2011-08-11T12:08:02-05:00 2010-09-30 RSM McGladrey Inc 230 N Elm St Ste 1100 Greensboro NC 27401 990 2009-10-01 560634527 THE UNITED METHODIST RETIREMENT HOMES INC UNIT 9193843000 2600 CROASDAILE FARM PKWY No a-500 DURHAM NC 277053153 jonathan erickson 9193843000 2011-08-04 Garrick L Martin 3362724551 2009 2016-02-24 21:20:13Z jonathan erickson 2600 CROASDAILE FARM PKWY No a-500 DURHAM NC 277053153 52544677 0 X WWW.UMRH.ORG X 1946 NC Continuing care retirement community 28 28 589 720 0 0 679526 720870 32538576 33410086 782515 1052002 5518557 5828063 39519174 41011021 401940 426879 0 14778599 14989511 0 0 21444457 22706467 36624996 38122857 2894178 2888164 141385027 145749030 125836834 127153285 15548193 18595745 To provide quality care and services for an inclusive and diverse population of senior adults. 0 0 30051393 426879 39185015 OPERATED CONTINUING CARE RETIREMENT COMMUNITY INCLUDING SKILLED NURSING FACILITIES. 30051393 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 1 61 0 1 589 1 0 0 0 0 0 0 0 0 0 1 1 28 28 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X STACY DOBSON 9193843002 2600 CROASDAILE FARM PKWY STE A-500 Durham NC 27705 jonathan erickson 40.00 X X 155814 0 7006 Nancy smith marks 1.00 X X 0 0 0 nelson price 1.00 X X 0 0 0 Julius Adams 1.00 X 0 0 0 JONATHAN biggs 1.00 X 0 0 0 Frank Brooks 1.00 X 0 0 0 Edgar Douglas 1.00 X 0 0 0 richard h evans 1.00 X 0 0 0 leonard fairley 1.00 X 0 0 0 joann falls 1.00 X 0 0 0 richard furr 1.00 X 0 0 0 Carol Goehring 1.00 X 0 0 0 Alfred Gwinn 1.00 X 0 0 0 Lee Harriss 1.00 X 0 0 0 John hemingway 1.00 X 0 0 0 lucy hinson 1.00 X 0 0 0 Elizabeth Hood 1.00 X 0 0 0 Robby Lowry 1.00 X 0 0 0 Clyde mcKee 1.00 X 0 0 0 Charles Mercer 1.00 X 0 0 0 Donald Metzger 1.00 X 0 0 0 Betsey Miller 1.00 X 0 0 0 Mack parker 1.00 X 0 0 0 walter pories 1.00 X 0 0 0 william sherman 1.00 X 0 0 0 Gray Southern 1.00 X 0 0 0 mark stephens 1.00 X 0 0 0 J Gregory Wallace 1.00 X 0 0 0 Meta Wood 1.00 X 0 0 0 STACY DOBSON 40.00 X 125742 0 13400 HOWARD DEWITT 40.00 X 128866 0 5472 WADE ROZIER 40.00 X 112456 0 10078 522878 0 35956 4 0 1 0 Morrison Management Specialists 4721 Morrison Drive Ste 300 Mobile AL 36625 Dietary Management 2205734 The Weitz Company LLC 5901 Thornton Avenue Des moiNES IA 50321 General Contractor 2188640 Life Care Services LLC 400 Locust Square Suite 820 des moiNES IA 50309 Management Company 1549275 Heritage Healthcare Inc 536 Old Howell Road greenville SC 29615 Therapy provider 1120216 Freedom Landscape Services Inc 85 Jared Drive Fuquay Varina NC 27526 Landscape Management 343699 11 720870 720870 PATIENT SERVICES 623000 26478417 26478417 Medicare/Medicaid Paym 623000 6931669 6931669 33410086 1046068 1046068 11748 11748 11748 11748 11536393 3197 11405749 127907 130644 -124710 5934 5934 AMORT. OF ADVANCE FEES 623000 4914463 4914463 MANAGEMENT FEE 623000 848482 848482 MISC OPERATING REVENUE 623000 38079 38079 15291 11984 3307 5816315 41011021 39185015 0 1105136 426879 426879 558834 558834 11730070 10583428 1146642 170162 127082 43080 1585399 1399455 185944 945046 824244 120802 1835774 270632 1565142 71380 71380 76927 76927 141565 141565 223451 223451 2575575 2465938 109637 1323805 870137 453668 37435 7347 30088 111388 67929 43459 4007369 3903979 103390 4757973 3127416 1630557 500926 500926 Contracted Labor 3018426 2815304 203122 Ancillary Expenses 1732146 1732146 Equipment Rental 476896 378861 98035 Patient Discounts 322262 322262 Retire Bond issue cost 191111 125617 65494 1302058 602737 699321 38122857 30051393 8071464 0 800 800 15321460 13123284 1470847 1864590 1451656 1937464 1146451 77109 102447 680586 627397 133493838 34752390 95529231 98741448 22701566 25455951 30349 30349 2974972 3865300 141385027 145749030 3986707 6578809 38445444 38835730 83004000 80572923 400683 1165823 125836834 127153285 X 13238205 15885559 550849 945008 1759139 1765178 15548193 18595745 141385027 145749030 X 0 1 1 X 0 X 689623 940038 585445 679526 720870 3615502 24419018 27298984 30413105 32682793 33410086 148223986 25108641 28239022 30998550 33362319 34130956 151839488 0 0 0 151839488 812033 1585506 1452481 1104942 1057816 6012778 812033 1585506 1452481 