2011-02-15T10:54:22-06:00 2010-06-30 Glass Jacobson PA 10711 Red Run Blvd Suite 101 Owings Mills MD 21117 990 2009-07-01 520906348 Caroline Nursing Home Inc CARO 4104792130 520 Kerr Avenue Denton MD 21629 Shari Blades 4104792130 2011-02-05 1 Patrick Trotta 4103561000 2011-02-05 2009 2016-02-24 21:20:13Z Shari Blades 520 Kerr Avenue Denton MD 21629 7351603 0 X www.carolinenursing.org X 1967 MD Nursing care for the sick, elderly and physically handicapped. 12 12 188 80 0 0 11146 1264 7084283 7258008 46287 26237 32431 41594 7174147 7327103 0 0 4367916 4826220 0 0 2515243 2506107 6883159 7332327 290988 -5224 7927714 7882864 1750958 1711331 6176756 6171533 Nursing care for the sick, elderly and physically handicapped. 0 0 6825112 7294102 Nursing care for the sick, elderly and physically handicapped. 6825112 1 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 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 5 0 188 1 0 0 0 0 0 0 0 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1 1 0 0 MD X X Shari Payne Blades 4104792130 520 Kerr Ave Denton MD 21629 William Eaton 1.00 X 0 0 0 Berl Lovelace 1.00 X 0 0 0 Charles Planner 1.00 X 0 0 0 George Sands 1.00 X 0 0 0 Nicholas Schwechtje 1.00 X 0 0 0 Jack Wegener 1.00 X 0 0 0 Robert Jarrell 1.00 X 0 0 0 Rev George Fisher 1.00 X 0 0 0 Sara Jane Davidson 1.00 X 0 0 0 Joseph Weaver 1.00 X 0 0 0 Charles Davis 1.00 X 0 0 0 Joann Staples 1.00 X 0 0 0 Shari Blades 45.00 X 109515 7181 0 109515 7181 0 1 0 0 0 United Healthcare Insurance Co Dept CH 10151 Palatine IL 60055 Health Insurance 461127 Sundance Rehabilitation 6549 Payshere Circle Chicago IL 60674 Therapy Rehabilitation 397482 Sysco PO Box 477 Pocomoke MD 21851 Food Supplies 248144 Key Risk Insurance Company PO Box 18746 Greensboro NC 27419 Workers Compensation Insurance 140037 Direct Energy PO Box 643249 Pittsburgh PA 15264 Electric Service Provider 103550 7 1264 1264 Program services 623000 6241887 6241887 Medicare/medicaid paym 623000 1016121 1016121 7258008 31737 31737 19000 24500 -5500 -5500 -5500 Barber & beauty 623000 15690 15690 Contract services 623000 14983 14983 Miscellaneous 623000 7184 7184 3737 3737 41594 7327103 7294102 0 31737 3886187 3886187 90562 90562 432510 432510 416961 416961 30536 30536 16500 16500 50127 50127 315268 287684 27584 12491 12491 2488 2488 229953 229953 72631 72631 Ancillary 571929 571929 Contracted services 312203 175684 136519 Food 245072 245072 Utilities 223216 223216 Medicaid qa assessment 190858 190858 232835 190235 42600 7332327 6825112 507215 0 624404 474883 14967 13635 730229 723881 1203 610 7302681 4125058 3142237 3177623 1844930 1844930 1569744 1647302 7927714 7882864 534563 522012 1125182 1074079 91213 115240 1750958 1711331 X 6166756 6162752 10000 8781 6176756 6171533 7927714 7882864 X 0 1 0 X 0 X 1492 3089 21907 11146 1264 38898 5888341 5960490 6371669 7084283 7258008 32562791 5889833 5963579 6393576 7095429 7259272 32601689 0 0 0 32601689 24631 33788 49993 46287 26237 180936 24631 33788 49993 46287 26237 180936 44471 30563 36597 32431 41594 185656 5958935 6027930 6480166 7174147 7327103 32968281 0.98890 0.98020 0.00550 0.00500 X 545362 545362 5160824 2883425 2277399 137324 35331 101993 1459171 1206302 252869 3177623 Investment in related entity 1844930 C 1844930 Bond issuance costs 38573 Due from third party payor 130000 Resident funds 12560 Other investments-long term 801431 PSB cd for md unemployment 664738 1647302 Resident trust liability 12560 Due to third party payor 76662 Accumulated amortization 16192 Due to related party 9826 115240 7327103 7332327 -5224 0 -5224 7321683 -5420 -5420 7327103 0 7327103 7326906 -5421 -5421 7332327 0 7332327 Part XII, Line 2d - Other Adjustments: Miscellaneous Part XIII, Line 2d - Other Adjustments: Miscellaneous X X X 0 0 0 0 0 0 0 0 0 Shari Blades 104300 6839 0 0 5215 342 0 0 0 0 109515 7181 0 0 Form 990, Part VI, Section B, line 11 The for 990 is reviewed by the board prior to filing. Form 990, Part VI, Section B, line 15a An independent consultant is utilized along with the compensation guidelines for the Maryland Medicaid program. Form 990, Part VI, Section C, line 19 ALL REQUIRED DOCUMENTS ARE MADE AVAILABLE ON OUR OWN WEBSITE AND UPON REQUEST. THE GABLES AT CAROLINE INC 520 KERR AVE DENTON MD 21629 522130279 ASSISTED LIVING FOR THE ELDERLY AND HANDICAPPED MD 501(c)(3) Public THE CAROLINE FOUNDATION INC 520 KERR AVE DENTON MD 21629 522043510 SUPPORTING ORGANIZATION FOR RELATED ENTITIES MD 501(c)(3) Public 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0