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 560556760 STANLY REGIONAL MEDICAL CENTER STAN 7049844393 POST OFFICE BOX 1489 ALBEMARLE NC 28002 NYKOLA SAMILO 7049844393 2012-08-15 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z ALFRED TAYLOR 301 YADKIN ROAD ALBEMARLE NC 28001 136491504 0 X WWW.STANLY.ORG X 1945 NC TO FACILITATE IMPROVING THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. 12 11 826 70 5594684 -74131 616827 729130 97142715 103069794 703457 2640530 850203 947306 99313202 107386760 31394 30222 0 0 41781123 43977572 0 0 0 49879252 53643252 91691769 97651046 7621433 9735714 108653546 112179894 42301863 42530196 66351683 69649698 X STANLY REGIONAL MEDICAL CENTER'S MISSION IS TO FACILITATE IMPROVING THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE, BY PROVIDING QUALITY SERVICES THAT ARE COMPREHENSIVE, AFFORDABLE AND DELIVERED: COMPASSIONATELY, APPROPRIATELY, RESPONSIBLY, EFFICIENTLY. THE HOSPITAL USES ITS RESOURCES TO EFFECTIVELY AND EFFICIENTLY PROVIDE QUALITY HEALTH CARE TO THE RESIDENTS OF STANLY COUNTY AND THE IMMEDIATELY SURROUNDING AREAS IN A PASSIONATE AND RESPONSIVE MANNER. IN KEEPING WITH THE HOSPITAL'S MISSION THE HOSPITAL:-PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS WITH REIMBURSEMENT AT A LEVEL BELOW THE COST OF PROVIDING THAT CARE;-PROVIDES BAD DEBT AND CHARITY CARE;-PROVIDES HEALTH ACTIVITIES, SPACE AND PROGRAMS TO SUPPORT THE COMMUNITY. 0 0 81225700 30222 97475110 STANLY REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY 21,000 INPATIENT DAYS OF CARE AND APPROXIMATELY 80,000 OUTPATIENT VISITS (EXCLUDING LABS) DURING 2011. DISCHARGES WERE APPROXIMATELY 5,000.AS STATED ABOVE, STANLY REGIONAL PROVIDED HEALTH CARE TO MEDICARE AND MEDICAID PATIENTS WITH REIMBURSEMENT BELOW THE HOSPITAL'S COST. THE HOSPITAL RECOGNIZES THESE AMOUNTS AS A FORM OF UNCOMPENSATED CARE IN MEETING ITS MISSION. 81225700 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 92 0 826 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X PENNY PATRICK 7049844643 301 YADKIN ROAD ALBEMARLE NC 28001 ALFRED P TAYLOR 40.00 X X 317076 0 42607 JOHN LOWDER 1.00 X 0 0 0 DARRELL ALMOND 1.00 X 0 0 0 DAVID W HORTON SR 1.00 X 0 0 0 JOEL HUNEYCUTT 1.00 X 0 0 0 LARRY BAUCOM 1.00 X 0 0 0 DAVID W HORTON SR 1.00 X 0 0 0 DARRELL ALMOND 1.00 X 0 0 0 JOHN LOWDER 1.00 X 0 0 0 JOSEPH GODWIN 1.00 X 0 0 0 ELBERT L WHIT WHITLEY JR 1.00 X 0 0 0 JACK P JORDAN 1.00 X 0 0 0 DR MICHAEL MCLEOD 1.00 X 0 0 0 SHERRILL SMITH 1.00 X 0 0 0 MICHAEL G HARWOOD 1.00 X 0 0 0 DAWN ALLEN 1.00 X 0 0 0 DR RUFUS S LEFLER III 1.00 X 0 0 0 NYKOLA SAMILO 40.00 X 214071 0 32636 JUDY DORAN 40.00 X 32500 0 0 BRIAN FREEMAN 40.00 X 158082 0 10804 BRAD MARINO 40.00 X 165083 0 10388 ANJANA M YOUNG 40.00 X 219070 0 10152 JEFFREY B PITMAN 40.00 X 216714 0 711 WILLIAM R DENNIS 40.00 X 185438 0 15437 KELLY J NEW 40.00 X 173752 0 9248 SCOTT M WINSLOW 40.00 X 171224 0 12810 DEBRA SMITH 0.00 X 227075 0 5310 2080085 0 150103 29 1 1 0 CAROLINAS MEDICAL CENTER 1000 BLYTHE BLVD CHARLOTTE NC 28203 MANAGEMENT SERVICES 2682982 MAXIT HEALTHCARE 705 E MAIN ST WESTFIELD IN 46074 SOFTWARE CONVERSION 853238 DIVERSIFIED CLINICAL SERVICES PO BOX 850001 ORLANDO FL 32885 WOUNDCARE 631540 TRUSTAFF 4270 GLENDALE MILFORD RD CINCINNATI OH 45242 NURSE STAFFING 586398 CMC-NORTHEAST 920 CHURCH ST NORTH CONCORD NC 28025 HOSPITALIST 572468 28 201624 527506 729130 PATIENT REVENUE 621400 93868452 93868452 UNRELATED PHARMACY 621400 5594684 5594684 3606658 3606658 103069794 535652 535652 31209622 29104744 2104878 2104878 2104878 EQUITY EARNINGS 900099 487141 487141 460165 460165 947306 107386760 97475110 5594684 3587836 30222 30222 810532 810532 34294745 30477247 3817498 836320 743238 93082 5742251 5109821 632430 2293724 2055926 237798 1361375 1361375 110931 110931 79914 79914 9878 9878 6688461 4811704 1876757 803974 803974 668168 355175 312993 2310608 2310608 1927130 1560366 366764 38554 30014 8540 182039 113990 68049 1284057 1284057 5252459 5019108 233351 1080609 1080609 PROGRAM SUPPLIES 14585855 14535980 49875 PROVISION FOR UNCOLLECT 12665344 12665344 EQUIPMENT EXPENSE 2361729 2097272 264457 REPAIRS AND MAINTENANCE 1070398 866319 204079 1161769 753974 407795 97651046 81225700 16425346 0 12953235 8828252 13223137 14620551 2298359 2417998 1326577 1685761 134451911 86906460 43397431 47545451 29805369 29854510 5649438 7227371 108653546 112179894 7232512 8257641 22830532 21522636 12238819 12749919 42301863 42530196 X 65782901 68723692 568782 926006 66351683 69649698 108653546 112179894 X 9735714 -6437699 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9878 9878 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF MEMBER ORGANIZATION DUES ARE ATTRIBUTABLE TO LOBBYING. 7787403 7787403 75432288 52798804 22633484 0 35686109 26918927 8767182 15546111 7188729 8357382 47545451 INVESTMENTS 29854510 F 29854510 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 7376510 PENSION LIABILITY 5373409 12749919 107386760 97651046 9735714 -2466845 -3970854 -6437699 3298015 100591837 -2466845 -3598948 -6065793 106657630 729130 729130 107386760 97651046 0 97651046 0 97651046 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: NET ASSETS RELEASED FROM RESTRICTION 371,906. UNRECOGNIZED PENSION EXPENSE -1,105,925. TRANSFERS TO AFFILIATES -2,864,929. PART XII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTION REVENUE 729,130. 1 1 1 X 1 X 1 1 0 1 1 1110559 1143081 -32522 0.00000 13014174 8943779 4070395 0.04790 385283 250188 135095 0.00160 14510016 10337048 4172968 0.04950 483944 483944 0.00570 11833 11833 0.00010 495777 495777 0.00580 15005793 10337048 4668745 0.05530 157592 157592 0.00190 157592 157592 0.00190 1 4159265 0 26614383 28409368 -1794985 X 1 1 1 WEST STANLY IMAGING RADIOLOGY JOINT VENTURE 0.51000 2 STANLY REGIONAL WEST LLC MEDICAL PROPERTY DEVELOPMENT/LEASING COMPANY 0.24200 1 1 STANLY REGIONAL MEDICAL CENTER INC

