2014-05-14T14:31:35-05:00 2013-09-30 420714325 MCGLADREY LLP 230 NORTH ELM STREET STE 1100 GREENSBORO NC 27401 990 2012-10-01 561961935 CYPRESS GLEN RETIREMENT COMMUNITY CYPR 9193843000 2600 CROASDAILE FARM PKWY DURHAM NC 277053153 JONATHAN ERICKSON 9193843000 2014-05-14 TAMELA L GAINEY P00437957 3362724551 2012 2015-11-30 17:44:51Z X LAURIE STALLINGS 100 HICKORY STREET GREENVILLE NC 27858 17151132 0 X WWW.UMRH.ORG/CYPRESSGLEN X 1996 NC CONTINUING CARE RETIREMENT COMMUNITY 27 27 304 120 0 0 312158 644219 11496262 13819450 604309 516778 2384055 262602 14796784 15243049 279823 214978 0 0 5122273 5395817 0 0 0 7477722 7608903 12879818 13219698 1916966 2023351 56804471 0 45028057 0 11776414 0 CYPRESS GLEN'S MISSION IS TO PROVIDE QUALITY CARE AND SERVICES FOR AN INCLUSIVE AND DIVERSE POPULATION OF SENIOR ADULTS. 0 0 11181940 214978 13819450 OPERATED CONTINUING CARE RETIREMENT COMMUNITY INCLUDING SKILLED NURSING FACILITY 11181940 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 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 1 0 1 0 0 1 0 0 0 1 19 0 1 304 1 0 0 0 0 0 0 0 0 0 0 X 27 27 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X STACY DOBSON 9193843002 2600 CROASDAILE FARM PKWY STE A-500 DURHAM NC 27705 X DONALD E METZGER 1.00 X X 0 0 0 GARY WHALEY 1.00 X X 0 0 0 JULIUS ADAMS 1.00 X X 0 0 0 NANCY SMITH MARKS 1.00 X X 0 0 0 LEE HARRISS 1.00 X X 0 0 0 DONNA BANKS 1.00 X 0 0 0 JACK CARROLL 1.00 X 0 0 0 PAUL CUNNINGHAM 1.00 X 0 0 0 JAMES EBERT 1.00 X 0 0 0 JERRY GAMBILL 1.00 X 0 0 0 CAROL GOEHRING 1.00 X 0 0 0 JOHN GRISSOM 1.00 X 0 0 0 CARL HAMILL 1.00 X 0 0 0 JERRY HOPFENGARDNER 1.00 X 0 0 0 JAYNE HUGGINS 1.00 X 0 0 0 BRUCE JOBE 1.00 X 0 0 0 ROBBY LOWRY 1.00 X 0 0 0 DEBBY MEYER 1.00 X 0 0 0 CONNIE MOSELEY 1.00 X 0 0 0 WALTER PORIES 1.00 X 0 0 0 DORIS REED 1.00 X 0 0 0 ARTIE ROGERS 1.00 X 0 0 0 LINDA TAYLOR 1.00 X 0 0 0 GREG WALLACE 1.00 X 0 0 0 HOPE WARD 1.00 X 0 0 0 JERRY WOODARD 1.00 X 0 0 0 SAM WYNN 1.00 X 0 0 0 JONATHAN ERICKSON 5.00 35.00 X 0 166133 33902 STACY DOBSON 5.00 35.00 X 0 143063 22270 LAURIE STALLINGS 40.00 X 140634 0 12550 140634 309196 68722 2 0 1 0 THE UNITED METHODIST RETIREMENT HOMES I 2600 CROASDAILE FARM PKWY STE A-500 DURHAM NC 27705 MANAGEMENT COMPANY 597964 HERITAGE HEALTH CARE 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY PROVIDER 323778 RUG SHOPPE CORPORATION 2010-B ALLEN ROAD GREENVILLE NC 27834 FLOORING CONTRACTOR 223321 WAC CORPORATION OF GREENVILLE PO BOX 2312 GREENVILLE NC 27834 LANDSCAPE CONTRACTOR 173369 SFCS INC 305 SOUTH JEFFERSON STREET ROANOKE VA 24011 ARCHITECT 148856 6 644219 52448 644219 PATIENT SERVICES 623000 11027717 11027717 ADMORT OF ADVANCE FEE 623000 2023451 2023451 MEDICARE PAYMENTS 623000 755432 755432 APPLICATION FEES 623000 12850 12850 13819450 595916 595916 1828945 1845646 62437 -16701 -62437 -79138 -79138 CAFE REVENUE 623000 183193 183193 BEAUTY & BARBER REVENUE 623000 103043 103043 MISC REVENUE 623000 -23634 -23634 262602 15243049 13819450 0 779380 214978 214978 147324 147324 4013309 3620322 392987 68746 52689 16057 775123 656853 118270 391315 340366 50949 620619 620619 17355 17355 29913 29913 60155 60155 342790 191673 151117 108436 108436 1040610 1011889 28721 717202 710030 7172 14383 7711 6672 18110 15351 2759 1116645 1105479 11166 1982972 1963142 19830 186983 186983 ANCILLARY EXPENSES 792653 792653 EQUIPMENT RENTAL 304209 295717 8492 CONTRACTED LABOR 255868 203087 52781 13219698 11181940 2037758 0 3140 0 6893181 0 679934 0 553272 0 0 0 0 25331 0 237838 0 0 30818509 0 16608967 0 0 0 0 984299 0 56804471 0 813399 0 18981662 0 24291115 0 941881 0 45028057 0 X 10370059 0 972970 0 433385 0 11776414 0 56804471 0 X 2023351 576444 -14376209 X X 0 1 X 1 0 X 82451 297346 990578 312158 644219 2326752 11002398 11357689 11687108 11496262 13819450 59362907 11084849 11655035 12677686 11808420 14463669 61689659 0 0 0 61689659 488532 384375 400782 537783 595916 2407388 488532 384375 400782 537783 595916 2407388 2049585 2091450 2661612 2384055 262602 9449304 13622966 14130860 15740080 14730258 15322187 73546351 0.83880 0.81160 0.03270 0.03370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 1 1.59 1 0 1058552 595881 537080 456668 1734845 1009503 285884 -131926 104909 1058552 913843 142255 57572 104167 1009503 581890 291001 94151 44700 8499 913843 532870 78443 17366 42400 -510 4899 581890 0.22230 0.77770 0 1 1 0 X 14977609 576444 -815200 -238756 15216365 26684 26684 15243049 12932535 0 12932535 287163 287163 13219698 EXPLANATION OF CHANGES TO CONSERVATION EASEMENTS: PART II, LINE 3: IN THE 1990'S, CYPRESS GLEN GRANTED AN EASEMENT TO THE CITY OF GREENVILLE FOR THE SOUTH TAR RIVER GREENWAY PROJECT. THE PROJECT CROSSES THE CYPRESS GLEN PROPERTY NEAR THE TAR RIVER. IN 2009, THE CITY BEGAN WORK ON THE PORTION OF THE GREENWAY BEHIND CYPRESS GLEN. THE CITY OF GREENVILLE WAS REQUIRED BY THE NC DIVISION OF WATER QUALITY TO AVOID SOME ENVIRONMENTALLY PROTECTED AREAS NEAR THE TAR RIVER IN THE CONSTRUCTION OF THE GREENWAY PROJECT. TO ACCOMPLISH THE REQUIREMENT, THE CITY ASKED THAT CYPRESS GLEN INCREASE THE EASEMENT IN A SPECIFIC AREA THAT IS 40 FEET WIDE AND 365 FEET LONG. THE EASEMENT WAS GRANTED BY THE BOARD CHAIRMAN IN NOVEMBER OF 2010. DESCRIPTION OF HOW ORGANIZATION REPORTS CONSERVATION EASEMENTS: PART II, LINE 9: THE ORGANIZATION DOES NOT REPORT CONSERVATION EASEMENTS IN ITS REVENUE AND EXPENSE STATEMENTS AND BALANCE SHEETS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: AS DICTATED BY THE DONOR, EARNINGS ON THE ENDOWMENT FUNDS WILL SUPPORT BENEVOLENT NEEDS AT THE COMMUNITY,EMPLOYEE SCHOLARSHIPS, AND CHARITABLE PURPOSES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE COMPANY HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. THE COMPANY BELIEVES THAT THEY ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST SWAP AGREEMENT 97,670. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 136,523. SPECIFIC ASSISTANCE TO INDIVIDUALS RECLASSED TO EXPENSES -214,978. LOSS ON EARLY EXTINGUISHMENT OF DEBT -981,461. CHANGE IN VALUE OF UNCONDITIONAL PROMISES 219,231. BEAUTY / BARBER EXPENSES -72,185. PART XI, LINE 4B - OTHER ADJUSTMENTS: NONCASH CONTRIBUTIONS NOT BOOKED AS REVENUE 26,684. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIFIC INDIVIDUAL ASSISTANCE 214,978. BEAUTY / BARBER EXPENSES 72,185. SCHEDULE D PART V LINE 1F(A) THE ENDOWMENT FUNDS BALANCE OF 1,734,845 WAS MERGED INTO THE ASSETS OF UMRH 1 BENEVOLENT ASSISTANCE FOR RESIDENTS 9 214978 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION WRITES OFF FORGONE CHARGES RESULTING FROM BENEVOLENT MONTHLY ASSISTANCE AND MONITORS THE RELATED ACCOUNTS. 1 X X X X 0 0 0 0 0 0 0 0 0 JONATHAN ERICKSON 0 134132 0 31449 0 552 0 7536 0 26366 0 200035 0 0 STACY DOBSON 0 129943 0 13000 0 120 0 1007 0 21263 0 165333 0 0 LAURIE STALLINGS 131458 0 9005 0 171 0 5601 0 6949 0 153184 0 0 0 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YDA1 2004-04-01 15410000 REFUND OUTSTANDING BONDS & N/P 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YDD5 2004-08-01 12960000 BUILD 54 NEW APARTMENTS 0 0 0 C NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2009-10-15 6585000 REFUND 2004B & 2004D SERIES BONDS 0 0 0 D NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820YKB1 2013-04-11 8370000 REFUND 2004C SERIES BONDS 0 0 0 A 15410000 1078169 308200 14023631 2004 1 0 1 1 B 12960000 497819 259200 12202981 2004 0 0 1 1 C 6585000 127489 6572252 2009 1 0 1 1 D 7960000 7960000 8577943 226863 8654317 171559 2013 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 1 1 1 BB&T 5.000000000000 0 0 0 0 1 D 1 0 0 0 0 1 A 1 B 1 C 1 D 1 X 1 26684 FMV X 2 25764 FMV 0 1 0 CASH, RECEIVABLES, PROPERTY AND EQUIPMENT, INVESTMENTS, ENDOWMENT FUNDS AND OTHER ASSETS. 2013-09-30 58765181 BOOK VALUE IS CONSIDERED FMV 560634527 THE UNITED METHODIST RETIREMENT HOMES INC 2600 CROASDAILE FARM PKWY DURHAM NC 27705 501(C)(3) 1 1 0 0 1 1 1 1 1 0 PART I, LINE 2E: BOARD OF TRUSTEES WILL CONTINUE TO BE PART OF THE BOARD FOR THE SURVIVING MERGED ENTITY UMRH.LAURIE STALLINGS WILL CONTINUE AS AN EMPLOYEE OF UMRH. PART I, LINE 2E: BOARD OF TRUSTEES OF THE SURVIVING ENTITY, THE UNITED METHODIST RETIREMENT HOMES, INC (UMRH) WILL BE COMPRISED OF THE FORMER TRUSTEES OF CYPRESS GLEN RETIREMENT COMMUNITY AND UMRH. PART I, LINE 7C: THE OUTSTANDING TAX-EXEMPT BOND LIABILITES WERE ASSUMED BY THE SURVIVING MERGED ENTITY UMRH FORM 990, SCHEDULE N, PART I, COMPANY MERGER: AT YEAR END CYPRESS GLEN RETIREMENT COMMUNITY(CYPRESS GLEN) MERGED WITH THE UNITED METHODIST RETIREMENT HOMES, INC (UMRH), EIN 56-0634527, IRC CODE SEC 501(C)(3) . THE SURVIVING ENTITY IS UMRH. THE MERGED ENTITY, THE UNITED METHODIST RETIREMENT HOMES, INC WILL CONTINUE WITH THE ARTICLES OF INCORPORATION AND BY-LAWS OF UMRH. THE NEW BOARD OF TRUSTEES WILL BE COMPRISED OF THE FORMER TRUSTEES OF CYPRESS GLEN AND UMRH. FORM 990, PART IV, LINE 31, COMPANY MERGER: AT YEAR END CYPRESS GLEN RETIREMENT COMMUNITY(CYPRESS GLEN) MERGED WITH THE UNITED METHODIST RETIREMENT HOMES, INC (UMRH), EIN 56-0634527, IRC CODE SEC 501(C)(3) . THE SURVIVING ENTITY IS UMRH. THE MERGED ENTITY, THE UNITED METHODIST RETIREMENT HOMES, INC WILL CONTINUE WITH THE ARTICLES OF INCORPORATION AND BY-LAWS OF UMRH. THE NEW BOARD OF TRUSTEES WILL BE COMPRISED OF THE FORMER TRUSTEES OF CYPRESS GLEN AND UMRH. FORM 990, PART VI, SECTION A, LINE 2 STACY DOBSON IS EMPLOYED BY UNITED METHODIST RETIREMENT HOMES, INC (UMRH). JONATHAN ERICKSON AND STACY DOBSON ARE OFFICERS IN CYPRESS GLEN RETIREMENT COMMUNITY AND UNITED METHODIST RETIREMENT HOMES,INC. UMRH IS A RELATED ENTITY DISCLOSED ON SCHEDULE R. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S CORPORATE EXECUTIVE DIRECTOR, CHIEF FINANCIAL OFFICER, AND A BOARD MEMBER REVIEW THE 990 RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CYPRESS GLEN BOARD FILLS OUT THE CONFLICT OF INTEREST POLICY FORM EACH SEPTEMBER NOTING ANY CONTINUED CONFLICTS OF INTEREST. NEW BOARD MEMBERS ARE ORIENTED TO THE POLICY AND SIGN THE FORM UPON BECOMING MEMBERS. EACH BOARD MEMBER IS REQUIRED TO DISCLOSE ANY CONFLICTS TO THE CHAIRMAN PRIOR TO A VOTE BEING TAKEN. THE MEMBER MUST ABSTAIN FROM VOTING. THE CONFLICT OF INTEREST POLICY IS ALSO REVIEWED FOR THE EMPLOYEES AT ORIENTATION AND AT ANNUAL REVIEW. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION ROUTINELY CONSULTS THE SERVICES OF AN OUTSIDE AGENCY TO EVALUATE THE ORGANIZATION'S WAGE SCALES AND PAY GRADES. THE RESULTING WAGE SCALE AND THE EMPLOYEE'S PERFORMANCE AND ACCOMPLISHMENTS ARE CONSIDERED IN THE ANNUAL REVIEW PROCESS. IN SOME INSTANCES, A SOFTWARE PROGRAM CALLED "PERFORMANCE NOW" IS USED TO SIMPLIFY THE COMMUNICATION OF THE REVIEW AND ITS RESULTS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, COLUMN F THE ORGANIZATION, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN COLUMN F, PART VII AND NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST SWAP AGREEMENT 97,670. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 136,523. CHANGE IN VALUE OF UNCONDITIONAL PROMISES 219,231. LOSS ON EARLY EXTINGUISHMENT OF DEBT -981,461. COMPANY MERGER ADJUSTMENT -13,848,172. FORM 990, PART XII, LINE 2C THE ORGANIZATION'S OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990 PART VII, SECTION A HOURS TO RELATED ORGANIZATION: JONATHAN ERICKSON - 40 HRS PER WEEK TO UNITED METHODIST RETIREMENT HOMES, INC. AS CORPORATE EXECUTIVE DIRECTOR. THE FOLLOWING MEMBERS OF THE BOARD OF TRUSTEES ARE ALSO MEMBERS OF THE BOARD OF TRUSTEES FOR UNITED METHODIST RETIREMENT HOMES, INC. AND PROVIDE 1 HR OF SERVICE PER WEEK: NANCY SMITH MARKS, JULIUS ADAMS, JONATHAN BIGGS, ROBBY LOWRY, WALTER PORIES, GREG WALLACE, CAROL GOEHRING, MARY LAMM, GARY WHALEY, CONNIE MOSELEY, CARL HAMILL, JOHN GRISSOM, PAUL CUNNINGHAM, JERRY WOODARD, LINDA TAYLOR, DONNA BANKS, JERRY HOPFENGARDNER, SAM WYNN, HOPE WARD, JAYNE HUGGINS, DON METZGER, AND LEE HARRISS. THE FOLLOWING MEMBERS OF THE BOARD OF TRUSTEES ARE ALSO MEMBERS OF THE BOARD OF TRUSTEES FOR UNITED METHODIST RETIREMENT HOMES FOUNDATION, INC. AND PROVIDE 1 HR OF SERVICE PER WEEK: JULIUS ADAMS, NANCY SMITH MARKS, CARL HAMILL, JOHN GRISSOM, ARTIE ROGERS, DON METZGER, AND LEE HARRISS. UNITED METHODIST RETIREMENT HOMES INC 2600 CROASDAILE FARM PARKWAY A-500 DURHAM NC 277053153 560634527 OPERATE CONTINUING CARE RETIREMENT COMMUNITY AND SKILLED NURSING FACILITY NC 501(C)(3) LINE 9 N/A 0 UNITED METHODIST RETIREMENT HOMES FOUNDATION INC 2600 CROASDAILE FARM PARKWAY A-500 DURHAM NC 277053153 561870172 CONTRIBUTE FUNDS TO UMRH, INC. AND CYPRESS GLEN RETIREMENT COMMUNITY NC 501(C)(3) LINE 11A N/A 0 UMRH AFFORDABLE HOUSING INC 2600 CROASDAILE FARM PARKWAY SUITE DURHAM NC 27705 010724816 OPERATE AFFORDABLE RENTAL HOUSING NC N/A C 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0