2013-08-15T08:26:56-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2011-10-01 566065223 CORNELIA NIXON DAVIS INC CORN 9106867195 1011 PORTERS NECK RD WILMINGTON NC 28405 CHARLES LONG 9106867195 2013-08-09 1 JOHN NORMAN P01506766 7049985200 2011 2016-02-24 21:20:13Z DAVIS HEALTH CARE CENTER CHARLES LONG 1011 PORTERS NECK RD WILMINGTON NC 28405 24185053 0 X WWW.THEDAVISCOMMUNITY.ORG X 1966 NC TO PROVIDE QUALITY HEALTH, REHABILITATION, AND WELLNESS SERVICES TO AGING ADULTS. 12 12 573 108 0 0 85568 798559 24298488 23318055 101597 26575 269609 -112551 24755262 24030638 0 0 0 0 12420955 13451213 0 0 1013 9175458 8491034 21596413 21942247 3158849 2088391 42318538 44744861 17128442 17466374 25190096 27278487 X OUR 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. 0 0 14192909 17154270 NURSING HOMECORNELIA NIXON DAVIS OPERATED A NURSING HOME THAT SERVED 69,699 PATIENT DAYS THROUGHOUT THE YEAR ENDED SEPTEMBER 30, 2011. TOTAL OCCUPANCY WAS 97%. 4424451 6022754 ASSISTED 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%. 91100 141031 WELLNESS 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. 18708460 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 61 0 1 573 1 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X VINCE MCKNIGHT 9106867195 1011 PORTERS NECK RD WILMINGTON NC 28405 DR BEN BARKER 1.00 X 0 0 0 W LEE WILLIAMS 1.00 X 0 0 0 ELIZABETH KING 1.00 X 0 0 0 LT GEN JAMES M LEE 1.00 X 0 0 0 E L MATHEWS JR 1.00 X 0 0 0 LINDA A PEARCE 1.00 X 0 0 0 WILLIAM N SMITH 1.00 X 0 0 0 ELIZABETH WRIGHT 1.00 X 0 0 0 CHERYLL SCHRAMM 1.00 X 0 0 0 WALTER CRAVEN 1.00 X 0 0 0 DR WILLIAM O MCMILLAN JR 1.00 X 0 0 0 WILLIAM O J LYNCH 1.00 X 0 0 0 CHARLES LONG 40.00 X 169174 0 16278 ANGELA BARR 40.00 X 109603 0 19536 278777 0 35814 2 0 1 0 GENESIS ELDERCARE PO BOX 7247-6524 PHILADELPHIA PA 19170 THERAPY SERVICES 1587591 BLUE CROSS BLUE SHIELD PO BOX 580017 CHARLOTTE NC 28258 INSURANCE PROVIDER 1534762 BMH AIA 514 MARKET ST WILMINGTON NC 28401 ARCHITECT 942737 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DIETARY MANAGEMENT 926927 GENESIS REHABILITATION SERVICES PO BOX 7247-6524 PHILADELPHIA PA 19170 THERAPY SERVICES 809745 5 10000 788559 136950 798559 RESIDENT SERVICE 623000 23318055 23318055 23318055 89191 89191 132812 91799 41013 41013 41013 62616 -62616 -62616 -62616 PERSONAL CARE 900099 93491 93491 EMPLOYEE MEALS 900099 67603 67603 REFUNDING OF DEBT 900099 -354930 -354930 40272 40272 -153564 24030638 23318055 0 -85976 185452 185452 9087532 8170903 916629 137817 118923 18894 3001655 2541970 459685 1038757 898510 140247 638 638 62958 62958 2450496 2347140 103356 120212 120212 185514 2162 183352 45946 45946 740797 740797 32035 9119 22916 31115 31115 1386876 1358518 28358 344835 344835 PROGRAM SUPPLIES 1563189 1563189 BED TAX ASSESSMENT 361229 361229 DIETARY SUPPLIES 339275 339275 BAD DEBT EXPENSE 200004 200004 625915 417950 206952 1013 21942247 18708460 3232774 1013 5022979 8625111 9158688 7176558 1970376 1608261 101397 123654 213422 225340 44583049 18310777 25250359 26272272 601317 713665 42318538 44744861 1598976 2370773 4466 5866 15525000 14930000 0 159735 17128442 17466374 X 25123878 27207634 11218 15853 55000 55000 25190096 27278487 42318538 44744861 2088391 0 X X 0 1 1 X 0 X 1132999 1886389 349883 85568 798559 4253398 19858997 20069035 21179018 24298488 23318055 108723593 20991996 21955424 21528901 24384056 24116614 112976991 895000 1800000 50000 736950 3481950 0 895000 1800000 50000 736950 3481950 109495041 325892 244342 123758 101597 221802 1017391 325892 244342 123758 101597 221802 1017391 219947 202834 378300 269609 1070690 21537835 22402600 22030959 24755262 24338416 115065072 0.95160 0.95050 0.00880 0.01070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 61335 201 61536 61065 270 61335 55245 5309 511 61065 130280 75407 152 150594 55245 0.89400 0.10600 0 0 3025957 3025957 32740690 12782467 19958223 6583850 5528310 1055540 2232552 2232552 26272272 ENVIRONMENTAL REMEDIATION LIABILITY 159735 159735 24030638 21942247 2088391 2088391 24486782 0 24486782 -456144 -456144 24030638 22033859 91799 91799 21942060 187 187 21942247 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. X X X X X 0 0 0 1 0 0 0 0 0 CHARLES LONG 135779 0 33395 0 0 0 5921 0 10357 0 185452 0 0 0 PART I, LINE 5 THE 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. NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DCX7 2009-10-29 5705000 CONSTRUCTION 1 0 0 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657902C67 2003-01-23 7000000 EXPANSION OF ASSISTED LIVING FACILITY 0 0 0 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 1920-09-27 27665000 NEW AND RENOVATED CONSTRUCTION 0 0 0 5245000 5534409 14733 222513 2010 0 0 1 1 140000 8614 6851385 2004 0 0 1 1 27665000 265000 5245000 22155000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 X 1 136950 APPRAISAL 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 WALKER TAYLOR HAS A BUSINESS RELATIONSHIP WITH THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR AND FINANCE ADMINISTRATOR REVIEW THE FORM 990 PRIOR TO ISSUANCE. FORM 990, PART VI, SECTION B, LINE 12C IN 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 15 ANNUALLY, 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 19 THE 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.