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CORNELIA NIXON DAVIS INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CORNELIA NIXON DAVIS INC (EIN 56-6065223)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-15
IRS object ID
201342279349300584
Schema version
2011v1.5
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)
Timestamp2013-08-15T08:26:56-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1101 N TRYON STREET SUITE 1000AddressLine1
CityCHARLOTTECity
StateNCState
ZIP Code28246ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN566065223EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CORNELIA NIXON DAVIS INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCORNNameControl
Phone9106867195Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11011 PORTERS NECK RDAddressLine1
CityWILMINGTONCity
StateNCState
ZIP Code28405ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCHARLES LONGName
TitleCEOTitle
Phone9106867195Phone
Date Signed2013-08-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOHN NORMANName
PTINP01506766PTIN
Phone7049985200Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1DAVIS HEALTH CARE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHARLES LONGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11011 PORTERS NECK RDAddressLine1
CityWILMINGTONCity
StateNCState
ZIP Code28405ZIPCode
FieldValueIRS element (for citing)
Gross Receipts24185053GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.THEDAVISCOMMUNITY.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1966YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY HEALTH, REHABILITATION, AND WELLNESS SERVICES TO AGING ADULTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees573TotalNbrEmployees
Total Nbr Volunteers108TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year85568ContributionsGrantsPriorYear
Contributions Grants Current Year798559ContributionsGrantsCurrentYear
Program Service Revenue Prior Year24298488ProgramServiceRevenuePriorYear
Program Service Revenue CY23318055ProgramServiceRevenueCY
Investment Income Prior Year101597InvestmentIncomePriorYear
Investment Income Current Year26575InvestmentIncomeCurrentYear
Other Revenue Prior Year269609OtherRevenuePriorYear
Other Revenue Current Year-112551OtherRevenueCurrentYear
Total Revenue Prior Year24755262TotalRevenuePriorYear
Total Revenue Current Year24030638TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12420955SalariesEtcPriorYear
Salaries Etc Current Year13451213SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1013TotalFundrsngExpCurrentYear
Other Expense Prior Year9175458OtherExpensePriorYear
Other Expenses Current Year8491034OtherExpensesCurrentYear
Total Expenses Prior Year21596413TotalExpensesPriorYear
Total Expenses Current Year21942247TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3158849RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2088391RevenuesLessExpensesCY
Total Assets BOY42318538TotalAssetsBOY
Total Assets EOY44744861TotalAssetsEOY
Total Liabilities BOY17128442TotalLiabilitiesBOY
Total Liabilities EOY17466374TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY25190096NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY27278487NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR MISSION IS TO PROVIDE QUALITY HEALTH, REHABILITATION, AND WELLNESS SERVICES TO AGING ADULTS IN A LOVING CONTINUUM OF CARE ENVIRONMENT IN WHICH EACH RESIDENT LIVES AT AN OPTIMUM LEVEL OF FUNCTION AND DIGNITY. WE STRIVE TO BE THE PLACE WHERE AGING ADULTS CHOOSE TO LIVE AND EMPLOYEES DESIRE TO WORK.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense14192909Expense
Revenue17154270Revenue
DescriptionNURSING HOMECORNELIA NIXON DAVIS OPERATED A NURSING HOME THAT SERVED 69,699 PATIENT DAYS THROUGHOUT THE YEAR ENDED SEPTEMBER 30, 2011. TOTAL OCCUPANCY WAS 97%.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4424451Expense
Revenue6022754Revenue
DescriptionASSISTED LIVING FACILITYCORNELIA NIXON DAVIS OPERATED AN ASSISTED LIVING RESIDENCY THAT SERVED 47,356 PATIENT DAYS THROUGHOUT THE YEAR ENDED SEPTEMBER 30, 2011. TOTAL OCCUPANCY WAS 88%.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense91100Expense
Revenue141031Revenue
DescriptionWELLNESS CENTERTHE WELLNESS CENTER OPENED IN OCTOBER OF 2010 AND PROVIDES A CONTINUUM OF CARE TO RESIDENTS THAT ARE DISCHARGED FROM INPATIENT REHABILITATION. THE WELLNESS CENTER IS OPEN TO SENIORS FROM WITHIN THE DAVIS COMMUNITY AND ALSO THE GENERAL PUBLIC. THE CENTER PROVIDES OUTPATIENT REHABILITATION SERVICES AS WELL AS A FULLY FUNCTIONAL FITNESS FACILITY. MEMBERSHIP TO THE FITNESS FACILITY INCLUDES ACCESS TO A HEATED SALTWATER POOL, WEIGHT AND CARDIO EXERCISE ROOMS, EXERCISE CLASSES, AND SEMINARS DESIGNED TO MEET THE HEALTH AND FITNESS NEEDS OF SENIORS.Description
FieldValueIRS element (for citing)
Total Program Service Expense18708460TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109661NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees573NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1VINCE MCKNIGHTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9106867195TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11011 PORTERS NECK RDAddressLine1
CityWILMINGTONCity
StateNCState
ZIP Code28405ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
DR BEN BARKER
CHAIRMAN1.00X000
W LEE WILLIAMS
SECRETARY/TREASURER1.00X000
ELIZABETH KING
BOARD MEMBER1.00X000
LT GEN JAMES M LEE
BOARD MEMBER1.00X000
E L MATHEWS JR
BOARD MEMBER1.00X000
LINDA A PEARCE
BOARD MEMBER1.00X000
WILLIAM N SMITH
BOARD MEMBER1.00X000
ELIZABETH WRIGHT
BOARD MEMBER1.00X000
CHERYLL SCHRAMM
BOARD MEMBER1.00X000
WALTER CRAVEN
BOARD MEMBER1.00X000
DR WILLIAM O MCMILLAN JR
VICE CHAIR1.00X000
WILLIAM O J LYNCH
BOARD MEMBER1.00X000
CHARLES LONG
CEO40.00169174016278X
ANGELA BARR
ADMINISTRATOR40.00109603019536X
FieldValueIRS element (for citing)
