CAROLINA ADVENTIST RETIREMENT SYSTEMS INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
CAROLINA ADVENTIST RETIREMENT SYSTEMS INC (EIN 56-1089384)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-02-18
IRS object ID
201130499349300128
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-02-18T14:01:22-06:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN561089384EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CAROLINA ADVENTIST RETIREMENT SYSTEMS INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCARONameControl
Phone7046679851Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line195 HOLCOMBE COVE RDAddressLine1
CityCANDLERCity
StateNCState
ZIP Code287159450ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDEBORAH HAWKINSName
TitleTREASURER / CFOTitle
Phone7046679851Phone
Date Signed2011-02-18DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAmy BibbyName
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID KIDDERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line195 HOLCOMBE COVE RDAddressLine1
CityCANDLERCity
StateNCState
ZIP Code287159450ZIPCode
FieldValueIRS element (for citing)
Gross Receipts22732830GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.PISGAHVALLEY.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1975YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionSERVING HEALTHCARE AND RESIDENTIAL NEEDS WHILE UPHOLDING CHRISTIAN PRINCIPLES.ActivityOrMissionDescription
Nbr Voting Members Governing Body24NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees624TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI91270TotalGrossUBI
Net Unrelated Business Txbl Income-8784NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year275538ContributionsGrantsPriorYear
Contributions Grants Current Year619724ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21031523ProgramServiceRevenuePriorYear
Program Service Revenue CY21709744ProgramServiceRevenueCY
Investment Income Prior Year41444InvestmentIncomePriorYear
Investment Income Current Year46968InvestmentIncomeCurrentYear
Other Revenue Prior Year388225OtherRevenuePriorYear
Other Revenue Current Year355860OtherRevenueCurrentYear
Total Revenue Prior Year21736730TotalRevenuePriorYear
Total Revenue Current Year22732296TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year50990GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY76635GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12490811SalariesEtcPriorYear
Salaries Etc Current Year12061953SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8206364OtherExpensePriorYear
Other Expenses Current Year8827971OtherExpensesCurrentYear
Total Expenses Prior Year20748165TotalExpensesPriorYear
Total Expenses Current Year20966559TotalExpensesCurrentYear
Revenues Less Expenses Prior Year988565RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1765737RevenuesLessExpensesCY
Total Assets BOY21465648TotalAssetsBOY
Total Assets EOY23101642TotalAssetsEOY
Total Liabilities BOY10330003TotalLiabilitiesBOY
Total Liabilities EOY10200260TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11135645NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12901382NetAssetsOrFundBalancesEOY
Mission DescriptionAS A FAITH-BASED SEVENTH-DAY ADVENTIST ORGANIZATION, WE ARE DEDICATED TO SERVING THE HEALTHCARE AND RESIDENTIAL NEEDS OF OUR COMMUNITY WHILE UPHOLDING CHRISTIAN PRINCIPLES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8483078Expense
Grants37965Grants
Revenue10611944Revenue
DescriptionPISGAH VALLEY RETIREMENT COMMUNITY OWNS AND OPERATES A LICENSED CONTINUING CARE RETIREMENT COMMUNITY WITH 13 INDEPENDENT LIVING DUPLEX CONDOMINIUM UNITS, A 24-UNIT MULTI-UNIT ASSISTED HOUSING WITH SERVICES FACILITY, AND A 118-BED SKILLED NURSING FACILITY IN CANDLER, NORTH CAROLINA. PROGRAM SERVICE ACCOMPLISHMENTS INCLUDE THE PROVIDING OF ROOM AND BOARD (SHELTER, UTILITIES, MEALS, HOUSEKEEPING, LAUNDRY, AND MAINTENANCE), TRANSPORTATION, WELLNESS CENTER/ACTIVITIES, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, AND MEDICAL SERVICES TO OUR COMMUNITY (PRIMARILY AGE 55 AND OLDER).Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense9391514Expense
Grants38670Grants
Revenue11097800Revenue
DescriptionWINSLOW OPERATES A RETIREMENT COMMUNITY WITH 24 INDEPENDENT LIVING STUDIO APARTMENT UNITS AND A 146-BED SKILLED NURSING FACILITY IN ELIZABETH CITY, NORTH CAROLINA. PROGRAM SERVICE ACCOMPLISHMENTS INCLUDE THE PROVIDING OF ROOM AND BOARD (SHELTER, UTILITIES, MEALS, HOUSEKEEPING, LAUNDRY, AND MAINTENANCE), TRANSPORTATION, ACTIVITIES, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, AND MEDICAL SERVICES TO OUR COMMUNITY (PRIMARILY AGE 55 AND OLDER).Description
FieldValueIRS element (for citing)
