WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN (EIN 90-0222618)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-14
- IRS object ID
- 201801349349302105
- Schema version
- 2016v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-14T09:18:41-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 900222618 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wake Forest University Health Sciences | BusinessNameLine1Txt |
| Business Name Line2 | Group Return | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WAKE | BusinessNameControlTxt |
| Phone | 3367164445 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Medical Center Blvd | AddressLine1Txt |
| City | WinstonSalem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27157 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Bradley A Clark | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 3367164445 | PhoneNum |
| Signature | 2018-05-05 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Julie A Freischlag MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Medical Center Blvd | AddressLine1Txt |
| City | WinstonSalem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27157 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $83,632,375 | GrossReceiptsAmt |
| Group Return For Affiliates | Yes (1) | GroupReturnForAffiliatesInd |
| All Affiliates Included | Yes (1) | AllAffiliatesIncludedInd |
| Group Exemption | 3884 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | Outpatient Medical Clinics for the promotion of health for the benefit of the community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $83,345,235 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $83,632,375 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $83,345,235 | PYTotalRevenueAmt |
| CY Total Revenue | $83,632,375 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $618,805 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $744,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $64,008,351 | PYOtherExpensesAmt |
| CY Other Expenses | $64,864,198 | CYOtherExpensesAmt |
| PY Total Expenses | $64,627,156 | PYTotalExpensesAmt |
| CY Total Expenses | $65,608,198 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $18,718,079 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $18,024,177 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $183,135,175 | TotalAssetsBOYAmt |
| Total Assets EOY | $200,306,258 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,062,402 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,209,308 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $177,072,773 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $195,096,950 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $58,060,110 | ExpenseAmt |
| Grant | $744,000 | GrantAmt |
| Revenue | $83,632,375 | RevenueAmt |
| Desc | 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 (1,449 in-center and 305 home dialysis patients). | Desc |
| Total Program Service Expenses | $58,060,110 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | 0 | OperateHospitalInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 142 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Health Systems Management Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2293865505 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 7710 | AddressLine1Txt |
| City | Tifton | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317937710 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| John D McConnell MD | ||||||||
| Chairman & President (to 4/26/17) | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $2,031,055 | $266,426 | |
| Barry I Freedman MD | ||||||||
| Director | 1.00 | 39.00 | Yes (X) | $0 | $544,145 | $45,985 | ||
| Terry L Hales Jr | ||||||||
| Director & Asst Treas | 2.00 | 38.00 | Yes (X) | Yes (X) | $0 | $470,129 | $119,381 | |
| Terry G Williams | ||||||||
| Director | 1.00 | 39.00 | Yes (X) | $0 | $0 | $0 | ||
| Chad A Eckes | ||||||||
| Director (To 6/10/17) | 0.50 | 39.50 | Yes (X) | $0 | $0 | $0 | ||
| Kevin P High MD | ||||||||
| Director & VP (Eff 5/31/17) | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $817,847 | $186,831 | |
| Julie A Frieschlag MD | ||||||||
| Chair & Pres (eff 5/30/17 & 5/31/17) | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| J Reid Morgan | ||||||||
| Secretary | 0.50 | 39.50 | Yes (X) | $0 | $560,584 | $142,553 | ||
| Bradley A Clark | ||||||||
| Treasurer | 0.50 | 39.50 | Yes (X) | $0 | $0 | $0 | ||
| K Barbara Carbone MD | ||||||||
| Former Director | 0.00 | 0.00 | $0 | $395,567 | $122 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,819,327 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $761,298 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HSM Dialysis Centers LLC | |||||
| PO Box 7710 | Tifton | GA | 31793 | Professional services | $7,425,653 |
| Nephrology Associates | |||||
| 730 Highland Oaks Drive | WinstonSalem | NC | 27103 | Medical Director | $255,000 |
| Infian LLC | |||||
| 2810 N Parham Rd Suite 220 | Richmond | VA | 23294 | IT Services | $185,596 |
| Metrolina Nephrology Assoc | |||||