301 YADKIN STREET ALBEMARLE NC 28001

X X X INPATIENT REHABILIATION UNIT AND INPATIENT PSYCHIATRIC UNIT STANLY REGIONAL MEDICAL CENTER INC 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X 1 X X X 1 X X X X X X 1 X 0 1 PART I, LINE 3C: WE USE THE FEDERAL POVERTY GUIDELINES AT 300% AS PUBLISHED BY THE US DEPT OF HEALTH AND HUMAN SERVICES. WE USE INCOME AND LIST OF ASSETS TO DETERMINE ELIGIBILITY.ON OCTOBER 1, 2010, STANLY REGIONAL INSTITUTED A NEW UNINSURED POLICY. UNDER THIS POLICY, UNINSURED PATIENTS RECEIVE A 40% DISCOUNT ON THEIR TOTAL CHARGES UP FRONT. DURING THIS TAX YEAR, $2,238,597 OF CHARGES AT COST (GROSS CHARGES OF $6,816,733) WERE WRITTEN OFF. PART I, LINE 7: THE ORGANIZATION USED THE IRS WORKSHEETS TO CALCULATE THE AMOUNTS REPORTED ON SCHEDULE H. PART I, LINE 7G: N/A. NO SUBSIDIZED HEALTH SERVICES PROVIDED. PART I, L7 COL(F): THE ORGANIZATION DOES NOT HAVE A PROCESS FOR ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY. THE ORGANIZATION MAKES ITS BEST EFFORT TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY WITH EVERY PATIENT. PART II: STANLY REGIONAL RECRUITS PHYSICIANS NEEDED TO PROVIDE ADEQUATE CARE AND PROMOTE HEALTH AMONG OUR COMMUNITY. PHYSICIANS RECRUITED RECENTLY INCLUDE FAMILY MEDICINE, GENERAL SURGERY, ORTHOPEDICS, GASTROENTROLOGY AND UROLOGY. ALSO, A MEMBER OF THE EXECUTIVE LEADERSHIP TEAM PARTICIPATES IN COMMUNITY COMMITTEES - LOCAL EMERGENCY PLANNING COMMITTEE AND ENVIRONMENTAL AFFAIRS BOARD. PART III, LINE 4: BAD DEBT EXPENSE IS CALCULATED BY ANALYZING THE AGING OF ACCOUNTS FROM THEIR SERVICE DATE AND APPLYING A RESERVE PERCENTAGE BASED ON THE AGING BUCKET THAT THEY FALL INTO. AGING BUCKETS ARE AS FOLLOWS: IN-HOUSE/UNBILLED @ 6%; < 30 DAYS @ 6%; 31-60 DAYS @ 8%; 61-90 DAYS @ 10%; 91-120 DAYS @ 25%; 121-150 DAYS @ 80%; >150 DAYS @ 90%. BAD DEBT WRITE OFFS AND RECOVERIES ARE POSTED TO THE BAD DEBT ALLOWANCE ACCOUNT AND THE ALLOWANCE ACCOUNT IS THEN ADJUSTED TO MATCH THE CALCULATED AMOUNT PER THE AGING MODEL. PART III, LINE 8: THE ORGANIZATION USED THE IRS WORKSHEETS TO CALCULATE THE AMOUNTS REPORTED ON SCHEDULE H. PART III, LINE 9B: THERE ARE NO COLLECTION EFFORTS AS SOON AS AN ACCOUNT IS IDENTIFIED AS CHARITY CARE OR FINANCIAL ASSISTANCE IF IT IS 100%. WE APPLY THE FULL ADJUSTMENT AT TIME OF APPROVAL. FOR ACCOUNTS THAT HAVE ONLY PARTIAL FINANCIAL ASSISTANCE THE REMAINING BALANCE FOLLOWS COLLECTION PROCESS DEFINED FOR ALL OTHER ACCOUNTS. STANLY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 17E: SEND LETTER TO POTENTIAL PATIENTS AFTER DISCHARGE. STANLY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 19D: ALL PATIENTS REGARDLESS OF COVERAGE ARE CHARGED THE SAME AMOUNT FOR ALL PROCEDURES. STANLY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 21: SAME AMOUNT IS CHARGED FOR ALL PATIENTS, THEN FINANCIAL ASSISTANCE ADJUSTMENT IS TAKEN WHEN APPROVED. PART VI, LINE 2: STANLY REGIONAL WORKS IN PARTNERSHIP WITH THE STANLY COUNTY HEALTH DEPARTMENT AND OTHER AREA AGENCIES TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. THE FINDINGS FROM THIS REPORT ARE USED TO HELP OUR ORGANIZATION TARGET SPECIFIC DEMOGRAPHICS AND RELATED HEALTH CONCERNS AND ILLNESSES WITH SIGNIFICANT PREVALENCE IN OUR SERVICE AREA. IN ADDITION TO THIS LOCAL EFFORT, STANLY REGIONAL ALSO RELIES ON STATISTICS PROVIDED BY THE NORTH CAROLINA HOSPITAL ASSOCIATION AND VARIOUS DISEASE-SPECIFIC AGENCIES SUCH AS THE NORTH CAROLINA STROKE ASSOCIATION TO OBTAIN NEEDS ASSESSMENT INFORMATION. PART VI, LINE 3: WE HAVE OUR POLICY POSTED ON OUR WEBSITE AS WELL AS THROUGH THE NC HOSPITAL ASSOCIATION. WE OFFER "ABOUT YOUR BILL" BROCHURES THAT HAVE DIFFERENT BILLING PROCEDURES INCLUDING OUR FINANCIAL ASSISTANCE. WE HAVE BILLING STAFF AVAILABLE M-F, 8:30 - 5:00 TO ASSIST AND ANSWER QUESTIONS RELATING TO OUR FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: THE PROFILES OF STANLY REGIONAL MEDICAL CENTER AUDIENCES CONSIST OF THE FOLLOWING GEOGRAPHIC AND DEMOGRAPHIC FACTORS. (1) CENTRAL SERVICE AREA - THE CENTRAL SERVICE AREA CONSISTS OF ALBEMARLE, NORWOOD, NEW LONDON, AND BADIN. THE MEDIAN INCOME FOR THIS AREA IS $45,179.00. THE 2008 POPULATION FOR THIS AREA WAS 44,042. THE 2013 PROJECTED POPULATION FOR THIS AREA IS 44,930. THE AVERAGE AGE OF THIS AREA IS 39. (2) WESTERN SERVICE AREA - THE WESTERN SERVICE AREA CONSISTS OF OAKBORO, STANFIELD, RICHFIELD, LOCUST, MISENHEIMER, GOLD HILL, AND MT. PLEASANT. THE MEDIAN INCOME FOR THIS AREA IS $48,764.00. THE 2008 POPULATION FOR THIS AREA WAS 18,724. THE 2013 PROJECTED POPULATION FOR THIS AREA IS 19,402. THE AVERAGE AGE OF THIS AREA IS 37. (3) EASTERN SERVICE AREA - THE EASTERN SERVICE AREA CONSISTS OF MT. GILEAD AND TROY. THE MEDIAN INCOME FOR THIS AREA IS $39,652. THE 2008 POPULATION FOR THIS AREA WAS 14,707. THE 2013 PROJECTED POPULATION FOR THIS AREA IS 14,931. THE AVERAGE AGE OF THIS AREA IS 39. PART VI, LINE 6: STANLY REGIONAL PROMOTES WELLNESS AND DISEASE MANAGEMENT IN THE COMMUNITIES IT SERVES BY HOSTING NUMEROUS HEALTH SCREENINGS TARGETING HIGH BLOOD PRESSURE, STROKE PREVENTION, HEART DISEASE AND DIABETES. THESE SCREENINGS TAKE PLACE THROUGH CIVIC GROUPS, AREA CHURCHES, COMMUNITY GROUPS AND GEOGRAPHIC SERVICE AREA EVENTS AND FESTIVALS. OUR EMPLOYEES ALSO SERVE AS MEMBERS OF A SPEAKER'S BUREAU WHERE THEY SERVE AS GUEST LECTURERS ON HEALTHCARE TOPICS OF INTEREST TO ORGANIZATIONS, SCHOOLS AND PUBLIC FORUMS.IN ADDITION TO DISEASE-SPECIFIC HEALTH SCREENINGS AND EDUCATION, THE HOSPITAL WORKS CLOSELY WITH OTHER AREA NOT-FOR-PROFITS TO CULTIVATE THE COMMUNITY'S NEEDS (HABITAT FOR HUMANITY, ADOPT-A-HIGHWAY, COMMUNITY TABLE, GROUP HOMES FOR THE AUTISTIC, ETC). THROUGH COMMUNITY EFFORTS AND INITIATIVES, THE HOSPITAL'S EMPLOYEES HAVE ASSISTED IN BUILDING AND CLEAN UP PROJECTS, AS WELL AS FEEDING AND CARING FOR THOSE LESS FORTUNATE IN THE AREA. STANLY REGIONAL ALSO DONATES MEDICAL SUPPLIES AS NEEDED TO AREA CHURCH GROUPS LEAVING FOR OVERSEAS MISSION TRIPS. PART VI, LINE 7: EFFECTIVE MARCH 1, 2009, THE PARENT COMPANY ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY D/B/A CAROLINAS HEALTHCARE SYSTEM (CHS). REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 EDUCATIONAL ASSISTANCE 9 30222 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: EMPLOYEES ARE GRANTED EDUCATION REIMBURSEMENT BASED ON NEED, AVAILABILITY, AND APPROPRIATE DOCUMENTATION. X X X X X 1 0 0 0 0 0 0 0 0 ALFRED P TAYLOR 239370 0 59819 0 17887 0 20258 0 22349 0 359683 0 0 0 NYKOLA SAMILO 182953 0 28738 0 2380 0 14960 0 17676 0 246707 0 0 0 BRIAN FREEMAN 149969 0 0 0 8113 0 0 0 10804 0 168886 0 0 0 BRAD MARINO 154889 0 0 0 10194 0 0 0 10388 0 175471 0 0 0 ANJANA M YOUNG 206593 0 0 0 12477 0 0 0 10152 0 229222 0 0 0 JEFFREY B PITMAN 200214 0 0 0 16500 0 0 0 711 0 217425 0 0 0 WILLIAM R DENNIS 168948 0 0 0 16490 0 0 0 15437 0 200875 0 0 0 KELLY J NEW 157252 0 0 0 16500 0 0 0 9248 0 183000 0 0 0 SCOTT M WINSLOW 154724 0 0 0 16500 0 0 0 12810 0 184034 0 0 0 DEBRA SMITH 44019 0 35897 0 147159 0 4741 0 569 0 232385 0 0 0 PART I, LINE 4A A FORMER OFFICER RECEIVED A SEVERANCE PAYMENT DURING THE YEAR. ALFRED P TAYLOR OFFICER/BOARD MEMBER ALFRED P. TAYLOR, AN OFFICER OF THE FILING ORGANIZATION, IS ALSO AN OFFICER OF LIFESMART, INC., A BOARD MEMBER OF STANLEX, INC., A BOARD MEMBER OF STANLY MANOR, INC., A BOARD MEMBER OF STANLY MEDICAL SERVICES, INC., AND AN OFFICER OF WEST STANLY IMAGING, LLC, ALL OF WHICH DO BUSINESS WITH THE FILING ORGANIZATION. SEE SCHEDULE R, PART V FOR A LISTING OF TRANSACTIONS BETWEEN THESE ORGANIZATIONS. 0 NYKOLA SAMILO OFFICER/BOARD MEMBER NYKOLA SAMILO, AN OFFICER OF THE FILING ORGANIZATION, IS ALSO AN OFFICER OF LIFESMART, INC., A BOARD MEMBER OF STANLY MANOR, INC., A BOARD MEMBER OF STANLY MEDICAL SERVICES, INC., AND AN OFFICER OF WEST STANLY IMAGING, LLC, ALL OF WHICH DO BUSINESS WITH THE FILING ORGANIZATION. SEE SCHEDULE R, PART V FOR A LISTING OF TRANSACTIONS BETWEEN THESE ORGANIZATIONS. 0 JUDY DORAN OFFICER/BOARD MEMBER JUDY DORAN, AN OFFICER OF THE FILING ORGANIZATION, IS ALSO AN OFFICER OF LIFESMART INC., A BOARD MEMBER OF STANLEX, INC., AND A BOARD MEMBER OF STANLY MANOR, INC., ALL OF WHICH DO BUSINESS WITH THE FILING ORGANIZATION. SEE SCHEDULE R, PART V FOR A LISTING OF TRANSACTIONS BETWEEN THESE ORGANIZATIONS. 