Total Program Service Expense17874592TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109641NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees624NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members24NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DEBORAH HAWKINSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8284182334TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line195 HOLCOMBE COVE ROADAddressLine1
CityCANDLERCity
StateNCState
ZIP Code28715ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (38 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
RICHARD ANDERSON
DIRECTOR1.00X120000
HOWARD ANDRUS
DIRECTOR1.00X000
SAMUEL BONHAM
DIRECTOR1.00X04500
ERNEST BOUGHMAN JR
DIRECTOR1.00X03750
WILLIAM BRYAN
DIRECTOR1.00X40000
JIMM BUNCH
DIRECTOR1.00X000
DEWAYNE BUTCHER MD
DIRECTOR1.00X02250
LOUIS CANOSA
DIRECTOR1.00X1600203881507
JOHN COELHO
DIRECTOR1.00X4006295214065
KEN COONLEY
DIRECTOR1.00X40019720203
JIM DAVIDSON
DIRECTOR/CHAIRMAN OF BOARD1.00X16007465214501
DONOVAN DAVIS
DIRECTOR1.00X06055113478
FAITH DURKIN
DIRECTOR1.00X03750
JOHN EARNHARDT
DIRECTOR1.00X06499113680
CHARLES FERGUSON
DIRECTOR1.00X06720513957
J KENNETH FORD
DIRECTOR1.00X08584912834
SAMUEL GARCIA
DIRECTOR1.00X03000
MAURY GILMORE
DIRECTOR1.00X03750
CHAD GRUNDY
DIRECTOR1.00X16006452613794
CRYSTAL HALL
DIRECTOR1.00X0750
WILMA HARRIS
DIRECTOR1.00X000
WANDA HINDMAN
DIRECTOR1.00X04500
RALPH HOLLENBECK
DIRECTOR1.00X06180313886
LARRY KROLL MD
DIRECTOR1.00X01500
MINERVINO LABRADOR JR
DIRECTOR1.00X08641513794
LISA LEATHERWOOD
DIRECTOR1.00X40000
GARY MOYER
DIRECTOR/SECRETARY1.00X12007213013869X
MARK RUMSEY
DIRECTOR1.00X000
RICHARD RUSSELL
DIRECTOR1.00X16007540213869
ANDRES SEQUERA
DIRECTOR1.00X0517333162
PAUL THARP
DIRECTOR1.00X160000
GEORGE THOMAS
DIRECTOR1.00X000
GARY TOLBERT
DIRECTOR1.00X07079314233
DAN TULLOCK
DIRECTOR1.00X120000
ALBERT WILLIAMS
DIRECTOR1.00X40000
NEWTON ZANES
DIRECTOR1.00X40000
DEBORAH HAWKINS
TREASURER/CFO40.00113932014041X
DAVID KIDDER
PRESIDENT/CEO40.0013747922518686X
FieldValueIRS element (for citing)
Total Reportable Comp From Org265411TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs942110TotalReportableCompFrmRltdOrgs
Total Other Compensation203559TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
KINDRED REHAB SERVICES INC (DBA PEOPLEF
705 JUNIPER STREET NEALTANTAGA30308PHYSICAL, SPEECH AND OCCUPATIONAL THERAP827697
SYNERTX
7540 NORTH 19TH AVENUEPHOENIXAZ85021PHYSICAL, SPEECH AND OCCUPATIONAL THERAP705964
DIXON HUGHES PLLC
500 RIDGEFIELD COURTASHEVILLENC28806AUDIT, TAX, DATA PROCESSING, CONSULTING198772
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Related Organizations464500RelatedOrganizations
All Other Contributions155224AllOtherContributions
Noncash Contributions433000NoncashContributions
Total Contributions619724TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID PAYM6230001661804016618040
SKILLED NURSING, ASSIS62300049877904987790
AMORTIZATION OF ENTRAN623000103914103914
FieldValueIRS element (for citing)
Total Program Service Revenue21709744TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column45888TotalRevenueColumn
Exclusion$45,888ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real30238Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real30238Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column30238TotalRevenueColumn
Exclusion$30,238ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1614Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other534Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other1080Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1080TotalRevenueColumn
Exclusion$1,080ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
MANAGEMENT FEES FROM H531390150300$150,300
WELLNESS CENTER REVENU7139401071811591191270
MISCELLANEOUS INCOME62300068141$68,141
FieldValueIRS element (for citing)
Total Other Revenue325622TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column22732296TotalRevenueColumn
Related Or Exempt Function Income21725655RelatedOrExemptFunctionIncome
Unrelated Business Revenue91270UnrelatedBusinessRevenue
Exclusion$295,647ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total76635Total
Program Services76635ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total298764Total
Management And General298764ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total57075Total
Management And General57075ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9585934Total
Program Services8845072ProgramServices
Management And General740862ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1371792Total
Program Services1174414ProgramServices
Management And General197378ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total748388Total
Program Services653856ProgramServices
Management And General94532ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total30783Total
Management And General30783ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total100224Total
Management And General100224ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2185026Total
Program Services2165950ProgramServices
Management And General19076ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total33283Total
Management And General33283ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2780989Total
Program Services2543638ProgramServices
Management And General237351ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total139728Total
Management And General139728ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1420228Total
Program Services1248403ProgramServices
Management And General171825ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total70511Total
Program Services51514ProgramServices
Management And General18997ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total54263Total
Program Services39089ProgramServices
Management And General15174ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total4201Total
Program Services4201ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1068028Total
Program Services1060106ProgramServices
Management And General7922ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total117564Total
Program Services11714ProgramServices
Management And General105850ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
BAD DEBT511667511667
PROVIDER TAX252270252270
MISCELLANEOUS5920659206

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total20966559Total
Program Services17874592ProgramServices
Management And General3091967ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY900BOY
EOY900EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4385219BOY
EOY5439870EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY89729BOY
EOY235000EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1951632BOY
EOY2065225EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY92281BOY
EOY91400EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY223199BOY
EOY207094EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis19820260LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4921499LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY14568244BOY
EOY14898761EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY154444BOY
EOY163392EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21465648BOY
EOY23101642EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1740409BOY
EOY1477089EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1957176BOY
EOY2573241EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY6584926BOY
EOY6146115EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY47492BOY
EOY3815EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY10330003BOY
EOY10200260EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY11135645BOY
EOY12901382EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11135645BOY
EOY12901382EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21465648BOY
EOY23101642EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years46582CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2170584CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1638448CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year275538CurrentTaxYearMinus1Year
Current Tax Year619724CurrentTaxYear
Total4750876Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8888251CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16463098CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18804594CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21068695CurrentTaxYearMinus1Year
Current Tax Year21709744CurrentTaxYear
Total86934382Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years208296CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years270525CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year253795CurrentTaxYearMinus1Year
Current Tax Year236752CurrentTaxYear
Total969368Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8934833CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18841978CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20713567CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21598028CurrentTaxYearMinus1Year
Current Tax Year22566220CurrentTaxYear
Total92654626Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50992654626PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years23398CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years70683CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years80286CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year59082CurrentTaxYearMinus1Year
Current Tax Year74806CurrentTaxYear
Total308255Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years23398CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years70683CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years80286CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year59082CurrentTaxYearMinus1Year
Current Tax Year74806CurrentTaxYear
Total308255Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8958231CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18912661CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20793853CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21657110CurrentTaxYearMinus1Year
Current Tax Year22641026CurrentTaxYear
Total92962881Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99670PublicSupportPercentage509
Prior Year Support Percentage0.99680PriorYearSupportPercentage
Investment Income Percentage0.00330InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00320PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis640000OtherCostOrOtherBasis
Book Value640000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6092416OtherCostOrOtherBasis
Depreciation965999Depreciation
Book Value5126417BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis8414424OtherCostOrOtherBasis
Depreciation1342273Depreciation
Book Value7072151BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4037341OtherCostOrOtherBasis
Depreciation2258072Depreciation
Book Value1779269BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis636079OtherCostOrOtherBasis
Depreciation355155Depreciation
Book Value280924BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings14898761TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ESTIMATED 3RD PARTY SETTLEMENTS$2,337
DUE TO RELATED PARTIES$1,478
FieldValueIRS element (for citing)
Total Of Amounts3815TotalOfAmounts
Total Revenue22732296TotalRevenue
Total Expenses20966559TotalExpenses
Excess Or Deficit For Year1765737ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS1765737ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt22709796TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal22709796RevenueSubtotal
Other Revenues Not Included22500OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt22500RevenueNotRptdOnFinStmt
Total Revenue Per Form99022732296TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt20944059TotExpensesEtcAuditedFinclStmt
Other Expenses Included-22500OtherExpensesIncluded
Expenses Not Rptd F990-22500ExpensesNotRptdF990
Expenses Subtotal20966559ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99020966559TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
Part XII, Line 4b - Other Adjustments:MANAGEMENT FEES INCLUDED IN EXPENSES: 22500.
Part XIII, Line 2d - Other Adjustments:MANAGEMENT FEES INCLUDED IN EXPENSES: -22500.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationPurpose Of GrantPurposeOfGrant
PISGAH ESTATES UNIT OWNERS ASSOCIATION
95 HOLCOMBE COVE ROADCANDLERNC2871556176998952824000FMVTO ASSIST WITH ROOF REPAIR
MOUNT PISGAH ACADEMY
75 ACADEMY DRIVECANDLERNC28715560713794501(c)(3)6545FMVTO ASSIST WITH STUDENT SCHOLARSHIPS
CAROLINA CONFERENCE ASSOCIAION OF SEVENTH-DAY ADVENTISTS
2701 WT HARRIS BLVDCHARLOTTENC28256560773159501(C)(3)38670FMVTO ASSIST WITH LOCAL PASTOR SALARY
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations1TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: ALTHOUGH THE ORGANIZATION DOES NOT HAVE A FORMAL WRITTEN MONITORING SYSTEM, THE ORGANIZATION CONTROLS ONE OF THE RECIPIENT ENTITIES (AS A RELATED ORGANIZATION) AND THE PRESIDENT IS ON THE BOARD OF THE OTHER TWO ORGANIZATIONS. THROUGH THESE CONTROL FACTORS, THERE IS AN INFORMAL MONITORING OF THE USE OF GRANT FUNDS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAVID KIDDERBusinessNameLine1
FieldValueIRS element (for citing)
Base Compensation Filing Org122813BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org800BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org13866OtherCompensationFilingOrg
Other Compensation Related Orgs225OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org18686NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org156165TotalCompensationFilingOrg
Total Compensation Related Orgs225TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonELLA KIDDERNamePerson
FieldValueIRS element (for citing)
RelationshipFAMILY RELATIONSHIP WITH DAVID KIDDER, CEORelationship
Amount Of Transaction57075AmountOfTransaction
Description Of TransactionELLA KIDDER IS AN EMPLOYEE OF THE ORGANIZATIONDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionLANDDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990433000NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 4THE ORGANIZATION'S BYLAWS WERE AMENDED TO CHANGE BOARD STRUCTURE. THE BOARD OF DIRECTORS IS NO LONGER A SELF-PERPETUATING BOARD. IT IS NOW CONTROLLED BY CAROLINA CONFERENCE OF SEVENTH-DAY ADVENTISTS, THE ORGANIZATION'S PARENT COMPANY.
Form 990, Part VI, Section A, line 7aTHE CAROLINA CONFERENCE OF SEVENTH-DAY ADVENTISTS, A RELATED ORGANIZATION, ESTABLISHES AN EXECUTIVE COMMITTEE THAT SERVES AS THE ORGANIZATION'S BOARD OF DIRECTORS.
