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2025-662-E-Aging Dept-CHARLES HOUSE-CHARLES HOUSE
Orange County Outside Agency Performance Agreement Revised 07/25—County Manager Version Page 1 of 12 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2025, (“Effective Date”) by and between the County of Orange, a political subdivision of the State of North Carolina, Post Office Box 8181, Hillsborough, North Carolina, 27278, ("County") and CHARLES HOUSE, a not-for-profit corporation, located at 7511 Sunrise Rd, CHAPEL HILL, North Carolina 27514 (“Provider”). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Provider agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2025 to June 30, 2026. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit A and the Scope of Services attached as Exhibit B, both of which are incorporated herein. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibits A and B, the maximum sum of $23400. b. All funds appropriated shall be used for purposes described in Exhibits A and B. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of $5850. The first payment is contingent upon receipt of the agency’s performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County’s obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 2 of 12 Rev.07/25 f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 – December 31; January 1 – March 31 and April 1 - June 30. Reports are due on January 6, April 6 and July 6 of the program fiscal year. The form of reports shall be as described in Attachment 2. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. Performance Measures and Outcomes are subject to posting on the County’s website. 5. Termination. a. Termination for Cause. In the event of any of the circumstances set forth below (hereinafter referred to as “default”), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten (10) business days from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County’s remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 3 of 12 Rev.07/25 be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. e. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 6. Responsibilities of the County. Cooperation and Coordination. The County has designated (JANICE TYLER) to act as the County's representative with respect to the Project who shall have the authority to render decisions within guidelines established by the County Manager or the County Board of Commissioners and who shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker’s Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Cyber Liability. For protection from claims resulting from data breach, virus, and cyberattack; iii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iv. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and v. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. vi. Sexual Misconduct. Sexual Abuse/Molestation Insurance is required when Provider works directly one-on-one with children, elderly or other at-risk populations. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A ‐ Statutory State NC, for each employee Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 4 of 12 Rev.07/25 Limits for Coverage B ‐ Employers Liability of: $1 million Each Occurrence $1,000,000 BID limit • Cyber Liability $1,000,000 Each Occurrence; $2,000,000 Aggregate *Only required for agencies transmitting personal identifiable information that is disseminated electronically. • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $1,000,000 Each Occurrence *Only required for agencies doing travel as part of the agreement with the County. • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate • Sexual Misconduct $1,000,000 Each Occurrence $2,000,000 Aggregate *Only required for agencies doing direct work with minors (under the age of 18). c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. For more information see the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements, (each document is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 d. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. 8. General Provisions. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.58. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81. Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 5 of 12 Rev.07/25 b. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy, which is incorporated herein by reference and can be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php. The County may enforce this provision by an action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. c. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. d. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The Orange County Living Wage Policy, which is incorporated herein by reference, can be viewed at: http://www.orangecountync.gov/departments/purchasing_division/contracts.php. The County’s living wage is $18.18 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. e. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. There are no third party beneficiaries of this Agreement and nothing in this Agreement, express or implied, is intended to confer on any person other than the parties hereto (and their respective successors, heirs and permitted assigns), any rights, remedies, or obligations. f. Compliance with all Laws and Certifications. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. Provider shall execute Attachment 1 and comply with all certifications therein. g. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. h. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 6 of 12 Rev.07/25 i. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. j. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. k. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. l. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. m. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Provider’s Name CHARLES HOUSE Attention: JANICE TYLER Attention: DEAN FOX P.O. Box 8181 Address: 7511 Sunrise Rd Hillsborough, NC 27278 CHAPEL HILL NC 27514 Email: Email: dean@charleshouse.org n. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on behalf of the Provider _____________________________ _______________________ , Date For and on behalf of Orange County Government _______________________________ ________________________ , County Manager Date Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Executive DirectorDean Fox 10/21/2025 Travis Myren 11/4/2025 Orange County Outside Agency Performance Agreement Page 7 of 12 Rev.07/25 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: CHARLES HOUSE Vendor Contact Person: DEAN FOX Phone: Address: 7511 SUNRISE RD City CHAPEL HILL State: NC Zip: 27514 Department: AGING Amount: $23400 Purpose: Budget Code(s): 10290050-710029 Vendor # 800031 Vendor Status with NCSOS: Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) Effective Date End Date Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by Signature Authority - BOCC Express Delegation (Agenda Date: ) - Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 - Budget Policy Section XV (Capital Improvement Project: ) Bidding Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# ) Department Affirmation This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement. This agreement is approved as to technical form and content. Services related to this agreement have already begun or been completed. Description of the nature of the emergency condition that was addressed: Department Director’s Signature ________________________________________ Date: ________ Information Technologies This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Inapplicable because no hardware/software purchases or related services Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ Clerk to the Board All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Received for record retention: Office of the Clerk to the Board __________________________________________Date:_________ Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 10/22/2025 10/27/2025 10/28/2025 11/4/2025 Orange County Outside Agency Performance Agreement Page 8 of 12 Rev.07/25 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 9 of 12 Rev.07/25 Exhibit A Insert Provider’s Outside Agency Application (located on the T:drive/Outside Agencies FY25-26 folder) Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 10 of 12 Rev.07/25 Exhibit B Insert Provider’s Revised Scope of Services and Program Budget Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 11 of 12 Rev.07/25 ATTACHMENT 1 Orange County Certifications – FY 2025-2026 Outside Agency Performance Agreement Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, residential address; phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization’s Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. Certified by: _______________________ Title: __________________________ Date: ___________ (Provider’s Signature) Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Executive Director 10/21/2025 Orange County Outside Agency Performance Agreement Page 12 of 12 Rev.07/25 FOR INFORMATION ONLY ATTACHMENT 2 As mentioned in Sections 3- Funding and Section 4- Agency Reporting of the performance agreement, the following two forms will be required before quarterly reimbursements can be made. They are included below for informational purposes. Forms are available online at https://www.orangecountync.gov/736/Contracts-Reporting Quarterly Expense Report Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Orange County Outside Agency Performance Agreement Page 13 of 12 Rev.07/25 Quarterly Outcomes Form Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 06/23/2025 Titan Risk Consultants, LLC 107 Conner Drive, Suite 225 Chapel Hill, NC 27514 License #: 1000643509 Victoria DeCamp (919)636-3252 v.decamp@titanriskconsultants.com 00065712-0 9 Charles House Association 7511 Sunrise Road Chapel Hill, NC 27514 Philadelphia Indemnity Insurance Company 18058 A Y PHPK2668936 05/10/2025 05/10/2026X X 1,000,000 5,000 1,000,000 3,000,000 3,000,000 Philadelphia Indemnity Insurance Company 18058 A PHPK2668936 05/10/2025 05/10/2026 X X 1,000,000 Philadelphia Indemnity Insurance Company 18058 A PHUB905151 05/10/2025 05/10/2026XX 0 1,000,000 1,000,000 Carolina Mutual Insurance 14090 B WC23000 06/25/2025 06/25/2026 X 1,000,000 1,000,000 1,000,000 Philadelphia Indemnity Insurance Company 18058 A PHPK2668936 05/10/2025 05/10/2026Professional E&O Each Claim 1,000,000 Philadelphia Indemnity Insurance Company 18058 A PHPK2668936 05/10/2025 05/10/2026Professional E&O Aggregate 3,000,000 Certificate holder is added as Additional Insured as respects General Liability as required by written contract. Orange County Government P.O. Box 8181 Hillsborough, NC 27278 (VCD) Printed by VCD on 06/23/2025 at 11:03AM ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Operating Budget for entire Agency Actual 2023-2024 Projected 2024-2025 Projected 2025- 2026 Percent Change 109,667$ 70,000$ 60,000$ -14% 1,059,746$ 1,275,000$ 1,362,000$ 7% -$ 1,000$ 1,000$ 0% -$ -$ -$ 0 4,500$ 4,000$ 4,000$ 0% -$ -$ -$ 0 24,750$ 26,000$ 28,000$ 8% -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 Private Foundation Grants 104,412.00$ 70,000.00$ 50,000.00$ -29% -$ -$ -$ 0 1,303,075$ 1,446,000$ 1,505,000$ 4% 1,253,302$ 1,210,000$ 1,142,000$ -6% 143,988$ 122,800$ 124,000$ 1% 80,981$ 69,000$ 71,452$ 4% -$ 55,800$ 1,000$ -98% 52,867$ 40,000$ 48,000$ 20% 1,531,138$ 1,497,600$ 1,386,452$ -7% (228,063)$ (51,600)$ 118,548$ 330% Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. PROGRAM EXPENSES Compensation Other Revenue Federal Government (CDBG/HOME/etc.) Total Program Revenue Agency Budget Rent & Utilities State Government Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro AGENCY NAME:Dean Fox Other Grants include funding from donor advised funds at Triangle Community Foundation, State Employees Combined Campaign, Carolyn Smith Foundation, Bertsch Family Charitable Foundation, and private individuals Other - Town of Carrboro SURPLUS/(DEFICIT) FOR PERIOD: Travel & Training Other Expenses: Total Program Expenses Supplies & Equipment 2023-2024 The decline in revenue is due to the closure of Charles house-Yorktown Eldercare Home. The organization incurred additional employee compensation to adjust to increases in Orange County Living Wage guidelines FY 2025-26 Agency Budget Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Compensation expenses are outpacing increases in client fees, in order to enhance employee pay scales, health insurance benefits, etc. The biggest change from last year is that we have budgeted very litte for travel & training. Modest program cost increases and health insurance cost savings are the other most significant line items driving the change from consecutive years of losses to a budget reflecting gains. 2024-2025 2025-2026 FY 2025-26 Agency Budget Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Actual 2023- 2024 Projected 2024-2025 Projected 2025-2026 Percent Change -$ -$ -$ 0 665,018$ 756,000$ 827,000$ 9% -$ 1,000$ 1,000$ 0% -$ -$ -$ 0 4,500$ 4,000$ 4,000$ 0% -$ -$ -$ 0 24,750$ 26,000$ 28,000$ 8% -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 Private Foundation Grants -$ -$ -$ 0 -$ -$ -$ 0 694,268$ 787,000$ 860,000$ 9% 740,588$ 680,000$ 640,000$ -6% 89,362$ 91,000$ 91,000$ 0% 50,456$ 44,000$ 46,000$ 5% -$ 6,000$ 1,000$ -83% 22,993$ 23,000$ 23,000$ 0% 903,399$ 844,000$ 801,000$ -5% (209,131)$ (57,000)$ 59,000$ 204% Please explain Other Grants SURPLUS/(DEFICIT) FOR PERIOD: Total Program Expenses PROGRAM EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Depreciation Other Revenue Total Program Revenue Triangle United Way State Government Federal Government (CDBG/HOME/etc.) Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Program Budget Operating Budget for Specific Program If you are requesting funds for more than one program, a program budget worksheet should be provided for each program. PROGRAM NAME: Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. 2025-2026 2023-24 The deficit is primarily the result of commitments the Charles House board has made to increase employee compensation to comply with Orange County Living Wage guidelines. 2024-25 The projected deficit represents a continuing board commitment to increase employee compensation, surpassing Orange County Living Wage guidelines, providing employer- sponsored health insurance, etc. The projected surplus is driven by the board of directors' commitment to bringing our budget back into balance, following consectutive years of financial losses. Recognizing that the need for increases in employee compensation have not subsided, the board elected to make increases to program costs that, while still modest, are of a slightly higher dollar amount than in recent years. Health insurance costs have also come down due to a change in plan type. Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Projected Actual Projected Projected 2023-2024 2023-2024 2024-2025 2025-2026 Sex Male 50 47 52 55 Female 60 59 63 60 Nonbinary Other/prefer not to answer/unknown Total 110 106 115 115 Race and Ethnicity American Indian or Alaska Native Asian 2 4 2 6 Black or African American 17 8 20 15 Native Hawaiian or Other Pacific Islander White 90 92 93 93 More than one race 1 1 Other 2 Prefer not to answer/unknown Total 110 106 115 115 Of the above, how many individuals identify as Hispanic or Latino 6 6 6 6 Of the above, how many individuals do not identify as Hispanic or Latino 104 100 109 109 Prefer not to answer/unknown Total 110 106 115 115 Age 0-5 years 6-18 years 19-50 years 51+ years 110 106 115 115 Total 110 106 115 115 Geographic Location Town of Chapel Hill 45 44 48 49 Town of Carrboro 8 6 8 5 Orange County (Outside of Chapel Hill/Carrboro) 6 8 7 6 Outside of Orange County 51 48 52 55 Total 110 106 115 115 Income Low-income (80% of the Area Median Income and Below) Please see income table in the attachments 15.1% received some sort of financial assistance 15% Unknown Total 0 0 0 0.15 Disability Presence of an intellectual, physical, blind/low vision, and/or deaf/hard of hearing disability 110 106 115 115 No indication of the presence of a disability Total 110 106 115 115 Program Target Population Demographics Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 32634004-01-23 CLIENT COPY BERNARD ROBINSON & COMPANY, LLP 4700 HOMEWOOD COURT, STE 105 RALEIGH, NC 27609 CHARLES HOUSE ASSOCIATION 7511 SUNRISE ROAD CHAPEL HILL, NC 27514 !275141! Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CLIENT COPY CLIENT'S COPY Caution: Forms printed from within Adobe Acrobat products may not meet IRS or state taxing agency specifications. When using Acrobat, select the "Actual Size" in the Adobe "Print" dialog. 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CLIENT COPY November 13, 2024 Mr. Dean Fox Charles House Association 7511 Sunrise Road Chapel Hill, NC 27514 Dear Dean: Enclosed are the original and one copy of the 2023 Exempt Organization return, as follows... 2023 Form 990 As required by Federal Treasury Regulations, 301.6104(d)-1, a tax-exempt organization must make its annual informational returns available for public inspection and/or distribution. Your organization is required to make its annual informational returns available for public inspection, without charge, at your designated office during regular business hours. Each annual information return is required be made available for a period of three years beginning on the date the return is required to be filed (including any extensions) or the date the return is actually filed, whichever is later. In addition, the organization must provide a copy of all or any part of any return required to be made available for public inspection to any individual who makes a request in person or in writing. Any such copy must be provided without charge (other than a reasonable fee for reproduction and actual postage charges). We have provided a copy for public inspection that should be retained at your office. We sincerely appreciate the opportunity to serve you. Please contact us if you have any questions concerning the tax return. Sincerely, John M. Robinson Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CLIENT COPY TAX RETURN FILING INSTRUCTIONS FORM 990 FOR THE YEAR ENDING December 31, 2023 Prepared For: Mr. Dean Fox Charles House Association 7511 Sunrise Road Chapel Hill, NC 27514 Prepared By: Bernard Robinson & Company, LLP 4700 Homewood Court, Ste 105 Raleigh, NC 27609 Amount Due or Refund: Not applicable Make Check Payable To: Not applicable Mail Tax Return and Check (if applicable) To: Not applicable Return Must be Mailed On or Before: Not applicable Special Instructions: This return has qualified for electronic filing. After you have reviewed the return for completeness and accuracy, please sign, date and return Form 8879-TE to our office. We will transmit the return electronically to the IRS and no further action is required. Return Form 8879-TE to us by November 15, 2024 The signed Form 8879 should be returned within 7 business days by ONE of the following methods: 1)If you are signing electronically via SafeSend Returns no further action on your part is needed. 2)Email admin@brccpa.com to request a secure link be emailed to you that will enable you to upload your signed e-file authorization form securely. 3)By Fax: 336.232.0591 4)Regular Mail: Bernard Robinson & Company, LLP P.O. Box 19608 Greensboro, NC 27419 5)Email using an unsecure method which is not recommended to efile@brccpa.com If you have any questions about Form 8879, please contact Kim Burroughs at 336.294.4494. Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 OMB No. 1545-0047 Form For calendar year 2023, or fiscal year beginning , 2023, and ending , 20 Department of the Treasury Internal Revenue Service Signature of officer or person subject to tax 302521 01-05-24 EIN or SSN Enter five numbers, butdo not enter all zerosERO firm name Do not enter all zeros Do not send to the IRS. Keep for your records. Go to www.irs.gov/Form8879TE for the latest information. 1a, 2a, 3a, 4a, 5a, 6a, 7a, 8a, 9a, 10a 1b, 2b, 3b, 4b, 5b, 6b, 7b, 8b, 9b,10b, Do not 1a 2a 3a 4a 5a 6a 7a 8a 9a 10a Form 990 Form 990-EZ Form 1120-POL b Total revenue, 1b 2b 3b 4b 5b 6b 7b 8b 9b 10b b Total revenue, b Total tax Form 990-PF Form 8868 b Tax based on investment income b Balance due Form 990-T b Total tax Form 4720 b Total tax Form 5227 b FMV of assets at end of tax year Form 5330 b Tax due Form 8038-CP b Amount of credit payment requested (a) (b)(c) PIN: check one box only ERO's EFIN/PIN. Pub. 4163, For Privacy Act and Paperwork Reduction Act Notice, see instructions. e-file Name of filer Name and title of officer or person subject to tax ~~~~ ~~~~~~~~~~~~~~~~~~~~ Date ERO's signature Date Form (2023) Check the box for the return for which you are using this Form 8879-TE and enter the applicable amount, if any, from the return. Form 8038-CP and Form 5330 filers may enter dollars and cents. For all other forms, enter whole dollars only. If you check the box on line or below, and the amount on that line for the return being filed with this form was blank, then leave line or whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. complete more than one line in Part I. check here check here check here ~~~if any (Form 990, Part VIII, column (A), line 12)~~~~~~ ~if any (Form 990-EZ, line 9)~~~~~~~~~~~~~~~ (Form 1120-POL, line 22)~~~~~~~~~~~~~~~~~~~ check here check here ~(Form 990-PF, Part V, line 5) ~~(Form 8868, line 3c) check here ~~(Form 990-T, Part III, line 4)~~~~~~~~~~~~~~~~~~ check here ~~(Form 4720, Part III, line 1) check here ~~ (Form 5227, Item D)~~~~~~~~~ check here ~~ (Form 5330, Part II, line 19)~~~~~~~~~~~~~~~~~~ check here (Form 8038-CP, Part III, line 22) Under penalties of perjury, I declare that I am an officer of the above entity or I am a person subject to tax with respect to (name of entity), (EIN)and that I have examined a copy of the 2023 electronic return and accompanying schedules and statements, and, to the best of my knowledge and belief, they are true, correct, andcomplete. I further declare that the amount in Part I above is the amount shown on the copy of the electronic return. I consent to allow myintermediate service provider, transmitter, or electronic return originator (ERO) to send the return to the IRS and to receive from the IRS anacknowledgement of receipt or reason for rejection of the transmission, the reason for any delay in processing the return or refund, and the dateof any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit)entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and thefinancial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 nolater than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronicpayment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I have selected apersonal identification number (PIN) as my signature for the electronic return and, if applicable, the consent to electronic funds withdrawal. I authorize to enter my PIN as my signature on the tax year 2023 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's disclosure consent screen. As an officer or person subject to tax with respect to the entity, I will enter my PIN as my signature on the tax year 2023 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I will enter my PIN on the return's disclosure consent screen. Enter your six-digit electronic filing identification number (EFIN) followed by your five-digit self-selected PIN. I certify that the above numeric entry is my PIN, which is my signature on the 2023 electronically filed return indicated above. I confirm that I am submitting this return in accordance with the requirements of Modernized e-File (MeF) Information for Authorized IRS Providers for Business Returns. LHA Part I Type of Return and Return Information Part II Declaration and Signature Authorization of Officer or Person Subject to Tax Part III Certification and Authentication ERO Must Retain This Form - See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So 8879-TE IRS E-file Signature Authorizationfor a Tax Exempt Entity8879-TE 2023 CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 1,353,042.X X BERNARD ROBINSON & COMPANY, LLP 85881 TREASURER 61814474910 11/13/24 BENJAMIN BUCKNER BERNARD ROBINSON & COMPANY, LLP X 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Department of the Treasury Internal Revenue Service File by the due date for filing your return. See instructions. 323841 12-22-23 File a separate application for each return. Go to www.irs.gov/Form8868 for the latest information. Electronic filing (e-file). Part I - Identification Type or Print Application Is For Return Code Application Is For Return Code Part II - Automatic Extension of Time To File for Exempt Organizations (see instructions) 1 2 3a b c 3a 3b 3c $ $ $ Balance due. For Privacy Act and Paperwork Reduction Act Notice, see instructions.8868 Form (Rev. January 2024)OMB No. 1545-0047 You can electronically file Form 8868 to request up to a 6-month extension of time to file any of the forms listed below except for Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts. An extension request for Form 8870 must be sent to the IRS in a paper format (see instructions). For more details on the electronic filing of Form 8868, visit www.irs.gov/e-file-providers/e-file-for-charities-and-non-profits. Caution: If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453-TE and Form 8879-TE for payment instructions. All corporations required to file an income tax return other than Form 990-T (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time to file income tax returns. Name of exempt organization, employer, or other filer, see instructions.Taxpayer identification number (TIN) Number, street, and room or suite no. If a P.O. box, see instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions. Enter the Return Code for the return that this application is for (file a separate application for each return) Form 990 or Form 990-EZ Form 4720 (individual) Form 990-PF 01 03 04 05 06 07 08 Form 4720 (other than individual)09 10 11 12 13 14 Form 5227 Form 6069 Form 8870 Form 5330 (individual) Form 990-T (sec. 401(a) or 408(a) trust) Form 990-T (trust other than above) Form 990-T (corporation)Form 5330 (other than individual) Form 1041-A ¥After you enter your Return Code, complete either Part II or Part III. Part III, including signature, is applicable only for an extension of ¥ time to file Form 5330. If this application is for an extension of time to file Form 5330, you must enter the following information. Plan Name Plan Number Plan Year Ending (MM/DD/YYYY) The books are in the care of Telephone No.Fax No. ¥If the organization does not have an office or place of business in the United States, check this box ~~~~~~~~~~~~~~~~~~ ¥If this is for a Group Return, enter the organization's four-digit Group Exemption Number (GEN). If this is for the whole group, check this box . If it is for part of the group, check this box and attach a list with the names and TINs of all members the extension is for. I request an automatic 6-month extension of time until , 20 , to file the exempt organization return for the organization named above. The extension is for the organization's return for: calendar year 20 or tax year beginning , 20 , and ending ., 20 If the tax year entered in line 1 is for less than 12 months, check reason:Initial return Final return Change in accounting period If this application is for Forms 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. If this application is for Forms 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit. Subtract line 3b from line 3a. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. Form (Rev. 1-2024) LHA Application for Extension of Time To File an Exempt Organization Return or Excise Taxes Related to Employee Benefit Plans8868 CLIENT COPY CHARLES HOUSE ASSOCIATION DEAN FOX X 0. 0. 0. 919-967-7570 7511 SUNRISE ROAD CHAPEL HILL, NC 27514 **-***2881 NOVEMBER 15 7511 SUNRISE ROAD - CHAPEL HILL, NC 27514 01 23 24 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Check if self-employed Department of the TreasuryInternal Revenue Service Check ifapplicable: Addresschange Namechange Initialreturn Finalreturn/termin-ated Gross receipts $ Amendedreturn Applica-tionpending Are all subordinates included? 332001 12-21-23 OMB No. 1545-0047 Beginning of Current Year Paid Preparer Use Only Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Do not enter social security numbers on this form as it may be made public.Open to Public InspectionGo to www.irs.gov/Form990 for instructions and the latest information. A For the 2023 calendar year, or tax year beginning and ending B C D Employer identification number E G H(a) H(b) H(c) F Yes No Yes No I J K Website: L M 1 2 3 4 5 6 7 3 4 5 6 7a 7b a bActivities & GovernancePrior Year Current Year 8 9 10 11 12 13 14 15 16 17 18 19Revenuea bExpenses End of Year 20 21 22 Sign Here Yes No For Paperwork Reduction Act Notice, see the separate instructions. (or P.O. box if mail is not delivered to street address)Room/suite )501(c)(3)501(c) ((insert no.)4947(a)(1) or 527 Corporation Trust Association OtherForm of organization:Year of formation:State of legal domicile:Net Assets orFund BalancesUnder penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Signature of officer Date Type or print name and title Date PTINPrint/Type preparer's name Preparer's signature Firm's name Firm's EIN Firm's address Phone no. Form Name of organization Doing business as Number and street Telephone number City or town, state or province, country, and ZIP or foreign postal code Is this a group return for subordinates?Name and address of principal officer:~~ If "No," attach a list. See instructions Group exemption number Tax-exempt status: Briefly describe the organization's mission or most significant activities: Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets. Number of voting members of the governing body (Part VI, line 1a) Number of independent voting members of the governing body (Part VI, line 1b) Total number of individuals employed in calendar year 2023 (Part V, line 2a) ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~ Total number of volunteers (estimate if necessary) Total unrelated business revenue from Part VIII, column (C), line 12 Net unrelated business taxable income from Form 990-T, Part I, line 11 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~ Contributions and grants (Part VIII, line 1h)~~~~~~~~~~~~~~~~~~~~~ Program service revenue (Part VIII, line 2g)~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~Investment income (Part VIII, column (A), lines 3, 4, and 7d) Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)~~~~~~~~ Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) Grants and similar amounts paid (Part IX, column (A), lines 1-3) Benefits paid to or for members (Part IX, column (A), line 4) Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ~~~~~~~~~~~ ~~~~~~~~~~~~~ ~~~ Professional fundraising fees (Part IX, column (A), line 11e) Total fundraising expenses (Part IX, column (D), line 25) ~~~~~~~~~~~~~~ Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 18 from line 12 ~~~~~~~~~~~~~ ~~~~~~~ Total assets (Part X, line 16) Total liabilities (Part X, line 26) Net assets or fund balances. Subtract line 21 from line 20 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ May the IRS discuss this return with the preparer shown above? See instructions LHA Form (2023) Part I Summary Signature BlockPart II 990 Return of Organization Exempt From Income Tax990 2023 CLIENT COPY EXTENDED TO NOVEMBER 15, 2024 CHARLES HOUSE ASSOCIATION **-***2881 919-967-75707511 SUNRISE ROAD 1,353,042. CHAPEL HILL, NC 27514 XDEAN FOX CHARLESHOUSE.ORG X 1995 NC ADULT ELDERCARE HOMES AND 12 12 55 45 0. 0. 244,424. 1,067,301. 41,317. 0. 1,681,901.1,353,042. 0. 0. 1,139,730. 0. 66,553. 359,286. 1,490,785.1,499,016. 191,116.-145,974. 2,776,285.2,723,003. 656,229.580,567. 2,120,056.2,142,436. BENJAMIN BUCKNER, TREASURER P01281319JOHN M. ROBINSON **-***1159BERNARD ROBINSON & COMPANY, LLP 4700 HOMEWOOD COURT, STE 105 RALEIGH, NC 27609 919-862-0004 X SAME AS C ABOVE DAYCARE PROVIDER. CHARLES HOUSE ASSOCIATION IS A NON PROFIT SEE SCHEDULE O FOR ORGANIZATION MISSION STATEMENT CONTINUATION X 194,789. 1,468,588. 18,301. 223. 0. 0. 1,113,949. 0. 376,836. JOHN M. ROBINSON 11/13/24 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Code:Expenses $including grants of $Revenue $ Code:Expenses $including grants of $Revenue $ Code:Expenses $including grants of $Revenue $ Expenses $including grants of $Revenue $ 332002 12-21-23 1 2 3 4 Yes No Yes No 4a 4b 4c 4d 4e Form 990 (2023)Page Check if Schedule O contains a response or note to any line in this Part III Briefly describe the organization's mission: Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990-EZ? If "Yes," describe these new services on Schedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization cease conducting, or make significant changes in how it conducts, any program services? If "Yes," describe these changes on Schedule O. ~~~~~~ Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. () ()() () ()() () ()() Other program services (Describe on Schedule O.) ()() Total program service expenses Form (2023) 2 Statement of Program Service AccomplishmentsPart III 990 CLIENT COPY ADULT ELDERCARE HOMES AND DAYCARE PROVIDER. CHARLES HOUSE ASSOCIATION X X IS A NON PROFIT ORGANIZATION THAT PROVIDES CERTIFIED DAYCARE AND ELDER 1,190,081.1,067,301. CENTER FOR COMMUNITY ELDERCARE AND ONE NEIGHBORHOOD ELDERCARE HOME. CHARLES HOUSE ASSOCIATION **-***2881 CARE HOMES IN A PLEASANT, HOME-LIKE SETTING FOR OLDER ADULTS OR ADULTS WITH DISABILITIES AS A VIABLE ALTERNATIVE TO INSTITUTIONAL CARE. CHARLES HOUSE ASSOCIATION IS A NONPROFIT ORGANIZATION OPERATING THE PROGRAMS INCLUDE A CERTIFIED DAYTIME ELDERCARE PROGRAM, THE BRADLEY PROGRAM IN LEARNING & SERVICE AND SUPPORT TO ELDERS AND THEIR CAREGIVING FAMILIES. 1,190,081. 3 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332003 12-21-23 Yes No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 10 Section 501(c)(3) organizations. a b c d e f a b 11a 11b 11c 11d 11e 11f 12a 12b 13 14a 14b 15 16 17 18 19 20a 20b 21 a b 20 21 a b If "Yes," complete Schedule A Schedule B, Schedule of Contributors If "Yes," complete Schedule C, Part I If "Yes," complete Schedule C, Part II If "Yes," complete Schedule C, Part III If "Yes," complete Schedule D, Part I If "Yes," complete Schedule D, Part II If "Yes," complete Schedule D, Part III If "Yes," complete Schedule D, Part IV If "Yes," complete Schedule D, Part V If "Yes," complete Schedule D, Part VI If "Yes," complete Schedule D, Part VII If "Yes," complete Schedule D, Part VIII If "Yes," complete Schedule D, Part IX If "Yes," complete Schedule D, Part X If "Yes," complete Schedule D, Part X If "Yes," complete Schedule D, Parts XI and XII If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional If "Yes," complete Schedule E If "Yes," complete Schedule F, Parts I and IV If "Yes," complete Schedule F, Parts II and IV If "Yes," complete Schedule F, Parts III and IV If "Yes," complete Schedule G, Part I. If "Yes," complete Schedule G, Part II If "Yes," complete Schedule G, Part III If "Yes," complete Schedule H If "Yes," complete Schedule I, Parts I and II Form 990 (2023)Page Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization required to complete ? See instructions Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~ Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? Did the organization maintain collections of works of art, historical treasures, or other similar assets? ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? Did the organization, directly or through a related organization, hold assets in donor-restricted endowments or in quasi-endowments? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable. Did the organization report an amount for land, buildings, and equipment in Part X, line 10? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for investments - other securities in Part X, line 12, that is 5% or more of its total assets reported in Part X, line 16? Did the organization report an amount for investments - program related in Part X, line 13, that is 5% or more of its total assets reported in Part X, line 16? ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for other assets in Part X, line 15, that is 5% or more of its total assets reported in Part X, line 16? Did the organization report an amount for other liabilities in Part X, line 25? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? Did the organization obtain separate, independent audited financial statements for the tax year? ~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization included in consolidated, independent audited financial statements for the tax year? ~~~~~ Is the organization a school described in section 170(b)(1)(A)(ii)? Did the organization maintain an office, employees, or agents outside of the United States? ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~ Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? See instructions ~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization operate one or more hospital facilities? ~~~~~~~~~~~~~~~~~ If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?~~~~~~~~~~ Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? ~~~~~~~~~~~~~~ Form (2023) 3 Part IV Checklist of Required Schedules 990 CLIENT COPY X X X X X X X X X X X X X X X X X X X X X X X X X X X X CHARLES HOUSE ASSOCIATION **-***2881 4 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332004 12-21-23 Yes No 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 22 23 24a 24b 24c 24d 25a 25b 26 27 28a 28b 28c 29 30 31 32 33 34 35a 35b 36 37 38 a b c d a b Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. a b c a b Section 501(c)(3) organizations. Note: Yes No 1 a b c 1a 1b 1c (continued) If "Yes," complete Schedule I, Parts I and III If "Yes," complete Schedule J If "Yes," answer lines 24b through 24d and complete Schedule K. If "No," go to line 25a If "Yes," complete Schedule L, Part I If "Yes," complete Schedule L, Part I If "Yes," complete Schedule L, Part II If "Yes," complete Schedule L, Part III If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule M If "Yes," complete Schedule M If "Yes," complete Schedule N, Part I If "Yes," complete Schedule N, Part II If "Yes," complete Schedule R, Part I If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1 If "Yes," complete Schedule R, Part V, line 2 If "Yes," complete Schedule R, Part V, line 2 If "Yes," complete Schedule R, Part VI Form 990 (2023)Page Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~ Did the organization engage in an excess benefit transaction with a disqualified person during the year? Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report any amount on Part X, line 5 or 22, for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons?~~~~~~~~~~~~~ Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons? ~~~ Was the organization a party to a business transaction with one of the following parties? (See the Schedule L, Part IV, instructions for applicable filing thresholds, conditions, and exceptions): A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A family member of any individual described in line 28a? A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization receive more than $25,000 in noncash contributions? Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization liquidate, terminate, or dissolve and cease operations? Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? ~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? Was the organization related to any tax-exempt or taxable entity? ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a controlled entity within the meaning of section 512(b)(13)? If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~ Did the organization make any transfers to an exempt non-charitable related organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? ~~~~~~~~ Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? All Form 990 filers are required to complete Schedule O Check if Schedule O contains a response or note to any line in this Part V Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~ Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable ~~~~~~~~~~ Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? Form (2023) 4 Part IV Checklist of Required Schedules Part V Statements Regarding Other IRS Filings and Tax Compliance 990 CLIENT COPY X X X X X X X X X X X X CHARLES HOUSE ASSOCIATION **-***2881 17 0 X X X X X X X X X 5 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332005 12-21-23 Yes No 2 3 4 5 6 7 a b 2a 2b 3a 3b 4a 5a 5b 5c 6a 6b 7a 7b 7c 7e 7f 7g 7h 8 9a 9b a b a b a b c a b Organizations that may receive deductible contributions under section 170(c). a b c d e f g h 7d 8 9 10 11 12 13 14 15 16 17 Sponsoring organizations maintaining donor advised funds. Sponsoring organizations maintaining donor advised funds. a b Section 501(c)(7) organizations. a b 10a 10b Section 501(c)(12) organizations. a b 11a 11b a b Section 4947(a)(1) non-exempt charitable trusts. 12a 12b Section 501(c)(29) qualified nonprofit health insurance issuers. Note: a b c a b 13a 13b 13c 14a 14b 15 16 17 Section 501(c)(21) organizations. ~~~~~~~~~~~~~~~~~~~ (continued) If "No" to line 3b, provide an explanation on Schedule O If "No," provide an explanation on Schedule O Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? Form (2023) Form 990 (2023)Page Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~ If at least one is reported on line 2a, did the organization file all required federal employment tax returns?~~~~~~~~~~ Did the organization have unrelated business gross income of $1,000 or more during the year? If "Yes," has it filed a Form 990-T for this year? ~~~~~~~~~~~~~~ ~~~~~~~~~~ At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~ If "Yes," enter the name of the foreign country See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? ~~~~~~~~~~~~ ~~~~~~~~~ If "Yes" to line 5a or 5b, did the organization file Form 8886-T?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization notify the donor of the value of the goods or services provided? Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? ~~~~~~~~~~~~~~~ If "Yes," indicate the number of Forms 8282 filed during the year Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~~~~~~~~~~~~~~~~ ~~~~~~~ ~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ~ Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?~~~~~~~~~~~~~~~~~~~ Did the sponsoring organization make any taxable distributions under section 4966? Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Enter: Initiation fees and capital contributions included on Part VIII, line 12 Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities ~~~~~~~~~~~~~~~ ~~~~~~ Enter: Gross income from members or shareholders Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization filing Form 990 in lieu of Form 1041? If "Yes," enter the amount of tax-exempt interest received or accrued during the year Is the organization licensed to issue qualified health plans in more than one state? See the instructions for additional information the organization must report on Schedule O. ~~~~~~~~~~~~~~~~~~~~~ Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans Enter the amount of reserves on hand ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization receive any payments for indoor tanning services during the tax year? If "Yes," has it filed a Form 720 to report these payments? ~~~~~~~~~~~~~~~~ ~~~~~~~~~ Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see the instructions and file Form 4720, Schedule N. Is the organization an educational institution subject to the section 4968 excise tax on net investment income? If "Yes," complete Form 4720, Schedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Did the trust, or any disqualified or other person engage in any activities that would result in the imposition of an excise tax under section 4951, 4952 or 4953? If "Yes," complete Form 6069. 5 Part V Statements Regarding Other IRS Filings and Tax Compliance 990 CLIENT COPY X X X X X X X X X X X X 55 CHARLES HOUSE ASSOCIATION **-***2881 X 6 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332006 12-21-23 Yes No 1a 1b 1 2 3 4 5 6 7 8 9 a b 2 3 4 5 6 7a 7b 8a 8b 9 a b a b Yes No 10 11 a b 10a 10b 11a 12a 12b 12c 13 14 15a 15b 16a 16b a b 12a b c 13 14 15 a b 16a b 17 18 19 20 For each "Yes" response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule O. See instructions. If "Yes," provide the names and addresses on Schedule O (This Section B requests information about policies not required by the Internal Revenue Code.) If "No," go to line 13 If "Yes," describe on Schedule O how this was done (explain on Schedule O) If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain on Schedule O. Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? Form (2023) Form 990 (2023)Page Check if Schedule O contains a response or note to any line in this Part VI Enter the number of voting members of the governing body at the end of the tax year Enter the number of voting members included on line 1a, above, who are independent ~~~~~~ ~~~~~~ Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, trustees, or key employees to a management company or other person?~~~~~~~~~~~~~~~ Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? Did the organization become aware during the year of a significant diversion of the organization's assets? Did the organization have members or stockholders? ~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The governing body? Each committee with authority to act on behalf of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? Did the organization have local chapters, branches, or affiliates? If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? Describe on Schedule O the process, if any, used by the organization to review this Form 990. Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Did the organization regularly and consistently monitor and enforce compliance with the policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a written whistleblower policy? Did the organization have a written document retention and destruction policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? The organization's CEO, Executive Director, or top management official Other officers or key employees of the organization If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions. ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? List the states with which a copy of this Form 990 is required to be filed Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply. Own website Another's website Upon request Other Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. State the name, address, and telephone number of the person who possesses the organization's books and records 6 Part VI Governance, Management, and Disclosure. Section A. Governing Body and Management Section B. Policies Section C. Disclosure 990 CLIENT COPY 12 12 X X X X X X X X X X X X X X X X X X X X DEAN FOX - 919-967-7570 7511 SUNRISE ROAD, CHAPEL HILL, NC 27514 NONE CHARLES HOUSE ASSOCIATION **-***2881 X X 7 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Individual trustee or directorInstitutional trusteeOfficerKey employeeHighest compensatedemployeeFormer(do not check more than one box, unless person is both an officer and a director/trustee) 332007 12-21-23 current Section A.Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a current current former former directors or trustees (A)(B)(C)(D)(E)(F) Form 990 (2023)Page Check if Schedule O contains a response or note to any line in this Part VII Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. ¥ List all of the organization's officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid. ¥ List all of the organization's key employees, if any. See the instructions for definition of "key employee." ¥ List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (box 5 of Form W-2, box 6 of Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the organization and any related organizations. ¥ List all of the organization's officers, key employees, and highest compensated employees who received more than $100,000 ofreportable compensation from the organization and any related organizations. ¥ List all of the organization's that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. See the instructions for the order in which to list the persons above. Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. PositionName and title Average hours per week (list any hours for related organizations below line) Reportable compensation from the organization (W-2/1099-MISC/ 1099-NEC) Reportable compensation from related organizations (W-2/1099-MISC/ 1099-NEC) Estimated amount of other compensation from the organization and related organizations Form (2023) 7 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors 990 CLIENT COPY (1) PAUL KLEVER EXECUTIVE DIRECTOR (2) DANIEL LEHMAN (3) ROBERT SMITH (4) PAMELA NIELSEN (5) ROBERT SPRANSY (6) BETH TILLMAN (7) TAMARA BAKER (8) BENJAMIN BUCKNER (9) PEGGY COHN (10) ELLEN CULLER (11) JULIE LINDSEY (12) LUKE RIGGSBEE (13) JAMILAH SABIR-CALLOWAY PRESIDENT VICE-PRESIDENT SECRETARY TREASURER PAST PRESIDENT DIRECTOR DIRECTOR DIRECTOR DIRECTOR DIRECTOR DIRECTOR DIRECTOR 40.00 1.00 1.00 1.00 1.00 0.40 0.40 0.40 0.40 0.40 0.40 0.40 0.40 X X X X X X X X X X X X X X X X X 140,000. 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. 4,200. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. CHARLES HOUSE ASSOCIATION **-***2881 8 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 FormerIndividual trustee or directorInstitutional trusteeOfficerHighest compensatedemployeeKey employee(do not check more than one box, unless person is both an officer and a director/trustee) 332008 12-21-23 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (B)(C)(A)(D)(E)(F) 1 b c d Subtotal Total from continuation sheets to Part VII, Section A Total (add lines 1b and 1c) 2 Yes No 3 4 5 former 3 4 5 Section B. Independent Contractors 1 (A)(B)(C) 2 (continued) If "Yes," complete Schedule J for such individual If "Yes," complete Schedule J for such individual If "Yes," complete Schedule J for such person Page Form 990 (2023) PositionAverage hours per week (list any hours for related organizations below line) Name and title Reportable compensation from the organization (W-2/1099-MISC/ 1099-NEC) Reportable compensation from related organizations (W-2/1099-MISC/ 1099-NEC) Estimated amount of other compensation from the organization and related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~ ~ Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization Did the organization list any officer, director, trustee, key employee, or highest compensated employee on line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? ~~~~~~~~~~~~~ Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. Name and business address Description of services Compensation Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization Form (2023) 8 Part VII 990 CLIENT COPY 140,000.0.4,200. 0.0.0. 1 0 NONE 140,000.0.4,200. CHARLES HOUSE ASSOCIATION X X X **-***2881 9 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Noncash contributions included in lines 1a-1f 332009 12-21-23 Business Code Business Code Total revenue. (A)(B)(C)(D) 1 a b c d e f 1 1 1 1 1 1 1 a b c d e f ggContributions, Gifts, Grantsand Other Similar Amountsh Total. a b c d e f g 2 Program ServiceRevenueTotal. 3 4 5 6 a b c d 6a 6b 6c 7 a 7a 7b 7c b c d a b c 8 8a 8b 9 a b c 9a 9b 10 a b c 10a 10bOther Revenue11 a b c d eMiscellaneousRevenue Total. 12 Revenue excluded from tax undersections 512 - 514 All other contributions, gifts, grants, and similar amounts not included above Gross amount from sales of assets other than inventory cost or other basis and sales expenses Gross income from fundraising events See instructions Form (2023) Page Form 990 (2023) Check if Schedule O contains a response or note to any line in this Part VIII Total revenue Related or exempt function revenue Unrelated business revenue Federated campaigns Membership dues ~~~~~ ~~~~~~~ Fundraising events Related organizations ~~~~~~~ ~~~~~ Government grants (contributions) ~ $ Add lines 1a-1f All other program service revenue ~~~~~ Add lines 2a-2f Investment income (including dividends, interest, and other similar amounts) Income from investment of tax-exempt bond proceeds ~~~~~~~~~~~~~~~~~~ Royalties (i) Real (ii) Personal Gross rents Less: rental expenses Rental income or (loss) Net rental income or (loss) ~~~~~ ~ (i) Securities (ii) Other Less: Gain or (loss) ~~~ ~~~~~ Net gain or (loss) (not including $of contributions reported on line 1c). See Part IV, line 18 ~~~~~~~~~~~~ Less: direct expenses ~~~~~~~~ Net income or (loss) from fundraising events Gross income from gaming activities. See Part IV, line 19 ~~~~~~~~~~~~ Less: direct expenses Net income or (loss) from gaming activities ~~~~~~~~ Gross sales of inventory, less returns and allowances ~~~~~~~~~~~~ Less: cost of goods sold Net income or (loss) from sales of inventory ~~~~~~~ All other revenue ~~~~~~~~~~~~~ Add lines 11a-11d 9 Part VIII Statement of Revenue 990 CLIENT COPY 6,980. 49,000. 1,067,301. 188,444. 244,424. 5,068. 1,067,301. 1,353,042.1,067,301.0.41,317. CHARLES HOUSE ASSOCIATION **-***2881 PARTICIPANT FEES 623990 1,067,301. 41,020.41,020. 297. 0. 297. 297.297. 0. 0. 0. 6,980. 10 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 if following SOP 98-2 (ASC 958-720) 332010 12-21-23 Total functional expenses. Joint costs. (A)(B)(C)(D) 1 2 3 4 5 6 7 8 9 10 11 a b c d e f g 12 13 14 15 16 17 18 19 20 21 22 23 24 a b c d e 25 26 Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A). Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 Compensation not included above to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) Professional fundraising services. See Part IV, line 17 (If line 11g amount exceeds 10% of line 25, column (A), amount, list line 11g expenses on Sch O.) Other expenses. Itemize expenses not covered above. (List miscellaneous expenses on line 24e. Ifline 24e amount exceeds 10% of line 25, column (A),amount, list line 24e expenses on Schedule O.) Add lines 1 through 24e Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here Form 990 (2023)Page Check if Schedule O contains a response or note to any line in this Part IX Total expenses Program serviceexpenses Management andgeneral expenses Fundraisingexpenses ~ Grants and other assistance to domestic individuals. See Part IV, line 22 ~~~~~~~ Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ~~~ Benefits paid to or for members ~~~~~~~ Compensation of current officers, directors, trustees, and key employees ~~~~~~~~ ~~~ Other salaries and wages ~~~~~~~~~~ Other employee benefits ~~~~~~~~~~ Payroll taxes ~~~~~~~~~~~~~~~~ Fees for services (nonemployees): Management Legal Accounting Lobbying ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Investment management fees Other. ~~~~~~~~ Advertising and promotion Office expenses Information technology Royalties ~~~~~~~~~ ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Occupancy ~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~Travel Payments of travel or entertainment expenses for any federal, state, or local public officials ~ Conferences, conventions, and meetings ~~ Interest Payments to affiliates ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~ Depreciation, depletion, and amortization Insurance ~~ ~~~~~~~~~~~~~~~~~ All other expenses Form (2023) Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII. 10 Statement of Functional ExpensesPart IX 990 CLIENT COPY 140,000. 823,860. 11,880. 89,403. 74,587. 20,359. 23,784. 5,425. 24,638. 109,951. 15,103. 62,857. 21,831. 53,309. 11,411. 4,708. 3,124. 2,786. 1,499,016. 28,000.70,000.42,000. 758,028.65,808.24. 9,688.1,674.518. 72,908.12,596.3,899. 60,826.10,509.3,252. 20,359. 6,272.16,558.954. 5,425. 18,350.4,686.1,602. 93,458.10,995.5,498. 15,103. 53,428.6,286.3,143. 4,922.16,673.236. 53,309. 11,411. 30.4,676.2. 1,562.1,562. 2,786. 1,190,081.242,382.66,553. PARTICIPANT FOOD SERVIC PARTICIPANT SUPPLIES BANK & ADMINISTRATIVE C DUES, SUBSCRIPTIONS, LI CHARLES HOUSE ASSOCIATION **-***2881 11 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332011 12-21-23 (A)(B) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 1 2 3 4 5 6 7 8 9 10c 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 a b 10a 10bAssets Total assets. LiabilitiesTotal liabilities. Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33. 27 28 Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33. 29 30 31 32 33Net Assets or Fund Balances Form 990 (2023)Page Check if Schedule O contains a response or note to any line in this Part X Beginning of year End of year Cash - non-interest-bearing Savings and temporary cash investments Pledges and grants receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~ Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons ~~~~~~~~~ Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B)~~ Notes and loans receivable, net Inventories for sale or use Prepaid expenses and deferred charges ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D Less: accumulated depreciation ~~~ ~~~~~~ Investments - publicly traded securities Investments - other securities. See Part IV, line 11 Investments - program-related. See Part IV, line 11 Intangible assets ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~ Add lines 1 through 15 (must equal line 33) Accounts payable and accrued expenses Grants payable Deferred revenue ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax-exempt bond liabilities Escrow or custodial account liability. Complete Part IV of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~ Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons ~~~~~~~~~ Secured mortgages and notes payable to unrelated third parties ~~~~~~ Unsecured notes and loans payable to unrelated third parties ~~~~~~~~ Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines 17 through 25 Net assets without donor restrictions Net assets with donor restrictions ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ Capital stock or trust principal, or current funds Paid-in or capital surplus, or land, building, or equipment fund Retained earnings, endowment, accumulated income, or other funds ~~~~~~~~~~~~~~~ ~~~~~~~~ ~~~~ Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~ Total liabilities and net assets/fund balances Form (2023) 11 Balance SheetPart X 990 CLIENT COPY 601,804.99,617. 23,368.43,379. 4,161.13,245. 1,053,582.1,612,618. 1,459,439. 667,366.854,536.792,073. 147,033.91,911. 2,776,285.2,723,003. 91,801.70,160. 88,409.107,354. 369,287.335,802. 173,533.112,411. 656,229.580,567. X 2,120,056.2,142,436. 2,120,056.2,142,436. 2,776,285.2,723,003. **-***2881CHARLES HOUSE ASSOCIATION 25,000.25,000. 12 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332012 12-21-23 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Yes No 1 2 3 a b c 2a 2b 2c a b 3a 3b Form 990 (2023)Page Check if Schedule O contains a response or note to any line in this Part XI Total revenue (must equal Part VIII, column (A), line 12) Total expenses (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 2 from line 1 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~ Net unrealized gains (losses) on investments Donated services and use of facilities Investment expenses Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other changes in net assets or fund balances (explain on Schedule O) Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B)) ~~~~~~~~~~~~~~~~~~ Check if Schedule O contains a response or note to any line in this Part XII Accounting method used to prepare the Form 990:Cash Accrual Other If the organization changed its method of accounting from a prior year or checked "Other," explain on Schedule O. Were the organization's financial statements compiled or reviewed by an independent accountant?~~~~~~~~~~~~ If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis Were the organization's financial statements audited by an independent accountant?~~~~~~~~~~~~~~~~~~~ If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~ If the organization changed either its oversight process or selection process during the tax year, explain on Schedule O. As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Uniform Guidance, 2 C.F.R. Part 200, Subpart F?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why on Schedule O and describe any steps taken to undergo such audits Form (2023) 12 Part XI Reconciliation of Net Assets Part XII Financial Statements and Reporting 990 CLIENT COPY X CHARLES HOUSE ASSOCIATION **-***2881 1,353,042. 1,499,016. -145,974. 2,120,056. 0. 2,142,436. 168,354. X X X X X 13 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 (iv) Is the organization listedin your governing document? OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 332021 12-21-23 (i)(iii)(v)(vi)(ii) Name of supported organization Type of organization (described on lines 1-10 above (see instructions)) Amount of monetary support (see instructions) Amount of other support (see instructions) EIN (Form 990)Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. Attach to Form 990 or Form 990-EZ. Go to www.irs.gov/Form990 for instructions and the latest information. Open to Public Inspection Name of the organization Employer identification number 1 2 3 4 5 6 7 8 9 10 11 12 section 170(b)(1)(A)(i). section 170(b)(1)(A)(ii). section 170(b)(1)(A)(iii). section 170(b)(1)(A)(iii). section 170(b)(1)(A)(iv). section 170(b)(1)(A)(v). section 170(b)(1)(A)(vi). section 170(b)(1)(A)(vi). section 170(b)(1)(A)(ix) section 509(a)(2). section 509(a)(4). section 509(a)(1)section 509(a)(2)section 509(a)(3). a b c d e f Type I. You must complete Part IV, Sections A and B. Type II. You must complete Part IV, Sections A and C. Type III functionally integrated. You must complete Part IV, Sections A, D, and E. Type III non-functionally integrated. You must complete Part IV, Sections A and D, and Part V. g Yes No Total For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule A (Form 990) 2023 (All organizations must complete this part.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) A church, convention of churches, or association of churches described in A school described in (Attach Schedule E (Form 990).) A hospital or a cooperative hospital service organization described in A medical research organization operated in conjunction with a hospital described in Enter the hospital's name, city, and state: An organization operated for the benefit of a college or university owned or operated by a governmental unit described in (Complete Part II.) A federal, state, or local government or governmental unit described in An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in (Complete Part II.) A community trust described in (Complete Part II.) An agricultural research organization described in operated in conjunction with a land-grant college or university or a non-land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or university: An organization that normally receives (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions, subject to certain exceptions; and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See (Complete Part III.) An organization organized and operated exclusively to test for public safety. See An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in or . See Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization. Enter the number of supported organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide the following information about the supported organization(s). LHA SCHEDULE A Part I Reason for Public Charity Status. Public Charity Status and Public Support 2023 CLIENT COPY X **-***2881CHARLES HOUSE ASSOCIATION Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Subtract line 5 from line 4. 332022 12-21-23 Calendar year (or fiscal year beginning in) Calendar year (or fiscal year beginning in) 2 (a) (b) (c) (d) (e) (f) 1 2 3 4 5 Total. 6 Public support. (a) (b) (c) (d) (e) (f) 7 8 9 10 11 12 13 Total support. 12 First 5 years. stop here 14 15 14 15 16 17 18 a b a b 33 1/3% support test - 2023. stop here. 33 1/3% support test - 2022. stop here. 10% -facts-and-circumstances test - 2023. stop here. 10% -facts-and-circumstances test - 2022. stop here. Private foundation. Schedule A (Form 990) 2023 Add lines 7 through 10 Schedule A (Form 990) 2023 Page (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.) 2019 2020 2021 2022 2023 Total Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")~~ Tax revenues levied for the organ- ization's benefit and either paid to or expended on its behalf ~~~~ The value of services or facilities furnished by a governmental unit to the organization without charge ~ Add lines 1 through 3 ~~~ The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)~~~~~~~~~~~~ 2019 2020 2021 2022 2023 Total Amounts from line 4 ~~~~~~~ Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~ Net income from unrelated business activities, whether or not the business is regularly carried on ~ Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)~~~~ Gross receipts from related activities, etc. (see instructions)~~~~~~~~~~~~~~~~~~~~~~~ If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and ~~~~~~~~~~~Public support percentage for 2023 (line 6, column (f), divided by line 11, column (f)) Public support percentage from 2022 Schedule A, Part II, line 14 % %~~~~~~~~~~~~~~~~~~~~~ If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and Explain in Part VI how the organization meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~ If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and Explain in Part VI how the organization meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~ If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) Section A. Public Support Section B. Total Support Section C. Computation of Public Support Percentage CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 15 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 (Subtract line 7c from line 6.) Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year (Add lines 9, 10c, 11, and 12.) 332023 12-21-23 Calendar year (or fiscal year beginning in) Calendar year (or fiscal year beginning in) Total support. 3 (a) (b) (c) (d) (e) (f) 1 2 3 4 5 6 7 Total. a b c 8 Public support. (a) (b) (c) (d) (e) (f) 9 10 a b c 11 12 13 14 First 5 years. stop here 15 16 15 16 17 18 19 20 2023 2022 17 18 a b 33 1/3% support tests - 2023. stop here. 33 1/3% support tests - 2022. stop here. Private foundation. Schedule A (Form 990) 2023 Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 Schedule A (Form 990) 2023 Page (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) 2019 2020 2021 2022 2023 Total Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")~~ Gross receipts from admissions, merchandise sold or services per- formed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose Gross receipts from activities that are not an unrelated trade or bus- iness under section 513 ~~~~~ Tax revenues levied for the organ- ization's benefit and either paid to or expended on its behalf ~~~~ The value of services or facilities furnished by a governmental unit to the organization without charge ~ ~~~ Add lines 1 through 5 Amounts included on lines 1, 2, and 3 received from disqualified persons ~~~~~~ Add lines 7a and 7b ~~~~~~~ 2019 2020 2021 2022 2023 Total Amounts from line 6 ~~~~~~~ Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~ ~~~~ Add lines 10a and 10b ~~~~~~ Net income from unrelated businessactivities not included on line 10b, whether or not the business is regularly carried on ~~~~~~~ Other income. Do not include gainor loss from the sale of capital assets (Explain in Part VI.)~~~~ If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and Public support percentage for 2023 (line 8, column (f), divided by line 13, column (f)) Public support percentage from 2022 Schedule A, Part III, line 15 ~~~~~~~~~~~% % Investment income percentage for (line 10c, column (f), divided by line 13, column (f)) Investment income percentage from Schedule A, Part III, line 17 ~~~~~~~~% %~~~~~~~~~~~~~~~~~~ If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~ If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and line 18 is not more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization ~~~~~~ If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions Part III Support Schedule for Organizations Described in Section 509(a)(2) Section A. Public Support Section B. Total Support Section C. Computation of Public Support Percentage Section D. Computation of Investment Income Percentage CLIENT COPY 230,366.257,553.792,896.194,789.244,424.1720028. X 1524492.1011625.1168660.1468588.1067301.6240666. 1754858.1269178.1961556.1663377.1311725.7960694. 1754858.1269178.1961556.1663377.1311725.7960694. 0. 749,922.694,206.651,970.636,232.386,483.3118813. 749,922.694,206.651,970.636,232.386,483.3118813. 4841881. 15,230.5,856.10,641.18,301.41,020.91,048. 15,230.5,856.10,641.18,301.41,020.91,048. 1,008.985.268.223.297.2,781. 8054523. 60.11 57.31 1.13 1.00 CHARLES HOUSE ASSOCIATION **-***2881 1771096.1276019.1972465.1681901.1353042. 16 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332024 12-21-23 4 Yes No 1 2 3 4 5 6 7 8 9 10 Part VI 1 2 3a 3b 3c 4a 4b 4c 5a 5b 5c 6 7 8 9a 9b 9c 10a 10b Part VI a b c a b c a b c a b c a b Part VI Part VI Part VI Part VI Part VI, Type I or Type II only. Substitutions only. Part VI. Part VI. Part VI. Part VI. Schedule A (Form 990) 2023 If "No," describe in how the supported organizations are designated. If designated by class or purpose, describe the designation. If historic and continuing relationship, explain. If "Yes," explain in how the organization determined that the supported organization was described in section 509(a)(1) or (2). If "Yes," answer lines 3b and 3c below. If "Yes," describe in when and how the organization made the determination. If "Yes," explain in what controls the organization put in place to ensure such use. If "Yes," and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below. If "Yes," describe in how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations. If "Yes," explain in what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes. If "Yes," answer lines 5b and 5c below (if applicable). Also, provide detail in including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document). If "Yes," provide detail in If "Yes," complete Part I of Schedule L (Form 990). If "Yes," complete Part I of Schedule L (Form 990). If "Yes," provide detail in If "Yes," provide detail in If "Yes," provide detail in If "Yes," answer line 10b below. (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings.) Schedule A (Form 990) 2023 Page (Complete only if you checked a box on line 12 of Part I. If you checked box 12a, Part I, complete Sections A and B. If you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part I, complete Sections A, D, and E. If you checked box 12d, Part I, complete Sections A and D, and complete Part V.) Are all of the organization's supported organizations listed by name in the organization's governing documents? Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? Was any supported organization not organized in the United States ("foreign supported organization")? Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? Did the organization add, substitute, or remove any supported organizations during the tax year? Was any added or substituted supported organization part of a class already designated in the organization's organizing document? Was the substitution the result of an event beyond the organization's control? Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? Did the organization have any excess business holdings in the tax year? Part IV Supporting Organizations Section A. All Supporting Organizations CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 17 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332025 12-21-23 5 Yes No 11 a b c 11a 11b 11cPart VI. Yes No 1 2 Part VI 1 2 Part VI Yes No 1 Part VI 1 Yes No 1 2 3 1 2 3 Part VI Part VI 1 2 3 (see instructions). a b c line 2 line 3 Part VI Answer lines 2a and 2b below.Yes No a b a b Part VI identify those supported organizations and explain 2a 2b 3a 3b Part VI Answer lines 3a and 3b below. Part VI. Part VI Schedule A (Form 990) 2023 If "Yes" to line 11a, 11b, or 11c, provide detail in If "No," describe in how the supported organization(s) effectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove officers, directors, or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year. If "Yes," explain in how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization. If "No," describe in how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s). If "No," explain in how the organization maintained a close and continuous working relationship with the supported organization(s). If "Yes," describe in the role the organization's supported organizations played in this regard. Check the box next to the method that the organization used to satisfy the Integral Part Test during the year Complete below. Complete below. Describe in how you supported a governmental entity (see instructions). If "Yes," then in how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities. If "Yes," explain in the reasons for the organization's position that its supported organization(s) would have engaged in these activities but for the organization's involvement. If "Yes" or "No" provide details in If "Yes," describe in the role played by the organization in this regard. Schedule A (Form 990) 2023 Page Has the organization accepted a gift or contribution from any of the following persons? A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization? A family member of a person described on line 11a above? A 35% controlled entity of a person described on line 11a or 11b above? Did the governing body, members of the governing body, officers acting in their official capacity, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization's officers, directors, or trustees at all times during the tax year? Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? Were a majority of the organization's directors or trustees during the tax year also a majority of the directors or trustees of each of the organization's supported organization(s)? Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided? Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? By reason of the relationship described on line 2, above, did the organization's supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or assets at all times during the tax year? The organization satisfied the Activities Test. The organization is the parent of each of its supported organizations. The organization supported a governmental entity. Activities Test. Did substantially all of the organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? Did the activities described on line 2a, above, constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? Parent of Supported Organizations. Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each of its supported organizations? (continued)Part IV Supporting Organizations Section B. Type I Supporting Organizations Section C. Type II Supporting Organizations Section D. All Type III Supporting Organizations Section E. Type III Functionally Integrated Supporting Organizations CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 18 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332026 12-21-23 6 1 Part VI See instructions. Section A - Adjusted Net Income 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8Adjusted Net Income Section B - Minimum Asset Amount 1 2 3 4 5 6 7 8 a b c d e 1a 1b 1c 1d 2 3 4 5 6 7 8 Total Discount Part VI Minimum Asset Amount Section C - Distributable Amount 1 2 3 4 5 6 7 1 2 3 4 5 6 Distributable Amount. Schedule A (Form 990) 2023 explain in explain in detail in Schedule A (Form 990) 2023 Page Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (). All other Type III non-functionally integrated supporting organizations must complete Sections A through E. (B) Current Year (optional)(A) Prior Year Net short-term capital gain Recoveries of prior-year distributions Other gross income (see instructions) Add lines 1 through 3. Depreciation and depletion Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) Other expenses (see instructions) (subtract lines 5, 6, and 7 from line 4) (B) Current Year (optional)(A) Prior Year Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): Average monthly value of securities Average monthly cash balances Fair market value of other non-exempt-use assets (add lines 1a, 1b, and 1c) claimed for blockage or other factors ( ): Acquisition indebtedness applicable to non-exempt-use assets Subtract line 2 from line 1d. Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). Net value of non-exempt-use assets (subtract line 4 from line 3) Multiply line 5 by 0.035. Recoveries of prior-year distributions (add line 7 to line 6) Current Year Adjusted net income for prior year (from Section A, line 8, column A) Enter 0.85 of line 1. Minimum asset amount for prior year (from Section B, line 8, column A) Enter greater of line 2 or line 3. Income tax imposed in prior year Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions). Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see instructions). Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 19 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332027 12-21-23 7 Section D - Distributions Current Year 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Part VI Part VI Total annual distributions. Part VI (i) Excess Distributions (ii) Underdistributions Pre-2023 (iii) Distributable Amount for 2023Section E - Distribution Allocations 1 2 3 4 5 6 7 8 Part VI a b c d e f g h i j Total a b c Part VI. Part VI Excess distributions carryover to 2024. a b c d e Schedule A (Form 990) 2023 provide details in describe in provide details in explain in explain in explain in Schedule A (Form 990) 2023 Page Amounts paid to supported organizations to accomplish exempt purposes Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity Administrative expenses paid to accomplish exempt purposes of supported organizations Amounts paid to acquire exempt-use assets Qualified set-aside amounts (prior IRS approval required - ) Other distributions ( ). See instructions. Add lines 1 through 6. Distributions to attentive supported organizations to which the organization is responsive ( ). See instructions. Distributable amount for 2023 from Section C, line 6 Line 8 amount divided by line 9 amount (see instructions) Distributable amount for 2023 from Section C, line 6 Underdistributions, if any, for years prior to 2023 (reason- able cause required - ). See instructions. Excess distributions carryover, if any, to 2023 From 2018 From 2019 From 2020 From 2021 From 2022 of lines 3a through 3e Applied to underdistributions of prior years Applied to 2023 distributable amount Carryover from 2018 not applied (see instructions) Remainder. Subtract lines 3g, 3h, and 3i from line 3f. Distributions for 2023 from Section D, line 7:$ Applied to underdistributions of prior years Applied to 2023 distributable amount Remainder. Subtract lines 4a and 4b from line 4. Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. For result greater than zero, See instructions. Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. For result greater than zero, . See instructions. Add lines 3j and 4c. Breakdown of line 7: Excess from 2019 Excess from 2020 Excess from 2021 Excess from 2022 Excess from 2023 (continued) Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 20 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332028 12-21-23 8 Schedule A (Form 990) 2023 Schedule A (Form 990) 2023 Page Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.) Part VI Supplemental Information. CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 21 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 323173 04-01-23 Payer's Name 2019 Amount 2020 Amount 2021 Amount 2022 Amount 2023 Amount Total to Schedule A, Part III, Line 7b ~~~~~~~~~~~ ** Do Not File ** *** Not Open to Public Inspection *** Excess Payments from Non-Disqualified PersonsIncluded on Part III, Line 7bSchedule A 2023 CLIENT COPY 694,206.749,922. VALERIE ADDO IDA PARRISH PAT CARPENTER JUDY COX 0. 