| 1300 Baxter St Suite 215 | Charlotte | NC | 28204 | Medical Director | $145,776 |
| Iredell Nephrology Center | |||||
| 2043 Simonton Rd Suite B | Statesville | NC | 28625 | Medical Director | $110,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Medical Services | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $83,632,375 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $83,632,375 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $83,632,375 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $83,632,375 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $83,632,375 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $744,000 | TotalAmt |
| Program Services | $744,000 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,506,012 | TotalAmt |
| Management And General | $7,506,012 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,100 | TotalAmt |
| Management And General | $23,100 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,955,620 | TotalAmt |
| Program Services | $25,936,644 | ProgramServicesAmt |
| Management And General | $18,976 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,232 | TotalAmt |
| Program Services | $245,232 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $669,719 | TotalAmt |
| Program Services | $669,719 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,693,937 | TotalAmt |
| Program Services | $2,693,937 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,853 | TotalAmt |
| Program Services | $161,853 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,335 | TotalAmt |
| Program Services | $101,335 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $697,888 | TotalAmt |
| Program Services | $697,888 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $18,308,580 | $18,308,580 |
| Bad Debt | $6,362,247 | $6,362,247 |
| Laboratory | $1,309,112 | $1,309,112 |
| Equipment | $829,563 | $829,563 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,608,198 | TotalAmt |
| Program Services | $58,060,110 | ProgramServicesAmt |
| Management And General | $7,548,088 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,067,262 | BOYAmt |
| EOY | $4,914,083 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,040,221 | BOYAmt |
| EOY | $10,825,667 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,762,354 | BOYAmt |
| EOY | $1,794,458 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,122 | BOYAmt |
| EOY | $143,050 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $166,129,216 | BOYAmt |
| EOY | $182,629,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $183,135,175 | BOYAmt |
| EOY | $200,306,258 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,062,402 | BOYAmt |
| EOY | $5,209,308 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,062,402 | BOYAmt |
| EOY | $5,209,308 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,072,773 | BOYAmt |
| EOY | $195,096,950 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,072,773 | BOYAmt |
| EOY | $195,096,950 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $183,135,175 | BOYAmt |
| EOY | $200,306,258 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $18,024,177 | 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 2 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (2 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| Wake Forest University | ||||
| 560532138 | 2 | Yes (1) | $0 | $0 |
| Wake Forest University Health Sciences | ||||
| 223849199 | 2 | Yes (1) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 2 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | WFUHS Capital Contribution | Desc |
| Book Value | $182,629,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $182,629,000 | TotalBookValueOtherAssetsAmt |
| 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, 2017 AND 2016, 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, 2017 and 2016. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| United Way of Forsyth County | |||||||
| 301 N Main Street | Winston Salem | NC | 27101 | 237357234 | 3 | $20,000 | Community Support |
| American Kidney Fund | |||||||
| 11921 Rockville Pike | Rockville | MD | 20852 | 237124261 | 3 | $724,000 | financial assistance program for qualified kidney patients |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | 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 organization follows the policy used by Wake Forest University Baptist Medical Center (to which entity the operation of the subsidiaries of its two members, wake forest university health sciences and north carolina baptist hospital, - including the filing organization - has been delegated) in reviewing eligibility and selection of grantees receiving certain exempt purpose funds. The organization maintains documentation of the eligibility and selection criteria and records of amounts disbursed. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John D McConnell MD | ||||||||||||||
| Chairman & President (to 4/26/17) | $0 | $1,026,651 | $0 | $434,548 | $0 | $569,856 | $0 | $247,313 | $0 | $19,113 | $0 | $2,297,481 | $0 | $0 |
| Barry I Freedman MD | ||||||||||||||
