2012-03-09T16:43:27-06:00 2011-09-30 DAVIDSON HOLLAND WHITESELL & CO PLLC 209 13TH AVE PLACE NW SUITE 200 HICKORY NC 28601 990 2010-10-01 561255030 MOUNTAIN VISTA HEALTH PARK INC MOUN 3368592181 POST OFFICE BOX 1547 DENTON NC 27239 MARIE PALMER 3368592181 2012-03-09 1 SUSAN M BALKE 8283222070 2010 2016-02-24 21:20:13Z MARIE PALMER POST OFFICE BOX 1547 DENTON NC 27239 6157089 0 X N/A X 1971 NC PROVIDE QUALITY LONG-TERM NURSING CARE FOR RESIDENTS. 9 9 159 17 0 0 0 0 5830748 6112172 41798 43117 2400 1800 5874946 6157089 0 0 0 0 3204432 3297246 0 0 0 2333361 2391648 5537793 5688894 337153 468195 4301178 4743215 463497 437339 3837681 4305876 TO PROVIDE QUALITY LONG-TERM SKILLED NURSING CARE AND ASSISTED LIVING SERVICES TO THE SOUTH DAVIDSON COUNTY COMMUNITY. 0 0 4754912 6112172 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, 2011, WE PROVIDED 21,550 DAYS OF CARE FOR RESIDENTS NEEDING NURSING CARE; WE PROVIDED 19,899 DAYS OF SERVICES FOR OTHER LEVELS OF CARE. 4754912 1 0 0 1 0 0 0 0 0 1 0 0 0 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 0 1 6 0 159 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 JIM KELLEY 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 ANNE BEAM 0.30 X X 0 0 0 CHARLES HEDRICK 0.30 X 0 0 0 TONY JACKSON 0.30 X 0 0 0 DALE FUTRELL 0.30 X 0 0 0 KURT BEYELOR 0.30 X 0 0 0 KATHY MCDONALD 40.00 X 96874 0 9336 CLIFTON BAKER 0.30 X 0 0 0 0 0 0 0 0 0 0 LEGACY HEALTHCARE SERVICES INC PO BOX 951003 CLEVELAND OH 44193 PHYSICAL, SPEECH & OCCUPATIONAL THERAPY 562237 BLUE CROSS BLUE SHIELD PO BOX 580017 CHARLOTTE NC 28258 GROUP MEDICAL INSURANCE 451228 TULLOCK MANAGEMENT COMPANY PO BOX 1678 CLEMMONS NC 27012 MANAGEMENT SERVICES 305936 US FOOD SERVICE 125 FORT MILL PARKWAY FORT MILL SC 29715 FOOD SERVICE AND SUPPLY 155468 YADKIN VALLEY HEALTHCARE 17955 SOUTH HIGHWAY 109 DENTON NC 27239 MEDICATIONS AND PHARMACY SERVICES 113471 5 ROUTINE NURSING CARE 623000 6098138 6098138 ANCILLARIES 623000 14034 14034 6112172 43117 43117 1800 1800 1800 1800 6157089 6112172 0 44917 2939673 2733179 206494 140147 99994 40153 217426 202101 15325 305936 305936 10107 10107 23350 23350 3413 3413 16602 9269 7333 33 33 81382 80635 747 326424 310299 16125 SUPPLIES 454707 451561 3146 CONTRACT SERVICES 436659 434398 2261 MEDICAID SETTLEMENT 261974 261974 RAW FOOD 211549 211549 UTILITIES 166280 149055 17225 93232 72872 20360 5688894 4754912 933982 0 3080941 3215939 464980 536615 13644 14974 44351 39919 3407104 2569712 598830 837392 98432 98376 4301178 4743215 437714 407201 25783 30138 463497 437339 X 3796811 4265006 40870 40870 3837681 4305876 4301178 4743215 468195 0 X 0 1 0 X 0 X 124111 2440 126551 4860585 5096209 5756949 5830748 6112172 27656663 1800 1800 4984696 5096209 5759389 5830748 6113972 27785014 0 0 0 27785014 86083 73727 52361 44198 43117 299486 86083 73727 52361 44198 43117 299486 5070779 5169936 5811750 5874946 6157089 28084500 0.98930 0.98900 0.01070 0.01100 X 766 0 0 0 0 0 0 0 0 1 766 766 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 OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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 1049002 333936 1401764 1063282 338482 524477 397832 126645 78567 59596 18971 837392 PATIENT FUNDS 30138 30138 6157089 5688894 468195 0 468195 6157056 0 6157056 33 33 6157089 5688861 0 5688861 33 33 5688894 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: EFFECTIVE OCTOBER 1, 2009, THE ORGANIZATION 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, 2011, THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 33. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSES NETTED AGAINST INCOME ON FINANCIAL STATEMENTS 33. 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 OFFICERS RECEIVE NO COMPENSATION. KEY EMPLOYEES 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.