DAVIE MEDICAL CENTER: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- DAVIE MEDICAL CENTER (EIN 56-2276994)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-13
- IRS object ID
- 201621349349301157
- Schema version
- 2014v6.0
- 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 | 2016-05-13T08:07:23-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | 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 COUNTY EMERGENCY HEALTH CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DAVI | BusinessNameControlTxt |
| Phone | 3369981300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1Txt |
| City | MOCKSVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27028 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANNY SQUIRES | PersonNm |
| Person Title | VP/CFO | PersonTitleTxt |
| Phone | 3369981300 | PhoneNum |
| Signature | 2016-05-04 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHAD BROWN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1Txt |
| City | MOCKSVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27028 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $39,864,808 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL/ | 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 | 268 | TotalEmployeeCnt |
| Total Volunteers | 49 | 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 | $24,152,242 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,839,894 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,102 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,093 | CYInvestmentIncomeAmt |
| PY Other Revenue | $7,433 | PYOtherRevenueAmt |
| CY Other Revenue | $20,821 | CYOtherRevenueAmt |
| PY Total Revenue | $24,160,777 | PYTotalRevenueAmt |
| CY Total Revenue | $39,864,808 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $32,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $26,400 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,832,066 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,954,379 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,656,108 | PYOtherExpensesAmt |
| CY Other Expenses | $20,174,959 | CYOtherExpensesAmt |
| PY Total Expenses | $28,520,174 | PYTotalExpensesAmt |
| CY Total Expenses | $30,155,738 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,359,397 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,709,070 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,496,583 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,517,085 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $26,861,729 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,173,161 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$6,365,146 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,343,924 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MEDICAL CENTER'S MISSION IS TO IMPROVE THE HEALTH OF OUR REGION BY: PROVIDING EXCELLENT CARE & AN EXCEPTIONAL EXPERIENCE; PROMOTING HEALTH & WELLNESS THROUGH COMMUNITY PARTNERSHIPS; & CONNECTING PEOPLE TO THE WORLD CLASS EXPERTISE OF WAKE FOREST BAPTIST MEDICAL CENTER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $27,468,233 | ExpenseAmt |
| Grant | $26,400 | GrantAmt |
| Revenue | $39,857,129 | RevenueAmt |
| Desc | DAVIE HOSPITAL PROVIDED MEDICAL, EMERGENCY, AND OUTPATIENT CARE SERVICES TO THE RESIDENTS OF DAVIE COUNTY, NORTH CAROLINA, AND THE SURROUNDING AREAS. DURING THE FISCAL YEAR, THE HOSPITAL HAD 81 LICENSED INPATIENT BEDS, 5,554 PATIENT DAYS WITH 228 INPATIENT ADMISSIONS, 24,822 OUTPATIENT CLINICAL VISITS AND 12,294 EMERGENCY ROOM VISITS. THE HOSPITAL'S VISIONTO BE A MEDICAL CENTER OF CHOICE, PROMOTING HEALTH AND SERVING AS A DESTINATION FOR EXCELLENCE IN PATIENT CARE.THE HOSPITAL'S VALUES- 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. | Desc |
| Total Program Service Expenses | $27,468,233 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | 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 | 0 | 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 | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 268 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | 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 | DANNY SQUIRES | PersonNm |
| Phone | 3362384287 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1Txt |
| City | MOCKSVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27028 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| K BARBARA CARBONE MD | |||||||||
| CHAIRMAN | 8.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| KEVIN P HIGH MD | |||||||||
