2015-06-15T15:20:22-05:00 2014-07-31 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2013-08-01 753054855 MERCY RESTORATIVE CARE HOSPITAL INC MERC 7046678050 10648 PARK ROAD CHARLOTTE NC 28210 DAN DUNMYER CEO 7046678050 2015-06-15 1 JOHN NORMAN P01506766 7049985200 2013 2016-04-25 22:37:26Z X CAROLINAS SPECIALTY HOSPITAL DAN DUNMYER 10648 PARK ROAD CHARLOTTE NC 28210 22172300 0 X WWW.CSHNC.COM X 2002 NC TO PROVIDE LONG TERM ACUTE CARE SERVICES. 9 9 202 18 0 0 0 0 20822254 21439929 768912 731648 27789 723 21618955 22172300 0 0 0 0 9569970 10774006 0 0 0 9475597 9971709 19045567 20745715 2573388 1426585 22867219 42725713 2292197 20464477 20575022 22261236 TO PROMOTE AND IMPROVE THE HEALTH STATUS OF THE COMMUNITY BY PROVIDING LONG TERM ACUTE CARE SERVICES. 0 0 16896015 21439929 PROVIDED LONG TERM ACUTE CARE SERVICES THROUGH THE OPERATION OF A 40 BED HOSPITAL-WITHIN-A-HOSPITAL. 16896015 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 197 0 202 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NC X DAN DUNMYER 7046678050 10648 PARK ROAD CHARLOTTE NC 28210 C NEAL ALEXANDER JR BOARD MEMBER 1.00 X 0 0 0 LYSA LONG BOARD MEMBER 1.00 X 0 0 0 EDWARD BETHEA BOARD MEMBER 1.00 X 0 0 0 CHERYL ATKINSON BOARD MEMBER 1.00 X 0 0 0 NANCY M GEEDEY BOARD MEMBER 1.00 X 0 0 0 SANFORD BENJAMIN MD BOARD MEMBER 1.00 X 0 0 0 JOYCE KORZEN BOARD MEMBER 1.00 X 0 0 0 C CURTIS COPENHAVER CHAIRMAN OF THE BOARD 4.00 X 0 0 0 DAVID THOMAS TREASURER / SECRETARY 2.00 X 0 0 0 DAN DUNMYER CEO 40.00 X 0 0 0 JOANNE TYO CFO 40.00 X 0 0 0 TESHIA DAVIS-CARR CCO 40.00 X 0 0 0 HAJRUDIN BEGIC RN 40.00 X 117835 0 0 117835 0 0 2 0 0 0 BLUE CROSS BLUE SHIELD PO BOX 580017 CHARLOTTE NC 28258 HEALTH CARE INSURANCE 1293467 CMC MERCY HOSPITAL PO BOX 32861 ATTN JULIE FRANCE CHARLOTTE NC 28232 MEDICAL SUPPLIES 1181835 ACUITY HEALTHCARE 10200 MALLARD CREEK RD CONCORD NC 28262 MGMT FEES AND LABOR 978814 CAROLINAS HEALTHCARE SYS PO BOX 32861 ATTN JULIE FRANCE CHARLOTTE NC 28232 MEDICAL SUPPLIES 583771 MARSH USA INC 121 RIVER STREET HOBOKEN NJ 07030 LIABILITY INSURANCE 314144 17 PATIENT REVENUE 621400 21439929 21439929 21439929 731648 731648 723 723 723 22172300 21439929 0 732371 X 7617476 5859717 1757759 2493095 2367183 125912 663435 663435 335983 54463 281520 137610 137610 61642 61642 3307155 3101743 205412 133680 127097 6583 81152 3217 77935 24754 24754 498269 446852 51417 65564 54579 10985 14648 11020 3628 636951 636951 1118207 1118207 164682 164682 PATIENT CARE SUPPLIES 2561237 2561237 BAD DEBT EXPENSE 183649 183649 PATIENT CARE EQUIPMENT 105179 105179 541347 100239 441108 20745715 16896015 3849700 0 3300008 5536277 3403198 2843740 23184 55223 205873 166259 22131500 1446335 1203213 20685165 13529192 13318323 1202551 