2018-08-06T05:41:46-05:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-10-01 561089384 CAROLINA ADVENTIST RETIREMENT SYSTEMS INC CARO 7046679851 95 HOLCOMBE COVE RD CANDLER NC 287159450 DEBORAH HAWKINS TREASURER 7046679851 2018-08-06 1 Amy Bibby P00445891 8282542254 2018-07-23 2016 2022-09-23 18:48:47Z DEBORAH HAWKINS 95 HOLCOMBE COVE RD CANDLER NC 287159450 13267093 0 X WWW.PISGAHVALLEY.ORG X 1975 NC SERVING HEALTHCARE AND RESIDENTIAL NEEDS WHILE UPHOLDING CHRISTIAN PRINCIPLES. 25 12 602 15 110670 0 97920 36951 15112330 12693834 7895234 189118 352076 347190 23457560 13267093 206275 12325 0 0 8999821 8192571 0 0 0 7510450 5586751 16716546 13791647 6741014 -524554 30884355 29720068 10155787 11147135 20728568 18572933 AS A FAITH-BASED SEVENTH-DAY ADVENTIST ORGANIZATION, WE ARE DEDICATED TO SERVING THE HEALTHCARE AND RESIDENTIAL NEEDS OF OUR COMMUNITY WHILE UPHOLDING CHRISTIAN PRINCIPLES. 0 0 11473191 12325 12736854 PISGAH VALLEY RETIREMENT COMMUNITY OWNS AND OPERATES A LICENSED CONTINUING CARE RETIREMENT COMMUNITY WITH 52 INDEPENDENT LIVING DUPLEX CONDOMINIUM UNITS, A 24-UNIT MULTI-UNIT ASSISTED HOUSING WITH SERVICES FACILITY, AND A 118-BED SKILLED NURSING FACILITY IN CANDLER, NORTH CAROLINA. PROGRAM SERVICE ACCOMPLISHMENTS INCLUDE THE PROVIDING OF ROOM AND BOARD (SHELTER, UTILITIES, MEALS, HOUSEKEEPING, LAUNDRY, AND MAINTENANCE), TRANSPORTATION, WELLNESS CENTER/ACTIVITIES, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, AND MEDICAL SERVICES TO OUR COMMUNITY (PRIMARILY AGE 55 AND OLDER). 11473191 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 48 0 1 602 1 1 1 0 0 0 0 0 0 0 0 0 X 25 12 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X DEBORAH HAWKINS 8284182334 95 HOLCOMBE COVE ROAD CANDLER NC 28715 LOUIS LESLIE DIRECTOR/CHAIRMAN 1.00 40.00 X 0 83592 49791 MOYER GARY DIRECTOR/SECRETARY 1.00 40.00 X X 0 79793 37514 ARCE MAIKEL DIRECTOR 1.00 X 0 0 0 BUNCH JIMM DIRECTOR 1.00 X 0 0 0 DONALDSON JEFF DIRECTOR 1.00 40.00 X 0 65637 40148 GRUNDY CHAD DIRECTOR 1.00 40.00 X 0 72319 18861 HENRIQUEZ ANDRES DIRECTOR 1.00 X 0 75 0 HUTCHINSON RICK staff rotator DIRECTOR 1.00 40.00 X 0 73200 16452 HYMBAUGH CHRISTINA DIRECTOR 1.00 X 0 150 0 KOCHENOWER BEN DIRECTOR 1.00 X 0 300 0 MORRISON LANCE staff rotator DIRECTOR 1.00 40.00 X 0 69490 18693 RICHARDSON DEXTER DIRECTOR 1.00 40.00 X 0 68075 51937 RIVERA JOSE DIRECTOR 1.00 40.00 X 0 67587 37499 ROUSE GARY DIRECTOR 1.00 40.00 X 0 71982 18861 RUSSELL RICHARD DIRECTOR 1.00 40.00 X 0 78463 18950 SHEPARD RAYMOND KEITH DIRECTOR 1.00 X 0 150 0 STAMP LINDA DIRECTOR 1.00 X 0 375 0 WETMORE DON DIRECTOR 1.00 X 0 450 0 WILLIAMS ANDREW DIRECTOR 1.00 X 0 375 0 WILLIAMS CHARLES DON DIRECTOR 1.00 X 0 300 0 WILLIAMS HASKELL DIRECTOR 1.00 40.00 X 0 72978 55429 WILLIAMS PATRICK DIRECTOR 1.00 40.00 X 0 69905 49603 WORTH KEVIN DIRECTOR 1.00 X 0 0 0 YASTE CHRISTIAN DIRECTOR 1.00 X 0 0 0 KIDDER DAVID DIRECTOR/PRESIDENT/CEO 40.00 1.00 X X 198831 0 37232 RILEA LESTER DIRECTOR 1.00 X 0 375 0 HAWKINS DEBORAH TREASURER/CFO 40.00 1.00 X 156567 0 15947 GRANDY MICHELLE DIRECTOR OF OPERATIONS 40.00 X 118991 0 12104 HARDY VICKIE DIRECTOR OF NURSING 40.00 X 105165 0 30635 579554 875571 509656 4 0 1 0 Kindred Rehab Services Inc dba Peoplefi PO Box 277365 Atlanta GA 303847365 Physical, Speech, and Occupational Thera 1121532 Love & Company 1209 N East Street Frederick MD 21701 Marketing Consultants 591794 Dixon Hughes Goodman LLP PO Box 602828 Charlotte NC 282602828 Auditing, Accounting, Tax, and Consultin 191688 Rehabcare Group East Inc dba Rehabcare PO Box 503534 St Louis MO 631503534 Physical, Speech, and Occupational Thera 109542 4 36951 36951 MEDICARE/MEDICAID PAYMENTS 623000 8053286 8053286 SKILLED NURSING, ASSISTED LIVING, 623000 4552167 4552167 AMORTIZATION OF ENTRANCE FEE 623000 88381 88381 12693834 189118 189118 MANAGEMENT FEES FROM HOA 531390 193500 193500 WELLNESS CENTER REVENUE 713940 116735 6065 110670 MISCELLANEOUS INCOME 623000 36955 36955 347190 13267093 12736854 110670 382618 12325 12325 382393 382393 6103446 5390578 712868 77481 63025 14456 1150396 942194 208202 478855 394283 84572 6513 6513 79195 79195 1240370 1239464 906 95292 95292 825323 549815 275508 117644 117644 767346 767346 55694 33114 22580 19111 4538 14573 5606 5606 1316010 1268296 47714 104327 11337 92990 Med. Related Supplies 791270 791270 BAD DEBT 161128 161128 MISCELLANEOUS 1922 1922 13791647 11473191 2318456 0 500 499 4548425 4769535 784073 659133 75100 69100 65962 45049 26354017 8321959 20022503 18032058 5155907 6092108 231885 52586 30884355 29720068 940614 1059642 745321 789068 43381 23899 8426471 9274526 10155787 11147135 X 20728568 18572933 20728568 18572933 30884355 29720068 X -524554 774353 -2405434 X X 0 1 X 1 0 X 185451 175785 138175 97920 36951 634282 22355989 23788657 23372147 15156576 12736854 97410223 259285 265383 261856 199013 193500 1179037 22800725 24229825 23772178 15453509 12967305 99223542 0 0 0 99223542 22302 19959 160614 283137 189118 675130 22302 19959 160614 283137 189118 675130 22823027 24249784 23932792 15736646 13156423 99898672 0.99320 0.99520 0.00680 0.00480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1723 1723 0 Part II-B, Line 1: THE ORGANIZATION IS A MEMBER OF THE HEALTHCARE FACILITIES ASSOCIATION (HFA) AND THE LEADING AGE ASSOCIATION (LAA). EACH YEAR, A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TOWARDS LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES. FOR FY 2017, AMOUNTS OF MEMBERSHIP DUES ALLOCATED TO THESE EXPENDITURES WERE $829 FOR HFA AND $894 FOR LAA. 794500 794500 21369418 5854076 15515342 188563 166208 22355 2245310 1418340 826970 1756226 883335 872891 18032058 Patient Trust Fund Liability 12600 resident refunds payable 8951599 RESIDENT DEPOSITS 86310 DUE TO CAROLINA CONFERENCE 200000 ESTIMATED 3RD PARTY SETTLEMENTS 24017 9274526 X 11737550 774353 -2255403 -1481050 13218600 48493 48493 13267093 13754447 0 13754447 37200 37200 13791647 Part X, Line 2: INCOME TAXES - CARS IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC), AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS BY RECORDING A LIABILITY FOR ANY TAX POSITION TAKEN THAT IS BENEFICIAL TO THE ORGANIZATION, INCLUDING ANY RELATED INTEREST AND PENALTIES, WHEN IT IS MORE LIKELY THAN NOT THE POSITION TAKEN BY MANAGEMENT WITH RESPECT TO A TRANSACTION OR CLASS OF TRANSACTIONS WILL BE OVERTURNED BY A TAXING AUTHORITY UPON EXAMINATION. MANAGEMENT BELIEVES THERE WERE NO SUCH POSITIONS AS OF SEPTEMBER 30, 2017 AND 2016 AND, ACCORDINGLY, NO LIABILITY WAS ACCRUED. Part XI, Line 2d - Other Adjustments: TRANSFER TO SPONSOR -200,000. LOSS ON PISGAH PROJECT -1,862,608. LOSS ON DISCONTINUED OPERATION -192,795. Part XI, Line 4b - Other Adjustments: MANAGEMENT FEES WITH EXPENSES 37,200. INTERCOMPANY TRANSFER 11,293. Part XII, Line 4b - Other Adjustments: MANAGEMENT FEES REVENUE NET WITH EXPENSES 37,200. 1 LeadingAge North Carolina Foundation 222 N PERSON STREET RALEIGH NC 27601 561541496 501(C)(3) 5000 FMV CAPITAL CAMPAIGN MOUNT PISGAH ACADEMY 75 ACADEMY DRIVE CANDLER NC 28715 560713794 501(C)(3) 5825 FMV STUDENT SCHOLARSHIPS AND GENERAL OPERATIONS Jessie F Richardson Foundation co Villages of Wilkes 15900 SE 82ND DRIVE CLACKMAS OR 97015 931316345 501(C)(3) 1500 FMV CARE OF ELDERS IN NICARAGUA 3 Part I, Line 2: THE ORGANIZATION PROVIDES ASSISTANCE TO OTHER SEVENTH-DAY ADVENTIST NOT-FOR-PROFIT ORGANIZATIONS FOR SPECIFIC PURPOSES RELATED TO ONE-TIME TRANSACTIONS (STUDENT SCHOLARSHIPS AND OTHER EDUCATIONAL MINISTRIES); THEREFORE, MONITORING OF THE EXPENDITURES IS ACCOMPLISHED THROUGH OBSERVATIONS. X 1 0 X X 0 1 0 0 0 0 0 0 0 KIDDER DAVID DIRECTOR/PRESIDENT/CEO 158033 0 1595 0 39203 0 5965 0 31267 0 236063 0 0 0 HAWKINS DEBORAH TREASURER/CFO 113460 0 1107 0 42000 0 4697 0 11250 0 172514 0 0 0 Part I, Line 1a CARS waives 100% of the standard membership fee for the CEO and CFO for membership at CARS' Pisgah Valley Wellness Center. Any remaining portion of the membership fee due is paid by the employee through payroll deductions. All employees at CARS' Pisgah Valley Retirement Community campus are eligible for waiver of some portion of Pisgah Valley Wellness Center membership fees. Form 990, Part VI, Section A, line 6 AS STATED IN CARS' BYLAWS SECTION 3.1 "THE MEMBERS OF THE CORPORATION SHALL BE THE MEMBERS OF THE EXECUTIVE COMMITTEE OF THE CAROLINA CONFERENCE." Form 990, Part VI, Section A, line 7a AS STATED IN CARS' BYLAWS SECTION 4.3 "EACH VOTING MEMBER OF THE EXECUTIVE COMMITTEE OF THE CAROLINA CONFERENCE SHALL SERVE EX OFFICIO AS A VOTING MEMBER OF THE CARS BOARD OF DIRECTORS (I.E., CONSTITUENT BOARD)." Form 990, Part VI, Section A, line 7b AS STATED IN CARS' BYLAWS SECTION 4.1 "THE BUSINESS AND AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY A BOARD OF DIRECTORS, REFERRED TO HEREIN AS THE "CONSTITUENT BOARD AND SECTION 4.13 "EXCEPT AS OTHERWISE PROVIDED IN THESE BYLAWS, THE ACT OF THE MAJORITY OF THE DIRECTORS PRESENT AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE THE ACT OF THE CONSTITUENT BOARD." Form 990, Part VI, Section B, line 11b THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. Form 990, Part VI, Section B, line 12c AT THE BOARD OF DIRECTORS ANNUAL MEETING, THE PRESIDENT AND CEO OF CAROLINA ADVENTIST RETIREMENT SYSTEMS, INC. PRESENTS A "STATEMENT OF ACCEPTANCE" OF THE POLICY ON CONFLICT OF INTEREST TO EACH OFFICER, DIRECTOR (I.E., BOARD MEMBER), AND KEY EMPLOYEE (I.E., ADMINISTRATORS). EACH OF THESE INDIVIDUALS ARE ASKED TO REVIEW AND SIGN THE STATEMENT WHICH INCLUDES A REPRESENTATION THAT THEY DO NOT HAVE A CONFLICT OF INTEREST. ADDITIONALLY, EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE RECEIVE AN ORIENTATION AND ANNUAL TRAINING RELATED TO THE ORGANIZATION'S CORPORATE COMPLIANCE POLICY, INCLUDING ITS CORE VALUE OF CARING, DEDICATION, INTEGRITY, PROFESSIONALISM, QUALITY, RESPECT, AND SAFETY. Form 990, Part VI, Section B, line 15 ANNUALLY MANAGEMENT OBTAINS A LETTER PREPARED BY A 3RD PARTY CONSULTANT COMPARING A RANGE OF CEO AND CFO SALARIES BASED ON HISTORICAL SALARIES OF COMPARABLE ORGANIZATIONS TO THE ORGANIZATION'S CEO AND CFO CURRENT SALARIES. IN THIS LETTER THE CONSULTANT PROVIDES COMMENTS AS TO THE REASONABLENESS OF THE ORGANIZATION'S CEO AND CFO'S SALARIES, WHICH IS REVIEWED BY THE ORGANIZATION'S BOARD OF DIRECTORS. THE BOARD MAKES RECOMMENDATIONS FOR CEO AND CFO ANNUAL SALARY ADJUSTMENTS, WHICH MANAGEMENT INCORPORATES INTO THE ORGANIZATION'S ANNUAL BUDGET. the Board did not review the results in 2016/2017. Form 990, Part VI, Section C, line 18 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. AUDITED FINANCIAL STATEMENTS ARE ALSO AVAILABLE TO THE PUBLIC ON THE NORTH CAROLINA DEPARTMENT OF INSURANCE'S WEBSITE. THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE UPON REQUEST. Form 990, Part XI, line 9: loss on pisgah project -1,862,608. transfer to sponsor -200,000. legal fees for pisgah sale -138,738. Loss on discontinued operation -192,795. Intercompany transfer -11,293. Form 990, Part XII, Line 2c: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CAROLINA CONFERENCE OF SEVENTH-DAY ADVENTISTS INC PO BOX 44270 CHARLOTTE NC 28215 454284485 SPIRITUAL DEVELOPMENT NC 501(C)(3) 1 N/A 0 PISGAH ESTATES UNIT OWNERS ASSOCIATION 95 HOLCOMBE COVE ROAD CANDLER NC 28715 561769989 HOME OWNERS ASSOCIATION NC N/A C 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 PISGAH ESTATES UNIT OWNERS ASSOCIATION L 193500 CASH PISGAH ESTATES UNIT OWNERS ASSOCIATION M 174359 CASH