2019-02-11T14:07:13-06:00 2018-03-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2017-04-01 237179679 CAROLINA VILLAGE INC CARO 8286926275 600 CAROLINA VILLAGE ROAD HENDERSONVILLE NC 28792 BRUCE D BELL CFO 8286926275 2019-02-11 1 AMY BIBBY P00445891 8282542254 24.241.144.70 2019-02-11 13:29:35 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3C4A73C7F70BFF54BAAC11A85090BDFB39FC8B01 2017 2019-02-21 02:37:17Z KEVIN PARRIES 600 CAROLINA VILLAGE ROAD HENDERSONVILLE NC 28792 23917558 0 X WWW.CAROLINAVILLAGE.COM X 1972 NC TO MAINTAIN AND OPERATE A RETIREMENT HOME, MEDICAL CENTER, AND ASSISTED LIVING CENTER. 16 16 455 225 0 0 862529 226930 23617289 23200590 430130 445601 44105 44437 24954053 23917558 0 0 0 0 12116023 12639014 0 0 0 13550754 12808977 25666777 25447991 -712724 -1530433 76757485 94153371 82343408 101088368 -5585923 -6934997 X CAROLINA VILLAGE IS A NOT FOR-PROFIT FULL-SERVICE RETIREMENT FACILITY FOR SENIOR CITIZENS WITH A MISSION TO PROVIDE HOUSING, CONTINUING LIFE CARE, UP-TO-DATE SERVICE, AND A PLEASANT, CONGENIAL SOCIAL ENVIRONMENT TO ENCOURAGE PERSONAL GROWTH AND COMMUNITY PARTICIPATION WITHOUT REGARD TO RACE OR RELIGIOUS PERSUASION. 0 0 20547796 0 23200590 CAROLINA VILLAGE SERVES 587 RESIDENTS IN DIRECT HEALTH CARE NEEDS, MEALS, HOUSING, AND TRANSPORTATION. IN THE PAST YEAR WE HAVE SERVED 37,772 DAYS OF DIRECT PATIENT CARE IN OUR HOME FOR THE AGED AND SKILLED NURSING CARE FACILITIES. ON OUR CAMPUS WE PROVIDE MEDICARE SERVICES INCLUDING BUT NOT LIMITED TO PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY. OUR RESIDENTS RECEIVE BENEFITS FROM OUR COMPREHENSIVE WELLNESS PROGRAM ORGANIZED AND COORDINATED BY A FACILITY STAFF MEMBER. THE WELLNESS PROGRAM INCLUDES EIGHT FACETS OF WELLNESS-PHYSICAL, SPIRITUAL, ENVIRONMENTAL, SOCIAL, VOCATIONAL, INTELLECTUAL, EMOTIONAL, AND NUTRITIONAL. WE MAINTAIN THE CAROLINA VILLAGE HUB WHICH IS A REAL TIME INFORMATION PORTAL FOR RESIDENTS AND EMPLOYEES TO RECEIVE UP TO THE MINUTE INFORMATION ABOUT CAROLINA VILLAGE. THE CV HUB IS EASILY ACCESSIBLE FROM ANY COMPUTER OR MOBILE DEVICE. THROUGH OUR QUALITY FIRST PROGRAM WE HAVE GIVEN BACK TO THE COMMUNITY THROUGH FOOD DRIVES, SCHOOL SUPPLY DRIVES, BENEFIT DINNERS, AND OTHER MONETARY GIFTS. WE HAVE PARTNERED WITH THE HENDERSON COUNTY COUNCIL ON AGING, SPECIAL OLYMPICS, MANNA FOOD BANK, UNITED WAY, AND OTHER LOCAL NON-PROFIT ORGANIZATIONS. CAROLINA VILLAGE PROVIDES 40 MEALS PER DAY, 5 DAYS A WEEK TO THE LOCAL CONGREGATE MEAL SITE IN ASSOCIATION WITH THE HENDERSON COUNTY MEALS-ON-WHEELS PROGRAM. 20547796 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 27 0 1 455 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X BRUCE BELL CFO 8286926275 600 CAROLINA VILLAGE ROAD HENDERSONVILLE NC 28792 KOHLAN FLYNN PRESIDENT 3.00 X X 0 0 0 STAN DUNCAN VICE PRESIDENT 1.50 X X 0 0 0 MARCIA CASERIO VICE PRESIDENT 1.50 X X 0 0 0 TERRY ANDERSON TREASURER 1.50 X X 0 0 0 JIM CRAFTON ASSISTANT TREASURER 1.50 X X 0 0 0 RENEE KUMOR SECRETARY 1.50 X X 0 0 0 ADAM SHEALY ASSISTANT SECRETARY 1.50 X X 0 0 0 RUTH BIRGE BOARD MEMBER 1.50 X 0 0 0 DANNY WILLIAMS BOARD MEMBER 1.50 X 0 0 0 CHUCK NOEGAL BOARD MEMBER 1.50 X 0 0 0 AMY PACE BOARD MEMBER 1.50 X 0 0 0 LYNN KILLIAN BOARD MEMBER 1.50 X 0 0 0 JERRY PYLES BOARD MEMBER 1.50 X 0 0 0 LOUIS SANTIAGO BOARD MEMBER 1.50 X 0 0 0 JUDY EDWARDS BOARD MEMBER 1.50 X 0 0 0 KIMBELA MCMINN BOARD MEMBER 1.50 X 0 0 0 KEVIN PARRIES CEO 40.00 X 235074 0 38794 BRUCE BELL CFO 40.00 X 202029 0 49614 VELDA CAPPS DIRECTOR OF HEALTH SERVICE 40.00 X 140980 0 20759 JON RENEGAR DIRECTOR OF OPERATIONS 40.00 X 146910 0 40279 ALEX TUCKER HEALTH CARE ADMINISTRATOR 40.00 X 105375 0 35023 830368 0 184469 5 0 1 0 LYTLE CONSTRUCTION SERVICE 432 FLAT CREEK ROAD FAIRVIEW NC 287309657 REMODELING & REPAIR 1454496 RLPS ARCHITECT 250 VALLEYBROOK DR LANCASTER PA 17601 ARCHITECTURAL SERVICES 998246 REHAB CARE PO BOX 503534 ST LOUIS MO 60353 REHABILITATION SERVICES 990025 BLUE RIDGE PHARMACY 1070 TUNNEL RD ASHEVILLE NC 28704 PHARMACY SERVICES 439385 DIXON HUGHES GOODMAN LLP PO BOX 602828 CHARLOTTE NC 28730 ACCOUNTING SERVICES 249876 12 226930 226930 APARTMENT REVENUE 623000 14225635 14225635 MEDICAL CENTER 623000 3696758 3696758 DIETARY 623000 2196559 2196559 CARE CENTER 623000 1646545 1646545 DIETARY - MED CTR 623000 1435093 1435093 23200590 23372 23372 422229 0 422229 422229 422229 MISCELLANEOUS 900099 44437 44437 44437 23917558 23200590 0 490038 525510 525510 49948 49948 8986133 7754779 1231354 187601 153131 34470 2188870 1786683 402187 700952 572158 128794 7810 7810 31440 31440 209902 209902 222237 222237 1458533 1056387 402146 27572 27572 1717994 1715753 2241 9898 9898 58822 48303 10519 2103986 2103986 3746571 3746571 9840 9840 FOOD 1354769 1354769 THERAPY EXPENSE 1033672 1033672 MEDICAL SUPPLY 686034 686034 MISCELLANEOUS EXPENSE 78817 78817 51080 51080 25447991 20547796 4900195 0 1398878 1619505 1859205 1629224 226427 233800 -96891 104864977 43141248 58380063 61723729 14857776 29018294 35136 25710 76757485 94153371 4497043 5643160 36138756 37856523 39627786 57428350 152400 160335 1927423 0 82343408 101088368 X -6715994 -8223876 767879 926687 362192 362192 -5585923 -6934997 76757485 94153371 X -1530433 254559 -73200 X X 0 1 X 1 0 X 158604 295286 181841 862592 226930 1725253 20998954 22132016 22232768 23617289 23200590 112181617 21157558 22427302 22414609 24479881 23427520 113906870 0 0 0 113906870 129621 73561 8964 31089 23372 266607 129621 73561 8964 31089 23372 266607 47112 47358 62186 44105 44437 245198 21334291 22548221 22485759 24555075 23495329 114418675 0.99550 0.99500 0.00230 0.00290 X 554507 54451 56587 45400 620145 507568 36268 51471 40800 554507 541745 12451 -13624 33004 507568 473258 65307 25424 22244 541745 451506 48952 27200 473258 0.58400 0.41600 0 0 1513495 1513495 69526651 30518764 39007887 17673329 7757718 9915611 7229880 3173560 4056320 8921622 1691206 7230416 61723729 X 24098917 254559 315423 569982 23528935 388623 388623 23917558 25447991 0 25447991 0 25447991 PART V, LINE 4: THE CAROLINA VILLAGE ENDOWMENT FUND WAS ESTABLISHED TO RECEIVE GIFTS, DEVISES, BEQUESTS, AND OTHER CONVEYANCES AND TO USE THEM FOR PROPERTY MAINTENANCE OR IMPROVEMENT PROJECTS, OR TO PROVIDE ECONOMIC ASSISTANCE TO RESIDENTS OR TO PERSONS DESIRING TO BE RESIDENTS. THE ENDOWMENT FUNDS INCLUDE DONOR-RESTRICTED FUNDS CLASSIFIED AS PERMANENTLY RESTRICTED, AND THE EARNINGS, INCLUDING NET APPRECIATION, ON THESE FUNDS THAT ARE TO BE SPENT ON THOSE PURPOSES WHICH ARE CLASSIFIED AS TEMPORARILY RESTRICTED. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES IN THE UNITED STATES OF AMERICA, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. PART X, LINE 2: THE VILLAGE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE VILLAGE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF MARCH 31, 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAIN/LOSS ON SWAP AGREEMENT 315,423. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 7,935. LOSS ON REFUNDING OF DEBT 380,688. X X X X 0 0 0 0 0 0 0 0 0 KEVIN PARRIES CEO 235074 0 0 0 0 0 30120 0 8674 0 273868 0 0 0 BRUCE BELL CFO 202029 0 0 0 0 0 27524 0 22090 0 251643 0 0 0 VELDA CAPPS DIRECTOR OF HEALTH SERVICE 140980 0 0 0 0 0 19772 0 987 0 161739 0 0 0 JON RENEGAR DIRECTOR OF OPERATIONS 146910 0 0 0 0 0 18876 0 21403 0 187189 0 0 0 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YPD2 2017-12-27 84363613 SERIES 2017 BONDS 0 0 0 A 84363613 1778125 1225735 41916313 39443440 2017 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 SCHEDULE K, PART II, LINE 3, TOTAL PROCEEDS: THE AMOUNT OF TOTAL PROCEEDS PRESENTED ON LINE 3 INCLUDES INVESTMENT EARNINGS FROM DATE OF ISSUE TO THE END OF THE PRESENT FISCAL YEAR AS FOLLOWS: SALE PROCEEDS: $ 84,363,613 INVESTMENT EARNINGS TO DATE: 0 TOTAL TO LINE 3: $ 84,363,613 SCHEDULE K, PART II, LINE 11, OTHER SPENT PROCEEDS: THE AMOUNT PRESENTED ON LINE 11 REPRESENTS PROCEEDS USED TO CURRENTLY REFUND PRIOR ISSUES SERIES 2008 AND SERIES 2013. TAMMY CAMBY SISTER OF CEO KEVIN PARRIES 49948 EMPLOYED BY ORGANIZATION AS MEDICAL RECORDS DIRECTOR. RECEIVED COMPENSATION OF $49,948 0 FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DISTRIBUTED TO THE MEMBERS OF THE BOARD OF DIRECTORS. THE FINANCE COMMITTEE FORMALLY REVIEWED THE RETURN, AND RECOMMENDED TO THE FULL BOARD THAT THE RETURN BE APPROVED BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CAROLINA VILLAGE POLICY COMMITTEE REVIEWS THE POLICY ON AN ANNUAL BASIS AND MAKES ANY RECOMMENDATIONS TO THE BOARD OF DIRECTORS FOR ANY UPDATES AND CHANGES. THE EXECUTIVE DIRECTOR ENSURES EACH MEMBER OF THE BOARD RECEIVES REVIEWS AND SIGNS A COPY OF THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. THE EXECUTIVE COMMITTEE AND EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR ENFORCING THE POLICY WITH EACH MEMBER. IF A SITUATION ARISES IN WHICH CONFLICT OF INTEREST IS POSSIBLE THE BOARD MEMBER(S) INVOLVED WILL REMOVE THEMSELVES DURING ANY DISCUSSIONS AND ABSTAIN FROM ANY VOTING. THE MINUTES OF THE BOARD WILL REFLECT THE PROCESS AND ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION FOLLOWS THE PROCESS DESCRIBED IN TREASURY REGULATION 4958(C) FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS IN THE REVIEW, APPROVAL, AND DOCUMENTATION OF OFFICER AND KEY EMPLOYEE COMPENSATION. A COMMITTEE APPOINTED BY THE BOARD OF DIRECTORS EXAMINES DATA FROM THE FORMS 990 FROM VARIOUS SIMILARLY-SITUATED ORGANIZATIONS IN LIKE-SIZED COMMUNITIES AND ESTABLISHES COMPENSATION PACKAGES FOR THE CEO AND OTHER ORGANIZATION EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE OR THE CAROLINA VILLAGE LIBRARY. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE AVAILABLE ON THE NORTH CAROLINA DEPARTMENT OF INSURANCE WEBSITE, AS WELL AS AVAILABLE FOR VIEWING AT THE CAROLINA VILLAGE LIBRARY. FORM 990, PART XI, LINE 9: UNREALIZED GAIN/LOSS ON SWAP AGREEMENT 315,423. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -7,935. LOSS ON REFUNDING -380,688. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.