120726 22867219 42725713 1538575 2859283 17438620 753622 166574 2292197 20464477 X 20575022 22261236 20575022 22261236 22867219 42725713 1426585 259629 0 X X 0 1 X 1 0 X 16613768 609172 16004596 2126588 54897 2071691 3183780 637610 2546170 207364 144656 62708 20685165 THIRD PARTY RESERVE 166574 166574 X 21988651 0 21988651 183649 183649 22172300 20562066 0 20562066 183649 183649 20745715 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE WITH EXEMPTION FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. MANAGEMENT IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THEIR TAX-EXEMPT STATUS. MANAGEMENT IS NOT AWARE OF ANY SIGNIFICANT ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL ACCOUNTS (SHOWN AS EXPENSES ON 990) 183,649. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL ACCOUNTS (SHOWN AS EXPENSES ON 990) 183,649. 1 1 1 X 1 X 0 1 0 0 129715 129715 0.00630 409203 212638 196565 0.00960 538918 212638 326280 0.01590 3243 3243 0.00020 3243 3243 0.00020 542161 212638 329523 0.01610 1 183649 15045770 12911400 2134370 X 1 0 1 ACUITY HEALTHCARE LP HOSPITAL MANAGEMENT 0.00000 0.00000 0.00000 1 1 MERCY RESTORATIVE CARE INC 10648 PARK ROAD CHARLOTTE NC 28210 X X MERCY RESTORATIVE CARE INC 1 1 X X X X X X 13 1 1 1 X X X X 0 0 1 1 200.000000000000 0 0 1 1 X X 0 0 0 X X X 0 0 MERCY RESTORATIVE CARE, INC. PART V, SECTION B, LINE 3: THE HOSPITAL RELIED HEAVILIY ON THE WORK PERFORMED BY THE MECKLENBURG COUNTY HEALTH DEPARTMENT IN COMPILING INFORMATION FOR THE CHNA. THE COUNTY DEVELOPED A HEALTH OPINION SURVEY FOR MECKLENBURG COUNTY RESIDENTS. THE SURVEY WAS OFFERED IN ENGLISH AND SPANISH AND WAS MADE AVAILABLE ONLINE THROUGH SURVEY MONKEY. THE COUNTY ALSO PROVIDED PAPER COPIES IN ENGLISH AND SPANISH TO THOSE THAT COULD NOT ACCESS THE ONLINE VERSIONS. LINKS TO THE ONLINE SURVEY WERE SENT VIA EMAIL TO EOMPLOYEES OF THE TOP 5 EMPLOYERS IN MECKLENBURG COUNTY, ELECTED OFFICIALS, HEADS OF NEIGHBORHOOD ASSOCIATIONS AND THROUGH OTHER VARIOUS CONTACT LISTS. ALL RECIPIENTS WERE ENCOURAGED TO SHARE THE LINK AMONG THEIR OWN CONTACTS. PAPER COPIES WERE DELIVERED TO ELEVEN LOCAL LIBRARIES RESPRESENTING ALL GEOGRAPHIC ARES OF THE COUNTY. FINALLY THERE WAS ALSO TARGETED DISTRIBUTION OF PAPER COPIES TO REACH SPECIFIC POPULATIONS, SUCH AS SENIOR CENTERS, SAFETY-NET CLINICS, HOMELESS SHELTERS, HEALTH EDUCATION CLASS FOR LATINAS, AN AFRICAN AMERICAN MALE YOUTH GROUP, AND AN ORGANIZATION THAT WORKS WITH INCARCERATED INDIVIDUALS. MERCY RESTORATIVE CARE, INC. PART V, SECTION B, LINE 4: NOVANT HEALTHCARE, CAROLINAS HEALTHCARE SYSTEM MERCY RESTORATIVE CARE, INC. PART V, SECTION B, LINE 7: BEING A SMALL SPECIALIZED ORGANIZATION, THE HOSPITAL HAS LIMITED RESOURCES TO ADDRESS THE MANY