2022-02-07T14:38:56-06:00 2021-09-30 560587953 GILLIAM BELL MOSER LLP PO BOX 621 BURLINGTON NC 272160621 990 2020-10-01 561270984 LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY NORTH CAROLINA LUTH 3365381500 3701 WADE COBLE DRIVE BURLINGTON NC 27215 BRENT CONKLIN CFO 3365381515 2022-01-28 1 BRENT CONKLIN 999009999 JEREMY C HARTLE P00643154 3362276283 2022-01-27 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TWIN LAKES COMMUNITY PAMELA S FOX 3701 WADE COBLE DRIVE BURLINGTON NC 27215 48347582 0 X WWW.TWINLAKESCOMM.ORG X 1980 NC TO PROVIDE COMPREHENSIVE RESIDENTIAL, SOCIAL, AND HEALTH RELATED SERVICES TO THE ELDERLY. 21 21 540 100 0 0 239897 3374534 33790720 35859005 414069 984696 13110 90 34457796 40218325 2141296 1976963 0 0 16211950 15749610 0 0 73758 14304507 15555084 32657753 33281657 1800043 6936668 185998741 193099314 135587426 133036784 50411315 60062530 AS A NON-PROFIT BUILT ON CHRISTIAN VALUES, WE CELEBRATE THE PROGRESSION OF LIFE AND DIGNITY OF THE INDIVIDUAL BY EMPOWERING ALL MEMBERS OF OUR COMMUNITY TO LIVE, WORK AND SERVE TO THEIR FULLEST POTENTIAL. 0 0 30254868 1976963 35859095 OPERATION OF CONTINUING CARE RETIREMENT COMMUNITY CONSISTING OF 104 NURSING CARE BEDS, 36 ASSISTED LIVING UNITS, 434 APARTMENTS, VILLAS AND GARDEN HOMES, AND 32 MEMORY CARE BEDS OF WHICH 16 ARE DESIGNATED FOR SKILLED CARE AND 16 FOR ASSISTED LIVING. THE NURSING FACILITY AND THE MEMORY CARE FACILITY PROVIDE SERVICES TO RESIDENTS THROUGH BOTH MEDICARE AND MEDICAID. THESE FACILITIES ALSO PROVIDE REHABILITATIVE SERVICES INCLUDING PHYSICAL THERAPY, SPEECH THERAPY AND OCCUPATIONAL THERAPY. THIS CONTINUING CARE RETIREMENT COMMUNITY ALSO PROVIDES ADULT DAY CARE AND HOME CARE SERVICES. PARKINSON'S SUPPORT AND CAREGIVER'S SUPPORT IS AVAILABLE ALONG WITH SERVICES FOR OLDER ADULTS WITH DEVELOPMENTALLY DISABLED ADULT CHILDREN. 30254868 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 31 0 540 1 0 0 0 0 0 0 0 0 0 0 X 21 21 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X BRENT CONKLIN 3365381502 3701 WADE COBLE DRIVE BURLINGTON NC 27215 JACKIE S COLE BOARD CHAIR 2.00 X X 0 0 0 C BRYAN PENNINGTON VICE CHAIR 2.00 X X 0 0 0 NED A CLINE BOARD MEMBER 1.00 X 0 0 0 DAVID H COOPER BOARD MEMBER 1.00 X 0 0 0 SUSAN C EZEKIEL TREASURER 2.00 X X 0 0 0 ROSLYN M CRISP BOARD MEMBER 1.00 X 0 0 0 TONY FORIEST BOARD MEMBER 1.00 X 0 0 0 JILL GERRINGER BOARD MEMBER 1.00 X 0 0 0 DAVID KOESTER BOARD MEMBER 1.00 X 0 0 0 JANET J LAHAYNE BOARD MEMBER 1.00 X 0 0 0 ROBERT M LEWIS BOARD MEMBER 1.00 X 0 0 0 BRUCE T MOORE BOARD MEMBER 1.00 X 0 0 0 CONNIE POOVEY BOARD MEMBER 1.00 X 0 0 0 JAMES K ROBERSON SECRETARY 2.00 X X 0 0 0 RAGHU TADEPALLI BOARD MEMBER 1.00 X 0 0 0 MELANIE THOMAS BOARD MEMBER 1.00 X 0 0 0 KYLE CORUM BOARD MEMBER 1.00 X 0 0 0 FRANKLIN RHUE BOARD MEMBER 1.00 X 0 0 0 JERRY R TOLLEY JR BOARD MEMBER 1.00 X 0 0 0 ELAINE B FRYAR BOARD MEMBER 1.00 X 0 0 0 SHERRY S HUNT BOARD MEMBER 1.00 X 0 0 0 PAMELA S FOX PRESIDENT/CEO 40.00 X 220661 0 13547 BRENT CONKLIN CFO 40.00 X 155862 0 12837 KIMBERLY THOMAS HRO 40.00 X 95073 0 5417 LAUREN COOK HC ADMINISTRATOR 40.00 X 102185 0 14591 JESSY TANGHAM HC RN 40.00 X 120630 0 6076 694411 0 52468 4 0 1 0 NEW ATLANTIC CONTRACTING INC 2635 REYNOLDA ROAD WINSTONSALEM NC 27106 BUILDING RENOVATIONS 4807208 TEAGUE FREYALDENHOVEN FREYALDENHOVEN 300 NORTH GREENE STREET SUITE 285 GREENSBORO NC 27401 ARCHITECT SERVICES 2054853 RAY A WHITESELL CONTRACTING LLC 1662 ST MARKS CHURCH ROAD BURLINGTON NC 27215 BUILDING RENOVATIONS 1679510 WEAVER COOKE CONSTRUCTION 8401 KEY BLVD GREENSBORO NC 27409 NEW CONSTRUCTION 591380 ID COLLABORATIVE 201 STATE STREET GREENSBORO NC 27408 INTERIOR DESIGN 542281 5 2932300 442234 3374534 INDEPENDENT LIVING FACILITIES 623000 13056410 13056410 NURSING CARE 623000 10396213 10396213 ADMISSION FEES EARNED 623000 5306095 5306095 MEMORY CARE 623000 3095774 3095774 ASSISTED LIVING 623000 1807086 1807086 2197427 2197427 35859005 315377 315377 90 0 90 90 90 8786402 12174 8124030 5227 662372 6947 669319 669319 40218325 35859095 0 984696 132392 132392 1844571 1844571 585965 585965 12411985 11484199 887238 40548 314651 281183 27938 5530 1737728 1611074 106193 20461 699281 604903 88233 6145 15849 15849 93983 93983 104898 104898 788712 752108 36604 97725 97725 2808251 2422516 385340 395 327954 71164 256790 1400507 1372497 28010 626 -884 1380 130 690944 677125 13819 6767444 6632095 135349 888832 871055 17777 PATIENT DRUGS AND FOOD 785158 785158 REPAIRS AND MAINTENANCE 685489 685489 BAD DEBTS 65019 65019 EDUCATION 33693 28223 4921 549 33281657 30254868 2953031 73758 43194878 19066599 1612441 1004908 349265 372561 42174 35746 239081977 86476297 123663194 152605680 17136789 20013820 185998741 193099314 5671070 4668524 61320195 62099963 63852496 65454056 2932300 0 1811365 814241 135587426 133036784 X 46460174 55241781 3951141 4820749 50411315 60062530 185998741 193099314 X 6936668 1717423 997124 X 0 1 X 1 0 X 226040 145980 212524 239897 3374534 4198975 27408091 29866945 33200212 33790720 35859005 160124973 27634131 30012925 33412736 34030617 39233539 164323948 126172 46023 37482 21018 221718 452413 0 126172 46023 37482 21018 221718 452413 163871535 289992 366124 584339 645699 315467 2201621 289992 366124 584339 645699 315467 2201621 27924123 30379049 33997075 34676316 39549006 166525569 0.98410 0.98370 0.01320 0.01430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3098737 17177 653875 49405 29517 3690867 2971938 3393 187723 38474 25843 3098737 2878960 52331 107746 42210 24889 2971938 2691092 2016 247182 36032 25298 2878960 2438699 18954 290259 33931 22889 2691092 0.07680 0.92320 0 0 8694791 8694791 141098245 65244637 75853608 13107450 9005069 4102381 76181491 12226591 63954900 152605680 RESERVE ON DERIVATIVE CONTRACT 814241 814241 40918384 1717423 997124 2714547 38203837 104898 1909590 2014488 40218325 31267173 4 4 31267169 104898 1909590 2014488 33281657 PART V, LINE 4: THE INCOME OF THE ENDOWMENT FUNDS IS USED TO SUPPORT THE OPERATIONS OF LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY, NORTH CAROLINA. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN MARKET VALUE OF RATE SWAP AGREEMENT RELATED TO TAX-EXEMPT BONDS 997,124. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED WITH REVENUE ON FINANCIALS 65,019. UNREIMBURSED COSTS UNDER MEDICAID 1,528,419. FORGIVEN MONTHLY AND DAILY FEES 316,152. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 4. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED WITH REVENUE ON FINANCIALS 65,019. UNREIMBURSED COSTS UNDER MEDICAID 1,528,419. FORGIVEN MONTHLY AND DAILY FEES 316,152. 1 LUTHERAN SERVICES IN AMERICA 100 MARYLAND AVE NE WASHINGTON DC 20002 363304707 501(C)(3) 10000 CONTRIBUTION FOR CEO AND LEADERSHIP ACADEMIES FOR 2020. TOWN OF ELON PO BOX 595 ELON NC 27244 561174600 501(C)(3) 56000 CONTRIBUTION TO COST OF PROVIDING FIRE AND EMERGENCY RESPONSE. ALAMANCE COMMUNITY COLLEGE FOUNDATION 1247 JIMMIE KERR RD GRAHAM NC 27253 581511004 501(C)(3) 12500 SCHOLARSHIPS AND DISTRESS FUND. MEALS ON WHEELS OF ALAMANCE COUNTY 508 W DAVIS STREET BURLINGTON NC 27215 561061980 501(C)(3) 10000 GENERAL AND EMERGENCY. UNITED WAY OF ALAMANCE COUNTY 803 HERMITAGE ROAD BURLINGTON NC 27215 560599239 501(C)(3) 5000 DONATION SALVATION ARMY 812 ANTHONY STREET BURLINGTON NC 27217 501(C)(3) 21897 LANES OF LIGHT PROCEEDS CONTRIBUTION FINANCIAL AID 48 1528419 FMV UNREIMBURSED COSTS UNDER MEDICAID FINANCIAL AID 14 316152 FMV FORGIVEN MONTHLY AND DAILY FEES X X X X 0 1 0 0 0 0 0 0 0 PAMELA S FOX PRESIDENT/CEO 220661 0 0 0 0 0 9294 0 4253 0 234208 0 0 0 BRENT CONKLIN CFO 155862 0 0 0 0 0 6659 0 6178 0 168699 0 0 0 PART I, LINE 4B PAMELA S. FOX, PRESIDENT/CEO - 457(B) DEFERRED COMPENSATION PLAN CONTRIBUTION FOR THE YEAR WAS $19,500. THIS CONTRIBUTION IS ACCRUED BY THE ORGANIZATION AND IS NOT INCLUDED IN TAXABLE COMPENSATION UNTIL RECEIVED. A NC MEDICAL CARE COMMISSION 521309402 2019-10-01 42860000 SEE DESCRIPTION ON SCHEDULE O 0 0 0 B NC MEDICAL CARE COMMISSION 521309402 2019-10-01 23025000 SEE DESCRIPTION ON SCHEDULE O 0 0 0 A 49221157 3702624 1088599 44429934 0 0 1 1 B 1730000 23025000 92100 2693721 16700000 3539179 1 0 1 1 A 0 0 0 1 0 0 0 1 0 B 0 0 0 1 1 0 0 1 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NC MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 11/17/2021 ISSUER NAME: NC MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 11/17/2021 FORM 990, PART VI, SECTION A, LINE 7B ANY AMENDMENT TO THE BYLAWS MUST BE APPROVED BY THE MACEDONIA LUTHERAN CHURCH GOVERNING COUNCIL. THE MACEDONIA LUTHERAN CHURCH GOVERNING COUNCIL MUST ALSO APPROVE THE SLATE OF NEW MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 WAS REVIEWED IN DETAIL WITH THE AUDIT COMMITTEE OF OUR BOARD OF DIRECTORS PRIOR TO FILING. AFTER A DISCUSSION PERIOD AND A QUESTION AND ANSWER PERIOD, THE AUDIT COMMITTEE VOTED TO RECOMMEND TO THE FULL BOARD OF DIRECTORS THAT THE FORM 990 BE ACCEPTED AND FILED. A COPY OF THE ENTIRE FORM 990 WAS PROVIDED TO EACH MEMBER OF THE ENTIRE BOARD OF DIRECTORS WHO THEN VOTED TO ACCEPT THE RECOMMENDATION OF THE AUDIT COMMITTEE. FORM 990 WAS FILED AFTER A COPY WAS PROVIDED TO EACH BOARD MEMBER AND THE BOARD HAD APPROVED THE RECOMMENDATION OF THE AUDIT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY, NORTH CAROLINA HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED, ACCEPTED AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THIS POLICY, EACH OFFICER AND BOARD MEMBER WILL DISCLOSE AND THEN EXCUSE THEMSELVES FROM ANY DISCUSSION AND VOTE FOR ANY MATTER FOR WHICH A CONFLICT EXISTS FOR THEMSELVES OR ANY FAMILY MEMBER. ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD WITHOUT THE PRESENCE OF THE INTERESTED PARTY. FORM 990, PART VI, SECTION B, LINE 15 LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY, NORTH CAROLINA FOLLOWS THE PROCESS DESCRIBED IN TREASURY REGULATION 4958(6)(C) FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS IN THE REVIEW, APPROVAL, AND DOCUMENTATION OF OFFICER, KEY MANAGEMENT, AND DIRECTOR COMPENSATION. ON AN ANNUAL BASIS THE ENTIRE GOVERNING BOARD REVIEWS AND APPROVES THE ENTIRE COMPENSATION PACKAGE OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER BASED ON COMPARABILITY FACTORS INCLUDING BUT NOT LIMITED TO THE SIZE OF THE ORGANIZATION, THE GEOGRAPHIC LOCATION OF THE ORGANIZATION, AND THE EMPLOYEE'S LENGTH OF SERVICE. THE EXECUTIVE COMMITTEE OF THE BOARD CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER, REVIEWS THE COMPARABILITY DATA, AND MAKES A RECOMMENDATION TO THE FULL BOARD OF DIRECTORS WHO THEN APPROVE THE ENTIRE COMPENSATION PACKAGE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO AVAILABLE AT THE NC DEPARTMENT OF INSURANCE WEBSITE AND THE ORGANIZATION'S FORM 990 IS AVAILABLE ON THE GUIDESTAR WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN MARKET VALUE OF RATE SWAP AGREEMENT RELATED TO TAX-EXEMPT BONDS 997,124. FORM 990, PART 1, LINE 1 LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY THROUGH ITS CONTINUING CARE RETIREMENT COMMUNITY, TWIN LAKES COMMUNITY (LRM/TLC) PROVIDES COMPREHENSIVE SERVICES TO THE ELDERLY. PROGRAMS AND SERVICES PROVIDED INCLUDE (1) A SKILLED NURSING FACILITY; (2) A RESIDENTIAL MODEL ASSISTED LIVING FACILITY; (3) A MEMORY CARE FACILITY; (4) INDEPENDENT LIVING UNITS; (5) HOME CARE AGENCY; (6) REHABILITATIVE/THERAPY SERVICES; (7) AN ADULT DAY CARE CENTER; (8) A PARKINSON'S SUPPORT GROUP; (9) CARE GIVER SUPPORT AND EDUCATION CLASSES; (10) PROGRAMS/ACTIVITIES WITHIN THE SPECTRUM OF WELLNESS AND HEALTHY AGING; (11) COMMUNITY OUTREACH PROGRAMS; (12) STUDENT INTERNSHIPS AND EDUCATIONAL PRACTICUMS; (13) GRIEF SUPPORT SERVICES; AND (14) RELIGIOUS/SPIRITUAL SERVICES. LRM/TLC SERVES A DIVERSE POPULATION OF APPROXIMATELY 1,000 INDIVIDUALS A YEAR. LRM/TLC IS AN ACCREDITED FACILITY THROUGH THE COMMISSION FOR ACCREDITATION OF REHABILITATIVE FACILITIES (CARF-CCRC). DURING THE YEAR, ITS SKILLED NURSING FACILITY OBTAINED A "5 STAR" RATING AND ITS MEMORY CARE FACILITY OBTAINED A "5 STAR" RATING THROUGH THE CMS SURVEY SYSTEM. LRM/TLC ACCEPTS MEDICAID PATIENTS AND PROVIDES FINANCIAL ASSISTANCE FOR PERSONS WHO WOULD NOT OTHERWISE QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS. ITS COMMUNITY OUTREACH PROGRAMS SUPPORTED OVER 50 GOVERNMENTAL, EDUCATIONAL, RELIGIOUS, AND NON-PROFIT CHARITABLE ORGANIZATIONS DURING THE YEAR. LRM/TLC PROVIDES WITHOUT CHARGE THE ONLY PARKINSON'S SUPPORT GROUP IN ALAMANCE COUNTY AND CONSISTENTLY SERVES 60 INDIVIDUALS AND FAMILIES. SCHEDULE K, PART I, ROW A, COLUMN (F) TO PAY OR REIMBURSE THE CORPORATION FOR PAYING A PORTION OF THE COSTS OF THE PROJECT AND PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE 2019A BONDS. SCHEDULE K, PART I, ROW A, COLUMN (F) TO REFUND A PORTION OF THE COMMISSION'S OUTSTANDING HEALTH CARE FACILITIES REVENUE AND REVENUE REFUNDING BONDS SERIES 2009 AND PAYING A PORTION OF THE COSTS OF THE PROJECT. MACEDONIA EVANGELICAL LUTHERAN CHURCH 421 WEST FRONT STREET BURLINGTON NC 27215 560594586 CHURCH NC 501(C)(3) 1 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0