2012-08-15T15:51:19-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-10-01 561623092 STANLY MANOR INC STAN 7049820770 625 BETHANY ROAD ALBEMARLE NC 28001 NYKOLA SAMILO 7049820770 2012-08-15 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z STEPHANIE HERRIN-HUNNEYCU 625 BETHANY ROAD ALBEMARLE NC 28001 7453100 0 X WWW.STANLY.ORG X 1989 NC TO PROVIDE SKILLED NURSING AND REHABILIATIVE SERVICES TO OUR COMMUNITY. 4 1 225 52 0 0 0 0 6940107 7448563 1084 1127 3017 3410 6944208 7453100 0 0 0 0 4304944 4244494 0 0 0 2691799 2828227 6996743 7072721 -52535 380379 3094726 3456267 2146600 2221377 948126 1234890 STANLY MANOR, INC. IS A PRIVATE NOT-FOR-PROFIT MULTI-LEVEL LONG-TERM CARE FACILITY OFFERING 24-HOUR CARE WITH ASSISTED LIVING AND NURSING CARE. 0 0 6484381 7448563 STANLY MANOR, INC. IS A 100 BED FACILITY PROVIDING MULTI-LEVEL LONG-TERM HEALTH CARE FOR NURSING HOME AND REST HOME PATIENTS. IT PROVIDES 24 HOUR NURSING CARE, NUTRITIOUS MEALS AND THERAPEUTIC DIETS, DIETICIAN SERVICE, 24 HOUR SECURITY AND EMERGENCY RESPONSE SYSTEMS, REHABILITATION SERVICES AND RESTORATIVE CARE, PHYSICIAN SERVICES, PHARMACY SERVICES, FULL COMPLEMENT OF SCHEDULED ACTIVITIES, BEAUTY SHOP/BARBER SHOP, HOUSEKEEPING AND LAUNDRY SERVICES, ON-STAFF SOCIAL WORKER, HOSPICE SERVICES, AND TRANSPORTATION FOR MEDICAL APPOINTMENTS. STANLY MANOR ACCEPTS MEDICAID, PRIVATE INSURANCE, AND MEDICARE PAYMENTS FOR SERVICES PROVIDED. 6484381 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 19 0 225 1 0 0 0 0 0 0 0 0 0 0 X 4 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X STEPHANIE HERRIN-HUNEYCUTT 7049820770 625 BETHANY ROAD ALBEMARLE NC 28001 ALFRED P TAYLOR 1.00 X 0 317076 42607 NYKOLA SAMILO 1.00 X 0 214071 32636 JOE GODWIN 1.00 X 0 0 0 JUDY DORAN 1.00 X 0 32500 0 STEPHANIE HERRIN-HUNEYCUTT 40.00 X 0 76024 10102 DEBRA SMITH 1.00 X 0 227075 5310 0 866746 90655 0 1 1 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPIES 627270 US FOODS PO BOX 602286 CHARLOTTE NC 28266 FOODS AND SUPPLEMENTS 318585 STOKES CONSTRUCTION 619 N SECOND ST ALBEMARLE NC 28001 LABOR/MATERIALS/INSTALLATION 245196 CCRX PHARMACY 622 MAYWOOD AVENUE RALEIGH NC 27603 DRUGS 209550 MCKESSON PO BOX 630693 CINCINNATI OH 45263 MEDICAL SUPPLIES 209187 7 PATIENT REVENUE 623000 7412295 7412295 36268 36268 7448563 1127 1127 3410 3410 3410 7453100 7448563 0 4537 93269 10020 83249 3135957 3048018 87939 76517 74375 2142 697723 678276 19447 241028 223630 17398 111449 111449 190 190 79994 79994 793469 788418 5051 1856 1856 20699 2090 18609 183208 183208 13976 7032 6944 58555 58555 137837 137837 13606 15 13591 SUPPLIES 894312 883949 10363 BED TAX ASSESSMENT 344990 344990 BAD DEBT EXPENSE 70621 70621 TELEPHONE AND CABLE 29476 29476 73989 31902 42087 7072721 6484381 588340 0 172193 182826 685358 842656 30793 38586 5267027 2901968 2183381 2365059 23001 27140 3094726 3456267 524524 565683 1158305 1034545 463771 621149 2146600 2221377 X 948126 1234890 948126 1234890 3094726 3456267 X 380379 -93615 X X 0 1 1 X 0 X 10000 16364 26364 5931183 6319220 6701205 6935633 7448563 33335804 5941183 6335584 6701205 6935633 7448563 33362168 0 0 0 33362168 4037 1947 1578 1084 1127 9773 4037 1947 1578 1084 1127 9773 44910 69346 198853 7491 3410 324010 5990130 6406877 6901636 6944208 7453100 33695951 0.99010 0.98590 0.00030 0.00050 X 166092 166092 4058526 2290899 1767627 0 718705 611069 107636 323704 323704 2365059 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 25000 ADVANCES FROM AFFILIATES 141296 PENSION LIABILITY 454853 621149 7453100 7072721 380379 -93615 -93615 286764 7359485 -93615 -93615 7453100 0 7453100 7072721 0 7072721 0 7072721 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FILING ORGANIZATION IS A NON PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAX ON REVENUE EARNED FROM ITS TAX-EXEMPT STATUS. THE FILING ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUSES NOR IS IT AWARE OF ANY OF ITS ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE YEARS 2007 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. THE FILING ORGANIZATION HAS ADOPTED THE INCOME TAX STANDARD ISSUED BY FINANCIAL ACCOUNTING STANDARDS BOARD IN LIGHT OF ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNRECOGNIZED PENSION EXPENSE -93,615. X X X X X 1 0 0 0 0 0 0 0 0 ALFRED P TAYLOR 0 239370 0 59819 0 17887 0 20258 0 22349 0 359683 0 0 NYKOLA SAMILO 0 182953 0 28738 0 2380 0 14960 0 17676 0 246707 0 0 DEBRA SMITH 0 44019 0 35897 0 147159 0 4741 0 569 0 232385 0 0 PART I, LINE 4A A FORMER OFFICER RECEIVED A SEVERANCE PAYMENT DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE MARCH 1, 2009, THE PARENT ENTERED INTO A MANAGEMENT SERVICES AGREEMENT (MSA) WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY D/B/A CAROLINAS HEALTHCARE SYSTEM (CHS) TO MANAGE THE PARENTS OPERATIONS. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DID NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WILL BE EMAILED TO EACH BOARD MEMBER AND OFFICER FOR THEIR REVIEW BEFORE SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE BYLAWS ADDRESS WHAT CONSTITUTES CONFLICTS OF INTEREST, THE RESPONSIBILITY OF DISCLOSURE OF EACH MEMBER, HOW CONFLICTS (AND POTENTIAL CONFLICTS) ARE ADDRESSED, AND 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. IN THE EVENT THE CORPORATION DETERMINES THAT A CONFLICT OF INTEREST EXISTS, IT SHALL TAKE SUCH ACTION(S) AS IT DEEMS NECESSARY TO RESOLVE THE CONFLICT OF INTEREST, INCLUDING: (A) PROHIBITING THE INTERESTED PERSON FROM ATTENDING ANY MEETING AT WHICH IS DISCUSSED THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST; (B) PROHIBITING THE INTERESTED PERSON FROM VOTING ON ANY MATTER RELATING TO THE CONFLICT OF INTEREST; (C) APPOINTING, IF APPROPRIATE, A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; (D) DETERMINING, BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS PRESENT AT A MEETING, WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATIONS BEST INTEREST AND FOR ITS OWN BENEFIT; IS FAIR AND REASONABLE TO THE CORPORATION; AND, AFTER EXERCISING DUE DILIGENCE, WHETHER THE CORPORATION CAN ENTER INTO A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES; AND (E) TAKING APPROPRIATE DISCIPLINARY ACTION WITH RESPECT TO AN INTERESTED PERSON WHO VIOLATES THE CORPORATIONS CONFLICTS OF INTEREST POLICY IN ORDER TO PROTECT THE CORPORATIONS BEST INTERESTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF TOP EXECUTIVES AND TOP MANAGEMENT IS DETERMINED THROUGH A MARKET COMPARISON. THIS PROCESS WAS LAST PERFORMED IN 2008. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNRECOGNIZED PENSION EXPENSE -93,615. TOTAL TO FORM 990, PART XI, LINE 5: -93,615. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART VII, DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS: OFFICERS LISTED ON PART VII WORK AN AVERAGE OF 40 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND THE RELATED ENTITIES LISTED ON SCHEDULE R. 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 0 STANLY MEDICAL SERVICES INC 320 YADKIN STREET ALBEMARLE NC 28001 561892763 HEALTHCARE NC 501(C)(3) 509(A)(2) N/A 0 STANLY REGIONAL MEDICAL CENTER INC 301 YADKIN STREET ALBEMARLE NC 28001 560556760 HOSPITAL NC 501(C)(3) 170(B)(1)(A)(III) N/A 0 STANLEX INC 907 NORTH SECOND STREET ALBEMARLE NC 28001 561532751 HEALTHCARE NC 501(C)(3) 509(A)(3) N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0