1104942 1057816 6012778 3827621 4510479 5691143 5509384 5816315 25354942 29748295 34335007 38142174 39976645 41005087 183207208 0.82880 0.83280 0.03280 0.03200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1893373 510626 251738 19400 345203 0 2291134 1823773 261816 43683 235899 1893373 0.00000 0.66130 0.33870 0 1 1 6060019 6060019 105020500 26344680 78675820 6067667 4106526 1961141 16345652 4301184 12044468 98741448 FUNDS HELD FOR OTHERS 444354 DUE TO RELATED PARTY 38608 Interest Rate Swap Agreement 682861 1165823 41011021 38122857 2888164 676393 -517005 159388 3047552 40132017 676393 -1555397 -879004 41011021 0 41011021 37084465 0 37084465 1038392 1038392 38122857 Part V, Line 4: Description of Intended Use of Endowment Funds: As dictated by the donor, earnings on the endowments funds will support benevolent needs at the community and employee scholarships. Part XI, Line 8 - Other Adjustments: Change in value of interest rate swap agreement - (682,861) Change in split interest agreements - (4,470) Change in value of pledges - 170,326 Part XII, Line 2d - Other Adjustments: Change in split interest agreements - (4,470) Change in value of pledges - 170,326 Specific Individual Assistance - (407,479) Beauty & Barber Expense - (87,540) Patient Service Revenue Discounts - (322,262) Change in value of interest rate swap agreement - (682,861) Bad Debt Expense reclassed to expenses - (30,000) Retirement of Bond Issuance Costs reclassed to expenses - (191,111) Part XIII, Line 4b - Other Adjustments: Specific Individual Assistance - 407,479 Beauty & Barber Expense - 87,540 Patient Service Revenue Discounts - 322,262 Bad Debt Expense reclassed from Revenue - 30,000 Retirement of Bond Issuance Costs reclassed from revenue - 191,111 1 Benevolent assistance for residents 14 407479 Nursing Scholarships 4 2400 Student Scholarships 17 17000 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Upon review of each resident's individual financial situation, the Company may permit the resident to remain at the facility for a lesser fee based on the resident's ability to pay but only after meeting all of the spend-down provisions of eligibility for the Medicaid program and any public assistance funds. THE UNITED METHODIST RETIREMENT HOMES HAS FOUR POST-SECONDARY EDUCATION SCHOLARSHIP PROGRAMS FOR EMPLOYEES OF UNITED METHODIST RETIREMENT HOMES AND ITS CONTRACTORS. THE SCHOLARSHIPS ARE FUNDED BY DONORS AND ARE AWARDED ANNUALLY. SCHOLARSHIP RECIPIENTS ARE NOMINATED BY THEIR MANAGEMENT AND ARE SELECTED BY A THREE-MEMBER COMMITTEE COMPRISING THE MANAGER OF THE SCHOLARSHIP APPLICANTS, THE UNITED METHODIST RETIREMENT HOMES DIRECTOR OF HUMAN RESOURCES, AND THE VICE PRESIDENT OF THE UNITED METHODIST RETIREMENT HOMES FOUNDATION. THE COMMITTEE MAKES SELECTIONS OF SCHOLARSHIP RECIPIENTS BASED ON THE POLICY FOR DONOR-DIRECTED SCHOLARSHIP FUNDS, AND ON THE DONOR'S CRITERIA FOR AWARDING THE SCHOLARSHIP. 1 X X X X 0 0 0 0 0 0 0 0 0 jonathan erickson 124127 0 31162 0 525 0 0 0 7006 0 162820 0 0 0 North Carolina Medical Care Commission 521309402 65820ydr4 2005-02-01 20790000 Build 59 new apartments 0 0 North Carolina Medical Care Commission 521309402 65820yew2 2005-09-01 47835000 Refund series 2000 bond balances 0 0 North Carolina Medical Care Commission 521309402 noneavail 2010-02-04 14300000 Replacement healthcare center 0 0 north Carolina Medical Care Commission 521309402 noneavail 2010-02-18 12880000 Convert 2005B bonds to BQ Status 0 0 20790000 2036537 415800 18337663 2005 0 0 1 1 47835000 3011368 956700 43866932 2005 0 1 1 1 14300000 13132000 268000 900000 2010 0 0 0 1 12880000 12880000 2010 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 1 bb&t 0 0 0 X 3 119767 Avg high/low prices 0 1 0 Form 990, Part VI, Section A, line 2 Jonathan Erickson (Corporate Executive Director) and Stacy Dobson (Chief Financial Officer) serve as officers of United Methodist Retirement Homes Affordable Housing, Inc. Jonathan Erickson is the President of UMRH Affordable Housing, Inc. and Stacy Dobson is the Secretary. The following members of the board of trustees are also members of the board of trustees for Cypress Glen Retirement Community, a related entity disclosed on Schedule R: Jonathan Erickson, Mack Parker, John Hemingway, Julius Adams, Nelson Price, Nancy Smith Marks, Jonathan Biggs, Edgar Douglas, Richard H. Evans, JoAnn Falls, Richard Furr, Robby Lowry, Donald E. Metzger, Greg Wallace, Walter Pories, Mark Stephens, Frank Brooks, Leonard E. Fairley, Carol Goehring, Gray Southern, Alfred W. Grinn, Jr., Elizabeth Hood, and William Sherman. The following members of the board of trustees are also members of the board of trustees for United Methodist Retirement Homes Foundation, Inc., a related entity disclosed on Schedule R: Jonathan Erickson, Stacy Dobson, Mack Parker, John Hemingway, Jonathan Biggs, and Richard Furr. Form 990, Part VI, Section B, line 11 The organization's Chief Financial Officer reviews the 990 return. Form 990, Part VI, Section B, line 12c The UMRH, Inc. board fills out the Conflict of Interst policy form each September noting any continued conflicts of interest. New board members are oriented to the policy and sign the form upon becoming members. Each board member is required to disclose any conflicts to the chairman prior to a vote being taken. The member must abstain from voting. The conflict of interest policy is also reviewed for the employees at orientation and at annual review. Form 990, Part VI, Section B, line 15 The organization routinely consults the services of an outside agency to evaluate the organization's wage scales and pay grades. The resulting wage scale and the employee's performance and accomplishments are considered in the annual review process. In some instances, a software program called "Performance Now" is used to simplify the communication of the review and its results. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part VII, Section A Hours to Related Organization: Jonathan Erickson - 1 hr per week to Cypress Glen Retirement Community as a member of the board of trustees and 1 hr per week to United Methodist Retirement Homes Foundation, Inc. as a member of the board of trustees. The following members of the board of trustees are also members of the board of trustees of Cypress Glen Retirement Community and provide 1 hr of service per week: Mack Parker, John Hemingway, Julius Adams, Nelson Price, Nancy Smith Marks, Jonathan Biggs, Edgar Douglas, Richard Evans, JoAnn Falls, Richard Furr, Robby Lowry, Donald Metzger, Walter Pories, Mark Stephens, J. Gregory Wallace, Frank Brooks, Leonard Fairley, Carol Goehring, Gray Southern, Elizabeth Hood, Alfred Gwinn, and William Sherman. The following members of the board of trustees are also members of the board of trustees of United Methodist Foundation, Inc. and provide 1 hr of service per week: Stacy Dobson, Mack Parker, John Hemingway, Jonathan Biggs, and Richard Furr. Form 990, Schedule R, Part V, Line 2 Transactions with related organizations: The filing organization and UMRH Affordable Housing, Inc. share a facility that has a net book basis of $78,675,820 (Cost = $105,020,500 and Accumulated Depreciation = $26,344,680) The filing organization and UMRH Affordable Housing, Inc. share two employees, Jonathan Erickson ($155,814 reportable compensation and $7,006 other compensation both paid by the filing organization) and Stacy Dobson ($125,742 reportable compensation and $13,400 other compensation both paid by the filing organization). UMRH Affordable Housing Development LLC 2600 Croasdaile Farm Pkwy Ste A-500 Durham NC 277053153 043701058 Develop affordable housing NC 220 87878 N/A Cypress Glen Retirement Community 2600 Croasdaile Farm Parkway Suite durham NC 27705 561961935 Continuing Care retirement home NC 501(c)(3) Line 9 N/A United Methodist Retirement Homes Foundation Inc 2600 Croasdaile Farm Parkway Suite durham NC 27705 561870172 Contribute funds to UMRH, Inc. and Cypress Glen Retirement Community NC 501(c)(3) Line 11a N/A UMRH Affordable Housing Inc 2600 Croasdaile Farm Parkway Suite Durham NC 27705 010724816 Operate Affordable Housing NC N/A C 4507 24613 1.00000 0 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 UMRH Affordable Housing Inc M 78675820 UMRH Affordable Housing Inc N 301962