2016-05-16T15:43:48-05:00 2015-09-30 561706742 DAVIDSON HOLLAND WHITESELL & CO PLLC 209 13TH AVE PLACE NW SUITE 200 HICKORY NC 28601 990 2014-10-01 561255030 MOUNTAIN VISTA HEALTH PARK INC MOUN 3368592181 POST OFFICE BOX 1547 DENTON NC 27239 AVA BADGETT TREASURER 3368592181 2016-04-27 SUSAN M BALKE P01056462 8283222070 2014 2016-08-17 19:52:53Z AVA BADGETT POST OFFICE BOX 1547 DENTON NC 27239 6127765 0 X N/A X 1971 NC PROVIDE QUALITY LONG-TERM NURSING CARE FOR RESIDENTS. 9 9 163 65 0 0 0 0 5935889 6141590 66372 -28056 1200 4765 6003461 6118299 0 0 0 0 3434986 3423978 0 0 0 2517143 2612911 5952129 6036889 51332 81410 5560137 5717775 513452 574893 5046685 5142882 TO PROVIDE QUALITY LONG-TERM SKILLED NURSING CARE AND ASSISTED LIVING SERVICES TO THE SOUTH DAVIDSON COUNTY COMMUNITY. 0 0 5049319 6141590 MOUNTAIN VISTA HEALTH PARK, INC. IS A CORPORATION WHICH PROVIDES LONG-TERM NURSING CARE AND ADULT CARE HOME SERVICES. THE FACILITY HAS 60 NURSING AND 60 ADULT-CARE BEDS. WE OFFER SERVICES TO THE PUBLIC WITHOUT REGARD TO RELIGION OR ETHNICITY. 5049319 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5 0 1 163 1 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X TULLOCK MANAGEMENT COMPANY 3369985001 5190 US HWY 158 ADVANCE NC 27006 MAL MARTIN PRESIDENT 0.30 X X 0 0 0 SCOTT MORRIS VICE PRESIDENT 0.30 X X 0 0 0 AVA BADGETT TREASURER 0.30 X X 0 0 0 ADALYN NOPANEN SECRETARY 0.30 X X 0 0 0 DEL CRANFORD DIRECTOR 0.30 X X 0 0 0 KURT BEYELER DIRECTOR 0.30 X 0 0 0 RANDY HARDISTER DIRECTOR 0.30 X 0 0 0 JEANETTE POTTS DIRECTOR 0.30 X 0 0 0 DALE FUTRELL ASST TREASURER 0.30 X 0 0 0 KATHY MCDONALD ADMINISTRATOR 40.00 X 90076 0 0 90076 0 0 0 0 0 0 LEGACY HEALTHCARE SERVICES INC PO BOX 951003 CLEVELAND OH 44193 PHYSICAL, SPEECH & OCC THERAPY 624978 BLUE CROSS BLUE SHIELD PO BOX 580017 CHARLOTTE NC 28258 GROUP MEDICAL INSURANCE 398675 US FOOD SERVICE 125 FORT MILL PARKWAY FORT MILL SC 29715 FOOD SERVICE/SUPPLY 183798 NEIL MEDICAL GROUP 2545 JETPORT ROAD KINSTON NC 28504 NURSING/MEDICAL SUPPLIES 105539 4 ROUTINE NURSING CARE 623000 6111936 6111936 ANCILLARIES 623000 29654 29654 6141590 -20432 -20432 4765 0 4765 4765 4765 1842 9466 -7624 -7624 -7624 6118299 6141590 0 -23291 90076 90076 2975597 2840793 134804 128814 93823 34991 229491 212246 17245 343489 343489 284216 284216 3981 3981 9415 9415 7663 5020 2643 32 32 130392 130392 314810 300731 14079 CONTRACT SERVICES 515222 512972 2250 SUPPLIES 477031 472791 4240 RAW FOOD 237745 237745 UTILITIES 188468 174200 14268 100447 68606 31841 6036889 5049319 987570 0 2208088 2525941 593599 510395 16626 16344 71157 78038 3799464 2990124 872231 809340 1798436 1777717 5560137 5717775 482463 542575 30989 32318 513452 574893 X 5046685 5142882 5046685 5142882 5560137 5717775 81410 14787 0 X 0 1 X 0 0 X 6112172 6131780 6273271 5935889 5141590 29594702 1800 2400 2400 1200 4765 12565 6113972 6134180 6275671 5937089 5146355 29607267 0 0 0 29607267 43117 25540 30703 66372 -20432 145300 43117 25540 30703 66372 -20432 145300 6157089 6159720 6306374 6003461 5125923 29752567 0.99510 0.99310 0.00490 0.00690 X 544 0 0 0 0 0 0 0 0 1 544 544 0 PART I-A, LINE 1: A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HEALTH CARE FACILITIES ASSOCIATION BY THE ENTITY WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES. PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HEALTH CARE FACILITIES ASSOCIATION BY THE ENTITY WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 19358 19358 1382938 1301310 81628 1629646 1158853 470793 707171 527461 179710 60351 2500 57851 809340 PATIENT FUNDS 32318 CASH VALUE OF LIFE INSURANCE 317367 INVESTMENTS 1428032 1777717 PATIENT FUNDS 32318 32318 X 6118268 1 1 6118267 32 32 6118299 6022071 1 1 6022070 14787 32 14819 6036889 PART X, LINE 2: THE COMPANY HAS IMPLEMENTED THE NEW ACCOUNTING REQUIREMENTS ASSOCIATED WITH UNCERTAINTY IN INCOME TAXES USING THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ASC 740, INCOME TAXES. USING THAT GUIDANCE, TAX POSITIONS INITIALLY NEED TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS WHEN IT IS MORE-LIKELY-THAN-NOT THE POSITIONS WILL BE SUSTAINED UPON EXAMINATION BY THE TAX AUTHORITIES. IT ALSO PROVIDES GUIDANCE FOR DE-RECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOUSURE AND TRANSITION. AS OF SEPTEMBER 30, 2015, THE COMPANY HAS NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS AND RECOGNIZED NO SUCH INTEREST OR PENALTIES DURING THE YEARS ENDED SEPTEMBER 30, 2015 AND 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 32. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 32. FORM 990, PART VI, SECTION A, LINE 3 MOUNTAIN VISTA HEALTH PARK CONTRACTS TULLOCK MANAGEMENT COMPANY TO PERFORM VARIOUS OPERATIONAL MANAGEMENT DUTIES FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF FORM 990 IS GIVEN TO THE DIRECTORS FOR REVIEW PRIOR TO BEING SIGNED BY THE APPROPRIATE OFFICER OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY FORM 990, PART VI, SECTION B, LINE 15 DIRECTORS RECEIVE NO COMPENSATION. KEY EMPLOYEE COMPENSATION IS REVIEWED BY THE MANAGEMENT COMPANY AND THE ADMINISTRATOR ANNUALLY. COMPENSATION RATES FOR KEY EMPLOYEES ARE COMMENSURATE WITH SIMILAR POSITIONS AS COMPARED WITH INDUSTRY DATA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST TO THE MANAGEMENT COMPANY DURING NORMAL BUSINESS HOURS.