2018-11-12T12:17:03-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2017-01-01 561380014 CAROLINA MEADOWS INC CARO 9199424014 100 CAROLINA MEADOWS CHAPEL HILL NC 275178505 KEVIN A MCLEOD PRESIDENT AND CEO 9199424014 2018-11-12 1 JOHN NORMAN P01506766 7049985200 2018-11-12 67.137.57.251 2018-11-12 12:55:34 ES P 9ACEB88934FFCCBD98C12E2F38B246F9B43CAC86 625448C0F55D99FA31EEB930CD4AF0F24507C48B 2017 2019-02-21 02:37:17Z KEVIN A MCLEOD 100 CAROLINA MEADOWS CHAPEL HILL NC 275178505 49290689 0 X WWW.CAROLINAMEADOWS.ORG X 1983 NC PROVIDING HOUSING, HEALTH CARE & OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A CCRC. 14 14 578 0 50000 10274 277296 0 37430393 40423955 105863 907667 27481 30467 37841033 41362089 891917 671250 0 0 20226331 19646786 0 0 0 15998410 17053537 37116658 37371573 724375 3990516 109226519 111647874 84806714 80116296 24419805 31531578 X TO ENRICH AND IMPROVE THE LIVES OF SENIORS. TO SUPPORT OUR LOCAL COMMUNITY, INVEST IN THE FUTURE OF AGING, CONTRIBUTE TO THE LOCAL ECONOMY AND PARTNER ON SENIOR INITIATIVES, AS WELL AS PROVIDE HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO SENIOR ADULTS THROUGH THE OPERATION OF A LIFE PLAN COMMUNITY. 0 0 33076255 671250 40373955 CAROLINA MEADOWS PROVIDES HOUSING, HEALTH AND WELLNESS SERVICES, AND SOCIAL OPPORTUNITIES, FOR SENIOR ADULTS IN A FINANCIALLY SECURE RETIREMENT COMMUNITY THROUGH A PERSON-CENTERED APPROACH THAT RESPECTS INDIVIDUAL DIGNITY, ENCOURAGES INDEPENDENCE, AND PROMOTES LIFELONG LEARNING THROUGHOUT THE SEQUENCES OF AGING. CAROLINA MEADOWS PROVIDED 223,284 RESIDENT DAYS OF HOUSING AND SERVICES FOR RESIDENTS LIVING WITHIN THE INDEPENDENT LIVING COMPONENT OF THE CAMPUS. IN ASSISTED LIVING, INCLUDING MEMORY CARE, 29,071 RESIDENT DAYS OF HOUSING AND SERVICES WERE PROVIDED. IN SKILLED NURSING, 22,286 PATIENT DAYS OF HOUSING AND SERVICES WERE PROVIDED. A TOTAL OF 5,224 DAYS OF CONTINUING CARE WITHOUT LODGING CONTRACTUAL SERVICES WERE PROVIDED TO 48 RESIDENTS LIVING OFF-CAMPUS WHO RECEIVE THE SAME ACCESS TO AMENITIES AND HEALTH CARE SERVICES OFFERED TO RESIDENTS LIVING ON-CAMPUS. GERIATRIC PHYSICIAN CARE, NURSE PRACTITIONER AND SPECIALTY PHYSICIAN CARE PROGRAMS SUCH AS AUDIOLOGY, PODIATRY, DERMATOLOGY AND DENTAL SERVICES ARE PROVIDED TO RESIDENTS IN ALL CARE LEVELS. THE CAMPUS PRIMARY CARE MEDICAL PRACTICE AVERAGED OVER 400 RESIDENT VISITS PER MONTH AND ALSO PROVIDED APPROXIMATELY 200 RESIDENT MEDICAL ASSESSMENTS PER MONTH.WE'VE HIGHLIGHTED OTHER ACCOMPLISHMENTS BELOW:FITNESS CENTERTHE FITNESS CENTER LOGGED SIGN-INS AVERAGE 1,455 PER MONTH. IN ADDITION, 30 REGULARLY SCHEDULED FITNESS CLASSES ARE OFFERED INCLUDING: POOL, AEROBICS, STRETCH, YOGA, MEDITATION AND OTHERS WITH AN AVERAGE ATTENDANCE OF FIVE TO TWENTY EIGHT PER CLASS. THERE ARE ALSO TWO ADDITIONAL NON-REGULAR FITNESS CLASSES AND CAMPUS GROUP WALKING OFFERINGS, AS WELL AS WEEKLY ORIENTATION OFFERED AT NO COST AND MONTHLY PERSONAL TRAINING SESSIONS. FOUR EMPLOYEES ARE DESIGNATED FOR THE WELLNESS PROGRAM AND ADDITIONAL SERVICES ARE PROVIDED UNDER CONTRACT INCLUDING MASSAGE, NUTRITION AND SWIM LESSONS. THERE ARE OVER 200 EMPLOYEES ENROLLED IN THE WELLNESS INITIATIVE. THE WELLNESS DEPARTMENT PERFORMS AN ANNUAL FUNCTIONAL FITNESS ASSESSMENT ON INDEPENDENT LIVING RESIDENTS THAT ARE PATIENTS OF OUR PRIMARY CARE MEDICAL PRACTICE AT THE TIME OF THEIR ANNUAL WELLNESS EXAM. THIS AVERAGES 20 PARTICIPANTS MONTHLY. IN ADDITION TO CREATING AN INDIVIDUAL WELLNESS PLAN, DATA FROM THE ASSESSMENTS IS USED IN AGGREGATE FORM ON BOTH THE COMMUNITY AND NATIONAL LEVEL FOR RESEARCH ON AGING.WELLNESS SERVICESPHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES ARE AVAILABLE ON OUR CAMPUS UNDER CONTRACT WITH GENESIS REHABILITATION. AVERAGE VISITS PER MONTH ARE AS FOLLOWS: PHYSICAL THERAPY - 142, OCCUPATIONAL THERAPY - 53, AND SPEECH THERAPY - 20.ACTIVITIESACTIVITIES ARE ARRANGED BY BOTH STAFF AND RESIDENTS. OFFERINGS EACH MONTH ARE DESIGNED TO MEET THE FULL RANGE OF NEEDS AND INTERESTS AS FOLLOWS: SOCIAL, INTELLECTUAL, SPIRITUAL, PHYSICAL AND EMOTIONAL. IN THE FAIRWAYS (ASSISTED LIVING) STAFF DESIGN AN ACTIVITIES CALENDAR WITH GROUP AND INDIVIDUAL OPPORTUNITIES. RESIDENTS ARE ENCOURAGED TO CONTINUE INTERESTS AND HOBBIES DEVELOPED OVER A LIFETIME. DESIGNATED STAFF PROVIDE ACTIVITIES IN THE GREEN (MEMORY SUPPORT ENVIRONMENT WITHIN THE FAIRWAYS). TWO SEPARATE PROGRAMS ARE PROVIDED IN THE PINES (SKILLED NURSING): APPROXIMATELY 10-15 RESIDENTS WITH SEVERE MEMORY IMPAIRMENT ARE SERVED DAILY IN A SPECIFIC PROGRAM FOR THIS POPULATION WHILE 15-20 RESIDENTS PARTICIPATE DAILY IN THE PROGRAM DESIGNED FOR THOSE WHOSE COGNITION IS INTACT. THERE IS ALSO A MUSIC & MEMORY PROGRAM USING IPODS THAT SERVES SKILLED NURSING AND MEMORY CARE RESIDENTS.DINING SERVICESDINING SERVICES PROVIDES MEALS DAILY FOR ALL LEVELS OF LIVING. APPROXIMATELY 5,500 MEALS PER MONTH ARE SERVED IN THE PINES, 5,300 IN THE FAIRWAYS AND 13,550 IN THE INDEPENDENT LIVING DINING VENUES.PHYSICAL PLANTTHE PHYSICAL PLANT DEPARTMENT ANNUALLY TURNS OVER AN AVERAGE OF 44 INDEPENDENT LIVING UNITS. EACH UNIT IS REFURBISHED TO NEW OR LIKE-NEW CONDITION. IN ADDITION, THIS DEPARTMENT COMPLETED 10,445 WORK ORDERS FOR INDEPENDENT LIVING RESIDENTS, 1,593 FOR PINES RESIDENTS AND 1,982 FOR FAIRWAYS RESIDENTS PLUS 4,928 COMMUNITY WIDE WORK ORDERS EXCLUSIVE OF SPECIAL PROJECTS, SECURITY RESPONSES AND TRASH PICKUP, FOR A TOTAL OF 18,948.ENVIRONMENTAL SERVICESTHE ENVIRONMENTAL SERVICES DEPARTMENT, IN ADDITION TO CLEANING ALL COMMON AREAS AND PROVIDING DAILY SERVICE TO ALL HEALTH CENTER AND ASSISTED LIVING RESIDENTS, PROVIDES CLEANING FOR APPROXIMATELY 200 INDEPENDENT LIVING RESIDENTS PER MONTH. APPROXIMATELY 185 POUNDS OF LINEN ARE WASHED, DRIED AND IRONED DAILY FOR THE CLUB CENTER DINING ROOMS, IN ADDITION TO LINENS PROVIDED IN THE PINES HEALTH CENTER AND THE FAIRWAYS ASSISTED LIVING.COMMUNITY INVOLVEMENTCAROLINA MEADOWS IS ACTIVELY INVOLVED IN THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY OUTREACH, EDUCATIONAL, CHARITABLE AND VOLUNTEER PROGRAMS SPONSORED ON CAMPUS OR THROUGHOUT THE SURROUNDING COMMUNITY. CAROLINA MEADOWS WORKS IN PARTNERSHIP WITH MANY CHARITABLE ORGANIZATIONS TO MAKE THE COMMUNITY A BETTER PLACE TO LIVE FOR ALL. CAROLINA MEADOWS HAS MADE SIGNIFICANT CHARITABLE GIFTS IN 2017 TO SUPPORT CHARITIES THAT SUPPORT OLDER ADULTS IN CHATHAM COUNTY, INCLUDING: -- A FIVE-YEAR PLEDGE WAS MADE IN 2016 TO THE UNC MEDICAL FOUNDATION FOR THE CREATION OF A NEW HOSPICE HOME IN PITTSBORO, NORTH CAROLINA THAT WILL SERVE CHATHAM COUNTY RESIDENTS AND BEYOND. THE PLEDGE WAS FOR $150,000 OVER FIVE YEARS; $37,500 WAS CONTRIBUTED IN 2017. -- A FIVE-YEAR PLEDGE WAS MADE IN 2016 TO THE CHATHAM COUNTY COUNCIL ON AGING TO SUPPORT THEIR FROZEN MEALS PROGRAM FOR ELDERS. THIS PROGRAM REACHES SENIORS WHO LIVE OUTSIDE OF THE MEALS FOR WHEELS ROUTES BUT STILL NEED CRUCIAL NUTRITIONAL SUPPORT. THIS PROGRAM IS A PARTNERSHIP OF CAROLINA MEADOWS, CHATHAM COUNTY GOVERNMENT AND THE COUNCIL ON AGING. THE PLEDGE WAS FOR $37,500 OVER FIVE YEARS. THE SECOND $7,500 DONATION WAS CONTRIBUTED IN 2017. BEYOND FINANCIAL SUPPORT, CAROLINA MEADOWS SUPPORTS NONPROFIT ORGANIZATIONS THROUGH DONATIONS OF TALENT, SPACE, FOOD, AND OTHER IN-KIND CONTRIBUTIONS. EXAMPLES INCLUDE: -- DONATED 35 PRINTERS AND 22 PRINT CARTRIDGES TO 13 NONPROFIT ORGANIZATION IN CHATHAM COUNTY AND THE TRIANGLE.-- PARTICIPATED IN A CHEF CHALLENGE SHARING STAFF TALENT, TIME AND FOOD (VALUED AT $1,747) TO BENEFIT TRANSITIONS GUIDING LIGHTS CAREGIVER SUPPORT ORGANIZATION. -- DONATED FOOD AND TIME TO CHARITABLE COMMUNITY EVENTS, SUCH AS ALL THE MEALS (VALUED AT $1,770) FOR 60 CHILDREN AND ADULT VOLUNTEERS AT DUKE HOSPICE'S CAMP RELEAF, A WEEKEND-LONG CAMP FOR KIDS WHO HAVE LOST FAMILY MEMBERS. -- PARTNERED WITH UNC CHAPEL HILL SCHOOL OF MEDICINE TO TRAIN 3RD YEAR MEDICAL STUDENTS IN FALLS RISK ASSESSMENT. CAROLINA MEADOWS HOSTS QUARTERLY WORKSHOPS WHERE UNC INSTRUCTORS PROVIDE TRAINING AND THEN THE STUDENTS PRACTICE NEWLY LEARNED SKILLS ON RESIDENT VOLUNTEERS. WE PROVIDED IN-KIND LUNCHES (VALUED AT $488 EACH CALENDAR QUARTER) TO FACILITATE STUDENT AND RESIDENT INTERACTION AND LEARNING. -- DONATED REFRIGERATORS, INDUSTRIAL LIGHTS FIXTURES AND OTHER IN-KIND APPLIANCES TO MANY SCHOOLS, CHURCHES AND THRIFT SHOPS IN OUR LOCAL COMMUNITY.STAFF GENEROUSLY DONATE THEIR TIME/SERVICE TO MANY COMMUNITY ORGANIZATIONS. EXAMPLES INCLUDE:-- PARTICIPATED ON PLANNING COMMITTEES FOR COMMUNITY-WIDE PROJECTS SUCH AS THE CHATHAM COUNTY SENIOR GAMES, ALZNC CAMPAIGN, CHATHAM HEALTH ALLIANCE AND CHATHAM COUNTY AGING PLAN. -- SERVED AS PRECEPTORS FOR STUDENTS FROM DURHAM TECH, UNIVERSITY OF NORTH CAROLINA, NORTH CAROLINA CENTRAL UNIVERSITY AND BEYOND. IN ADDITION TO OUR ROBUST CORPORATE COMMUNITY OUTREACH PROGRAM, OUR RESIDENT ASSOCIATION HAS A RESIDENT COMMUNITY OUTREACH COMMITTEE. -- THIS COMMITTEE HAS RESIDENT LIAISONS WITH VARIOUS NONPROFIT ORGANIZATIONS IN CHATHAM COUNTY. THE LIAISONS SHARE INFORMATION AND VOLUNTEER OPPORTUNITIES ABOUT EACH GROUP WITH THE RESIDENTS.-- THIS GROUP ALSO ORGANIZES A COAT DRIVE IN THE WINTER, AND A SCHOOL SUPPLIES DRIVE IN THE FALL. OUR RESIDENTS OFFER MANY HOURS OF VOLUNTEER TIME TO SUPPORT NONPROFITS IN OUR AREA AS WELL AS OUR OWN CAMPUS COMMUNITY. -- IN OUR 2017 RESIDENT SURVEY, RESIDENTS REPORTED NEARLY 45,000 VOLUNTEER HOURS TO THE GREATER COMMUNITY. THIS EQUATES TO A VALUE OF OVER A MILLION DOLLARS. -- RESIDENTS ALSO VOLUNTEER WITHIN OUR OWN COMMUNITY. MORE THAN 67 RESIDENT VOLUNTEERS PROVIDED MORE THAN 1,750 HOURS OF SERVICE INCLUDING ONE-ON-ONE VISITS, MAIL DELIVERY, AND ACTIVITIES IN HIGHER LEVELS OF CARE.CHARITABLE DONATIONSCHARITABLE DONATIONS AND COMMUNITY BENEFITS FOR THE YEAR ENDED DECEMBER 31, 2017 INCLUDED $601,594 IN BENEVOLENT CARE, $106,653 IN CHARITABLE DONATIONS AND $44,877 IN DONATED VOLUNTEER SERVICES.PROPERTY TAXESFOR 2017, PROPERTY TAX PAYMENTS OF $885,878 WERE MADE TO SUPPORT NEEDED INFRASTRUCTURE TO HELP CHATHAM COUNTY PROSPER. 33076255 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 80 0 578 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X GARY LEVINE 9193707128 100 CAROLINA MEADOWS CHAPEL HILL NC 275178505 DIANNE STIMSON CHAIR 3.00 X X 0 0 0 JOAN PHARR TREASURER 3.00 X X 0 0 0 JOHN MODISETT SECRETARY 2.50 X X 0 0 0 RHODES CRAVER MEMBER 2.00 X 0 0 0 JB CULPEPPER MEMBER 2.00 X 0 0 0 JOHN GABOR MEMBER 2.00 X 0 0 0 RODGERS HARSHBARGER MEMBER 2.00 X 0 0 0 BOB JACKSON MEMBER 2.00 X 0 0 0 WILLIAM KALKOFF MEMBER 2.00 X 0 0 0 ANNE KISSEL MEMBER 2.00 X 0 0 0 PAT MANDELL MEMBER 2.00 X 0 0 0 STEVE MILLER MEMBER 2.00 X 0 0 0 JOAN PELLETTIER MEMBER 2.00 X 0 0 0 DON STEDMAN MEMBER 2.00 X 0 0 0 PHILLIP SLOANE MEMBER 2.00 X 0 0 0 MARIECHEN SMITH MEMBER 2.00 X 0 0 0 BETSY AHERN EX-OFFICIO 0.00 X 0 0 0 MCLEOD KEVIN CHIEF EXECUTIVE OFFICER 40.00 X X 351640 0 24144 CORNTHWAITE BENJAMIN CHIEF OPERATING OFFICER 40.00 X X 198144 0 33187 LEVINE GARY CHIEF FINANCIAL OFFICER 40.00 X X 201733 0 17575 COWARD HOLLY JEAN MEDICAL DIRECTOR 30.00 X 223915 0 10602 KASS MELISSA VICE PRESIDENT - MARKETING 40.00 X 145508 0 17370 DALEY-PLACIDE RACQUEL PHYSICIAN 30.00 X 142493 0 36919 ITZKOWITZ BRAD VICE PRESIDENT - DINING 40.00 X 117215 0 37903 HARRILL EMMA DIRECTOR OF WELLBEING 40.00 X 111557 0 5230 HOGAN MELISSA DIRECTOR OF FINANCE 40.00 X 110943 0 11395 1603148 0 194325 13 0 1 0 US FOODSERVICE PO BOX 602211 CHARLOTTE NC 28260 FOOD 1301106 CHATHAM CARPET 50 STILL WATERS DRIVE SILER CITY NC 27344 FLOORING 804317 MARSH KITCHEN & BATH PO BOX 1401 GRAHAM NC 27523 CABINETS/COUNTERTOPS 457160 SYSCO PO BOX 129 SELMA NC 27576 FOOD 414743 RUPPERT LANDSCAPE 23601 LAYTONSVILLE ROAD LAYTONSVILLE MD 20882 LANDSCAPING 269700 22 INDEPENDENT LIVING REV 623000 21009144 21009144 HEALTH CARE CENTER REV 623000 7860134 7860134 ASSISTED LIVING REV 623000 7320752 7320752 REFURBISHING 623000 1872720 1872720 REMARKETING 623000 828355 828355 1532850 1482850 50000 40423955 460253 460253 21135 0 21135 21135 21135 8376014 7928600 447414 447414 447414 MISCELLANEOUS 623000 9332 9332 9332 41362089 40373955 50000 938134 69656 69656 601594 601594 975430 223915 751515 14928461 13317034 1611427 428277 349170 79107 2164470 2040207 124263 1150148 966009 184139 181884 129880 52004 47121 47121 97901 97901 1787275 1773864 13411 136826 29918 106908 1261881 1124328 137553 43478 43478 2288736 1545052 743684 106630 68840 37790 33028 19136 13892 475118 475118 4217240 4217240 56844 56844 FOOD COSTS 2119626 2119626 UPGRADES & MODIFICATION 2074014 2074014 REPAIRS & MAINTENANCE 881949 881949 SHARED APPRECIATION 734462 734462 509524 258399 251125 37371573 33076255 4295318 0 2035916 2844412 2458 2533 1993217 2486530 334067 373167 259138 157971 139823871 63876663 78605427 75947208 25954312 29798583 41984 37470 109226519 111647874 4328057 4207992 56092686 53347933 14447367 13859267 2638316 2778454 1835712 964280 5464576 4958370 84806714 80116296 X 24419805 31531578 24419805 31531578 109226519 111647874 X 3990516 2924403 196854 X 0 1 X 1 0 X 16263 29175 23914 15081 84433 33270335 35245986 36000478 37430393 40373955 182321147 33286598 35275161 36024392 37445474 40373955 182405580 0 0 0 182405580 444091 158651 275477 372219 481388 1731826 444091 158651 275477 372219 481388 1731826 50000 50000 23294 13098 11439 5855 16135 69821 33753983 35446910 36311308 37823548 40921478 184257227 0.99000 0.98900 0.00940 0.01040 X 0 2638316 140138 2778454 1 X 2096762 2096762 121415219 53623751 67791468 9792562 6876177 2916385 6519328 3376735 3142593 75947208 INVESTMENTS AND ASSETS WHOSE USE IS LIMITED 29798583 F 29798583 INTEREST RATE SWAP AGREEMENTS 379339 OTHER DEFERRED REVENUE 923600 ADVANCE DEPOSITS 3009375 FAIRWAYS ENTRANCE FEE REFUNDS DUE 646056 4958370 X PART IV, LINE 2B: RESIDENT FUNDS HELD IN AGENCY ACCOUNTS REPRESENT FUNDS WITHHELD FROM RESIDENTS DETERMINED TO BE A FINANCIAL RISK AND RESIDENTS WISHING TO ESTABLISH AGENCY ACCOUNTS IN LIEU OF LONG-TERM CARE INSURANCE. CAROLINA MEADOWS HAS DEPOSITED THESE FUNDS ON THE RESIDENTS' BEHALF IN CERTIFICATES OF DEPOSIT OR MONEY MARKET FUNDS WITH A FINANCIAL INSTITUTION. CAROLINA MEADOWS ACTS AS CUSTODIAN FOR THE AGENCY ACCOUNTS, WHICH ARE LEGALLY OWNED BY THE RESIDENTS. AT DECEMBER 31, 2017 AND 2016, AGENCY FUNDS DUE RESIDENTS WERE $2,778,454 AND $2,638,316, RESPECTIVELY. PART X, LINE 2: CAROLINA MEADOWS IS A NONPROFIT, TAX-EXEMPT ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3); ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. CAROLINA MEADOWS HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFIT OR OBLIGATION AS OF DECEMBER 31, 2017. 1 ALZHEIMER'S ASSOCIATION OF NC 9131 ANSON WAY SUITE 206 RALEIGH NC 27615 561501117 501(C)(3) 5422 TO SUPPORT ALZHEIMER'S AND CAREGIVER SUPPORT SERVICES CHATHAM COUNTY COUNCIL ON AGING PO BOX 715 PITTSBORO NC 27312 561084260 501(C)(3) 7650 TO SUPPORT THE FROZEN MEALS PROGRAM FOR SENIORS THROUGHOUT CHATHAM COUNTY, AND THE SENIOR GAMES CHATHAM COUNTY LITERACY COUNCIL PO BOX 1696 PITTSBORO NC 27312 581870076 501(C)(3) 8000 TO SUPPORT TUTOR TRAINING FOR RESIDENTS AND GREATER COMMUNITY; TO SUPPORT ESL TUTOR PROGRAM AT CM FOR STAFF AND FOR COMMUNITY CITIZENS IN NEED HUMANITIES AT UNC 1700 MLK BLVD CB 3425 CHAPEL HILL NC 27599 566001393 501(C)(3) 5000 SPONSORSHIP OF A HUMANITIES PROGRAM AT UNC FOR COMMUNITY MEMBERS UNC MEDICAL FOUNDATION UNC PO BOX 309 CHAPEL HILL NC 27514 566057494 501(C)(3) 37500 CONTRIBUTION OF SECOND OF FIVE YEAR PLEDGE FOR THE NEW UNC HOSPICE HOME IN CHATHAM COUNTY 5 0 RESIDENT FINANCIAL ASSISTANCE 8 601594 BOOK VALUE N/A PART I, LINE 2: GRANTEES MUST HAVE 501(C)(3) STATUS AND MUST BE LOCATED IN AND/OR SERVE RESIDENTS IN CHATHAM COUNTY, NORTH CAROLINA. THE FOLLOWING CRITERIA ARE USED DURING THE GRANT EVALUATION PROCESS PROJECT DESCRIPTION: (1) DESCRIPTION - IS THE PROPOSED PROJECT OR PROGRAM CLEARLY DESCRIBED? (2) MISSION SUPPORT - IS THERE CLEAR EVIDENCE THAT THE PROJECT SUPPORTS THE MISSION OF THE AGENCY? (3) NEED - DOES THE PROPOSAL CLEARLY DOCUMENT/EXPLAIN THE NEED FOR THE PROJECT/PROGRAM IN CHATHAM COUNTY? (4) IMPACT - ARE THE PROPOSED OUTCOMES CLEAR, REALISTIC AND MEASURABLE? (5) BUDGET - IS THE BUDGET SUFFICIENTLY DETAILED, REALISTIC AND APPROPRIATE GIVEN THE DESIRED GOALS/IMPACT? (6) EFFECT - IS THERE EVIDENCE THAT A GRANT FROM CAROLINA MEADOWS WILL SIGNIFICANTLY INCREASE THE IMPACT OF THE PROPOSED PROJECT/PROGRAM? (7) COLLABORATIVE EFFORT - IS THE PROPOSED PROJECT/PROGRAM A COLLABORATIVE EFFORT INVOLVING MULTIPLE AGENCIES? (8) REPORTING - GRANTEES ARE REQUIRED TO SUBMIT INTERIM AND FINAL REPORTS TO CAROLINA MEADOWS. X X X X 0 0 0 0 0 0 0 0 0 MCLEOD KEVIN CHIEF EXECUTIVE OFFICER 328088 0 16404 0 7148 0 12528 0 11616 0 375784 0 0 0 CORNTHWAITE BENJAMIN CHIEF OPERATING OFFICER 197856 0 0 0 288 0 1616 0 31571 0 231331 0 0 0 LEVINE GARY CHIEF FINANCIAL OFFICER 192066 0 8992 0 675 0 9781 0 7794 0 219308 0 0 0 COWARD HOLLY JEAN MEDICAL DIRECTOR 211048 0 11557 0 1310 0 10602 0 0 0 234517 0 0 0 KASS MELISSA VICE PRESIDENT - MARKETING 139016 0 6268 0 224 0 5790 0 11580 0 162878 0 0 0 DALEY-PLACIDE RACQUEL PHYSICIAN 141272 0 1030 0 191 0 5625 0 31294 0 179412 0 0 0 ITZKOWITZ BRAD VICE PRESIDENT - DINING 116831 0 0 0 384 0 6332 0 31571 0 155118 0 0 0 A NC MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2010-12-22 17810000 TO REFUND THE 2004 BONDS 0 0 0 A 3885000 17810000 17810000 2006 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 1 SUNTRUST 3.000000000000 0 0 0 0 1 A 1 K&M CONSTRUCTIONKEVIN STEDMAN COMPANY OWNED BY FAMILY MEMBER OF BOARD MEMBER 192382 K&M CONSTRUCTION WAS USED TO COMPLETE VARIOUS PROJECTS RELATED TO CAROLINA MEADOWS RESIDENTIAL UNIT 'REDECKING' OF OUTDOOR DECKS. 0 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS FIRST REVIEWED IN DETAIL BY THE MEMBERS OF THE BOARD FINANCE COMMITTEE PRIOR TO PRESENTATION TO THE FULL BOARD. THE ENTIRE BOARD THEN REVIEWS FORM 990 PRIOR TO THE RETURN BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C GOVERNING DOCUMENTS, INCLUDING BY-LAWS, AND CONFLICT OF INTEREST STATEMENTS, ARE PLACED IN THE CAROLINA MEADOWS RESIDENT'S LIBRARY QUARTERLY AND ANNUAL FINANCIALS STATEMENTS ARE INCLUDED IN THE BOARD OF DIRECTORS MINUTES AND ALSO PLACED IN THE LIBRARY. ARTICLES OF INCORPORATION ARE AVAILABLE ON THE WEBSITE OF THE NC SECRETARY OF STATE. THE ANNUAL DISCLOSURE STATEMENT IS AVAILABLE ON-LINE THROUGH THE NC DEPARTMENT OF INSURANCE (NCDOI.COM), AND INCLUDES IN APPENDICES COPIES OF THE DOI CCRC LICENSE, DHSR NURSING FACILITY LICENSE, ANNUAL AUDITED FINANCIAL STATEMENTS, 5-YEAR FINANCIAL PROJECTIONS, CONFLICT OF INTEREST POLICY, CCRC CONTRACT AND OTHER CORPORATE INFORMATION. ALL GOVERNING DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST IN THE EXECUTIVE OFFICES. THE GOVERNANCE COMMITTEE ANNUALLY REVIEWS THE CONFLICT OF INTEREST POLICY TO DETERMINE THAT ALL BOARD MEMBERS ARE IN COMPLIANCE. THE FORM IS SENT TO EACH MEMBER FOR THEIR SIGNATURE PRIOR TO FILING AND REVIEWED BY THE GOVERNANCE COMMITTEE AT ITS MEETING FOLLOWING THE BOARD'S FULL MEETING AT WHICH THE POLICY WAS APPROVED. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES, SALARY SURVEY DATA IS COMPILED BY THE HUMAN RESOURCES VICE PRESIDENT FOR USE BY THE CEO. USING THE SURVEY DATA AND PERFORMANCE ANALYSIS AS A BENCHMARK, THE CEO SETS COMPENSATION BASED ON PERFORMANCE AND WITHIN SALARY RANGES. THE PROPOSED SALARIES ARE SUBMITTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, INCLUDING BY-LAWS, AND CONFLICT OF INTEREST STATEMENTS, ARE PLACED IN THE CAROLINA MEADOWS RESIDENT'S LIBRARY. QUARTERLY AND ANNUAL FINANCIALS STATEMENTS ARE INCLUDED IN THE BOARD OF DIRECTORS MINUTES AND ALSO PLACED IN THE LIBRARY. ARTICLES OF INCORPORATION ARE AVAILABLE ON THE WEBSITE OF THE NC SECRETARY OF STATE. THE ANNUAL DISCLOSURE STATEMENT IS AVAILABLE ON-LINE THROUGH THE NC DEPARTMENT OF INSURANCE (NCDOI.COM), AND INCLUDES IN APPENDICES COPIES OF THE DOI CCRC LICENSE, DHSR NURSING FACILITY LICENSE, ANNUAL AUDITED FINANCIAL STATEMENTS, 5-YEAR FINANCIAL PROJECTIONS, CONFLICT OF INTEREST POLICY, CCRC CONTRACT AND OTHER CORPORATE INFORMATION. ALL GOVERNING DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST IN THE EXECUTIVE OFFICES. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE INTEREST RATE SWAP 190,051. CHANGE IN VALUE OF GIFT ANNUITIES 6,803. CAROLINA MEADOWS HOME CARE INC 100 CAROLINA MEADOWS CHAPEL HILL NC 27517 821777558 HEALTH CARE NC 501(C)(3) LINE 12B, II CAROLINA MEADOWS SENIOR COMMUNITIES & SERVICES INC 0 CAROLINA MEADOWS SENIOR COMMUNITIES AND SERVICES INC 100 CAROLINA MEADOWS CHAPEL HILL NC 27517 821792692 HEALTH CARE NC 501(C)(3) LINE 12B, II 0 CAROLINA MEADOWS MANAGEMENT AND DEVELOPMENT SERVICES INC 100 CAROLINA MEADOWS CHAPEL HILL NC 27517 821768377 MANAGEMENT SERVICES NC CAROLINA MEADOWS SENIOR COMMUNITIES & SERVICES INC C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0