2019-08-14T15:21:52-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2017-10-01 560729010 PENICK VILLAGE INC PENI 9106920300 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 JEFFREY I HUTCHINS CEO 9106920300 2019-08-12 1 JOHN NORMAN P01506766 7049985200 2019-08-12 67.137.57.251 2019-08-12 13:30:55 ED P E6B36A5AA947C5ABCF14DB2FEAA03B911CABFB79 ADD9B0FA008286EFA839A4825521FFB3520D5A5C 2017 2019-02-21 02:37:17Z JEFFREY I HUTCHINS 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 18392282 0 X WWW.PENICKVILLAGE.ORG X 1957 NC WE ARE A FAMILY CREATING A LOVING COMMUNITY BY MAKING EACH DAY GREAT FOR ONE ANOTHER. 17 17 363 350 350708 -93989 304186 871432 16197265 16982904 430531 537946 -6241 0 16925741 18392282 0 0 0 0 8325105 8850531 0 0 0 7958253 8553527 16283358 17404058 642383 988224 55464548 55317094 48869185 47544742 6595363 7772352 X PENICK VILLAGE'S MISSION IS TO BE A FAMILY THAT CREATES A LOVING COMMUNITY BY MAKING EVERY DAY GREAT FOR ONE ANOTHER THROUGH ITS UNCOMPROMISING COMMITMENT TO DEINSTITUTIONALIZING THE AGING EXPERIENCE. 0 0 10693169 16632196 PENICK VILLAGE PROVIDES HOUSING, SERVICES, AND LONG-TERM CARE TO OVER 200 RESIDENTS. THE SERVICES AND CARE ARE PROVIDED IN INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING AREAS. PENICK VILLAGE ALSO CONTRIBUTES TO THE GREATER SOUTHERN PINES COMMUNITY AND MOORE COUNTY IN WHICH IT IS LOCATED BY DONATING TIME AND RESOURCES TO, AMONG OTHERS, THE MOORE COUNTY CHAMBER OF COMMERCE, FIRSTHEALTH HOSPITAL, LEADINGAGE NC, EPISCOPAL DAY SCHOOL, RED CROSS, MEALS ON WHEELS OF THE SANDHILLS, FRIEND TO FRIEND, AND THE SOUTHERN PINES FIRE AND POLICE DEPARTMENTS. THE PENICK VILLAGE COMMUNITY ALSO PROVIDES FINANCIAL ASSISTANCE TO THOSE RESIDENTS IN NEED.NURSING IS KEY TO THE CONTINUUM OF CARE FOR THE RESIDENTS AT PENICK VILLAGE. SKILLED NURSING SERVICES ARE PROVIDED PER PHYSICIAN ORDERS THAT MAY INCLUDE BUT ARE NOT LIMITED TO ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, MEDICATION ADMINISTRATION, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, SPECIALIZED DIETS AND OTHER NEEDS PER ORDERS. THE QUALITY NURSING IS KEY TO ACHIEVING THIS AND IN MAXIMIZING THE QUALITY OF LIFE FOR EACH OF THE RESIDENTS. THE CARE IS PERSONALIZED, AND A STRONG PARTNERSHIP IS DEVELOPED AMONG THE RESIDENT, HIS OR HER FAMILY, AND THE STAFF AT PENICK VILLAGE IN ORDER TO HAVE THE RESIDENT'S NEEDS DRIVE HIS OR HER PLAN OF CARE. PENICK VILLAGE ALSO OFFERS A BROAD RANGE OF IN-HOME SERVICES TO THOSE SENIORS THAT PREFER TO AGE IN HOME. PENICK TAILORS CARE PLANS INDIVIDUALLY, FOLOWING A FREE IN-HOME CONSULTATION AND ASSESSMENT. POTENTIAL HOME CARE SERVICES INCLUDE COMPANION/SITTER/RESPITE CARE (INCLUDING TRANSPORTATION, LIGHT HOUSEKEEPING, ERRANDS, PET CARE, DAILY CHECK-INS, AND MEDICATION REMINDERS), CARE MANAGEMENT TO ENSURE PROPER TREATMENT, AND POST HOSPITAL DISCHARGE FOLLOW UPS (INCLUDING MEDICARE/LONG-TERM CARE INSURANCE REVIEWS, HOME ORGANIZING/DOWNSIZING, SUPPORT THROUGH DIFFERENT LEVELS OF CARE, HOME SAFETY ASSESSMENTS/MODIFICATIONS, AND REFERRALS TO COMMUMINITY PARTNERS).INDIVIDUALS WHO MOVE INTO PENICK FOR ASSISTED LIVING ARE PROVIDED A UNIQUE SERVICE THAT HAS BEEN PURPOSEFULLY PLANNED TO FILL THEIR INDIVIDUAL NEEDS AND PREFERENCES AND DESIGNED TO SERVE THEM TO THE BEST OF OUR ABILITY. OUR NURSING STAFF MEETS WITH THE NEW RESIDENT AND FAMILY PRIOR TO MOVE IN TO FULLY UNDERSTAND EACH SITUATION AND DESIGN A PERSONALIZED PLAN. ASSISTED LIVING RESIDENTS ENJOY: - A SPACIOUS, PRIVATE APARTMENT- LICENSED CARE SEVEN DAYS A WEEK- DELICIOUS, NUTRITIOUS MEALS- A SAFE SETTING THAT PROMOTES INDEPENDENCE- MEDICATION ASSISTANCE AND/OR ADMINISTRATION AVAILABLE- CARING AND DEDICATED HEALTHCARE PROFESSIONALS- 24-HOUR EMERGENCY CALL SYSTEMS- A VIBRANT SOCIAL ATMOSPHERE- ACCESS TO ALL COMMUNITY AMENITIESDINING SERVICES IS ONE OF PENICK VILLAGE'S ESSENTIAL SERVICES. DINING SERVICES STRIVES TO PRIVIDE A WONDERFUL DINING EXPERIENCE IN ALL LEVELS OF CARE FOR THE RESIDENTS AND THEIR FAMILY AND FRIENDS. THERE ARE SEVERAL DINING OPPORTUNITIES ON THE CAMPUS, INCLUDING THE CAFE EXPERIENCE, A PRIVATE DINING ROOM, CATERING IN ONE'S APARTMENT OR COTTAGE, INDIVIDUALIZED MENUS AND MORE. DINING SERVICES IS COMMITTED TO PREPARING THE SAME QUALITY AND CHOICES OF FOOD ITEMS IN THE HEALTHCARE AREAS THAT ARE AVAILABLE TO INDEPENDENT RESIDENTS. DINING SERVICES ALSO PREPARES THE MEALS FOR MEALS ON WHEELS OF THE SANDHILLS ALONG WITH HOSTING EVENTS FOR OTHER SPECIAL COMMUNITY GROUPS SUCH AS THE KIWANIS. AS AN EMPLOYEE BENEFIT, THE STAFF ALSO ENJOYS WONDERFUL MEALS AT A GENEROUS DISCOUNT.PENICK VILLAGE IS ALSO VERY PROUD OF ITS HOUSEKEEPING SERVICES. HOUSEKEEPING PROVIDES GENERAL CLEANING SERVICES ALONG WITH LINEN SERVICES AS REQUESTED. THE HOUSEKEEPING TEAM BUILDS GREAT RELATIONSHIPS WITH THE RESIDENTS THEY ARE SERVING AND HAVE HELPED SIGNIFICANTLY IN TIMES OF NEED. HOME CARE: HOME CARE IS ANOTHER OF PENICK VILLAGE'S ESSENTIAL SERVICES. IT ALLOWS RESIDENTS TO AGE IN PLACE IN THEIR INDEPENDENT LIVING HOMES WHILE RECEIVING COMPANIONSHIP AND A PERSON TO HELP WITH DAILY ACTIVITIES SUCH AS PET WALKING, DRIVING TO DOCTOR APPOINTMENTS, SHOPPING AND ACCOMPANYING THEM TO MEALS WITHIN THE VILLAGE. THIS ALLOWS THE RESIDENT TO REMAIN AT HOME FOR A LONGER PERIOD OF TIME AND GIVES THEIR FAMILIES PEACE OF MIND WHEN THEY ARE NOT AVAILABLE TO PROVIDE THE SERVICES HOME CARE CAN PROVIDE FOR THE RESIDENT.LIFE ENRICHMENT: LIFE ENRICHMENT IS THE HUB FOR ACTIVIES FOR THE RESIDENTS OF ALL LEVELS OF CARE. THEY PROVIDE ACTIVIES FOR THE MIND, BODY AND SPIRIT OF THE RESIDENTS. SOME OF THE ACTIVITIES ARE CHAIR VOLLEYBALL, EXERCISE CLASSES, NUTRITIONAL CLASSES AND ONE ON ONE SESSIONS WITH THE REGISTERED DIETICIAN, CONCERTS, TRIPS TO PLAYS, NC SYMPHONY, MUSEUMS AND MUCH MORE. THEY PROVIDE SING-ALONGS, BINGO AND CRAFTS FOR THE SKILLED AND ASSISTED LIVING RESIDENTS AS WELL AS LOCAL OUTINGS. THEIR MISSION IS TO KEEP THE RESIDENTS ACTIVE, TO EXERCISE THEIR BODIES AND MINDS EQUALLY. 10693169 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 99 0 1 363 1 1 1 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X JEFFREY I HUTCHINS 9106920300 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 THE RT REV SAMUEL RODMAN BOARD MEMBER 1.00 X 0 0 0 THE RT REV ANNE HODGES-COPPLE BOARD MEMBER 1.00 X 0 0 0 THE RE DAVID BEAM BOARD MEMBER 1.00 X 0 0 0 BYRD GWINN BOARD MEMBER 1.00 X 0 0 0 RICHARD HIGGINBOTHAM TREASURER 1.00 X X 0 0 0 RAY PARDUE BOARD MEMBER 1.00 X 0 0 0 KAY RHOADES BOARD MEMBER 1.00 X 0 0 0 DOUG GILL BOARD MEMBER 1.00 X 0 0 0 GARY KRASICKY PRESIDENT 1.00 X X 0 0 0 MIKE PENICK BOARD MEMBER 1.00 X 0 0 0 RICK SMITH BOARD MEMBER 1.00 X 0 0 0 EDNA STEPHENS BOARD MEMBER 1.00 X 0 0 0 DARLENE VAUGHN BOARD MEMBER 1.00 X 0 0 0 JOHN FRIZZELL III SECOND VICE PRESIDENT 1.00 X X 0 0 0 JIM GRAY BOARD MEMBER 1.00 X 0 0 0 LYNNE HEALY FIRST VICE PRESIDENT 1.00 X X 0 0 0 STEVE LEGGETT BOARD MEMBER 1.00 X 0 0 0 JEFFREY I HUTCHINS CHIEF EXECUTIVE OFFICER 40.00 X 172480 0 0 TERRY KEES CHIEF FINANCIAL OFFICER 40.00 X 212332 0 0 CAROLINE HENDRICKS CHIEF OPERATING OFFICER 40.00 X 41323 0 0 426135 0 0 2 0 1 0 REHAB CARE PO BOX 503534 ST LOUIS MO 63150 REHAB SERVICES 530924 PINNACLE DEVELOPMENT DESIGN BUILD PO BOX 55 SOUTHERN PINES NC 28388 CONSTRUCTION CONTRACTOR 518782 HOLLIDAY HEALTHCARE INC 2560 LANDMARK DR WINSTONSALEM NC 27103 PHARMACY AND MEDICAL SUPPLIES 121575 BKD LLP PO BOX 1190 SPRINGFIELD MO 65801 3RD PARTY MEDICARE BILLING 110784 4 871432 871432 HEALTHCARE 623000 7389339 7389339 INDEPENDENT LIVING 623000 6150708 6150708 EARNED ENTRANCE FEES 623000 2626775 2626775 816082 465374 350708 16982904 265962 265962 271984 0 271984 271984 271984 18392282 16632196 350708 537946 384812 384812 6548567 5536335 1012232 1411455 814131 597324 505697 411832 93865 97764 97764 1003451 524213 479238 216392 3216 213176 908359 606827 301532 862419 793400 69019 30094 10525 19569 6381 6381 983775 983775 2202142 2202142 24155 5761 18394 OTHER PATIENT SERVICES 1627141 1617636 9505 PHARMACEUTICALS 134378 134378 EMPLOYEE RECRUITMENT AN 116071 44033 72038 MEDICAL SUPPLIES 107761 107761 233244 83121 150123 17404058 10693169 6710889 0 1200 1200 2485337 2193937 921049 1196963 600441 148201 58272372 16578504 42144667 41693868 8943760 9720509 368094 362416 55464548 55317094 1238890 1255987 15136594 14983691 23929157 7882873 23701138 8285597 48869185 47544742 X 5735274 6891270 530682 551675 329407 329407 6595363 7772352 55464548 55317094 X 988224 112822 75943 X X 0 1 X 1 0 X 234500 4060236 240170 304186 871432 5710524 13880620 14354470 15050652 16197265 16982904 76465911 14115120 18414706 15290822 16501451 17854336 82176435 0 0 0 82176435 194006 166322 192312 279545 265962 1098147 194006 166322 192312 279545 265962 1098147 153195 186323 138927 135718 614163 14462321 18767351 15622061 16916714 18120298 83888745 0.97960 0.01310 X 678542 678542 54144208 14657698 39486510 188362 83393 104969 2209056 1806621 402435 1052204 30792 1021412 41693868 REFUND LIABILITY 7157111 APPLICATION AND PREPAID ADMISSION DEPOSITS 883079 DUE TO AFFILIATE 245407 8285597 0 0 0 0 0 0 0 0 0 JEFFREY I HUTCHINS CHIEF EXECUTIVE OFFICER 172480 0 0 0 0 0 0 0 0 0 172480 0 0 0 TERRY KEES CHIEF FINANCIAL OFFICER 212332 0 0 0 0 0 0 0 0 0 212332 0 0 0 A NC MEDICAL CARE COMMISSION 521309402 2010-01-20 30000000 NEW CONTRUCTION 0 0 0 A 13542677 28031368 428691 550000 27052677 2011 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 1 BB&T 6.750000000000 0 0 0 1 A 1 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE ORGANIZATION'S OFFICERS, THEN SENT TO THE FINANCE COMMITTEE FOR REVIEW AND COMMENTS AND THEN PRESENTED TO THE FULL BOARD OF DIRECTORS. IT WILL BE REVIEWED BY THE OFFICERS AND FINANCE COMMITTEE MEMBERS BEFORE FILING WITH THE IRS AND WITH THE FULL BOARD IF THEY ARE SCHEDULED TO MEET BEFORE THE FILING DEADLINE. IF NOT IT WILL BE SENT TO THEM BEFORE THE FILING DEADLINE AND REVIEWED AT THE NEXT SCHEDULED MEETING. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS AND BOARD MEMBERS ARE REQUIRED TO RECEIVE, REVIEW AND SIGN A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY AND DISCLOSE IF ANY CONFLICTS MIGHT ARISE IN THE COURSE OF CONDUCTING PENICK VILLAGE BUSINESS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS APPOINTED AN AD-HOC COMPENSATION REVIEW COMMITTEE TO DETERINE THE COMPENSATION FOR THE CEO OF THE ORGANIZATION. THIS REVIEW IS CONDUCTED ON AN ANNUAL BASIS AND USES DATA FROM OTHER ORGANIZATIONS AS WELL AS WAGE SURVEYS TO DETERMINE THE COMPENSATION. THE RESULTS ARE DOCUMENTED IN THE CEO'S PERSONNEL FILE IN HR. THE CEO CONDUCTS ANNUAL REVIEWS FOR THE CFO AND COO OF THE ORGANIZATION. BASED ON THOSE REVIEWS AND WAGE SURVEYS, THE CEO DETERMINES THE UPCOMING YEAR COMPENSATION FOR THESE KEY EMPLOYEES. THE EVALUATION AND ADVICE OF PAYROLL ARE DOCUMENTED IN THE PERSONNEL FILES IN HR FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ADMINISTRATION OFFICES. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF SPLIT-INTEREST AGREEMENT 75,948. ROUNDING ADJUSTMENT -5. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. JA GREER GROUP LLC 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28387 814456670 RENTAL NC 350708 3810467 PENICK VILLAGE PENICK VILLAGE FOUNDATION INC 500 EAST RHODE ISLAND AVENUE SOUTHERN PINES NC 28237 201055492 CHARITABLE FUNDRAISING NC 501(C)(3) LINE 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PENICK VILLAGE FOUNDATION A 602156 CASH