STRATEGY STUDIO / PUBLIC DATA EXPLORER

CAROLINA VILLAGE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CAROLINA VILLAGE INC (EIN 23-7179679)
Tax period
2010-04-01 to 2011-03-31
Filed
2011-11-02
IRS object ID
201113069349300516
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)
Timestamp2011-11-02T09:45:30-05:00Timestamp
Tax Period End Date2011-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237179679EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CAROLINA VILLAGE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCARONameControl
Phone8286926275Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 CAROLINA VILLAGE ROADAddressLine1
CityHENDERSONVILLECity
StateNCState
ZIP Code28792ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBRUCE D BELLName
TitleCFOTitle
Phone8286926275Phone
Date Signed2011-11-02DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKEVIN PARRIESNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1600 CAROLINA VILLAGE ROADAddressLine1
CityHENDERSONVILLECity
StateNCState
ZIP Code28792ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19001570GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CAROLINAVILLAGE.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTO MAINTAIN AND OPERATE A RETIREMENT HOME, MEDICAL CENTER, AND ASSISTED LIVING CENTER.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees353TotalNbrEmployees
Total Nbr Volunteers125TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year289922ContributionsGrantsPriorYear
Contributions Grants Current Year210254ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15318154ProgramServiceRevenuePriorYear
Program Service Revenue CY18384469ProgramServiceRevenueCY
Investment Income Prior Year-44892InvestmentIncomePriorYear
Investment Income Current Year377626InvestmentIncomeCurrentYear
Other Revenue Prior Year27774OtherRevenuePriorYear
Other Revenue Current Year29221OtherRevenueCurrentYear
Total Revenue Prior Year15590958TotalRevenuePriorYear
Total Revenue Current Year19001570TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year16250GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7999738SalariesEtcPriorYear
Salaries Etc Current Year9384132SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8424570OtherExpensePriorYear
Other Expenses Current Year10885126OtherExpensesCurrentYear
Total Expenses Prior Year16440558TotalExpensesPriorYear
Total Expenses Current Year20269258TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-849600RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1267688RevenuesLessExpensesCY
Total Assets BOY82020287TotalAssetsBOY
Total Assets EOY73058142TotalAssetsEOY
Total Liabilities BOY82544688TotalLiabilitiesBOY
Total Liabilities EOY74731473TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-524401NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-1673331NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCAROLINA VILLAGE IS A NOT FOR-PROFIT FULL-SERVICE RETIREMENT FACILITY FOR SENIOR CITIZENS WITH A MISSION TO PROVIDE HOUSING, CONTINUING LIFE CARE, UP-TO-DATE SERVICE, AND A PLEASANT, CONGENIAL SOCIAL ENVIRONMENT TO ENCOURAGE PERSONAL GROWTH AND COMMUNITY PARTICIPATION WITHOUT REGARD TO RACE OR RELIGIOUS PERSUASION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense16684448Expense
Revenue18384469Revenue
DescriptionCAROLINA VILLAGE SERVES 474 RESIDENTS IN DIRECT HEALTH CARE NEEDS, MEALS, HOUSING, AND TRANSPORTATION. IN THE PAST YEAR WE HAVE SERVED 32,772 DAYS OF DIRECT PATIENT CARE IN OUR HOME FOR THE AGED AND SKILLED NURSING CARE FACILITIES. ON OUR CAMPUS WE PROVIDE MEDICARE SERVICES INCLUDING, BUT NOT LIMITED TO, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY. OUR RESIDENTS RECIEVE BENEFITS FROM OUR COMPREHENSIVE WELLNESS PROGRAM ORGANIZED AND COORDINATED BY A FACILITY STAFF MEMBER. THE WELLNESS PROGRAM INCLUDES EIGHT FACETS OF WELLNESS: PHYSICAL, SPIRITUAL, ENVIRONMENTAL, SOCIAL, VOCATIONAL, INTELLECTUAL, EMOTIONAL, AND NUTRITIONAL. WE PUBLISH A 12 PAGE MONTHLY NEWSLETTER PRODUCED AND DISTRIBUTED BY A COMBINATION OF RESIDENTS AND FACILITY STAFF. THROUGH OUR QUALITY FIRST PROGRAM WE HAVE GIVEN BACK TO THE COMMUNITY THROUGH FOOD DRIVES, SCHOOL SUPPLY DRIVES, BENEFIT DINNERS, AND OTHER MONETARY GIFTS. WE HAVE PARTNERED WITH THE HENDERSON COUNTY COUNCIL ON AGING, SPECIAL OLYMPICS, MANNA FOOD BANK, UNITED WAY, AND OTHER LOCAL NON-PROFIT ORGANIZATIONS. CAROLINA VILLAGE PROVIDES 30 MEALS PER DAY, 5 DAYS A WEEK TO THE LOCAL CONGREGRATE MEAL SITE IN ASSOCIATION WITH THE HENDERSON COUNTY MEALS-ON-WHEELS PROGRAM.Description
Total Program Service Expense16684448TotalProgramServiceExpense
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 Liabilities1ReportOtherLiabilities
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 Individuals1GrantsToIndividuals
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 Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
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 With109618NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees353NumberOfEmployees
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
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
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 Body1Form990ProvidedToGoverningBody
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
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BRUCE BELL CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8286926275TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1600 CAROLINA VILLAGE ROADAddressLine1
CityHENDERSONVILLECity
StateNCState
ZIP Code28792ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
MARCIA CASERIO
PRESIDENT1.50XX000
KOHLAN FLYNN
INTERNAL VICE-PRESIDENT1.50XX000
DANNY WILLIAMS
EXTERNAL VICE-PRESIDENT1.50XX000
TERRY ANDERSON
TREASURER1.50XX000
JIM CRAFTON
ASSISTANT TREASURER1.50XX000
MARY LOUISE CORN
SECRETARY1.50XX000
CHARLES WATERS
ASSISTANT SECRETARY1.50XX000
WILLIAM FOLWELL
BOARD MEMBER1.50X000
FRANK BYRD
BOARD MEMBER1.50X000
MIKE COOPER
BOARD MEMBER1.50X000
DAVID G KELLY JR MDIV
BOARD MEMBER1.50X000
MARIAN LOWRY
BOARD MEMBER1.50X000
NICK PENCE
BOARD MEMBER1.50X000
JOHN SAMS
BOARD MEMBER1.50X000
CHERYL SMITH
BOARD MEMBER1.50X000
NELDA ORR
BOARD MEMBER1.50X000
WILLIAM MEDINA MD
IMMEDIATE PAST PRESIDENT1.50X000
KEVIN PARRIES
CEO40.00X14477203699
BRUCE BELL
CFO40.00X139588022301
VELDA CAPPS
HEALTH SERVICES DIR40.00113164010489X
FieldValueIRS element (for citing)
Total Reportable Comp From Org397524TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation36489TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1COOPER CONSTRUCTIONBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1761 SOUTH ALLEN ROADAddressLine1
CityFLAT ROCKCity
StateNCState
ZIP Code28731ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCONSTRUCTIONDescriptionOfServices
Compensation110184Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions210254AllOtherContributions
Noncash Contributions32850NoncashContributions
Total Contributions210254TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
APARTMENT REVENUE6230001056680910566809
MEDICAL CENTER62300042071274207127
DIETARY62300019474961947496
DIETARY - MED CTR623000956986956986
CARE CENTER623000706051706051
FieldValueIRS element (for citing)
Total Program Service Revenue18384469TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column146878TotalRevenueColumn
Exclusion$146,878ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities230748Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities230748Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column230748TotalRevenueColumn
Exclusion$230,748ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column29221TotalRevenueColumn
Exclusion$29,221ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue29221TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column19001570TotalRevenueColumn
Related Or Exempt Function Income18384469RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$406,847ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7123883Total
Program Services6209289ProgramServices
Management And General914594ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total75636Total
Program Services75636ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1641033Total
Program Services1641033ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total543580Total
Program Services543580ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1375Total
Management And General1375ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total52870Total
Management And General52870ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total113696Total
Program Services113696ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3852576Total
Program Services3657488ProgramServices
Management And General195088ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10120Total
Program Services10120ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1258953Total
Program Services1254512ProgramServices
Management And General4441ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total2182Total
Management And General2182ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total34044Total
Program Services29397ProgramServices
