DAVIE MEDICAL CENTER: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- DAVIE MEDICAL CENTER (EIN 56-2276994)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-14
- IRS object ID
- 202121349349301782
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-05-14T08:34:40-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 562276994 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DAVI | BusinessNameControlTxt |
| Phone | 3367164445 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 329 NC HWY 801N | AddressLine1Txt |
| City | BERMUDA RUN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27006 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRADLEY A CLARK | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 3367164445 | PhoneNum |
| Signature | 2021-04-30 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHAD BROWN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 329 NC HWY 801N | AddressLine1Txt |
| City | BERMUDA RUN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27006 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $83,666,061 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | PROVISION OF PATIENT-CENTERED HEALTHCARE SERVICES TO THE SURROUNDING AREA | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 62 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,644,181 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $86,573,765 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $81,851,052 | CYProgramServiceRevenueAmt |
| PY Investment Income | $52,463 | PYInvestmentIncomeAmt |
| CY Investment Income | $170,828 | CYInvestmentIncomeAmt |
| PY Other Revenue | $88,407 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $86,714,635 | PYTotalRevenueAmt |
| CY Total Revenue | $83,666,061 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $24,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $18,204 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,976,752 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,220,307 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $41,551,942 | PYOtherExpensesAmt |
| CY Other Expenses | $37,487,215 | CYOtherExpensesAmt |
| PY Total Expenses | $67,553,194 | PYTotalExpensesAmt |
| CY Total Expenses | $67,725,726 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $19,161,441 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $15,940,335 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $52,134,000 | TotalAssetsBOYAmt |
| Total Assets EOY | $135,525,491 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,057,132 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $72,508,288 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $47,076,868 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $63,017,203 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | DAVIE MEDICAL CENTER (AT TIMES ALSO REFERRED TO AS THE "HOSPITAL OR "DMC OR "THE FILING ORGANIZATION") IS PART OF WAKE FOREST BAPTIST HEALTH (AT TIMES ALSO REFERRED TO AS "WFBH"), A PREEMINENT LEARNING HEALTH SYSTEM AND ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION THAT PROMOTES BETTER HEALTH FOR ALL THROUGH COLLABORATION, EXCELLENCE AND INNOVATION. WFBH'S MISSION IS TO IMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY: GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE; TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE; AND SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $62,964,263 | ExpenseAmt |
| Grant | $18,204 | GrantAmt |
| Revenue | $81,851,052 | RevenueAmt |
| Desc | DAVIE MEDICAL CENTER IS A 50 ACUTE CARE BED HOSPITAL PROVIDING MEDICAL, EMERGENCY, AND OUTPATIENT CARE SERVICES TO THE RESIDENTS OF DAVIE COUNTY, NORTH CAROLINA AND SURROUNDING AREAS. THE ORGANIZATION SERVES AS A SATELLITE PROVIDER OF WAKE FOREST BAPTIST HEALTH SPECIALTY SERVICES AT ITS BERMUDA RUN CAMPUS IN BOTH MEDICAL PLAZA ONE AND MEDICAL PLAZA TWO, INCLUDING CARDIAC REHABILITATION, CARDIOLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEUROLOGY, ORTHOPAEDICS, PULMONOLOGY, PODIATRY, SLEEP LAB, IMAGING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, ENDOSCOPY, LAB AND PHARMACY. DAVIE MEDICAL CENTER ("DMC") IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. THE SEAL OF ACCREDITATION IS ACCEPTED NATIONWIDE AS THE HIGHEST STANDARDS OF MEDICAL CARE IN PERSONNEL, EQUIPMENT, AND ORGANIZATION.DURING FISCAL YEAR 2020, THE HOSPITAL FACILITY HAD 11,245 PATIENT DAYS, WITH 1,973 INPATIENT ADMISSIONS, AND 16,052 EMERGENCY ROOM VISITS.AS PART OF WAKE FOREST BAPTIST HEALTH, DMC'S VISION IS A PREEMINENT LEARNING HEALTH SYSTEM THAT PROMOTES BETTER HEALTH FOR ALL THROUGH COLLABORATION, EXCELLENCE AND INNOVATION.THE HOSPITAL'S VALUES ARE AS FOLLOWS:-COMPASSION: RESPONSIVE TO THE PHYSICAL, EMOTIONAL, SPIRITUAL, AND INTELLECTUAL NEEDS OF ALL;-SERVICE: CULTIVATE SELFLESS CONTRIBUTION FOR THE GREATER GOOD;-EXCELLENCE: DEMONSTRATE THE HIGHEST STANDARDS OF PATIENT-CENTERED CARE, EDUCATION, RESEARCH, AND OPERATIONAL EFFECTIVENESS; -INTEGRITY: DEMONSTRATE FAIRNESS, HONESTY, SINCERITY, AND ACCOUNTABILITY;-COLLEGIALITY: FOSTER MUTUAL RESPECT, FACILITATE PROFESSIONAL GROWTH AND MENTORSHIP, AND REWARD TEAMWORK AND COLLABORATION; -INNOVATION: PROMOTE CREATIVITY TO ENHANCE DISCOVERY AND THE APPLICATION OF KNOWLEDGE; AND-DIVERSITY: HONOR INDIVIDUALITY AND PROTECT THE DIGNITY OF ALL.-SAFETY: EMBRACE CULTURE OF RELIABILITY THROUGH BETTER PROCESS DESIGN & ACCOUNTABILITY.DURING THE SECOND HALF OF FY20, WAKE FOREST BAPTIST HEALTH RESPONDED TO THE COVID-19 PANDEMIC. THE HEALTH SYSTEM INSTITUTED VISITOR RESTRICTIONS, DELAYED NON-ESSENTIAL SURGERIES, PROCEDURES AND APPOINTMENTS, AND RAPIDLY EXPANDED OPTIONS FOR PATIENT TELEHEALTH VISITS BY PHONE AND VIDEO. OTHER STEPS RELATED TO COVID-19 INCLUDED OPENING MORE THAN A DOZEN RESPIRATORY SYMPTOM CLINICS AT EXISTING FAMILY MEDICINE, PRIMARY AND URGENT CARE LOCATIONS THROUGHOUT THE HEALTH SYSTEM; ESTABLISHING A COVID-19 RESPONSE FUND TO GALVANIZE COMMUNITY SUPPORT FOR PATIENTS AND HEALTH CARE WORKERS; PARTICIPATING IN A COMMUNITY-WIDE EFFORT TO PRODUCE AND DISTRIBUTE MASKS; AND LEADING A COMMUNITY-BASED RESEARCH STUDY OF THE NOVEL CORONAVIRUS WITH PARTNERS JAVARA INC. AND ORACLE. | Desc |
| Total Program Service Expenses | $62,964,263 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ERIN KOEWING | PersonNm |
