2020-07-14T10:47:49-05:00 2019-06-30 990 2018-07-01 900222618 WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN WAKE 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 BRADLEY A CLARK TREASURER 3367164445 2020-07-08 152.11.92.106 2020-07-08 08:10:29 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 92F11F32722E8792293CAF8DF02A44B038BF976A 2018 2021-01-29 14:40:06Z JULIE A FREISCHLAG MD MEDICAL CENTER BLVD WINSTONSALEM NC 27157 104012236 1 1 3884 X N/A X 2003 NC OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY. 5 1 0 0 0 0 0 0 93089713 103985583 1710 26653 0 0 93091423 104012236 1147340 1074395 0 0 0 0 0 0 0 75180438 83691116 76327778 84765511 16763645 19246725 218753107 238734104 6892512 7626784 211860595 231107320 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 75782393 1074395 103985583 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 (1,693 IN-CENTER AND 294 HOME DIALYSIS PATIENTS). 75782393 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 1 106 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 BARRY I FREEDMAN MD DIRECTOR 0.50 39.50 X 0 556709 49258 TERRY L HALES JR DIRECTOR & ASST TREAS 0.50 39.50 X X 0 579911 68917 TERRY G WILLIAMS DIRECTOR 0.50 39.50 X 0 0 0 KEVIN P HIGH MD DIRECTOR & VP 0.50 39.50 X X 0 828234 219300 JULIE A FREISCHLAG MD CHAIR & PRESIDENT 0.50 39.50 X X 0 1742588 353250 J REID MORGAN SECRETARY 0.50 39.50 X 0 560012 187816 BRADLEY A CLARK TREASURER 0.50 39.50 X 0 0 0 JOHN D MCCONNELL MD FORMER OFFICER (4-26-17) 0.00 40.00 X 0 5552781 44771 0 9820235 923312 0 1 1 0 HSM DIALYSIS CENTERS LLC PO BOX 7710 TIFTON GA 31793 PROFESSIONAL SERVICES 8233274 NEPHROLOGY ASSOCIATES 730 HIGHLAND OAKS DRIVE WINSTONSALEM NC 27103 MEDICAL DIRECTOR 518580 METROLINA NEPHROLOGY ASSOC 1300 BAXTER ST SUITE 215 CHARLOTTE NC 28204 MEDICAL DIRECTOR 149100 HIGH POINT NEPHROLOGY ASSOC 404 WESTWOOD AVE 105 HIGH POINT NC 27262 MEDICAL DIRECTOR 137700 IREDELL NEPHROLOGY 2117 SIMONTON ROAD 102 STATESVILLE NC 28625 MEDICAL DIRECTOR 122100 5 MEDICAL SERVICES 621300 103985583 103985583 103985583 26653 26653 104012236 103985583 0 26653 X 1074395 1074395 8474496 8474496 139933 97953 41980 33191480 33191480 597166 514641 82525 748633 663661 84972 3532400 3233255 299145 205448 205448 19528 19528 566170 566170 MEDICAL SUPPLIES 28490044 28490044 BAD DEBT 7725818 7725818 84765511 75782393 8983118 0 3219521 5054531 13410765 13121947 2134116 1953643 59638 74916 199929067 218529067 218753107 238734104 6892512 7626784 6892512 7626784 X 211860595 231107320 211860595 231107320 218753107 238734104 19246725 0 X 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 0 0 0 0 0 0 0 0 0 0 1 0 0 WFUHS CAPITAL CONTRIBUTION 218529067 218529067 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, 2018 AND 2019, 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, 2018 AND 2019. 