2017-05-12T07:46:10-05:00 2016-06-30 990 2015-07-01 900222618 WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN WAKE 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 TERRY L HALES JR ASSISTANT TREASURER 3367164445 2017-05-05 2015 2021-01-29 14:40:06Z JOHN D MCCONNELL MD MEDICAL CENTER BLVD WINSTONSALEM NC 27157 83345235 1 1 3884 X N/A X 2003 NC OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY. 6 0 0 0 0 0 0 0 80646283 83345235 0 0 0 0 80646283 83345235 497029 618805 0 0 0 0 0 0 0 61289823 64008351 61786852 64627156 18859431 18718079 164505958 183135175 6151264 6062402 158354694 177072773 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 57174523 618805 83345235 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 (1,437 IN-CENTER AND 290 HOME DIALYSIS PATIENTS). 57174523 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 1 144 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 0 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 JOHN D MCCONNELL MD CHAIRMAN & PRESIDENT 0.50 39.50 X X 0 2031489 252556 BARRY I FREEDMAN MD DIRECTOR 1.00 39.00 X 0 545289 34213 TERRY L HALES JR DIRECTOR & ASST TREAS 2.00 38.00 X X 0 481853 102471 TERRY G WILLIAMS DIRECTOR 1.00 39.00 X 0 710936 147833 CHAD A ECKES DIRECTOR 0.50 39.50 X 0 678676 166330 KEVIN P HIGH MD DIRECTOR 0.50 39.50 X 0 683568 115815 J REID MORGAN SECRETARY 0.30 39.70 X 0 510246 97801 WILLIAM B APPLEGATE MD FORMER DIRECTOR & OFFICER 0.00 40.00 X 0 242496 32243 0 5884553 949262 0 1 1 0 HSM DIALYSIS CENTERS LLC PO BOX 7710 TIFTON GA 31793 PROFESSIONAL SERVICES 7181241 NEPHROLOGY ASSOCIATES 730 HIGHLAND OAKS DRIVE WINSTONSALEM NC 27103 MEDICAL DIRECTOR 285000 METROLINA NEPHROLOGY ASSOC 1300 BAXTER ST SUITE 215 CHARLOTTE NC 28204 MEDICAL DIRECTOR 145657 INFIAN LLC 2810 N PARHAM RD SUITE 220 RICHMOND VA 23294 IT SERVICES 137639 IREDELL NEPHROLOGY CENTER 2043 SIMONTON RD SUITE B STATESVILLE NC 28625 MEDICAL DIRECTOR 110000 5 MEDICAL SERVICES 621300 83345235 83345235 83345235 83345235 83345235 0 0 X 618805 618805 7348948 7348948 32081 32081 25475953 25404349 71604 12 12 212079 212079 592921 592921 2543786 2543786 161627 161627 89845 89845 641559 641559 MEDICAL SUPPLIES 17971779 17971779 BAD DEBT 6567070 6567070 LABORATORY 1318283 1318283 EQUIPMENT 1052408 1052408 64627156 57174523 7452633 0 3431013 4067262 10089500 11040221 32000 1684847 1762354 4531 136122 149264067 166129216 164505958 183135175 5916264 6062402 235000 0 6151264 6062402 X 158354694 177072773 158354694 177072773 164505958 183135175 18718079 0 X 0 1 X 1 0 X X 2 WAKE FOREST UNIVERSITY 560532138 2 1 0 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES 223849199 2 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 WFUHS CAPITAL CONTRIBUTION 166129216 166129216 X PART X, LINE 2: THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED. THE ORGANIZATION WAS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF FOR-PROFIT SUBSIDIARIES, IF APPLICABLE. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S STATEMENT OF OPERATIONS FOR THE YEARS ENDED JUNE 30, 2015 AND 2016. 1 UNITED WAY OF FORSYTH COUNTY 301 N MAIN STREET WINSTON SALEM NC 27101 237357234 3 20000 COMMUNITY SUPPORT AMERICAN KIDNEY FUND 11921 ROCKVILLE PIKE ROCKVILLE MD 20852 237124261 3 570000 FINANCIAL ASSISTANCE PROGRAM FOR QUALIFIED KIDNEY PATIENTS 2 0 PART I, LINE 2: 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. 0 1 0 0 0 0 0 0 0 JOHN D MCCONNELL MD CHAIRMAN & PRESIDENT 0 1003000 0 458633 0 569856 0 232214 0 20342 0 2284045 0 0 BARRY I FREEDMAN MD DIRECTOR 0 517227 0 24450 0 3612 0 11303 0 22910 0 579502 0 0 TERRY L HALES JR DIRECTOR & ASST TREAS 0 364384 0 116222 0 1247 0 79354 0 23117 0 584324 0 0 TERRY G WILLIAMS DIRECTOR 0 524352 0 185324 0 1260 0 123033 0 24800 0 858769 0 0 CHAD A ECKES DIRECTOR 0 535569 0 142351 0 756 0 140589 0 25741 0 845006 0 0 KEVIN P HIGH MD DIRECTOR 0 530747 0 132889 0 19932 0 93700 0 22115 0 799383 0 0 J REID MORGAN SECRETARY 0 447334 0 25000 0 37912 0 26500 0 71301 0 608047 0 0 WILLIAM B APPLEGATE MD FORMER DIRECTOR & OFFICER 0 210004 0 12206 0 20286 0 11572 0 20671 0 274739 0 0 PART I, LINE 4B CERTAIN EXECUTIVES OF THE FILING ORGANIZATION DURING THE TAX PERIOD PARTICIPATED IN OR RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS (SERP) (ALL OF WHICH WAS PAID BY RELATED ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES, AS PART OF THE INDIVIDUAL'S COMPENSATION FROM RELATED ORGANIZATIONS). THE FOLLOWING INDIVIDUAL RECEIVED SERP PAYMENTS FROM THE RELATED ORGANIZATION (WAKE FOREST UNIVERSITY HEALTH SCIENCES) IN HIS 2015 COMPENSATION. SERP JOHN D. MCCONNELL, MD $546,312 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 11 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 EXECUTIVE 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 .5 RELATED ORG 19.2 UNRELATED ORG 20.3 BARRY I FREEDMAN MD FILING ORG 1.0 RELATED ORG 39.0 TERRY L HALES JR FILING ORG 2.0 RELATED ORG 19.0 UNRELATED ORG 19.0 TERRY G WILLIAMS FILING ORG 1.0 RELATED ORG 6.3 UNRELATED ORG 32.7 CHAD ECKES FILING ORG 0.5 RELATED ORG 10.6 UNRELATED ORG 28.9 KEVIN P HIGH, MD FILING ORG 0.5 RELATED ORG 11.5 UNRELATED ORG 28.0 J REID MORGAN FILING ORG .3 RELATED ORG 39.7 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 25,235,294. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,235,294. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 169,055. MANAGEMENT AND GENERAL EXPENSES 71,604. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 240,659. 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 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 11A, 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 11A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 IDEALLIANCE FOUNDATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 562094060 BUSINESS DEVELOPMENT ACTIVITIES NC 501(C)(3) LINE 11A, 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 DIALYSIS ACCESS GROUP OF WFU LLC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 204241942 HEALTHCARE NC 501(C)(3) LINE 9 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 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 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 1 1 1