2012-03-30T15:06:22-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-10-01 566065223 CORNELIA NIXON DAVIS INC CORN 9106867195 1011 PORTERS NECK RD WILMINGTON NC 28405 CHARLES LONG 9106867195 2012-03-30 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z DAVIS HEALTH CARE CENTER CHARLES LONG 1011 PORTERS NECK RD WILMINGTON NC 28405 24829137 0 X WWW.THEDAVISCOMMUNITY.ORG X 1966 NC TO PROVIDE QUALITY HEALTH, REHABILITATION, AND WELLNESS SERVICES TO AGING ADULTS. 13 13 540 85 0 0 349883 85568 21179018 24298488 123994 101597 378064 269609 22030959 24755262 0 0 0 0 11855897 12420955 0 0 1000 7999014 9175458 19854911 21596413 2176048 3158849 41395626 42318538 19364379 17128442 22031247 25190096 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 14075703 18140605 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%. 4225686 5999030 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%. 61964 158853 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. 18363353 1 1 0 0 0 0 0 0 1 1 0 0 0 0 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 0 0 0 0 0 0 0 0 0 0 1 121 0 540 1 0 0 0 0 0 0 0 0 X 13 13 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 WALKER TAYLOR III 1.00 X 0 0 0 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 161240 0 10860 161240 0 10860 1 0 1 0 GENESIS REHABILITATION SERVICE PO BOX 7247-6524 PHILADELPHIA PA 19170 THERAPY SERVICES 2640442 BLUE CROSS BLUE SHIELD PO BOX 2291 DURHAM NC 27702 INSURANCE PROVIDER 1515541 RX SERVICE PO BOX 740391 CINCINNATI OH 45274 RX CONTRACTOR 599192 US FOOD SERVICE 9399 WEST HIGGINS ROAD ROSEMONT IL 60018 FOOD SUPPLIER 520819 MCKESSON MEDICAL 4411 LEATHERWOOD DR WILMINGTON NC 28412 HEALTH CARE SERVICES 389777 21 85568 85568 RESIDENT SERVICE 623000 24298488 24298488 24298488 101597 101597 114310 73875 40435 40435 40435 PERSONAL CARE 900099 96787 96787 EMPLOYEE MEALS 900099 59992 59992 72395 72395 229174 24755262 24298488 0 371206 172100 172100 8833238 7898864 934374 150400 130842 19558 2275181 1835144 440037 990036 860718 129318 3431 3431 52862 52862 2709276 2628443 80833 131725 373 131352 185829 2923 182906 46207 46207 723119 723119 59526 11951 47575 45752 45752 1333602 1305244 28358 354345 354345 PROGRAM SUPPLIES 1557241 1557241 DIETARY SUPPLIES 832607 832607 BED TAX ASSESSMENT 354613 354613 BAD DEBT EXPENSE 200665 200665 584658 375219 208439 1000 21596413 18363353 3232060 1000 4122652 5022979 8980721 9158688 1829030 1970376 108290 101397 209121 213422 42668303 17417944 25371802 25250359 774010 601317 41395626 42318538 2979869 1598976 14510 4466 16370000 15525000 19364379 17128442 X 21958517 25123878 11910 11218 60820 55000 22031247 25190096 41395626 42318538 3158849 0 X X 0 1 1 X 0 X 699822 1132999 1886389 349883 85568 4154661 18159340 19858997 20069035 21179018 24298488 103564878 18859162 20991996 21955424 21528901 24384056 107719539 320000 895000 1800000 50000 3065000 0 320000 895000 1800000 50000 3065000 104654539 380489 325892 244342 123758 101597 1176078 380489 325892 244342 123758 101597 1176078 142182 219947 202834 378300 269609 1212872 19381833 21537835 22402600 22030959 24755262 110108489 0.95050 0.94280 0.01070 0.01390 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 61065 270 61335 55245 5309 511 61065 130280 75407 152 150594 55245 0.90000 0.10000 0 0 2889007 2889007 32913163 12741578 20171585 0 5124716 3691823 1432893 1741417 984543 756874 25250359 24755262 21596413 3158849 0 3158849 24836705 28157 28157 24808548 -53286 -53286 24755262 21670288 73875 73875 21596413 0 21596413 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. X X X X X 0 0 0 1 0 0 0 0 0 CHARLES LONG 129954 0 31286 0 0 0 0 0 10860 0 172100 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 0 0 0 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657902C67 2003-01-23 7000000 EXPANSION OF ASSISTED LIVING FACILITY 0 0 0 5534409 14733 222513 2010 0 0 1 1 140000 8615 6851385 2004 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 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: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.