Total Reportable Comp From Org278777TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation35814TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
GENESIS ELDERCARE
PO BOX 7247-6524PHILADELPHIAPA19170THERAPY SERVICES1587591
BLUE CROSS BLUE SHIELD
PO BOX 580017CHARLOTTENC28258INSURANCE PROVIDER1534762
BMH AIA
514 MARKET STWILMINGTONNC28401ARCHITECT942737
MORRISON MANAGEMENT SPECIALISTS
PO BOX 102289ATLANTAGA30368DIETARY MANAGEMENT926927
GENESIS REHABILITATION SERVICES
PO BOX 7247-6524PHILADELPHIAPA19170THERAPY SERVICES809745
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants10000GovernmentGrants
All Other Contributions788559AllOtherContributions
Noncash Contributions136950NoncashContributions
Total Contributions798559TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT SERVICEDescription
Business Code623000BusinessCode
Total Revenue Column23318055TotalRevenueColumn
Related Or Exempt Function Income23318055RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue23318055TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column89191TotalRevenueColumn
Exclusion$89,191ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real132812Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real91799Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real41013Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column41013TotalRevenueColumn
Exclusion$41,013ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other62616Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-62616Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-62616TotalRevenueColumn
Exclusion-$62,616ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PERSONAL CARE90009993491$93,491
EMPLOYEE MEALS90009967603$67,603
REFUNDING OF DEBT900099-354930-$354,930

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column40272TotalRevenueColumn
Exclusion$40,272ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue-153564TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column24030638TotalRevenueColumn
Related Or Exempt Function Income23318055RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$85,976ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total185452Total
Management And General185452ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9087532Total
Program Services8170903ProgramServices
Management And General916629ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total137817Total
Program Services118923ProgramServices
Management And General18894ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3001655Total
Program Services2541970ProgramServices
Management And General459685ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1038757Total
Program Services898510ProgramServices
Management And General140247ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total638Total
Management And General638ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total62958Total
Management And General62958ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2450496Total
Program Services2347140ProgramServices
Management And General103356ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total120212Total
Management And General120212ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total185514Total
Program Services2162ProgramServices
Management And General183352ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total45946Total
Management And General45946ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total740797Total
Program Services740797ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total32035Total
Program Services9119ProgramServices
Management And General22916ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total31115Total
Management And General31115ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1386876Total
Program Services1358518ProgramServices
Management And General28358ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total344835Total
Management And General344835ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROGRAM SUPPLIES15631891563189
BED TAX ASSESSMENT361229361229
DIETARY SUPPLIES339275339275
BAD DEBT EXPENSE200004200004

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total625915Total
Program Services417950ProgramServices
Management And General206952ManagementAndGeneral
Fundraising1013Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total21942247Total
Program Services18708460ProgramServices
Management And General3232774ManagementAndGeneral
Fundraising1013Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5022979BOY
EOY8625111EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY9158688BOY
EOY7176558EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1970376BOY
EOY1608261EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY101397BOY
EOY123654EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY213422BOY
EOY225340EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis44583049LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec18310777LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY25250359BOY
EOY26272272EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY601317BOY
EOY713665EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY42318538BOY
EOY44744861EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1598976BOY
EOY2370773EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY4466BOY
EOY5866EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY15525000BOY
EOY14930000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY159735EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY17128442BOY
EOY17466374EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY25123878BOY
EOY27207634EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY11218BOY
EOY15853EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY55000BOY
EOY55000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY25190096BOY
EOY27278487EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY42318538BOY