| Phone | 3367164445 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | MEDICAL CENTER BOULEVARD | AddressLine1Txt |
| City | WINSTONSALEM | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27157 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| BRADLEY A CLARK | |||||||||
| TREASURER | 0.50 | 39.50 | Yes (X) | $0 | $947,093 | $237,452 | |||
| J MCLAIN WALLACE JR | |||||||||
| SECRETARY | 0.50 | 39.50 | Yes (X) | $0 | $787,541 | $162,746 | |||
| CHAD BROWN | |||||||||
| PRESIDENT | 20.00 | 20.00 | Yes (X) | $0 | $320,958 | $78,060 | |||
| LYNN PITMAN | |||||||||
| BOARD MEMBER | 2.00 | 38.00 | $0 | $209,146 | $31,319 | Yes (X) | |||
| MARTHA SOOTS | |||||||||
| CLINICAL INSTRUCTOR CRNA | 40.00 | 0.00 | $0 | $208,083 | $22,357 | Yes (X) | |||
| BARRY WALD | |||||||||
| FINANCE DIRECTOR | 20.00 | 20.00 | $0 | $191,975 | $31,233 | Yes (X) | |||
| JONATHAN DUNN | |||||||||
| CLINICAL INSTRUCTOR CRNA | 40.00 | 0.00 | $0 | $192,899 | $28,109 | Yes (X) | |||
| BRYAN C LEE | |||||||||
| CLINICAL INSTRUCTOR CRNA | 40.00 | 0.00 | $0 | $172,586 | $36,721 | Yes (X) | |||
| DENISE CLARK | |||||||||
| CLINICAL INSTRUCTOR CRNA | 40.00 | 0.00 | $0 | $175,502 | $29,437 | Yes (X) | |||
| KARLA CROMER | |||||||||
| CLINICAL INSTRUCTOR CRNA | 40.00 | 0.00 | $0 | $178,229 | $16,209 | Yes (X) | |||
| KEVIN P HIGH MD | |||||||||
| CHAIR | 0.30 | 39.70 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| CHARLES L BRANCH JR MD | |||||||||
| BOARD MEMBER | 2.00 | 38.00 | $0 | $0 | $0 | Yes (X) | |||
| DARRIN HARTNESS PHD | |||||||||
| BOARD MEMBER (FROM 8/8/19) | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| KENNETH PEACOCK | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| KENNETH RETHMEIER | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| L ANDREW KOMAN MD | |||||||||
| BOARD MEMBER | 2.00 | 38.00 | $0 | $0 | $0 | Yes (X) | |||
| MICHAEL CARTWRIGHT MD | |||||||||
| BOARD MEMBER | 2.00 | 38.00 | $0 | $0 | $0 | Yes (X) | |||
| PHILLIP FULLER | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| RUSSELL HOWERTON MD | |||||||||
| BOARD MEMBER | 0.30 | 39.70 | $0 | $0 | $0 | Yes (X) | |||
| STEPHEN ROBERTSON | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| TERRY RENEGAR | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| WILLIAM JUNKER | |||||||||
| BOARD MEMBER | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| CRAIG M GREVEN MD | |||||||||
| BOARD MEMBER | 2.00 | 38.00 | $0 | $0 | $0 | Yes (X) | |||
| DINA MARTY | |||||||||
| ASSISTANT SECRETARY | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,384,012 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $673,643 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 6600 | NEWPORT | CA | 92658 | HEALTHCARE SERVICES | $619,813 |
| 9W HALO OPCO LP DBA ANGELICA | |||||
| 4 ANSON STREET | DURHAM | NC | 27703 | LINEN SERVICES | $311,205 |
| BLAKLEY LANDSCAPE SERVICES INC | |||||
| 274 BAITY RD | MOCKSVILLE | NC | 27028 | LAWN CARE SERVICES | $219,956 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $21,205 | RelatedOrganizationsAmt |
| Government Grants | $1,621,578 | GovernmentGrantsAmt |
| All Other Contributions | $1,398 | AllOtherContributionsAmt |
| Total Contributions | $1,644,181 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $81,757,965 | $81,757,965 |
| DIETARY REVENUE | 722210 | $93,087 | $93,087 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $81,851,052 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $170,828 | TotalRevenueColumnAmt |
| Exclusion | $170,828 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $83,666,061 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $81,851,052 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $170,828 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,515 | TotalAmt |
| Program Services | $17,515 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $689 | TotalAmt |
| Program Services | $689 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,070 | TotalAmt |
| Program Services | $215,784 | ProgramServicesAmt |
| Management And General | $19,286 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,194,603 | TotalAmt |
| Program Services | $22,218,931 | ProgramServicesAmt |
| Management And General | $1,975,672 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $882,978 | TotalAmt |
| Program Services | $810,535 | ProgramServicesAmt |
| Management And General | $72,443 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,699,903 | TotalAmt |
| Program Services | $3,396,348 | ProgramServicesAmt |
| Management And General | $303,555 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,207,753 | TotalAmt |
| Program Services | $1,108,664 | ProgramServicesAmt |
| Management And General | $99,089 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,556 | TotalAmt |
| Program Services | $5,556 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,126 | TotalAmt |
| Program Services | $146,225 | ProgramServicesAmt |
| Management And General | $9,901 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,377,389 | TotalAmt |
| Program Services | $4,260,083 | ProgramServicesAmt |
| Management And General | $1,117,306 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,269 | TotalAmt |
| Program Services | $43,204 | ProgramServicesAmt |
| Management And General | $10,065 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,646 | TotalAmt |
| Program Services | $49,999 | ProgramServicesAmt |
| Management And General | $11,647 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,658,074 | TotalAmt |
| Program Services | $3,777,991 | ProgramServicesAmt |
| Management And General | $880,083 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,382 | TotalAmt |
| Program Services | $8,089 | ProgramServicesAmt |
| Management And General | $1,293 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,032 | TotalAmt |
| Program Services | $11,957 | ProgramServicesAmt |
| Management And General | $2,075 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,016,409 | TotalAmt |
| Program Services | $1,836,759 | ProgramServicesAmt |
| Management And General | $179,650 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,727 | TotalAmt |
| Program Services | $139,727 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $18,407,747 | $18,407,747 | |
| BAD DEBT EXPENSE | $4,513,531 | $4,513,531 | |
| PROVIDER ASSESSMENT TAX | $1,654,091 | $1,654,091 | |