0 JOEL HUNEYCUTT BOARD MEMBER JOEL HUNEYCUTT, A BOARD MEMBER OF THE FILING ORGANIZATION, IS ALSO A BOARD MEMBER OF STANLY MEDICAL SERVICES, INC., WHICH DOES BUSINESS WITH THE FILING ORGANIZATION. SEE SCHEDULE R, PART V FOR A LISTING OF TRANSACTIONS BETWEEN THESE ORGANIZATIONS. 0 JOSEPH GODWIN BOARD MEMBER JOSEPH GODWIN, A BOARD MEMBER OF THE FILING ORGANIZATION, IS ALSO A BOARD MEMBER OF STANLY MANOR, INC., WHICH DOES BUSINESS WITH THE FILING ORGANIZATION. SEE SCHEDULE R, PART V FOR A LISTING OF TRANSACTIONS BETWEEN THESE ORGANIZATIONS. 0 JACK P JORDAN BOARD MEMBER JACK P. JORDAN, A BOARD MEMBER OF THE FILING ORGANIZATION, IS ALSO A BOARD MEMBER OF STANLEX, INC., WHICH DOES BUSINESS WITH THE FILING ORGANIZATION. SEE SCHEDULE R, PART V FOR A LISTING OF TRANSACTIONS BETWEEN THESE ORGANIZATIONS. 0 DR MICHAEL MCLEOD BOARD MEMBER DR. MICHAEL MCLEOD, A BOARD MEMBER OF THE FILING ORGANIZATION, IS ALSO A BOARD MEMBER OF STANLY MEDICAL SERVICES, INC., WHICH DOES BUSINESS WITH THE FILING ORGANIZATION. SEE SCHEDULE R, PART V FOR A LISTING OF TRANSACTIONS BETWEEN THESE ORGANIZATIONS. 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. 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 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 REVIEWS BASED ON COMPARABLE INDUSTRY DATA ARE PERFORMED BY INDEPENDENT CONSULTANTS. THE LAST REVIEW AS PERFORMED IN 2009. 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: NET UNREALIZED LOSSES ON INVESTMENTS: -2,466,845. UNRECOGNIZED PENSION EXPENSE -1,105,925. TRANSFERS TO AFFILIATES -2,864,929. TOTAL TO FORM 990, PART XI, LINE 5: -6,437,699. 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 OR MORE. 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 MEDICAL SERVICES INC 320 YADKIN STREET ALBEMARLE NC 28001 561892763 HEALTHCARE NC 501(C)(3) 509(A)(2) 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 STANLY REGIONAL WEST LLC 301 YADKIN STREET ALBEMARLE NC 28001 260512251 HEALTHCARE NC N/A PATIENT SERVICES 18710 129738 0 1 0.24200 WEST STANLY IMAGING LLC 301 YADKIN STREET ALBEMARLE NC 28001 262414332 HEALTHCARE NC N/A PATIENT SERVICES 158078 384653 0 1 0.51000 ALLIANCE MEDICAL INC 907 N SECOND STREET ALBEMARLE NC 28002 561682606 HEALTHCARE NC N/A C 2235771 2589430 1.00000 LIFESMART INC 301 YADKIN STREET ALBEMARLE NC 28001 010790640 HEALTHCARE NC N/A C 68568 43146 1.00000 1 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 STANLY MEDICAL SERVICES INC A 626451 MARKET VALUE STANLY MEDICAL SERVICES INC Q 717000 CASH VALUE STANLY REGIONAL MEDICAL CENTER FOUNDATION INC O 75000 EXPENSES STANLY MEDICAL SERVICES INC O 1520509 EXPENSES STANLY REGIONAL MEDICAL CENTER FOUNDATION INC C 201624 CASH VALUE STANLY REGIONAL MEDICAL CENTER FOUNDATION INC N 50319 SALARY & BENEFITS