EOY44744861EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2088391ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1132999CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1886389CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years349883CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year85568CurrentTaxYearMinus1Year
Current Tax Year798559CurrentTaxYear
Total4253398Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years19858997CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20069035CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21179018CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24298488CurrentTaxYearMinus1Year
Current Tax Year23318055CurrentTaxYear
Total108723593Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years20991996CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years21955424CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21528901CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24384056CurrentTaxYearMinus1Year
Current Tax Year24116614CurrentTaxYear
Total112976991Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years895000CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1800000CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year50000CurrentTaxYearMinus1Year
Current Tax Year736950CurrentTaxYear
Total3481950Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years895000CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1800000CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year50000CurrentTaxYearMinus1Year
Current Tax Year736950CurrentTaxYear
Total3481950Total
FieldValueIRS element (for citing)
Public Support Total509109495041PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years325892CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years244342CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years123758CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year101597CurrentTaxYearMinus1Year
Current Tax Year221802CurrentTaxYear
Total1017391Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years325892CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years244342CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years123758CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year101597CurrentTaxYearMinus1Year
Current Tax Year221802CurrentTaxYear
Total1017391Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years219947CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years202834CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years378300CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year269609CurrentTaxYearMinus1Year
Total1070690Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years21537835CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22402600CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22030959CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24755262CurrentTaxYearMinus1Year
Current Tax Year24338416CurrentTaxYear
Total115065072Total
FieldValueIRS element (for citing)
Public Support Percentage5090.95160PublicSupportPercentage509
Prior Year Support Percentage0.95050PriorYearSupportPercentage
Investment Income Percentage0.00880InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01070PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance61335BeginningOfYearBalance
Investment Earnings Or Losses201InvestmentEarningsOrLosses
End Of Year Balance61536EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance61065BeginningOfYearBalance
Investment Earnings Or Losses270InvestmentEarningsOrLosses
End Of Year Balance61335EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance55245BeginningOfYearBalance
Contributions5309Contributions
Investment Earnings Or Losses511InvestmentEarningsOrLosses
End Of Year Balance61065EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance130280BeginningOfYearBalance
Contributions75407Contributions
Investment Earnings Or Losses152InvestmentEarningsOrLosses
Other Expenditures150594OtherExpenditures
End Of Year Balance55245EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.89400PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.10600TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3025957OtherCostOrOtherBasis
Book Value3025957BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis32740690OtherCostOrOtherBasis
Depreciation12782467Depreciation
Book Value19958223BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis6583850OtherCostOrOtherBasis
Depreciation5528310Depreciation
Book Value1055540BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2232552OtherCostOrOtherBasis
Book Value2232552BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings26272272TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionENVIRONMENTAL REMEDIATION LIABILITYDescription
Amount$159,735Amount
FieldValueIRS element (for citing)
Total Of Amounts159735TotalOfAmounts
Total Revenue24030638TotalRevenue
Total Expenses21942247TotalExpenses
Excess Or Deficit For Year2088391ExcessOrDeficitForYear
Excess Or Deficit Per FS2088391ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt24486782TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal24486782RevenueSubtotal
Other Revenues Not Included-456144OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-456144RevenueNotRptdOnFinStmt
Total Revenue Per Form99024030638TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt22033859TotExpensesEtcAuditedFinclStmt
Other Expenses Included91799OtherExpensesIncluded
Expenses Not Rptd F99091799ExpensesNotRptdF990
Expenses Subtotal21942060ExpensesSubtotal
Other Expenses Not Included187OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt187ExpensesNotRptdOnFinStmt
Total Expenses Per Form99021942247TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE EARNINGS FROM THE CORPUS AMOUNT OF THE INVESTED ENDOWMENT FUNDS ARE INTENDED TO BE USED TOWARDS EMPLOYEE APPRECIATION.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE 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. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2011 OR 2010.
