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CORNELIA NIXON DAVIS INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CORNELIA NIXON DAVIS INC (EIN 56-6065223)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-03-30
IRS object ID
201230909349301033
Schema version
2010v3.4
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)
Timestamp2012-03-30T15:06:22-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-10-01TaxPeriodBeginDate

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 Signed2012-03-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGREGORY W JOHNSName
Phone7049985200Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
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 Receipts24829137GrossReceipts
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 Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees540TotalNbrEmployees
Total Nbr Volunteers85TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year349883ContributionsGrantsPriorYear
Contributions Grants Current Year85568ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21179018ProgramServiceRevenuePriorYear
Program Service Revenue CY24298488ProgramServiceRevenueCY
Investment Income Prior Year123994InvestmentIncomePriorYear
Investment Income Current Year101597InvestmentIncomeCurrentYear
Other Revenue Prior Year378064OtherRevenuePriorYear
Other Revenue Current Year269609OtherRevenueCurrentYear
Total Revenue Prior Year22030959TotalRevenuePriorYear
Total Revenue Current Year24755262TotalRevenueCurrentYear
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 Year11855897SalariesEtcPriorYear
Salaries Etc Current Year12420955SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1000TotalFundrsngExpCurrentYear
Other Expense Prior Year7999014OtherExpensePriorYear
Other Expenses Current Year9175458OtherExpensesCurrentYear
Total Expenses Prior Year19854911TotalExpensesPriorYear
Total Expenses Current Year21596413TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2176048RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3158849RevenuesLessExpensesCY
Total Assets BOY41395626TotalAssetsBOY
Total Assets EOY42318538TotalAssetsEOY
Total Liabilities BOY19364379TotalLiabilitiesBOY
Total Liabilities EOY17128442TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY22031247NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY25190096NetAssetsOrFundBalancesEOY
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
Expense14075703Expense
Revenue18140605Revenue
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)
Expense4225686Expense
Revenue5999030Revenue
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)
Expense61964Expense
Revenue158853Revenue
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 Expense18363353TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Liabilities0ReportOtherLiabilities
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 Contributions0DeductibleNonCashContributions
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 With1096121NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees540NumberOfEmployees
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
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
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 CompensationOtherCompensationOfficerOfficer
WALKER TAYLOR III
CHAIRMAN1.00X000
DR BEN BARKER
VICE-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
BOARD MEMBER1.00X000
WILLIAM O J LYNCH
BOARD MEMBER1.00X000
CHARLES LONG
CEO40.00161240010860X
FieldValueIRS element (for citing)
Total Reportable Comp From Org161240TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation10860TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
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 REHABILITATION SERVICE
PO BOX 7247-6524PHILADELPHIAPA19170THERAPY SERVICES2640442
BLUE CROSS BLUE SHIELD
PO BOX 2291DURHAMNC27702INSURANCE PROVIDER1515541
RX SERVICE
PO BOX 740391CINCINNATIOH45274RX CONTRACTOR599192
US FOOD SERVICE
9399 WEST HIGGINS ROADROSEMONTIL60018FOOD SUPPLIER520819
MCKESSON MEDICAL
4411 LEATHERWOOD DRWILMINGTONNC28412HEALTH CARE SERVICES389777
FieldValueIRS element (for citing)
Number Of Contractors GT100 K21NumberOfContractorsGT100K
All Other Contributions85568AllOtherContributions
Total Contributions85568TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT SERVICEDescription
Business Code623000BusinessCode
Total Revenue Column24298488TotalRevenueColumn
Related Or Exempt Function Income24298488RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue24298488TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column101597TotalRevenueColumn
Exclusion$101,597ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real114310Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real73875Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real40435Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column40435TotalRevenueColumn
Exclusion$40,435ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PERSONAL CARE90009996787$96,787
EMPLOYEE MEALS90009959992$59,992

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column72395TotalRevenueColumn
Exclusion$72,395ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue229174TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column24755262TotalRevenueColumn
Related Or Exempt Function Income24298488RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$371,206ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total172100Total
Management And General172100ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8833238Total
Program Services7898864ProgramServices
Management And General934374ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total150400Total
Program Services130842ProgramServices
Management And General19558ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2275181Total
Program Services1835144ProgramServices
Management And General440037ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total990036Total
Program Services860718ProgramServices
Management And General129318ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3431Total
Management And General3431ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total52862Total
Management And General52862ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2709276Total
Program Services2628443ProgramServices
Management And General80833ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total131725Total
Program Services373ProgramServices
Management And General131352ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total185829Total
Program Services2923ProgramServices
Management And General182906ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total46207Total
Management And General46207ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total723119Total
Program Services723119ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total59526Total
Program Services11951ProgramServices
Management And General47575ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total45752Total
Management And General45752ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1333602Total
Program Services1305244ProgramServices
Management And General28358ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total354345Total
Management And General354345ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROGRAM SUPPLIES15572411557241
DIETARY SUPPLIES832607832607
BED TAX ASSESSMENT354613354613
BAD DEBT EXPENSE200665200665