SIGNIFICANT NEEDS OF OUR COMMUNITY. AS SUCH, THE HOSPITAL IDENTIFIED CERTAIN NEEDS THAT IT BELIEVED IT COULD MOST GREATLY IMPACT OVER THE COMING YEARS. THOSE NEEDS INCLUDE CHRONIC DISEASE PREVENTION AND ACCESS TO CARE. MERCY RESTORATIVE CARE, INC. PART V, SECTION B, LINE 10: THE HOSPITAL DOES NOT OFFER DISCOUNTED CARE; INSTEAD, THE HOSPITAL OFFERS CHARITY CARE TO ALL PATIENTS WHO ARE ELIGIBLE TO PARTICIPATE. FOR THOSE THAT DO NOT HAVE INSURANCE, OR ARE NOT ELIGIBLE FOR MEDICARE OR MEDICAID, THE HOSPITAL'S CHARITY CARE POLICY STATES THAT THE HOSPITAL WILL PROVIDE THOSE INDIVIDUALS WITH UNCOMPENSATED CARE (CONSISTENT WITH THE HOSPITAL'S RESOURCES). PATIENTS WHO ARE DEEMED ELIGIBLE UNDER THE HOSPITAL'S GUIDELINES TO RECEIVE UNCOMPENSATED CARE MAY APPLY FOR RELIEF FROM RESPONSIBILITY FOR ALL OR A PORTION OF THE AMOUNT THEY OWE FOR SERVICES RENDERED BY THE HOSPITAL. MERCY RESTORATIVE CARE, INC. PART V, SECTION B, LINE 19C: WE ARE A HOSPITAL WITHIN A HOSPITAL AND DO NOT HAVE AN EMERGENCY ROOM. MERCY RESTORATIVE CARE, INC. PART V, SECTION B, LINE 20D: THE HOSPITAL DID NOT PROVIDE CARE FOR ANY EMERGENCY MEDICAL CONDITIONS. PART I, LINE 3C: MERCY RESTORATIVE CARE HOSPITAL, INC. ("THE HOSPITAL") BUDGETS AMOUNTS FOR AND PROVIDES FREE OR DISCOUNTED CARE TO MEDICALLY INDIGENT IN ACCORDANCE WITH THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE GUIDLINE OF 200% OF FEDERAL POVERTY LEVEL IS USED, BASED UPON INCOME PROVIDED BY THE PATIENT ON THE FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY. PROOF OF INCOME IS REQUIRED OF PATIENTS: W-2, COPIES OF PAYROLL CHECKS, TAX RETURNS, AND/OR BANK STATEMENTS, IF AVAILABLE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 183,649. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL DOES NOT ENGAGE IN ANY COMMUNITY BUILDING ACTIVITES DUE TO THE NATURE OF ITS EXISTENCE. PART III, LINE 2: THE HOSPITAL DOES NOT HAVE A PROCESS FOR ESTIMATING THAT AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY. CHARITY DISCOUNTS ARE ADJUSTED OFF AND NOT INCLUDED IN BAD DEBTS. ANY PAYMENTS RECEIVED ARE NOT INCLUDED IN BAD DEBT EXPENSE ON ANY PATIENT. PART III, LINE 4: THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS USING MANAGEMENT'S JUDGMENT AND HISTORICAL EXPERIENCE. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS GENERALLY REQUIRED WITHIN 30 DAYS RECEIPT OF INVOICE OR CLAIM SUBMITTED. SELF-PAY ACCOUNT BALANCES PAST DUE MORE THAN 180 DAYS ARE CLASSIFIED AS UNCOLLECTIBLE. FEDERAL REGULATIONS REQUIRE A 120-DAY PERIOD OF COLLECTION EFFORTS ON MEDICARE ACCOUNTS BEFORE BEING CLASSIFIED AS UNCOLLECTIBLE. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS RECEIVABLE BASED ON HISTORICAL EXPERIENCE OF THE HOSPITAL. AT JULY 31, 2013 AND 2012, THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS APPROXIMATELY $253,000 AND $663,000, RESPECTIVELY. PART III, LINE 8: MEDICARE INPATIENT ACUTE-CARE SERVICES PROVIDED BY THE HOSPITAL ARE PAID AT PROSPECTIVELY DETERMINED RATES PER DISCHARGE BASED PRIMARILY ON THE PATIENT'S DIAGNOSIS AND MARKET AREA WAGES. MEDICARE PAYS FOR THE OPERATING AND CAPITAL COSTS ASSOCIATED WITH HOSPITAL INPATIENT STAYS IN LONG TERM CARE HOSPITALS. PATIENTS MUST HAVE AN AVERAGE MEDICARE LENGTH OF STAY GREATER THAN 25 DAYS. PART III, LINE 9B: THE HOSPITAL DOES NOT PURSUE COLLECTIONS FROM PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: MERCY RESTORATIVE CARE HOSPITAL, INC. D/B/A CAROLINAS SPECIALTY HOSPITAL (THE "HOSPITAL") IS A 40-BED LONG-TERM ACUTE CARE HOSPITAL. THE HOSPITAL WAS INCORPORATED UNDER THE LAWS OF NORTH CAROLINA FOR THE PURPOSE OF PROMOTING AND IMPROVING THE HEALTH STATUS OF THE COMMUNITY BY DEVELOPING AND PROVIDING LONG-TERM ACUTE CARE SERVICES FOR THE BENEFIT OF CITIZENS OF MECKLENBURG AND SURROUNDING COUNTIES. THE HOSPITAL BEGAN OPERATIONS IN JANUARY 2003. PART VI, LINE 3: THE HOSPITAL HAS A CHARITY CARE PROGRAM FOR THOSE WHO QUALIFY BASED ON INCOME STANDARDS. THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE APPLICATIONS. CHARITY CARE POLICY IS AVAILABLE ON WEB SITE. PART VI, LINE 4: THE HOSPITAL PROVIDES SERVICES PRIMARILY TO THE RESIDENTS OF MECKLENBURG COUNTY, NORTH CAROLINA AND SURROUNDING COUNTIES, WITHOUT COLLATERAL OR OTHER PROOF OF ABILITY TO PAY. PART VI, LINE 5: THE HOSPITAL SPONSORED A HEALTHCARE CONVENTION. PART VI, LINE 6: THE HOSPITAL IS HOUSED IN ANOTHER HOSPITAL BUT ARE SEPARATE FOR PURPOSES OF SPONSORSHIP AND COMMUNITY RELATED HEALTHCARE EVENTS. X 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 DURING THE YEAR, THE CEO AND CFO WERE EMPLOYED THROUGH A MANAGEMENT CONTRACT WITH ACUITY HEALTHCARE, LP, AN UNRELATED ORGANIZATION. AS SUCH, THEIR COMPENSATION INFORMATION IS NOT REQUIRED ON PART VII. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT PERFORMED A REVIEW OF THE FORM 990 PRIOR TO APPROVING IT FOR FILING. FORM 990, PART VI, SECTION B, LINE 12C IF A BOARD MEMBER IS FOUND TO HAVE A CONFLICT, THEY ABSTAIN FROM THE VOTING PROCESS. FORM 990, PART VI, SECTION B, LINE 15 A CONFLICT-FREE BOARD DETERMINES APPROPRIATE COMPENSATION, RELYING ON COMPARABLE INFORMATION. BOARD REVIEWS AND DECIDES CEO ANNUAL COMPENSATION THROUGH CLOSED BOARD SESSION. ONE BOARD MEMBER IS AN HR RESPRESENTATIVE AND PARTICIPATES IN DISCUSSIONS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,101,743. MANAGEMENT AND GENERAL EXPENSES 205,412. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,307,155. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.