STRATEGY STUDIO / PUBLIC DATA EXPLORER

VALDESE NURSING HOME INC COLLEGE PINES NURSING CENTER: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
VALDESE NURSING HOME INC COLLEGE PINES NURSING CENTER (EIN 58-1978560)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-15
IRS object ID
201703199349303075
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-15T08:43:04-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1227 WEST TRADE STREET SUITE 800AddressLine1Txt
CityCHARLOTTECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28202ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN581978560EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1VALDESE NURSING HOME INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlVALDBusinessNameControlTxt
Phone8285806800PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line195 LOCUSTAddressLine1Txt
CityCONNELLY SPRINGSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28612ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonROBERT G FRITTSPersonNm
Person TitleSENIOR VP FINANCE/CFOPersonTitleTxt
Phone8285806800PhoneNum
Signature2017-11-08SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOHN NORMANPreparerPersonNm
PTINP01506766PTIN
Phone7049985200PhoneNum
Preparation2017-11-08PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.137.57.251IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-08IPDt
IP Tm10:29:22IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id56A3924725E2BEE8CC280EE407B1779D17F37F30AtSubmissionCreationDeviceId
At Submission Filing Device Id7A1B27052E545E28D90A8875D3947817BFF1AEF5AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKATHY BAILEYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line195 LOCUSTAddressLine1Txt
CityCONNELLY SPRINGSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28612ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$8,542,654GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BLUERIDGEHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1993FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO PROVIDE HEALTHCARE TO THE ELDERLY AND AGING.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee172TotalEmployeeCnt
Total Volunteers13TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$7,672,613PYProgramServiceRevenueAmt
CY Program Service Revenue$8,542,654CYProgramServiceRevenueAmt
PY Investment Income-$4,789PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$7,667,824PYTotalRevenueAmt
CY Total Revenue$8,542,654CYTotalRevenueAmt
PY Grants And Similar Paid$8,931PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,481,271PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,392,419CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,416,003PYOtherExpensesAmt
CY Other Expenses$2,476,182CYOtherExpensesAmt
PY Total Expenses$8,906,205PYTotalExpensesAmt
CY Total Expenses$8,868,601CYTotalExpensesAmt
PY Revenues Less Expenses-$1,238,381PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$325,947CYRevenuesLessExpensesAmt
Total Assets BOY$2,588,084TotalAssetsBOYAmt
Total Assets EOY$2,494,121TotalAssetsEOYAmt
Total Liabilities BOY$5,881,148TotalLiabilitiesBOYAmt
Total Liabilities EOY$6,113,132TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$3,293,064NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$3,619,011NetAssetsOrFundBalancesEOYAmt
MissionVALDESE NURSING HOME, INC. IS DEDICATED TO PROVIDING EXCELLENT CARE AND HELPING EACH RESIDENT ACHIEVE AN OPTIMAL QUALITY OF LIFE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$7,251,913ExpenseAmt
Revenue$8,542,624RevenueAmt
DescVALDESE NURSING HOME, INC. PROVIDES INTERMEDIATE AND ASSISTED LIVING, AND PROVIDES COMPLETE REHABILITATION SERVICES WITH A FOCUS ON FOSTERING INDEPENDENCE WITHIN THE FACILITY. VALDESE NURSING HOME PROVIDES A COMPLETE RANGE OF THERAPY SERVICES UTILIZING BOTH CONTRACTED AND LICENSED THERAPISTS; THESE SERVICES INCLUDE: OCCUPATIONAL, PHYSICAL, RESPIRATORY AND SPEECH THERAPY. VALDESE NURSING HOME PROVIDED 36,266 DAYS OF CARE TO AN AVERAGE OF 99 RESIDENTS. VALDESE NURSING HOME OPERATES A 104 BED FACILITY TO MEET THE LONG-TERM AND SHORT-TERM CARE NEEDS OF ITS RESIDENTS.Desc
Total Program Service Expenses$7,251,913TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee172EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PATRICIA MOLLBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8285805003PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12201 S STERLING STAddressLine1Txt
CityMORGANTONCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28655ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtKey EmployeeKeyEmployeeInd
J MICHAEL BRIDGES
CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
MH MCCRARY
VICE CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
SHERROD SALSBURY
SECRETARY1.00Yes (X)Yes (X)$0$0$0
JEFF CARSWELL
TREASURER1.00Yes (X)Yes (X)$0$0$0
CLAY RICHARDSON MD
MEMBER AT LARGE1.00Yes (X)Yes (X)$0$280,971$61,24450.00
JOHN BRANSTROM
BOARD MEMBER1.00Yes (X)$0$0$0
LISA BUFF
BOARD MEMBER1.00Yes (X)$0$0$0
ALAN GRIFFIN
BOARD MEMBER1.00Yes (X)$0$0$0
ALLEN VANNOPPEN
BOARD MEMBER1.00Yes (X)$0$0$0
BRIAN GWYN
BOARD MEMBER1.00Yes (X)$0$0$0
FRANK LETHERBY
BOARD MEMBER1.00Yes (X)$0$0$0
SPENCER LILLY
BOARD MEMBER1.00Yes (X)$0$0$0
STEPHEN LAWLER
BOARD MEMBER1.00Yes (X)$0$0$0
KATHY BAILEY
PRESIDENT & CEO1.00Yes (X)$0$0$050.00
ROBERT G FRITTS
SENIOR VP OF FINANCE/CFO1.00Yes (X)$0$0$050.00
EDWARD PLYLER
CONTINUING CARE SERV.1.00$0$312,143$56,14350.00Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$593,114TotReportableCompRltdOrgAmt
Total Other Compensation$117,387TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT REVENUE623000$8,531,105$8,531,105
OTHER900099$11,549$11,549
FieldValueIRS element (for citing)
Total Program Service Revenue$8,542,654TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,542,654TotalRevenueColumnAmt
Related Or Exempt Func Income$8,542,654RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,405,880TotalAmt
Program Services$4,054,410ProgramServicesAmt
Management And General$1,351,470ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$30,635TotalAmt
Program Services$30,635ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$679,171TotalAmt
Program Services$679,171ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$276,733TotalAmt
Program Services$276,733ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$20,910TotalAmt
Management And General$20,910ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$280,206TotalAmt
Program Services$257,790ProgramServicesAmt
Management And General$22,416ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$21,073TotalAmt
Management And General$21,073ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$83,592TotalAmt
Management And General$83,592ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$169,647TotalAmt
Program Services$169,647ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$6,037TotalAmt
Program Services$6,037ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$4,448TotalAmt
Program Services$4,448ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$164,065TotalAmt
Program Services$164,065ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$37,227TotalAmt
Management And General$37,227ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
SUPPLIES$619,348$619,348
INTERCOMPANY EXPENSE$610,775$610,775
ASSESSMENT$358,854$358,854

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$100,000TotalAmt
Program Services$20,000ProgramServicesAmt
Management And General$80,000ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,868,601TotalAmt
Program Services$7,251,913ProgramServicesAmt
Management And General$1,616,688ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$171,292BOYAmt
EOY$94,598EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$709,923BOYAmt
EOY$750,839EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$22,018BOYAmt
EOY$19,246EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$29,989BOYAmt
EOY$30,876EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,114,223LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,524,319LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,630,733BOYAmt
EOY$1,589,904EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$24,129BOYAmt
EOY$8,658EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,588,084BOYAmt
EOY$2,494,121EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$391,592BOYAmt
EOY$439,979EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,489,556BOYAmt
EOY$5,673,153EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,881,148BOYAmt
EOY$6,113,132EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$3,293,064BOYAmt
EOY-$3,619,011EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$3,293,064BOYAmt
EOY-$3,619,011EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,588,084BOYAmt
EOY$2,494,121EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$325,947ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$726,288CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,976,346CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,737,845CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,672,613CurrentTaxYearMinus1YearAmt
