2017-08-28T14:53:31-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2016-01-01 561380014 CAROLINA MEADOWS INC CARO 9199424014 100 CAROLINA MEADOWS CHAPEL HILL NC 275178505 KEVIN A MCLEOD PRESIDENT AND CEO 9199424014 2017-08-25 1 JOHN NORMAN P01506766 7049985200 2017-08-25 67.137.57.251 2017-08-25 15:18:40 ED P 56A3924725E2BEE8CC280EE407B1779D17F37F30 5DEF943CD230F9172C3BB07685551BC8488F4494 2016 2021-01-29 14:40:06Z KEVIN A MCLEOD 100 CAROLINA MEADOWS CHAPEL HILL NC 275178505 38085763 0 X WWW.CAROLINAMEADOWS.ORG X 1983 NC PROVIDING HOUSING, HEALTH CARE & OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A CCRC. 13 13 566 125 0 0 23914 277296 36000478 37430393 913364 105863 35476 27481 36973232 37841033 920015 891917 0 0 19876963 20226331 0 0 0 15527836 15998410 36324814 37116658 648418 724375 110107829 109226519 87508847 84806716 22598982 24419803 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 33160419 891917 37185663 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 222,870 RESIDENT DAYS OF HOUSING AND SERVICES FOR RESIDENTS LIVING WITHIN THE INDEPENDENT LIVING COMPONENT OF THE CAMPUS. IN ASSISTED LIVING, INCLUDING MEMORY CARE, 26,487 RESIDENT DAYS OF HOUSING AND SERVICES WERE PROVIDED. IN SKILLED NURSING, 22,625 PATIENT DAYS OF HOUSING AND SERVICES WERE PROVIDED. (CONTINUED ON SCHEDULE O)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 325 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 1,100 PER MONTH. IN ADDITION, 27 REGULARLY SCHEDULED FITNESS CLASSES ARE OFFERED INCLUDING: POOL, AEROBICS, STRETCH, YOGA, MEDITATION AND OTHERS WITH AN AVERAGE ATTENDANCE OF FOUR TO TWENTY ONE PER CLASS. THERE ARE ALSO TWO ADDITIONAL NON-REGULAR FITNESS CLASSES AND CAMPUS GROUP WALKING OFFERINGS, AS WELL AS 230 MONTHLY PERSONAL TRAINING SESSIONS. THREE AND A HALF EMPLOYEES ARE DESIGNATED FOR THE WELLNESS PROGRAM AND ADDITIONAL SERVICES ARE PROVIDED UNDER CONTRACT. THERE ARE APPROXIMATELY 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 WHICH 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 - 414, OCCUPATIONAL THERAPY - 203, AND SPEECH THERAPY - 131.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 IN ALL LEVELS OF LIVING. APPROXIMATELY 5,800 MEALS PER MONTH ARE SERVED IN THE HEALTH CENTER, 6,000 IN ASSISTED LIVING AND 17,250 IN THE INDEPENDENT LIVING DINING VENUES.ENVIRONMENTAL SERVICESTHE ENVIRONMENTAL SERVICES DEPARTMENT, IN ADDITION TO CLEANING ALL COMMON AREAS AND DAILY SERVICE TO ALL HEALTH CENTER AND ASSISTED LIVING RESIDENTS, PROVIDES SERVICE TO APPROXIMATELY 190 INDEPENDENT LIVING RESIDENTS PER MONTH. APPROXIMATELY 200 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. OUR COMMUNITY GRANTS PROGRAM PARTNERS WITH LOCAL NONPROFITS TO IMPROVE THE LIVES OF COUNTLESS CITIZENS IN CHATHAM COUNTY. GRANT OUTCOMES/IMPACTS FROM OUR 2016 GRANT CYCLE INCLUDE WEEKLY BACKPACKS OF FOOD SUPPLIED TO MORE THAN 500 ELEMENTARY AND MIDDLE SCHOOL STUDENTS IN NEED OF NOURISHMENT OVER THE WEEKEND, 27,300 MEALS PROVIDED TO LOW-INCOME NEIGHBORS THROUGH CHATHAM OUTREACH ALLIANCE (CORA), AND 1,098 FAMILIES ACCESSED FOOD FROM THE TAKE AND EAT FOOD PANTRY IN EASTERN CHATHAM COUNTY. IN ADDITION, MORE THAN 1,200 HOURS OF CHARITABLE HOME CARE WERE PROVIDED TO SENIORS IN NEED THROUGH A HELPING HAND, AND 2,353 ONE-WAY RIDES TO CRUCIAL MEDICAL APPOINTMENTS WERE PROVIDED TO SENIORS THROUGH THE CHATHAM COUNTY COUNCIL ON AGING. THE GRANTS INCREASED ACCESS TO QUALITY AND AFFORDABLE ADULT DAY SERVICES THROUGH CHARLES HOUSE, AND THE HOMES OF EIGHTEEN SENIORS WERE UPDATED BY REBUILDING TOGETHER OF THE TRIANGLE TO ASSURE THEIR HOMES WERE SAFE AND HEALTHY. LOW-INCOME SENIORS RECEIVED FREE MEDICATIONS THAT THEY COULD NOT AFFORD THROUGH CHATHAM CARES PHARMACY. OVER 1,000 FAMILY AND PAID CAREGIVERS RECEIVED EDUCATION AND SUPPORT THROUGH THREE CAREGIVER CONFERENCES IN THE TRIANGLE; CAROLINA MEADOWS WAS THE PLATINUM SPONSOR. CAROLINA MEADOWS ALSO MADE A SIGNIFICANT PLEDGE TO THE UNC MEDICAL FOUNDATION FOR THE CREATION OF A NEW HOSPICE HOME THAT WILL SERVE CHATHAM COUNTY. THE PLEDGE WAS FOR $150,000 OVER FIVE YEARS. THE FIRST $30,000 WAS CONTRIBUTED IN 2016. CAROLINA MEADOWS ALSO FULFILLED THE FIRST OF ITS FIVE YEAR PLEDGE TO THE CHATHAM COUNTY COUNCIL ON AGING TO SUPPORT THEIR FROZEN FOOD PROGRAM. THE FIRST $7,500 WAS CONTRIBUTED IN 2016. IN ADDITION, CAROLINA MEADOWS PROVIDED COUNTLESS IN-KIND MEALS TO CHARITABLE ORGANIZATIONS IN OUR REGION. THIS INCLUDED ALL THE MEALS FOR CAMP RELEAF, A WEEKEND HOSPICE BEREAVEMENT CAMP FOR 60 KIDS AND FIFTEEN VOLUNTEER COUNSELORS, AND FOOD FOR THE CHATHAM LITERACY COUNCIL'S TUTOR TWO-DAY TRAINING PROGRAM. CAROLINA MEADOWS ALSO HOSTED A FALLS PREVENTION WORKSHOPS AND PROVIDED LUNCH FOR 150 MEDICAL STUDENTS. OUR RESIDENTS ALSO OFFERED COUNTLESS HOURS OF VOLUNTEER TIME TO SUPPORT LOCAL NONPROFITS IN OUR AREA. A SURVEY OF RESIDENTS REPORTED 44,908 HOURS OF VOLUNTEERING, VALUED AT A CONTRIBUTION OF $1,058,032. PHYSICAL PLANT THE PHYSICAL PLANT DEPARTMENT ANNUALLY TURNS OVER AN AVERAGE OF 40 INDEPENDENT LIVING UNITS. EACH UNIT IS REFURBISHED TO NEW OR LIKE-NEW CONDITION. IN ADDITION, THIS DEPARTMENT COMPLETED 11,100 WORK ORDERS FOR INDEPENDENT LIVING RESIDENTS, 1,500 FOR PINES RESIDENTS AND 1,900 FOR FAIRWAYS RESIDENTS AND 4,400 COMMUNITY WIDE WORK ORDERS EXCLUSIVE OF SPECIAL PROJECTS, SECURITY RESPONSES AND TRASH PICKUP.CHARITABLE DONATIONSCHARITABLE DONATIONS AND COMMUNITY BENEFITS FOR THE YEAR ENDED DECEMBER 31, 2016 INCLUDED $709,385 IN BENEVOLENT CARE, $209,494 IN CHARITABLE DONATIONS AND $47,199 IN DONATED VOLUNTEER SERVICES.PROPERTY TAXESFOR 2016 PROPERTY TAX PAYMENTS OF $807,281 WERE MADE TO SUPPORT NEEDED INFRASTRUCTURE TO HELP CHATHAM COUNTY PROSPER.RESIDENT GIFT AND REMEMBERANCE FUNDFOR 2016 APPROXIMATELY $15,100 IN RESIDENT DONATIONS TO THE RESIDENT REMEMBRANCE AND GIFT FUND WERE USED TO PROVIDE VARIOUS "BRICKS & MORTAR" TYPE IMPROVEMENTS AROUND OUR CAMPUS. 33160419 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 1 0 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 0 0 0 0 1 68 0 1 566 1 0 0 0 0 0 0 0 0 0 0 X 13 13 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 HALEH MODDASSER VICE CHAIR 3.00 X X 0 0 0 JOAN PHARR TREASURER 2.50 X X 0 0 0 JOHN MODISETT SECRETARY 2.50 X X 0 0 0 WILLIAM KALKHOF MEMBER 2.00 X 0 0 0 DON STEDMAN MEMBER 2.00 X 0 0 0 JB CULPEPPER MEMBER 2.00 X 0 0 0 BOB JACKSON MEMBER 2.00 X 0 0 0 RHODES CRAVER MEMBER 2.00 X 0 0 0 JOHN GABOR MEMBER 2.00 X 0 0 0 STEVE MILLER MEMBER 2.00 X 0 0 0 ANNE KISSEL MEMBER 2.00 X 0 0 0 ROSEMARY HUTCHINSON CHAIR 2.00 X X 0 0 0 STEVE MICHALAK MEMBER 2.00 X 0 0 0 MARIECHEN SMITH MEMBER 2.00 X 0 0 0 JAMES JOHNSON MEMBER 2.00 X 0 0 0 STEVE PIKE MEMBER 2.00 X 0 0 0 PHILIP SLOANE MEMBER 2.00 X 0 0 0 BETSY AHERN EX OFFICIO 2.00 X 0 0 0 GORDON BATTLE EX OFFICIO 2.00 X 0 0 0 KEVIN MCLEOD CHIEF EXECUTIVE OFFICER 40.00 X X 283180 0 13250 BEN CORNTHWAITE CHIEF OPERATING OFFICER 40.00 X 44636 0 0 GARY LEVINE CHIEF FINANCIAL OFFICER 40.00 X 159270 0 8134 HOLLY JEAN COWARD PHYSICIAN/MEDICAL DIRECTOR 30.00 X 211436 0 10602 RACQUEL DALEY-PLACIDE PHYSICIAN 30.00 X 132344 0 5625 MELISSA KASS VICE PRESIDENT - MARKETING 40.00 X 124064 0 5196 JOSEPH ZANNINI VICE PRESIDENT - PHYSICAL PLANT 40.00 X 123947 0 6230 BRAD ITZKOWITZ VICE PRESIDENT - DINING SERVICES 40.00 X 116005 0 6192 MELISSA HOGAN DIRECTOR OF FINANCE 40.00 X 109516 0 2766 1304398 0 57995 15 0 1 0 WEAVER COOKE CONSTRUCTION LLC PO BOX 26030 GREENSBORO NC 27420 CONSTRUCTION CONTRACTOR 683732 IDEAL LANDSCAPING INC 131 TRADITION TRAIL HOLLY SPRINGS NC 27540 LANDSCAPING SERVICES 522303 SFCS INC 305 SOUTH JEFFERSON STREET ROANOKE VA 24011 ARCHITECTURAL SERVICES 297513 RUSTON PAVING COMPANY 3874 SOUTH ALSTON AVENUE DURHAM NC 27713 PAVING SERVICES 140714 EASTERN PAINT CONTRACTORS 5617 DEPARTURE DRIVE STE 102 RALEIGH NC 27616 PAINTING SERVICES 137430 6 277296 277296 INDEPENDENT LIVING REV 623000 20274035 20274035 HEALTH CARE CENTER REV 623000 7714077 7714077 ASSISTED LIVING REV 623000 6399172 6399172 REFURBISHING 623000 1193182 1193182 REMARKETING 623000 557962 557962 1291965 1291965 37430393 350593 350593 21626 0 21626 21626 21626 244730 -244730 -244730 -244730 MISCELLANEOUS 623000 5855 5855 5855 37841033 37185663 0 378074 182532 182532 709385 709385 698523 211436 487087 14860232 13256170 1604062 444939 362754 82185 3074938 2898404 176534 1147699 963952 183747 54907 39208 15699 55435 55435 84507 84507 1928709 1912793 15916 117047 25593 91454 1195060 1064791 130269 29987 29987 2415776 1630813 784963 95638 61744 33894 31757 18400 13357 474385 474385 4507750 4507750 49051 49051 FOOD COSTS 1935840 1935840 UPGRADES & MODIFICATION 1599366 1599366 REPAIRS & MAINTENANCE 749713 749713 SHARED APPRECIATION 334352 334352 339130 171987 167143 37116658 33160419 3956239 0 100133 2035916 19101 2458 2397499 1993217 358250 334067 233629 259138 138285390 59679963 81353107 78605427 25599612 25954312 46498 41984 110107829 109226519 3570686 4328059 58921682 56092686 15015467 14447367 1635868 2638316 2420215 1835712 5944929 5464576 87508847 84806716 X 22598982 24419803 22598982 24419803 110107829 109226519 X 724375 885658 210788 X X 0 1 X 1 0 X 16460 16263 29175 23914 15081 100893 31933881 33270335 35245986 36000478 37430393 173881073 31950341 33286598 35275161 36024392 37445474 173981966 0 0 0 173981966 572547 444091 158651 275477 372219 1822985 572547 444091 158651 275477 372219 1822985 52952 23294 13098 11439 5855 106638 32575840 33753983 35446910 36311308 37823548 175911589 0.98900 0.98700 0.01040 0.01220 X SCHEDULE A, LIST OF UNUSUAL GRANTS RECEIVED DESCRIPTION: FORBEARANCE OF ENTRANCE FEE REFUND AMOUNT: 262,215 0 1635868 1245203 242755 2638316 1 X 2096762 2096762 120431417 50649788 69781629 9380844 5933459 3447385 6376367 3096716 3279651 78605427 INVESTMENTS AND ASSETS WHOSE USE IS LIMITED 25954312 F 25954312 INTEREST RATE SWAP AGREEMENTS 569390 OTHER DEFERRED REVENUE 439231 ADVANCE DEPOSITS 4000955 FAIRWAYS ENTRANCE FEE REFUNDS DUE 455000 5464576 X 37841033 0 37841033 0 37841033 37116658 0 37116658 0 37116658 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, 2016 AND 2015, AGENCY FUNDS DUE RESIDENTS WERE $2,638,316 AND $1,635,838, 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, 2016. 1 A HELPING HAND 1502 WEST NC HWY 54 SUITE 405 DURHAM NC 27707 561923835 501(C)(3) 7500 TO PROVIDE SUPPORT FOR THEIR CHARITABLE HOME CARE PROGRAM CHARLES HOUSE 109 HILLCREST AVE CARRBORO NC 27510 581582881 501(C)(3) 7500 TO SUPPORT SCHOLARSHIP FUND AND GENERAL SUPPORT TO ALLOW CHARLES HOUSE ADULT DAY SERVICES TO BE ACCESSIBLE TO BROAD SPECTRUM OF SENIORS CHATHAM CARES COMMUNITY PHARMACY 127 E RALEIGH STREET SILER CITY NC 27344 412170926 501(C)(3) 10000 FUNDING FOR SALARY SUPPORT IN ORDER TO INCREASE ACCESS TO PHARMACY SERVICES CHATHAM COUNTY COUNCIL ON AGING PO BOX 715 PITTSBORO NC 27312 561084260 501(C)(3) 15000 TO PROVIDE GENERATING OPERATING SUPPORT TO FURTHER THE MISSION OF THE COA CHATHAM COUNTY COUNCIL ON AGING PO BOX 715 PITTSBORO NC 27312 561084260 501(C)(3) 7500 TO SUPPORT THE FROZEN MEALS PROGRAM FOR SENIORS THROUGHOUT CHATHAM COUNTY CHATHAM COUNTY LITERACY COUNCIL PO BOX 1696 PITTSBORO NC 27312 581870076 501(C)(3) 5105 TO SUPPORT TUTOR TRAINING FOR RESIDENTS AND GREATER COMMUNITY; TO SUPPORT ESL TUTOR PROGRAM AT CM FOR STAFF AND FOR COMMUNITY CITIZENS IN NEED CHATHAM OUTREACH ALLIANCE PO BOX 1326 PITTSBORO NC 27312 561668767 501(C)(3) 15000 PURCHASE OF FOOD FOR NEEDY RESIDENTS FOR DISTRIBUTION THROUGH PANTRY OR SNACK PROGRAM FARMER FOODSHARE PO BOX 2873 CHAPEL HILL NC 27515 273717889 501(C)(3) 7000 PARTNER WITH THE CHATHAM COUNTY COUNCIL ON AGING TO PROVIDE FRESH FOOD IN THEIR CONGREGATE PROGRAM, AS WELL AS OTHER BACKPACK AND HUNGER RELIEF PROGRAMS IN CHATHAM COUNTY GUIDING LIGHTS CAREGIVER SUPPORT CENTER 3724 NATIONAL DRIVE SUITE 130 RALEIGH NC 27612 800555761 501(C)(3) 5000 TO INCREASE THE NUMBER OF CHATHAM COUNTY RESIDENTS WHO ATTEND AND BENEFIT FROM TRIANGLE CAREGIVERS CONFERENCE HUMANITIES AT UNC 1700 MLK BLVD CB 3425 CHAPEL HILL NC 27599 566001393 501(C)(3) 5000 SPONSORSHIP OF A HUMANITIES PROGRAM AT UNC REBUILDING TOGETHER OF THE TRIANGLE 150 DONMOOR CT GARNER NC 27529 561955629 501(C)(3) 12500 HOME REPAIR PROGRAM TO HELP ELDERLY CHATHAM COUNTY RESIDENTS REMAIN IN THEIR HOMES SAFELY ST JULIA CHURCH - FOOD PANTRY 210 HAROLD HART ROAD SILER CITY NC 27344 530196617 501(C)(3) 10000 TO PROVIDE SUPPORT TO THE ST. JULIA FOOD PANTRY AND ASSISTANCE SERVICES PROGRAM TAKE AND EAT FOOD PANTRY AT EVERGREEN UMC 11098 US HWY 15-501 N CHAPEL HILL NC 27517 561763504 501(C)(3) 5000 PROVIDING FREE SUPPLEMENTAL NOURISHING FOOD TO ECONOMICALLY DISADVANTAGED LOCAL CITIZENS UNC MEDICAL FOUNDATION UNC PO BOX 309 CHAPEL HILL NC 27514 566001393 501(C)(3) 30000 CONTRIBUTION OF FIRST OF FIVE YEAR PLEDGE FOR THE NEW UNC HOSPICE HOME IN CHATHAM COUNTY WEST CHATHAM FOOD PANTRY 126 VILLAGE LAKE ROAD SILER CITY NC 27344 510634273 501(C)(3) 12000 TO PROVIDE WEEKEND FOOD FOR BACKPACKS FOR AS MANY HUNGRY CHILDREN AS POSSIBLE, IN 3 SILER CITY ELEMENTARY SCHOOLS XDS INC - PAWS AT PENNY LANE PO BOX 368 CARRBORO NC 27510 680582042 501(C)(3) 7000 TO SUPPORT THE PAWS AT PENNY LANE PROGRAM FOR SENIORS IN CHATHAM COUNTY 15 0 RESIDENT FINANCIAL ASSISTANCE 8 709385 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 KEVIN MCLEOD CHIEF EXECUTIVE OFFICER 280794 0 0 0 2386 0 10673 0 0 0 293853 0 0 0 GARY LEVINE CHIEF FINANCIAL OFFICER 159270 0 0 0 0 0 9724 0 0 0 168994 0 0 0 HOLLY JEAN COWARD PHYSICIAN/MEDICAL DIRECTOR 211436 0 0 0 0 0 2339 0 0 0 213775 0 0 0 A NC MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2010-12-22 17810000 TO REFUND THE 2004 BONDS 0 0 0 A 3275000 17810000 17810000 2006 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 1 SUNTRUST 4.000000000000 0 0 0 0 1 A 1 K&M CONSTRUCTIONKEVIN STEDMAN FAMILY MEMBER OF BOARD MEMBER 121740 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 REVIEWD 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 210,788. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NEITHER CHANGED ITS OVERSIGHT PROCESS NOR ITS SELECTION PROCESS DURING THE TAX YEAR.