2015-02-16T08:08:58-06:00 2014-09-30 561706742 DAVIDSON HOLLAND WHITESELL & CO PLLC 209 13TH AVE PLACE NW SUITE 200 HICKORY NC 28601 990 2013-10-01 561255030 MOUNTAIN VISTA HEALTH PARK INC MOUN 3368592181 POST OFFICE BOX 1547 DENTON NC 27239 AVA BADGETT TREASURER 3368592181 2015-02-16 SUSAN M BALKE P01056462 8283222070 2013 2016-02-25 16:41:14Z AVA BADGETT POST OFFICE BOX 1547 DENTON NC 27239 6003461 0 X N/A X 1971 NC PROVIDE QUALITY LONG-TERM NURSING CARE FOR RESIDENTS. 9 9 163 35 0 0 0 0 6273271 5935889 30703 66372 2400 1200 6306374 6003461 0 0 0 0 3356928 3434986 0 0 0 2494160 2517143 5851088 5952129 455286 51332 5465627 5560137 482524 513452 4983103 5046685 TO PROVIDE QUALITY LONG-TERM SKILLED NURSING CARE AND ASSISTED LIVING SERVICES TO THE SOUTH DAVIDSON COUNTY COMMUNITY. 0 0 4997023 5935889 MOUNTAIN VISTA HEALTH PARK, INC. IS A CORPORATION WHICH PROVIDES LONG-TERM NURSING CARE AND ADULT CARE HOME SERVICES. THE FACILITY HAS 60 NURSING AND 60 ADULT-CARE BEDS. WE OFFER SERVICES TO THE PUBLIC WITHOUT REGARD TO RELIGION OR ETHNICITY. 4997023 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 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 0 0 0 0 0 1 5 0 1 163 1 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X TULLOCK MANAGEMENT COMPANY 3369985001 5190 US HWY 158 ADVANCE NC 27006 MAL MARTIN PRESIDENT 0.30 X X 0 0 0 TONY JACKSON VICE PRESIDENT 0.30 X X 0 0 0 AVA BADGETT TREASURER 0.30 X X 0 0 0 JEANETTE SKEEN SECRETARY 0.30 X X 0 0 0 DEL CRANFORD DIRECTOR 0.30 X X 0 0 0 KURT BEYELER DIRECTOR 0.30 X 0 0 0 SCOTT MORRIS DIRECTOR 0.30 X 0 0 0 DALE FUTRELL DIRECTOR 0.30 X 0 0 0 KATHY MCDONALD ADMINISTRATOR 40.00 X 98413 0 1688 98413 0 1688 0 0 0 0 LEGACY HEALTHCARE SERVICES INC PO BOX 951003 CLEVELAND OH 44193 PHYSICAL, SPEECH & OCC THERAPY 563963 BLUE CROSS BLUE SHIELD PO BOX 580017 CHARLOTTE NC 28258 GROUP MEDICAL INSURANCE 378164 US FOOD SERVICE 125 FORT MILL PARKWAY FORT MILL SC 29715 FOOD SERVICE/SUPPLY 173254 NEIL MEDICAL GROUP 2545 JETPORT ROAD KINSTON NC 28504 NURSING/MEDICAL SUPPLIES 106806 YADKIN VALLEY HEALTHCARE 17955 SOUTH HWY 109 DENTON NC 27239 PHARMACY CONTRACT SERVICE 105723 5 ROUTINE NURSING CARE 623000 5919554 5919554 ANCILLARIES 623000 16335 16335 5935889 66372 66372 1200 0 1200 1200 1200 6003461 5935889 0 67572 3077252 2856605 220647 127102 93066 34036 230632 213726 16906 298473 298473 3050 3050 17400 17400 12250 12250 280645 280645 2884 2884 9695 9695 8388 4018 4370 44 44 133377 133377 308751 292973 15778 SUPPLIES 476107 473347 2760 CONTRACT SERVICES 452041 443091 8950 RAW FOOD 225610 225610 UTILITIES 207309 194468 12841 81119 66742 14377 5952129 4997023 955106 0 2777647 2208088 604182 593599 15079 16626 80184 71157 3800291 2928060 945458 872231 1043077 1798436 5465627 5560137 453563 482463 28961 30989 482524 513452 X 4983103 5046685 4983103 5046685 5465627 5560137 51332 12250 0 X 0 1 X 0 0 X 5830748 6112172 6131780 6273271 5935889 30283860 1800 2400 2400 1200 7800 5830748 6113972 6134180 6275671 5937089 30291660 0 0 0 30291660 44198 43117 25540 30703 66372 209930 44198 43117 25540 30703 66372 209930 5874946 6157089 6159720 6306374 6003461 30501590 0.99310 0.99350 0.00690 0.00650 X 822 0 0 0 0 0 0 0 0 1 822 822 0 PART I-A, LINE 1: A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HEALTH CARE FACILITIES ASSOCIATION BY THE ENTITY WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES. PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HEALTH CARE FACILITIES ASSOCIATION BY THE ENTITY WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 19358 19358 1382938 1090713 292225 1620160 1280403 339757 699268 494288 204980 78567 62656 15911 872231 PATIENT FUNDS 30989 CASH VALUE OF LIFE INSURANCE 303960 INVESTMENTS 1463487 1798436 PATIENT FUNDS 30989 30989 X 6003417 0 6003417 44 44 6003461 5939835 0 5939835 12250 44 12294 5952129 PART X, LINE 2: THE COMPANY HAS IMPLEMENTED THE NEW ACCOUNTING REQUIREMENTS ASSOCIATED WITH UNCERTAINTY IN INCOME TAXES USING THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ASC 740, INCOME TAXES. USING THAT GUIDANCE, TAX POSITIONS INITIALLY NEED TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS WHEN IT IS MORE-LIKELY-THAN-NOT THE POSITIONS WILL BE SUSTAINED UPON EXAMINATION BY THE TAX AUTHORITIES. IT ALSO PROVIDES GUIDANCE FOR DE-RECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOUSURE AND TRANSITION. AS OF SEPTEMBER 30, 2014, THE COMPANY HAS NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS AND RECOGNIZED NO SUCH INTEREST OR PENALTIES DURING THE YEARS ENDED SEPTEMBER 30, 2014 AND 2013. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 44. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 44. FORM 990, PART VI, SECTION A, LINE 3 MOUNTAIN VISTA HEALTH PARK CONTRACTS TULLOCK MANAGEMENT COMPANY TO PERFORM VARIOUS OPERATIONAL MANAGEMENT DUTIES FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF FORM 990 IS GIVEN TO THE DIRECTORS FOR REVIEW PRIOR TO BEING SIGNED BY THE APPROPRIATE OFFICER OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY FORM 990, PART VI, SECTION B, LINE 15 DIRECTORS RECEIVE NO COMPENSATION. KEY EMPLOYEE COMPENSATION IS REVIEWED BY THE MANAGEMENT COMPANY AND THE ADMINISTRATOR ANNUALLY. COMPENSATION RATES FOR KEY EMPLOYEES ARE COMMENSURATE WITH SIMILAR POSITIONS AS COMPARED WITH INDUSTRY DATA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST TO THE MANAGEMENT COMPANY DURING NORMAL BUSINESS HOURS.