2012-11-14T08:57:54-06:00 2011-12-31 420714325 MCGLADREY LLP 230 N ELM ST STE 1100 GREENSBORO NC 27401 990 2011-01-01 562103741 THE CYPRESS OF CHARLOTTE CLUB INC CYPR 7047145500 3442 CYPRESS CLUB DR CHARLOTTE NC 28210 GEORGE M CHATFIELD III 7047145500 2012-11-07 ADRIENNE MCKINNEY P00819656 3362724551 2011 2016-02-24 21:20:13Z THE CYPRESS OF CHARLOTTE GEORGE M CHATFIELD III 3442 CYPRESS CLUB DR CHARLOTTE NC 28210 12805459 0 X WWW.THECYPRESS.COM X 1998 NC SEE SCHEDULE OTHE CYPRESS OF CHARLOTTE CLUB, INC. WAS ESTABLISHED AS A NON-PROPIETARY, NON-SHAREHOLDER, NOT-FOR-PROFIT MUTUAL BENEFIT CORPORATION UNDER THE LAWS OF NC, EXCLUSIVELY TO MAINTAIN HOUSING FOR THE ELDERLY, TO DIRECTLY PROVIDE HEALTHCARE FOR THE PHYSICAL AND MENTAL WELL-BEING OF ITS RESIDENTS, TO PROVIDE FINANCIAL SECURITY FOR ITS RESIDENTS WITH POLICIES PERMITTING RESIDENTS TO REMAIN AT THE CYPRESS EVEN THOUGH THEY MAY RUN OUT OF FUNDS, AND TO OPERATE THE FACILITY AT ITS LOWEST FEASIBLE AND ACCEPTABLE COST. 5 3 391 50 0 0 0 0 11121927 11439749 83313 116682 0 0 11205240 11556431 0 0 0 0 6681646 6875087 0 0 0 4638608 4761232 11320254 11636319 -115014 -79888 4736220 4909306 2695530 3026605 2040690 1882701 THE CYPRESS OF CHARLOTTE, CHARLOTTE'S PREMIER CONTINUING CARE RETIREMENT COMMUNITY, IS COMMITTED TO ENHANCING THE LIVES OF OUR MEMBERS BY PROVIDING EXCEPTIONAL SERVICE AND PEACE OF MIND IN AN UPSCALE ENVIRONMENT. 0 0 9089301 11439749 THE CYPRESS OF CHARLOTTE CLUB PROVIDES SERVICES TO ELDERLY RESIDENTS LIVING IN 310 PRIVATELY OWNED RESIDENTIAL UNITS. RESIDENTS RECEIVED ASSISTED LIVING, INCLUDING HEALTHCARE, FOR PHYSICAL AND MENTAL WELL BEING. 9089301 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 45 0 1 391 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 1 0 0 1 0 0 1 1 0 0 0 0 1 1 0 0 0 X GEORGE M CHATFIELD III 7047145500 3442 CYPRESS CLUB DR CHARLOTTE NC 28210 X JAMES P COLEMAN 5.00 X X 0 0 0 DR ROBERT HIGGINS 0.30 X 0 0 0 GEORGE M CHATFIELD III 40.00 X X 140499 0 28025 MICHELLE FISH 0.30 X 0 0 0 MICHAEL J HARRISON 0.30 X 0 0 0 REBECCA C DAVIS 40.00 X 158612 0 3268 SONDRA C KEY 40.00 X 117100 0 0 416211 0 31293 3 0 1 1 THE CYPRESS OF CHARLOTTE LLC 20 LADY SLIPPER LANE HILTON HEAD ISLAND SC 29926 CONTRACTUAL OVERHEAD-SEE STMT O 1336662 LIFE CARE SERVICES LLC 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 516097 HERITAGE HEALTHCARE INC 536 OLD HOWELL ROAD GREENVILLE SC 29615 HEALTHCARE PROVIDER 376146 TOMMIE FARMER 7708 DENBUR DRIVE CHARLOTTE NC 28215 BEAUTY SALON OPERATOR 143208 4 MEMBER DUES 623000 6397071 6397071 HEALTH SERVICE 623000 3074548 3074548 HOME HEALTH SERVICE 621610 1516993 1516993 OTHER MEMBER FEES 623000 451137 451137 11439749 43999 43999 1321711 1249028 72683 72683 72683 11556431 11439749 0 116682 168524 168524 5521017 5200854 320163 28344 18807 9537 695290 612820 82470 461912 443419 18493 1320462 68135 1252327 9922 9922 54250 54250 142425 142425 25337 25183 154 24668 24668 4277 4277 297221 284870 12351 14253 10324 3929 239 239 203988 203988 78053 78053 FOOD COST 1270029 1270029 MEDICAL EXPENSES 522608 522608 SUPPLIES 251173 230808 20365 ACTIVITIES 156974 156974 385353 244470 140883 