Management And General4647ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2409613Total
Management And General2409613ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1988192Total
Program Services1988192ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total10628Total
Program Services10628ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
THERAPY EXPENSE10029581002958
BAD DEBT6656566565
ANNUITY EXPENDITURES4740547405
MISCELLANEOUS3394933949

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total20269258Total
Program Services16684448ProgramServices
Management And General3584810ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7000BOY
EOY7000EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5031801BOY
EOY6144602EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1352497BOY
EOY1168915EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY122719BOY
EOY131473EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY248216BOY
EOY183797EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis75582337LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec19784719LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY56625771BOY
EOY55797618EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17872565BOY
EOY8752329EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY759718BOY
EOY872408EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY82020287BOY
EOY73058142EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2194842BOY
EOY2214262EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY29213589BOY
EOY31672804EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY49173202BOY
EOY38780425EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY76196BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1886859BOY
EOY2063982EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY82544688BOY
EOY74731473EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-1521375BOY
EOY-2745567EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY684782BOY
EOY760044EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY312192BOY
EOY312192EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-524401BOY
EOY-1673331EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY82020287BOY
EOY73058142EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1267688ReconcilationRevenueExpenses
Reconcilation Other Changes118758ReconcilationOtherChanges
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 Years774955CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years624909CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years218414CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year289922CurrentTaxYearMinus1Year
Current Tax Year210254CurrentTaxYear
Total2118454Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11900427CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12454910CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12999735CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15318154CurrentTaxYearMinus1Year
Current Tax Year18384469CurrentTaxYear
Total71057695Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12675382CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13079819CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13218149CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15608076CurrentTaxYearMinus1Year
Current Tax Year18594723CurrentTaxYear
Total73176149Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50973176149PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years255089CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years216995CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years196697CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year70224CurrentTaxYearMinus1Year
Current Tax Year146878CurrentTaxYear
Total885883Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years255089CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years216995CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years196697CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year70224CurrentTaxYearMinus1Year
Current Tax Year146878CurrentTaxYear
Total885883Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years116316CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years168214CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years28579CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year27774CurrentTaxYearMinus1Year
Current Tax Year29221CurrentTaxYear
Total370104Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13046787CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13465028CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13443425CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15706074CurrentTaxYearMinus1Year
Current Tax Year18770822CurrentTaxYear
Total74432136Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98310PublicSupportPercentage509
Prior Year Support Percentage0.98060PriorYearSupportPercentage
Investment Income Percentage0.01190InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01320PriorYrInvestIncomePercentage
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 Balance402997BeginningOfYearBalance
Investment Earnings Or Losses52575InvestmentEarningsOrLosses
Other Expenditures19500OtherExpenditures
End Of Year Balance436072EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance323960BeginningOfYearBalance
Investment Earnings Or Losses95287InvestmentEarningsOrLosses
Other Expenditures16250OtherExpenditures
End Of Year Balance402997EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.28410BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.71590PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1513495OtherCostOrOtherBasis
Book Value1513495BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis62448572OtherCostOrOtherBasis
Depreciation16704754Depreciation
Book Value45743818BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis6841789OtherCostOrOtherBasis
Depreciation1830152Depreciation
Book Value5011637BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4672267OtherCostOrOtherBasis
Depreciation1249813Depreciation
Book Value3422454BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis106214OtherCostOrOtherBasis
Book Value106214BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings55797618TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
GIFT/CHAR. REMAINDER TRUST ANNUITIES PAYABLE$378,926
FAIR VALUE OF SWAP AGREEMENT$1,685,056
FieldValueIRS element (for citing)
Total Of Amounts2063982TotalOfAmounts
Total Revenue19001570TotalRevenue
Total Expenses20269258TotalExpenses
Excess Or Deficit For Year-1267688ExcessOrDeficitForYear
Net Unrealized GL On Investments307304NetUnrealizedGLOnInvestments
Other-$188,546OtherAmount
Total Adjustments118758TotalAdjustments
Excess Or Deficit Per FS-1148930ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt19120328TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments307304NetUnrealizedGainsInvestments
Other Revenues30250OtherRevenues
Revenue Not Rptd F990337554RevenueNotRptdF990
Revenue Subtotal18782774RevenueSubtotal
Other Revenues Not Included218796OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt218796RevenueNotRptdOnFinStmt
Total Revenue Per Form99019001570TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt20269258TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal20269258ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99020269258TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE CAROLINA VILLAGE ENDOWMENT FUND WAS ESTABLISHED TO RECEIVE GIFTS, DEVISES, BEQUESTS, AND OTHER CONVEYANCES AND TO USE THEM FOR PROPERTY MAINTENANCE OR IMPROVEMENT PROJECTS, OR TO PROVIDE ECONOMIC ASSISTANCE TO RESIDENTS OR TO PERSONS DESIRING TO BE RESIDENTS. THE ENDOWMENT FUNDS INCLUDE DONOR-RESTRICTED FUNDS CLASSIFIED AS PERMANENTLY RESTRICTED, AND THE EARNINGS, INCLUDING NET APPRECIATION, ON THESE FUNDS THAT ARE TO BE SPENT ON THOSE PURPOSES WHICH ARE CLASSIFIED AS TEMPORARILY RESTRICTED. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES IN THE UNITED STATES OF AMERICA, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE VILLAGE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE VILLAGE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF MARCH 31, 2011. FISCAL YEARS ENDED ON OR AFTER MARCH 31, 2008, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
PART XI, LINE 8 - OTHER ADJUSTMENTS:UNREALIZED GAIN ON SWAP AGREEMENT -218,796. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 30,250.
PART XII, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 30,250.
PART XII, LINE 4B - OTHER ADJUSTMENTS:UNREALIZED LOSS ON SWAP AGREEMENT 218,796.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients9NumberOfRecipients
Amount Of Cash Grant19500AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: TO RECEIVE A SCHOLARSHIP, AN APPLICANT MUST SUBMIT AN APPLICATION INCLUDING A NARRATIVE DESCRIBING HIS EDUCATION AND FUTURE PLANS. THE SCHOLARSHIP COMMITTEE, CONSISTING OF STAFF, RESIDENTS, AND BOARD OF DIRECTORS, REVIEWS THE APPLICATIONS AND DETERMINES WHO WILL RECEIVE A SCHOLARSHIP AND THE AMOUNT GIVEN. AN APPROVED SCHOLARSHIP IS THEN PAID DIRECTLY TO THE EDUCATIONAL INSTITUTION AND COVERS ONLY TUITION. IF THE RECIPIENT DOES NOT ATTEND OR COMPLETE THE ACADEMIC YEAR THE SCHOLARSHIP IS REFUNDED BY THE INSTITUTION.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
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 PersonBRUCE BELLNamePerson
Base Compensation Filing Org139588BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org13226DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org9075NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org161889TotalCompensationFilingOrg
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 4BReturnReference
ExplanationBRUCE BELL RECEIVED $13,226 IN COMPENSATION FROM A SUPPLEMENTAL NONQUALIFIED REIREMENT PLAN.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
52130940265820YHR02008-02-2819575000SERIES 2008A; REFUNDING, CONSTRUCTION AND EQUIPMENT000
NORTH CAROLINA MEDICAL CARE COMMISSION
52130940265820YHS82008-02-2825000000SERIES 2008B AND C; REFUNDING, CONSTRUCTION AND EQUIPMENT000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetiredCredit EnhancementCreditEnhancement
19358147112002141500247872820101001
2500000050000021383796092902010100110000000146624

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001

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
000010
010010

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1COOPER CONSTRUCTIONBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipENTITY OWNED 50% BY BOARD MEMBER MIKE COOPERRelationship
Amount Of Transaction110184AmountOfTransaction
Description Of TransactionCOOPER CONSTRUCTION HAS BEEN ENGAGED BY THE ORGANIZATION FOR A MULTI-YEAR CONSTRUCTION PROJECT. MIKE COOPER, A CURRENT BOARD MEMBER, IS THE EXECUTIVE VICE PRESIDENT OF AND OWNS 50% OF COOPER CONSTRUCTION. TO PREVENT A CONFLICT OF INTEREST, MR. COOPER WAS REMOVED FROM ALL STRATEGIC PLANNING MEETINGS REGARDING CONCEPT AND DESIGN. HE ALSO WAS NOT INVOLVED IN ANY MEETINGS WITH THE ARCHITECT PRIOR TO THE MATERIALS GOING OUT FOR BID. THE BID PROCESS WAS A BLIND BID TO THE BOARD. THE BIDS WERE RECEIVED IN SEALED ENVELOPES, OPENED DURING A CLOSED MEETING; EACH BID WAS ASSIGNED A NUMERICAL IDENTIFICATION. THE ONLY INFORMATION THE BOARD RECEIVED WAS THE NUMERICAL IDENTIFICATION NUMBER AND THE TOTAL AMOUNT OF BID. THE LOWEST BID WAS AWARDED THE PROJECT. COOPER CONSTRUCTION WAS THE LOWEST BID RECEIVED ON THE ASSISTED LIVING PROJECT. ANOTHER UNRELATED ENTITY WAS AWARDED THE PROJECT FOR THE 63 INDEPENDENT LIVING APARTMENTS.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99010350NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionWELLNESS EQUIPMENTDescription
Number Of Contributions2NumberOfContributions
Noncash Contribs Rptd F99022500NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DISTRIBUTED TO THE MEMBERS OF THE BOARD OF DIRECTORS. THE FINANCE COMMITTEE FORMALLY REVIEWED THE RETURN, AND RECOMMENDED TO THE FULL BOARD THAT THE RETURN BE APPROVED BEFORE FILING WITH THE IRS.
CAROLINA VILLAGE POLICY COMMITTEE REVIEWS THE POLICY ON AN ANNUAL BASIS AND MAKES ANY RECOMMENDATIONS TO THE BOARD OF DIRECTORS FOR ANY UPDATES AND CHANGES. THE EXECUTIVE DIRECTOR ENSURES EACH MEMBER OF THE BOARD RECEIVES REVIEWS AND SIGNS A COPY OF THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. THE EXECUTIVE COMMITTEE AND EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR ENFORCING THE POLICY WITH EACH MEMBER. IF A SITUATION ARISES IN WHICH CONFLICT OF INTEREST IS POSSIBLE THE BOARD MEMBER(S) INVOLVED WILL REMOVE THEMSELVES DURING ANY DISCUSSIONS AND ABSTAIN FROM ANY VOTING. THE MINUTES OF THE BOARD WILL REFLECT THE PROCESS AND ADDITIONAL INFORMATION.FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION FOLLOWS THE PROCESS DESCRIBED IN TREASURY REGULATION 4958(C) FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS IN THE REVIEW, APPROVAL, AND DOCUMENTATION OF OFFICER AND KEY EMPLOYEE COMPENSATION. A COMMITTEE APPOINTED BY THE BOARD OF DIRECTORS EXAMINES DATA FROM THE FORMS 990 FROM VARIOUS SIMILARLY-SITUATED ORGANIZATIONS IN LIKE-SIZED COMMUNITIES AND ESTABLISHES COMPENSATION PACKAGES FOR THE CEO AND CFO.FORM 990, PART VI, SECTION B, LINE 15
PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE OR THE CAROLINA VILLAGE LIBRARY. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG.FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUENTS ARE AVAILABLE ON THE NORTH CAROLINA DEPARTMENT OF INSURANCE WEBSITE, AS WELL AS AVAILABLE FOR VIEWING AT THE CAROLINA VILLAGE LIBRARY.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 307,304. UNREALIZED GAIN ON SWAP AGREEMENT -218,796. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 30,250. TOTAL TO FORM 990, PART XI, LINE 5: 118,758.FORM 990, PART XI, LINE 5: