2011-07-28T10:04:04-05:00 2010-12-31 LARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-01-01 561497371 WELL-SPRING RETIREMENT COMMUNITY INC WELL 3365455418 4100 WELL SPRING DRIVE GREENSBORO NC 27410 K ALAN TUTTEROW 3365455418 2011-07-28 1 GREGORY W JOHNS 7049985200 2010 2016-03-07 17:11:31Z K ALAN TUTTEROW 4100 WELL SPRING DRIVE GREENSBORO NC 27410 30389300 0 X WWW.WELL-SPRING.ORG X 1987 NC TO PROVIDE RETIREMENT LIVING SERVICES. 18 18 458 60 0 0 77302 953771 19980845 20470203 463744 712287 -24601 -85830 20497290 22050431 844893 914262 0 0 9559239 10034175 954 15476 15476 8715329 8787065 19120415 19750978 1376875 2299453 62222740 62392268 59655199 56661505 2567541 5730763 X WELL-SPRING IS A NOT-FOR-PROFIT COMMUNITY PROVIDING RETIREMENT LIVING SERVICES WHICH CREATE AN EXPERIENCE THAT EXCEEDS THE NEEDS OF AN EVOLVING POPULATION OF OLDER ADULTS IN A SPIRITUALLY NURTURING SETTING.WE ARE COMMITTED TO: -THE CONTINUING PHYSICAL, MENTAL AND SPIRITUAL CARE, WELL-BEING AND HAPPINESS OF OUR RESIDENTS, -DEVELOPING, OBTAINING AND RETAINING EFFECTIVE AND EFFICIENT MANAGEMENT AND EMPLOYEES, -PROVIDING UNSURPASSED CUSTOMER SERVICE AND VALUE, -BEING FISCALLY RESPONSIBLE AND KNOWLEDGEABLE OF INDUSTRY BEST PRACTICES, -INTEGRITY, ETHICAL CONDUCT, AND OPEN AND HONEST COMMUNICATIONS, -WELCOMING, ENCOURAGING AND HONORING DIVERSITY, AND -BEING GOOD CITIZENS, COMMUNITY LEADERS AND ADVOCATES FOR THE NEEDS OF OLDER ADULTS. 0 0 17863562 20470203 WELL-SPRING RETIREMENT COMMUNITY, INC ("WELL-SPRING"), A NORTH CAROLINA NONPROFIT CORPORATION, WAS ORGANIZED FOR THE PURPOSE OF OPERATING A CONTINUING CARE RETIREMENT COMMUNITY. WELL-SPRING IS GOVERNED BY A BOARD OF TRUSTEES COMPOSED OF CIVIC LEADERS, CURRENTLY CONSISTING OF 18 INDIVIDUALS, WHO SERVE WITHOUT COMPENSATION FOR STAGGERED THREE-YEAR TERMS. A MULTI-DENOMINATIONAL GROUP OF CHURCHES IN GREENSBORO, NORTH CAROLINA SPONSOR AND PROVIDE LEADERSHIP TO WELL-SPRING.REV. RUL. 72-124, 1972-1 C.B. 145, SETS OUT REQUIREMENTS THAT "HOME FOR THE AGED" MUST MEET TO QUALIFY FOR SECTION 501(C) (3) EXEMPTION. THE INTERNAL REVENUE SERVICE PROVIDED THE FOLLOWING REQUIREMENTS: (1) SATISFACTION OF THE NEED FOR HOUSING THROUGH THE PROVISION OF EMOTIONAL, RECREATIONAL, SOCIAL, RELIGIOUS AND SIMILAR NEEDS OF AGED PERSONS; (2) SATISFACTION OF THE NEED FOR HEALTH CARE THROUGH PROVISION OF PHYSICAL AND MENTAL HEALTH SERVICES DIRECTLY OR THROUGH CONTINUING ARRANGEMENTS WITH OUTSIDE ORGANIZATIONS; AND (3) SATISFACTION OF THE NEED FOR FINANCIAL SECURITY THROUGH MAINTAINING IN RESIDENCE ANY PERSONS WHO BECOME UNABLE TO PAY THEIR REGULAR CHARGE AND THROUGH PROVIDING SERVICES AT THE LOWEST FEASIBLE COST. WELL-SPRING SATISFIES ALL THREE REQUIREMENTS.PROGRAM SERVICES REVENUE AND EXPENSE RELATE TO THE PROVISION OF EMOTIONAL, RECREATIONAL, SOCIAL, RELIGIOUS AND SIMILAR NEEDS OF THE RESIDENTS, AS WELL AS THE PROVISION OF PHYSICAL AND MENTAL HEALTH SERVICES. RENTAL INCOME IS RECEIVED FROM BEAUTY/BARBER SHOP, THERAPY COMPANY AND GUEST