2022-05-23T17:36:29-05:00 2021-06-30 990 2020-07-01 900222618 WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN WAKE 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 STEPHAN LILLIE TREASURER 3367164445 2022-05-16 STEPHAN LILLIE 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JULIE A FREISCHLAG MD MEDICAL CENTER BLVD WINSTONSALEM NC 27157 111398791 1 1 3884 X WWW.WAKEHEALTH.EDU X 2003 NC OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY. 5 1 0 6 0 0 1591961 951791 109688330 110447000 38822 0 0 0 111319113 111398791 1249685 1363605 0 0 0 0 0 0 0 89228409 88757302 90478094 90120907 20841019 21277884 261972979 282624081 10024640 9397858 251948339 273226223 OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY AND AS A SUPPORTING ORGANIZATION EXCLUSIVELY FOR THE BENEFIT OF WAKE FOREST UNIVERSITY AND WAKE FOREST UNIVERSITY HEALTH SCIENCES. 0 0 80390089 1363605 110447000 HEMODIALYSIS: THE CLINICS SERVE THE TEACHING AND RESEARCH PROGRAMS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES AND WAKE FOREST UNIVERSITY BY PROVIDING DIALYSIS TREATMENTS TO END STAGE RENAL DISEASE PATIENTS (1,844 IN-CENTER AND 307 HOME DIALYSIS PATIENTS), OR BY TRAINING PATIENTS IN SELF-ADMINISTRATION OF AT-HOME DIALYSIS TREATMENTS. 80390089 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 108 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SYSTEMS MANAGEMENT INC 2293865505 PO BOX 7710 TIFTON GA 317937710 X JULIE A FREISCHLAG MD CHAIR & PRESIDENT 0.50 39.50 X X 0 3070030 440136 KEVIN P HIGH MD DIRECTOR & VP 0.50 39.50 X X 0 1158409 259311 TERRY L HALES JR DIRECTOR & ASST TREAS 0.50 39.50 X X 0 631751 137670 BARRY I FREEDMAN MD DIRECTOR (TO 10/30/20) 0.50 39.50 X 0 558952 42327 TERRY G WILLIAMS DIRECTOR 0.50 39.50 X 0 0 0 RUSSELL M HOWERTON MD DIRECTOR (FROM 10/30/20) 0.50 39.50 X 0 714931 174772 J REID MORGAN SECRETARY 0.50 39.50 X 0 659852 140201 BRADLEY A CLARK TREASURER 0.50 39.50 X 0 0 0 JOHN D MCCONNELL MD FORMER OFF (4/26/17) 0.00 40.00 X 0 489759 43549 0 7283684 1237966 0 1 1 0 HSM DIALYSIS CENTERS LLC PO BOX 7710 TIFTON GA 31793 PROFESSIONAL SERVICES 8721837 NEPHROLOGY ASSOCIATES 730 HIGHLAND OAKS DRIVE WINSTONSALEM NC 27103 MEDICAL DIRECTOR 527242 HIGH POINT NEPHROLOGY ASSOC 404 WESTWOOD AVE 105 HIGH POINT NC 27262 MEDICAL DIRECTOR 141970 IREDELL NEPHROLOGY 2117 SIMONTON ROAD 102 STATESVILLE NC 28625 MEDICAL DIRECTOR 123868 4 951791 951791 PATIENT SERVICE REVENUE 621300 110447000 110447000 110447000 111398791 110447000 0 0 X 1363605 1363605 8803348 8803348 21446 21446 85589 57917 27672 39173474 39004140 169334 119 119 517446 451284 66162 1010778 881538 129240 3761897 3280892 481005 128544 112108 16436 28408 24776 3632 486117 452128 33989 MEDICAL SUPPLIES 26584713 26584713 BAD DEBT 8155423 8155423 90120907 80390089 9730818 0 5316171 5349834 13287609 12768953 2327077 2944308 13055 31919 241029067 261529067 261972979 282624081 9072849 9397858 951791 0 10024640 9397858 X 251948339 273226223 251948339 273226223 261972979 282624081 21277884 0 X 0 1 X 1 0 X X 2 WAKE FOREST UNIVERSITY 560532138 2 1 0 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES 223849199 2 1 0 0 2 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 PART IV, LINE 6 EXPLANATION THE ORGANIZATION