2012-05-31T09:46:31-05:00 2011-09-30 BERNARD ROBINSON & COMPANY LLP PO BOX 19608 GREENSBORO NC 274199608 990 2010-10-01 566056582 UNITED CHURCH HOMES AND SERVICES UNIT 8284658006 100 LEONARD AVENUE NEWTON NC 28658 DOUGLAS FLEEGLE 8284658006 2012-05-31 1 LORY H KELLEY 3362944494 2012-05-30 2010 2016-02-24 21:20:13Z DOUGLAS FLEEGLE 100 LEONARD AVENUE NEWTON NC 28658 37220873 0 X WWW.UCHAS.ORG X 1961 NC CONTINUING CARE RETIREMENT COMMUNITY. 18 18 868 160 30058 -52447 0 0 30654018 32295659 1046792 3481194 1318580 1423724 33019390 37200577 181598 223746 0 0 19365639 20002907 0 0 0 15185714 16038119 34732951 36264772 -1713561 935805 87413857 86351581 54253503 56352262 33160354 29999319 X THE MISSION OF UNITED CHURCH HOMES AND SERVICES IS TO CARRY ON CHRISTIAN MINISTRY IN THE SOUTHERN CONFERENCE OF THE UNITED CHURCH OF CHRIST THAT ADDS LIFE TO THE YEARS OF THOSE WE SERVE BY PROVIDING SENIOR LIVING AND HEALTH RELATED COMMUNITIES, BENEVOLENCE ASSISTANCE AND SERVICE PROGRAMS OF OUTREACH INTO THE WIDER COMMUNITY. 0 0 29561191 35370742 UNITED CHURCH HOMES AND SERVICES OWNS AND OPERATES CONTINUING CARE RETIREMENT COMMUNITIES IN NEWTON ("ABERNETHY LAURELS") AND THOMASVILLE ("PIEDMONT CROSSING"), NORTH CAROLINA, CONSISTING OF RESIDENTIAL LIVING UNITS, ASSISTED LIVING UNITS AND NURSING FACILITIES PROVIDING ADULT CARE AND INTERMEDIATE AND SKILLED NURSING CARE, AND A SKILLED NURSING FACILITY IN LEXINGTON, NORTH CAROLINA ("CENTERCLAIR"). 29561191 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 11 0 1 868 1 1 1 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X GARY SHULL 8284658006 100 LEONARD AVENUE NEWTON NC 28658 STEVE A BALOG 1.00 X 0 0 0 DOUGLAS F BROWN 1.00 X 0 0 0 MARK L BURNS 1.00 X 0 0 0 DANIEL F DAGENHART 1.00 X 0 0 0 WALTER HOFFMAN 1.00 X 0 0 0 CHARLES W MOSS 1.00 X 0 0 0 JEFFREY GILLIAM 1.00 X X 0 0 0 J RAY DEAL 1.00 X X 0 0 0 ROBERT C CLAUD SR 1.00 X X 0 0 0 ANTHONY J BRANCH 1.00 X X 0 0 0 DWIGHT L HEDRICK JR 1.00 X X 0 0 0 GREGORY M ALCORN 1.00 X X 0 0 0 DAVID BOONE 1.00 X 0 0 0 JIM BUCHANAN 1.00 X 0 0 0 RALPH L HOWELL JR 1.00 X 0 0 0 BRENDA C ECKARD 1.00 X 0 0 0 LINDA MORRIS 1.00 X 0 0 0 MARK W SIGMON 1.00 X 0 0 0 DOUGLAS J FLEEGLE 40.00 X 238090 0 32734 GARY WAYNE SHULL 40.00 X 164530 0 24259 STEPHEN TIMOTHY PATERSON 40.00 X 143882 0 22251 LEE B SYRIA 40.00 X 129732 0 20294 DONNA BECK SPRINKLE 40.00 X 120671 0 16098 JOYCE BAUGUESS CLINE 40.00 X 115669 0 6918 MARY M WESLEY 40.00 X 119048 0 21778 1031622 0 144332 11 0 1 0 SELECT REHABILITATION INC 550 FRONTAGE ROAD NORTHFIELD IL 60093 THERAPIES 1888758 ACS BENEFIT SERVICES INC PO BOX 2000 WINSTONSALEM NC 27102 HEALTHCARE PROVIDER 849921 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPIES 203710 COORDINATED HEALTHCARE PROGRAMS LLC C/O QUANTUM HEALTH INC COLUMBUS OH 43235 HEALTHCARE CONSULTANT 157958 4 RESIDENT REVENUE 623000 32295659 32295659 32295659 1435762 1435762 11649 11649 11649 11649 2045432 2045432 