PART XII, LINE 4B - OTHER ADJUSTMENTS:LOSS ON REFUNDING OF DEBT -354,930. LOSS ON DISPOSAL OF EQUIPMENT -62,616. RENTAL EXPENSE -91,799. RESTRICTED INVESTMENT INCOME 201. CONTRIBUTIONS 52,813. OTHER 187.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:MOB RENTAL EXPENSES 91,799.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:OTHER 187.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonCHARLES LONGNamePerson
Base Compensation Filing Org135779BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org33395BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org5921DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org10357NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org185452TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 5ReturnReference
ExplanationTHE EXECUTIVE DIRECTORS COMPENSATION INCLUDES A YEARLY BONUS THAT INCLUDES BOTH OPERATIONAL AND FINANCIAL OBJECTIVES. THE EXECUTIVE COMMITTEE OF THE BOARD EVALUATES EXECUTIVE DIRECTOR PERFORMANCE AND DETERMINES THE YEARLY BONUS ACHIEVEMENT PERCENTAGE.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
NORTH CAROLINA MEDICAL CARE COMMISSION
52130940265821DCX72009-10-295705000CONSTRUCTION100
NORTH CAROLINA MEDICAL CARE COMMISSION
521309402657902C672003-01-237000000EXPANSION OF ASSISTED LIVING FACILITY000
NORTH CAROLINA MEDICAL CARE COMMISSION
521309402NONEAVAIL1920-09-2727665000NEW AND RENOVATED CONSTRUCTION000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Amount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsCapitalized InterestCapitalizedInterestIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCredit EnhancementCreditEnhancementCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspent
524500055344091473322251320100011
1400002004001186146851385
276650002650001001524500022155000

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00000
00000
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
110000
110000
110000

Schedule M IRS990ScheduleM

Real Estate Other RealEstateOther

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990136950NoncashContribsRptdF990
Method Of Determining RevenuesAPPRAISALMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 2WALKER TAYLOR HAS A BUSINESS RELATIONSHIP WITH THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11THE EXECUTIVE DIRECTOR AND FINANCE ADMINISTRATOR REVIEW THE FORM 990 PRIOR TO ISSUANCE.
FORM 990, PART VI, SECTION B, LINE 12CIN THE COURSE OF MEETINGS OR ACTIVITIES, EACH DIRECTOR WILL DISCLOSE ANY INTERESTS IN A TRANSACTION OR DECISION WHERE THE DIRECTOR (INCLUDING THE DIRECTORS BUSINESS OR OTHER NONPROFIT AFFILIATION), THE DIRECTORS FAMILY AND /OR SIGNIFICANT OTHER, EMPLOYER, OR CLOSE ASSOCIATES WILL RECEIVE A BENEFIT OR GAIN. AFTER DISCLOSURE THE DIRECTOR WILL BE ASKED TO LEAVE THE ROOM FOR THE DISCUSSION AND NOT BE PERMITTED TO VOTE ON THE QUESTION.
FORM 990, PART VI, SECTION B, LINE 15ANNUALLY, THE COMPENSATION COMMITTEE REVIEWS THE EXECUTIVE DIRECTOR'S PERFORMANCE AND COMPARES HIS COMPENSATION TO SIMILAR NON-PROFITS BY REVIEWING 990 FORMS. THE COMPENSATION COMMITTEE IS COMPRISED ENTIRELY OF BOARD MEMBERS. THE FINANCE COMMITTE REVIEWS THE PROPOSED SALARIES OF ALL ADMINISTRATORS DURING ANNUAL BUDGET APPROVAL. EACH YEAR, THE NEED FOR A WAGE COMPARABILITY STUDY IS EVALUATED AND A CONSULTANT IS HIRED AS NECESSARY. ADDITIONALLY, THE HR DIRECTOR USES A PRINTED PUBLICATION ABOUT CCRC COMPENSATION TO REVIEW INDIVIDUAL SALARIES FOR COMPARISON TO INDUSTRY AVERAGES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMETNS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C:NO CHANGE IN METHOD SINCE PRIOR YEAR.