2015-01-27T16:29:14-06:00 2014-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1869 CHARTER LANE STE 301 LANCASTER PA 17601 990 2013-07-01 521071433 CHARLES COUNTY NURSING & REHABILITATION CENTER INC CHAR 3019341900 10200 LA PLATA ROAD LA PLATA MD 20646 WILLIAM M HOLMAN CEO 3019341900 2015-01-22 1 MICHAEL S FREY P00327329 7173935696 2013 2016-03-07 17:11:31Z WILLIAM M HOLMAN 10200 LA PLATA ROAD LA PLATA MD 20646 18227951 0 X WWW.CCNRC.ORG X 1976 MD LONG-TERM CARE, REHABILITATION, ASSISTED LIVING, AND ADULT DAY SERVICES. 9 9 358 35 0 0 4713 13866 17201483 17862701 20377 28748 280950 310715 17507523 18216030 0 0 0 0 10935764 10900980 0 0 0 5368906 6348844 16304670 17249824 1202853 966206 25084261 8493869 7825613 2987401 17258648 5506468 X TO PROVIDE EXCELLENCE IN REHABILITATION AND AGING SERVICES DELIVERED BY EMPLOYEES THAT REFLECT OUR VALUES. 1 1 12309991 0 14952814 CHARLES COUNTY NURSING & REHABILITATION CENTER PROVIDES LONG-TERM CARE AND REHABILITATIVE SERVICES TO THE RESIDENTS OF SOUTHERN MARYLAND. TOTAL RESIDENT DAYS OF 57,578 EQUATE TO AN AVERAGE OF OVER 157 RESIDENTS ON ANY GIVEN DAY OUT OF A CAPACITY OF 165 WITH A TOTAL OF ALMOST 200 RESIDENTS BEING ADMITTED ANNUALLY. MOST OF THESE RESIDENTS ARE ADMITTED FOR REHABILITATIVE SERVICES AFTER DISCHARGE FROM AN ACUTE-CARE SETTING. THE REMAINDER ARE ADMITTED FOR LONG-TERM CARE ON A MEDICALLY-NECESSARY BASIS. THE MAJORITY OF LONG-TERM CARE RESIDENTS ARE INDIGENT AND QUALIFY FINANCIALLY FOR THE MEDICAL ASSISTANCE PROGRAM. THE CENTER ALSO PROVIDES CHARITY CARE IN THE FORM OF DENTISTRY AND OTHER MEDICAL SERVICES THAT ARE NOT COVERED BY THE MEDICAL ASSISTANCE PROGRAM. 1387566 0 1632961 THE ASSISTED LIVING FACILITY, ABBEY MANOR, PROVIDES CARE AND SUPPORT TO THE AGED WHO HAVE MEDICAL DIAGNOSES AND WHO REQUIRE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. IN A FACILITY THAT HAS A CAPACITY TO CARE FOR 32 RESIDENTS, CARE WAS PROVIDED TO AN AVERAGE OF OVER 31 RESIDENTS PER DAY. 887934 0 1078564 THE ADULT DAY CENTER IS A 63-SLOT PROGRAM PROVIDING DAY CARE FOR DISABLED AND SEVERELY DISABLED ADULTS OF ALL AGES THROUGHOUT CHARLES COUNTY, MARYLAND. THE CENTER PROVIDES TRANSPORTATION FOR ALL PARTICIPANTS REQUIRING IT. THE CENTER FURTHER SUPPORTS THE NEEDS OF ITS PARTICIPANTS AND THEIR FAMILY MEMBERS OPERATING ON A 6-DAY WEEK, RATHER THAN A 5-DAY WEEK. ABILITY TO PAY IS NOT A CRITERION FOR PARTICIPATION, AS THE CENTER PARTICIPATES IN THE MARYLAND MEDICAL ASSISTANCE PROGRAM. THE CENTER TYPICALLY AVERAGES ALMOST 50 OF THE ENROLLED PARTICIPANTS ON A DAILY BASIS. 163303 0 198362 THE MEMORY CARE FACILITY, HOMEPLACE, PROVIDES CARE AND SUPPORT TO THE AGED WHO HAVE MEDICAL DIAGNOSES INCLUDING FORMS OF DEMENTIA, AND WHO REQUIRE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. IN A FACILITY THAT HAS A CAPACITY TO CARE FOR 12 RESIDENTS, CARE WAS PROVIDED TO AN AVERAGE OF OVER 10 RESIDENTS PER DAY. 163303 0 198362 14748794 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 25 0 1 358 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X DENNIS O'NEILL CFO 3019341900 10200 LA PLATA ROAD LA PLATA MD 20646 KING ADKINS JR PAST - CHAIR 1.50 1.00 X X 0 0 0 CAROLYN W CORE CHAIR 1.50 1.00 X X 0 0 0 THOMAS M DATCHER JR TRUSTEE (RESIGNED) 1.50 1.00 X 0 0 0 SUE GREEN TRUSTEE 1.50 1.00 X 0 0 0 MOHAMMED HAZIQ MD TRUSTEE 1.50 1.00 X 0 0 0 DEL SALLY JAMESON TRUSTEE 1.50 1.00 X 0 0 0 JON JOHNSON SECRETARY/TREASURER 1.50 1.00 X X 0 0 0 GRANT A MCCLURE CHAIR-ELECT 1.50 1.00 X X 0 0 0 FRANK A NICOLAI TRUSTEE 1.50 1.00 X 0 0 0 DANA LEVY TRUSTEE 1.50 1.00 X 0 0 0 WILLIAM M HOLMAN PRESIDENT/CEO 30.00 10.00 X 220523 0 14474 TERESA ROBINSON VP CLINICAL SVC 30.00 10.00 X 142533 0 10817 DENNIS O'NEILL VP FINANCE/CFO 30.00 10.00 X 112758 0 10339 PATRICIA YOUNGER VP ASSISTED LIVING 30.00 10.00 X 109600 0 2218 ROSEMOND BARTLES RN 40.00 X 127381 0 10785 MICHAEL MUDD VP FACILITIES 30.00 10.00 X 105142 0 2133 BEVERLY AUTH VP HUMAN RESOURCES 30.00 10.00 X 107534 0 6211 CYNTHIA PARKER VP MARKETING 40.00 X 102332 0 9190 1027803 0 66167 10 0 1 0 REHAB CARE GROUP INC PO BOX 277365 ATLANTA GA 30384 THERAPY 853933 THE KORTH COMPANIES 9101 A GAITHER ROAD GAITHERSBURG MD 20877 CONSTRUCTION 672810 2 19 13847 13866 NURSING CARE 623000 14952813 14952813 ASSISTED LIVING 623000 1632962 1632962 ADULT DAY CARE 623000 1078564 1078564 MEMORY CARE 623000 198362 198362 17862701 29726 29726 110322 10943 99379 99379 99379 978 -978 -978 -978 MANAGEMENT FEES 623000 123046 123046 COMMUNITY FEE 623000 45000 45000 BEAUTY/BARBERSHOP INCOME 623000 28925 28925 14365 14365 211336 18216030 17862701 0 339463 441529 441529 8758810 8243641 515169 51849 26839 25010 799871 394104 405767 848921 771587 77334 462497 462497 3034 3034 55525 55525 1500794 1394503 106291 33146 640 32506 542151 472253 69898 45198 45198 1139995 1107535 32460 1887 156 1731 14313 3276 11037 7367 7367 652934 652934 198562 41731 156831 MEDICAL SUPPLIES 709348 709348 FOOD 648635 648635 SOCIAL EVENTS 116868 116868 BAD DEBT EXPENSE 79331 79331 137259 78046 59213 17249824 14748794 2501030 0 287817 3350 4016456 2954805 1888849 1940707 93269 110434 19508 61807 4164049 2544819 16287416 1619230 2291247 1782225 103792 0 95907 21311 25084261 8493869 1514617 1371498 475466 486197 5537818 0 79962 721341 217750 408365 7825613 2987401 X 17258303 5506468 345 0 17258648 5506468 25084261 8493869 X 966206 5691 -12724077 X 0 1 X 1 0 X 7899520 70070 25928 4713 13866 8014097 16651647 17311578 16998313 17201483 17915201 86078222 24551167 17381648 17024241 17206196 17929067 94092319 0 0 0 94092319 26252 22173 20755 147567 140048 356795 26252 22173 20755 147567 140048 356795 49229 81413 135450 167478 211336 644906 24626648 17485234 17180446 17521241 18280451 95094020 0.98950 0.99250 0.00380 0.00290 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2009 AMOUNT: $ 2,649. 2010 AMOUNT: $ 864. 2011 AMOUNT: $ 446. 2012 AMOUNT: $ 196. 2013 AMOUNT: $ 1,345. TELEPHONE TV REHAB - 2009 AMOUNT: $ 4,580. 2010 AMOUNT: $ 4,960. 2011 AMOUNT: $ 5,420. 2012 AMOUNT: $ 4,397. 2013 AMOUNT: $ 5,520. MANAGEMENT FEES - 2009 AMOUNT: $ 42,000. 2010 AMOUNT: $ 42,000. 2011 AMOUNT: $ 43,560. 2012 AMOUNT: $ 77,856. 2013 AMOUNT: $ 123,046. APPLICATION FEE - 2010 AMOUNT: $ 5,000. 2011 AMOUNT: $ 7,000. 2012 AMOUNT: $ 7,500. 2013 AMOUNT: $ 7,500. BEAUTY BARBERSHOP INCOME - 2010 AMOUNT: $ 28,589. 2011 AMOUNT: $ 35,524. 2012 AMOUNT: $ 33,429. 2013 AMOUNT: $ 28,925. COMMUNITY FEE - 2011 AMOUNT: $ 43,500. 2012 AMOUNT: $ 44,100. 2013 AMOUNT: $ 45,000. 1 44161 1011649 1001047 54763 0 10000 10000 1591333 832975 758358 2562716 1711844 850872 1619230 DUE TO THIRD PARTY PAYORS 408365 408365 X 18232664 5691 5691 18226973 -10943 -10943 18216030 17260767 10943 10943 17249824 0 17249824 PART IV, LINE 1B: THE ORGANIZATION SERVES AS CUSTODIAN FOR RESIDENTS WHO ARE UNABLE TO MANAGE THEIR OWN FINANCES. RESIDENTS CONTACT THE INDIVIDUAL CUSTODIAN OF THEIR ACCOUNT WHEN FUNDS ARE NEEDED TO REQUEST DISBURSEMENTS. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISIONS OF ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES WHICH PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE PROVISION ALSO PROVIDES GUIDANCE ON DE-RECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, AND DISCLOSURES. MANAGEMENT HAS DETERMINED THAT THESE PROVISIONS DO NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS. CHARLES COUNTY NURSING & REHABILITATION CENTER, INC.'S FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2013, 2012 AND 2011 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -10,943. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 10,943. X X X 0 0 0 0 0 0 0 1 0 WILLIAM M HOLMAN PRESIDENT/CEO 181763 0 38760 0 0 0 3549 0 10925 0 234997 0 0 0 TERESA ROBINSON VP CLINICAL SVC 137450 0 5083 0 0 0 0 0 10817 0 153350 0 0 0 PART I, LINE 7 THE CEO AND VICE PRESIDENTS MAY RECEIVE A BONUS AT THE DISCRETION OF THE BOARD BASED ON A NUMBER OF FACTORS SURROUNDING THE ORGANIZATION'S FINANCIAL HEALTH AS WELL AS QUALITY AND STRATEGIC INDICATORS. WILLIAM HOLMAN RECEIVED VARIABLE COMPENSATION OF $38,760 FOR THE YEAR REPORTED. TERESA ROBINSON RECEIVED $5,083 IN ADDITIONAL COMPENSATION FOR THE YEAR. CASH, ORGANIZATION COSTS, MARKETING COSTS 2014-04-01 2392951 BOOK VALUE 900860390 FAMILY OF CARE ALLIANCE INC 10200 LA PLATA ROAD LA PLATA MD 20646 501(C)(3) CASH, FIXED ASSETS, ORGANIZATION COSTS, DEBT, DEFERRED FINANCING COSTS 2014-04-01 10331125 BOOK VALUE 800827126 FAMILY OF CARE REAL ESTATE HOLDING COMPANY INC 10200 LA PLATA ROAD LA PLATA MD 20646 501(C)(3) 1 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: KING ADKINS, GRANT MCCLURE, JON JOHNSON AND CAROLYN CORE PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: THESE CHARLES COUNTY NURSING AND REHABILITATION CENTER, INC. BOARD MEMBERS ARE ALSO ON THE BOARD OF FAMILY OF CARE REAL ESTATE HOLDING COMPANY, INC. SECTION II LINE 2E ALL BOARD MEMBER OF CHARLES COUNTY NURSING AND REHABILITATION CENTER, INC. ARE ALSO BOARD MEMBERS FOR FAMILY OF CARE ALLIANCE, INC. KEY EMPLOYEES OF CHARLES COUNTY NURSING AND REHABILITATION CENTER, INC. WHO BECAME EMPLOYEES OF FAMILY OF CARE ALLIANCE, INC ARE: WILLIAM HOLMAN, TERESA ROBINSON, AND DENNIS O'NEILL. FORM 990, PART III, LINE 2 HOMEPLACE, A MEMORY CARE ASSISTED LIVING FACILITY, OPENED IN MARCH 2014 WITH A CAPACITY TO CARE FOR 12 RESIDENTS. FORM 990, PART III, LINE 3 CHARLES COUNTY NURSING AND REHABILITATION CENTER, INC. UNDERWENT A CHANGE IN STRUCTURE WITH THE ESTABLISHMENT OF A PARENT COMPANY, FAMILY OF CARE ALLIANCE, INC. (EIN 90-0860390), WHICH PROVIDES MANAGEMENT AND FUNDRAISING SUPPORT, AND FAMILY OF CARE REAL ESTATE HOLDING COMPANY (EIN 80-0827126) WHICH HOLDS THE REAL PROPERTY FOR CHARLES COUNTY NURSING AND REHABILITATION CENTER, INC. FORM 990, PART VI, SECTION A, LINE 3 CONTROL OVER MANAGEMENT DUTIES IS DELEGATED TO FAMILY OF CARE ALLIANCE, INC. (90-0860390), A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION AND BYLAWS WERE AMENDED TO REFLECT CHARLES COUNTY NURSING & REHABILIATION'S RELATIONSHIP WITH FAMILY OF CARE ALLIANCE AS ITS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 6 FAMILY OF CARE ALLIANCE, INC. (90-0860390), A MARYLAND NONSTOCK CORPORATION, IS THE SOLE MEMBER OF CHARLES COUNTY NURSING & REHABILITATION CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, FAMILY OF CARE ALLIANCE, ELECTS ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS RESERVED THE FOLLOWING POWERS AND SHALL REQUIRE THE AFFIRMATIVE VOTE OR WRITTEN CONSENT OF THE SOLE MEMBER: 1. APPROVAL OF ANY AMENDMENT, ALTERATION, REPEAL OR ADOPTION OF CHANGES TO THE BY-LAWS OR THE CHARTER 2. ADOPTION, APPROVAL OR REPEAL OF ANY PLAN OF DISSOLUTION, OR MERGER 3. ADOPTION, APPROVAL, OR REPEAL OF ANY MATERIAL CHANGES IN OPERATIONS, INCLUDING WITHOUT LIMITATION, ANY CHANGE OR OMISSION THAT WOULD RESULT IN THE LOSS OF OR NEGATIVE IMPACT ON ANY OF THE CORPORATION'S LICENSES, PERMITS, CERTIFICATES OF NEED OR THE LIKE. FORM 990, PART VI, SECTION B, LINE 11 THE CFO WILL COMPARE THE DRAFT FORM 990 TO THE PREVIOUS YEAR'S RETURN IN DETAIL, LOOKING FOR ANY SIGNIFICANT DIFFERENCES OR OMISSIONS. THE CFO ALSO TRACES AMOUNTS TO THE AUDITED FINANCIAL STATEMENTS AND TRIAL BALANCE. THE CFO THEN REVIEWS THE 990 WITH THE CEO BEFORE IT IS PRESENTED TO THE FINANCE COMMITTEE AND THE BOARD OF TRUSTEES FOR APPROVAL BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT THAT AFFIRMS COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE BOARD AS A WHOLE MONITORS THE POLICY. ANY BOARD MEMBER, OFFICER, OR KEY EMPLOYEE WHO IS INVOLVED IN A CONFLICT SITUATION WILL REMOVE HIMSELF OR HERSELF FROM ANY DECISION-MAKING REGARDING THE CONFLICT. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED IN THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE OFFICERS AND KEY EMPLOYEES OF THE CENTER IS DETERMINED BASED ON A REVIEW OF INDIVIDUAL PERFORMANCE UTILIZING COMPARABLE COMPENSATION DATA FROM VARIOUS SOURCES, SUCH AS FROM OTHER ENTITIES' FORM 990S AND SALARY SURVEY REPORTS. THE BOARD OF TRUSTEES APPROVES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES THROUGH THE PERFORMANCE REVIEW PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS -12,724,077. CHARLES CO NURSING & REHAB CTR FOUND 10200 LA PLATA ROAD LA PLATA MD 20646 201666771 FUNDRAISING FOR RELATED ENTITY MD 501(C)(3) LINE 7 N/A 0 FAMILY OF CARE ALLIANCE INC 10200 LA PLATA ROAD LA PLATA MD 20646 900860390 FUNDING AND SUPPORT FOR AFFILIATED ORGANIZATIONS MD 501(C)(3) LINE 11B, II N/A 0 FAMILY OF CARE REAL ESTATE HOLDING COMPANY INC 10200 LA PLATA ROAD LA PLATA MD 20646 800827126 REAL ESTATE HOLDINGS FOR AFFILIATED ORGANIZATIONS MD 501(C)(3) LINE 11B, II FAMILY OF CARE ALLIANCE INC 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0