2015-12-02T13:21:40-06:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2014-01-01 581978560 VALDESE NURSING HOME INC VALD 8285806800 95 LOCUST CONNELLY SPRINGS NC 28612 ROBERT G FRITTS SENIOR VP FINANCE/CFO 8285806800 2015-12-02 1 P01506766 7049985200 2014 2016-04-25 22:37:26Z KATHY BAILEY 95 LOCUST CONNELLY SPRINGS NC 28612 7737845 0 X WWW.BLUERIDGEHEALTH.ORG X 1993 NC TO PROVIDE HEALTHCARE TO THE ELDERLY AND AGING. 12 11 155 11 0 0 0 0 7976346 7737845 798 0 0 0 7977144 7737845 0 0 0 0 5989529 6353800 0 0 0 2358671 2247497 8348200 8601297 -371056 -863452 2636658 2590531 3827889 4645214 -1191231 -2054683 VALDESE NURSING HOME, INC. IS DEDICATED TO PROVIDING EXCELLENT CARE AND HELPING EACH RESIDENT ACHIEVE AN OPTIMAL QUALITY OF LIFE. 0 0 7923107 7737845 VALDESE 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 34,700 DAYS OF CARE TO AN AVERAGE OF 95 RESIDENTS. VALDESE NURSING HOME OPERATES A 104 BED FACILITY TO MEET THE LONG-TERM AND SHORT-TERM CARE NEEDS OF ITS RESIDENTS. 7923107 1 0 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 155 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PATRICIA MOLL 8285805003 2201 S STERLING ST MORGANTON NC 28655 X J MICHAEL BRIDGES CHAIRMAN 1.00 X 0 0 0 MH MCCRARY VICE CHAIRMAN 1.00 X 0 0 0 SHERROD SALSBURY SECRETARY 1.00 X 0 0 0 JEFF CARSWELL TREASURER 1.00 X 0 0 0 CLAY RICHARDSON MD MEMBER AT LARGE 1.00 50.00 X 0 289391 55441 JOHN BRANSTROM BOARD MEMBER 1.00 X 0 0 0 LISA BUFF BOARD MEMBER 1.00 X 0 0 0 ALAN GRIFFIN BOARD MEMBER 1.00 X 0 0 0 ALLEN VANNOPPEN BOARD MEMBER 1.00 X 0 0 0 BRIAN GWYN BOARD MEMBER 1.00 X 0 0 0 FRANK LETHERBY BOARD MEMBER 1.00 X 0 0 0 SPENCER LILLY BOARD MEMBER 1.00 X 0 0 0 KATHY BAILEY PRESIDENT & CEO 1.00 50.00 X 0 0 0 ROBERT G FRITTS SENIOR VP OF FINANCE/CFO 1.00 50.00 X 0 0 0 MAXINE MOLTER MANAGEMENT 1.00 50.00 X 0 184263 16251 EDWARD PLYLER CONTINUING CARE SERV. 1.00 50.00 X 0 327516 37957 0 801170 109649 1 0 1 0 0 RESIDENT REVENUE 623000 7728282 7728282 OTHER 900099 9563 9563 7737845 7737845 7737845 0 0 5228226 4966815 261411 27055 25702 1353 831986 790387 41599 266533 253206 13327 26544 26544 182381 173262 9119 23158 23158 78471 78471 143001 143001 3327 3327 110610 110610 138699 138699 45492 45492 SUPPLIES 576600 547770 28830 INTERCOMPANY EXPENSE 485946 291568 194378 ASSESSMENT 361371 361371 71897 71897 8601297 7923107 678190 0 131161 129278 769838 705356 18486 19181 24554 18564 4452441 2745417 1679808 1707024 12811 11128 2636658 2590531 489108 388459 3338781 4256755 3827889 4645214 X -1191231 -2054683 -1191231 -2054683 2636658 2590531 -863452 0 X X 0 1 X 1 0 X 726288 7976346 7737845 16440479 726288 7976346 7737845 16440479 0 0 0 16440479 9 20 29 9 20 29 726297 7976366 7737845 16440508 1.00000 1.00000 0.00000 0.00000 X 0 0 0 0 0 0 0 0 1 896 896 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: MEMBERSHIP DUES FOR NCHCFA. 