11636319 9089301 2547018 0 500 500 422677 621087 585253 721417 83047 92256 250408 269198 2039977 1232744 958347 807233 1086348 815402 1340728 1582213 8912 0 4736220 4909306 955033 1099526 89188 75974 1651309 1851105 2695530 3026605 X 2040690 1882701 2040690 1882701 4736220 4909306 X -79888 -78101 X X 0 1 1 X 0 2039977 1232744 807233 807233 INSURANCE RESERVES-CDS & MONEY MKT 1582213 F 1582213 DUE TO AFFILIATES 1693882 EMPLOYEE FUNDS 42572 DUE TO HOMEOWNERS 75500 CAPITAL LEASE OBLIGATION 39151 1851105 11556431 11636319 -79888 -78101 -78101 -157989 11478330 -78101 -78101 11556431 0 11556431 11636319 0 11636319 0 11636319 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CLUB FOLLOWS THE PROVISIONS OF ACCOUNTING ASC 740-10 AND DETERMINED THAT THE CLUB DID NOT HAVE ANY UNCERTAIN TAX POSITIONS REQUIRING RECOGNITION ON DECEMBER 31, 2011. WITH FEW EXCEPTIONS, THE CLUB IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL TAX AUTHORITIES FOR YEARS BEFORE 2008. 0 0 0 0 0 0 0 0 0 GEORGE M CHATFIELD III 120647 0 19852 0 0 0 8712 0 19313 0 168524 0 0 0 REBECCA C DAVIS 64612 0 94000 0 0 0 0 0 3268 0 161880 0 0 0 SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, SECTION A, LINE 5: UNRELATED ORGANIZATION - LIFE CARE SERVICES, LLC PERSONS RECEIVING COMPENSATION - GEORGE M. CHATFIELD,III, SECRETARY/TREASURER; REBECCA DAVIS, MARKETING DIRECTOR COMPENSATION - REFER TO FORM 990, SCHEDULE J, PART II CYPRESS OF CHARLOTTE LLC SEE STMT O 1336662 SEE STMT O 0 FORM 990, PART VI, SECTION A, LINE 3 THE CYPRESS OF CHARLOTTE CLUB ("CLUB")HAS CONTRACTED WITH LIFE CARE SERVICES, LLC TO PROVIDE SERVICES, INCLUDING MANAGEMENT SERVICES AND EMPLOYEES, TO THE CLUB. THE CLUB HAS AN AGREEMENT WITH THE CYPRESS OF CHARLOTTE, LLC ("COMPANY") TO PROVIDE SUPERVISION AND OVERSIGHT OF THOSE CONTRACTED ACTIVITIES AND EMPLOYEES. THE BOARD IS STILL ULTIMATELY RESPONSIBLE FOR THE CLUB AND MAY TERMINATE THE MANAGEMENT AGREEMENT WITH THE COMPANY SHOULD THE COMPANY BE IN DEFAULT. FORM 990, PART VI, SECTION A, LINE 6 ONE CLASS OF MEMBERS FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WILL BE CONDUCTED FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE THROUGH THE ORGANIZATION'S ANNUAL DISCLOSURE STATEMENT, WHICH IS REQUIRED BY THE NC DEPARTMENT OF INSURANCE, WHICH REGULATES ALL CONTINUING CARE RETIREMENT COMMUNITIES IN THE STATE OF NORTH CAROLINA. ALL CYPRESS MEMBERS, ALL POTENTIAL CYPRESS MEMBERS, AND ANY OTHER INTERESTED PARTIES CAN RECEIVE A COPY OF THE DISCLOSURE STATEMENT UPON REQUEST. FORM 990, PART VII, SECTION A, COLUMN F THE ORGANIZATION, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN COLUMN F, PART VII AND IS NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -78,101. FORM 990, PART XII, LINE 2C, AUDIT COMMITTEE:: THE BOARD ITSELF SERVES AS THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THE BOARD IS MADE UP, IN THE MAJORITY, OF INDEPENDENT DIRECTORS WITH NO OTHER AFFILIATION WITH ANY OF THE CYPRESS ENTITIES. THE AUDIT COMMITTEE'S PROCESS OF EVALUATION HAS NOT CHANGED SINCE PRIOR YEAR. FORM 990, PART I, LINE 6: WE HAVE MEMBERS (RESIDENTS) WHO ARE ELECTED TO SERVE ON ADVISORY COMMITTEES AND OTHER MEMBERS WHO VOLUNTEER THEIR TIME AT OUR NURSING FACILITY READING TO AND VISITING THE SICK. FORM 990, PART VI, LINES 15A & B: THE PROCESS OF DETERMINING COMPENSATION FOR THE EXECUTIVE DIRECTOR AND HEALTHCARE ADMINISTRATION IS CONDUCTED BY THE ORGANIZATION'S MANAGEMENT COMPANY, LIFE CARE SERVICES, LLC OF DES MOINES, IOWA, SUBJECT TO THE APPROVAL OF THE BOARD. THE EXECUTIVE DIRECTOR AND HEALTHCARE ADMINISTRATOR ARE LIFE CARE SERVICES, LLC EMPLOYEES (I.E. THEY ARE NOT EMPLOYEES OF THE CYPRESS OF CHARLOTTE). SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: THE CYPRESS OF CHARLOTTE, LLC (B) RELATIONSHIP OF INTERESTED PERSON AND ORGANIZATION: BOARD PRESIDENT JAMES COLEMAN INDIRECTLY OWNS 25% OF THE CYPRESS OF CHARLOTTE, LLC (D) DESCRIPTION OF TRANSACTION: THE CYPRESS OF CHARLOTTE, LLC PLANNED, DESIGNED, AND BUILT THE CYPRESS OF CHARLOTTE COMMUNITY. THE BUSINESS MODEL ALLOWED THE COMMUNITY TO BE BUILT AND OPERATED WITHOUT DEBT BY ALLOWING FOR AN OVERHEAD PAYMENT EQUAL TO 10% OF THE OPERATING EXPENSES TO BE PAID TO THE LLC. THIS STRUCTURE ALLOWS THE CYPRESS OF CHARLOTTE CLUB MEMBER FEES TO BE LOWER THAN 95% OF COMPARABLE COMMUNITIES, WHILE AT THE SAME TIME PROVIDING A HIGHER LEVEL OF FINANCIAL SECURITY FOR THE MEMBERS OF THE COMMUNITY. THE AMOUNTS PAID TO THE CYPRESS OF CHARLOTTE, LLC ARE SET AS FIXED PERCENTAGES ESTABLISHED WHEN THE COMMUNITY WAS STARTED. THE SAME PAYMENTS WOULD BE MADE TO THE LLC REGARDLESS OF MR. COLEMAN'S PRESENCE ON THE BOARD, NOR ARE THEY TIED TO THE REVENUE OF THE CLUB. FORM 990, SCHEDULE R, PART III AND PART IV: THE NORTH CAROLINA DEPARTMENT OF INSURANCE ISSUED THE LICENSE TO OPERATE A CONTINUING CARE RETIREMENT COMMUNITY COLLECTIVELY TO THE CYPRESS OF CHARLOTTE CLUB ("CLUB"), THE CYPRESS OF CHARLOTTE OWNERS' ASSOCIATION ("OA"), AND THE CYPRESS OF CHARLOTTE, LLC ("COMPANY"). THE DEPARTMENT OF INSURANCE REQUIRES THESE THREE LEGAL ENTITIES WORK TOGETHER TO FULFILL THE MISSION OF THE CYPRESS OF CHARLOTTE. THIS STRUCTURE ALLOWS THE COMPANY TO CONTRIBUTE REAL AND PERSONAL PROPERTY TO THE PROJECT WITHOUT DEBT TO EITHER THE CLUB OR THE OA, ALLOWING FOR MUCH GREATER FINANCIAL SECURITY AND LOWER MEMBER FEES THAN ANY COMPARABLE COMMUNITIES. IN RETURN, THE COMPANY RECOVERS ITS INVESTMENT THROUGH THE OVERHEAD FEES PAID BY THE COMMUNITY. THE TERMS OF AND DETAILS OF THE OVERHEAD PAYMENT ARE PROVIDED TO AND ACKNOWLEDGED BY MEMBERS WHEN THEY JOIN THE COMMUNITY. THIS MODEL ALIGNS THE INTERESTS OF THE CLUB, OA, COMPANY AND MEMBERS TO ENSURE THE COMMUNITY CONTINUES TO GROW AND THRIVE. THE SUCCESS OF THIS STRUCTURE CAN BE SEEN IN A 95% MEMBER SATISFACTION RATE AND SIGNIFICANT INCREASES IN THE VALUE OF THE RESIDENCES UPON RESALE. THE CYPRESS OF CHARLOTTE LLC 3442 CYPRESS CLUB DR CHARLOTTE NC 28210 MGT SERVICES & CO-LICENSEE OF CYPRESS OF CHARLOTTE. NC 0 0 THE CYPRESS OF CHARLOTTE OWNERS' ASSOCIATION 3442 CYPRESS CLUB DRIVE CHARLOTTE NC 28210 562205827 HOME OWNERS ASSOC AND CO-LICENSEE OF THE CYPRESS OF CHARLOTTE. NC C 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 0 0 0 THE CYPRESS OF CHARLOTTE OWNERS'ASSOCIATION O 1693882 CLUB INCOME/EXPENSE ALLOCATION