| OTHER SUPPLIES | $420,236 | $340,838 | $79,398 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,725,726 | TotalAmt |
| Program Services | $62,964,263 | ProgramServicesAmt |
| Management And General | $4,761,463 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,628,040 | BOYAmt |
| EOY | $30,120,024 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,144,750 | BOYAmt |
| EOY | $25,673,129 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,424,490 | BOYAmt |
| EOY | $1,296,384 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,022 | BOYAmt |
| EOY | $38,904 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,976,478 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,832,586 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,920,698 | BOYAmt |
| EOY | $7,143,892 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $71,253,158 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,134,000 | BOYAmt |
| EOY | $135,525,491 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,199,718 | BOYAmt |
| EOY | $4,340,002 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $857,414 | BOYAmt |
| EOY | $68,168,286 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,057,132 | BOYAmt |
| EOY | $72,508,288 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,076,868 | BOYAmt |
| EOY | $63,017,203 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,076,868 | BOYAmt |
| EOY | $63,017,203 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,134,000 | BOYAmt |
| EOY | $135,525,491 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $15,940,335 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,556 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,556 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HEALTHCARE ASSOCIATION (NCHA). A PORTION OF THE MEMBERSHIP DUES PAID ARE ALLOCATED TO LOBBYING EFFORTS BY THOSE ORGANIZATIONS ON BEHALF OF THEIR MEMBERSHIP BODIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $53,830 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,149 | DepreciationAmt |
| Book Value | $37,681 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,228,565 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,285,141 | DepreciationAmt |
| Book Value | $6,943,424 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $694,083 | OtherCostOrOtherBasisAmt |
| Depreciation | $531,296 | DepreciationAmt |
| Book Value | $162,787 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,143,892 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASES (LESS ACCUM DEPREC) | Desc |
| Book Value | $71,253,158 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $71,253,158 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED 3RD PARTY PAYABLE | $619,605 |
| OPERATING LEASE PAYABLE | $67,548,681 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $68,168,286 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS FISCAL YEARS ENDED JUNE 30, 2020 AND 2019, INCLUDING A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF ITS JOINT VENTURES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2020 AND 2019. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $627,277 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $627,277 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00990 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,605,184 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,037,993 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,567,191 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02480 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,505,977 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,714,694 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,738,438 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,752,687 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,194,468 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03470 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,106 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,515 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,515 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,621 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $19,621 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,758,059 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,752,687 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,214,089 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03500 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $843,394 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $26,094,467 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $28,566,327 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,471,860 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIE MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 329 NC HWY 801N | AddressLine1Txt |
| City | BERMUDA RUN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27006 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTE | WebsiteAddressTxt |
| State License | H0171 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DAVIE MEDICAL CENTER | PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS OBTAINED THROUGH THE FOLLOWING SOURCES: (1) 2017 DAVIE COUNTY RESIDENT SURVEYS CONDUCTED BY THE DAVIE COUNTY HEALTH DEPARTMENT WHICH FOCUSED ON HEALTH STATUS, HEALTH BEHAVIORS AND QUALITY OF LIFE FACTORS; (2) TWO FAITHHEALTH NC (A DEPARTMENT OF WAKE FOREST BAPTIST MEDICAL CENTER) COMMUNITY ASSET MAPPING WORKSHOPS WHICH SOUGHT OPINIONS OF BOTH HEALTH PROVIDERS (INCLUDING RELIGIOUS AND SOCIAL SERVICES) AND HEALTH SEEKERS IN DAVIE COUNTY'S MOST VULNERABLE COMMUNITIES; (3) 2018 DAVIE COUNTY RESIDENT SURVEYS CONDUCTED BY THE DAVIE AGING PLANNING COMMITTEE/DAVIE COUNTY SENIOR SERVICES TO IDENTIFY RESIDENT CONCERNS RELATED TO AGING AND DAVIE COUNTY'S EFFORTS TO ADDRESS THESE CONCERNS; (4) SIX FACILITATOR-LED MEETINGS HELD IN OCTOBER 2018 WITH REPRESENTATIVES FROM DAVIE MEDICAL CENTER AND THE DAVIE AGING PLANNING COMMITTEE TO DISCUSS THE SUCCESSES AND OPPORTUNITIES FOR IMPROVEMENT REGARDING DAVIE COUNTY'S SUPPORT OF ITS AGING POPULATION; (5) REVIEW OF THE WAKE FOREST BAPTIST HEALTH 3-YEAR STRATEGIC PLAN TO IDENTIFY APPLICABLE COMMUNITY BENEFIT STRATEGIES; AND (6) COMMENTS FROM PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY.ADDITIONALLY, OTHER SECONDARY DATA SOURCES WERE REVIEWED INCLUDING: WAKE FOREST BAPTIST MEDICAL CENTER COMMUNITY DASHBOARD/HEALTH COMMUNITIES INSTITUTE, COUNTY HEALTH RANKINGS & ROADMAPS, 2016 STATE OF THE COUNTY HEALTH REPORT, US CENSUS BUREAU 2010 CENSUS, NC CENTER FOR HEALTH STATISTICS, HEALTHY DAVIE INITIATIVE, HEALTHY PEOPLE 2020, HEALTHY NORTH CAROLINA 2020, AND CENTERS FOR MEDICARE/MEDICAID- HEALTH OUTCOMES SURVEY. |
| DAVIE MEDICAL CENTER | PART V, SECTION B, LINE 6A: THE HOSPITAL'S MOST RECENT CHNA WAS CONDUCTED IN COLLABORATION WITH NORTH CAROLINA BAPTIST HOSPITAL AND LEXINGTON MEDICAL CENTER. BOTH LEXINGTON MEDICAL CENTER AND NORTH CAROLINA BAPTIST HOSPITAL ARE AFFILIATE HOSPITALS OF WAKE FOREST BAPTIST HEALTH. |
| DAVIE MEDICAL CENTER | PART V, SECTION B, LINE 7D: N/APART V, SECTION B, LINE 7A:HTTPS://WWW.WAKEHEALTH.EDU/ABOUT-US/SERVING-OUR-COMMUNITIES/NEEDS-ASSESSMENTS-AND-IMPLEMENTATION-REPORTSPART V, SECTION B, LINE 10A:HTTPS://WWW.WAKEHEALTH.EDU/ABOUT-US/SERVING-OUR-COMMUNITIES/NEEDS-ASSESSMENTS-AND-IMPLEMENTATION-REPORTS |
| DAVIE MEDICAL CENTER | PART V, SECTION B, LINE 11: THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") IDENTIFIED THE FOLLOWING SIGNIFICANT HEALTH NEEDS WITHIN THE COMMUNITY: (1) CHRONIC DISEASE MANAGEMENT AND PREVENTION, (2) DRUG MISUSE AND ABUSE PREVENTION AND EDUCATION, (3) ACCESS TO AFFORDABLE HEALTH CARE, (4) FINANCIAL COST OF HEALTH CARE AND DENTAL SERVICES, (5)AFFORDABLE HOUSING, AND (6) LACK OF FINANCES. DAVIE MEDICAL CENTER (DMC) PRIORITIZED THE FOLLOWING FOUR SIGNIFICANT COMMUNITY HEALTH NEEDS FOR ITS CURRENT CHNA AS FOLLOWS: (1) ACCESS TO CARE; (2) CHRONIC DISEASE MANAGEMENT & PREVENTION; (3) BEHAVIORAL HEALTH & SUBSTANCE DEPENDENCY; AND (4) MATERNAL & CHILD HEALTH. DMC PLANS TO PROVIDE COMMUNITY BENEFIT PROGRAMS RESPONSIVE TO THESE HEALTH NEEDS THROUGH ITS APPROVED CHNA IMPLEMENTATION STRATEGY. THE DMC CHNA IMPLEMENTATION STRATEGY OUTLINES THE IMPLEMENTATION OF PROGRAMS AND THE EVALUATION OF IMPACT OF THOSE PROGRAMS ON PRIORITY COMMUNITY HEALTH NEEDS IDENTIFIED FROM THE CHNA. SPECIFICALLY, THE HOSPITAL IS ADDRESSING THE SIGNIFICANT HEALTH NEEDS AS FOLLOWS:1. ACCESS TO CAREBARRIERS SUCH AS LACK OF INDIVIDUAL HEALTH INSURANCE AND HIGH COSTS DECREASE ACCESS TO QUALITY HEALTH CARE AND CAN LEAD TO UNMET HEALTH NEEDS. THE HOSPITAL'S CURRENT STRATEGIES TO ADDRESS THESE NEEDS INCLUDE THE FOLLOWING:--REDUCING TRANSPORTATION BARRIERS FOR INDIVIDUALS IN RURAL AREAS OF THE COMMUNITY THROUGH 1.) UTILIZATION OF FAITHHEALTH NC RESOURCES TO PROVIDE TRANSPORTATION ASSISTANCE FOR DAVIE COUNTY RESIDENTS TO THEIR MEDICAL APPOINTMENTS AFTER HOSPITAL DISCHARGE, 2.) COLLABORATION WITH LOCAL AGENCIES TO DETERMINE RESOURCES AND ASSESSMENT OF THE TRANSPORTATION ASSISTANCE NEEDS THROUGHOUT DAVIE COUNTY, AND 3.) PROMOTION AND ANALYSIS REGARDING THE USE OF MOCKSVILLE'S CIRCULATOR ROUTE (YADKIN VALLEY'S PUBLIC TRANSPORTATION AUTHORITY BUS ROUTE) AND THE NEED FOR ONSITE CLINICS IN HIGH NEED AREAS. --IMPROVING ACCESS TO COMMUNITY CENTERED SOCIAL AND HEALTH EDUCATION SERVICES AND REGULAR SOURCES OF HEALTH CARE THROUGH 1.) PARTNERING WITH DAVIE COUNTY AGENCIES TO PROVIDE HEALTH EDUCATION EVENTS AND SCREENINGS AT VARIOUS LOCATIONS IN DAVIE COUNTY, 2.) PROVIDING SUPPORT TO THE DAVIE COUNTY HEALTH DEPARTMENT AND THE STOREHOUSE FOR JESUS CLINIC WITH FREE IMAGING SERVICES, 3.) WORKING WITH LOCAL FAITH COMMUNITIES TO PROVIDE PROGRAMS AND ENLIST LAY LEADER SUPPORT TO ASSIST PARISHIONERS NEEDING ACCESS, 4.) EXPANDING BESTHEALTH HEALTH EDUCATION PROGRAMMING AT COMMUNITY EVENTS AND VENUES IN DAVIE COUNTY, AND 5.) ASSESSING THE PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES NEEDS IN VULNERABLE LOCATIONS OF DAVIE COUNTY. --IMPROVING ACCESS TO HEALTH INSURANCE BY 1.) PARTNERING WITH DAVIE COUNTY DEPARTMENT OF SOCIAL SERVICES TO ASSIST WITH ENROLLING COMMUNITY MEMBERS INTO INSURANCE PROGRAMS AND WITH NORTHWEST COMMUNITY CARE NETWORK, (A WAKE FOREST BAPTIST MEDICAL CENTER AFFILIATE) TO MANAGE THEIR HEALTHCARE, AND 2.) ENGAGING WITH COMMUNITY PARTNERS IN DAVIE COUNTY TO EDUCATE THE PUBLIC REGARDING HEALTH INSURANCE OPTIONS. 2. CHRONIC DISEASE MANAGEMENT AND PREVENTIONDMC RECOGNIZES THE EFFECT OF CONTINUITY OF CARE WITH HEALTH CARE PROVIDERS ON PATIENT BEHAVIORS, DISEASE MANAGEMENT, AND HEALTH STATUS.THE HOSPITAL'S CURRENT STRATEGIES INCLUDE:--IMPROVING THE CAPACITY OF COMMUNITY BASED ORGANIZATIONS AND HEALTH CARE PROVIDERS TO SUPPORT EFFORTS RELATED TO CHRONIC DISEASE PREVENTION AND MANAGEMENT THROUGH 1.) CONTINUING TO SUPPORT FAITHHEALTH NC COMMUNITY HEALTH WORKERS TO ADDRESS CHRONIC DISEASE MANAGEMENT AND COMMUNITY HEALTH PROGRAMMING, 2.) INCREASING COMMUNITY AND HEALTHCARE PROVIDER REFERRAL TO EXISTING WAKE FOREST BAPTIST HEALTH CHRONIC DISEASE MANAGEMENT PROGRAMS, FAMILY MEDICINE AND ADDITIONAL RESOURCES BY CENTRALIZING & DISSEMINATING HEALTH CARE INFORMATION, 3.) ASSESSING THE NEED FOR ADDITIONAL MEDICAL SPECIALISTS IN DAVIE COUNTY AND, 4.) EXPLORING A POSSIBLE PARTNERSHIP WITH GASTON FAMILY HEALTH SERVICES TO PROVIDE PREVENTATIVE DENTAL CARE SERVICES. --PROVIDING EDUCATION AND SUPPORT PROGRAMS TO INCREASE OVERALL COMMUNITY WELLNESS THROUGH 1.) CONTINUING THE PROMOTION OF BESTHEALTH CLASSES FOCUSED ON COOKING, NUTRITION AND HEALTHY LIVING AT DMC, 2.) ENCOURAGING ADDITIONAL COMMUNITY UTILIZATION OF DAVIE PATH TO WELLNESS, DMC'S WALKING TRAIL NETWORK, AND 3.) OFFERING EDUCATIONAL PROGRAMMING THROUGH FAITHHEALTH INNOVATIONS AND CARENET. 3. BEHAVIORAL HEALTH & SUBSTANCE DEPENDENCYDMC IS COMMITTED TO PROVIDING POSITIVE OUTCOMES OF RECOVERY AND MENTAL HEALTH WELLNESS THROUGHOUT THE COMMUNITY IT SERVES. THE HOSPITAL'S CURRENT STRATEGIES INCLUDE:--DECREASING THE SUICIDE DEATH RATE THROUGH 1.) BUILDING CAPACITY AMONG LAY PERSONS IN THE COMMUNITY IN THE AREAS OF MENTAL HEALTH FIRST AID, SUICIDE PREVENTION, AND SUBSTANCE ABUSE RECOVERY PROGRAMS, AND 2.) PARTNERING WITH AND SUPPORTING SOURCES OF STRENGTH, A PEER BASED SUICIDE INITIATIVE IN DAVIE COUNTY MIDDLE SCHOOLS, ALONG WITH OTHER PREVENTATIVE PROGRAMS TAILORED TOWARD ADOLESCENTS AND BEHAVIORAL HEALTH.--REDUCING THE NUMBER OF EMERGENCY DEPARTMENT VISITS RELATED TO BEHAVIORAL HEALTH ISSUES THROUGH 1.) WORKING WITH MENTAL HEALTH RESOURCES IN DAVIE COUNTY TO IDENTIFY KEY RESOURCES FOR REFERRALS AND PROGRAMMING FOR PATIENTS NEEDING MENTAL HEALTH SERVICES, 2.) PROMOTING DAYMARK RECOVERY SERVICES' WALK-IN CLINIC IN MOCKSVILLE--CONTINUING TO GROW AWARENESS OF EXISTING CARENET SERVICES AVAILABLE AT DMC AND OTHER LOCATIONS IN DAVIE COUNTY & TO PROVIDE SUPPORT TO DMC'S CAREGIVER ACADEMY PROGRAMS IN ORDER TO REDUCE CAREGIVER STRESS THROUGH EDUCATION, INFORMATION AND SUPPORT. --SERVING AS ONE OF DAVIE COUNTY'S PERMANENT MEDICATION DISPOSAL LOCATIONS, & SUPPORTING THE NC MEDASSIST PROGRAM THROUGH A MOBILE PHARMACY OFFERING IN DAVIE COUNTY.4. MATERNAL & CHILD HEALTHDMC IS COMMITTED TO PROVIDING INNOVATIVE, FAMILY-CENTERED CARE FOR THE COMMUNITY'S CHILDREN AND WOMEN. THE HOSPITAL'S CURRENT STRATEGIES INCLUDE:--DECREASING TEEN PREGNANCY, REDUCING INFANT MORTALITY, AND INCREASING THE BREAST FEEDING RATES THROUGH 1.) PARTNERING WITH THE DAVIE COUNTY HEALTH DEPARTMENT, LOCAL SCHOOLS AND OTHER COUNTY AGENCIES TO DETERMINE RESOURCES AND PROGRAMS AVAILABLE TO NEW AND EXPECTING MOTHERS AND FAMILIES, 2.) CONTINUING TO PROVIDE BOARD CERTIFIED LACTATION CONSULTANTS TO NEW MOTHERS WITHIN WAKE FOREST BAPTIST HEALTH NETWORK, AND 3.) ENCOURAGING MOMS AND MOMS-TO-BE TO ATTEND WAKE FOREST BAPTIST HEALTH MATERNAL AND CHILD HEALTH PROGRAMS --INCREASING PHYSICAL WELLNESS AT LOCAL SCHOOLS THROUGH 1.) PROMOTING AND ENGAGING UNITED WAY OF DAVIE COUNTY'S INITIATIVE FOR HEALTHY SCHOOLS, 2.) EVALUATING THE EXPANSION OF WAKE FOREST BAPTIST HEALTH'S BRENNER FIT'S PROGRAMS IN DAVIE COUNTY TO EDUCATE ELEMENTARY AND MIDDLE SCHOOL STUDENTS/PARENTS ABOUT GOOD NUTRITION AND HEALTHY EATING/HEALTHY LIFESTYLE OPTIONS, AND 3.) ENHANCING THE PARTNERSHIP WITH TWIN CITY SOCCER ASSOCIATION THROUGH TRAINING, EDUCATION AND PROVIDING MEDICAL KITS TO STAFF AND COACHES. ALL OF THE AFOREMENTIONED EFFORTS IN COMBINATION WITH THE HOSPITAL'S VALUES OF NONDISCRIMINATION AND COMPASSIONATE CARE ARE DESIGNED TO MEET THE SIGNIFICANT HEALTH NEEDS OF THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. |
| DAVIE MEDICAL CENTER | PART V, SECTION B, LINE 13H: THE HOSPITAL MAY USE COMMERCIALLY AVAILABLE FINANCIAL PROFILING AND CREDIT SCORING TECHNOLOGIES TO PRESUMPTIVELY SCREEN RESPONSIBLE INDIVIDUALS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE DISCOUNTS. |
| DAVIE MEDICAL CENTER | PART V, SECTION B, LINE 16J: DAVIE MEDICAL CENTERPART V, LINE 16A, FAP WEBSITE: WWW.WAKEHEALTH.EDU/PATIENT-AND-FAMILY-RESOURCES/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCEDAVIE MEDICAL CENTERPART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.WAKEHEALTH.EDU/PATIENT-AND-FAMILY-RESOURCES/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCEDAVIE MEDICAL CENTERPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: WWW.WAKEHEALTH.EDU/PATIENT-AND-FAMILY-RESOURCES/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCEDAVIE MEDICAL CENTER:PART V, SECTION B, LINE 16J: IN ADDITION TO THE METHODS PREVIOUSLY DESCRIBED, DAVIE MEDICAL CENTER INFORMS PATIENTS ABOUT ITS FAP DURING INTAKE AND DISCHARGE BY PROVIDING A PLAIN LANGUAGE SUMMARY OF THE FAP. THE HOSPITAL ALSO PLACES A CONSPICUOUS WRITTEN NOTICE OF THE FAP ON ITS PATIENT BILLING STATEMENTS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 10 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - DIGESTIVE HEALTH SERVICES - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | GASTROENTEROLOGY |
| 2 - SPINE CENTER - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | SPINE SERVICES |
| 3 - CARDIOLOGY - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | CARDIAC REHAB |
| 4 - PODIATRY SERVICES - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | PODIATRY |
| 5 - ORTHOPAEDICS - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | X-RAY & ORTHOPAEDICS |
| 6 - PULMONOLOGY & CRITICAL CARE - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | PULMONARY |
| 7 - NEUROLOGY - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | EEG/EMG TESTING, SLEEP LAB |
| 8 - EYE CENTER - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | OPTHALMOLOGY |
| 9 - PULMONARY SLEEP - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | SLEEP MEDICINE |
| 10 - PHYSICAL THERAPY - DAVIE | ||||
| 329 NC HWY 801 N | BERMUDA RUN | NC | 27006 | REHABILITATION SERVICES |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE ORGANIZATION UTILIZES COMMERCIALLY AVAILABLE FINANCIAL PROFILING AND CREDIT SCORING TECHNOLOGIES TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE DISCOUNTS UNDER ITS FAP POLICY. ADDITIONAL ELIGIBILITY CRITERIA INCLUDES THE FOLLOWING:-PATIENT MUST BE UNINSURED OR HAVE NO OTHER THIRD PARTY FUNDING SOURCE OR GUARANTOR.-SERVICES FOR WHICH DISCOUNTS APPLY MUST BE EMERGENT AND MEDICALLY NECESSARY CARE.-PATIENT MUST BE A VALID RESIDENT WITHIN A ZIP CODE BOUNDED BY OR INTERSECTING ON OF THE COUNTIES DEFINED AS WAKE FOREST BAPTIST HEALTH'S SERVICE AREA. -PATIENTS MUST ENROLL IN ALL OTHER PRIMARY PAYER PROGRAMS FOR WHICH THE PATIENT IS ELIGIBLE AND MUST ASSIGN BENEFITS TO WAKE FOREST BAPTIST HEALTH EXCEPT IN THE CASE WHERE SUCH POLICY PREMIUM FOR ENROLLMENT WOULD RESULT IN MEDICAL INDIGENCE. |
| PART I, LINE 7: | THE ORGANIZATION USED THE WORKSHEETS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H TO COMPUTE ITS COST TO CHARGE RATIO FOR PURPOSES OF THE 2019 SCHEDULE H.PART I, LINE 7B MEDICAID DIRECT OFF-SETTING REVENUETHE HOSPITAL PARTICIPATES IN A PROVIDER ASSESSMENT PROGRAM ADMINISTERED BY THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES. UNDER THE PROGRAM, A FEE IS ASSESSED AGAINST NON-MEDICAID PATIENT SERVICE REVENUE OF PRIVATE HOSPITALS. THE FEDERAL GOVERNMENT MATCHES THE ASSESSMENT AT A RATE OF 2 TO 1 AND THESE AMOUNTS ARE ALLOCATED TO NORTH CAROLINA HOSPITALS QUARTERLY. ADDITIONALLY, THE HOSPITAL PARTICIPATES IN THE NORTH CAROLINA MEDICAID REIMBURSEMENT INITIATIVE (MRI). UNDER THE MRI, THE HOSPITAL RECEIVES ADDITIONAL REIMBURSEMENT BASED ON MEDICAID COST DEFICITS AND TREATMENT OF A DISPROPORTIONATE SHARE OF UNINSURED PATIENTS. |
| PART I, LN 7 COL(F): | THE ORGANIZATION'S PATIENT BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $4,513,531 FOR THE FISCAL YEAR ENDED JUNE 30, 2020. THIS AMOUNT IS NOT INCLUDED IN THE CALCULATION OF CHARITY CARE FOR PART I, LINE 7. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | DAVIE MEDICAL CENTER IS COMMITTED TO IMPROVING THE HEALTH OF THE INDIGENT AND MEDICALLY UNDERSERVED IN DAVIE COUNTY AND SURROUNDING AREAS. DAVIE MEDICAL CENTER REPRESENTATIVES ARE INVOLVED IN THE COMMUNITY THROUGH INITIATIVES SUCH AS HEALTHY DAVIE, PART OF THE DAVIE COMMUNITY FOUNDATION. THE MEDICAL CENTER HOSTS FREE CLASSES, SCREENINGS AND COOKING DEMONSTRATIONS THROUGH ITS BESTHEALTH PROGRAM; HOWEVER, THESE CLASSES WERE LIMITED IN THE PRIOR YEAR DUE TO COVID-19. DAVIE MEDICAL CENTER PARTNERS WITH OTHER AGENCIES THROUGHOUT THE COMMUNITY TO CONTINUE TO IMPROVE HEALTH, INCLUDING SENIOR SERVICES, DRAGONFLY HOUSE, SMART START OF DAVIE COUNTY, FAMILY PROMISE OF DAVIE COUNTY, UNITED WAY OF DAVIE COUNTY, CARDINAL INNOVATIONS, DAVIE COUNTY SCHOOLS, DAVIE-DAVIDSON COMMUNITY COLLEGE, AND THE DAVIE YMCA. DAVIE MEDICAL CENTER ALSO HAS REPRESENTATION IN LEADERSHIP DAVIE AND SERVES AS A COMMUNITY AGENCY FOR EDUCATING LEADERS ON LOCAL HEALTHCARE INITIATIVE THOUGH THAT PROGRAM. |
| PART III, LINE 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A DISCRETE FOOTNOTE EXPLAINING BAD DEBT EXPENSE. BAD DEBT HAS NOT BEEN INCLUDED IN THE COMPUTATION OF COMMUNITY BENEFIT ON PART I, LINE 7. AMOUNTS USED TO COMPUTE CHARITY CARE AND BAD DEBT ON SCHEDULE H USE THE MOST CURRENT DATA AVAILABLE AT THE TIME OF FILING. THE ORGANIZATION USED WORKSHEET 2 OF THE 2019 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST TO CHARGES RATIO USED TO CALCULATE BAD DEBT AT COST. |
| PART III, LINE 8: | THE HOSPITAL USES AN OVERALL COST TO CHARGE RATIO CALCULATION BASED ON AUDITED FINANCIAL STATEMENTS BUT REMOVES COST ASSOCIATED WITH BAD DEBT, COMMUNITY BUILDING, AND CHARITY CARE SO AS NOT TO COUNT THOSE COSTS TWICE. |
| PART III, LINE 9B: | THE HOSPITAL MAKES A REASONABLE EFFORT TO DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE ENGAGING IN ANY COLLECTION ACTIONS. ALL COLLECTION ACTIONS WILL BE SUSPENDED IF THE INDIVIDUAL SUBMITS A COMPLETED FAP APPLICATION DURING THE APPLICATION PERIOD, OR IF THE INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION DURING THE APPLICATION PERIOD THAT IS SUBSEQUENTLY COMPLETED WITHIN A REASONABLE TIME AFTER THE HOSPITAL REQUESTS FURTHER INFORMATION. IF THE INDIVIDUAL IS DETERMINED NOT TO BE ELIGIBLE FOR A FULL DISCOUNT UNDER THE FAP, ANY COLLECTION ACTIVITIES WILL BE RESUMED AS TO THE OUTSTANDING BALANCE OWED. IF THE INDIVIDUAL IS DETERMINED TO BE ELIGIBLE FOR ANY LEVEL OF ASSISTANCE UNDER THE FAP, APPROPRIATE MEASURES ARE TAKEN TO REFUND ANY AMOUNTS OWED TO THE INDIVIDUAL AND REVERSE OR MODIFY COLLECTION ACTIONS CONSISTENT WITH THE NEW BALANCE OWED AFTER APPLYING THE APPLICABLE FAP DISCOUNTS. |
| PART VI, LINE 2: | THE HOSPITAL'S CURRENT NEEDS ASSESSMENT PLAN WAS BASED ON A SET OF BEST PRACTICES FOR COMMUNITY HEALTH ASSESSMENTS WITH THE PURPOSE OF IDENTIFYING TWO TO FOUR REGIONAL PRIORITY AREAS TO FOCUS ON FOR FY 2020-2022. DAVIE MEDICAL CENTER WORKED CLOSELY WITH THE DAVIE COUNTY HEALTH DEPARTMENT TO GAIN INSIGHT ON THE HEALTH NEEDS OF THE COMMUNITY. DMC WAS PART OF DAVIE COUNTY HEALTH DEPARTMENT'S COMMUNITY HEALTH ASSESSMENT TEAM THAT COLLABORATIVELY CREATED THE HEALTH DEPARTMENT'S COMMUNITY HEALTH ASSESSMENT PROCESS AND REPORT. THE HEALTH DEPARTMENT'S COMMUNITY ASSESSMENT IS THE RESULT OF EFFORTS TO ASSESS THE HEALTH NEEDS OF DAVIE COUNTY, AS REQUIRED AT LEAST EVERY FOUR YEARS BY THE NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES. THE PURPOSE THE COMMUNITY HEALTH ASSESSMENT IS TO PROVIDE AN UNDERSTANDING OF THE CURRENT HEALTH STATUS AND NEEDS OF DAVIE COUNTY, ALONG WITH COMMUNITY STRENGTHS, ASSETS AND POTENTIAL RESOURCES TO ADDRESS THOSE NEEDS. THE HOSPITAL'S ASSESSMENT WAS CONDUCTED IN THREE STAGES: (1) DATA REVIEW (PRIMARY AND SECONDARY DATA), (2) SETTING PRIORITIES, AND (3) COMMUNITY ASSET INVENTORY. THE DATA REVIEW AND PRIORITY SETTING PHASE BEGAN WITH THE COMPILATION OF EXISTING HEALTH-RELATED DATA. STAKEHOLDERS REVIEWED MULTIPLE DATA SETS INCLUDING THE DAVIE COUNTY HEALTH DEPARTMENT'S PUBLIC HEALTH NEEDS ASSESSMENTS, NORTH CAROLINA INDICATORS FOR COMMUNITY HEALTH ASSESSMENT, INTERNAL DISEASE REGISTRIES, AND COUNTY HEALTH RANKINGS. ONCE THE COMMUNITY HEALTH NEEDS WERE IDENTIFIED, AN INTERNAL STEERING COMMITTEE AND SENIOR LEADERSHIP REVIEW A SET OF CRITERIA TO DEVELOP THE PRIORITY RANKINGS. THE PRIORITIZATION PROCESS IDENTIFIED THE FOLLOWING TOP FOUR PRIORITY CHALLENGES FOR THE COMMUNITY: (1) ACCESS TO CARE, (2) CHRONIC DISEASE MANAGEMENT & PREVENTION, (3) BEHAVIORAL HEALTH & SUBSTANCE ABUSE, AND (4) MATERNAL & CHILD HEALTH. FAITHHEALTHNC (A DIVISION OF NORTH CAROLINA BAPTIST HOSPITAL) PROVIDED COMMUNITY ENGAGEMENT THROUGH A COMPREHENSIVE ASSET MAPPING STRATEGY BASED ON AN APPROACH FROM SOUTH AFRICA AND REDEFINED IN MEMPHIS, TN DESIGNED TO BUILD COMMUNITY PARTNERSHIPS ON THE ASSETS THAT EXIST, INSTEAD OF JUST NEEDS. THE MAPPING DEVELOPED AN INVENTORY OF EXISTING PROGRAMS AND SERVICES WITHIN THE REGION RELATED TO THE PRIORITY AREAS IDENTIFIED IN THE NEEDS ASSESSMENT. THE INVENTORY INCLUDED THE LOCATION OF THE PROGRAM (HOSPITAL, CLINIC, OR COMMUNITY SERVICE) AS WELL AS THE NATURE OF THE INTANGIBLE FACTORS, ESPECIALLY TRUST, THAT DETERMINE ACCESS AND COLLABORATION AMONG COMMUNITY PARTNERS. THE PURPOSE OF THE INVENTORY WAS TO IDENTIFY GAPS IN SERVICES, OPPORTUNITIES FOR NEW WORK, WHERE AND WITH WHOM THERE IS ALREADY WORK BEING DONE, AND OPPORTUNITIES FOR PARTNERSHIP AND COLLABORATION. FROM THIS THREE STEP PROCESS, THE HOSPITAL DEVELOPED AN IMPLEMENTATION STRATEGY TO IDENTIFY THE MEANS THROUGH WHICH IT PLANS TO ADDRESS NEEDS THAT ARE CONSISTENT WITH THE CHARITABLE MISSION AS PART OF ITS COMMUNITY BENEFIT PROGRAMS FOR THE FISCAL YEARS 2020-2022. BEYOND THE PROGRAMS THAT WILL BE ADDRESSED IN THE IMPLEMENTATION STRATEGY, THE HOSPITAL WILL CONTINUE TO ADDRESS MANY OF THE PRIORITIES BY PROVIDING CARE TO ALL, REGARDLESS OF THE ABILITY TO PAY. |
| PART VI, LINE 3: | THE ORGANIZATION USES A VARIETY OF MEANS TO EDUCATE AND INFORM PATIENTS OF THEIR CHARITY CARE OPTIONS, INCLUDING INFORMATION ON A WEBSITE, PAMPHLETS, CONSPICUOUSLY DISPLAYED SIGNAGE, INFORMATION ON PATIENT BILL STATEMENTS, AND FROM STAFF MEMBERS DURING CONVERSATIONS CONCERNING A PATIENT'S LIABILITY FOR SERVICES. THE HOSPITAL EMPLOYS A PRE-SERVICE FINANCIAL CLEARANCE PROCESS THAT SCREENS PATIENTS PRIOR TO SERVICE DELIVERY FOR EXISTING OR AVAILABLE PAYER SOURCES AS A MEANS OF AVOIDING BAD DEBT AND INAPPROPRIATE BILLING TO PATIENTS WITHOUT THE MEANS TO PAY. IF A PAYER SOURCE IS IDENTIFIED, HOSPITAL STAFF WILL ASSIST THE PATIENT WITH ENROLLMENT. |