0. 0. 0. 0. 0. 0. 0. JIM WEBB SANFORD JACOBS ERIKA WING PETER WINMORE LYNN BROWN DONNA SCANDLIN DOUG TAYLOR BILL TUCKER KATHY ZINK 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 694,206. CHARLES HOUSE ASSOCIATION **-***2881 0. 636,232.651,970. 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. 651,970.636,232.386,483. 0. 75,490. 2,310. 5,970. 6,710. 75,270. 5,945. 3,120. 50,170. 6,235. 5,745. 4,070. 70,178. 75,270. 749,922. Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332251 04-01-23 Payer's Name Amount Received in 2023 2023 Excess Payments Total Excess Payments to Schedule A, Part III, Line 7b, column (e)~~~~~~~~~~~~~~~~~~~~~~~~~~~ ** Do Not File ** *** Not Open to Public Inspection *** Identification of Excess Support PaymentsIncluded on Part III, Line 7b, column (e)Schedule A 2023 CLIENT COPY VALERIE ADDO 89,020.75,490. IDA PARRISH PAT CARPENTER JUDY COX JIM WEBB 15,840. 19,500. 20,240. 88,800. 2,310. 5,970. 6,710. 75,270. SANFORD JACOBS ERIKA WING PETER WINMORE LYNN BROWN DONNA SCANDLIN DOUG TAYLOR BILL TUCKER KATHY ZINK 19,475. 16,650. 63,700. 19,765. 19,275. 17,600. 83,708. 88,800. 5,945. 3,120. 50,170. 6,235. 5,745. 4,070. 70,178. 75,270. 386,483. CHARLES HOUSE ASSOCIATION **-***2881 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Department of the Treasury Internal Revenue Service 323451 12-26-23 For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF.Schedule B (Form 990) (2023) OMB No. 1545-0047 (Form 990)Attach to Form 990, 990-EZ, or 990-PF. Go to www.irs.gov/Form990 for the latest information. Employer identification number Organization type Filers of:Section: not General Rule Special Rule. Note: General Rule Special Rules (1) (2) General Rule Caution: must exclusively exclusively exclusively nonexclusively Name of the organization (check one): Form 990 or 990-EZ 501(c)() (enter number) organization 4947(a)(1) nonexempt charitable trust treated as a private foundation 527 political organization Form 990-PF 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501(c)(3) taxable private foundation Check if your organization is covered by the or a Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions. For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions. For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of $5,000; or 2% of the amount on (i) Form 990, Part VIII, line 1h; or (ii) Form 990-EZ, line 1. Complete Parts I and II. For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the year, total contributions of more than $1,000 for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I (entering "N/A" in column (b) instead of the contributor name and address), II, and III. For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an religious, charitable, etc., purpose. Don't complete any of the parts unless the applies to this organization because it received religious, charitable, etc., contributions totaling $5,000 or more during the year ~~~~~~~~~~~~~~~~~$ An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990), but it answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990). LHA Schedule B Schedule of Contributors 2023 CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 X 3 X Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 323452 12-26-23 Schedule B (Form 990) (2023) Employer identification number (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash Schedule B (Form 990) (2023)Page Name of organization (see instructions). Use duplicate copies of Part I if additional space is needed. $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) 2 Part I Contributors CLIENT COPY 1 X 8,769. MARGARET RIDER IRREVOCABLE TRUST 535 WASHINGTON STREET SUITE 1000 BUFFALO, NY 14203 2 X 22,000. ENDOWMENT FUND OF TRIANGLE COMMUNITY HOME HEALTH FOUNDATION OF CHAPEL HILL 202 PRESQUE ISLE LANE CHAPEL HILL, NC 27514 3 X 5,000. CHRISTINE LATHREN AND FAMILY 30070 BENBURY CHAPEL HILL, NC 27517 4 X 10,000. H. EDWARD AND PHYLLIS C. WRIGHT 721 DC FARMS ROAD HILLSBOROUGH, NC 27278 5 X 5,200. FOUNDATION THE NED S. AND SANDRA L. MCCLURG 105 WOODKIRK LANE CHAPEL HILL, NC 27514 6 X 6,000. INC. BERTSCH FAMILY CHARITABLE FOUNDATION, 6625 CREEK WOOD DRIVE CHAPEL HILL, NC 27514 CHARLES HOUSE ASSOCIATION **-***2881 25 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 323452 12-26-23 Schedule B (Form 990) (2023) Employer identification number (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash Schedule B (Form 990) (2023)Page Name of organization (see instructions). Use duplicate copies of Part I if additional space is needed. $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) 2 Part I Contributors CLIENT COPY 7 X 10,000. PAT CARPENTER 108 SILVER CEDAR LANE CHAPEL HILL, NC 27514 8 X 15,000. THE CAROLYN SMITH FOUNDATION 1050 GLENBROOK WAY SUITE 480 #506 HENDERSONVILLE , TN 37085 9 X 10,000. MICHAEL BRADLEY 11199 NORTH POINT HAYDEN DR. HAYDEN LAKE, ID 83835 10 X5,068. JULIAN AND CATHERINE CULTON 417 FLAT RAIL TRAIL CARY, NC 27511 CHARLES HOUSE ASSOCIATION **-***2881 26 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 323453 12-26-23 Schedule B (Form 990) (2023) Employer identification number (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received Schedule B (Form 990) (2023)Page Name of organization (see instructions). Use duplicate copies of Part II if additional space is needed. (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ 3 Part II Noncash Property CLIENT COPY 10 12/31/235,068. 85 SHARES OF COCA COLA CO (KO) CHARLES HOUSE ASSOCIATION **-***2881 27 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 completing Part III, enter the total of exclusively religious,charitable, etc., contributions of for the year. (Enter this info. once.) 323454 12-26-23 Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor.(a)(e) and $1,000 or less Schedule B (Form 990) (2023) Complete columns through the following line entry. For organizations Employer identification number (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee Schedule B (Form 990) (2023)Page Name of organization $ Use duplicate copies of Part III if additional space is needed. 4 Part III CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 28 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Department of the Treasury Internal Revenue Service 332051 09-28-23 OMB No. 1545-0047 Held at the End of the Tax Year Complete if the organization answered "Yes" on Form 990,Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b. Attach to Form 990.Go to www.irs.gov/Form990 for instructions and the latest information. (Form 990) Open to PublicInspection Name of the organization Employer identification number (a) (b) 1 2 3 4 5 6 Yes No Yes No 1 2 3 4 5 6 7 8 9 a b c d 2a 2b 2c 2d Yes No Yes No 1 2 a b (i) (ii) a b For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule D (Form 990) 2023 Complete if the organization answered "Yes" on Form 990, Part IV, line 6. Donor advised funds Funds and other accounts Total number at end of year Aggregate value of contributions to (during year) Aggregate value of grants from (during year) Aggregate value at end of year ~~~~~~~~~~~~~~~ ~~~~ ~~~~~~ ~~~~~~~~~~~~~ Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control?~~~~~~~~~~~~~~~~~~ Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? Complete if the organization answered "Yes" on Form 990, Part IV, line 7. Purpose(s) of conservation easements held by the organization (check all that apply). Preservation of land for public use (for example, recreation or education) Protection of natural habitat Preservation of open space Preservation of a historically important land area Preservation of a certified historic structure Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year. Total number of conservation easements Total acreage restricted by conservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Number of conservation easements on a certified historic structure included on line 2a Number of conservation easements included on line 2c acquired after July 25, 2006, and not on a historic structure listed in the National Register ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year Number of states where property subject to conservation easement is located Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds?~~~~~~~~~~~~~~~~~~~~~~~~~ Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year Does each conservation easement reported on line 2d above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide in Part XIII the text of the footnote to its financial statements that describes these items. If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items. Revenue included on Form 990, Part VIII, line 1 Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~$ $~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under FASB ASC 958 relating to these items: Revenue included on Form 990, Part VIII, line 1 Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~$ $ LHA Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Part II Conservation Easements. Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. SCHEDULE D Supplemental Financial Statements 2023 CLIENT COPY CHARLES HOUSE ASSOCIATION **-***2881 29 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332052 09-28-23 3 4 5 a b c d e Yes No 1 2 a b c d e f a b Yes No 1c 1d 1e 1f Yes No (a) (b) (c) (d) (e) 1 2 3 4 a b c d e f g a b c a b Yes No (i) (ii) 3a(i) 3a(ii) 3b (a) (b) (c) (d) 1a b c d e Total. Schedule D (Form 990) 2023 (continued) (Column (d) must equal Form 990, Part X, line 10c, column (B)) Two years back Three years back Four years back Schedule D (Form 990) 2023 Page Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its collection items (check all that apply). Public exhibition Scholarly research Preservation for future generations Loan or exchange program Other Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII. During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the organization's collection? Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. Is the organization an agent, trustee, custodian, or other intermediary for contributions or other assets not included on Form 990, Part X? If "Yes," explain the arrangement in Part XIII and complete the following table: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amount Beginning balance Additions during the year Distributions during the year Ending balance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 10. Current year Prior year Beginning of year balance Contributions Net investment earnings, gains, and losses Grants or scholarships ~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~ Other expenditures for facilities and programs Administrative expenses End of year balance ~~~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~~~ Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as: Board designated or quasi-endowment Permanent endowment Term endowment The percentages on lines 2a, 2b, and 2c should equal 100%. % % % Are there endowment funds not in the possession of the organization that are held and administered for the organization by: Unrelated organizations? Related organizations? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R? Describe in Part XIII the intended uses of the organization's endowment funds. ~~~~~~~~~~~~~~~~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10. Description of property Cost or other basis (investment) Cost or other basis (other) Accumulated depreciation Book value Land Buildings Leasehold improvements ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~ Equipment Other ~~~~~~~~~~~~~~~~~ Add lines 1a through 1e. 2 Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets Part IV Escrow and Custodial Arrangements Part V Endowment Funds Part VI Land, Buildings, and Equipment CLIENT COPY 152,167. 885,768. 229,928. 62,213. 129,363. 327,173. 191,628. 49,963. 98,602. 152,167. 558,595. 38,300. 12,250. 30,761. 792,073. CHARLES HOUSE ASSOCIATION **-***2881 30 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 (including name of security) 332053 09-28-23 Total. Total. (a) (b) (c) (1) (2) (3) (a) (b) (c) (1) (2) (3) (4) (5) (6) (7) (8) (9) (a) (b) (1) (2) (3) (4) (5) (6) (7) (8) (9) Total. (a) (b) 1. Total. 2. Schedule D (Form 990) 2023 (Column (b) must equal Form 990, Part X, line 15, col. (B)) (Column (b) must equal Form 990, Part X, line 25, col. (B)) Description of security or category (Col. (b) must equal Form 990, Part X, line 12, col. (B)) (Col. (b) must equal Form 990, Part X, line 13, col. (B)) Schedule D (Form 990) 2023 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12. Book value Method of valuation: Cost or end-of-year market value Financial derivatives Closely held equity interests Other ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ (A) (B) (C) (D) (E) (F) (G) (H) Complete if the organization answered "Yes" on Form 990, Part IV, line 11c. See Form 990, Part X, line 13. Description of investment Book value Method of valuation: Cost or end-of-year market value Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15. Description Book value Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25. Description of liability Book value (1) (2) (3) (4) (5) (6) (7) (8) (9) Federal income taxes Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII 3 Part VII Investments - Other Securities Part VIII Investments - Program Related. Part IX Other Assets Part X Other Liabilities CLIENT COPY CHARLES HOUSE ASSOCIATION LEASE LIABILITY SECURITY DEPOSITS **-***2881 91,911. 20,500. 112,411. X 31 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 332054 09-28-23 1 2 3 4 5 1 a b c d e 2a 2b 2c 2d 2a 2d 2e 32e 1 a b c 4a 4b 4a 4b 3 4c. 4c 5 1 2 3 4 5 1 a b c d e 2a 2b 2c 2d 2a 2d 2e 1 2e 3 a b c 4a 4b 4a 4b 3 4c. 4c 5 Schedule D (Form 990) 2023 (This must equal Form 990, Part I, line 12.) (This must equal Form 990, Part I, line 18.) Schedule D (Form 990) 2023 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. Total revenue, gains, and other support per audited financial statements Amounts included on line 1 but not on Form 990, Part VIII, line 12: ~~~~~~~~~~~~~~~~~~~ Net unrealized gains (losses) on investments Donated services and use of facilities Recoveries of prior year grants Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts included on Form 990, Part VIII, line 12, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIII.) ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and Total revenue. Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. Total expenses and losses per audited financial statements Amounts included on line 1 but not on Form 990, Part IX, line 25: ~~~~~~~~~~~~~~~~~~~~~~~~~~ Donated services and use of facilities Prior year adjustments Other losses Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines through Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts included on Form 990, Part IX, line 25, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIII.) ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and Total expenses. Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. 4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return Part XIII Supplemental Information CLIENT COPYTHE ORGANIZATION BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. IT SHOULD BE NOTED THE PRIOR THREE TAX RETURNS REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. 1,521,396. 168,354. 168,354. 1,353,042. 0. 1,353,042. 1,499,016. 0. 1,499,016. 0. 1,499,016. PART X, LINE 2: CHARLES HOUSE ASSOCIATION **-***2881 32 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 332211 11-14-23 Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information. Attach to Form 990 or Form 990-EZ.Go to www.irs.gov/Form990 for the latest information. Open to Public Inspection Employer identification number For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule O (Form 990) 2023 Name of the organization LHA (Form 990) SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2023 CLIENT COPY FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: ORGANIZATION THAT PROVIDES CERTIFIED DAYCARE AND ELDERCARE HOMES IN A PLEASANT, HOME-LIKE SETTING FOR OLDER ADULTS OR ADULTS WITH DISABILITIES AS A VIABLE ALTERNATIVE TO INSTITUTIONAL CARE. FORM 990, PART VI, SECTION B, LINE 11B: THE FORM 990 IS APPROVED BY THE TREASURER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C: THE EXECUTIVE DIRECTOR COLLECTS ANNUAL CONFLICTS OF INTEREST FORMS FROM BOARD MEMBERS AND REVIEWS FOR ANY NEW CONFLICTS OF INTEREST THAT MIGHT EXIST. FORM 990, PART VI, SECTION B, LINE 15A: DURING THE ANNUAL BUDGET PROCESS, THE FINANCE COMMITTEE AND THE BOARD PRESIDENT RECOMMEND COMPENSATION FOR THE EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19: THE EXECUTIVE DIRECTOR MAINTAINS CURRENT COPIES OF ALL ORGANIZATIONAL DOCUMENTS IN THE ORGANIZATION'S OFFICE AND RELEASES THEM UPON REQUEST. CHARLES HOUSE ASSOCIATION **-***2881 33 13521113 252547 113105 2023.05000 CHARLES HOUSE ASSOCIATION 113105_1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION BOARD OF DIRECTORS Daniel Lehman, President (6/27) Vice President Operations UNC Hospitals 984-974-3596 15 Ashwood Drive Chapel Hill, NC 27516 919-923-8289 daniel.lehman@unch.unc.edu Robert Smith, III, Vice President (7/27) Vice Dean UNC Gillings School of Global Public Health 919-966-3215; Cell: 434-960-8305 15007 Barnhardt Ct. Chapel Hill, NC 27517 919-918-7506 rosmith@email.unc.edu Pamela Nielsen, Secretary (6/27) Personal Finances Management, Inc. 919-932-6822; Cell: 919-923-6600 103 Bella Rose Dr. Chapel Hill, NC 27517 pnielsen@dailymoneymanagement.com Jeff Bloomfield (11/27) Attorney/Owner Carolina Estate Planning 200 Sharp St. Chapel Hill, NC 27516 919-525-3928 jeff@carolinaestateplanning.com Benjaman Buckner (9/26) CPA, Frost PLLC, Raleigh 3407 Cameron Drive Henderson, NC 27636 910-385-6802 bbuckner@frostpllc.com Peggy Cohn (6/27) Former Charles House Family Caregiver 750 Weaver Dairy Rd. #116 Chapel Hill, NC 27514 919-918-3698 peggycohn38@gmail.com Ellen Culler (6/27) 200 Plaza Drive #3 Chapel Hill, NC 27517 919-218-4688 eculler@unc.edu Julie Lindsey, MD (12/25) Duke Family Medicine 919 385-4904; Cell: 919 698-2612 408 Simerville Rd Chapel Hill, NC 27517 julielindseymd@gmail.com Luke Riggsbee (2/26/2nd) Titan Risk Consultants 919-636-3252; Cell: 919-280-8238 104 Watters Road Carrboro, NC 27510 l.riggsbee@titanriskconsultants.com Jamilah Sabir-Calloway (7/27 ) 321 McDade St. Chapel Hill, NC 27516 919-423-8617 jsabircallowayee@gmail.com Dean Fox, Executive Director 3403 Bonaparte Way Durham, NC 27707 (cell) 336-337-6073 dean@charleshouse.org Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION FINANCIAL STATEMENTS YEAR ENDED DECEMBER 31, 2023 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Table of Contents Page No. Independent Auditor's Report ……………………………………………………………1 Financial Statements Statement of Financial Position ……………………………………………………3 Statement of Activities and Changes in Net Assets …………………………………4 Statement of Functional Expenses …………………………………………………5 Statement of Cash Flows ……………………………………………………………7 Notes to Financial Statements ………………………………………………………8 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Independent Auditor's Report To the Board of Directors and Management Charles House Association Chapel Hill, North Carolina Opinion We have audited the accompanying financial statements of Charles House Association (the "Organization"),which comprise the statement of financial position as of December 31, 2023,and the related statements of activities and changes in net assets,functional expenses, and cash flows for the year then ended, and the related notes to the financial statements. In our opinion, the financial statements referred to above present fairly,in all material respects,the financial position of Charles House Association as of December 31, 2023,and the changes in its net assets,functional expenses and its cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America. Basis for Opinion We conducted our audit in accordance with auditing standards generally accepted in the United States of America.Our responsibilities under those standards are further described in the Auditor's Responsibilities for the Audit of Financial Statements section of our report.We are required to be independent of Charles House Association and to meet our other ethical responsibilities in accordance with the relevant ethical requirements relating to our audit.We believe the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Responsibility of Management for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America;this includes the design,implementation,and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement,whether due to fraud or error. In preparing the financial statements,management is required to evaluate whether there are conditions or events, considered in the aggregate, that raise substantial doubt about Charles House Association's ability to continue as a going concern within one year after the date the financial statements are available to be issued. Page 1 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 •Exercise professional judgment and maintain professional skepticism throughout the audit. •Identify and assess the risks of material misstatement of the financial statements,whether due to fraud or error,and design and perform audit procedures responsive to those risks.Such procedures include examining,on a test basis,evidence regarding the amounts and disclosures in the financial statements. •Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances,but not for the purpose of expressing an opinion on the effectiveness of Charles House Association's internal control.Accordingly,no such opinion is expressed. •Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management,as well as evaluate the overall presentation of the financial statements. •Conclude whether,in our judgment,there are conditions or events,considered in the aggregate, that raise substantial doubt about Charles House Association's ability to continue as a going concern for a reasonable period of time. Raleigh, North Carolina September 17, 2024 Auditor's Responsibilities for the Audit of the Financial Statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement,whether due to fraud or error,and to issue an auditor's report that includes our opinion.Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with auditing standards generally accepted in the United States of America will always detect a material misstatement when it exists.The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error,as fraud may involve collusion,forgery,intentional omissions, misrepresentations,or the override of internal control.Misstatements,including omissions,are considered material if there is a substantial likelihood that,individually or in the aggregate,they would influence the judgment made by a reasonable user based on the financial statements. In performing an audit in accordance with generally accepted auditing standards, we: We are required to communicate with those charged with governance regarding,among other matters, the planned scope and timing of the audit,significant audit findings,and certain internal control related matters that we identified during the audit. Page 2 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Statement of Financial Position December 31, 2023 Current Assets: Cash and cash equivalents 169,777$ Investments 1,612,618 Grant and accounts receivable 43,379 Total current assets 1,825,774 Fixed Assets: Furniture, fixtures, & equipment 1,459,439 Less accumulated depreciation and amortization 667,366 Total fixed assets 792,073 Other Assets: Right-of-use asset 91,911 Other assets 13,245 Total other assets 105,156 Total assets 2,723,003$ Current Liabilities: Accounts payable 10,830$ Accrued expenses 96,524 Security deposits 20,500 Total current liabilities 127,854 Long-Term Liabilities: Lease liability 91,911 Long-term debt 360,802 Total long-term liabilities 452,713 Total liabilities 580,567 Net Assets: Without donor restrictions 2,142,436 With donor restrictions - Total net assets 2,142,436 Total liabilities and net assets 2,723,003$ Assets Liabilities and Net Assets See Notes to Financial Statements Page 3 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Statement of Activities and Changes in Net Assets Year Ended December 31, 2023 Without Donor Restrictions Revenue: Program service fees 1,067,301$ Contributions 87,982 Grants 134,837 Net investment income 209,374 Special events, net 21,605 Other revenue 297 Total revenue 1,521,396 Expenses: Program services 1,190,081 Management and general 242,382 Fundraising 66,553 Total expenses 1,499,016 Change in net assets 22,380 Net assets - beginning of year 2,120,056 Net assets - end of year 2,142,436$ See Notes to Financial Statements Page 4 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Statement of Functional Expenses Year Ended December 31, 2023 Program Services Management and General Fundraising Grand Total Personnel Costs: Salaries and wages 786,028$ 135,808$ 42,024$ 963,860$ Payroll tax employer share 60,826 10,509 3,252 74,587 Employee health insurance 55,129 9,525 2,947 67,601 Pension plan contribution 9,688 1,674 518 11,880 Workers compensation insurance 6,107 1,055 327 7,489 Other personnel cost 7,159 1,237 383 8,779 Contract labor, stipends 946 163 51 1,160 Humana dental/vision insurance 3,567 616 191 4,374 Payroll processing fees - 16,557 - 16,557 Total personnel costs 929,450 177,144 49,693 1,156,287 Occupancy Costs: Mortgage interest 13,819 - - 13,819 Utilities 8,529 1,003 502 10,034 Property and liability ins/umbrella 4,017 473 236 4,726 Telephone and internet 14,646 1,723 862 17,231 Contract services-maintenance 10,200 1,200 600 12,000 Repairs and maintenance 17,962 2,113 1,057 21,132 Other occupancy costs 1,663 196 97 1,956 Security/monitory 4,104 483 241 4,828 Occupancy lease (CH)51,000 6,000 3,000 60,000 Total occupancy costs 125,940 13,191 6,595 145,726 Program Costs: Program food service 53,309 - - 53,309 Contract services-entertainment 6,275 - - 6,275 Program supplies and equipment 11,411 - - 11,411 Clinical services and supplies 2,261 - - 2,261 Interest expense 1,284 - - 1,284 Other program costs 904 - - 904 Total program costs 75,444 - - 75,444 Development and Outreach Costs: Development and outreach costs - - - - Newsletter/printing costs - - 4,575 4,575 Special events, outreach - - 427 427 Consulting and contract fees - - 850 850 Donor processing fees - - 527 527 Total development and outreach costs - - 6,379 6,379 See Notes to Financial Statements Page 5 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Statement of Functional Expenses (Continued) Year Ended December 31, 2023 Program Services Management and General Fundraising Grand Total Administrative Costs: Professional fees -$ 3,516$ -$ 3,516$ Office supplies/equip/software 3,704 2,963 741 7,408 Accounting and auditing fees - 20,359 - 20,359 Dues, subscriptions, licensure 1,561 1,562 - 3,123 Other administrative costs 29 4 2 35 Bad debt expense 525 - - 525 Directors & officers (Flex+5)- 14,955 - 14,955 Bank/finance charges - 1,156 - 1,156 Insurance-cyber - 1,246 - 1,246 Total administrative costs 5,819 45,761 743 52,323 1,136,653 236,096 63,410 1,436,159 Depreciation and amortization 53,428 6,286 3,143 62,857 1,190,081$ 242,382$ 66,553$ 1,499,016$ See Notes to Financial Statements Page 6 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Statement of Cash Flows Year Ended December 31, 2023 Cash flows from operating activities: Change in net assets 22,380$ Adjustments to reconcile change in net assets to net cash used in operating activities: Depreciation and amortization 62,463 Amortization of right-of-use asset 55,122 Donated investments (5,068) Unrealized change in investments, net (168,354) (Increase) decrease in: Accounts receivable (20,011) Other assets (9,085) Increase (decrease) in: Accounts payable 1,722 Accrued expenses 17,223 Security deposits (6,000) Cash payments on lease liability (60,000) Discount on lease liability 4,878 Net cash used in operating activities (104,730) Cash flows from investing activities: Purchases of investments (385,613) Purchase of property and equipment - Net cash used in investing activities (385,613) Cash flows from financing activities: Payment on long-term debt (33,485) Net cash used in financing activities (33,485) Change in cash and cash equivalents (523,828) Cash and cash equivalents - beginning of year 693,605 Cash and cash equivalents - end of year 169,777$ See Notes to Financial Statements Page 7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Notes to Financial Statements Nature of Activities Net Assets Cash and Cash Equivalents Investments/Fair Value Measurements General Expenditures NOTE 1 - NATURE OF ACTIVITIES Charles House Association (the "Organization")was founded in 1984 to enrich the lives of elders, support families caring for aging family members and represent the community's commitment to its elders.The Organization derives its support and revenue primarily from fees for its services from private pay clients (i.e., exchange transactions) and contributions from the public. The Organization considers the costs related to its normal activities to be general expenditures unless such costs are limited by the donors for specified, restricted purposes. NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES The Organization reports information regarding its financial position and activities according to the following net asset classifications: Net assets without donor restrictions:Net assets that are not subject to donor-imposed restrictions and may be expended for any purpose in performing the primary objectives of the Organization.These net assets may be used at the discretion of the Organization's management and the Board of Directors. Net assets with donor restrictions:Net assets subject to stipulations imposed by donors and grantors. Some donor restrictions are temporary in nature;those restrictions will be met by actions of the Organization or by the passage of time.Other donor restrictions may be permanent in nature,whereby the donors have stipulated the funds be maintained in perpetuity. As a general rule,the Organization considers all highly liquid investments available for current use with an initial maturity of three months or less to be cash equivalents. Investments in marketable securities with readily determinable fair values and all investments in debt securities are reported at their fair values in the statement of financial position.Unrealized gains and losses are included in the change in net assets.Investment income and gains restricted by donor are reported as increases in unrestricted net assets if the restrictions are met (either by passage of time or by use) in the reporting period in which the income and gains are recognized. U.S.GAAP specifies a hierarchy of valuation techniques.The following summarizes the fair value hierarchy:Level 1 Inputs -Unadjusted quoted market prices for identical assets and liabilities in an active market that the Organization has the ability to access.Level 2 Inputs -Other than the quoted prices in active markets that are observable either directly or indirectly.Level 3 Inputs--Based on prices or valuation techniques that are both unobservable and significant to the overall fair value measurements.All investments of the Organization are considered to be Level 1 assets.The Organization had no Level 2 or 3 assets during the years presented. Page 8 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Notes to Financial Statements General Expenditures (Continued) Functional Allocation of Expenses Income Taxes Uncertain Tax Positions Right-To-Use Leased Asset and Lease Liabilities Property and Equipment The costs of providing program and other activities have been summarized on a functional basis in the statements of activities and functional expenses.Accordingly,certain costs have been allocated among the program and supporting services benefited.Such allocations are determined by management on an equitable basis. NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Continued) The Organization is exempt from income tax under Section 501(c)(3)of the Internal Revenue Code, and classified as a public charity under 170(b)(1)(A)(vi).It is also exempt from North Carolina income and franchise taxes under the North Carolina Non-Profit Corporation Act.It is responsible for unrelated business income,if any.No provision has been made for income taxes in the financial statements. It is the Organization's policy to capitalize property and equipment with an original cost or donated value of $2,500 or more and an estimated useful life of more than one year.Purchased property and equipment are recorded at cost.Donated property and equipment are recorded as revenue at their estimated fair value as of the date of the contribution.Such donations are reported as unrestricted contributions unless the donor has restricted the donated asset to a specific purpose.Depreciation is computed over the straight-line method over the estimated useful lives of the assets,which range from three to thirty years. The allocation of staffing expenses is based on time and effort studies of the Organization's employees. The remaining categories on the statement of functional expenses are allocated based on approximate direct usage. Leases that provide the Organization the right-to-use an asset for a period of more than one year are considered a capital asset.Right-to-use leased assets are recorded at the initial measurement of the lease liability which equals the present value of all payments expected to be made during the lease term. The right-to-use leased assets are amortized on a straight-line basis over the term of the lease(s). Lease liabilities represent the Board's financial obligation to make lease payments during the term of the lease and is measured at the present value of future lease payments. Accordingly,the related resources for the latter have been excluded in the quantitative information detailing the financial assets available to meet general expenditures within one year. The Organization believes it has appropriate support for any tax positions taken,and as such,does not have any uncertain tax positions that are material to the financial statements.It should be noted the prior three tax returns remain subject to examination by major tax jurisdictions. Page 9 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Notes to Financial Statements Property and Equipment (Continued) Receivable and Revenue Recognition Expenditures for repairs and maintenance are charged to expense as incurred.The cost of major renewals and betterments are capitalized and depreciated over their useful lives.Upon disposition of property and equipment,the related asset and accumulated depreciation accounts are removed and any gain or loss is reflected in the statement of activities for the period. While the Organization technically leases property to eldercare home clients,it has elected the practical expedient that allows for the combination of the lease and the non-lease components into a single component for accounting and disclosure purposes.Therefore,these arrangements are accounted for under the dictates of Topic 606 (rather than the accounting standards that typically apply to leases of property). The Organization evaluates each service deliverable contracted with the client to determine whether it represents promises to transfer distinct services under Topic 606.These are referred to as performance obligations.One or more service deliverables often represent a single performance obligation.This evaluation requires significant judgment and the impact of combining or separating performance obligations may change the time over which revenue from the contract is recognized. Revenues are recognized as performance obligations are satisfied.The Organization determines the transaction price based on standard charges for goods and services provided,reduced by contractual adjustments provided to third-party payers and discounts provided to uninsured patients in accordance with the Organization's policies. The Organization's contracts for program service fees are single performance obligations that are satisfied over time,so the resulting income is recognized monthly for financial reporting purposes. The lengths of the arrangements with clients vary up to a maximum of twelve months. The viability of the Organization's program service fees is dependent on 1)the strength of the overall economy in Chapel Hill,North Carolina and the general vicinity,(2)the Organization's ability to collect on its contracts,and (3)the ability of clients to congregate with one another and the staff of the Organization. NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Continued) Contributions are recognized when the donor makes a promise to give the Organization that is,in substance, unconditional. Donor-restricted support is reported as an increase in net assets without donor restrictions if the restrictions expire in the year in which the support is recognized.All other donor-restricted contributions are reported as increases in net assets with donor restrictions.When a restriction expires (that is,when a stipulated time restriction ends or purpose restriction is accomplished),net assets are reclassified and reported in the statement of activities as net assets released from restrictions. The Organization uses the allowance method to determine uncollectible receivables.The allowance is based on prior years'experience and management's analysis of specific promises made.No allowance was considered necessary for the year presented. The Organization considers a contract with a client to exist when there is approval and commitment from the Organization and the client,the rights of the parties and payment terms are identified,the contract has commercial substance, and the collectability of consideration is probable. Page 10 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Notes to Financial Statements Receivable and Revenue Recognition (Continued) Use of Estimates NOTE 3 - INVESTMENTS Equity securities 502,402$ Bonds 687,213 Certificates of deposit (CDs)203,281 Money market funds 219,722 1,612,618$ NOTE 4 - DONATED SERVICES NOTE 5 - GRANTS AND ACCOUNTS RECEIVABLE At times,the Organization may extend credit to customers,substantially all of whom are local residents. The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. Actual results could differ from those estimates. The Organization considers accounts receivable to be past due if payments are not received within 30 days. Past due accounts are not charged interest, but late fees ranging from $15 to $50 can be applied. Management estimates it received approximately 1,800 hours of volunteer time for the year ended December 31,2023.No amounts have been reflected in these financial statements for such services because they do not meet the criteria established by U.S. GAAP for recognition. Grants and accounts receivable are comprised of amounts due to the Association for grants and service fees.Accounts outstanding longer than the contractual payment terms are considered past due.The grants are drawn on a reimbursement basis.All the grants and accounts receivable are expected to be collected. NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Continued) Investments are carried at fair value. Fair value by type of security at December 31 is detailed below: The certificates of deposit bear interest ranging from 2.15%to 5%and have maturities ranging from April 2024 to October 2025,with penalties for early withdrawal.Any such penalties would not have a material effect on the financial statements. Page 11 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Notes to Financial Statements NOTE 5 - GRANTS AND ACCOUNTS RECEIVABLE (Continued) Grants receivable 20,750$ Accounts receivable 22,629 43,379$ NOTE 6 - FURNITURE, FIXTURES AND EQUIPMENT Furniture, fixtures and equipment 1,459,439$ Less accumulated depreciation (667,366) Net 792,073$ NOTE 7 - RIGHT-TO-USE LEASED ASSETS AND RELATED LEASE LIABILITIES Amortization 55,122$ Interest 4,878 60,000$ Years Ending December 31st Principal Interest Total Payments 2024 57,368$ 2,632$ 60,000$ 2025 34,543 457 35,000 91,911$ 3,089$ 95,000$ NOTE 8 - RETIREMENT PLAN Lease liabilities are comprised of the following: Lease expenses were comprised of the following: Depreciation expense totaled $62,857 for the year ended December 31, 2023. Furniture, fixtures and equipment consist of the following at December 31: The Organization maintains a defined contribution (SIMPLE IRA)retirement plan on behalf of eligible employees.The Organization will match participant deferrals up to 3%of compensation.The Organization contributed $11,880 to the retirement plan for the year ended December 31, 2023. The Organization has a lease providing the right-to-use rental of space for its adult day care center and administrative offices under a noncancelable agreement expiring in July 2025.The Organization estimated a discount rate of 4%in the initial lease liability calculation.The lease requires monthly payments of $5,000. The grants and accounts receivable were comprised of the following at December 31, 2023: Page 12 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Notes to Financial Statements NOTE 9 - CONCENTRATIONS NOTE 10 - RELATED PARTY TRANSACTIONS NOTE 11 - LONG-TERM DEBT 2024 36,447$ 2025 37,014 2026 38,457 2027 39,956 2028 41,515 Thereafter 167,413 360,802$ NOTE 12 - CONTINGENCIES It is not unusual for members of the Board of Directors to make contributions to the Organization.The amounts involved for the years presented are not considered material to the financial statements taken as a whole. The Organization maintains cash balances at various financial institutions.The Organization's accounts at these institutions are insured by the Federal Deposit Insurance Corporation (FDIC)up to $250,000 and may at times exceed the federally insured limits.The Organization has never experienced any losses in such accounts.At December 31,2023,no cash was in excess of FDIC limits. On May 8,2017,First Citizens Bank and Trust Company issued a promissory note to the Organization at 4.55%interest with monthly installments of $4,121,based on a 15-year amortization schedule and secured by real property.The loan was modified on February 14,2020 and now carries an interest rate of 3.85%with monthly installments of $3,942.All remaining principal and accrued interest is due on May 8, 2032. Financial assistance from various awarding agencies is subject to special audit.Such audits could result in claims against the Organization for disallowed costs or noncompliance with grantor restrictions.Management is not aware of any disallowable costs or instances of noncompliance with grantor restrictions.Consequently,no provision has been made for liabilities,if any,that may arise from such audits. In June 2020,the Organization also received an Economic Injury Disaster Loan (EIDL)of $25,000 from the SBA at an interest rate of 2.75%per annum.Repayments of $107 per month over thirty years were deferred until January 2023. Future maturities of all long-term debt are as follows: Page 13 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 CHARLES HOUSE ASSOCIATION Notes to Financial Statements NOTE 13 - LEASE Years ending December 31: 2024 60,000$ 2025 35,000 95,000 Less interest (3,089) 91,911$ NOTE 14 - SUBSEQUENT EVENTS NOTE 15 - AVAILABILITY AND LIQUIDITY Financial assets at year end: Cash and cash equivalents 169,777$ Investments 1,612,618 Grants and accounts receivable 43,379 Financial assets available to meet general expenditures over the next twelve months 1,825,774$ The following represents the Organization's financial assets at December 31: The Organization's goal is generally to maintain financial assets to meet 120 days of operating expenses (approximately $530,000).As part of its liquidity plan,excess cash is invested in money market funds and certificates of deposit. The Organization has elected the practical expedient not to recognize leases with terms of 12 months or less on the statement of financial position and instead recognizes the lease payments on a straight-line basis over the term of the lease and variable lease payments in the period in which the obligation for the payments is incurred.Therefore,the short-term lease liabilities for the periods presented do not reflect the ongoing short-term lease commitment for office space.The amounts involved are not considered material to the financial statements taken as a whole. The Organization sold the Charles House,Yorktown property in April 2024,and paid off the applicable loan described in Note 11. In accordance with U.S.GAAP,the Organization has evaluated all events subsequent to the statement of financial position through September 17,2024,which is the date these financial statements were available to be issued, and has determined that there are no subsequent events that require disclosure. The Organization has recorded one operating right-of-use asset related to its rental of space for its adult day care center and administrative offices under a non-cancelable agreement expiring in July 2025. The Organization calculated the lease liability using a discount rate of 4.00%.The rent expense for use of this space for the year ended December 31,2023 was $60,000.The following is a maturity analysis of this operating lease arrangement with a reconciliation of the undiscounted cash flows: Page 14 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 5/30/2024 Titan Risk Consultants, LLC 107 Conner Drive, Suite 225 Chapel Hill, NC 27514 License #: 1000643509 Victoria DeCamp (919)636-3252 v.decamp@titanriskconsultants.com 00065712-0 3 Charles House Association Paul Klever 7511 Sunrise Road Chapel Hill, NC 27514 Philadelphia Indemnity Insurance Company 18058 A Y PHPK2394159 5/10/2024 5/10/2025X 1,000,000 100,000 5,000 1,000,000 3,000,000 3,000,000 Philadelphia Indemnity Insurance Company 18058 A PHPK2394159 5/10/2024 5/10/2025 X X 1,000,000 Philadelphia Indemnity Insurance Company 18058 A PHPK2394159 5/10/2024 5/10/2025XX 0.00 1,000,000 1,000,000 Carolina Mutual Insurance Company B WC23000-2020 6/25/2024 6/25/2025 1,000,000 1,000,000 1,000,000 Certificate holder is added as Additional Insured as respects General Liability as required by written contract. Town of Chapel Hill 405 Martin Luther King Jr. Boulevard Chapel Hill, NC 27514 (VCD) Printed by VCD on 05/30/2024 at 01:44PM ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7 Projected Actual Projected Projected 2023-2024 2023-2024 2024-2025 2025-2026 Sex Male 50 47 52 55 Female 60 59 63 60 Nonbinary Other/prefer not to answer/unknown Total 110 106 115 115 Race and Ethnicity American Indian or Alaska Native Asian 2 4 2 6 Black or African American 17 8 20 15 Native Hawaiian or Other Pacific Islander White 90 92 93 93 More than one race 1 1 Other 2 Prefer not to answer/unknown Total 110 106 115 115 Of the above, how many individuals identify as Hispanic or Latino 6 6 6 6 Of the above, how many individuals do not identify as Hispanic or Latino 104 100 109 109 Prefer not to answer/unknown Total 110 106 115 115 Age 0-5 years 6-18 years 19-50 years 51+ years 110 106 115 115 Total 110 106 115 115 Geographic Location Town of Chapel Hill 45 44 48 49 Town of Carrboro 8 6 8 5 Orange County (Outside of Chapel Hill/Carrboro)6 8 7 6 Outside of Orange County 51 48 52 55 Total 110 106 115 115 Income Low-income (80% of the Area Median Income and Below) Please see income table in the attachments 15.1% received some sort of financial assistance 15% Unknown Total 0 0 0 0.15 Disability Presence of an intellectual, physical, blind/low vision, and/or deaf/hard of hearing disability 110 106 115 115 No indication of the presence of a disability Total 110 106 115 115 Program Target Population Demographics Docusign Envelope ID: FE6E03E9-3378-4BE8-B2E5-0623619296B7