2045432 2045432 0 7455 -7455 -7455 25277 12841 12436 12436 MANAGEMENT FEE 541200 699186 699186 OTHER REVENUE 623000 253279 253279 MEAL SALES/VENDING 722210 168576 168576 286053 77186 30058 178809 1407094 37200577 35370742 30058 1799777 223746 223746 459613 459613 14713484 11407777 3305707 513429 513429 2902420 2902420 1413961 1413961 27201 27201 95100 95100 163717 163717 980229 635941 344288 93912 884 93028 1663054 1663054 104709 2974 101735 55086 55086 1131956 1131956 3514194 3514194 558940 41567 517373 SUPPLIES 4039324 3949938 89386 FOOD 1435985 1435985 EQUIPMENT AND RENTAL MA 405126 67510 337616 OTHER EMPLOYEE EXPENSES 404615 299514 105101 WORKERS COMPENSATION CL 395567 7047 388520 969404 349294 620110 36264772 29561191 6703581 0 101569 459352 1919131 2013666 95341 85218 301849 213234 82074070 39829628 39925297 42244442 41783856 38599341 3286814 2736328 87413857 86351581 3035714 2702065 15403858 14664425 30552937 33650236 3435997 3618875 1824997 1716661 54253503 56352262 X 32413100 29299270 747254 700049 33160354 29999319 87413857 86351581 X 935805 -4096840 X 0 1 1 X 0 X 16173 16173 28056683 29115528 30833512 30680734 32320936 151007393 28072856 29115528 30833512 30680734 32320936 151023566 0 0 0 151023566 1555843 1538922 1267957 1211467 1447412 7021601 1555843 1538922 1267957 1211467 1447412 7021601 1497694 1313260 1336981 1300624 1407094 6855653 31126393 31967710 33438450 33192825 35175442 164900820 0.91580 0.91540 0.04260 0.04150 X 1044781 1044781 65551965 32542103 33009862 8932814 6470126 2462688 6544510 817399 5727111 42244442 RESIDENT PERSONAL FUNDS LIABILITY 29650 REFUNDS PAYABLE 46061 ADVANCE DEPOSITS 442257 RESIDENT ESCROWS 753444 OTHER PAYABLES 69531 CHECKS IN EXCESS OF DEPOSITS 375718 1716661 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IT IS THE ORGANIZATION'S POLICY TO EVALUATE ALL TAX POSITIONS TO IDENTIFY ANY THAT MAY BE CONSIDERED UNCERTAIN. ALL IDENTIFIED MATERIAL TAX POSITIONS ARE ASSESSED AND MEASURED BY A "MORE-LIKELY-THANNOT" THRESHOLD TO DETERMINE IF THE TAX POSITION IS UNCERTAIN AND WHAT, IF ANY, THE EFFECT OF THE UNCERTAIN TAX POSITION MAY HAVE ON THE FINANCIAL STATEMENTS. NO MATERIAL UNCERTAIN TAX POSITIONS WERE IDENTIFIED FOR 2011 AND 2010. 1 BENEVOLENT ASSISTANCE FOR RESIDENTS WHO ARE UNABLE TO PAY FOR CONTINUING CARE AT THE RESIDENTIAL FACILITIES OPERATED BY UNITED CHURCH HOMES AND SERVICES. EIGHT PRIMARY RESIDENTS RECEIVED BENEVOLENT FUNDS, AND MANY RESIDENTS RECEIVED BLOCK GRANTS. BLOCK GRANTS ARE ASSISTANCE PROVIDED TO MULTIPLE RESIDENTS IN NEED. 8 223746 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE BENEVOLENT ASSISTANCE FUNDS ARE MANAGED BY THE ORGANIZATION'S FINANCE PERSONNEL TO COVER THE EXPENSES OF INDIGENT RESIDENTS. THE ASSISTANCE IS DISBURSED ON AN AS NEEDED CASE BY CASE BASIS. X X X X 0 0 0 0 0 0 0 0 0 DOUGLAS J FLEEGLE 238090 0 0 0 0 0 19521 0 13213 0 270824 0 0 0 GARY WAYNE SHULL 164530 0 0 0 0 0 16530 0 7729 0 