2023-05-02T09:44:04-05:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2022-01-01 561722754 GRACE LIFECARE INC GRAC 8285805000 500 LENOIR ROAD MORGANTON NC 28655 PATRICIA A MOLL CHIEF FINANCIAL OFFICER 8285805000 2023-04-26 1 PATRICIA MOLL 999009999 0 JOHN A NORMAN II P01506766 7049985200 2023-04-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KATHY BAILEY 500 LENOIR ROAD MORGANTON NC 28655 4983135 0 X WWW.BLUERIDGEHEALTH.ORG X 1992 NC COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EXCELLENT & COMPASSIONATE CARE. 9 9 0 25 0 0 743674 0 9673063 4894057 359870 74917 0 14161 10776607 4983135 0 0 0 0 5239264 2857730 0 0 0 5555670 3158914 10794934 6016644 -18327 -1033509 25476311 23871390 23317669 23754571 2158642 116819 GRACE LIFECARE IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITIES BY PROVIDING EXCELLENT AND COMPASSIONATE CARE. 0 0 5075244 4908218 THE ORGANIZATION OPERATES A RETIREMENT COMMUNITY CONSISTING OF INDEPENDENT LIVING QUARTERS, A HEALTH FACILITY, AND OTHER AMENITIES FOR RETIREMENT LIVING. 5075244 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 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 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PATRICIA MOLL 8285805003 2201 S STERLING ST MORGANTON NC 28655 X X J MICHAEL BRIDGES CHAIRMAN 1.00 X X 0 0 0 M H MCCRARY VICE-CHAIRMAN 1.00 X X 0 0 0 SHERROD SALSBURY SECRETARY 1.00 X X 0 0 0 JEFF CARSWELL TREASURER 1.00 X X 0 0 0 JOHN BRANSTROM BOARD MEMBER 1.00 X 0 0 0 ALAN GRIFFIN BOARD MEMBER 1.00 X 0 0 0 SUSAN HAIRE BOARD MEMBER 1.00 X 0 0 0 ALAN VANNOPPEN BOARD MEMBER 1.00 X 0 0 0 FELICIA SIMMONS BOARD MEMBER 1.00 X 0 0 0 PATRICIA MOLL CFO 1.00 50.00 X 0 0 0 KATHY BAILEY PRESIDENT & CEO 1.00 50.00 X 0 0 0 0 0 0 0 0 0 0 0 OPERATING REVENUE 623000 3696546 3696546 RESIDENT REVENUE 623000 1197511 1197511 4894057 48544 48544 26373 0 26373 26373 26373 14161 14161 14161 4983135 4908218 0 74917 X 2611541 2272041 339500 26767 23287 3480 106980 93073 13907 112442 97825 14617 36000 36000 1028968 823174 205794 204576 204576 13363 13363 51471 51471 309545 309545 5695 5695 756585 756585 34332 34332 SUPPLIES 506903 506903 INTERCOMPANY 127328 127328 LEASE 2912 2912 81236 56876 24360 6016644 5075244 941400 0 600 600 284395 222646 167068 229031 36343 38331 107303 86071 34627297 17660632 17691816 16966665 1573004 0 4600000 5313000 1013373 1013373 2409 1673 25476311 23871390 1141684 746181 10570859 10741407 11605126 12266983 23317669 23754571 X 2158642 116819 2158642 116819 25476311 23871390 -1033509 -1004438 -3876 0 X X 0 1 X 1 0 X 8349 26155 39339 743674 0 817517 9407885 10102184 9577200 9673063 4894057 43654389 9416234 10128339 9616539 10416737 4894057 44471906 0 0 0 44471906 246055 180939 191716 343167 44668 1006545 246055 180939 191716 343167 44668 1006545 6236 15849 24883 16345 26373 89686 9668525 10325127 9833138 10776249 4965098 45568137 0.97590 0.97620 0.02210 0.02250 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 6,236. 2019 AMOUNT: $ 15,849. 2020 AMOUNT: $ 24,883. 2021 AMOUNT: $ 16,345. 2022 AMOUNT: $ 26,373. SCHEDULE A, PART III THE SUPPORT TEST INCLUDES A SHORT YEAR FROM JANUARY 1, 2022 THROUGH JUNE 30, 2022. 289233 289233 26157991 15286016 10871975 2182988 1686214 496774 5997085 688402 5308683 16966665 STATUTORY OPERATING RESERVE 5313000 F 5313000 REFUNDABLE ENTRANCE FEES 3806502 INTERCOMPANY PAYABLES 8460481 12266983 X 3974821 -1004438 -1004438 4979259 3876 3876 4983135 6016644 0 6016644 0 6016644 PART X, LINE 2: THE FILING ORGANIZATION IS A TAX-EXEMPT ORGANIZATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE FILING ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE FILING ORGANIZATION ADOPTED THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THIS STANDARD HAD NO IMPACT ON THE FILING ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2022 OR DECEMBER 31, 2021. FORM 990, PART VI, SECTION A, LINE 3 IN 2021, THE ORGANIZATION TERMINATED THE MANAGEMENT SERVICES CONTRACT WITH ATRIUM HEALTH AND ENTERED INTO A MANAGEMENT SERVICES CONTRACT WITH UNC HEALTH. THE TERMS OF THE CONTRACT CALL FOR THE ORGANIZATION TO PAY UNC HEALTH AN ANNUAL MANAGEMENT FEE BASED UPON THE ORGANIZATION'S NET OPERATING REVENUES. FORM 990, PART VI, SECTION B, LINE 11B THE CHIEF FINANCIAL OFFICER, THE BOARD AND THE EXECUTIVE COMMITTEE WILL REVIEW THE PREPARED FORM 990 BEFORE IT IS FILED WITH THE IRS. A DRAFT OF FORM 990 WAS POSTED FOR ACCESS BY THE GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CORPORATE COUNSEL, WHO REVIEWS ALL ANNUAL CONFLICT OF INTEREST DISCLOSURES, IS PRESENT AT EVERY BOARD MEETING TO ENSURE THAT ANY POTENTIAL CONFLICTS ARE APPROPRIATELY HANDLED BY MEMBERS ABSTAINING FROM VOTES AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION PACKAGE DURING 2022. FORM 990, PART VI, SECTION C, LINE 19 BY-LAWS ARE AVAILABLE UPON REQUEST THROUGH CORPORATE COUNSEL. ARTICLES OF INCORPORATION ARE FILED WITH NORTH CAROLINA SECRETARY OF STATE AND ARE AVAILABLE ON THEIR WEBSITE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PART VII DESCRIPTION OF HOURS -- FOR RELATED ORGANIZATIONS, OFFICERS LISTED ON PART VII WORK AN AVERAGE OF 40 TO 50 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND OTHER RELATED ENTITIES LISTED ON SCHEDULE R. ALSO, BECAUSE THE ORGANIZATION IS FILING A SIX MONTH SHORT PERIOD RETURN ENDING JUNE 30, 2022, THE ORGANIZATION DID NOT HAVE ANY 1099 OR W-2 YEAR END INFORMATION TO USE FOR THIS RETURN. CONSEQUENTLY, SECTIONS A AND B DO NOT CONTAIN ANY PAYMENT INFORMATION FOR EMPLOYEES OR SERVICE PROVIDERS, AS MANDATED BY THE FORM 990 FILING INSTRUCTIONS. FORM 990, PART IX, LINE 11G OTHER PROG FEES: PROGRAM SERVICE EXPENSES 823,174. MANAGEMENT AND GENERAL EXPENSES 205,794. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,028,968. FORM 990, PART XII, LINE 2C: NO CHANGES FOR APPROVING AUDITED FINANCIAL STATEMENTS OR SELECTION OF INDEPENDENT ACCOUNTANTS HAVE OCCURRED FROM THE PRIOR YEAR. BLUE RIDGE HEALTHCARE HOSPITALS INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 560529976 HEALTHCARE NC 501(C)(3) LINE 3 N/A 0 VALDESE NURSING HOME INC 95 LOCUST STREET CONNELLY SPRINGS NC 28612 581978560 HEALTHCARE NC 501(C)(3) LINE 10 N/A 0 GRACE NURSING CENTER INC 109 FOOTHILLS DRIVE MORGANTON NC 28655 561838369 HEALTHCARE NC 501(C)(3) LINE 10 N/A 0 GRACE PROPERTIES INC 500 LENOIR ROAD MORGANTON NC 28655 561727514 HEALTHCARE NC 501(C)(3) LINE 12A, I N/A 0 BLUE RIDGE FOUNDATION INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 582063920 HEALTHCARE NC 501(C)(3) LINE 7 N/A 0 BLUE RIDGE HEALTHCARE MEDICAL GROUP INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 020777195 HEALTHCARE NC 501(C)(3) LINE 10 N/A 0 BLUE RIDGE HEALTHCARE SYSTEM INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 562150313 HEALTHCARE NC 501(C)(3) LINE 12B, II N/A 0 GRACE HEALTH VENTURES INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 561581317 RELATED NC BLUE RIDGE HEALTHCARE SYSTEM C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0