2011-02-15T15:22:53-06:00 2010-09-30 LarsonAllen LLP 101 N Tryon Street Suite 1000 Charlotte NC 28246 990 2009-10-01 561623092 Stanly Manor Inc STAN 7049820770 625 Bethany Road Albemarle NC 28001 Nykola Samilo 7049820770 2011-02-15 1 7049985200 2009 2016-02-24 21:20:13Z stephanie herrin-hunneycu 625 Bethany Road Albemarle NC 28001 6944208 0 X www.stanly.org X 1989 NC To provide skilled nursing and rehabiliative services to our community. 4 4 242 30 0 0 0 6701205 6940107 1578 1084 198853 3017 6901636 6944208 0 0 4013191 4304944 0 0 2318008 2691799 6331199 6996743 570437 -52535 3410311 3094726 2356636 2146600 1053675 948126 STANLY MANOR, INC. IS A PRIVATE NOT-FOR-PROFIT MULTI-LEVEL LONG-TERM CARE FACILITY OFFERING 24-HOUR CARE WITH ASSISTED LIVING AND NURSING CARE. 0 0 5674409 6943124 Stanly Manor, Inc. is a 100 bed facility providing multi-level long-term health care for nursing home and rest home patients. It provides 24 hour nursing care, nutritious meals and therapeutic diets, dietician service, 24 hour security and emergency response systems, rehabilitation services and restorative care, physician services, pharmacy services, full complement of scheduled activities, beauty shop/barber shop, housekeeping and laundry services, on-staff social worker, Hospice services, and transportation for medical appointments. Stanly Manor accepts Medicaid, private insurance, and Medicare payments for services provided. 5674409 1 0 0 0 0 0 0 0 0 1 0 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 1 0 0 0 1 12 0 242 1 0 0 0 0 0 0 0 0 0 4 4 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X STEPHANIE HERRIN-HUNEYCUTT 7049820770 625 Bethany Road Albemarle NC 28001 alfred p taylor 1.00 X 0 0 0 NYKOLA SAMILO 1.00 X 0 0 0 Debra Smith 1.00 X 0 0 0 Joe Godwin 1.00 X 0 0 0 Stephanie Herrin-Huneycu 40.00 X 74968 0 10025 74968 0 10025 0 0 0 0 AUTUMN CARE CORP 451 N Winstead Ave PO Box 7728 Rocky Mount NC 27804 Physical Therapy 483304 US Foods PO Box 668347 Charlotte NC 28266 Raw Foods and Supplements 266182 ccrx pharmacy 622 maywood avenue raleigh NC 27603 Pharmacy 219787 McKesson PO BOX 630693 Cincinnati OH 45263 Medical/Personal Care Supplies 197101 City of Albemarle 144 North 2nd St Albemarle NC 28801 Utilities 103397 5 patient revenue 623000 6935633 6935633 4474 4474 6940107 1084 1084 3017 3017 3017 6944208 6943124 0 1084 91626 10020 81606 3198245 3109388 88857 99604 99604 675074 33808 641266 240395 226342 14053 104252 104252 77147 77147 704580 697279 7301 1206 1206 18867 2654 16213 168908 168908 10776 4110 6666 65527 65527 135265 135265 32978 32978 Supplies 799735 792504 7231 Bed Tax Assessment 335230 335230 Bad Debt Expense 99208 99208 Minor Equipment 40146 34773 5373 Telephone and Cable 32642 32642 65332 24920 40412 6996743 5674409 1322334 0 393591 172193 674586 685358 26904 30793 4954888 2771507 2292346 2183381 22884 23001 3410311 3094726 598718 524524 1275825 1158305 21877 460216 463771 2356636 2146600 X 1053675 948126 1053675 948126 3410311 3094726 X 0 1 1 X 0 X 3000 10000 16364 29364 5632507 5931183 6319220 6701205 6935633 31519748 5635507 5941183 6335584 6701205 6935633 31549112 0 0 0 31549112 8385 4037 1947 1578 1084 17031 8385 4037 1947 1578 1084 17031 113026 44910 69346 198853 7491 433626 5756918 5990130 6406877 6901636 6944208 31999769 0.98590 0.98500 0.00050 0.00070 X 166092 166092 4032435 2177715 1854720 702655 541792 160863 53706 52000 1706 2183381 estimated third-party payor settlements 25000 advances from affiliates 33966 pension liability 404805 463771 Form 990, Part VI, Section A, line 3 Effective March 1, 2009, the Parent entered into a Management Services Agreement (MSA) with The Charlotte-Mecklenburg Hospital Authority d/b/a Carolinas HealthCare System (CHS) to manage the Parents operations. Form 990, Part VI, Section A, line 8b the organization did not have a committee with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 A copy of the Form 990 will be emailed to each board member and officer for their review before submission. 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. In the event the Corporation determines that a conflict of interest exists, it shall take such action(s) as it deems necessary to resolve the conflict of interest, including: (a) Prohibiting the Interested Person from attending any meeting at which is discussed the transaction or arrangement that results in the conflict of interest; (b) Prohibiting the Interested Person from voting on any matter relating to the conflict of interest; (c) Appointing, if appropriate, a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement; (d) Determining, by a majority vote of the disinterested directors present at a meeting, whether the transaction or arrangement is in the Corporations best interest and for its own benefit; is fair and reasonable to the Corporation; and, after exercising due diligence, whether the Corporation can enter into a more advantageous transaction or arrangement with reasonable efforts under the circumstances; and (e) Taking appropriate disciplinary action with respect to an Interested Person who violates the Corporations conflicts of interest policy in order to protect the Corporations best interests. Form 990, Part VI, Section B, line 15 Compensation of top executives and top management is determined through a market comparison. 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. form 990, part xi, line 2c: The process has not changed from the prior year. Stanly Regional Medical Center Foundation Inc 301 yadkin street albemarle Charity NC 28001 561698181 charity NC 501(c)(3) 170(b)(1)(A)(vi) N/A Stanly Medical Services Inc 320 yadkin street albemarle Healthcare NC 28001 561892763 healthcare NC 501(c)(3) 509(a)(2) N/A Stanly Regional Medical Center Inc 301 yadkin street albemarle Hospital NC 28001 560556760 hospital NC 501(c)(3) 170(b)(1)(A)(iii) N/A Stanlex Inc 907 north second street albemarle healthcare NC 28001 561532751 healthcare NC 501(c)(3) 509(a)(3) N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0