UNITS LOCATED ON THE WELL-SPRING PREMISES FOR THE CONVENIENCE OF THE ELDERLY RESIDENTS. IN ADDITION, REVENUES RECEIVED FROM OTHER INCOME RELATE TO THE PROCESSING OF APPLICATIONS FOR RESIDENTS AND RELATE TO WELL-SPRING'S EXEMPT PURPOSE OF PROVIDING FOR THE PRIMARY NEEDS OF ELDERLY INDIVIDUALS. IN CONJUNCTION WITH ITS COMMITMENT TO MAINTAINING PERSONS IN RESIDENCE WHO BECOME UNABLE TO PAY, WELL-SPRING HAS ESTABLISHED A BENEVOLENCE FUND WHICH WILL BE USED FOR THE EXCLUSIVE PURPOSE OF PROVIDING CHARITY TO RESIDENTS IN NEED. A BENEVOLENCE COMMITTEE DETERMINES WHICH RESIDENTS OF WELL-SPRING SHOULD RECEIVED BENEFITS FROM THE FUND. 17863562 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 65 0 1 458 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X K ALAN TUTTEROW 3365455418 4100 WELL SPRING DRIVE GREENSBORO NC 27410 D HAYES CLEMENT JR 4.00 X X 0 0 0 FLORENCE F GATTEN 3.00 X X 0 0 0 TIMOTHY J CLONTZ 2.00 X 0 0 0 WILLIAM R CROWDER 1.00 X 0 0 0 K WILLIAM FRASER 2.00 X 0 0 0 MARVIN PINSON 1.00 X 0 0 0 CHARLES M REID 1.00 X 0 0 0 ROBERT E SEVIER 1.00 X 0 0 0 CHARLES L WEILL JR 2.00 X 0 0 0 DAVID M WORTH 1.00 X 0 0 0 SALLY B CONE 1.00 X 0 0 0 SHARON DANIEL 1.00 X 0 0 0 DAVID R HOWARD 2.00 X 0 0 0 WILLIAM A MCLAUGHLIN 1.00 X 0 0 0 ANN SENN 1.00 X 0 0 0 MACARTHUR SIMS 1.00 X 0 0 0 SUSAN L WILLIAMS 1.00 X 0 0 0 THOMAS WRIGHT 2.00 X 0 0 0 STEPHEN P FLEMING 40.00 X 233610 0 24013 K ALAN TUTTEROW 40.00 X 142742 0 21284 BARBARA W ADAMS 40.00 X 78798 0 8007 GEORGE GALVIN 40.00 X 104113 0 14732 559263 0 68036 3 0 1 0 UNITED HEALTH CARE INSURANCE 22561 NETWORK PLACE CHICAGO IL 606731225 EMPLOYEE MEDICAL INSURANCE 911579 US FOODSERVICE 125 FORT MILL PARKWAY FORT MILL SC 29715 FOOD 834200 DUKE ENERGY PO BOX 70516 CHARLOTTE NC 282720516 ELECTRICITY 477288 RENTENBACH CONSTRUCTORS INC 2400 SUTHERLAND AVENUE KNOXVILLE TN 37919 CONSTRUCTION 319931 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 HOUSEKEEPING MANAGEMENT 279076 15 65470 888301 953771 RESIDENT FEES 623990 19581960 19581960 888243 888243 20470203 513944 513944 87124 83716 3408 3408 3408 8453496 8241292 13861 212204 -13861 198343 198343 DEBT EXTINGUISHMENT LO 900099 -89238 -89238 -89238 22050431 20470203 0 626457 914262 914262 455151 455151 7594892 6771528 823364 210012 176658 33354 987265 830467 156798 786855 661886 124969 18267 18267 64670 64670 15476 15476 681303 681303 202217 6850 195367 582226 582226 947467 947467 10821 10821 25331 25331 1012133 1012133 3107506 3107506 218329 218329 FOOD 955293 955293 EQUIP. RENTAL & MAINT. 817725 817725 MAINT. & HORTICULTURE 75581 75581 RESIDENT ACTIVITIES 68196 68196 19750978 17863562 1871940 15476 2653668 3287844 3717578 4115805 367281 365511 316360 40903 92714 63892341 26497132 39168194 37395209 15386698 16048527 931091 727625 62222740 62392268 1762725 1849638 32566354 30992393 23790000 22390000 1536120 1429474 59655199 56661505 X 2360129 5179867 207412 550896 2567541 5730763 62222740 62392268 X 2299453 863769 X X 0 1 1 X 0 X 1188479 140607 