Current Tax Year$8,542,624CurrentTaxYearAmt
Total$32,655,716TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$726,288CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,976,346CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,737,845CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,672,613CurrentTaxYearMinus1YearAmt
Current Tax Year$8,542,624CurrentTaxYearAmt
Total$32,655,716TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$32,655,716PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$9CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20CurrentTaxYearMinus3YearsAmt
Current Tax Year$30CurrentTaxYearAmt
Total$59TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$9CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20CurrentTaxYearMinus3YearsAmt
Current Tax Year$30CurrentTaxYearAmt
Total$59TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$726,297CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,976,366CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,737,845CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,672,613CurrentTaxYearMinus1YearAmt
Current Tax Year$8,542,654CurrentTaxYearAmt
Total$32,655,775TotalAmt
FieldValueIRS element (for citing)
Public Support CY5091.00000PublicSupportCY509Pct
Public Support PY5091.00000PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$1,130OtherActivitiesAmt
Total Lobbying Expenditures$1,130TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1, LOBBYING ACTIVITIES:FormAndLineReferenceDesc
ExplanationA PORTION OF THE MEMBERSHIP DUES PAID TO NCHCFA ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,347OtherCostOrOtherBasisAmt
Book Value$6,347BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,848,430OtherCostOrOtherBasisAmt
Depreciation$1,455,113DepreciationAmt
Book Value$1,393,317BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,051,164OtherCostOrOtherBasisAmt
Depreciation$979,742DepreciationAmt
Book Value$71,422BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$208,282OtherCostOrOtherBasisAmt
Depreciation$89,464DepreciationAmt
Book Value$118,818BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,589,904TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
THIRD PARTY SETTLEMENTS$212,053
INTERCOMPANY LIABILITIES$5,461,100
FieldValueIRS element (for citing)
Total Liability$5,673,153TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE FILING ORGANIZATION IS A TAX-EXEMPT ORGANIZATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE FILING ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE FILING ORGANIZATION ADOPTED THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THIS STANDARD HAD NO IMPACT ON THE FILING ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED DECEMBER 31, 2016 OR DECEMBER 31, 2015.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CLAY RICHARDSON MD
MEMBER AT LARGE$0$280,971$0$0$0$0$0$12,232$0$49,012$0$342,215$0$0
EDWARD PLYLER
CONTINUING CARE SERV.$0$289,443$0$0$0$22,700$0$12,580$0$43,563$0$368,286$0$0

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1AALL BENEFITS PROVIDED TO OFFICERS FACILITATE BUSINESS RELATIONSHIPS. DURING THE YEAR, A RELATED ORGANIZATION PAID FOR THE CLUB DUES FOR KATHY BAILEY AND INCLUDED THE AMOUNT OF DUES PAID IN HER TAXABLE INCOME.
PART I, LINE 3UNCHECKED ITEMS ARE CONDUCTED BY CHS AS PART OF THE MANAGEMENT AGREEMENT. THE ORGANIZATION COMPENSATION COMMITTEE REVIEWS AND APPROVES.
PART I, LINE 4BDURING THE YEAR, THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SECTION 457(F) PLAN: EDWARD PLYLER $22,700
PART I, LINE 6BONUSES ARE PAID IF THE ORGANIZATION'S RESULTS MET CERTAIN PERFORMANCE INDICATORS.
PART IICOMPENSATION FOR KATHY BAILEY AND ROBERT FRITTS IS PAID BY CAROLINAS HEALTHCARE SYSTEM THROUGH A MANAGEMENT SERVICE CONTRACT.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3IN 1999, THE ORGANIZATION ENTERED INTO A MANAGEMENT SERVICES CONTRACT WITH CAROLINAS HEALTHCARE SYSTEM. THE TERMS OF THE CONTRACT CALL FOR THE ORGANIZATION TO PAY CAROLINAS HEALTHCARE SYSTEM AN ANNUAL MANAGEMENT FEE BASED UPON THE ORGANIZATION'S NET OPERATING REVENUES. IN ADDITION, CAROLINAS HEALTHCARE SYSTEM IS REQUIRED TO FURNISH THE ORGANIZATION WITH A CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. THE ORGANIZATION REIMBURSES CAROLINAS HEALTHCARE SYSTEM FOR THE SALARY AND BENEFITS' COST OF THESE INDIVIDUALS.