Form 990, Part VI, Section A, line 7bDECISIONS MADE BY THE ORGANIZATION ARE SUBJECT TO THE APPROVAL OF THE CAROLINA CONFERENCE OF SEVENTH-DAY ADVENTISTS.
Form 990, Part VI, Section B, line 11A DRAFT OF THE FORM 990 WAS REVIEWED BY THE PREPARER WITH THE EXECUTIVE BOARD OF THE BOARD DIRECTORS, CEO, AND CFO PRIOR TO ITS FILING DATE. IT WAS THEN FINALIZED BY THE PREPARER AND PROVIDED TO EACH BOARD OF DIRECTORS MEMBER PRIOR TO ITS FILING.
Form 990, Part VI, Section B, line 12cAT THE BOARD OF DIRECTORS ANNUAL MEETING, THE PRESIDENT AND CEO OF CAROLINA ADVENTIST RETIREMENT SYSTEMS, INC. PRESENTS A "STATEMENT OF ACCEPTANCE" OF THE POLICY ON CONFLICT OF INTEREST TO EACH OFFICER, DIRECTOR (I.E., BOARD MEMBER), AND KEY EMPLOYEE (I.E., ADMINISTRATORS). EACH OF THESE INDIVIDUALS ARE ASKED TO REVIEW AND SIGN THE STATEMENT WHICH INCLUDES A REPRESENTATION THAT THEY DO NOT HAVE A CONFLICT OF INTEREST. ADDITIONALLY, EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE RECEIVE AN ORIENTATION AND ANNUAL TRAINING RELATED TO THE ORGANIZATION'S CORPORATE COMPLIANCE POLICY, INCLUDING ITS CORE VALUE OF CARING, DEDICATION, INTEGRITY, PROFESSIONALISM, QUALITY, RESPECT, AND SAFETY.
Form 990, Part VI, Section B, line 15ANNUALLY MANAGEMENT PREPARES A SCHEDULE SHOWING THE PRIOR YEAR SALARIES PAID AND THE CURRENT YEAR BUDGETED SALARIES FOR THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE SCHEDULE COMPARES THE BUDGETED SALARY TO THE MOST CURRENT NORTH CAROLINA ASSOCIATION OF NOT-FOR-PROFIT HOMES FOR THE AGED WAGE & BENEFIT SURVEY AND SALARIES OF TWO LOCAL NOT-FOR-PROFIT CCRC'S AS OBTAINED FROM THEIR ORGANIZATION'S FORM 990 AS AVAILABLE ON GUIDESTAR. THIS SCHEDULE IS REVIEWED AND APPROVED BY THE EXECUTIVE BOARD OF THE BOARD OF DIRECTORS. THE EXECUTIVE BOARD THEN PRESENTS THIS INFORMATION AS PART OF THE BUDGET TO THE FULL BOARD OF DIRECTORS AT THEIR ANNUAL MEETING.
Form 990, Part VI, Section C, line 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 2C:THE EXECUTIVE BOARD, A SUBCOMMITTEE OF THE BOARD OF DIRECTORS, IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CAROLINA CONFERENCE ASSOCIATION OF SEVENTH-DAY ADVENTISTS INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 44270AddressLine1
CityCHARLOTTECity
StateNCState
ZIP Code28215ZIPCode
FieldValueIRS element (for citing)
EIN560773159EIN
Primary ActivitiesSPIRITUAL DEVELOPMENTPrimaryActivities
Legal Domicile StateNCLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status1PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PISGAH ESTATES UNIT OWNERS ASSOCIATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line195 HOLCOMBE COVE ROADAddressLine1
CityCANDLERCity
StateNCState
ZIP Code28715ZIPCode
FieldValueIRS element (for citing)
EIN561769989EIN
Primary ActivityHOME OWNERS ASSOCIATIONPrimaryActivity
Legal Domicile StateNCLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Percentage Ownership0.70000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1PISGAH ESTATES UNIT OWNERS ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeKTransactionType
Amount Involved150300AmountInvolved

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