2012-08-15T15:51:19-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-10-01 561892763 STANLY MEDICAL SERVICES INC STAN 7049820636 320 YADKIN STREET ALBEMARLE NC 28801 NYKOLA SAMILO 7049820636 2012-08-14 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z BRAD MARINO 320 YADKIN STREET ALBEMARLE NC 28801 15239717 0 X WWW.STANLYMEDICALSERVICES.ORG X 1994 NC TO PROMOTE, IMPROVE, AND ENHANCE THE HEALTH AND WELFARE OF COMMUNITIES IN OR OUTSIDE OF THIS STATE. 5 2 153 2 0 0 20384 0 13609817 15239717 0 0 3144 0 13633345 15239717 0 0 0 0 11835273 13075748 0 0 0 4410882 5046222 16246155 18121970 -2612810 -2882253 3952765 3897837 2601820 2757259 1350945 1140578 X 1) TO PROMOTE, IMPROVE, AND ENHANCE THE HEALTH AND WELFARE OF COMMUNITIES IN OR OUTSIDE OF THIS STATE THROUGH THE SUPPORT OF OR INVOLVEMENT IN THE RECRUITMENT, FORMATION, DEVELOPMENT, MANAGEMENT, EQUIPPING, AND MAINTENANCE OF HEALTHCARE SERVICES PROVIDED IN AFFILIATION WITH THE HEALTH CARE SYSTEM OF WHICH STANLY REGIONAL MEDICAL CENTER, INC., A NORTH CAROLINA NONPROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE CODE, IS AN AFFILIATE AND OTHER HEALTH CARE PROVIDERS LOCATED IN AND AROUND ALBEMARLE, STANLY COUNTY, NORTH CAROLINA (A MEDICALLY UNDERSERVED AREA). 2) TO PROVIDE FUNDS, PROPERTY, OR OTHER BENEFITS FOR THE BENEFIT OF OTHER MEDICALLY UNDERSERVED AREAS IN OR OUTSIDE OF THIS STATE. 3) TO PROMOTE AND CARRY ON EDUCATIONAL ACTIVITIES RELATED TO THE CARE OF THE SICK, INJURED, OR RELATED TO THE PROMOTION OF HEALTH. 4) TO PROMOTE OR CARRY OUT SUCH OTHER ACTIVITIES AS MAY BE DEEMED ADVISABLE FOR THE BETTERMENT OF THE GENERAL HEALTH OF THE COMMUNITIES SERVED. 0 0 16297008 14615442 HEALTH SERVICESPROVIDED HEALTHCARE IN A PROVIDER'S OFFICE SETTING. SERVICES INCLUDED GENERAL PATIENT SERVICES, LABORATORY SERVICES, AND X-RAY SERVICES. 478332 624275 CENTRAL LAB 16775340 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 17 0 153 1 0 0 0 0 0 0 0 0 0 0 X 5 2 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PENNY PATRICK 7049844643 301 YADKIN STREET ALBEMARLE NC 28001 AL TAYLOR 1.00 X X 0 317076 42607 AMY BOGER 1.00 X 0 0 0 DR YOLANDA JOHNSON 1.00 X 230336 0 10278 NYKOLA SAMILO 1.00 X X 0 214071 32636 KRISTI JACKSON 1.00 X 0 0 0 BRAD MARINO 40.00 X 0 165083 10388 ERIC JOHN MALLICO 40.00 X 597012 0 8598 JOHN DAVID HILL 40.00 X 479759 0 11658 JOSEPH ZUCKER 40.00 X 439196 0 11495 TIMOTHY SEAN HALL 40.00 X 398378 0 11330 EDWARD WILLIAMS 40.00 X 349266 0 5278 2493947 696230 144268 29 0 1 0 WINDSTREAM PO BOX 9001908 LOUISVILLE KY 402901908 PHONE/FAX/INTERNET SERVICES 169491 LABORATORY CORP OF AMERICA HOLDINGS PO BOX 12140 BURLINGTON NC 272162140 LAB SERVICES 124936 2 PATIENT REVENUE 621300 15115634 15115634 124083 124083 15239717 15239717 15239717 0 0 1095726 246224 849502 9763009 9763009 231349 231349 1408926 1295488 113438 576738 519144 57594 19055 19055 65172 65172 351809 336728 15081 9851 9189 662 317988 317988 1627035 1484646 142389 23728 8854 14874 50 50 179245 138633 40612 68414 61377 7037 MEDICAL SUPPLIES 977188 977188 BAD DEBT EXPENSE 975050 975050 MAINTENANCE/REPAIRS 299500 287288 12212 CLEANING/LAUNDRY 132137 123135 9002 18121970 16775340 1346630 0 1160802 1184709 1979812 1909210 106873 92160 3375614 2708880 637408 666734 67870 45024 3952765 3897837 1687598 1821149 914222 936110 2601820 2757259 X 1350945 1140578 1350945 1140578 3952765 3897837 X -2882253 2671886 X X 0 1 1 X 0 X 33145 71189 19143 20382 143859 9268830 11420767 13121277 13609817 15239717 62660408 9301975 11491956 13140420 13630199 15239717 62804267 0 0 0 62804267 5024 2342 364 7730 5024 2342 364 7730 3390 3144 6534 9306999 11494298 13144174 13633343 15239717 62818531 0.99980 0.99970 0.00010 0.00020 X 18285 9898 8387 3335829 2685363 650466 21500 13619 7881 666734 PENSION LIABILITY 933241 ADVANCES FROM AFFILIATES 2869 936110 15239717 18121970 -2882253 2671886 2671886 -210367 17911603 2671886 2671886 15239717 0 15239717 18121970 0 18121970 0 18121970 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 2007 TO 2010 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. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNRECOGNIZED PENSION EXPENSE -192,074. TRANSFERS TO AFFILIATES 2,863,960. X X X X X 0 0 0 0 0 0 0 0 0 AL TAYLOR 0 239370 0 59819 0 17887 0 20258 0 22349 0 359683 0 0 DR YOLANDA JOHNSON 177486 0 36350 0 16500 0 0 0 10278 0 240614 0 0 0 NYKOLA SAMILO 0 182953 0 28738 0 2380 0 14960 0 17676 0 246707 0 0 BRAD MARINO 0 154889 0 0 0 10194 0 0 0 10388 0 175471 0 0 ERIC JOHN MALLICO 460570 0 119942 0 16500 0 0 0 8598 0 605610 0 0 0 JOHN DAVID HILL 463259 0 0 0 16500 0 0 0 11658 0 491417 0 0 0 JOSEPH ZUCKER 414558 0 2638 0 22000 0 0 0 11495 0 450691 0 0 0 TIMOTHY SEAN HALL 329507 0 52371 0 16500 0 0 0 11330 0 409708 0 0 0 EDWARD WILLIAMS 332766 0 0 0 16500 0 0 0 5278 0 354544 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THREE EMPLOYEES (CEO, COO, CFO) ARE EMPLOYED BY THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY D/B/A CAROLINAS HEALTHCARE SYSTEM ("CHS") AND LEASED TO THE ORGANIZATION THROUGH A MANAGEMENT AGREEMENT. AS SUCH, THEIR COMPENSATION INFORMATION IS NOT REQUIRED ON PART VII. FORM 990, PART VI, SECTION B, LINE 11 THE CFO AND CONTROLLER WILL REVIEW THE DRAFT, COPIES WILL BE EMAILED TO THE BOARD MEMBERS, AND THE DRAFT WILL BE REVIEWED AT THE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE BYLAWS ADDRESS WHAT CONSTITUTES CONFLICTS OF INTEREST, THE RESPONSIBILITY OF DISCLOSURE OF EACH MEMBER, HOW CONFLICTS (AND POTENTIAL CONFLICTS) ARE ADDRESSED, AND EACH MEMBER OF THE BOARD OF DIRECTORS FILES A CONFLICT OF INTEREST STATEMENT ANNUALLY WHICH IS REVIEWED BY THE BOARD CHAIR AND IS MAINTAINED BY THE CORPORATE SECRETARY. 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 COMPENSATION OF TOP EXECUTIVES AND TOP MANAGEMENT AND OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED THROUGH AN INDEPENDENT CONSULTANT'S REVIEW OF MARKET COMPARISON STUDIES. THIS PROCESS WAS LAST PERFORMED IN 2008. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNRECOGNIZED PENSION EXPENSE -192,074. TRANSFERS FROM AFFILIATES 2,863,960. TOTAL TO FORM 990, PART XI, LINE 5: 2,671,886. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART VII, DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS: OFFICERS LISTED ON PART VII WORK AN AVERAGE OF 40 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND THE RELATED ENTITIES LISTED ON SCHEDULE R. STANLY REGIONAL MEDICAL CENTER FOUNDATION INC 301 YADKIN STREET ALBEMARLE NC 28001 561698181 CHARITY NC 501(C)(3) 170(B)(1)(A)(VI) 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 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 STANLY REGIONAL MEDICAL CENTER INC R 717000 CASH VALUE STANLY REGIONAL MEDICAL CENTER INC J 626451 MARKET VALUE STANLY REGIONAL MEDICAL CENTER INC P 1520509 EXPENSES