2013-11-27T12:43:56-06:00 2013-09-30 560587953 GILLIAM COBLE & MOSER LLP PO BOX 621 BURLINGTON NC 272160621 990 2012-10-01 561077371 PRESBYTERIAN HOME OF HAWFIELDS INC PRES 3365784701 2502 SOUTH NC 119 MEBANE NC 27302 MR MAX KERNODLE 3365784701 2013-11-26 1 SCOTT WILLIAMS P00024567 3362276283 2012 2015-11-30 17:44:51Z MR MAX KERNODLE 2502 SOUTH NC 119 MEBANE NC 27302 6185764 0 X WWW.HAWFIELDS.ORG X 1973 NC TO PROVIDE HOUSING & RELATED FACILITIES & SERVICE FOR THE ELDERLY AND NEEDY. 9 9 194 90 0 0 1570 9033 6700276 6148298 8103 7049 57758 19111 6767707 6183491 0 0 0 0 4181532 4020734 0 0 0 2623283 2509711 6804815 6530445 -37108 -346954 3264761 3045264 466613 594070 2798148 2451194 TO PROVIDE HOUSING & RELATED FACILITIES & SERVICE FOR THE ELDERLY AND NEEDY IN A HEALTH CARE SETTING. 0 0 5953150 6148298 THE ORGANIZATION OPERATES A NURSING HOME FACILITY WITH 117 NURSING BEDS AND 37 INDEPENDENT LIVINGS BEDS IN MEBANE, NORTH CAROLINA. 5953150 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 9 0 194 0 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X MAX KERNODLE 3365784701 2502 SOUTH NC 119 MEBANE NC 27302 REV AB PLEXICO 1.00 X 0 0 0 MARY SCOTT 1.00 X 0 0 0 HENDERSON SCOTT 1.00 X 0 0 0 BILL MEBANE 1.00 X 0 0 0 TOM GAMBLE 1.00 X 0 0 0 BILL STOCKARD 1.00 X 0 0 0 JIMMY EVANS 1.00 X 0 0 0 GEORGE BASON 1.00 X 0 0 0 FENTON COVINGTON 1.00 X 0 0 0 MAX KERNODLE 70.00 X 133352 0 18727 133352 0 18727 1 0 0 0 GENESIS ELDERCARE REHAB SERVICES PO BOX 7247 PHILADELPHIA PA 19170 REHAB THERAPY 420898 DIVISION OF MEDICAL ASSISTANCE 2022 MAIL SERVICE CENTER RALEIGH NC 27699 NURSING ASSESSMENT FEES 407802 NIGHTINGALE NURSING SERVICES PO BOX 1163 CARRBORO NC 27510 AGENCY NURSING 355337 SYSCO FOOD SERVICES PO BOX 129 SELMA NC 27576 RAW FOODS/SUPPLEMENTS 326617 J11 MAC PALMETTO GBA LLC PO BOX 100238 COLUMBIA SC 29202 MEDICAID INSURANCE SERVICES 300000 9 9033 9033 SKILLED CARE RESIDEN 623000 5623474 5623474 SPECIAL SERVICES REVEN 623000 305161 305161 INDEPENDENT LIVING REV 623000 213463 213463 COMMERICAL INSURANCE 623000 6200 6200 6148298 322 322 2380 0 2380 2380 2380 9000 2273 6727 6727 6727 LATE PAYMENT INCOME 900099 7319 7319 DUKE POWER GENERATOR U 900099 7118 7118 EMPLOYEE/GUEST MEALS 900099 1638 1638 656 656 16731 6183491 6148298 0 26160 118832 118832 2759105 2637893 121212 878085 785832 92253 264712 247014 17698 5715 5715 36480 36480 586517 568025 18492 8784 8784 48765 48765 304840 265294 39546 7401 6071 1330 7806 6928 878 123820 123820 SUPPLIES 828430 828430 THERAPY 403683 403683 BAD DEBT EXPENSE 67310 67310 PHARMACY 55897 55897 24263 24263 6530445 5953150 577295 0 545793 204701 100000 100000 669086 896095 53914 49922 52247 45094 6233380 4491894 1836703 1741486 7018 7966 3264761 3045264 459595 486104 7018 107966 466613 594070 X 2698148 2351194 100000 100000 2798148 2451194 3264761 3045264 -346954 0 X 0 1 X 1 0 X 3257 4182 11201 1570 9033 29243 6945172 7027639 6660229 6700276 6148298 33481614 6948429 7031821 6671430 6701846 6157331 33510857 685 482 80 140 210 1597 0 685 482 80 140 210 1597 33509260 34990 24791 18070 7052 10021 94924 34990 24791 18070 7052 10021 94924 12239 13997 13816 58809 16139 115000 6995658 7070609 6703316 6767707 6183491 33720781 0.99370 0.99330 0.00280 0.00270 X 1028277 1028277 3909720 3318800 590920 931990 829935 102055 363393 343159 20234 1741486 RESIDENT TRUST FUNDS 7966 LINE OF CREDIT 100000 107966 6183491 0 6183491 0 6183491 6530445 0 6530445 0 6530445 FORM 990, PART VI, SECTION A, LINE 2 FENTON COVINGTON (TREASURER) IS MAX KERNODLE'S (SECRETARY/ADMINISTRATOR) BROTHER-IN-LAW. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE SEVERAL COMMITTEES IN PLACE THAT REPORT TO THE GOVERNING BOARD AND MINUTES ARE RECORDED FOR THEIR PARTICULAR MEETINGS. THESE COMMITTEES DO NOT HAVE THE RIGHTS TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 WILL BE DISTRIBUTED AND REVIEWED AT THE NOVEMBER BOARD MEETING. ANY CHANGES WILL BE MADE PRIOR TO FILING THE FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD REVIEWS ANNUALLY AND SIGNS-OFF ON DOCUMENTS WHICH ARE RECORDED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 RECOMMENDATIONS ARE MADE AND DISCUSSED THROUGH THE FINANCE COMMITTEE. THE BOARD OF DIRECTORS THEN APPROVE ANY RECOMMENDATIONS. FORM 990, PART VI, SECTION C, LINE 19 ALL OTHER APPLICABLE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.