1 AMERICAN KIDNEY FUND 11921 ROCKVILLE PIKE ROCKVILLE MD 20852 237124261 501(C)(3) 1054295 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 BARRY I FREEDMAN MD DIRECTOR 0 553097 0 0 0 3612 0 23649 0 25609 0 605967 0 0 TERRY L HALES JR DIRECTOR & ASST TREAS 0 407549 0 112287 0 60075 0 44824 0 24093 0 648828 0 0 KEVIN P HIGH MD DIRECTOR & VP 0 628644 0 177478 0 22112 0 199887 0 19413 0 1047534 0 0 JULIE A FREISCHLAG MD CHAIR & PRESIDENT 0 1198945 0 533149 0 10494 0 330402 0 22848 0 2095838 0 0 J REID MORGAN SECRETARY 0 499312 0 40000 0 20700 0 107368 0 80448 0 747828 0 0 JOHN D MCCONNELL MD FORMER OFFICER (4-26-17) 0 1038530 0 0 0 4514251 0 23648 0 21123 0 5597552 0 3858352 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 WERE PAID BY A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES, AS PART OF THE INDIVIDUAL'S COMPENSATION FROM RELATED ORGANIZATIONS). THE FOLLOWING CURRENT AND FORMER DIRECTORS AND/OR OFFICERS RECEIVED SERP PAYMENTS FROM THE RELATED ORGANIZATION (WAKE FOREST UNIVERSITY HEALTH SCIENCES) IN CALENDAR YEAR 2018: JOHN D. MCCONNELL, M.D. $4,477,272 TERRY L. HALES, JR. $58,815 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 0.1 UNRELATED ORG 39.9 JULIE A. FREISCHLAG, MD FILING ORG 0.5 RELATED ORG 18.3 UNRELATED ORG 21.2 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 4.0 UNRELATED ORG 35.5 KEVIN P. HIGH, MD FILING ORG 0.5 RELATED ORG 6.7 UNRELATED ORG 32.8 J. REID MORGAN FILING ORG 0.5 RELATED ORG 33.5 UNRELATED ORG 6.0 BRADLEY A. CLARK FILING ORG 0.5 RELATED ORG 7.1 UNRELATED ORG 32.4 NORTH CAROLINA BAPTIST HOSPITAL ("NCBH") AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") ARE UNRELATED ORGANIZATIONS TO THE SEPARATE DIALYSIS CENTER ORGANIZATIONS INCLUDED IN THIS GROUP RETURN. PURSUANT TO THE TERMS OF THE "MEDICAL CENTER INTEGRATION AGREEMENT" (AN AGREEMENT ENTERED INTO IN 2010 AMONG FOUR PARTIES: WAKE FOREST UNIVERSITY, WAKE FOREST UNIVERSITY HEALTH SCIENCES (BOTH RELATED ORGANIZATIONS OF THE FILING ORGANIZATION), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER AND NORTH CAROLINA BAPTIST HOSPITAL (BOTH UNRELATED TO THE FILING ORGANIZATION), UNDER WHICH AGREEMENT THE OPERATION OF WFUHS AND NCBH, AND ALL OF THE RESPECTIVE SUBSIDIARIES OF EACH, WAS DELEGATED TO WFUBMC), THE CORPORATE OFFICERS OF WFUBMC GENERALLY SERVE ALSO AS THE CORPORATE OFFICERS OF WFUHS AND NCBH. THUS, CERTAIN OFFICERS OF THE ORGANIZATIONS INCLUDED IN THIS GROUP RETURN ALSO DEVOTE HOURS TO THE RELATED ORGANIZATIONS, AS WELL AS TO THE UNRELATED ORGANIZATIONS (WFUBMC AND NCBH), AS SHOWN IN THE BREAKDOWN OF HOURS ABOVE. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES & MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 30,964,378. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,964,378. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,227,102. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,227,102. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. 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 EDUCATION, RESEARCH, HEALTHCARE 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 575 N PATTERSON AVENUE WINSTON SALEM NC 27101 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 ACCELERATE DEVELOPMENT OF REGENERATIVE MEDICINE THERAPY NC 501(C)(3) LINE 7 WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 VERGER FUND II LLC PO BOX 7201 WINSTON SALEM NC 27109 352514227 INVESTMENT NC N/A WAKE FOREST TECHNOLOGY DEVELOPMENT PROGRAM LP 2520 MERIDIAN PARKWAY DURHAM NC 27713 475437596 INVESTMENT NC N/A WAKE FOREST AMBULATORY VENTURES LLC MEDICAL CENTER BOULEVARD WINSTON SALEM NC 27157 820777206 HEALTHCARE NC N/A 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