| CHAIRMAN | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| C DANIEL BARRETT | |||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| TERRY BRALLEY | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| BETH DIRKS | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CRAIG M GREVEN MD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| HEATHER L HAYES | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $36,555 | $3,030 | 38.00 | |||
| RUSSELL HOWERTON MD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| WILLIAM F JUNKER | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| ANDREW L KOMAN MD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| DOUGLAS NELSON | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| LYNN PITMAN | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $197,559 | $20,817 | 38.00 | |||
| KEN RETHMEIER | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARY RITTLING PHD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| STEPHEN ROBERTSON | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | 6.00 | |||
| RONALD SMALL | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| STEVEN C SNELGROVE | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $42,245 | $3,417 | ||||
| CHARLES TEGELER MD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| KENNON WHITE | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CHAD BROWN | |||||||||
| PRESIDENT | 40.00 | Yes (X) | $0 | $176,830 | $27,805 | ||||
| CHAD ECKES | |||||||||
| TREASURER | 10.00 | Yes (X) | $0 | $0 | $0 | ||||
| MIKE RUTHERFORD | |||||||||
| TREASURER | 10.00 | Yes (X) | $0 | $0 | $0 | ||||
| J MCLAIN WALLACE JR | |||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $458,252 | $105,752 | 38.00 | |||
| DINA MARTY | |||||||||
| ASSISTANT SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | 38.00 | |||
| H GREGORY BRAY | |||||||||
| ASSISTANT TREASURER | 2.00 | Yes (X) | $0 | $221,679 | $24,425 | 38.00 | |||
| DANNY SQUIRES | |||||||||
| VP - CFO | 15.00 | $210,375 | $0 | $24,310 | 25.00 | Yes (X) | |||
| DONNY C LAMBETH | |||||||||
| FORMER OFFICER | 0.00 | $0 | $272,778 | $6,504 | Yes (X) | ||||
| BRET NICKS MD | |||||||||
| FORMER OFFICER | 10.00 | $414,106 | $0 | $27,930 | 30.00 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $624,481 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,405,898 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $243,990 | 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 | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LINCARE INC | |||||
| 3900 WESTPOINT BLVD | WINSTON SALEM | NC | 27103 | RESPIRATORY SPECIALISTS | $570,800 |
| NURSEFINDERS | |||||
| PO BOX 3749 | BATON ROUGE | LA | 70821 | STAFFING | $556,834 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| 100 BAYVIEW CIRCLE | NEWPORT BEACH | CA | 92660 | MEDICAL SERVICES | $140,528 |
| BLAKLEY LANDSCAPING SERVICES INC | |||||
| 274 BAITY ROAD | MOCKSVILLE | NC | 27028 | LANDSCAPING | $133,794 |
| LINDE RSS REMEO LLC | |||||
| 104B WEST COURT SQUARE | LIVINGTON | TN | 38570 | RESPIRATORY SOLUTIONS | $124,900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $39,839,894 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,839,894 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,839,894 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,093 | TotalRevenueColumnAmt |
| Exclusion | $4,093 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,586 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,586 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,586 | TotalRevenueColumnAmt |
| Exclusion | $3,586 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $17,235 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,235 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $17,235 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,864,808 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,857,129 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,679 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,400 | TotalAmt |
| Program Services | $26,400 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,952,139 | TotalAmt |
| Program Services | $6,896,095 | ProgramServicesAmt |
| Management And General | $1,056,044 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $262,730 | TotalAmt |
| Program Services | $227,839 | ProgramServicesAmt |
| Management And General | $34,891 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,054,171 | TotalAmt |
| Program Services | $914,177 | ProgramServicesAmt |
| Management And General | $139,994 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $685,339 | TotalAmt |
| Program Services | $594,326 | ProgramServicesAmt |
| Management And General | $91,013 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,332 | TotalAmt |
| Management And General | $14,332 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,380 | TotalAmt |
