2012-10-03T13:36:10-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2011-01-01 570647976 ROLLING GREEN VILLAGE ROLL 8649879800 1 HOKE SMITH BLVD GREENVILLE SC 29615 LYNNE LENTZ 8649879800 2012-10-03 1 GREGORY W JOHNS P00535091 7049985200 2011 2016-02-24 21:20:13Z ERIC DUDASKO 1 HOKE SMITH BLVD GREENVILLE SC 29615 12043281 0 X WWW.ROLLINGGREENVILLAGE.COM X 1977 SC TO OPERATE A RESIDENTIAL RETIREMENT COMMUNITY IN A SECURE, CARING ENVIRONMENT. 13 13 287 65 0 0 17890 14950 11656452 12069609 68620 30498 -1870248 -71776 9872714 12043281 0 0 0 0 5483766 5204944 0 0 0 5314701 5559763 10798467 10764707 -925753 1278574 15505670 17157558 12638619 13089499 2867051 4068059 X THE MISSION OF ROLLING GREEN VILLAGE IS TO OPERATE A CONTINUING CARE RETIREMENT COMMUNITY IN A SECURE, CARING ENVIRONMENT TO PROMOTE THE HEALTH, WELLNESS, AND INDEPENDENCE OF THE COMMUNITY'S RESIDENTS. 0 0 7861701 12069609 THE LICENSED AREAS INCLUDE 24 HOUR CARE INCLUDING ASSISTANCE WITH BATHING, DRESSING, MEDICATION ADMINISTRATION, THREE WELL BALANCED MEALS EACH DAY WITH ACCOMODATIONS FOR SPECIAL DIETS WHEN PRESCRIBED BY A PHYSICIAN, WEEKLY HOUSEKEEPING WITH DAILY TIDYING OF APARTMENT FLAT, LAUNDRY AND PERSONAL LAUNDRY SERVICES, EMERGENCY CALL SYSTEM TO LICENSED NURSE AVAILABLE 24-HOURS, A DAY FULL ACTIVITIES PROGRAM, UTILITIES INCLUDING ELECTRICITY, GAS, WATER, SEWER, AND BASIC CABLE TELEVISION. MANY OTHER SERVICES ARE ALSO AVAILABLE AT AN ADDITIONAL CHARGE SUCH AS BEAUTY AND BARBER, ESCORTS TO PHYSICIAN APPOINTMENTS, PERSONAL AND MEDICAL SUPPLIES, AND GUEST MEALS. ROLLING GREEN VILLAGE'S ("RGV") ANNUAL SERVICE AGENDA COVERS CUSTOMER SERVICES, RESIDENT RIGHTS, SAFETY, HIPAA, INFECTION CONTROL, ABUSE REPORTING, SEXUAL HARASSMENT TRAINING, EMPLOYEE HANDBOOK AND BENEFITS. IN ADDITION, THE EMPLOYEE HANDBOOK OUTLINES AND DETAILS RGV'S BUSINESS PRACTICES, POLICIES AND PROCEDURES EACH DEPARTMENT ALSO HAS A QUALITY ASSURANCE MANUAL THAT THE DEPARTMENT HEADS MUST REVIEW AND APPROVE ANNUALLY. THE COMMUNITY OPERATES UNDER THE SUPERVISION OF THE SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS AND THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL. THE EXECUTIVE DIRECTOR ASSURES ALL STATE RULES AND REGULATIONS ARE FOLLOWED. THE COMMUNITY FILES AN ANNUAL STATEMENT WITH THE DEPARTMENT OF CONSUMER AFFAIRS. 7861701 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 44 0 287 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X LYNNE LENTZ 8649879800 1 HOKE SMITH BLVD GREENVILLE SC 29615 X MARTIN ATKINS 5.00 X X 0 0 0 ROBBY DAVIS 3.00 X 0 0 0 DUKE MCCALL 5.00 X 0 0 0 DAVID MURRAY 3.00 X 0 0 0 DANIEL PAGE 5.00 X X 0 0 0 SYLVIA FRAZIER 3.00 X 0 0 0 JERRY WELMAKER 3.00 X 0 0 0 ROY CHAMLEE III 5.00 X X 0 0 0 RONNIE COLSON 5.00 X X 0 0 0 ERICKA SPLAWN 3.00 X 0 0 0 RICHARD SMITH 5.00 X X 0 0 0 DAVID HILL 5.00 X X 0 0 0 ERIC DUDASKO 40.00 X 177105 0 0 HOPE HICKMAN 40.00 X 53542 0 0 230647 0 0 1 0 1 1 LIFE CARE SERVICES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT FEES 777828 SYSCO FOOD SERVICES 131 SYSCO CT COLUMBIA SC 29209 FOOD 630811 COMPANION HEALTHCARE 4101 PERCIVAL RD COLUMBIA SC 29229 EE HEALTH INSURANCE 541715 HERITAGE HC 536 OLD HOWELL ROAD GREENVILLE SC 29616 THERAPY SERVICES 392476 AJ GALLAGHER RISK MGMT SVCS RM 15 S MAIN ST SUITE 900 GREENVILLE SC 29601 PROFESSIONAL INSURANCE 368958 5 14950 14950 FACILITY FEES 623000 6392515 6392515 RESIDENT FEES 623000 3125659 3125659 HOME FEES 623000 1019090 1019090 ENTRANCE FEES 623000 945960 945960 PATIENT MEMBERSHIP FEE 623000 182750 182750 403635 403635 12069609 21115 21115 9383 0 9383 9383 9383 LOSS ON EXTINGUISHMENT 900099 -71776 -71776 -71776 12043281 12069609 0 -41278 514259 285339 228920 3844720 2916644 928076 28760 18996 9764 463000 300615 162385 354205 259184 95021 619110 216430 402680 45728 45728 33134 33134 688080 603112 84968 300435 300435 323758 15684 308074 39971 39971 7674 1728 5946 787388 400725 386663 103011 87675 15336 17571 9361 8210 991424 991424 306522 143369 163153 FOOD SUPPLIES 677896 677896 MAINTENANCE & REPAIR 432984 408036 24948 MEDICAL SUPPLIES 185077 185077 10764707 7861701 2903006 0 2206288 4264455 1041476 0 635452 930572 34712 29117 275390 559601 27588974 16359752 10553802 11229222 152952 144591 605598 0 15505670 17157558 754729 1037444 5171096 4818091 6000000 5963918 712794 1270046 12638619 13089499 X 2825594 4024990 41457 43069 2867051 4068059 15505670 17157558 X 1278574 -77566 X X 0 1 1 X 0 X 14061 94574 7431 17890 14950 148906 10157761 10420356 11168980 11656452 12069609 55473158 10171822 10514930 11176411 11674342 12084559 55622064 3045 3045 0 3045 3045 55619019 159960 107500 93531 68620 21115 450726 159960 107500 93531 68620 21115 450726 -71776 -71776 10331782 10622430 11269942 11742962 12033898 56001014 0.99320 0.98510 0.00800 0.00980 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 312742 346576 1326 660644 280617 11692 20433 312742 258202 1445 20970 280617 258202 258202 0 0 846417 846417 23475758 14882357 8593401 2329581 1339487 990094 937218 137908 799310 11229222 PROSPECTIVE RESIDENT DEPOSITS 8000 INTEREST RATE SWAP INSTRUMENTS 752654 CAPITAL LEASE OBLIGATIONS 509392 1270046 12043281 10764707 1278574 -77566 -77566 1201008 11964103 -77566 10101 -67465 12031568 11713 11713 12043281 10764707 0 10764707 0 10764707 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: BOARD DESIGNATED NET ASSETS DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THE STATUS BE CHALLENGED IN THE FUTURE, THE 2008, 2009, AND 2010 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE ORGANIZATION ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE IMPLEMENTATION HAS HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 10,101. PART XII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 11,713. X X 0 0 0 0 0 0 0 0 0 ERIC DUDASKO 138414 0 14521 0 24170 0 0 0 0 0 177105 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 LIFE CARE SERVICES ("LCS") MANAGES RGV. LCS IS A RECOGNIZED LEADER IN THE DEVELOPMENT AND MANAGEMENT OF CONTINUING CARE RETIREMENT COMMUNITIES WITH OVER 40 YEARS OF EXPERIENCE. THE EXECUTIVE DIRECTOR AND THE ADMINISTRATOR OF RGV ARE EMPLOYEES OF LIFE CARE SERVICES. THE REGIONAL ACCOUNTING DIRECTOR FOR LCS OVERSEES AND REVIEWS FINANCIAL STATEMENTS AND QUARTERLY RECONCILIATIONS. LCS ALSO PROVIDES SUPPORT SERVICES AND ALL FINANCIAL SOFTWARES USED. FORM 990, PART VI, SECTION B, LINE 11 BEFORE FILING, THE FORM 990 WAS MADE AVAILABLE TO THE GOVERNING BODY AND REVIEWED DURING THE OCTOBER BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C ROLLING GREEN VILLAGE HAS A CONFLICT OF INTEREST POLICY THAT THE BOARD OF TRUSTEES SIGN ANNUALLY. ROLLING GREEN VILLAGE ALSO CONDUCTS OIG CHECKS ON ALL VENDORS FOR MEDICARE FRAUD. THE ORGANIZATION HAS A POLICY THAT IS REVIEWED AT NEW EMPLOYEE ORIENTATION AND ON AN ANNUAL BASIS THAT STATES THAT EMPLOYEES ARE NOT PERMITTED TO WORK PRIVATELY FOR ANY RESIDENTS. FORM 990, PART VI, SECTION B, LINE 15 LIFE CARE SERVICES DETERMINES SALARIES AND BENEFITS FOR KEY OFFICERS BASED ON COMPARABLE WAGE AND SALARY SURVEYS. THESE SALARIES AND PERFORMANCE REQUIREMENTS ARE SHARED WITH THE TRUSTEES VIA THE ANNUAL BUDGETING PROCESS, AS WELL AS THE MANAGEMENT CONTRACT WITH LIFE CARE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE IN DIFFERENT WAYS. SOME OF THESE DOCUMENTS ARE AVAILABLE IN THE ROLLING GREEN VILLAGE LIBRARY AND OTHERS ARE AVAILABLE UPON REQUEST. ANNUAL AUDITED FIANCIAL STATEMENTS ARE PLACED IN THE RESIDENT LIBRARY EVERY YEAR AS THEY BECOME AVAILABLE FROM THE AUDIT FIRM. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -77,566. FORM 990, PART XII, LINE 2C: THE BOARD HAS ESTABLISHED A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE COMMITTEE HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.