188789 0 0 0 STEPHEN TIMOTHY PATERSON 143882 0 0 0 0 0 17843 0 4408 0 166133 0 0 0 LEE B SYRIA 129732 0 0 0 0 0 13153 0 7141 0 150026 0 0 0 NC MEDICAL CARE COMMISSION 521309402 2005-04-21 13755000 FINANCING EXPANSION 0 0 0 NC MEDICAL CARE COMMISSION 521309402 2005-04-21 5000000 FINANCING EXPANSION 0 0 0 NC MEDICAL CARE COMMISSION 521309402 2010-12-21 23225000 SEE PART V 0 0 0 13755000 233592 13521408 2007 0 0 1 1 5000000 84912 4915088 2007 0 0 1 1 15155101 23225000 353708 3915979 3800212 1 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE BOARD'S FINANCE COMMITTEE BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND EMPLOYEES OF THE ORGANIZATION HAVE AN OBLIGATION TO CONDUCT BUSINESS WITHIN GUIDELINES THAT PROHIBIT ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. ALL EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO EVALUATE COMPLIANCE WITH CONFLICT OF INTEREST POLICY ANNUALLY AND DISCLOSE ANY POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT IS DETERMINED BY THE BOARD'S EXECUTIVE COMMITTEE. THE PROCESS FOR DETERMINING COMPENSATION INCLUDES SALARY SURVEYS OF SIMILAR ORGANIZATIONS ACROSS THE COUNTRY AS WELL AS THE USE OF COMPARABILITY DATA. COMPENSATION OF OFFICERS AND KEY EMPLOYEES IS SUGGESTED BY THE CEO AND APPROVED BY THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE KEPT ON FILE AT THE ADMINISTRATION OFFICE AND ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -4,097,077. LAKE PRINCE CENTER INC 100 LEONARD AVENUE NEWTON NC 28658 562151716 CONTINUING CARE RETIREMENT COMMUNITY NC 501(C)(3) LINE 9 N/A 0 UNITED CHURCH HOMES AND SERVICES FOUNDATION 100 LEONARD AVENUE NEWTON NC 28658 562243082 FUND AND SUPPORT THE OPERATIONS & PROGRAMS OF UNITED CHURCH HOMES & SERVICES NC 501(C)(3) LINE 11A, I N/A 0 ALBEMARLE OLDER ADULT HOUSING INC 411 SOUTH FOURTH STREET ALBEMARLE NC 28001 800030872 PROVIDING AFFORDABLE HOUSING TO SENIOR CITIZENS NC 501(C)(3) LINE 9 N/A 0 NEW BERN OLDER ADULT HOUSING INCORPORATE 3800 LOFLAND WAY NEW BERN NC 28562 562133316 PROVIDING AFFORDABLE HOUSING TO SENIOR CITIZENS NC 501(C)(3) LINE 9 N/A 0 STATESVILLE ELDERLY HOUSING INC 700 WILS WAY STATESVILLE NC 28677 562192096 PROVIDING AFFORDABLE HOUSING TO SENIOR CITIZENS NC 501(C)(3) LINE 9 N/A 0 UCC LIVING CENTERS INCORPORATED 103 CULBREATH ROAD CHAPEL HILL NC 27516 561964906 PROVIDING AFFORDABLE HOUSING TO SENIOR CITIZENS NC 501(C)(3) LINE 9 N/A 0 0 0 1 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 UNITED CHURCH HOMES AND SERVICES FOUNDATION D 2022033 UNITED CHURCH HOMES AND SERVICES FOUNDATION O UNITED CHURCH HOMES AND SERVICES FOUNDATION N 213532 LAKE PRINCE CENTER INC E 1579956 LAKE PRINCE CENTER INC K 594828 LAKE PRINCE CENTER INC N 3044879 ALBEMARLE OLDER ADULT HOUSING INC N 51359 NEW BERN OLDER ADULT HOUSING INCORPORATED D 133047 NEW BERN OLDER ADULT HOUSING INCORPORATED N 72574 STATESVILLE ELDERLY HOUSING INC N 59521 UCC LIVING CENTERS INCORPORATED N 65911