ADMINISTRATOR

2012-11-29T15:27:46-06:00 2012-09-30 560587953 GILLIAM COBLE & MOSER LLP PO BOX 621 BURLINGTON NC 272160621 990 2011-10-01 561077371 PRESBYTERIAN HOME OF HAWFIELDS INC PRES 3365784701 2502 SOUTH NC 119 MEBANE NC 27302 MR MAX KERNODLE ADMINISTRATOR 3365784701 2012-11-27 1 SCOTT WILLIAMS P00024567 3362276283 2011 2016-02-24 21:20:13Z MR MAX KERNODLE 2502 SOUTH NC 119 MEBANE NC 27302 6768040 0 X WWW.HAWFIELDS.ORG X 1973 NC TO PROVIDE HOUSING & RELATED FACILITIES & SERVICE FOR THE ELDERLY AND NEEDY. 10 10 180 90 0 0 11201 1570 6660229 6700276 -1281 8103 29883 57758 6700032 6767707 0 0 0 0 4306693 4181532 0 0 0 2581813 2623283 6888506 6804815 -188474 -37108 3343159 3264761 507903 466613 2835256 2798148 TO PROVIDE HOUSING & RELATED FACILITIES & SERVICE FOR THE ELDERLY AND NEEDY IN A HEALTH CARE SETTING. 0 0 6173956 6700276 THE ORGANIZATION OPERATES A NURSING HOME FACILITY WITH 117 NURSING BEDS AND 37 INDEPENDENT LIVINGS BEDS IN MEBANE, NORTH CAROLINA. 6173956 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 0 1 10 0 180 0 0 0 0 0 0 0 0 0 X 10 10 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 BOARD OF DIRECTOR 1.00 X 0 0 0 MARY SCOTT BOARD OF DIRECTOR 1.00 X 0 0 0 HENDERSON SCOTT BOARD OF DIRECTOR 1.00 X 0 0 0 MARSHALL TAYLOR BOARD OF DIRECTOR 1.00 X 0 0 0 BILL MEBANE BOARD OF DIRECTOR 1.00 X 0 0 0 TOM GAMBLE BOARD OF DIRECTOR 1.00 X 0 0 0 BILL STOCKARD BOARD OF DIRECTOR 1.00 X 0 0 0 JIMMY EVANS CHAIRMAN 1.00 X 0 0 0 GEORGE BASON VICE CHAIRMAN 1.00 X 0 0 0 FENTON COVINGTON TREASURER 1.00 X 0 0 0 MAX KERNODLE ADMINISTRATOR/SECRETARY 70.00 X 119123 0 15893 119123 0 15893 1 0 0 0 SUNDANCE REHABILITATION 6459 PAYSPHERE CIRCLE CHICAGO IL 60674 REHAB THERAPY 488083 DIVISION OF MEDICAL ASSISTANCE 2022 MAIL SERVICE CENTER RALEIGH NC 27699 NURSING ASSESSMENT FEES 377232 SYSCO FOOD SERVICES PO BOX 129 SELMA NC 27576 RAW FOODS/SUPPLEMENTS 305405 MMS PO BOX 955588 ST LOUIS MO 63195 MEDICAL SUPPLIES 194542 NIGHTINGALE NURSING SERVICES PO BOX 1163 CARRBORO NC 27510 AGENCY NURSING 193353 10 1570 1570 INTER & SKILLED CARE 623000 6064366 6064366 SPECIAL SERVICES 623000 328280 328280 INDEPENDENT LIVING 623000 307630 307630 6700276 436 436 2380 0 2380 2380 2380 8000 333 7667 7667 7667 TIMBER SALE 900099 40408 40408 DUKE POWER GENERATOR R 900099 8249 8249 LATE PAYMENT INCOME 900099 4236 4236 2485 2485 55378 6767707 6700276 0 65861 111765 111765 2840615 2723143 117472 969999 871202 98797 259153 239588 19565 36000 36000 500743 486464 14279 5568 5568 46720 944 45776 353228 315181 38047 6443 5906 537 7027 6510 517 126620 126620 SUPPLIES 850125 850125 THERAPY 448855 448855 BAD DEBT EXPENSE 142536 142536 PHARMACY 83182 83182 16236 16236 6804815 6173956 630859 0 476808 545793 100000 100000 710130 669086 51702 53914 56608 52247 6242748 4406045 1942056 1836703 5855 7018 3343159 3264761 502048 459595 5855 7018 507903 466613 X 2735256 2698148 100000 100000 2835256 2798148 3343159 3264761 -37108 0 X 0 1 1 X 0 X 8796 3257 4182 11201 1570 29006 6988046 6945172 7027639 6660229 6700276 34321362 6996842 6948429 7031821 6671430 6701846 34350368 413 685 482 80 140 1800 0 413 685 482 80 140 1800 34348568 7694 34990 24791 18070 7052 92597 7694 34990 24791 18070 7052 92597 38677 12239 13997 13816 58809 137538 7043213 6995658 7070609 6703316 6767707 34580503 0.99330 0.99390 0.00270 0.00270 X 1028277 1028277 3911352 3229030 682322 918727 822662 96065 384392 354353 30039 1836703 RESIDENT TRUST FUNDS 7018 7018 6767707 6804815 -37108 -37108 6767707 0 6767707 0 6767707 6804815 0 6804815 0 6804815 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.