| Director | $0 | $507,697 | $0 | $32,836 | $0 | $3,612 | $0 | $22,945 | $0 | $23,040 | $0 | $590,130 | $0 | $0 |
| Terry L Hales Jr | ||||||||||||||
| Director & Asst Treas | $0 | $367,182 | $0 | $101,696 | $0 | $1,251 | $0 | $96,836 | $0 | $22,545 | $0 | $589,510 | $0 | $0 |
| Kevin P High MD | ||||||||||||||
| Director & VP (Eff 5/31/17) | $0 | $585,172 | $0 | $211,063 | $0 | $21,612 | $0 | $165,135 | $0 | $21,696 | $0 | $1,004,678 | $0 | $0 |
| J Reid Morgan | ||||||||||||||
| Secretary | $0 | $459,486 | $0 | $40,000 | $0 | $61,098 | $0 | $64,000 | $0 | $78,553 | $0 | $703,137 | $0 | $0 |
| K Barbara Carbone MD | ||||||||||||||
| Former Director | $0 | $0 | $0 | $0 | $0 | $395,567 | $0 | $0 | $0 | $122 | $0 | $395,689 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | CERTAIN EXECUTIVES of the filing organization pARTICIPATEd IN OR RECEIVED PAYMENTS FROM severance plans and SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANS during the tax period (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 officers RECEIVED severance and/or SERP PAYMENTS from the related organization (Wake forest University Health Sciences) IN Calendar year 2016: SERP Severance John D. McConnell, MD $546,312 K. Barbara Carbone, MD $395,567 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Chad Eckes and Terry Williams, both officers of the organization, were board members of MedCost Benefit Services. |
| Form 990, Part VI, Section A, line 6 | Wake Forest University Health Sciences is the parent organization. |
| Form 990, Part VI, Section A, line 7a | The members of the Board of Directors of the organization 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 his 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 organization's governing body which require approval by the parent organization, Wake Forest University Health Sciences, include amendments to the organization's governance documents (Articles of Incorporation and Bylaws), and the election and removal of directors. |
| Form 990, Part VI, Section B, line 11b | THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES 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 | The organization requires its officers and directors to disclose conflicts of interest annually, and as they arise. Any items disclosed are reviewed and managed in accordance with the organization's policy on conflicts of interest. |
| Form 990, Part VI, Section B, line 15 | The organization pays no compensation to officers or directors; as the organization has no employees, it does not pay any compensation to any key employees. All compensation paid to officers and directors and former officers or directors was paid by related organizations. The governance & compensation committee of the Wake Forest University Baptist Medical Center Board is (through Authority delegated to it by Wake Forest University Health Sciences - the parent of the filing organization) 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 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 not available to the public. |
| Part VII, Section A, Column B, Hours | JOHN D. MCCONNELL, MD FILING ORG 0.5 RELATED ORG 18.2 UNRELATED ORG 21.3 Julie A. Frieschlag, MD FILING ORG 0.5 RELATED ORG 23.0 UNRELATED ORG 16.5 BARRY I. FREEDMAN, MD FILING ORG 1.0 RELATED ORG 39.0 TERRY L. HALES, JR. FILING ORG 2.0 RELATED ORG 21.8 UNRELATED ORG 16.2 TERRY G. WILLIAMS FILING ORG 1.0 RELATED ORG 8.3 UNRELATED ORG 30.7 CHAD ECKES FILING ORG 0.5 RELATED ORG 10.0 UNRELATED ORG 29.5 KEVIN P. HIGH, MD FILING ORG 0.5 RELATED ORG 10.1 UNRELATED ORG 29.4 J. REID MORGAN FILING ORG 0.5 RELATED ORG 39.5 BRADLEY A. CLARK FILING ORG 0.5 RELATED ORG 13.8 UNRELATED ORG 25.7 NORTH CAROLINA BAPTIST HOSPITAL IS AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION. 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 (A RELATED ORGANIZATION OF BOTH WAKE FOREST UNIVERSITY AND WAKE FOREST UNIVERSITY HEALTH SCIENCES) AND NORTH CAROLINA BAPTIST HOSPITAL (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 FILING ORGANIZATION ALSO DEVOTE HOURS TO THE RELATED ORGANIZATIONS, AS WELL AS TO THE UNRELATED ORGANIZATION (NCBH), AS SHOWN IN THE BREAKDOWN OF HOURS ABOVE. |
| Form 990, Part IX, line 11g | Contracted Services & Medical Director: Program service expenses 25,751,878. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,751,878. Professional Fees: Program service expenses 184,766. Management and general expenses 18,976. Fundraising expenses 0. Total expenses 203,742. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WFUBMC Community Physicians | |||||||||||
| 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 | 0 | N/A | |
| 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | North District Owners Association | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Medical Center Blvd | AddressLine1Txt |
| City | Winston Salem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27157 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 471128865 | EIN |
| Primary Activities | Property Owners Association | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |