILLAGE'S ESSENTIAL SERVICES. HOUSEKEEPING PROVIDES GENERAL CLEANING SERVICES ALONG WITH LINEN SERVICES AS REQUESTED. THE HOUSEKEEPING PERSONNEL ALSO BUILD GREAT RELATIONSHIPS WITH THE RESIDENTS THEY ARE SERVING AND HAVE HELPED SIGNIFICANTLY IN TIMES OF NEED. 3120141 0 NURSING IS KEY TO THE CONTINUUM OF CARE FOR THE RESIDENTS AT PENICK VILLAGE. SKILLED NURSING SERVICES ARE PROVIDED PER PHYSICIAN ORDERS THAT MAY INCLUDE BUT ARE NOT LIMITED TO ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, MEDICATION ADMINISTRATION, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, SPECIALIZED DIETS, AND OTHER NEEDS PER ORDERS. THE VISION OF PENICK VILLAGE IS TO DEINSTITUTIONALIZE THE AGING EXPERIENCE. QUALITY NURSING IS KEY TO ACHIEVING THIS AND IN MAXIMIZING THE QUALITY OF LIFE FOR EACH OF THE RESIDENTS. THE CARE IS PERSONALIZED, AND A STRONG PARTNERSHIP IS DEVELOPED AMONG THE RESIDENT, HIS OR HER FAMILY, AND THE STAFF AT PENICK VILLAGE IN ORDER TO HAVE THE RESIDENT'S NEEDS DRIVE HIS OR HER PLAN OF CARE. 3579177 PERSONAL CARE, PERSONAL SERVICES, FACILITY SERVICES, ACTIVITIES, AND HOME CARE. 3579177 10636417 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 1 74 0 1 361 1 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X JEFFREY I HUTCHINS 9106920300 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 KEITH JUNK VICE PRESIDENT 1.00 X X 0 0 0 ROOT EDMONSON BOARD MEMBER 1.00 X 0 0 0 JOHN FRIZZELL III BOARD MEMBER 1.00 X 0 0 0 JANE MASK BOARD MEMBER 1.00 X 0 0 0 DARLENE G VAUGHN BOARD MEMBER 1.00 X 0 0 0 DOUGLAS GILL BOARD MEMBER 1.00 X 0 0 0 RICHARD HIGGINBOTHAM TREASURER 1.00 X X 0 0 0 DAVID BYRD GWINN PRESIDENT 1.00 X X 0 0 0 C MARCUS HARRIS BOARD MEMBER 1.00 X 0 0 0 LYNNE HEALY SECOND VICE PRESIDENT 1.00 X X 0 0 0 REV NICHOLSON B WHITE BOARD MEMBER 1.00 X 0 0 0 RT REV ANNE HODGES-COPPLE BOARD MEMBER 1.00 X 0 0 0 DR GARY KRASICKY SECRETARY 1.00 X X 0 0 0 RAY PARDUE BOARD MEMBER 1.00 X 0 0 0 JIM GRAY BOARD MEMBER 1.00 X 0 0 0 JEFFREY HUTCHINS CHIEF EXECUTIVE OFFICER 40.00 X 209403 0 0 CHERYL FUTRELL DIRECTOR OF INDEPENDENT LI 40.00 X 0 0 0 DAVID G PAGE CHIEF OPERATING OFFICER 40.00 X 158728 0 0 TERRY KEES CHIEF FINANCIAL OFFICER 40.00 X 206832 0 0 574963 0 0 3 0 1 0 FIRST BANK 5 BLAKE BLVD PINEHURST NC 28374 FINANCIAL INSTITUTION 1859863 UNIDINE CORP PO BOX 360639 PITTSBURGH PA 15251 DINING SERVICES 1624565 PINNACLE DEVELOPMENT DESIGN BUILD PO BOX 55 SOUTHERN PINES NC 28388 ARCHITECT SERVICES 809274 REHABCARE PO BOX 503534 ST LOUIS MO 63150 CARE SERVICES 514671 PINNACLE RESOLUTE CONSTRUCTION JV LLC PO BOX 55 SOUTHERN PINES NC 28388 ARCHITECT SERVICES 468808 14 304186 304186 RESIDENT CARE 623000 6310559 6310559 ADMISSION DONATION 623000 2961711 2961711 NURSING 623000 2663681 2663681 PERSONAL CARE 623000 1665862 1665862 2595452 2595452 16197265 279545 279545 267036 408995 -141959 -141959 -141959 2577133 500 2426647 0 150486 500 150986 150986 MEALS ON WHEELS 900099 71568 71568 GUEST FEES & MEALS 900099 59172 59172 R & R INCOME 900099 4978 4978 135718 16925741 16621555 0 0 6764690 5491435 1273255 1091177 952625 138552 469238 398374 70864 104460 104460 52543 52543 1236530 764870 471660 45363 45363 1887864 1700505 187359 744184 743597 587 61833 43795 18038 594114 594114 2133874 2133874 410195 410195 REPAIRS & MAINTENANCE 467463 445241 22222 MISCELLANEOUS 174462 43432 131030 BAD DEBTS 45368 45368 16283358 10636417 5646941 0 1200 1200 3681350 2485337 1024010 921049 266081 600441 65312558 23167891 40204136 42144667 8208403 8943760 303847 368094 53689027 55464548 2721439 1238890 21362747 23929157 24019988 23701138 48104174 48869185 X 4758481 5735274 496965 530682 329407 329407 5584853 6595363 53689027 55464548 X 642383 373017 -4890 X 0 1 X 1 0 X 245190 234500 4060236 240170 304186 5084282 12767023 13880620 14354470 15050652 16197265 72250030 13012213 14115120 18414706 15290822 16501451 77334312 207500 222500 3971440 237500 242500 4881440 0 207500 222500 3971440 237500 242500 4881440 72452872 128806 194006 166322 192312 279545 960991 128806 194006 166322 192312 279545 960991 202228 153195 186323 138927 135718 816391 13343247 14462321 18767351 15622061 16916714 79111694 0.91580 0.91370 0.01210 0.01070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 786909 786909 51604391 18937121 32667270 7954694 7954694 4436809 4230770 206039 529755 529755 42144667 DEFERRED ENTRANCE FEES 15822059 REFUND LIABILITY 7849619 SECURITY DEPOSIT 29460 23701138 0 0 0 0 0 0 0 0 0 JEFFREY HUTCHINS CHIEF EXECUTIVE OFFICER 209403 0 0 0 0 0 0 0 0 0 209403 0 0 0 DAVID G PAGE CHIEF OPERATING OFFICER 158728 0 0 0 0 0 0 0 0 0 158728 0 0 0 TERRY KEES CHIEF FINANCIAL OFFICER 206832 0 0 0 0 0 0 0 0 0 206832 0 0 0 A NC MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2010-01-20 30000000 NEW CONSTRUCTION 0 0 0 A 13045400 28031368 428691 550000 27052677 2011 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 BB&T 15.000000000000 0 0 0 0 1 A 1 PART I, COLUMN F THE PROCEEDS OF THE SERIES 2010 ISSUE WERE USED TO PROVIDE FUNDS FOR (I) PAY A PORTION OF THE ISSUANCE COSTS AND (II) THE PROJECT, A NEW 69-UNIT APARTMENT BUILDING AND A NEW APPROXIMATELY 39,000 SQUARE FOOT COMMUNITY CENTER ON EXISTING CAMPUS. PART II, LINE 3 TOTAL PROCEEDS ON LINE 3 FOR BOND (A) INCLUDES CUMULATIVE INVESTMENT EARNINGS OF $185,655. LYNNE HEALY BOARD MEMBER 3118 THE ORGANIZATION PURCHASED BEVERAGE PRODUCTS FROM HEALY WHOLESALE CO., INC. 0 990, PART III, LINE 4 PROGRAM SERVICE IS PROVIDED AS A RESULT OF RESIDENTS' OVERALL MONTHLY PAYMENTS. NO REVENUE IS DIRECTLY DERIVED FROM THE PROGRAM SERVICE. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO THE FILING OF THE FORM 990, THE ORGANIZATION PROVIDED A COPY OF FORM 990 TO ALL VOTING MEMBERS OF THE BOARD AND ASKED FOR QUESTIONS. FORM 990 IS REVIEWED IN DEPTH BY THE FINANCE COMMITTEE WHICH HAS BEEN APPOINTED BY THE BOARD OF DIRECTORS FOR THIS OVERSIGHT. THE BOARD OF DIRECTORS VOTED TO APPROVE AND ACCEPT THE FORM 990 AS PRESENTED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES THE BOARD TO ANNUALLY COMPLETE DISCLOSURE FORMS CONCERNING POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS APPOINTED A COMPENSATION REVIEW COMMITTEE TO DETERMINE COMPENSATION FOR THE CEO, CFO AND COO OF THE ORGANIZATION. THIS REVIEW IS CONDUCTED ON AN ANNUAL BASIS IN ACCORDANCE WITH THE REBUTTABLE PRESUMPTION OF REASONABLENESS GUIDELINES AND MUST BE REVIEWED AND APPROVED BY THE ENTIRE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ADMINISTRATION OFFICES. FORM 990, PART XI, LINE 9: INCREASE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENT 16,258. UNREALIZED LOSS ON FAIR VALUE OF INTEREST RATE CAP AGREEMENT -21,148. JA GREER GROUP LLC 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 814456670 RENTAL NC -141959 3638501 PENICK VILLAGE INC PENICK VILLAGE FOUNDATION 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 201055492 TO RAISE AND HOLD FUNDS FOR CHARITABLE PURPOSES NC 501(C)(3) LINE 10 PENICK VILLAGE INC 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 PENICK VILLAGE FOUNDATION C 424275 CASH