FORM 990, PART VI, SECTION B, LINE 11BTHE CHIEF FINANCIAL OFFICER, THE BOARD AND THE EXECUTIVE COMMITTEE WILL REVIEW THE PREPARED FORM 990 BEFORE IT IS FILED WITH THE IRS. A DRAFT OF FORM 990 WAS POSTED FOR ACCESS BY THE GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CCORPORATE COUNSEL, WHO REVIEWS ALL ANNUAL CONFLICT OF INTEREST DISCLOSURES, IS PRESENT AT EVERY BOARD MEETING TO ENSURE THAT ANY POTENTIAL CONFLICTS ARE APPROPRIATELY HANDLED BY MEMBERS ABSTAINING FROM VOTES AS APPROPRIATE.
FORM 990, PART VI, SECTION B, LINE 15SUCH A PROCESS WAS PERFORMED FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT/CEO, CFO AND EXECUTIVE DIRECTOR DURING 2016.
FORM 990, PART VI, SECTION C, LINE 19BY-LAWS ARE AVAILABLE UPON REQUEST THROUGH CORPORATE COUNSEL. ARTICLES OF INCORPORATION ARE FILED WITH THE NORTH CAROLINA SECRETARY OF STATE AND ARE AVAILABLE ON THEIR WEBSITE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART VIIDESCRIPTION OF HOURS -- FOR RELATED ORGANIZATIONS, OFFICERS AND KEY EMPLOYEES LISTED ON PART VII WORK AN AVERAGE OF 40 TO 50 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND OTHER RELATED ENTITIES LISTED ON SCHEDULE R.
FORM 990, PART XII, LINE 2CNO CHANGES FOR APPROVING AUDITED FINANCIAL STATEMENTS OR SELECTION OF INDEPENDENT ACCOUNTANTS HAVE OCCURRED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
BLUE RIDGE HEALTHCARE HOSPITALS INC
2201 SOUTH STERLING STREETMORGANTONNC28655560529976HEALTHCARENC501(C)(3)170(B)(1)(A)N/A0
GRACE LIFECARE INC
500 LENOIR ROADMORGANTONNC28655561722754HEALTHCARENC501(C)(3)509(A)(2)N/A0
GRACE PROPERTIES INC
500 LENOIR ROADMORGANTONNC28655561727514HEALTHCARENC501(C)(3)509(A)(3)N/A0
BLUE RIDGE FOUNDATION INC
2201 SOUTH STERLING STREETMORGANTONNC28655582063920HEALTHCARENC501(C)(3)509(A)(1)N/A0
BLUE RIDGE HEALTHCARE MEDICAL GROUP INC
2201 SOUTH STERLING STREETMORGANTONNC28655020777195HEALTHCARENC501(C)(3)509(A)(2)N/A0
BLUE RIDGE HEALTHCARE SYSTEM INC
2201 SOUTH STERLING STREETMORGANTONNC28655562150313HEALTHCARENC501(C)(3)509(A)(3)N/A0
GRACE NURSING CENTER INC
109 FOOTHILLS DRIVEMORGANTONNC28655561838369HEALTHCARENC501(C)(3)509(A)(2)N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1GRACE HEALTH VENTURES INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12201 SOUTH STERLING STREETAddressLine1Txt
CityMORGANTONCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28655ZIPCd
FieldValueIRS element (for citing)
EIN561581317EIN
Primary ActivitiesRELATEDPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BLUE RIDGE HEALTHCARE SYSTEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd