2014-02-15T11:11:30-06:00 2013-03-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFILD COURT ASHEVILLE NC 28806 990 2012-04-01 540524902 COVENANT WOODS COVE 8045698173 7090 COVENANT WOODS DRIVE MECHANICSVILLE VA 23111 ERIK MAURITSEN 8045698173 2014-02-18 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z TIMOTHY JOHNSON 7090 COVENANT WOODS DRIVE MECHANICSVILLE VA 23111 13572596 0 X WWW.COVENANTWOODS.COM X 1901 VA NOT-FOR-PROFIT CONTINUING CARE RETIREMENT COMMUNITY 22 22 294 180 14353 0 1921651 137740 11271673 11795387 -226557 1424187 260503 214551 13227270 13571865 0 445875 0 0 6708043 6934314 0 0 121377 6297279 7119508 13005322 14499697 221948 -927832 84521573 127638235 55478978 97341007 29042595 30297228 X IT IS THE MISSION OF COVENANT WOODS, A NOT-FOR-PROFIT CONTINUING CARE RETIREMENT COMMUNITY, TO PROVIDE OUR RESIDENTS WITH EXCEPTIONAL CARE, QUALITY OF LIFE, AND SECURITY AND COMFORT IN KEEPING WITH THE BENEVOLENT VISION OF OUR METHODIST AND PRESBYTERIAN FOUNDERS IN 1883. 0 0 12485038 445875 11795387 COVENANT WOODS (CW), A VIRGINIA NONSTOCK CORPORATION FOUNDED IN OCTOBER 1883, IS A NOT-FOR-PROFIT CONTINUING CARE RETIREMENT COMMUNITY IN MECHANICSVILLE, VA. CW CONSISTS OF 133 INDEPENDENT LIVING UNITS, 43 ASSISTED LIVING UNITS, AND 39 LICENSED NURSING BEDS.THE COST TO OPERATE CW DURING FY2013 APPROXIMATES $14,378,320. CW OFFERS SERVICES FOR THEIR RESIDENTS COMPARABLE TO OTHER CCRC'S IN THE STATE. UTILITIES SUCH AS WATER, ELECTRICITY, HEATING AND COOLING, AND BASIC CABLE ARE PROVIDED. HOUSEKEEPING OF ALL COTTAGES, APARTMENTS, ROOMS, LOBBIES, CORRIDORS AND OTHER COMMON AREAS AND BASIC GROUNDS KEEPING CARE, INCLUDING LAWN SERVICE AND SNOW REMOVAL FROM WALKWAYS ARE PROVIDED BY CW. NECESSARY REPAIRS, MAINTENANCE AND REPLACEMENT OF PROPERTY OWNED BY CW ARE PERFORMED. INDIVIDUAL MAIL BOXES ARE PROVIDED IN A CENTRAL LOCATION FOR ALL RESIDENTS. PROGRAMS OF SOCIAL, RECREATIONAL, AND RELIGIOUS ACTIVITIES ARE PROVIDED FOR ALL RESIDENTS' SPIRITUAL, PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS AS WELL AS FOR INTELLECTUAL APPOINTMENTS. A HEALTH CLINIC IS PROVIDED FOR RESIDENTS TO BE EXAMINED AND TREATED AS OUTPATIENTS. A PHYSICIAN IS AVAILABLE DURING SPECIFIED PERIODS OF THE WEEK.CW HAS A MISSION TO PROVIDE BENEVOLENT CARE TO THOSE RESIDENTS WHO NEED IT. THE CARE IS FUNDED THROUGH CW'S ENDOWMENT FUND THROUGH INVESTMENT EARNINGS OR THE SALE OF INVESTMENTS. THE AMOUNT OF BENEVOLENT CARE GIVEN IN FY2013 AMOUNTED TO APPROXIMATELY $443,833. 12485038 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 95 0 1 294 1 1 1 0 0 0 0 0 0 0 0 0 X 22 22 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X ERIK MAURITSEN 8045698002 7090 COVENANT WOODS DR MECHANICSVILLE VA 23111 CARLENE BASS 1.00 X X 0 0 0 O RANDOLPH ROLLINS 1.00 X X 0 0 0 JIMMY MILLS 1.00 X X 0 0 0 PATRICK BRADY 1.00 X 0 0 0 SUSAN DRUMWRIGHT 1.00 X 0 0 0 EMILY ELMORE 1.00 X 0 0 0 BRENDA COWLBECK 1.00 X 0 0 0 HELEN GATES 1.00 X 0 0 0 NATALIE KENT 1.00 X 0 0 0 ANNE DOWNING 1.00 X 0 0 0 JOSEPH MARSHBURN 1.00 X 0 0 0 KATHY MILLER 1.00 X 0 0 0 CHARLOTTE FORRESTER 1.00 X 0 0 0 JIM ELLIOTT JR 1.00 X 0 0 0 JACOB MAST 1.00 X 0 0 0 HAROLD ROHRS 1.00 X 0 0 0 GENA WALLACE 1.00 X 0 0 0 DON TINDALL 1.00 X 0 0 0 MARGIE TURBYFILL 1.00 X 0 0 0 EDDIE STILES 1.00 X 0 0 0 THELMA WATSON 1.00 X 0 0 0 JAMES DARDEN JR MD 1.00 X 0 0 0 TIMOTHY JOHNSON 40.00 X 208146 0 19000 ERIK MAURITSEN 40.00 X 112241 0 2540 320387 0 21540 2 0 1 0 WM JORDAN COMPANY 708 BAINBRIDGE ST RICHMOND VA 23224 CONSTRUCTION - PHASE III PROJECT 1512743 SB&A 207 W FRANKLIN ST RICHMOND VA 23220 MARKETING CONSULTANT 762153 ANTHEM HEALTHKEEPERS PO BOX 26623 RICHMOND VA 232850031 HEALTHCARE PROVIDER 361415 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING SERVICES 350947 SFCS 305 S JEFFERSON ST ROANOKE VA 24011 ARCHITECTURAL/DESIGN 290939 19 137740 137740 RESIDENTIAL SERVICES 623990 5855100 5855100 HEALTHCARE SERVICES 624100 5826099 5826099 RESIDENT SERVICES 812900 114188 114188 11795387 1257378 14353 1243025 21580 0 21580 21580 21580 167540 0 731 167540 -731 166809 166809 MEAL/FOOD REVENUE 722210 119814 119814 DRUGS/MEDICAL SUPPLIES 900099 41034 41034 MISCELLANEOUS INCOME 900099 32123 32123 192971 13571865 11681199 14353 1738573 200 200 445675 445675 341927 102578 239349 4987826 3877743 1041893 68190 191153 133424 52488 5241 967450 824570 131608 11272 445958 324161 114744 7053 41381 41381 54867 54867 78843 78843 559335 520139 39196 118262 118262 1709063 1597000 82442 29621 66113 66113 1103203 1103203 19144 17130 2014 61292 57915 3377 695356 695356 2025433 2025433 202007 202007 EARLY EXTINGUISHMENT OF 362437 362437 MISCELLANEOUS 22772 11692 11080 14499697 12485038 1893282 121377 165103 516 240760 458068 1381224 1620658 689470 6463 7628 4428074 7310032 72060070 18332611 43700221 53727459 24761353 53566324 4115302 5192553 4102415 6686185 84521573 127638235 1000725 4487507 23782631 24757403 28640000 64972388 1962692 3044310 92930 79399 55478978 97341007 X 25529217 26666024 1833073 1925123 1680305 1706081 29042595 30297228 84521573 127638235 X -927832 2144128 38337 X X 0 1 X 1 0 X 123567 100520 91720 1921651 137740 2375198 9391863 9945828 10500712 11168887 11681199 52688489 298569 217375 245214 340426 307159 1408743 9813999 10263723 10837646 13430964 12126098 56472430 0 1708445 1708445 1708445 1708445 54763985 1358661 1146980 1288224 826287 1278958 5899110 1358661 1146980 1288224 826287 1278958 5899110 11172660 11410703 12125870 14257251 13405056 62371540 0.87800 0.88730 0.09460 0.08940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 214 214 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF THE VIRGINIA ASSOCIATION OF NONPROFIT HOMES FOR THE AGING AND LEADING AGE. A SMALL PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING EXPENDITURES CONDUCTED BY THESE ORGANIZATIONS. 0 1 X 3904683 3904683 45619436 15820288 29799148 3091430 1072072 2019358 4153113 1440251 2712862 15291408 15291408 53727459 RESIDENT FUNDS 7515 BENEFICIAL INTERESTS IN TRUST FUNDS 3626614 ESCROW FUNDS 3044310 COMMUNITY SERVICE FUNDS 7746 6686185 RESIDENT FUNDS 7399 ADVANCE FEE DEPOSITS 72000 79399 X 15310497 2144128 38337 2182465 13128032 443833 443833 13571865 14055864 0 14055864 443833 443833 14499697 PART IV, LINE 2B: FUNDS HELD BY ESCROW AGENT ARE ALL ADVANCED FEE DEPOSITS FROM POTENTIAL FUTURE RESIDENTS FOR PHASE III LIVING UNITS. THESE DEPOSITED FUNDS ARE KEPT AND MAINTAINED IN AN ACCOUNT SEPARATE FROM THE ORGANIZATION'S BUSINESS ACCOUNT AS REQUIRED BY LAW. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION 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 ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF MARCH 31, 2013. THE ORGANIZATION BELIEVES THAT IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO MARCH 31, 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: OTHER THAN TEMPORARY IMPAIREMENTS 12,561. CHANGE IN VALUE OF PERPETUAL TRUSTS 25,776. PART XI, LINE 4B - OTHER ADJUSTMENTS: COVENANT PROGRAM / BENEVOLENT CARE 443,833. PART XII, LINE 4B - OTHER ADJUSTMENTS: COVENANT PROGRAM BENEVOLENT CARE 443,833. CENTRAL AMERICA AND THE CARIBBEAN INVESTMENTS 447353 EAST ASIA AND THE PACIFIC INVESTMENTS 4518 EUROPE (INCLUDING ICELAND & GREENLAND) INVESTMENTS 128075 SUB-SAHARAN AFRICA INVESTMENTS 286 0 0 0 0 0 0 580232 0 580232 1 0 0 0 0 0 1 COVENANT PROGRAM / BENEVOLENT CARE 6 443833 FMV RESIDENTIAL SERVICE AND NURSING CARE. PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: COVENANT WOODS PROVIDES BENEVOLENCE FUNDS UNDER THE COVENANT PROGRAM TO RESIDENTS WITHIN THE ORGANIZATION WHO CAN NO LONGER AFFORD TO PAY FOR THEIR CARE. THE PROGRAM IS DESIGNED TO PRESERVE THE DIGNITY OF THE PARTICIPANTS AND TO ENHANCE THEIR QUALITY OF LIFE IN KEEPING WITH THE MISSION OF COVENANT WOODS. THE IDENTITY OF PERSONS RECEIVING COVENANT PROGRAM ASSISTANCE IS STRICTLY CONFIDENTIAL. FROM THE INFORMATION PROVIDED BY THE APPLICANT, A DETERMINATION WILL BE MADE BY THE CFO AND CEO REGARDING WHETHER OR NOT THE RESIDENT QUALIFIES FOR FINANCIAL ASSISTANCE FROM THE COVENANT PROGRAM, AND IF SO, HOW MUCH. ASSISTANCE MAY BE PROVIDED IN TWO FORMS: ENTRANCE FEE ASSISTANCE AND MONTHLY FEE ASSISTANCE. X X 0 1 0 0 0 1 0 0 0 TIMOTHY JOHNSON 191625 0 16521 0 0 0 15500 0 3500 0 227146 0 0 0 PART I, LINE 4B THE ORGANIZATION CONTRIBUTED $10,000 TO A SECTION 457(F) PLAN FOR THE CEO. PART I, LINE 6 THE ORGANIZATION'S CEO AND CFO PARTICIPATE IN AN EXECUTIVE BONUS PLAN THAT CONSIDERS NEW STRATEGIC INITIATIVES, INCREASED DONATIONS, EMPLOYEE AND RESIDENT SATISFACTION SURVEY REULTS, AND IMPROVEMENT IN NET OPERATING MARGIN AS ONE OF THE FACTORS FOR THE BONUS. THE BONUS IS LIMITED TO 10% OF GROSS ANNUAL PAY. A ECONOMIC DEVELOPMENT AUTHORITY OF HANOVER COUNTY VA 541228097 41077CAM7 2012-12-20 101495000 SEE PART VI 0 0 0 A 101981701 3891382 28035000 1826631 16313390 51915298 2014 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 1 0 0 0 0 PART I, LINE A, COLUMN F - DESCRIPTION OF PURPOSE: THE SERIES 2012A AND 2012B BONDS WERE ISSUED TO: (1) REFUND THE OUSTANDING PRINCIPAL AMOUNT OF THE SERIES 2010 BONDS, (2) FINANCE THE ACQUISITION, CONSTRUCTION, AND EQUIPPING OF (A) A THREE STORY BUILDING CONTAINING 84 INDEPENDENT LIVING APARTMENTS AND UNDERGROUND PARKING, COMMUNITY LIVING SPACE, AND INDOOR/OUTDOOR DINING FACILITIES (B) 22 INDEPENDENT LIVING COTTAGES WITH GARAGES, (C) RENOVATIONS TO THE EXISTING FACILITIES, INCLUDING EXPANSION OF THE CURRENT DINING AND BISTRO AREA AND THE ADDITION OF A LIBRARY, EXCERCISE AREA AND SALON, AND (D) ROUTINE CAPITAL IMPROVEMENTS AND OTHER CAPITAL EXPENDITURES FOR THE EXISTING FACILITIES, (3) FUND A DEBT SERVICE RESERVE FUND FOR THE SERIES 2012A BONDS, AND (4) FINANCE FUNDED INTEREST, WORKING CAPITAL, AND ISSUANCE COSTS. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF ALL OFFICERS OF THE CORPORATION WHO ARE DIRECTORS AND THE CHAIRMEN OF FINANCE, DEVELOPMENT, BUILDING/GROUNDS, NOMINATIONS/RESOURCES, ADMISSIONS AND COMMUNITY INVOLVEMENT COMMITTEES, IF SUCH COMMITTEE(S) THEN EXISTS, TO PROVIDE THE EXECUTIVE COMMITTEE WITH AT LEAST 9 MEMBERS. IF AT ANY TIME THE EXECUTIVE COMMITTEE HAS FEWER THAN 9 MEMBERS, THE EXECUTIVE COMMITTEE SHALL MAKE SUCH RECOMMENDATION TO THE BOARD OF DIRECTORS AS TO ADDITIONAL MEMBERS AS IT SHALL DETERMINE, AND THE BOARD OF DIRECTORS SHALL BY A RESOLUTION APPOINT SUCH ADDITIONAL MEMBERS AS IT MAY DETERMINE FOR A TERM OF NO MORE THAN TWO YEARS. THE CHAIRMAN OF THE CORPORATION SHALL BE CHAIRMAN OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE MAY MEET AND MAKE RECOMMENDATIONS AS IT SHALL DEEM ADVISABLE TO THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL BE VESTED WITH FULL AND COMPLETE AUTHORITY WITH RESPECT TO THE BUSINESS AND AFFAIRS OF THE CORPORATION EXCEPT THAT IT SHALL NOT WITHOUT THE APPROVAL OF THE BOARD OF DIRECTORS: (1) FILL VACANCIES ON THE BOARD OR ON ANY OF ITS COMMITTEES; (2) AMEND THE ARTICLES OF INCORPORATION PURSUANT TO VIRGINIA CODE SECTION 13.1-885 (ALLOWING AMENDMENT OF THE ARTICLES OF INCORPORATION BY THE BOARD OF DIRECTORS); (3) ADOPT, AMEND, OR APPEAL THE BYLAWS; (4) APPROVE A PLAN OF MERGER; (5) SELL THE ASSETS OF THE CORPORATION OTHER THAN IN THE REGULAR COURSE OF BUSINESS; (6) DISSOLVE THE CORPORATION; OR ANY OTHER ACTIONS SPECIFIED IN VIRGINIA CODE SECTIONS 13.1-869, 13.1-885, 13.1-895, 13.1-900, 13.1-903 (OR THE EQUIVALENT SECTION OF ANY CODE OF LAW SUBSEQUENTLY ENACTED BY THE COMMONWEALTH OF VIRGINIA) OR ANY ACTION OTHERWISE PROHIBITED BY LAW. FORM 990, PART VI, SECTION B, LINE 11 A COPY WAS SENT TO EACH BOARD MEMBER, WHICH INCLUDES FINANCE COMMITTEE MEMBERS, REQUESTING COMMENTS OR QUESTIONS TO BE DIRECTED TO THE CFO WITHIN 10 DAYS. THE 990 WAS FILED WITH THE IRS AFTER SUCH TIME. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD IS POLLED ANNUALLY AND SURVEYS ARE COLLECTED BY THE EXECUTIVE SECRETARY AND CHECKED FOR COMPLIANCE WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS EVALUATED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD. EACH COMMITTEE MEMBER DOES AN INDEPENDENT EVALUATION, AND THE COMMITTEE CHAIRMAN COMPILES THE SCORE. THE CEO EVALUATES THE CFO WITH FEEDBACK FROM THE BOARD. THE BOARD CHAIR REQUESTS COMPARATIVE SALARY DATA THAT THE HR DIRECTOR ACQUIRES FROM VARIOUS LONG-TERM CARE GROUPS, WHICH IS USED TO DETERMINE BASE WAGE INCREASES. BONUS AMOUNTS ARE DETERMINED BASED ON HOW WELL THE CEO AND CFO EXECUTE THE STRATEGIC PLAN FOR THE YEAR - MEETING BUDGET, SATISFACTION, DEVELOPMENT, ETC. BONUS AMOUNTS ARE CAPPED AT 10% OF BASE SALARY. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S RECENT FORMS 990 ARE AVAILABLE AT WWW.GUIDESTAR.ORG AND UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE FOR PUBLIC INSPECTION AT THIS TIME. FINANCIAL STATEMENTS ARE PROVIDED TO WWW.EMMA.ORG. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF PERPETUAL TRUSTS 25,776. OTHER THAN TEMPORARY INVESTMENTS 12,561. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.