PROVIDED SUPPORT TO AMERICAN KIDNEY FUND AND UNITED WAY OF FORSYTH COUNTY, BOTH OF WHICH ARE 501(C)(3) ORGANIZATIONS. AMERICAN KIDNEY FUND PROVIDES FINANCIAL ASSISTANCE FOR QUALIFIED KIDNEY PATIENTS AND DIRECTLY BENEFITS INDIVIDUALS BENEFITTED BY THE ORGANIZATION'S SUPPORTED ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES. SIMILARLY, UNITED WAY OF FORSYTH COUNTY PROVIDES HEALTH, FINANCIAL, AND OTHER ASSISTANCE TO INDIVIDUALS AND FAMILIES IN NEED IN FORSYTH COUNTY, NC, DIRECTLY BENEFITTING INDIVIDUALS BENEFITTED BY THE ORGANIZATION'S SUPPORTED ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES. 0 WFUHS CAPITAL CONTRIBUTION 261529067 261529067 X PART X, LINE 2: ALL DIALYSIS CENTER ORGANIZATIONS REPRESENTED IN THIS GROUP RETURN HAVE EVALUATED UNCERTAIN TAX POSITIONS FOR THEIR FISCAL YEARS ENDED JUNE 30, 2021 AND 2020, INCLUDING A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF JOINT VENTURES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATIONS' FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2021 AND 2020. 1 AMERICAN KIDNEY FUND 11921 ROCKVILLE PIKE ROCKVILLE MD 20852 237124261 501(C)(3) 1343605 FINANCIAL ASSISTANCE PROGRAM FOR QUALIFIED KIDNEY PATIENTS UNITED WAY OF FORSYTH COUNTY 301 N MAIN STREET WINSTON SALEM NC 27101 237357234 501(C)(3) 20000 COMMUNITY SUPPORT 2 0 PART I, LINE 2: ALL ORGANIZATIONS REPRESENTED IN THIS GROUP EXEMPTION RETURN FOLLOW THE CORPORATE POLICY USED BY WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER (TO WHICH ENTITY THE OPERATION OF THE SUBSIDIARIES OF WAKE FOREST UNIVERSITY HEALTH SCIENCES "WFUHS AND NORTH CAROLINA BAPTIST HOSPITAL "NCBH" (INCLUDING THE FILING ORGANIZATION) HAS BEEN DELEGATED) IN REVIEWING ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE ORGANIZATIONS MAINTAIN DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF AMOUNTS DISBURSED. 0 1 0 0 0 0 0 0 0 JULIE A FREISCHLAG MD CHAIR & PRESIDENT 0 1456803 0 663750 0 949477 0 412187 0 27949 0 3510166 0 905232 KEVIN P HIGH MD DIRECTOR & VP 0 747328 0 292006 0 119075 0 238046 0 21265 0 1417720 0 95467 RUSSELL M HOWERTON MD DIRECTOR (FROM 10/30/20) 0 506209 0 71182 0 137540 0 144519 0 30253 0 889703 0 0 J REID MORGAN SECRETARY 0 489082 0 150000 0 20770 0 104450 0 35751 0 800053 0 0 TERRY L HALES JR DIRECTOR & ASST TREAS 0 426648 0 135000 0 70103 0 110199 0 27471 0 769421 0 0 BARRY I FREEDMAN MD DIRECTOR (TO 10/30/20) 0 542658 0 10750 0 5544 0 21519 0 20808 0 601279 0 0 JOHN D MCCONNELL MD FORMER OFF (4/26/17) 0 444351 0 0 0 45408 0 21519 0 22030 0 533308 0 0 PART I, LINE 4B CERTAIN OFFICERS AND DIRECTORS OF THE ORGANIZATIONS INCLUDED IN THIS GROUP RETURN PARTICIPATED IN AND/OR RECEIVED PAYMENTS FROM SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANS (SERP) AND EXECUTIVE INCENTIVE COMPENSATION PLANS (ALL OF WHICH WAS PAID BY RELATED ORGANIZATIONS, WAKE FOREST UNIVERSITY HEALTH SCIENCES OR WAKE FOREST UNIVERSITY, AS PART OF THE INDIVIDUAL'S COMPENSATION FROM THE RELATED ORGANIZATIONS). THE FOLLOWING CURRENT DIRECTORS AND OFFICERS RECEIVED SERP PAYMENTS IN THEIR CALENDAR YEAR 2020 COMPENSATION: JULIE A. FREISCHLAG, M.D. $915,849 KEVIN P. HIGH, M.D. $95,467 RUSSELL M. HOWERTON, M.D. $112,000 TERRY L. HALES, JR. $67,985 J. REID MORGAN $75,950 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ALL ORGANIZATIONS INCLUDED IN THIS GROUP RETURN IS WAKE FOREST UNIVERSITY HEALTH SCIENCES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATIONS INCLUDED IN THIS GROUP RETURN ARE APPOINTED BY THE GOVERNING BODY OF WAKE FOREST UNIVERSITY HEALTH SCIENCES OR BY A MEMBER OF THE GOVERNING BODY OR BY AN OFFICER OF WAKE FOREST UNIVERSITY HEALTH SCIENCES ACTING IN THEIR OFFICIAL CAPACITY, IN ACCORDANCE WITH PROCEDURES PRESCRIBED BY THE BOARD OF DIRECTORS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE ORGANIZATIONS' GOVERNING BODIES WHICH REQUIRE APPROVAL BY THE PARENT ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES, INCLUDE AMENDMENTS TO THE ORGANIZATIONS' GOVERNANCE DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS), AND THE ELECTION AND REMOVAL OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARDS OF DIRECTORS OF ALL ORGANIZATIONS REPRESENTED ON THIS GROUP RETURN RECEIVE A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW, THE REVISED FORM 990 IS REDISTRIBUTED PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A SUMMARY OF THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C ALL ORGANIZATIONS INCLUDED IN THIS GROUP RETURN REQUIRE OFFICERS AND DIRECTORS TO DISCLOSE CONFLICTS OF INTEREST ANNUALLY, AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATIONS' POLICY ON CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 NO ORGANIZATIONS INCLUDED IN THIS GROUP RETURN PAY COMPENSATION TO OFFICERS OR DIRECTORS. ALL COMPENSATION PAID TO OFFICERS AND DIRECTORS AND FORMER OFFICERS OR DIRECTORS IS PAID BY RELATED ORGANIZATIONS. THE GOVERNANCE & COMPENSATION COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER BOARD IS RESPONSIBLE FOR REVIEWING AND APPROVING MOST OFFICERS' COMPENSATION. THE COMMITTEE UTILIZES INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH SUCH OFFICERS' COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ARTICLES OF INCORPORATION OF EACH OF THE SEPARATE DIALYSIS CENTER ORGANIZATIONS INCLUDED IN THIS GROUP EXEMPTION RETURN ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. SUCH ORGANIZATIONS' BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THEIR BYLAWS ARE INCLUDED AS NECESSARY IN SUCH ORGANIZATIONS' POLICIES, AND ARE ATTACHED TO THE FORMS 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS OF SUCH ORGANIZATIONS ARE AVAILABLE TO THE PUBLIC ON REQUEST. PART VII, SECTION A, COLUMN B, HOURS JOHN D. MCCONNELL, MD FILING ORG 0.0 RELATED ORG 0.0 UNRELATED ORG 40.0 JULIE A. FREISCHLAG, MD FILING ORG 0.5 RELATED ORG 17.7 UNRELATED ORG 21.8 BARRY I. FREEDMAN, MD FILING ORG 0.5 RELATED ORG 39.5 TERRY L. HALES, JR. FILING ORG 0.5 RELATED ORG 39.5 TERRY G. WILLIAMS FILING ORG 0.5 RELATED ORG 3.3 UNRELATED ORG 36.2 KEVIN P. HIGH, MD FILING ORG 0.5 RELATED ORG 5.8 UNRELATED ORG 33.7 J. REID MORGAN FILING ORG 0.5 RELATED ORG 30.5 UNRELATED ORG 9.0 BRADLEY A. CLARK FILING ORG 0.5 RELATED ORG 7.0 UNRELATED ORG 32.5 RUSSELL M. HOWERTON, MD FILING ORG 0.5 RELATED ORG 16.6 UNRELATED ORG 22.9 A MEDICAL CENTER INTEGRATION AGREEMENT ("MCIA") WAS ORIGINALLY ENTERED INTO IN 2010 AMONG FOUR PARTIES: WAKE FOREST UNIVERSITY ("WFU"), WAKE FOREST UNIVERSITY HEALTH SCIENCES ("WFUHS"), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") AND NORTH CAROLINA BAPTIST HOSPITAL ("NCBH"). PURSUANT TO THE TERMS OF THE ORIGINAL MCIA, THE OPERATION OF WFUHS AND NCBH, AND ALL OF THE RESPECTIVE SUBSIDIARIES OF EACH, IS DELEGATED TO WFUBMC. ADDITIONALLY, THE CORPORATE OFFICERS OF WFUBMC GENERALLY SERVE AS THE CORPORATE OFFICERS OF WFUHS AND NCBH. THE MCIA WAS REVISED AND RESTATED IN 2020 TO DELEGATE OVERSIGHT AND MANAGEMENT AUTHORITY OVER WFUBMC TO ATRIUM HEALTH, INC. ("AHI"). CERTAIN DIRECTORS AND/OR CORPORATE OFFICERS OF WFUHS, NCBH, & WFUBMC ALSO SERVE AS DIRECTORS OR CORPORATE OFFICERS OF AHI. WFU AND WFUHS ARE ORGANIZATIONS RELATED TO THE SEPARATE DIALYSIS CENTER ORGANIZATIONS INCLUDED IN THIS GROUP RETURN. NCBH, WFUBMC, AND AHI ARE ORGANIZATIONS UNRELATED TO THE ORGANIZATIONS INCLUDED IN THIS GROUP RETURN. THUS, CERTAIN DIRECTORS AND OFFICERS OF THE ORGANIZATIONS INCLUDED IN THIS GROUP RETURN DEVOTE HOURS TO RELATED ORGANIZATIONS (WFU & WFUHS) AND UNRELATED ORGANIZATIONS (WFUBMC, NCBH, AND AHI) AS SHOWN IN THE BREAKDOWN OF HOURS ABOVE. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 35,804,688. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,804,688. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,199,452. MANAGEMENT AND GENERAL EXPENSES 169,334. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,368,786. WAKE FOREST EMERGENCY PROVIDERS MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561903275 HEALTHCARE NC 501(C)(3) LINE 3 WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES MEDICAL CENTER BLVD WINSTON SALEM NC 27157 223849199 HEALTHCARE, EDUCATION, RESEARCH NC 501(C)(3) LINE 2 WAKE FOREST UNIVERSITY 0 WAKE FOREST UNIVERSITY BOX 7201 WINSTON SALEM NC 27109 560532138 EDUCATION NC 501(C)(3) LINE 2 N/A 0 WAKE FOREST INNOVATION QUARTER MANAGEMENT CO MEDICAL CENTER BLVD WINSTON SALEM NC 27157 061818498 RESEARCH PARK DEVELOPMENT NC 501(C)(3) LINE 12A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST INNOVATION QUARTER CDC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 200177581 RESEARCH PARK DEVELOPMENT NC 501(C)(3) LINE 12A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST INNOVATION QUARTER DEVELOPMENT CO MEDICAL CENTER BLVD WINSTON SALEM NC 27157 562094067 RESEARCH PARK DEVELOPMENT NC 501(C)(6) WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 CHILDRESS INSTITUTE FOR PEDIATRIC TRAUMA MEDICAL CENTER BLVD WINSTON SALEM NC 27157 463674691 HEALTHCARE RESEARCH NC 501(C)(3) LINE 7 WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 REGENMED DEVELOPMENT ORGANIZATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 202710571 HEALTHCARE RESEARCH NC 501(C)(3) LINE 7 WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 VERGER FUND II LLC 751 W FOURTH STREET SUITE 410 WINSTON SALEM NC 27101 352514227 INVESTMENT NC N/A 0 0 WAKE FOREST TECHNOLOGY DEVELOPMENT PROGRAM LP 2520 MERIDIAN PARKWAY DURHAM NC 27713 475437596 INVESTMENT NC N/A 0 0 WAKE FOREST AMBULATORY VENTURES LLC MEDICAL CENTER BOULEVARD WINSTON SALEM NC 27157 820777206 HEALTHCARE NC N/A 0 0 NORTH DISTRICT OWNERS ASSOCIATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 471128865 PROPERTY OWNERS ASSOCIATION NC N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 1