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FRIENDS HOMES INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
FRIENDS HOMES INC (EIN 56-0754599)
Tax period
2010-10-01 to 2011-09-30
Filed
2011-12-12
IRS object ID
201123469349300257
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)
Timestamp2011-12-12T13:00:44-06:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Turlington and Company LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1697AddressLine1
CityLexingtonCity
StateNCState
ZIP Code272931697ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN560754599EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Friends Homes IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFRIENameControl
Phone3362928187Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1925 New Garden RoadAddressLine1
CityGreensboroCity
StateNCState
ZIP Code27410ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWilson SheldonName
TitleExecutive DirectorTitle
Phone3362928187Phone
Date Signed2011-12-01DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameMarcia W HenriksenName
Phone3362496856Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonWilson SheldonNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1925 New Garden RoadAddressLine1
CityGreensboroCity
StateNCState
ZIP Code27410ZIPCode
FieldValueIRS element (for citing)
Gross Receipts26110798GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitefriendshomes.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1958YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTo establish and operate continuing care retirement communities in accordance with the principles of the Religious Society of Friends. These principles require that our communities provide, at a reasonable cost, an environment which fosters independence and a sense of wholeness, health, and security so that each resident may realize his or her full potential. In doing so we facilitate the basic Quaker principle that "there is God in every person," meaning that everyone has worth and value. Through continuous improvement and expansion, the organization will provide affordable services to the aged and support to the community at large. We accept the responsibility to promote consistent quality care while providing a HOME for our residents.ActivityOrMissionDescription
Nbr Voting Members Governing Body25NbrVotingMembersGoverningBody
Nbr Independent Voting Members25NbrIndependentVotingMembers
Total Nbr Employees403TotalNbrEmployees
Total Nbr Volunteers366TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year186299ContributionsGrantsPriorYear
Contributions Grants Current Year426574ContributionsGrantsCurrentYear
Program Service Revenue Prior Year22599845ProgramServiceRevenuePriorYear
Program Service Revenue CY23478229ProgramServiceRevenueCY
Investment Income Prior Year478049InvestmentIncomePriorYear
Investment Income Current Year359916InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year23264193TotalRevenuePriorYear
Total Revenue Current Year24264719TotalRevenueCurrentYear
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 Year11445855SalariesEtcPriorYear
Salaries Etc Current Year11747647SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10549242OtherExpensePriorYear
Other Expenses Current Year11094116OtherExpensesCurrentYear
Total Expenses Prior Year21995097TotalExpensesPriorYear
Total Expenses Current Year22841763TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1269096RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1422956RevenuesLessExpensesCY
Total Assets BOY78532071TotalAssetsBOY
Total Assets EOY77174697TotalAssetsEOY
Total Liabilities BOY57308755TotalLiabilitiesBOY
Total Liabilities EOY55163234TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY21223316NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY22011463NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide nursing and residential care and other support services to the elderly.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense19728951Expense
Revenue23478229Revenue
DescriptionThere are 10 cottages, 361 apartments, 90 assisted care beds and 109 nursing beds.Description
Total Program Service Expense19728951TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
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 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 With1096126NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees403NumberOfEmployees
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 Members25NbrVotingGoverningBodyMembers
Number Independent Voting Members25NumberIndependentVotingMembers
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 Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Wilson SheldonBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3362928187TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1925 New Garden RoadAddressLine1
CityGreensboroCity
StateNCState
ZIP Code27410ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per WeekAverageHoursPerWeekKey EmployeeKeyEmployee
Jack Kirk
Board MemberX000
Dick Coe
SecretaryX000
Ed Harris
Board MemberX000
Mark Farlow
Board MemberX000
Dale Brent McKinney
Board MemberX000
Sarah Johnson
Board MemberX000
Martha Jo Jones
Board MemberX000
David Millikan
Board MemberX000
Janie Edgerton
Board MemberX000
Carolyn McPherson
Board MemberX000
Clark English
Vice-chairX000
Jim Newlin
Board MemberX000
Scott Wagoner
Board MemberX000
Carl Semmler
Board MemberX000
Gwen Taylor
Board MemberX000
Terri Harris
Board MemberX000
Daniel Thames
Board MemberX000
Lawrence Ross
Board MemberX000
Brenda Shelton
Board MemberX000
Dan Allen
TreasurerX000
Mary Farlow
Board MemberX000
Carole Hunter
Board MemberX000
Sara Beth Terrell
Board MemberX000
Jon Mitchell
Board MemberX000
Tom Wright
ChairX000
Wilson Sheldon Jr
CEO1628750040.00X
FieldValueIRS element (for citing)
Total Reportable Comp From Org162875TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions426574AllOtherContributions
Noncash Contributions22572NoncashContributions
Total Contributions426574TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionResident servicesDescription
Business Code623000BusinessCode
Total Revenue Column23478229TotalRevenueColumn
Related Or Exempt Function Income23478229RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue23478229TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column475544TotalRevenueColumn
Exclusion$475,544ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1730451Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1846079Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-115628Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-115628TotalRevenueColumn
Exclusion-$115,628ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column24264719TotalRevenueColumn
Related Or Exempt Function Income23478229RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$359,916ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10708569Total
Program Services9437734ProgramServices
Management And General1270835ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total271212Total
Program Services232631ProgramServices
Management And General38581ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total767866Total
Program Services689387ProgramServices
Management And General78479ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total14793Total
Management And General14793ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total73084Total
Management And General73084ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total82926Total
Program Services82926ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total164776Total
Program Services86952ProgramServices
Management And General77824ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total51516Total
Program Services43741ProgramServices
Management And General7775ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1159195Total
Program Services1047075ProgramServices
Management And General112120ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1971734Total
Program Services1873147ProgramServices
Management And General98587ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Dietary18160851816085
Insurance17506341635608115026
Utilities1068889108662960227
Supplies77338072652946851
Repairs & maintenance695805695805

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1471299Total
Program Services1252669ProgramServices
Management And General218630ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22841763Total
Program Services19728951ProgramServices
Management And General3112812ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY8403312BOY
EOY6060531EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1354151BOY
EOY1017272EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY184437BOY
EOY200957EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY531124BOY
EOY267741EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis78460036LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec27957018LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY51883878BOY
EOY50503018EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY14931022BOY
EOY17749674EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1244147BOY
EOY1375504EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY78532071BOY
EOY77174697EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1874168BOY
EOY1987558EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY12753996BOY
EOY12006651EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY38805000BOY
EOY37745000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1741500BOY
EOY1739500EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2134091BOY
EOY1684525EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY57308755BOY
EOY55163234EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY19594891BOY
EOY20252554EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1613425BOY
EOY1693909EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY15000BOY
EOY65000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21223316BOY
EOY22011463EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY78532071BOY
EOY77174697EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1422956ReconcilationRevenueExpenses
Reconcilation Other Changes-634809ReconcilationOtherChanges
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 Years62281CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years294280CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years196638CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year184218CurrentTaxYearMinus1Year
Current Tax Year426574CurrentTaxYear
Total1163991Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years21925050CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22154506CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22523520CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22601926CurrentTaxYearMinus1Year
Current Tax Year23478229CurrentTaxYear
Total112683231Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years21987331CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22448786CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22720158CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22786144CurrentTaxYearMinus1Year
Current Tax Year23904803CurrentTaxYear
Total113847222Total

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 Total509113847222PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years990836CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1060338CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years536830CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year386167CurrentTaxYearMinus1Year
Current Tax Year475544CurrentTaxYear
Total3449715Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years990836CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1060338CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years536830CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year386167CurrentTaxYearMinus1Year
Current Tax Year475544CurrentTaxYear
Total3449715Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22978167CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years23509124CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years23256988CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year23172311CurrentTaxYearMinus1Year
Current Tax Year24380347CurrentTaxYear
Total117296937Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97060PublicSupportPercentage509
Prior Year Support Percentage0.96670PriorYearSupportPercentage
Investment Income Percentage0.02940InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.03330PriorYrInvestIncomePercentage
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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5179990OtherCostOrOtherBasis
Book Value5179990BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis62106360OtherCostOrOtherBasis
Depreciation22145191Depreciation
Book Value39961169BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis5820800OtherCostOrOtherBasis
Depreciation1534897Depreciation
Book Value4285903BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5352886OtherCostOrOtherBasis
Depreciation4276930Depreciation
Book Value1075956BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings50503018TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Occupancy deposits$45,525
Obligation under interest rate swap$1,639,000
FieldValueIRS element (for citing)
Total Of Amounts1684525TotalOfAmounts
Total Revenue24264719TotalRevenue
Total Expenses22841763TotalExpenses
Excess Or Deficit For Year1422956ExcessOrDeficitForYear
Net Unrealized GL On Investments-1011928NetUnrealizedGLOnInvestments
Other$377,119OtherAmount
Total Adjustments-634809TotalAdjustments
Excess Or Deficit Per FS788147ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt23629910TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-1011928NetUnrealizedGainsInvestments
Other Revenues377119OtherRevenues
Revenue Not Rptd F990-634809RevenueNotRptdF990
Revenue Subtotal24264719RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99024264719TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt22841763TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal22841763ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99022841763TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X:No uncertain tax positions under FIN 48
Part XI, Line 8 - Other Adjustments:Unrealized gain/loss on interest rate swap 408,591. Change in value of split-interest agreements -31,472.
Part XII, Line 2d - Other Adjustments:Unrealized loss on interest rate swap 408,591. Change in value of split interest agreements -31,472.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
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 PersonWilson Sheldon JrNamePerson
Base Compensation Filing Org162875BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org162875TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1North Carolina Medical Care CommissionBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN521309402IssuerEIN
CUSIP Number657902M41CUSIPNumber
Date Issued2003-10-16DateIssued
Issue Price45165000IssuePrice
Description Of PurposeConstructing continuing care retirement facilities and refund prior issueDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds45165000TotalProceeds
Issuance Costs From Proceeds680631IssuanceCostsFromProceeds
Capital Expenditures23699447CapitalExpenditures
Year Of Subst Completion2004YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged1BondCounselRoutinelyEngaged
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed1Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1Bank of AmericaBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge10.000000000000TermOfHedge
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section B, line 11The 990 is reviewed by the Executive Director, the controller and Chairman of the board.
The policy is signed each time a member joins the board. The organization relies on the integrity of the board members to monitor their independence.Form 990, Part VI, Section B, line 12c
The CEO's compensation is set by the compensation committee of the board who are independent.Form 990, Part VI, Section B, line 15a
The Organization is regulated by the Insurance Commission and our Financials are part of the Disclosure required by them.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Net unrealized losses on investments: -1,011,928. Unrealized gain/loss on interest rate swap 408,591. Change in value of split-interest agreements -31,472. Total to Form 990, Part XI, Line 5: -634,809.Form 990, Part XI, line 5: