2011-03-15T12:44:41-05:00 2010-07-31 LarsonAllen LLP 101 N Tryon Street Suite 1000 Charlotte NC 28246 990 2009-08-01 753054855 Mercy Restorative Care Hospital Inc MERC 7043046025 10200 Mallard Creek Road No 300 Charlotte NC 28262 Joanne Tyo 7043046025 2011-03-15 1 Gregory W Johns 7049985200 2009 2016-02-24 21:20:13Z Joanne Tyo 10200 Mallard Creek Road No 300 Charlotte NC 28262 22772401 0 X www.cshnc.com X 2002 NC to provide long term acute care services. 9 9 201 0 0 0 0 18587224 22266828 178789 497599 13529 7974 18779542 22772401 0 0 7610842 8330915 0 0 9032469 9505503 16643311 17836418 2136231 4935983 12718165 17246276 4915700 4104688 7802465 13141588 To promote and improve the health status of the community by providing long term acute care services. 0 0 15688381 22274802 provided long term acute care services through the OPERATION OF A 40 BED hOSPITAL-WITHIN-A-HOSPITAL. 15688381 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 27 0 201 1 0 0 0 0 0 0 0 0 0 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X Acuity Healthcare LP 7048877285 10200 Mallard Creek Road No 300 Charlotte NC 28262 X Curtis Copenhaver 1.00 X 0 0 0 David Thomas 1.00 X 0 0 0 Robert King 1.00 X 0 0 0 Mary Piepenbring 1.00 X 0 0 0 Dr Roger Ray 1.00 X 0 0 0 Neal Alexander 1.00 X 0 0 0 Nancy Geedey 1.00 X 0 0 0 Lysa Long 1.00 X 0 0 0 Edward Bethea 1.00 X 0 0 0 Susan Davis 40.00 X 0 0 0 Joanne Tyo 40.00 X 0 0 0 Kimberly H Singleton 40.00 X 140199 0 1170 Hajrudin Begic 40.00 X 142700 0 11366 Halina Brengel 40.00 X 137203 0 5837 420102 0 18373 3 0 1 0 CMC Mercy Hospital PO Box 32861 Charlotte NC 28232 Medical Services 3815898 Acuity Healthcare LP 10200 Mallard Creek Rd Charlotte NC 28262 Labor, Consulting 1299762 Blue Cross Blue Shield PO Box 580017 Charlotte NC 28258 Physician Services 749199 Carolinas Healthcare Systems PO Box 32861 Attn Julie France charlotte NC 28232 Medical Services 670996 Charlotte Meck Hospital 2001 Vail Avenue Diane Boney 7th Fl charlotte NC 28207 Medical Services 540702 5 Patient revenue 621400 22266828 22266828 22266828 497599 497599 7974 7974 7974 22772401 22274802 0 497599 6659524 5707516 952008 41234 35339 5895 1120100 836701 283399 510057 437142 72915 204000 204000 55700 55700 18000 18000 3801078 3731291 69787 15320 14342 978 73370 73370 7662 7662 683463 651631 31832 34227 30006 4221 11322 9787 1535 1388 1388 158221 158221 164544 143581 20963 Patient Care Supplies 2736069 2736069 Bad Debt Expense 765761 765761 Patient Care Equipment 430758 430758 344620 236 344384 17836418 15688381 2148037 0 3930508 4053071 4471775 9663323 3515911 2546019 33946 25356 80621 85830 1625892 873490 573977 752402 111427 120275 12718165 17246276 1850781 1826753 3064919 2277935 4915700 4104688 X 7802465 13141588 7802465 13141588 12718165 17246276 X 0 1 1 X 0 X 51911 6943 44968 1573981 866547 707434 752402 THIRD PARTY RESERVE 2277935 2277935 22772401 17836418 4935983 403140 403140 5339123 23175541 403140 403140 22772401 0 22772401 17836418 0 17836418 0 17836418 1 1 1 X 1 X 1 1 0 0 722184 722184 0.04050 272982 272982 0.01530 995166 995166 0.05580 500 500 0.00000 500 500 995666 995666 0.05580 1 765761 217476 15535033 11227194 4307839 X 1 0 Acuity Healthcare Hospital Management 0.00000 0.00000 0.00000 Mercy Restorative Care Inc

2001 Vail Avenue CHARLOTTE NC 28207

X X Part I, Line 7g: Host hospital performs services then bills Mercy Restorative Care Hospital accordingly Part III, Line 8: Cost Report Part VI, Line 2: Hospital houses 40 licensed beds for long-term acute care. Part VI, Line 3: Hospital has a charity care program for those who qualify based on income standards. Hospital provides financial assistance applications. Part VI, Line 4: Mecklenburg County and surrounding regions Part VI, Line 5: None Part VI, Line 6: Sponsor of healthcare convention Part VI, Line 7: Hospital is housed in another hospital but are separate for purposes of sponsorship and community related healthcare events 0 0 0 0 0 0 0 0 0 Hajrudin Begic 142700 0 0 0 0 0 0 0 11366 0 154066 0 0 0 Form 990, Part VI, Section A, line 3 CEO and CFO are employed through 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 XI, Line 2c: No Changes for approving audited financial statemeNTs or selection of independent accountants have occurred from the prior year.