MERCY RESTORATIVE CARE HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MERCY RESTORATIVE CARE HOSPITAL INC (EIN 75-3054855)
- Tax period
- 2012-08-01 to 2013-07-31
- Filed
- 2014-05-28
- IRS object ID
- 201421489349300867
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-28T13:23:24-05:00 | Timestamp |
| Tax Period End Date | 2013-07-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 N TRYON STREET SUITE 1000 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-08-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 753054855 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY RESTORATIVE CARE HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MERC | NameControl |
| Phone | 7046678050 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10200 MALLARD CREEK ROAD NO 300 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28262 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAN DUNMYER | Name |
| Title | CEO | Title |
| Phone | 7046678050 | Phone |
| Date Signed | 2014-05-22 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN NORMAN | Name |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAROLINAS SPECIALTY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAN DUNMYER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10200 MALLARD CREEK ROAD NO 300 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28262 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 21618955 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CSHNC.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE LONG TERM ACUTE CARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 198 | TotalNbrEmployees |
| Total Nbr Volunteers | 13 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 20451401 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 20822254 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 760622 | InvestmentIncomePriorYear |
| Investment Income Current Year | 768912 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 9089 | OtherRevenuePriorYear |
| Other Revenue Current Year | 27789 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21221112 | TotalRevenuePriorYear |
| Total Revenue Current Year | 21618955 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9038329 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9569970 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8906943 | OtherExpensePriorYear |
| Other Expenses Current Year | 9475597 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 17945272 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19045567 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3275840 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2573388 | RevenuesLessExpensesCY |
| Total Assets BOY | 20240544 | TotalAssetsBOY |
| Total Assets EOY | 22867219 | TotalAssetsEOY |
| Total Liabilities BOY | 2448567 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2292197 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17791977 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 20575022 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROMOTE AND IMPROVE THE HEALTH STATUS OF THE COMMUNITY BY PROVIDING LONG TERM ACUTE CARE SERVICES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15514613 | Expense |
| Revenue | 21618955 | Revenue |
| Description | PROVIDED LONG TERM ACUTE CARE SERVICES THROUGH THE OPERATION OF A 40 BED HOSPITAL-WITHIN-A-HOSPITAL. | Description |
| Total Program Service Expense | 15514613 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 197 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 198 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ACUITY HEALTHCARE LP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7048877285 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10200 MALLARD CREEK ROAD NO 300 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28262 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CURTIS COPENHAVER | |||||||
| PRESIDENT | 2.00 | X | 0 | 0 | 0 | ||
| DAVID THOMAS | |||||||
| TREASURER / SECRETARY | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT KING | |||||||
| VICE PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| NEAL ALEXANDER | |||||||
| 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 GEEDEY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DR SANFORD BENJAMIN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ELIZABETH STEGER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOYCE KORZEN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAN DUNMYER | |||||||
| CEO | 40.00 | 0 | 0 | 0 | X | ||
| JOANNE TYO | |||||||
| CFO | 40.00 | 0 | 0 | 0 | X | ||
| TESHIA DAVIS-CARR | |||||||
| CCO | 40.00 | 0 | 0 | 0 | X | ||
| HAJRUDIN BEGIC | |||||||
| RN | 40.00 | 136337 | 0 | 17116 | X | ||
| KOHE LOMBADU | |||||||
| RN | 40.00 | 108929 | 0 | 9500 | X | ||
| KIMBERLY SINGLETON | |||||||
| RN | 40.00 | 108934 | 0 | 5266 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 354200 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 31882 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CMC MERCY HOSPITAL | |||||
| PO BOX 32861 | CHARLOTTE | NC | 28232 | MEDICAL SERVICES | 3907803 |
| ACUITY HEALTHCARE LP | |||||
| 10200 MALLARD CREEK RD SUITE 300 | CHARLOTTE | NC | 28262 | INSURANCE PAYMENTS | 1650168 |
| BLUE CROSS BLUE SHIELD | |||||
| PO BOX 580017 | CHARLOTTE | NC | 28258 | INSURANCE | 1120832 |
| CAROLINAS HEALTHCARE SYSTEMS | |||||
| PO BOX 32861 | CHARLOTTE | NC | 28232 | MEDICAL SUPPLIES | 503610 |
| MORRISON MANAGEMENT | |||||
| 5801 PEACHTREE DUNWOODY RD NE | ATLANTA | GA | 30368 | FOOD SERVICE | 436019 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 15 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT REVENUE | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 20822254 | TotalRevenueColumn |
| Related Or Exempt Function Income | 20822254 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 20822254 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 768912 | TotalRevenueColumn |
| Exclusion | $768,912 | ExclusionAmount |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 27789 | TotalRevenueColumn |
| Exclusion | $27,789 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 27789 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21618955 | TotalRevenueColumn |
| Related Or Exempt Function Income | 20822254 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $796,701 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6824157 | Total |
| Program Services | 5225791 | ProgramServices |
| Management And General | 1598366 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2135401 | Total |
| Program Services | 2033537 | ProgramServices |
| Management And General | 101864 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 610412 | Total |
| Management And General | 610412 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 281520 | Total |
| Management And General | 281520 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 223747 | Total |
| Management And General | 223747 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48045 | Total |
| Management And General | 48045 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3728533 | Total |
| Program Services | 3641879 | ProgramServices |
| Management And General | 86654 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85093 | Total |
| Program Services | 81869 | ProgramServices |
| Management And General | 3224 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73471 | Total |
| Program Services | 2906 | ProgramServices |
| Management And General | 70565 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13938 | Total |
| Management And General | 13938 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 714998 | Total |
| Program Services | 673157 | ProgramServices |
| Management And General | 41841 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 84916 | Total |
| Program Services | 54706 | ProgramServices |
| Management And General | 30210 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15402 | Total |
| Management And General | 15402 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 887 | Total |
| Management And General | 887 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200957 | Total |
| Program Services | 200957 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180215 | Total |
