2011-08-15T16:14:35-05:00 2010-12-31 LARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-01-01 570647976 ROLLING GREEN VILLAGE ROLL 8649879800 1 HOKE SMITH BLVD GREENVILLE SC 29615 LYNNE LENTZ 8649879800 2011-05-25 1 7049985200 2010 2016-02-24 21:20:13Z ERIC DUDASKO 1 HOKE SMITH BLVD GREENVILLE SC 29615 9872714 0 X WWW.ROLLINGGREENVILLAGE.COM X 1977 SC TO OPERATE A RESIDENTIAL RETIREMENT COMMUNITY IN A SECURE, CARING ENVIRONMENT. 13 13 305 30 0 0 7431 17890 11167980 11656452 93531 68620 0 -1870248 11268942 9872714 0 0 0 0 5241818 5483766 0 0 0 5138971 5314701 10380789 10798467 888153 -925753 17281492 15505670 13473515 12638619 3807977 2867051 X THE MISSION OF ROLLING GREEN VILLAGE IS TO OPERATE A CONTINUING CARE RETIREMENT COMMUNITY IN A SECURE, CARING ENVIRONMENT TO PROMOTE THE HEALTH, WELLNESS, AND INDEPENDENCE OF THE COMMUNITY'S RESIDENTS. 0 0 8530661 11656452 THE LICENSED AREAS INCLUDE 24 HOUR CARE INCLUDING ASSISTANCE WITH BATHING, DRESSING, MEDICATION ADMINISTRATION, THREE WELL BALANCED MEALS EACH DAY WITH ACCOMODATIONS FOR SPECIAL DIETS WHEN PRESCRIBED BY A PHYSICIAN, WEEKLY HOUSEKEEPING WITH DAILY TIDYING OF APARTMENT FLAT, LAUNDRY AND PERSONAL LAUNDRY SERVICES, EMERGENCY CALL SYSTEM TO LICENSED NURSE AVAILABLE 24-HOURS, A DAY FULL ACTIVITIES PROGRAM, UTILITIES INCLUDING ELECTRICITY, GAS, WATER, SEWER, AND BASIC CABLE TELEVISION. MANY OTHER SERVICES ARE ALSO AVAILABLE AT AN ADDITIONAL CHARGE SUCH AS BEAUTY AND BARBER, ESCORTS TO PHYSICIAN APPOINTMENTS, PERSONAL AND MEDICAL SUPPLIES, AND GUEST MEALS. ROLLING GREEN VILLAGE'S ("RGV") ANNUAL SERVICE AGENDA COVERS CUSTOMER SERVICES, RESIDENT RIGHTS, SAFETY, HIPAA, INFECTION CONTROL, ABUSE REPORTING, SEXUAL HARASSMENT TRAINING, EMPLOYEE HANDBOOK AND BENEFITS. IN ADDITION, THE EMPLOYEE HANDBOOK OUTLINES AND DETAILS RGV'S BUSINESS PRACTICES, POLICIES AND PROCEDURES EACH DEPARTMENT ALSO HAS A QUALITY ASSURANCE MANUAL THAT THE DEPARTMENT HEADS MUST REVIEW AND APPROVE ANNUALLY. THE COMMUNITY OPERATES UNDER THE SUPERVISION OF THE SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS AND THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL. THE EXECUTIVE DIRECTOR ASSURES ALL STATE RULES AND REGULATIONS ARE FOLLOWED. THE COMMUNITY FILES AN ANNUAL STATEMENT WITH THE DEPARTMENT OF CONSUMER AFFAIRS. 8530661 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 38 0 305 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X LYNNE LENTZ 8649879800 1 HOKE SMITH BLVD GREENVILLE SC 29615 MARTIN ATKINS 5.00 X X 0 0 0 ROBBY DAVIS 3.00 X 0 0 0 DUKE MCCALL 5.00 X X 0 0 0 DAVID MURRAY 3.00 X 0 0 0 DANIEL PAGE 5.00 X 0 0 0 SYLVIA FRAZIER 3.00 X 0 0 0 ED BURRELL 3.00 X 0 0 0 JERRY WELMAKER 3.00 X 0 0 0 ROY CHAMLEE III 5.00 X 0 0 0 RONNIE COLSON 5.00 X 0 0 0 ERICKA SPLAWN 3.00 X 0 0 0 RICHARD SMITH 5.00 X X 0 0 0 DAVID HILL 5.00 X 0 0 0 ERIC DUDASKO 40.00 X 167709 0 0 KYLE EXLINE 40.00 X 67120 0 0 234829 0 0 1 0 1 1 LIFE CARE SERVICES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT FEES 598583 HERITAGE HC 536 OLD HOWELL ROAD GREENVILLE SC 29616 THERAPY SERVICES 268779 DONALD ALLISON PO BOX 176 PIEDMONT SC 29673 REFURBISHMENTS/REPAIRS 128959 3 17890 17890 FACILITY FEES 623000 6265628 6265628 RESIDENT FEES 623000 3197487 3197487 HOME FEES 623000 953100 953100 ENTRANCE FEES 623000 833721 833721 PATIENT MEMBERSHIP FEE 623000 182700 182700 223816 223816 11656452 68620 68620 PROJECT DISPOSAL LOSS 900099 -1870248 -1870248 -1870248 9872714 11656452 0 -1801628 234829 67111 167718 4436237 4030788 405449 17675 14882 2793 437773 376516 61257 357252 324238 33014 415379 415379 44566 44566 37120 37120 589665 473083 116582 294148 237189 56959 72029 13281 58748 71779 38302 33477 6647 4138 2509 1005536 492754 512782 26286 24852 1434 41965 11914 30051 8187 8187 1013551 1013551 127974 127974 FOOD SUPPLIES 732606 732606 MAINTENANCE & REPAIR 368842 327199 41643 MEDICAL SUPPLIES 186585 186585 DURABLE SUPPLIES 169532 153485 16047 102304 102304 10798467 8530661 2267806 0 1086233 2206288 1527954 1041476 532872 635452 31166 34712 298895 275390 25949044 15395242 13054250 10553802 140318 152952 609804 605598 17281492 15505670 696313 754729 5360490 5171096 6700000 6000000 716712 712794 13473515 12638619 X 3761567 2825594 46410 41457 3807977 2867051 17281492 15505670 X -925753 -15173 X X 0 1 1 X 0 X 5350 14061 94574 7431 17890 139306 5689787 10157761 10420356 11168980 11656452 49093336 5695137 10171822 10514930 11176411 11674342 49232642 2448 3045 5493 219728 219728 222176 3045 225221 49007421 60203 159960 107500 93531 68620 489814 60203 159960 107500 93531 68620 489814 24578 24578 5779918 10331782 10622430 11269942 11742962 49747034 0.98510 0.98240 0.00980 0.01080 X 280617 11692 20433 312742 258202 1445 20970 280617 258202 258202 1.00000 0 0 846417 846417 20183020 12378087 7804933 2528513 1550717 977796 2162291 1326116 836175 228803 140322 88481 10553802 PROSPECTIVE RESIDENT DEPOSITS 4000 INTEREST RATE SWAP INSTRUMENTS 689776 CAPITAL LEASE OBLIGATIONS 19018 712794 9872714 10798467 -925753 -15173 -15173 -940926 9862494 -15173 7153 -8020 9870514 2200 2200 9872714 10798467 0 10798467 0 10798467 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: BOARD DESIGNATED NET ASSETS PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 7,153. PART XII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 2,200. X X X 0 0 0 0 0 0 0 0 0 ERIC DUDASKO 123624 0 32085 0 12000 0 0 0 0 0 167709 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 LIFE CARE SERVICES ("LCS") MANAGES RGV. LCS IS A RECOGNIZED LEADER IN THE DEVELOPMENT AND MANAGEMENT OF CONTINUING CARE RETIREMENT COMMUNITIES WITH OVER 40 YEARS OF EXPERIENCE. THE EXECUTIVE DIRECTOR AND THE ADMINISTRATOR OF RGV ARE EMPLOYEES OF LIFE CARE SERVICES. THE REGIONAL ACCOUNTING DIRECTOR FOR LCS OVERSEES AND REVIEWS FINANCIAL STATEMENTS AND QUARTERLY RECONCILIATIONS. LCS ALSO PROVIDES SUPPORT SERVICES AND ALL FINANCIAL SOFTWARES USED. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED DURING THE MAY BOARD MEETING. PRIOR TO THAT MEETING, THE FINANCE COMMITTEE MET AND REVIEWED THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ROLLING GREEN VILLAGE HAS A CONFLICT OF INTEREST POLICY THAT THE BOARD OF TRUSTEES SIGN ANNUALLY. ROLLING GREEN VILLAGE ALSO CONDUCTS OIG CHECKS ON ALL VENDORS FOR MEDICARE FRAUD. THE ORGANIZATION HAS A POLICY THAT IS REVIEWED AT NEW EMPLOYEE ORIENTATION AND ON AN ANNUAL BASIS THAT STATES THAT EMPLOYEES ARE NOT PERMITTED TO WORK PRIVATELY FOR ANY RESIDENTS. FORM 990, PART VI, SECTION B, LINE 15 LIFE CARE SERVICES DETERMINES SALARIES AND BENEFITS FOR KEY OFFICERS BASED ON COMPARABLE WAGE AND SALARY SURVEYS. THESE SALARIES AND PERFORMANCE REQUIREMENTS ARE SHARED WITH THE TRUSTEES VIA THE ANNUAL BUDGETING PROCESS, AS WELL AS THE MANAGEMENT CONTRACT WITH LIFE CARE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE IN DIFFERENT WAYS. SOME OF THESE DOCUMENTS ARE AVAILABLE IN THE ROLLING GREEN VILLAGE LIBRARY AND OTHERS ARE AVAILABLE UPON REQUEST. ANNUAL AUDITED FIANCIAL STATEMENTS ARE PLACED IN THE RESIDENT LIBRARY EVERY YEAR AS THEY BECOME AVAILABLE FROM THE AUDIT FIRM. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -15,173. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.