83659 77302 65470 1555517 16188361 16756057 18460376 19371522 20470203 91246519 507835 578114 621205 609323 2316477 17884675 17474778 19165240 20058147 20535673 95118513 1292990 643430 425614 594443 2956477 597323 825450 489065 1911838 1890313 643430 1251064 1083508 4868315 90250198 1287091 1355105 1159246 725470 715696 5242608 1287091 1355105 1159246 725470 715696 5242608 -89238 -89238 19171766 18829883 20324486 20783617 21162131 100271883 0.90010 0.87950 0.05230 0.05500 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 602097 -434530 25055 192622 1023437 -500000 318933 240273 602097 1.00000 0 0 2830213 2830213 45182046 18178052 27003994 6314867 2744385 3570482 5267490 3230612 2036878 4297725 2344083 1953642 37395209 INVESTMENTS 16048527 F 16048527 REFUNDABLE FEES 1014188 ADMISSION DEPOSITS 355771 OTHER LIABILITIES 59515 1429474 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE FOR THE PURPOSE OF PROVIDING CHARITY CARE TO WELL-SPRING RETIREMENT COMMUNITY RESIDENTS. 1 ALZHEIMER'S ASSOCIATION 122 N ELM STREET SUITE 800 GREENSBORO NC 27401 561440727 5100 MEMORY WALK AMERICAN HEART ASSOCIATION 4217 PARK PLACE COURT GLEN ALLEN VA 23060 135613797 5100 HEART WALK APPALACHIAN STATE UNIVERSITY 231 PLEMMONS STUDENT UNION BOONE NC 28608 561176030 7000 HEALTH CARE MANAGMENT SCHOLARSHIP BELL HOUSE 2400 SUMMIT AVENUE GREENSBORO NC 27405 561145963 20000 OPERATING SUPPORT EASTERN MUSIC FESTIVAL 200 N DAVIE STREET STE 303 GREENSBORO NC 27401 560771005 5000 OPERATING SUPPORT GTCC PO BOX 309 JAMESTOWN NC 27282 566085391 4000 LPN AND RN SCHOLARSHIPS HABITAT FOR HUMANITY 617-B N ELM STREET GREENSBORO NC 27401 561586870 60000 HOUSE CONSTRUCTION HOUSING GREENSBORO INC PO BOX 3341 GREENSBORO NC 27402 566001468 20250 OPERATING SUPPORT MOSES CONE HEALTH SYSTEM 1200 N ELM STEET GREENSBORO NC 27401 581588823 25000 CANCER CENTER/HEALTHSERVE SPONSOR NC A&T 1601 E MARKET ST GREENSBORO NC 27411 566000007 2000 NURSING SCHOLARSHIP TRIAD FLIGHT OF HONOR PO BOX 4613 GREENSBORO NC 27404 562130185 25000 OPERATING SUPPORT TRIAD STAGE 232 S ELM STREET GREENSBORO NC 27401 621743981 6300 OPERATING SUPPORT UNCG PO BOX 26170 GREENSBORO NC 27402 566001468 82000 NURSING SCHOLARSHIP UNITED WAY OF GREATER GREENSBORO 1500 YANCEYVILLE STREET GREENSBORO NC 27405 560668555 10750 OPERATING SUPPORT WELL-SPRING FOUNDATION 4100 WELL SPRING DRIVE GREENSBORO NC 27410 562217797 500000 OPERATING SUPPORT 15 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: WELL-SPRING RETIREMENT COMMUNITY RECEIVES PERIODIC REPORTS FOR THE ORGANIZATION TO WHOM FUNDS WERE DONATED TO ESTABLISH SCHOLARSHIPS. X X X X 0 0 0 0 0 0 0 0 0 STEPHEN P FLEMING 195000 0 27000 0 11610 0 7008 0 17005 0 257623 0 0 0 K ALAN TUTTEROW 123900 0 14912 0 3930 0 4282 0 17002 0 164026 0 0 0 HEALTH CARE FACILITIES FIRST MORTGAGE REVENUE REFUNDING BONDS SERIES 2003C 521309402 NONEAVAIL 2010-11-10 7065000 TO REFUND THE 2003C BONDS 0 0 0 NC MEDICAL CARE COMMISSION (SERIES 2003ABC) 521309402 657902M58 2003-12-23 27437618 PARTIAL REFUNDING OF 1997 BONDS 1 0 0 1998 1 0 1 1 3338456 4021219 548752 1998 1 0 1 1 0 1 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 BEFORE THE FILING OF THE INFORMATION TAX RETURN 990 FOR WELL-SPRING RETIREMENT COMMUNITY, THE FORM 990 WAS REVIEWED IN DETAIL BY THE CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER. EACH MEMBER OF THE WELL-SPRING RETIREMENT COMMUNITY'S BOARD OF TRUSTEES WAS PROVIDED WITH A COPY OF WELL-SPRING RETIREMENT COMMUNITY'S FORM 990 PRIOR TO FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES SHALL COMPLETE AND RETURN TO THE SECRETARY AN ANNUAL STATEMENT THAT EACH OF THEM: (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) AGREES TO COMPLY WITH THIS POLICY; (D) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES; AND (E) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 PRESIDENT/CEO COMPENSATION: IT SHALL BE THE POLICY OF WELL-SPRING RETIREMENT COMMUNITY TO ANNUALLY REVIEW THE PERFORMANCE OF THE PRESIDENT AND CEO UNLESS CIRCUMSTANCES DEMAND MORE FREQUENT REVIEW INTERVALS. THE PRESIDENT/CEO'S REVIEW SHALL BE CONDUCTED BY THE BOARD OF TRUSTEES; HOWEVER THE BOARD OF TRUSTEES MAY DELEGATE THIS FUNCTION TO ITS COMPENSATION COMMITTEE. PROCEDURES FOR SETTING COMPENSATION: 1. A BOARD OF TRUSTEES COMPENSATION COMMITTEE SHALL BE APPOINTED ANNUALLY BY THE BOARD CHAIR. THE COMMITTEE SHALL BE COMPRISED OF THE CURRENT CHAIR, IMMEDIATE PAST CHAIR, CHAIR-ELECT (IF ANY) AND 1-2 TRUSTEES AT LARGE. 2. THE COMMITTEE SHALL MEET APPROXIMATELY THIRTY DAYS PRIOR TO THE END OF THE WELL-SPRING RETIREMENT COMMUNITY'S FISCAL YEAR. 3. PRIOR TO THE MEETING, THE PRESIDENT/CEO SHALL PROVIDE COMPARABLE SALARY AND BENEFIT DATA THROUGH EXTERNAL SOURCES SUCH AS: THE AAHSA SALARY AND BENEFIT REPORT, NCANPHA WAGE SURVEY, PUBLIC RECORD IRS FORM 990S, AND INDEPENDENT SURVEYS. 4. PRIOR TO THE MEETING, THE PRESIDENT/CEO SHALL PROVIDE A STATEMENT OF ACHIEVEMENTS COMPARED TO GOALS FOR THE CURRENT YEAR AND A PRELIMINARY LIST OF PERFORMANCE GOALS FOR THE SUCCEEDING YEAR. 5. AT THE MEETING, THE PRESIDENT/CEO SHALL INFORM THE COMMITTEE OF PROPOSED SALARY ADJUSTMENTS FOR SENIOR MANAGEMENT FOR THE SUCCEEDING YEAR. THE PRESIDENT/CEO MAY PRESENT COMPARABLE SALARY DATA FOR SENIOR MANAGEMENT AT THE COMMITTEE'S DISCRETION. 6. AT THE MEETING AND AFTER PRESENTING YEAR-END RESULTS AND SUCCEEDING YEAR GOALS, THE COMMITTEE MAY EXCUSE THE PRESIDENT/CEO, ENTER INTO EXECUTIVE SESSION AND DISCUS THE PRESIDENT/CEO'S PERFORMANCE AND COMPENSATION. 7. AT THE CONCLUSION OF THE MEETING, THE BOARD OF TRUSTEES' CHAIR SHALL MEET WITH THE PRESIDENT/CEO IN ORDER TO REVIEW THE COMMITTEE'S ASSESSMENT OF PERFORMANCE AND SALARY. SALARY ADJUSTMENTS TO THE PRESIDENT/CEO'S COMPENSATION SHALL BE AUTHORIZED BY SIGNATURE OF THE BOARD CHAIR OR VICE CHAIR ONLY. 8. AT THE FIRST BOARD OF TRUSTEES' MEETING FOLLOWING THE COMPENSATION COMMITTEE'S MEETING, THE BOARD OF TRUSTEES' CHAIR SHALL REPORT THE COMMITTEE'S FINDINGS AND THE COMMITTEE'S ACTIONS REGARDING EMPLOYMENT STATUS, RECOMMENDATIONS AND SALARY OR BENEFIT ADJUSTMENTS FOR THE PRESIDENT/CEO. EXECUTIVE MANAGERS COMPENSATION PHILOSOPHY OBJECTIVE: THE COMPENSATION COMMITTEE BELIEVES THAT THE PRIMARY OBJECTIVES OF WELL-SPRING'S EXECUTIVE COMPENSATION POLICIES SHOULD BE: -TO ATTRACT AND RETAIN TALENTED EXECUTIVES BY PROVIDING COMPENSATION THAT IS, OVERALL, HIGHLY COMPETITIVE WITH THE COMPENSATION PROVIDED TO EXECUTIVES AT COMPANIES OF COMPARABLE POSITION IN THE CONTINUING CARE RETIREMENT COMMUNITY FIELD, WHILE MAINTAINING COMPENSATION WITHIN LEVELS THAT ARE CONSISTENT WITH WELL-SPRING'S ANNUAL BUDGET, FINANCIAL OBJECTIVES, OPERATING PERFORMANCE AND RESIDENT AND STAFF SATISFACTION; AND -TO PROVIDE APPROPRIATE INCENTIVES FOR EXECUTIVES TO WORK TOWARD THE ACHIEVEMENT OF WELL-SPRING'S ANNUAL FINANCIAL PERFORMANCE AND BUSINESS GOALS BASED ON WELL-SPRING'S ANNUAL BUDGET. THE COMPENSATION COMMITTEE REVIEWS EXECUTIVE COMPENSATION POLICIES ANNUALLY TAKING INTO CONSIDERATION WELL-SPRING'S FINANCIAL PERFORMANCE, ITS ANNUAL BUDGET, ITS POSITION IN THE INDUSTRY AND WELL-SPRING'S MISSION STATEMENT AND CORE VALUES. THE COMPENSATION COMMITTEE BELIEVES THAT IN ADDITION TO CORPORATE PERFORMANCE, IT IS APPROPRIATE IN SETTING AND REVIEWING EXECUTIVE COMPENSATION TO CONSIDER THE LEVEL OF EXPERIENCE AND RESPONSIBILITIES OF EACH EXECUTIVE OFFICER AS WELL AS THE PERSONAL CONTRIBUTIONS A PARTICULAR INDIVIDUAL AMY MAKE TO THE SUCCESS OF WELL-SPRING RETIREMENT COMMUNITY, INC. FORM 990, PART VI, SECTION C, LINE 19 WELL-SPRING RETIREMENT COMMUNITY'S FINANCIAL STATEMENTS ARE CONSOLIDATED WITH THOSE OF WELL-SPRING FOUNDATION. INCLUDED WITH THE AUDITED FINANCIAL STATEMENTS ARE SCHEDULES WHICH SHOW STAND ALONE FIGURES FOR BOTH WELL-SPRING FOUNDATION AND WELL-SPRING RETIREMENT COMMUNITY. THE CONSOLIDATED FINANCIAL STATEMENTS ARE PART OF WELL-SPRING'S ANNUAL DISCLOSURE STATEMENT WHICH IS FILED WITH THE NC DEPARTMENT OF INSURANCE. THE NC DEPARTMENT OF INSURANCE POST ALL DISCLOSURE STATEMENTS ON THEIR WEB SITE. THE CONSOLIDATED FINANCIAL STATEMENTS ARE FILED ANNUALLY WITH THE SEC VIA EMMA (ELECTRONIC MUNICIPAL MARKET ACCESS). ADDITIONALLY, COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 798,299. ENDOWMENT CONTRIBUTION 65,470. TOTAL TO FORM 990, PART XI, LINE 5: 863,769. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. TAX-EXEMPT BONDS - PRIVATE BUSINESS USE SCHEDULE K, PART III, LINE A: THIS SECTION IS NOT REQUIRED TO BE COMPLETED AS THE OUTSTANDING BONDS ARE THE RESULT OF REFUNDING OF BONDS ISSUED BEFORE 2003 AND THUS NO REPORTING IS REQUIRED. WELL-SPRING FOUNDATION 4100 WELL SPRING DRIVE GREENSBORO NC 27410 562217797 FUNDRAISING NC 501(C)(3) LINE 11A, I N/A 0 PACE OF GUILFORD & ROCKINGHAM COUNTIES INC 721 GREEN VALLEY ROAD GREENSBORO NC 27408 271560334 ALL INCLUSIVE ELDERLY CARE NC N/A PATIENT SERVICES -246586 838239 0 1 0.51000 0 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 WELL SPRING FOUNDATION B 500000 WELL SPRING FOUNDATION C 65470