| PART VI, LINE 4: | DAVIE COUNTY IS LOCATED IN THE PIEDMONT TRIAD REGION OF NORTH CAROLINA, COVERING 264 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 42,500. WIDELY RURAL, THE COUNTY IS CHARACTERIZED BY ROLLING FARMLAND. THE NEAREST METROPOLITAN AREA IS WINSTON-SALEM, LOCATED JUST 12 MILES TO THE NORTHEAST. APPROXIMATELY 61% OF DAVIE COUNTY'S RESIDENTS TRAVEL OUTSIDE OF THE COUNTY FOR EMPLOYMENT. THE MEDIAN INCOME FOR DAVIE COUNTY RESIDENTS IS APPROXIMATELY $51,662. THE FOLLOWING DEMOGRAPHIC FIGURES REFLECT THE POPULATION FOR DAVIE COUNTY: - 51% FEMALE, 49% MALE - BELOW 20 YEARS: 25% - AGE 55 AND OLDER: 33%THE COUNTY POPULATION BREAKDOWN BY RACE IS: - WHITE NON-HISPANIC (84%) - BLACK (6.5%) - HISPANIC (7.0%) - TWO OR MORE RACES (2.0%) - AMERICAN INDIAN (0.7%)THERE ARE THREE TOWNS AND SEVEN TOWNSHIPS IN DAVIE COUNTY. MOCKSVILLE IS THE LARGEST MUNICIPALITY WITH 5,291 RESIDENTS, AND IS ALSO THE COUNTY SEAT. APPROXIMATELY 70% OF DAVIE COUNTY'S POPULATION LIVES IN RURAL AREAS OF THE COUNTY. |
| PART VI, LINE 5: | THE HOSPITAL HAS MAINTAINED A STRONG COMMITMENT TO PROMOTING AND EXPANDING COMMUNITY HEALTH PROGRAMS IN DAVIE COUNTY. SUCH PROGRAMS INCLUDE BESTHEALTH COMMUNITY EDUCATION CLASSES, CHRONIC DISEASES SELF-MANAGEMENT PROGRAMS, PUBLIC SCREENINGS, AND OTHER HEALTH EDUCATION EVENTS HELD LOCALLY THROUGHOUT THE YEAR. THE HOSPITAL'S WALKING TRAIL NETWORK, PATH TO WELLNESS, PROVIDES A SAFE AND BEAUTIFUL ENVIRONMENT FOR THE COMMUNITY TO EXERCISE. DAVIE MEDICAL CENTER, IN PARTNERSHIP WITH BEST HEALTH, WAKE FOREST BAPTIST HEALTH'S COMMUNITY WELLNESS PROGRAM, CONTINUED THE CAREGIVER ACADEMY PROGRAM, WHICH FEATURES FREE CLASSES TO EDUCATE THE COMMUNITY ON HOW TO PREPARE FOR CAREGIVING AND PROVIDE ASSISTANCE FOR LOVED ONES INCLUDING FINDING THE RIGHT RESOURCES, BEING YOUR OWN HEALTH CARE ADVOCATE, AND DEALING WITH THE PAPERWORK AND FINANCIAL BURDENS. THE CAREGIVER ACADEMY PROGRAM PROVIDES A VIRTUAL CURRICULUM OF FREE 90 MINUTE CLASSES OFFERED MONTHLY. WE HAVE TWO FAITHHEALTH CONNECTORS IN DAVIE THAT SERVE MARGINALIZED POPULATIONS AND GIVE VOICE TO HEALTH DISPARITIES IN THE COMMUNITIES SURROUNDING DAVIE MEDICAL CENTER. IN ADDITION, DAVIE MEDICAL CENTER CMO OFFERED A TALK ON COVID RELATED SAFETY PRECAUTIONS TO A FAITHHEALTH CONGREGATION LAST FALL. |
| PART VI, LINE 6: | THE FILING ORGANIZATION, NORTH CAROLINA BAPTIST HOSPITAL, HIGH POINT MEDICAL CENTER, LEXINGTON MEDICAL CENTER, WILKES REGIONAL MEDICAL CENTER, WAKE FOREST UNIVERSITY HEALTH SCIENCES (WFUHS), AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ARE INTEGRAL PARTS OF WAKE FOREST BAPTIST HEALTH, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. WFUHS OPERATES THE WAKE FOREST UNIVERSITY'S SCHOOL OF MEDICINE AND WAKE FOREST INNOVATION QUARTER (RESEARCH PARK). WAKE FOREST BAPTIST HEALTH COMPRISES 1,535 ACUTE CARE AND REHABILITATION BEDS, OFFERS EXPERTISE IN MORE THAN 100 AREAS OF MEDICINE ENCOMPASSING COMPREHENSIVE PREVENTIVE AND HIGHLY SPECIALIZED CARE FOR ALL AGES, AND HAS BEEN RANKED AS ONE OF "AMERICA'S TOP HOSPITALS" BY U.S. NEWS AND WORLD REPORT SINCE 1993. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NC |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORSYTH BACKPACK PROGRAM | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 402 380-H KNOLLWOOD ST | AddressLine1Txt |
| City | WINSTONSALEM | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27103 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 461940233 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $5,015 | CashGrantAmt |
| Purpose Of Grant | COMMUNITY SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL FOLLOWS THE MEDICAL CENTER'S CORPORATE POLICY USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE HOSPITAL MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS DISBURSED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRADLEY A CLARK | ||||||||||||||
| TREASURER | $0 | $675,958 | $0 | $270,235 | $0 | $900 | $0 | $209,458 | $0 | $27,994 | $0 | $1,184,545 | $0 | $0 |
| J MCLAIN WALLACE JR | ||||||||||||||
| SECRETARY | $0 | $511,009 | $0 | $165,720 | $0 | $110,812 | $0 | $147,473 | $0 | $15,273 | $0 | $950,287 | $0 | $87,942 |
| CHAD BROWN | ||||||||||||||
| PRESIDENT | $0 | $301,273 | $0 | $0 | $0 | $19,685 | $0 | $64,124 | $0 | $13,936 | $0 | $399,018 | $0 | $15,967 |
| LYNN PITMAN | ||||||||||||||
| BOARD MEMBER | $0 | $208,100 | $0 | $0 | $0 | $1,046 | $0 | $15,306 | $0 | $16,013 | $0 | $240,465 | $0 | $0 |
| MARTHA SOOTS | ||||||||||||||
| CLINICAL INSTRUCTOR CRNA | $0 | $202,156 | $0 | $0 | $0 | $5,927 | $0 | $14,802 | $0 | $7,555 | $0 | $230,440 | $0 | $0 |
| BARRY WALD | ||||||||||||||
| FINANCE DIRECTOR | $0 | $191,814 | $0 | $0 | $0 | $161 | $0 | $13,914 | $0 | $17,319 | $0 | $223,208 | $0 | $0 |
| JONATHAN DUNN | ||||||||||||||
| CLINICAL INSTRUCTOR CRNA | $0 | $192,656 | $0 | $0 | $0 | $243 | $0 | $13,737 | $0 | $14,372 | $0 | $221,008 | $0 | $0 |
| BRYAN C LEE | ||||||||||||||
| CLINICAL INSTRUCTOR CRNA | $0 | $171,519 | $0 | $0 | $0 | $1,067 | $0 | $12,875 | $0 | $23,846 | $0 | $209,307 | $0 | $0 |
| DENISE CLARK | ||||||||||||||
| CLINICAL INSTRUCTOR CRNA | $0 | $175,182 | $0 | $0 | $0 | $320 | $0 | $12,179 | $0 | $17,258 | $0 | $204,939 | $0 | $0 |
| KARLA CROMER | ||||||||||||||
| CLINICAL INSTRUCTOR CRNA | $0 | $168,052 | $0 | $10,000 | $0 | $177 | $0 | $9,458 | $0 | $6,751 | $0 | $194,438 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | CERTAIN DIRECTORS AND OFFICERS OF THE FILING ORGANIZATION PARTICIPATED IN SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANS (SERP), ALL OF WHICH WERE PAID BY A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, AS PART OF THE INDIVIDUAL'S COMPENSATION FROM THE RELATED ORGANIZATION. THE DETERMINATION OF THE AMOUNT OF THE NON QUALIFIED RETIREMENT PLANS FOLLOWED THE RELATED ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE FORM 990. THE FOLLOWING DIRECTOR AND/OR OFFICER RECEIVED SERP PAYMENTS IN THEIR CALENDAR YEAR 2019 COMPENSATION: J. MCLAIN WALLACE, JR. $87,942 CHAD BROWN $15,967 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART IV, LINE 20B | THE HOSPITAL HAS ATTACHED A COPY OF ITS CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR ITS FISCAL YEAR ENDED JUNE 30, 2020 TO THE FORM 990. THE CONSOLIDATED FINANCIAL STATEMENTS HAVE BEEN PREPARED ON THE ACCRUAL BASIS IN CONFORMITY WITH U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDE THE ASSETS AND OPERATIONS OF HIGH POINT REGIONAL HEALTH AND AFFILIATES, LEXINGTON MEDICAL CENTER AND AFFILIATE, NORTH CAROLINA BAPTIST HOSPITAL AND AFFILIATES, WAKE FOREST UNIVERSITY HEALTH SCIENCES AND AFFILIATES, DAVIE MEDICAL CENTER, NORTHWEST COMMUNITY CARE NETWORK, INC., FAITHHEALTH INNOVATIONS, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER (WFUBMC), WAKE FOREST HEALTH NETWORK, LLC, WILKES REGIONAL MEDICAL CENTER, AND OTHER WFUBMC AFFILIATES. ALL SIGNIFICANT INTERCOMPANY TRANSACTIONS HAVE BEEN ELIMINATED IN CONSOLIDATION. |
| FORM 990, PART VI, SECTION A, LINE 3 | PURSUANT TO THE ORGANIZATION'S BYLAWS, THE BOARD OF TRUSTEES MAY ESTABLISH AN EXECUTIVE COMMITTEE CONSISTING OF THREE OR MORE TRUSTEES, THE MAJORITY OF WHOM SHALL BE SOLE MEMBER TRUSTEES (WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER TRUSTEES) AND THE REMAINDER SHALL BE DAVIE COUNTY TRUSTEES. DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF TRUSTEES, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE THE POWERS OF THE BOARD OF TRUSTEES IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION; PROVIDED THAT THE EXECUTIVE COMMITTEE MAY NOT TAKE ANY ACTION THAT WOULD REQUIRE A SUPERMAJORITY VOTE OF THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, A NORTH CAROLINA NONPROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER OF THE ORGANIZATION SHALL HAVE THE RIGHT AT ALL TIMES, WITH RESPECT TO THE ORGANIZATION, TO ELECT AND REMOVE THE TRUSTEES, AS PROVIDED IN THE ORGANIZATION'S BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7B | AS PROVIDED IN THE ORGANIZATION'S BYLAWS, THE SOLE MEMBER OF THE ORGANIZATION SHALL HAVE THE RIGHT AT ALL TIMES, WITH RESPECT TO THE ORGANIZATION, TO APPROVE OF THE SALE, LEASE, OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, TO APPROVE ANY AMENDMENTS TO THE ORGANIZATION'S ARTICLES OR BYLAWS, AND TO APPROVE THE MISSION, VISION AND VALUE STATEMENTS OF THE ORGANIZATION. THE SOLE MEMBER MAY ACT WITHOUT A MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVE COPIES OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL DIRECTORS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ON AN ANNUAL BASIS (AND AS THEY ARISE), ALL TRUSTEES AND OFFICERS OF THE FILING ORGANIZATION ARE ASKED TO REVIEW THE APPLICABLE CONFLICTS OF INTEREST POLICY AND TO DESCRIBE ANY POTENTIAL CONFLICTS OF INTEREST THEY MAY HAVE. UPON COMPLETION OF THE CONFLICTS OF INTEREST SURVEY, THE LEGAL DEPARTMENT REVIEWS THE COMPLETED QUESTIONNAIRES ON BEHALF OF THE FILING ORGANIZATION. ANY CONFLICTS IDENTIFIED ARE COMMUNICATED TO THE FILING ORGANIZATION'S CHAIRMAN OF THE BOARD AND ARE PRESENTED TO THE MEDICAL CENTER GOVERNANCE AND COMPENSATION COMMITTEE. ALL CONFLICTS OF INTEREST ARE RESOLVED BY MANAGEMENT PLANS DEVELOPED BY THE MEDICAL CENTER GOVERNANCE AND COMPENSATION COMMITTEE AND THE INTERNAL AUDIT AND COMPLIANCE OFFICES. THE MEDICAL CENTER GOVERNANCE AND COMPENSATION COMMITTEE'S CHAIR PRESENTS AN ANNUAL REPORT ON CONFLICTS TO THE FULL BOARD OF THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | DAVIE MEDICAL CENTER IS AN INTEGRAL PART OF WAKE FOREST BAPTIST HEALTH, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. THE FILING ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS AND KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS, DIRECTORS AND KEY EMPLOYEES WAS PAID BY A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, OR WAKE FOREST UNIVERSITY HEALTH SCIENCES, AN UNRELATED ORGANIZATION. BOTH EMPLOYERS ARE ENTITIES WITHIN THE WAKE FOREST BAPTIST HEALTH LEGAL STRUCTURE. COMPENSATION PAID TO THESE INDIVIDUALS IS REVIEWED AND APPROVED IN ACCORDANCE WITH THE APPLICABLE ORGANIZATION'S COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICER'S AND DIRECTOR'S COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES, AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|
| DAVIE COUNTY HOSPITAL FOUNDATION | ||||||||||
| 156 ROLAND RD | MOCKSVILLE | NC | 27028 | 581477280 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 12C, III-FI | 0 | |
| WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER | ||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 510190238 | HEALTHCARE | NC | 501(C)(3) | LINE 12A, I | 0 | |
| LEXINGTON MEDICAL CENTER | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 560543238 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | 0 | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER |
| LEXINGTON MEDICAL CENTER FOUNDATION | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 581876553 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 12A, I | 0 | LEXINGTON MEDICAL CENTER |
| NORTHWEST COMMUNITY CARE NETWORK | ||||||||||
| 2000 WEST FIRST STREET | WINSTON SALEM | NC | 27104 | 020774853 | HEALTHCARE | NC | 501(C)(3) | LINE 7 | 0 | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER |
| FAITHHEALTH INNOVATIONS INC | ||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 237426944 | HEALTHCARE | NC | 501(C)(3) | LINE 10 | 0 | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER |
| WRMC HOSPITAL OPERATING CORPORATION | ||||||||||
| PO BOX 609 | NORTH WILKESBORO | NC | 28659 | 830343789 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | 0 | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER |
| HIGH POINT REGIONAL HEALTH | ||||||||||
| PO BOX HP-5 | HIGH POINT | NC | 27261 | 560532309 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | 0 | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER |
| HIGH POINT REGIONAL HEALTH FOUNDATION | ||||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 272854711 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 12A, I | 0 | HIGH POINT REGIONAL HEALTH |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| MS LAND HOLDING CO LLC | |||||||
| 1901 MOONEY STREET | WINSTON SALEM | NC | 27103 | 824005370 | REAL ESTATE | NC | N/A |
| HIGH POINT SURGERY CENTER LLC | |||||||
| 600 N LINDSAY STREET | HIGH POINT | NC | 27262 | 561867005 | HEALTHCARE | NC | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIGH POINT HEALTH CARE VENTURES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 NORTH ELM STREET | AddressLine1Txt |
| City | HIGH POINT | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27261 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561497164 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |