2013-08-14T15:57:47-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2011-10-01 561698181 STANLY REGIONAL MEDICAL CENTER FOUNDATION STAN 7049823888 POST OFFICE BOX 254 ALBEMARLE NC 28002 JANE BOONE 7049823888 2013-08-13 1 JOHN NORMAN P01506766 7049985200 2011 2016-02-24 21:20:13Z JANE BOONE POST OFFICE BOX 254 ALBEMARLE NC 28002 9382426 0 X WWW.STANLY.ORG X 1990 NC THE ORGANIZATION EXISTS EXCLUSIVELY FOR THE BENEFIT OF STANLY HEALTH SERVICES, INC. 17 17 0 30 0 0 231732 426694 0 0 384533 1042115 -40865 100570 575400 1569379 226468 83787 0 0 0 0 0 0 8007 23674 48306 250142 132093 325258 1437286 5750822 7228820 3009 1214 5747813 7227606 X "SEE SCHEDULE O"THE STANLY REGIONAL MEDICAL CENTER FOUNDATION EXISTS EXCLUSIVELY FOR THE BENEFIT OF STANLY HEALTH SERVICES, INC. ITS PRINCIPAL PURPOSE IS TO IDENTIFY, SOLICIT, RECORD, MANAGE AND DISBURSE GIFT INCOME FROM THE PRIVATE SECTOR TO ENSURE THE FUTURE OF EXCEPTIONAL COMMUNITY BASED HEALTH CARE. 0 0 85276 83787 IN FISCAL YEAR 2012, IN ADDITION TO GENERAL SOLICITATION OF CHARITABLE CONTRIBUTIONS, THE STANLY REGIONAL MEDICAL CENTER FOUNDATION ADDED SEVERAL MAJOR DONORS (THOSE GIVING IN EXCESS OF $10K OVER TEN YEARS) TO THE ROSTER OF THE STANLY SOCIETY, HAD OVER 225 EMPLOYEES WHO GAVE 1 HOURS PAY PER MONTH BACK TO THE FOUNDATION AS MEMBERS OF THE PRESIDENTS CLUB, AND HELD TWO PUBLIC FUNDRAISERS THAT NETTED OVER $98,070 IN UNRESTRICTED FUNDS WHICH WERE PLACED INTO THE ENDOWMENT. THE FOUNDATION FUNDED OVER A DOZEN HEALTH CARE PROJECTS AND PROGRAMS WITHIN STANLY HEALTH SERVICES AND AWARDED SCHOLARSHIPS TO OVER A DOZEN STUDENTS. 85276 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 17 17 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X JANE BOONE 7049823888 POST OFFICE BOX 254 ALBEMARLE NC 28002 DARRELL ALMOND 1.00 X 0 0 0 RICHARD ALMOND 1.00 X 0 0 0 BOB BEANE 1.00 X 0 0 0 SUE BOHNSACK 1.00 X 0 0 0 ANDY CASTELLOE 1.00 X 0 0 0 STEVE CUMMING 1.00 X 0 0 0 FRANK GREEN 1.00 X 0 0 0 SUSAN DEVEREUX 1.00 X 0 0 0 SUE JORDAN 1.00 X 0 0 0 BILL MULLINIX 1.00 X 0 0 0 DEE PANKEY 1.00 X 0 0 0 JANE LISK 1.00 X 0 0 0 MIKE SNYDER 1.00 X 0 0 0 SUSAN STOKES 1.00 X 0 0 0 CAROL SULLIVAN 1.00 X 0 0 0 CATHERINE MOELLER 1.00 X 0 0 0 CHRISTINE VAUGHN 1.00 X 0 75409 18663 JANE BOONE 28.00 X 0 51253 2116 0 126662 20779 0 0 0 0 0 426694 426694 126460 126460 8669758 7754103 915655 915655 915655 157014 58944 98070 98070 2500 2500 2500 1569379 0 0 1142685 78537 78537 5250 5250 161 161 6904 6904 2289 2289 13936 13936 980 980 OTHER DIRECT EXPENSE 18222 1489 8726 8007 MEMBERSHIPS AND DUES 5814 5814 132093 85276 38810 8007 151281 182617 2154 276017 2512 3132 3099 3099 0 0 5594875 6767054 5750822 7228820 3009 1214 3009 1214 X 5344541 6768242 192716 248808 210556 210556 5747813 7227606 5750822 7228820 X 1437286 42507 X X 0 1 1 X 0 X 241870 199992 219827 231732 426694 1320115 241870 199992 219827 231732 426694 1320115 80846 1239269 182479 134332 149264 93334 126460 685869 -12003 3678 3317 2700 2500 192 2006176 0.61770 0.52590 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3099 3099 0 0 INVESTMENTS 6767054 F 6767054 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FILING ORGANIZATION IS A NON PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAX ON REVENUE EARNED FROM ITS TAX-EXEMPT STATUS. THE FILING ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUSES NOR IS IT AWARE OF ANY OF ITS ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE YEARS 2008 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. THE FILING ORGANIZATION HAS ADOPTED THE INCOME TAX STANDARD ISSUED BY FINANCIAL ACCOUNTING STANDARDS BOARD IN LIGHT OF ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. DANCING WITH THE STARS 51172 51172 132 7260 5178 PLAY FOR THE CURE 16275 16275 89567 89567 1049 45325 157014 157014 1049 45325 132 7260 5178 58944 98070 1 STANLY REGIONAL MEDICAL CENTER INC 301 YADKIN STREET ALBEMARLE NC 28001 560556760 501(C)(3) 53537 SUPPORT COMMUNITY CARE CLINIC 220 YADKIN STREET ALBEMARLE NC 28001 562274174 501(C)(3) 25000 SUPPORT 2 0 EDUCATIONAL SCHOLARSHIPS 2 5250 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: HINSON SCHOLARSHIP: THIS SCHOLARSHIP IS OFFERED TO APPLICANTS WHO HAVE ALREADY COMPLETED TWO YEARS OF UNDERGRADUATE STUDY BY JUNE AND HAVE BEEN ACCEPTED INTO A COURSE OF STUDY IN THE MEDICAL/HEALTHCARE FIELD. APPLICANTS MUST HAVE A 3.5 CUMULATIVE UNDERGRADUATE GPA OR HIGHER. APPLICANTS MUST BE CURRENTLY EMPLOYED BY STANLY HEALTH SERVICES, INC. OR BE THE DEPENDENTS OF A CURRENT EMPLOYEE OF STANLY HEALTH SERVICES, INC. APPLICANTS MUST SUBMIT A STATEMENT EXPLAINING WHAT A CAREER IN HEALTHCARE WILL MEAN TO THEM AND HOW IT WILL BENEFIT HUMANITY. RECOMMENDATIONS FROM A PROFESSOR AND FROM SOMEONE WITHIN STANLY HEALTH SERVICES ARE REQUIRED. FOUNDATION CB CROOK FAMILY HEALTHCARE SCHOLARSHIP: THIS SCHOLARSHIP IS OFFERED TO STUDENTS WHO HAVE ALREADY COMPLETED TWO YEARS OF UNDERGRADUATE STUDY AND HAVE BEEN ACCEPTED INTO A COURSE OF STUDY IN THE HEALTH CARE FIELD. SCHOLARSHIP IS AWARDED BASED ON ACADEMIC PERFORMANCE AND COMMUNITY INVOLVEMENT. APPLICANTS MUST SUBMIT AN APPLICATION, TRANSCRIPT, AND A COMPLETE LIST OF SCHOOL AND COMMUNITY RELATED ACTIVITIES. RECOMMENDATIONS ARE REQUIRED. FORM 990, PART VI, SECTION A, LINE 7B THE STANLY HEALTH SERVICES BOARD OF DIRECTORS MUST APPROVE NEW DIRECTORS NOMINATED TO THE FOUNDATION BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 CFO AND CONTROLLER WILL REVIEW AND COPIES WILL BE EMAILED TO BOARD MEMBERS AND REVIEWED AT FINANCE COMMITTEE AND BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF DIRECTORS DECLARES ANY POTENTIAL CONFLICTS OF INTEREST ANNUALLY. MEMBERS WITH POTENTIAL CONFLICTS ARE ASKED TO EXCUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE OF POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE STAFF IS EMPLOYED BY STANLY REGIONAL MEDICAL CENTER. THE FOUNDATION HAS NO EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -32,493. TRANSFERS FROM AFFILIATES 75,000. TOTAL TO FORM 990, PART XI, LINE 5: 42,507. FORM 990, PART VII, DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS OFFICERS LISTED ON PART VII WORK AN AVERAGE OF 40 HOURS PER WEEK OR MORE. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND THE RELATED ENTITIES LISTED ON SCHEDULE R. STANLY MEDICAL SERVICES INC 320 YADKIN STREET ALBEMARLE NC 28001 561892763 HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 STANLY REGIONAL MEDICAL CENTER INC 301 YADKIN STREET ALBEMARLE NC 28001 560556760 HOSPITAL NC 501(C)(3) 170(B)(1)(A)(III) N/A 0 STANLY MANOR INC 625 BETHANY ROAD ALBEMARLE NC 28001 561623092 LONG-TERM HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 STANLEX INC 907 NORTH SECOND STREET ALBEMARLE NC 28001 561532751 HEALTHCARE NC 501(C)(3) 509(A)(3) N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 STANLY REGIONAL MEDICAL CENTER INC P 75000 EXPENSES STANLY REGIONAL MEDICAL CENTER INC B 101368 CASH STANLY REGIONAL MEDICAL CENTER INC N 120410 SALARY&BENEFITS