| Program Services | 180215 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| PATIENT CARE SUPPLIES | 2637555 | 2637555 |
| BAD DEBT EXPENSE | 532822 | 532822 |
| PATIENT CARE EQUIPMENT | 247051 | 247051 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 406447 | Total |
| Program Services | 2168 | ProgramServices |
| Management And General | 404279 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19045567 | Total |
| Program Services | 15514613 | ProgramServices |
| Management And General | 3530954 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3227122 | BOY |
| EOY | 3300008 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2921166 | BOY |
| EOY | 3403198 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18077 | BOY |
| EOY | 23184 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71186 | BOY |
| EOY | 205873 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2638060 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1434847 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 854519 | BOY |
| EOY | 1203213 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12277199 | BOY |
| EOY | 13529192 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 871275 | BOY |
| EOY | 1202551 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20240544 | BOY |
| EOY | 22867219 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1694499 | BOY |
| EOY | 1538575 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 754068 | BOY |
| EOY | 753622 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2448567 | BOY |
| EOY | 2292197 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17791977 | BOY |
| EOY | 20575022 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17791977 | BOY |
| EOY | 20575022 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20240544 | BOY |
| EOY | 22867219 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 2573388 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 209657 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Activities | 1 | OtherActivities |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | NONDEDUCTIBLE ASSOCIATION DUES | Explanation |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 53812 | OtherCostOrOtherBasis |
| Depreciation | 46977 | Depreciation |
| Book Value | 6835 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1601755 | OtherCostOrOtherBasis |
| Depreciation | 914069 | Depreciation |
| Book Value | 687686 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 982493 | OtherCostOrOtherBasis |
| Depreciation | 473801 | Depreciation |
| Book Value | 508692 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1203213 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 386922 |
| INVESTMENT IN JOINT VENTURE | 760250 |
| OTHER ASSETS | 55379 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1202551 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | THIRD PARTY RESERVE | Description |
| Amount | $753,622 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 753622 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 21086133 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 21086133 | RevenueSubtotal |
| Other Revenues Not Included | 532822 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 532822 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 21618955 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 18512745 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 18512745 | ExpensesSubtotal |
| Other Expenses Not Included | 532822 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 532822 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 19045567 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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) 532,822. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR DOUBTFUL ACCOUNTS (SHOWN AS EXPENSES ON 990) 532,822. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 162978 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 162978 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00860 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 298882 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 129539 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 169343 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00890 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 461860 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 129539 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 332321 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01750 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 461860 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 129539 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 332321 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01750 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $133,259 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 15045770 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12911400 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 2134370 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 ACUITY HEALTHCARE LP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | HOSPITAL MANAGEMENT | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.00000 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.00000 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.00000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY RESTORATIVE CARE INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10648 PARK ROAD | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28210 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY RESTORATIVE CARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Permit Body Attachment | X | PermitBodyAttachment |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 1 | CollectionActivities |
| Other Actions | X | OtherActions |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| No Emergency Care | X | NoEmergencyCare |
| Other Reason | X | OtherReason |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (21 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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 7G: ACUITY HEALTHCARE, LP. (THE MANAGEMENT COMPANY) PERFORMS SERVICES THEN BILLS THE HOSPITAL ACCORDINGLY. | |
| PART I, L7 COL(F): 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 II: THE HOSPITAL DOES NOT ENGAGE IN ANY COMMUNITY BUILDING ACTIVITES DUE TO THE NATURE OF ITS EXISTENCE. | |
| 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 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. PATER 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 16E: DEFAULT JUDGEMENT ON PATIENT THAT RECEIVED INSURANCE FUNDS FOR HOSPITAL SERVICES AND WOULD NOT PAY THE HOSPITAL | MERCY RESTORATIVE CARE, INC. |
| PART V, SECTION B, LINE 17E: DEFAULT JUDGEMENT ON PATIENT THAT RECEIVED INSURANCE FUNDS FOR HOSPITAL SERVICES AND WOULD NOT PAY THE HOSPITAL | MERCY RESTORATIVE CARE, INC. |
| PART V, SECTION B, LINE 18E: PATIENT RECEIVED INSURANCE FUNDS AND WAS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE | MERCY RESTORATIVE CARE, INC. |
| PART V, SECTION B, LINE 19C: THE HOSPITAL DOES 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. | MERCY RESTORATIVE CARE, INC. |
| 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | HAJRUDIN BEGIC | NamePerson |
| Title | RN | Title |
| Base Compensation Filing Org | 133713 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 1160 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 1464 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 3686 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 13430 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 153453 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE CEO AND CFO ARE EMPLOYED THROUGH A MANAGEMENT CONTRACT WITH ACUITY HEALTHCARE, LP. AS SUCH, THEIR COMPENSATION INFORMATION IS NOT REQUIRED ON PART VII. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF FORM 990 WAS PROVIDED TO THE BOARD BY E-MAIL. MANAGEMENT PERFORMED A COMPLETE REVIEW. | |
| 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 3,641,879. MANAGEMENT AND GENERAL EXPENSES 86,654. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,728,533. | OTHER FEES |
| 990, PART XII, LINE 2C | NO CHANGE IN METHOD FROM PRIOR YEAR. |