6347 6347 2869762 1582562 1287200 1312599 1038101 274498 263733 124754 138979 1707024 THIRD PARTY SETTLEMENTS 212053 INTERCOMPANY LIABILITIES 4044702 4256755 X PART X, LINE 2: THE 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, 2014 OR DECEMBER 31, 2013. X 1 1 X X 0 0 0 0 0 1 1 0 0 CLAY RICHARDSON MD MEMBER AT LARGE 0 289391 0 0 0 0 0 10847 0 44594 0 344832 0 0 MAXINE MOLTER MANAGEMENT 0 151924 0 27839 0 4500 0 6944 0 9307 0 200514 0 0 EDWARD PLYLER CONTINUING CARE SERV. 0 304816 0 0 0 22700 0 10499 0 27458 0 365473 0 0 PART I, LINE 1A BENEFITS PROVIDED TO OFFICERS TO FACILITATE BUSINESS RELATIONSHIPS. PART I, LINE 3 UNCHECKED ITEMS ARE CONDUCTED BY CHS AS PART OF THE MANAGEMENT AGREEMENT. THE ORGANIZATION COMPENSATION COMMITTEE REVIEWS AND APPROVES. PART I, LINE 6 BONUSES ARE PAID IF THE ORGANIZATION'S RESULTS MET CERTAIN PERFORMANCE INDICATORS. PART II EXPLANATION: COMPENSATION FOR KATHY BAILEY AND ROBERT FRITTS IS PAID BY CAROLINA HEALTH SYSTEMS THROUGH A MANAGEMENT SERVICE CONTRACT. FORM 990, PART VI, SECTION A, LINE 3 IN 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 11 THE CHIEF FINANCIAL OFFICER 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 12C CORPORATE 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 15 SUCH A PROCESS WAS PERFORMED FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT/CEO, CFO AND EXECUTIVE DIRECTOR DURING 2014. FORM 990, PART VI, SECTION C, LINE 19 BY-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. PART VII DESCRIPTION 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 2C: NO CHANGES FOR APPROVING AUDITED FINANCIAL STATEMENTS OR SELECTION OF INDEPENDENT ACCOUNTANTS HAVE OCCURED FROM THE PRIOR YEAR. BLUE RIDGE HEALTHCARE HOSPITALS INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 560529976 HEALTHCARE NC 501(C)(3) 170(B)(1)(A) N/A 0 GRACE LIFECARE INC 500 LENOIR ROAD MORGANTON NC 28655 561722754 HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 GRACE PROPERTIES INC 500 LENOIR ROAD MORGANTON NC 28655 561727514 HEALTHCARE NC 501(C)(3) 509(A)(3) N/A 0 BLUE RIDGE FOUNDATION INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 582063920 HEALTHCARE NC 501(C)(3) 509(A)(1) N/A 0 BLUE RIDGE MEDICAL GROUP INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 020777195 HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 BLUE RIDGE HEALTHCARE SYSTEM INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 562150313 HEALTHCARE NC 501(C)(3) 509(A)(3) N/A 0 GRACE NURSING CENTER INC 109 FOOTHILLS DRIVE MORGANTON NC 28655 561838369 HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 GRACE HEALTH VENTURES INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 561581317 RELATED NC BLUE RIDGE HEALTHCARE SYSTEM C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 BLUE RIDGE HEALTHCARE SYSTEM INC O 123145 INTERCOMPANY INVOICES BLUE RIDGE HEALTHCARE HOSPITALS INC M 198612 INTERCOMPANY INVOICES BLUE RIDGE HEALTHCARE HOSPITALS INC P 225770 INTERCOMPANY INVOICES