2014-07-14T08:06:00-05:00 2013-09-30 561706742 DAVIDSON HOLLAND WHITESELL & CO PLLC 209 13TH AVE PLACE NW SUITE 200 HICKORY NC 28601 990 2012-10-01 561255030 MOUNTAIN VISTA HEALTH PARK INC MOUN 3368592181 POST OFFICE BOX 1547 DENTON NC 27239 MARIE PALMER 3368592181 2014-06-03 SUSAN M BALKE P01056462 8283222070 2012 2015-11-30 17:44:51Z MARIE PALMER POST OFFICE BOX 1547 DENTON NC 27239 6306374 0 X N/A X 1971 NC PROVIDE QUALITY LONG-TERM NURSING CARE FOR RESIDENTS. 9 9 158 35 0 0 0 0 6131780 6273271 25540 30703 2400 2400 6159720 6306374 0 0 0 0 3368330 3356928 0 0 0 2569449 2494160 5937779 5851088 221941 455286 5051680 5465627 523863 482524 4527817 4983103 TO PROVIDE QUALITY LONG-TERM SKILLED NURSING CARE AND ASSISTED LIVING SERVICES TO THE SOUTH DAVIDSON COUNTY COMMUNITY. 0 0 4911097 6273271 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.DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2012, WE PROVIDED 21,550 DAYS OF CARE FOR RESIDENTS NEEDING NURSING CARE; WE PROVIDED 19,899 DAYS OF SERVICES FOR OTHER LEVELS OF CARE. 4911097 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 1 158 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 DEWEY SNIDER 0.30 X X 0 0 0 TONY JACKSON 0.30 X X 0 0 0 MARIE PALMER 0.40 X X 0 0 0 JEANETTE SKEEN 0.30 X X 0 0 0 AVA BADGETT 0.30 X X 0 0 0 DEL CRANFORD 0.30 X 0 0 0 MAL MARTIN 0.30 X 0 0 0 KURT BEYELOR 0.30 X 0 0 0 KATHY MCDONALD 40.00 X 101206 0 10400 101206 0 10400 1 0 0 0 LEGACY HEALTHCARE SERVICES INC PO BOX 951003 CLEVELAND OH 44193 PHYSICAL, SPEECH & OCCUPATIONAL THERAPY 592010 BLUE CROSS BLUE SHIELD PO BOX 580017 CHARLOTTE NC 28258 GROUP MEDICAL INSURANCE 320289 US FOOD SERVICE 125 FORT MILL PARKWAY FORT MILL SC 29715 FOOD SERVICE AND SUPPLY 187610 NEIL MEDICAL GROUP 2545 JETPORT ROAD KINSTON NC 28504 NURSING AND MEDICAL SUPPLIES 121070 YADKIN VALLEY HEALTH CARE 17955 SOUTH HWY 109 DENTON NC 27239 PHARMACY CONTRACT SERVICE 106850 5 ROUTINE NURSING CARE 623000 6259527 6259527 ANCILLARIES 623000 13744 13744 6273271 30703 30703 2400 0 2400 2400 2400 6306374 6273271 0 33103 3009220 2799070 210150 122555 90113 32442 225153 209261 15892 314443 314443 20295 20295 2269 2269 16948 8658 8290 26 26 119253 119253 303250 291799 11451 SUPPLIES 505585 501950 3635 CONTRACT SERVICES 422937 420792 2145 MEDICAID SETTLEMENT 287554 287554 RAW FOOD 224945 224945 276655 245256 31399 5851088 4911097 939991 0 3200360 2777647 574425 604182 13399 15079 41831 80184 3740141 2794683 897463 945458 324202 1043077 5051680 5465627 499661 453563 24202 28961 523863 482524 X 4527817 4983103 4527817 4983103 5051680 5465627 455286 0 X 0 1 X 0 0 X 2440 2440 5756949 5830748 6112172 6131780 6273271 30104920 1800 2400 2400 6600 5759389 5830748 6113972 6134180 6275671 30113960 0 0 0 30113960 52361 44198 43117 25540 30703 195919 52361 44198 43117 25540 30703 195919 5811750 5874946 6157089 6159720 6306374 30309879 0.99350 0.99180 0.00650 0.00820 X 785 0 0 0 0 0 0 0 0 1 785 785 0 ORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES: 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. EXPLANATION OF 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 1061883 321055 1587875 1219283 368592 671403 460407 210996 78567 53110 25457 945458 PATIENT FUNDS 28961 CASH VALUE OF LIFE INSURANCE 300000 INVESTMENTS 714116 1043077 PATIENT FUNDS 28961 28961 X 6306348 0 6306348 26 26 6306374 5851062 0 5851062 26 26 5851088 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013, 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 TEH YEARS ENDED SEPTEMBER 30, 2013 AND 2012. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 26. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 26. 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.