2011-08-15T13:41:45-05:00 2010-09-30 LarsonAllen LLP 101 N Tryon Street Suite 1000 Charlotte NC 28246 990 2009-10-01 560556760 Stanly Regional Medical Center STAN 7049844393 post office box 1489 albemarle NC 28002 alfred taylor 7049844000 2011-08-15 1 7049985200 2009 2016-02-24 21:20:13Z alfred taylor 301 Yadkin Road albemarle NC 28001 101109723 0 X www.stanly.org X 1945 NC to facilitate improving the health of people in the communities we serve. 13 12 834 110 6233250 -66692 225408 616827 86871142 97142715 747553 703457 -1538633 850203 86305470 99313202 31085 31394 0 38075918 41781123 0 0 45732307 49879252 83839310 91691769 2466160 7621433 103596758 108653546 42650623 42301863 60946135 66351683 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 69665050 31394 92293181 Stanly Regional Medical Center provided approximately 20,000 inpatient days of care and approximately 80,000 outpatient visits (excluding labs) during 2010. 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. 69665050 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 76 0 834 1 1 1 0 0 0 0 0 0 0 0 13 12 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 274724 0 16796 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 linda carter 1.00 X 0 0 0 wd bill lawhon 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 linda lawrence md 1.00 X 0 0 0 jack p jordan 1.00 X 0 0 0 dr michael mcleod 1.00 X 0 0 0 nykola samilo 40.00 X 172669 0 10836 Debra b Smith 40.00 X 167949 0 1554 Anjana Young 40.00 X 194242 0 7062 william r dennis 40.00 X 175462 0 9858 jeffrey b pitman 40.00 X 199249 0 664 jessica w steed 40.00 X 167322 0 8338 kelly j new 40.00 X 172802 0 6486 1524419 0 61594 24 0 1 0 Carolinas Medical Center po box 32861 charlotte NC 28232 management services 2174135 Stokes Construction Co po box 640 albemarle NC 28002 construction 715878 diversified clinical services po box 850001 orlando FL 32885 hospitalist 527567 CMC-Northeast 920 church st north concord NC 28025 Hospitalist 509177 favorite healthcare staffing po box 803356 kansas city MO 64180 nursing 504201 5 75000 541827 616827 patient Revenue 621400 89473323 89473323 unrelated pharmacy 621400 6233250 6233250 1436142 1436142 97142715 703457 703457 1404548 1796521 -391973 -391973 -391973 Equity Earnings 900099 1060030 1060030 182146 182146 1242176 99313202 90909465 6233250 1553660 31394 31394 376270 376270 31930940 27718505 4212435 1413851 1413851 5903098 59866 5843232 2156964 1916919 240045 1466780 1466780 485681 485681 42797 42797 3523758 2550774 972984 605854 489 605365 401871 353503 48368 2461239 2461239 1157144 934575 222569 15101 8646 6455 109361 76087 33274 1359928 1359928 4124873 3793419 331454 1073868 1073868 Program Supplies 15065012 14978448 86564 provision for uncollect 11728829 11728829 equipment rental 2530187 2292971 237216 repairs and maintenance 971171 872045 99126 Dues and Subscriptions 622156 348669 273487 2133642 1623641 510001 91691769 69665050 22026719 0 8244124 12953235 14096922 13223137 1973614 2298359 1495855 1326577 128978145 85580714 45860297 43397431 28420883 29805369 3505063 5649438 103596758 108653546 14539357 7232512 24687505 22830532 3423761 12238819 42650623 42301863 X 60560811 65782901 385324 568782 60946135 66351683 103596758 108653546 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12154 12154 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: the PORTION OF MEMBER ORGANIZATION DUES ATTRIBUTABLE TO LOBBYING are $12,154. 7839496 7839496 75891373 49930845 25960528 34953302 28994209 5959093 10293974 6655660 3638314 43397431 investments 29805369 F 29805369 Advances to affiliates 1563770 Other Assets 3410029 Other Receivables 675639 5649438 estimated third-party payor settlements 7144511 pension liability 5094308 12238819 1 1 1 X 1 X 1 1 1 0 1 1 4784860 0 4784860 0.05220 16479654 14514963 1964691 0.02140 563761 278783 284978 0.00310 21828275 14793746 7034529 0.07670 342975 342975 0.00370 11150 11150 0.00010 354125 354125 0.00380 22182400 14793746 7388654 0.08050 615 615 0.00000 195941 195941 0.00210 196556 196556 0.00210 1 5883774 0 23749131 25516568 -1767437 X 1 1 west stanly imaging radiology joint venture 0.51000 stanly regional west llc medical property development/leasing company 0.24200 stanly regional medical center inc

301 yadkin street albemarle NC 28001

X X X Inpatient Rehabiliation unit and Inpatient Psychiatric unit 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. 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: Cost to charge ratio determined by Worksheet 2. 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. 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 5: 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 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). NC 1 educational assistance 10 31394 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 0 0 0 0 0 0 0 0 0 Alfred p Taylor 266507 0 0 0 8217 0 0 0 16796 0 291520 0 0 0 nykola samilo 171212 0 0 0 1457 0 0 0 10836 0 183505 0 0 0 Debra b Smith 160113 0 0 0 7836 0 0 0 1554 0 169503 0 0 0 Anjana Young 177874 0 0 0 16368 0 0 0 7062 0 201304 0 0 0 william r dennis 159072 0 0 0 16390 0 0 0 9858 0 185320 0 0 0 jeffrey b pitman 182786 0 0 0 16463 0 0 0 664 0 199913 0 0 0 jessica w steed 150746 0 0 0 16576 0 0 0 8338 0 175660 0 0 0 kelly j new 156339 0 0 0 16463 0 0 0 6486 0 179288 0 0 0 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 debra b smith officer/board member Debra B. smith, 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. form 990, part xi, line 2c: This process has not changed from the prior year. 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 Stanly Medical Services Inc 320 yadkin street albemarle NC 28001 561892763 Healthcare NC 501(c)(3) 509(a)(2) N/A Stanly Manor Inc 625 Bethany Road albemarle NC 28001 561623092 Long-term Healthcare NC 501(c)(3) 509(a)(2) N/A Stanlex Inc 907 north second street albemarle NC 28001 561532751 healthcare NC 501(c)(3) 509(a)(3) N/A stanly regional west llc 301 Yadkin Street Albemarle NC 28001 260512251 healthcare NC N/A patient services 0 1 stanly west imaging llc 301 Yadkin Street Albemarle NC 28001 262414332 healthcare NC N/A patient services 0 1 Alliance Medical Inc 907 N Second Street Albemarle NC 28002 561682606 healthcare NC N/A C 1.00000 LifeSmart Inc 301 Yadkin Street Albemarle NC 28001 010790640 healthcare NC N/A C 1.00000 0 1 1 1 0 0 0 0 0 1 1 0 0 1 0 1 0 1 stanly medical services inc J 682604 stanly regional medical center foundation inc B 173361 stanly west imaging llc D 1515626