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total584658Total
Program Services375219ProgramServices
Management And General208439ManagementAndGeneral
Fundraising1000Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total21596413Total
Program Services18363353ProgramServices
Management And General3232060ManagementAndGeneral
Fundraising1000Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4122652BOY
EOY5022979EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY8980721BOY
EOY9158688EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1829030BOY
EOY1970376EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY108290BOY
EOY101397EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY209121BOY
EOY213422EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis42668303LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec17417944LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY25371802BOY
EOY25250359EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY774010BOY
EOY601317EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY41395626BOY
EOY42318538EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2979869BOY
EOY1598976EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY14510BOY
EOY4466EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY16370000BOY
EOY15525000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY19364379BOY
EOY17128442EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY21958517BOY
EOY25123878EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY11910BOY
EOY11218EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY60820BOY
EOY55000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22031247BOY
EOY25190096EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY41395626BOY
EOY42318538EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses3158849ReconcilationRevenueExpenses
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 Years699822CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1132999CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1886389CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year349883CurrentTaxYearMinus1Year
Current Tax Year85568CurrentTaxYear
Total4154661Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18159340CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years19858997CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20069035CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21179018CurrentTaxYearMinus1Year
Current Tax Year24298488CurrentTaxYear
Total103564878Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18859162CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20991996CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21955424CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21528901CurrentTaxYearMinus1Year
Current Tax Year24384056CurrentTaxYear
Total107719539Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years320000CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years895000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1800000CurrentTaxYearMinus2Years
Current Tax Year50000CurrentTaxYear
Total3065000Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years320000CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years895000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1800000CurrentTaxYearMinus2Years
Current Tax Year50000CurrentTaxYear
Total3065000Total
FieldValueIRS element (for citing)
Public Support Total509104654539PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years380489CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years325892CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years244342CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year123758CurrentTaxYearMinus1Year
Current Tax Year101597CurrentTaxYear
Total1176078Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years380489CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years325892CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years244342CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year123758CurrentTaxYearMinus1Year
Current Tax Year101597CurrentTaxYear
Total1176078Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years142182CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years219947CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years202834CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year378300CurrentTaxYearMinus1Year
Current Tax Year269609CurrentTaxYear
Total1212872Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years19381833CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years21537835CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22402600CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22030959CurrentTaxYearMinus1Year
Current Tax Year24755262CurrentTaxYear
Total110108489Total
FieldValueIRS element (for citing)
Public Support Percentage5090.95050PublicSupportPercentage509
Prior Year Support Percentage0.94280PriorYearSupportPercentage
Investment Income Percentage0.01070InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01390PriorYrInvestIncomePercentage
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 Balance61065BeginningOfYearBalance
Investment Earnings Or Losses270InvestmentEarningsOrLosses
End Of Year Balance61335EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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 Balance0.90000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.10000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2889007OtherCostOrOtherBasis
Book Value2889007BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis32913163OtherCostOrOtherBasis
Depreciation12741578Depreciation
Book Value20171585BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5124716OtherCostOrOtherBasis
Depreciation3691823Depreciation
Book Value1432893BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1741417OtherCostOrOtherBasis
Depreciation984543Depreciation
Book Value756874BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings25250359TotalOfBookValueLandBuildings
Total Revenue24755262TotalRevenue
Total Expenses21596413TotalExpenses
Excess Or Deficit For Year3158849ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS3158849ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt24836705TotRevenueEtcAuditedFinclStmt
Other Revenues28157OtherRevenues
Revenue Not Rptd F99028157RevenueNotRptdF990
Revenue Subtotal24808548RevenueSubtotal
Other Revenues Not Included-53286OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-53286RevenueNotRptdOnFinStmt
Total Revenue Per Form99024755262TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt21670288TotExpensesEtcAuditedFinclStmt
Other Expenses Included73875OtherExpensesIncluded
Expenses Not Rptd F99073875ExpensesNotRptdF990
Expenses Subtotal21596413ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99021596413TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 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 XI, LINE 8 - OTHER ADJUSTMENTS:PERMANENTLY RESTRICTED INVESTMENT INCOME
PART XII, LINE 2D - OTHER ADJUSTMENTS:NET ASSETS RELEASED FROM RESTRICTION 28,157.
PART XII, LINE 4B - OTHER ADJUSTMENTS:RESTRICTED CONTRIBUTIONS 20,319. RESTRICTED INVESTMENT INCOME 270. MOB RENTAL EXPENSES -73,875.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:MOB RENTAL EXPENSES 73,875.

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 Org129954BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org31286BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org10860NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org172100TotalCompensationFilingOrg
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 (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
NORTH CAROLINA MEDICAL CARE COMMISSION
52130940265821DCX72009-10-295705000CONSTRUCTION000
NORTH CAROLINA MEDICAL CARE COMMISSION
521309402657902C672003-01-237000000EXPANSION OF ASSISTED LIVING FACILITY000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsCapitalized InterestCapitalizedInterestIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCredit EnhancementCreditEnhancementCapital ExpendituresCapitalExpenditures
55344091473322251320100011
1400002004001186156851385

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
000010.000000.000000.000001
000011

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

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

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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.
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 12C
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 B, LINE 15
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMETNS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.FORM 990, PART XII, LINE 2C: