2018-11-15T10:41:54-06:00 2017-12-31 560571159 BERNARD ROBINSON & COMPANY LLP PO BOX 19608 GREENSBORO NC 274199608 990 2017-01-01 560529956 MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA INC MASO 3362990031 700 S HOLDEN ROAD GREENSBORO NC 27407 MARK KOLADA EXECUTIVE DIRECTOR 3362990031 2018-11-15 1 OLGA OGANESOV P01279668 3362944494 2018-11-15 12.198.32.162 2018-11-15 10:49:12 ES P 3974AEFBA20495FFE06AFDB72D4A5A654C1F283E 828DDE096FB258ADD7155A80A40AC906467CDE46 2017 2019-02-21 02:37:17Z WHITESTONE MARK KOLADA 700 S HOLDEN ROAD GREENSBORO NC 27407 24161858 0 X WWW.MESHHOME.ORG X 1912 NC AS A RETIREMENT COMMUNITY LEADER SINCE 1912, MASONIC AND EASTERN STAR HOME OF NC IS DEVOTED TO EXCELLENCE IN HOSPITALITY WITH TRADITIONAL VALUES PROMOTING FRATERNAL SERVICE, DIGNITY, DEPENDABILITY, AND CHOICE. 20 20 323 100 0 0 1096277 2250218 16249624 16678448 877047 1620294 15940 8309 18238888 20557269 1229979 1271315 0 0 7653809 8108909 0 0 0 9044519 9079138 17928307 18459362 310581 2097907 56199624 82496467 39892013 63770091 16307611 18726376 AS A RETIREMENT COMMUNITY LEADER SINCE 1912, MASONIC AND EASTERN STAR HOME OF NC IS DEVOTED TO EXCELLENCE IN HOSPITALITY WITH TRADITIONAL VALUES PROMOTING FRATERNAL SERVICE, DIGNITY, DEPENDABILITY, AND CHOICE. 0 0 16274107 1271315 16686757 MASONIC AND EASTERN STAR HOME OF NC PROVIDES RESIDENTIAL, HEALTH CARE, AND OTHER RELATED SERVICES TO ELDERLY RESIDENTS. THE HOME OFFERS INDEPENDENT LIVNG, ASSISTED LIVING, AND SKILLED NURSING SERVICES. 16274107 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 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 1 0 0 0 1 59 0 1 323 1 0 0 0 0 0 0 0 0 0 0 X 20 20 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PHIL HUGHES 3362990031 700 S HOLDEN ROAD GREENSBORO NC 27407 X GENE JERNIGAN CHAIRMAN 1.00 X X 0 0 0 JAMES H WOOLARD DIRECTOR 1.00 X 0 0 0 REX EVANS SECRETARY 1.00 X X 0 0 0 LINDA HYATT VICE CHAIR 1.00 X X 0 0 0 WAYNE SOUTHERN TREASURER 1.00 X X 0 0 0 ARNOLD GENE COBB DIRECTOR 1.00 X 0 0 0 ROSS GELLER DIRECTOR 1.00 X 0 0 0 JOEY TRANSOU DIRECTOR 1.00 X 0 0 0 KEVIN COMBS DIRECTOR 1.00 X 0 0 0 GILBERT BAILEY DIRECTOR 1.00 X 0 0 0 DON ALDERMAN DIRECTOR 1.00 X 0 0 0 BILLY L PRICE JR MD DIRECTOR 1.00 X 0 0 0 STEVEN A GREEN DIRECTOR 1.00 X 0 0 0 MICHAEL J FISCHER DIRECTOR 1.00 X 0 0 0 HELEN LENTZ DIRECTOR 1.00 X 0 0 0 SPEED HALLMAN DIRECTOR 1.00 X 0 0 0 DWIGHT SIGMON DIRECTOR 1.00 X 0 0 0 JON CANUPP DIRECTOR 1.00 X 0 0 0 DEBBIE OWEN DIRECTOR 1.00 X 0 0 0 WILLIAM HORNE DIRECTOR 1.00 X 0 0 0 MARK KOLADA EXECUTIVE DIRECTOR 40.00 X 0 0 0 DIANNE ARMSTRONG HEALTH CENTER ADMINISTRATO 40.00 X 108107 0 10964 108107 0 10964 1 0 0 1 LIFE CARE SERVICES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 873336 HERITAGE HEALTHCARE 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY SERVICES 733178 CHEEK CONSTRUCTION 7020 PAWNEE ROAD GREENSBORO NC 27410 CONSTRUCTION AND REMODELING 318665 H&J TECHNICAL AIR SERVICE PO BOX 187 RANDLEMAN NC 27317 HVAC 192131 CARPET SUPER MART INC 4114 SPRING GARDEN STREET GREENSBORO NC 27407 FLOORING 123629 5 836611 1413607 2250218 RESIDENT SERVICES 623000 16678448 16678448 16678448 234794 234794 4990089 3604589 1385500 1385500 1385500 OTHER INCOME 623000 8309 8309 8309 20557269 16686757 0 1620294 1271315 1271315 6669493 5905366 764127 68127 59688 8439 738163 693586 44577 633126 598729 34397 682455 54517 627938 20746 20746 53005 53005 203405 76254 127151 1510080 1510080 68869 21887 46982 1901588 1901588 1741035 1741035 194193 194193 MEDICAL SERVICES 1155970 1155970 VARIOUS SUPPLIES 572242 533094 39148 REPAIRS AND MAINTENANCE 413340 383580 29760 MISCELLANEOUS 239715 117432 122283 322495 249986 72509 18459362 16274107 2185255 0 3043319 26465816 45686 47858 1942839 2240069 81978 68582 227101 237111 50984380 19350654 32167444 31633726 10785180 12197237 4897168 5425285 1966943 3399313 1041966 781470 56199624 82496467 1954857 2059971 12426535 12090856 21240122 45258302 4270499 4360962 39892013 63770091 X 7155906 8594406 2764206 3264764 6387499 6867206 16307611 18726376 56199624 82496467 2097907 320858 0 X 0 1 X 1 0 X 914810 1165145 1852247 1096277 2250218 7278697 914810 1165145 1852247 1096277 2250218 7278697 3201197 4077500 119903 139750 174266 199207 234794 867920 47631 23631 6929 15940 8309 102440 8249057 80029089 0.49430 0.55100 X 6387499 479707 6867206 6404560 -17061 6387499 6871104 -466544 6404560 6958944 -87840 6871104 6624695 334249 6958944 0 0 123290 123290 46893215 17120641 29772574 2703217 1648745 1054472 1264658 581268 683390 31633726 ASSETS IN SPLIT INTEREST AGREEMENTS 5425285 F 5425285 REFUNDABLE ADVANCE FEES 3929193 DEPOSITS ON UNOCCUPIED UNITS 190401 RESIDENT TRUST FUNDS 241368 4360962 X 19606812 320858 320858 19285954 1271315 1271315 20557269 17188047 0 17188047 1271315 1271315 18459362 PART X, LINE 2: IT IS THE HOME'S POLICY TO EVALUATE ALL TAX POSITIONS TO IDENTIFY ANY THAT MAY BE CONSIDERED UNCERTAIN. ALL IDENTIFIED MATERIAL TAX POSITIONS ARE ASSESSED AND MEASURED BY A "MORE-LIKELY-THAN-NOT" THRESHOLD TO DETERMINE IF THE TAX POSITION IS UNCERTAIN AND WHAT, IF ANY, THE EFFECT OF THE UNCERTAIN TAX POSITION MAY HAVE ON THE FINANCIAL STATEMENTS. NO MATERIAL UNCERTAIN TAX POSITIONS WERE IDENTIFIED DURING 2017. PART XI, LINE 4B - OTHER ADJUSTMENTS: GRANTS MADE TO RESIDENTS 1,271,315. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANTS MADE TO RESIDENTS 1,271,315. 1 WAIVER OF FEES FOR INDIVIDUALS DUE TO HARDSHIPS 60 1271315 FMV RESIDENTIAL AND HEALTH SERVICES PART I, LINE 2: THE ORGANIZATION PROVIDES GRANTS FOR RESIDENTS UNABLE TO AFFORD TO PAY FOR THEIR CARE. THE MAJORITY OF THE GRANT RECIPIENTS ALSO RECEIVE MEDICAID BENEFITS. EACH RESIDENT IS REQUIRED TO CONTRIBUTE AS MUCH AS THEY CAN AFFORD TOWARDS THE COST OF THEIR CARE. THE GRANTS ARE PAID DIRECTLY TO THE VENDORS PROVIDING THE CARE, TO ENSURE THE FUNDS ARE USED APPROPRIATELY. X 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 MARK KOLADA IS THE EXECUTIVE DIRECTOR OF MASONIC AND EASTERN STAR HOME OF NORTH CAROLINA. HOWEVER, MARK KOLADA IS EMPLOYED BY LIFE CARE SERVICES, LLC. (AN UNRELATED ORGANIZATION). MASONIC AND EASTERN STAR HOME OF NC PAYS LIFE CARE SERVICES, LLC. TO MANAGE OPERATIONS OF THE HOME. MARK KOLADA'S SALARY AND BENEFITS ARE PAID BY LIFE CARE SERVICES, LLC. FOR THE 2017 TAX YEAR, LIFE CARE SERVICES, LLC PAID MARK KOLADA MEDICARE WAGES IN THE AMOUNT OF $187,736. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YJN7 2011-04-28 26642514 SEE PART VI 0 0 0 A 26642514 1971475 2234840 3874001 532850 12196700 5832648 2012 1 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 A 0 FORM 990, SCHEDULE K, PART I, COLUMN F THE BONDS WERE ISSUED TO PAY FOR CONSTRUCTION OF AN EXPANSION TO THE HOMES' EXISTING FACILITY, REFUNDING CERTAIN INDEBTEDNESS INCURRED TO FINANCE A PORTION OF THE EXPANSION, FUNDING A DEBT SERVICE RESERVE FUND AND PAYING CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE BONDS. FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF DIRECTORS HAS CONTRACTED WITH LIFE CARE SERVICES, LLC. TO MANAGE, OPERATE AND MAINTAIN THE RETIREMENT COMMUNITY. THE EXECUTIVE DIRECTOR, MARK KOLADA, IS AN EMPLOYEE OF LIFE CARE SERVICES, LLC. FORM 990, PART VI, SECTION A, LINE 7A THE GRAND MASTER APPOINTS THREE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS WILL REVIEW THE FORM 990 AS IT IS PRESENTED BY LIFE CARE SERVICES, LLC. THE BOARD OF DIRECTORS WILL ASK ANY PERTINENT QUESTIONS AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL MONITORING OF CONFLICT OF INTEREST IS PART OF THE DUTIES OF THE CORPORATE COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR CEO, CURRENT OFFICERS, ETC. IS REVIEWED AS A PART OF ANNUAL BUDGET BY THE BOARD OF DIRECTORS, FINANCE COMMITTEE AND PERSONNEL COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. THE AUDITED FINANCIALS ARE INCLUDED IN ANNUAL DISCLOSURE AS REQUIRED BY DEPARTMENT OF INSURANCE. GRAND LODGE OF THE AF AND AM OF NC PO BOX 6506 RALEIGH NC 27628 560228750 PROVIDE SUPPORT FOR NC MASONS NC 501(C)(10) 0 GRAND CHAPTER OF THE ORDER OF THE EASTERN STAR OF NC PO BOX 4730 WILMINGTON NC 28406 560239941 CHARITABLE, EDUCATIONAL AND FRATERNAL NC 501(C)(8) 0 NC MASONIC FOUNDATION INC PO BOX 6506 RALEIGH NC 27628 566049500 RECEIVE DONATIONS AND DISTRIBUTE ALL INCOME TO CHARITABLE ORGANIZATIONS NC 501(C)(3) LINE 12B, II 0 NC EASTERN STAR FOUNDATION INC PO BOX 2296 GARNER NC 27529 561974972 INVEST FUNDS RAISED TO PROVIDE PERPETUAL FUND TO EASTERN STAR HOME NC 501(C)(3) PF 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NORTH CAROLINA MASONIC AND EASTERN STAR HOME FOUNDATION LLC C 562754 GRAND CHAPTER OF THE ORDER OF THE EASTERN STAR OF NC C 273857