| Management And General | $24,380 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,074 | TotalAmt |
| Program Services | $2,074 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,940,354 | TotalAmt |
| Program Services | $2,560,042 | ProgramServicesAmt |
| Management And General | $380,312 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,137 | TotalAmt |
| Program Services | $290,137 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,057 | TotalAmt |
| Program Services | $17,393 | ProgramServicesAmt |
| Management And General | $2,664 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,400 | TotalAmt |
| Program Services | $18,558 | ProgramServicesAmt |
| Management And General | $2,842 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,899,529 | TotalAmt |
| Program Services | $4,248,872 | ProgramServicesAmt |
| Management And General | $650,657 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,571 | TotalAmt |
| Program Services | $12,571 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,870 | TotalAmt |
| Program Services | $30,831 | ProgramServicesAmt |
| Management And General | $5,039 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,866,517 | TotalAmt |
| Program Services | $1,618,643 | ProgramServicesAmt |
| Management And General | $247,874 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,383 | TotalAmt |
| Program Services | $46,294 | ProgramServicesAmt |
| Management And General | $7,089 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $8,067,775 | $8,067,775 | |
| BAD DEBT EXPENSE | $1,451,144 | $1,451,144 | |
| PROVIDER ASSESSMENT TAX | $246,712 | $246,712 | |
| MISCELLANEOUS EXPENSE | $228,724 | $198,350 | $30,374 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,155,738 | TotalAmt |
| Program Services | $27,468,233 | ProgramServicesAmt |
| Management And General | $2,687,505 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,515,396 | BOYAmt |
| EOY | $12,329,826 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,501,895 | BOYAmt |
| EOY | $4,848,879 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $907,429 | BOYAmt |
| EOY | $911,583 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $50,000 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,365,094 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,148,695 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,534,668 | BOYAmt |
| EOY | $9,216,399 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,195 | BOYAmt |
| EOY | $160,398 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,496,583 | BOYAmt |
| EOY | $27,517,085 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,990,908 | BOYAmt |
| EOY | $20,874,985 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,870,821 | BOYAmt |
| EOY | $3,298,176 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,861,729 | BOYAmt |
| EOY | $24,173,161 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$6,366,158 | BOYAmt |
| EOY | $3,342,911 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,012 | BOYAmt |
| EOY | $1,013 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$6,365,146 | BOYAmt |
| EOY | $3,343,924 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,496,583 | BOYAmt |
| EOY | $27,517,085 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $9,709,070 | 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 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 | $2,074 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,074 | 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 HOSPITAL ASSOCIATION (NCHA). A PORTION OF THE MEMBERSHIP DUES PAID ARE ALLOCATED TO LOBBYING EFFORTS BY THOSE ORGANIZATIONS ON BEHALF OF THEIR MEMBERSHIPS. THE CURRENT PORTION OF MEMBERSHIP DUES ALLOCATED TO LOBBYING IS $2,074. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $329,832 | OtherCostOrOtherBasisAmt |
| Depreciation | $222,647 | DepreciationAmt |
| Book Value | $107,185 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,035,262 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,926,048 | DepreciationAmt |
| Book Value | $9,109,214 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,216,399 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED 3RD PARTY PAYABLE | $829,442 |
| DUE TO NCBH | $2,468,734 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,298,176 | 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 HOSPITAL IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. THE HOSPITAL HAS DETERMINED THAT THEY DO NOT HAVE UNCERTAIN INCOME TAX POSITIONS AS OF JUNE 30, 2015 AND JUNE 30, 2014. ALSO, THE HOSPITAL DOES NOT ANTICIPATE ANY INCREASE OR DECREASE IN UNRECOGNIZED TAX BENEFITS DURING THE NEXT TWELVE MONTHS THAT WOULD RESULT IN A MATERIAL CHANGE IN THEIR FINANCIAL PRESENTATION. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| 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 | $2,172,163 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,172,163 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07570 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,389,123 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,627,232 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$238,109 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $93,957 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $120,410 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$26,453 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,655,243 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,747,642 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,907,601 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07570 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,400 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,400 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,681,643 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,747,642 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,934,001 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07660 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $369,688 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $8,557,358 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,945,852 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,388,494 | 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 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1Txt |
| City | MOCKSVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27028 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL | 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 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS.HTM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS.HTM | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS.HTM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS.HTM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.WAKEHEALTH.EDU/FINANCIAL-ASSISTANCE.HTM | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | PART V, SECTION B, LINE 5: THE COMMUNITY'S PERSPECTIVE WAS OBTAINED THROUGH A THIRTY QUESTION COMMUNITY SURVEY DISTRIBUTED TO DAVIE COUNTY RESIDENTS VIA SURVEY MONKEY. OVER 500 RESPONSES WERE RECEIVED, INCLUDING THOSE FROM A STOREHOUSE FOR JESUS (SHFJ). SHFJ SERVES WORKING POOR FAMILIES, FAMILIES WITHOUT INCOME, SINGLE PARENT FAMILIES, FAMILES AFFECTED BY ILLNESS, ELDERLY, DOMESTIC VIOLENCE FAMILIES AND THE HOMELESS/TRANSIENT POPULATION OF DAVIE COUNTY. THE HOSPITAL ALSO WORKED WITH PUBLIC HEALTH EXPERTS FROM THE DAVIE COUNTY HEALTH DEPARTMENT TO CONDUCT THE CHNA. |
| WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | PART V, SECTION B, LINE 11: THE HOSPITAL IS EDUCATING THE COMMUNITY ON THE PRINCIPALS OF PROPER NUTRITION AND PHYSICAL ACTIVITY BY WORKING IN COLLABORATION WITH SMART START OF DAVIE COUNTY AND THE DAVIE CHAMBER OF COMMERCE TO DISSEMINATE INFORMATION AND ACTIVITY KITS ABOUT HEALTHY EATING, EXERCISE AND HEALTHY LIFESTYLE TIPS. IN ADDITION, THE HOSPITAL SPONSORS BOOTHS TO PROMOTE HEALTHY LIFESTYLES AND PROVIDES HEALTHY EATING TIPS THROUGH VISITS WITH A REGISTERED DIETITIAN OR PHYSICIAN. FINALLY, THE HOSPITAL PROVIDES FREE BMI SCREENINGS ANNUALLY TO INCREASE THE PUBLIC AWARENESS OF OBESITY.THE HOSPITAL WORKS WITH VARIOUS PARTNERS, INCLUDING THE DAVIE FAMILY YMCA, DAVIE COUNTY SENIOR CENTER AND THE PUBLIC HEALTH DEPARTMENT TO PROVIDE INFORMATION AND FREE SCREENINGS TO LOWER THE RISK OF HEART DISEASE. THE HOSPITAL'S HEALTHY HEART PROGRAMS INCLUDE BLOOD PRESSURE SCREENINGS, FREE SELF-HELP SMOKING CESSATION INFORMATION AND OTHER PROGRAMS RELATED TO CHRONIC HEART DISEASE AND PREVENTION IN THE COMMUNITY. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA PART V, SECTION B, LINE 16A WEBSITE: | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS.HTM |
| WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA PART V, SECTION B, LINE 16B WEBSITE: | WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS.HTM |
| WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA PART V, SECTION B, LINE 16C WEBSITE: | WWW.WAKEHEALTH.EDU/FINANCIAL-ASSISTANCE.HTM |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 14 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| DMC BERMUDA RUN - PHYSICAL THERAPY | ||||
| 313 NC HWY 801 | BERMUDA RUN | NC | 27006 | PHYSICAL THERAPY |
| DMC BERMUDA RUN - OCCUPATIONAL THERAPY | ||||
| 313 NC HWY 801N | BERMUDA RUN | NC | 27006 | OCCUPATIONAL THERAPY |
| DMC BERMUDA RUN - CARDIOLOGY | ||||
| 313 NC HWY 801 | BERMUDA RUN | NC | 27006 | CARDIAC REHAB |
| DMC BERMUDA RUN - LAB | ||||
| 313 NC HWY 801 | BERMUDA RUN | NC | 27006 | PHLEBOTOMY |
| DMC BERMUDA RUN - ORTHOPAEDICS | ||||
| 313 NC HWY 801 | BERMUDA RUN | NC | 27006 | X-RAY & ORTHOPEDICS |
| DMC BERMUDA RUN - PULMONARY | ||||
| 329 NC HWY 801 - PLAZA 2 | BERMUDA RUN | NC | 27006 | PULMONARY FUNCTION LAB |
| DMC BERMUDA RUN - RADIOLOGY | ||||
| 329 NC HWY 801 - PLAZA 2 | BERMUDA RUN | NC | 27006 | RADIOLOGY |
| DMC BERMUDA RUN - NEUROLOGY | ||||
| 329 NC HWY 801 - PLAZA 2 | BERMUDA RUN | NC | 27006 | EEG/EMG TESTING |
| DMC BERMUDA RUN - NEUROLOGY | ||||
| 329 NC HWY 801 - PLAZA 2 | BERMUDA RUN | NC | 27006 | SLEEP LAB |
| DMC BERMUDA RUN - LAB | ||||
| 329 NC HWY 801 - PLAZA 2 | BERMUDA RUN | NC | 27006 | PHLEBOTOMY |
| DMC EMERGENCY SERVICES | ||||
| 329 NC HWY 801 | BERMUDA RUN | NC | 27006 | EMERGENCY ROOM |
| DMC BERMUDA RUN - EYE CENTER | ||||
| 313 NC HWY 801N | BERMUDA RUN | NC | 27006 | OPTHALMOLOGY |
| DMC BERMUDA RUN - NEUROLOGY | ||||
| 313 NC HWY 801N | BERMUDA RUN | NC | 27006 | NEUROLOGY |
| DMC BERMUDA RUN - PODIATRY | ||||
| 313 NC HWY 801N | BERMUDA RUN | NC | 27006 | PODIATRY |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE ORGANIZATION ALSO EVALUATES CERTAIN CREDIT FILE DATA ELEMENTS TO INDENTIFY POTENTIAL SOURCES OF HIDDEN INCOME TO MORE ACCURATELY INFORM CHARITY CARE ELIGIBILITY ASSESSMENTS. PATIENTS WITH ESTIMATED HOUSEHOLD INCOME BELOW 200% OF FPG, WHO ARE IDENTIFIED AS HAVING COMMERICAL CREDIT ACCOUNTS THAT ARE BEING SERVICED IN A MANNER THAT SUGGESTS ADDITIONAL SOURCES OF INCOME, ARE NOT AUTOMATICALLY GRANTED PRESUMPTIVE CHARITY CARE. |
| 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 2014 SCHEDULE H. |
| PART I, LN 7 COL(F): | THE ORGANIZATION'S PATIENT BAD DEBT EXPENSE PER THE AUDITED FINANCIALS STATEMENTS WAS $1,451,144. THIS AMOUNT WAS REMOVED FROM THE CALCULATION OF CHARITY CARE. |
| PART I, LINE 7B - MEDICAID DIRECT OFF SETTING REVENUE | THE 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 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 2014 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 COSTS ASSOCIATED WITH BAD DEBT, GME, COMMUNITY BUILDING AND CHARITY CARE. |
| PART III, LINE 9B: | PATIENT FINANCIAL RESOURCES SERVICES WORKS WITH THE PATIENT FOR ANY PATIENT LIABILITY. OUR MAIN FOCUS IS PRIOR TO SERVICES AND/OR DISCHARGE; HOWEVER, WE DO WORK WITH PATIENTS AFTER SERVICES HAVE BEEN RECEIVED AND BILLED. PATIENT FINANCIAL RESOURCES SERVICES IS REALLY TWO AREAS IN ONE--THE RESOURCE RECOVERY SPECIALIST/RRS (FORMERLY FINANCIAL COUNSELING) AND THE MEDICAID ELIGIBILITY TEAM/MPS. THESE TWO AREAS WORK TOGETHER TO FIND A RESOLUTION TO PATIENT LIABILITY, SELF PAY OR INSURED. THE RRS WORKS TO NOTIFY THE PATIENT OF ANY PATIENT LIABILITY AND ASK FOR PAYMENT FOR THAT LIABILITY. IF THE PATIENT INDICATES THAT HE/SHE NEEDS ASSISTANCE, THEN THE RRS WILL COMPLETE A FINANCIAL STATEMENT ON THE PATIENT. WHILE TAKING THAT FINANCIAL STATEMENT THE RRS IS LOOKING FOR INFORMATION THAT COULD QUALIFY THE PATIENT FOR MEDICAID OR FOR OTHER AGENCY PROGRAMS THAT ARE AVAILABLE TO THE MEDICAL CENTER. WHEN THAT INFORMATION IS IDENTIFIED THE RRS WILL LET THE PATIENT KNOW THAT A REFERRAL WILL BE MADE FOR MEDICAID OR OTHER ASSISTANCE AND A MPS WILL BE IN TOUCH WITH HIM/HER. THE RRS ALSO EXPLAINS TO THE PATIENT OR FAMILY THAT CHARITY CARE IS A LAST RESORT AND THEY MUST COOPERATE WITH ANY OTHER ASSISTANCE PROGRAMS THAT WE HAVE IDENTIFIED AND BE FOUND INELIGIBLE BEFORE CHARITY CARE WILL BE APPROVED/APPLIED. IT IS ALSO COMMUNICATED WITH THE PATIENT OR FAMILY IS INFORMED IF ANY SUPPORTING DOCUMENTATION IS NEEDED FOR ANY ASSISTANCE, WHETHER THAT BE CHARITY, MEDICAID, OR OTHER PROGRAMS. |
| PART VI, LINE 2: | THE BOARD OF TRUSTEES APPROVED THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT ON MAY 7, 2013. A COMMUNITY WIDE TEAM COMPRISED OF THE DAVIE COUNTY HEALTH DEPARTMENT, THE HOSPITAL, UNITED WAY, STOREHOUSE FOR JESUS, THE YMCA AND OTHER COMMUNITY GROUPS, THE DAVIE COUNTY GOVERNMENT AND OTHERS CONVENED TO CONDUCT A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT WITH INPUT FROM COUNTY HEALTH EXPERTS, KEY COMMUNITY LEADERS AND THE PUBLIC (THROUGH SURVEYS). THE HOSPITAL ALSO PARTICIPATES IN A WIDE VARIETY OF LOCAL COALITIONS, INCLUDING SEVERAL SPONSORED BY THE DAVIE COUNTY HEALTH DEPARTMENT - CHRONIC DISEASE COMMITTEE AND THE COUNTY WELLNESS COMMITTEE, AS WELL AS PARTNERSHIPS AND SPONSORSHIPS WITH MANY COMMUNITY BASED ORGANIZATIONS. |
| 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, BILLING PAMPHLETS AVAILABLE IN CLINICAL OFFICES AND THE BUSINESS OFFICE, SIGNS IN CHECK-IN AREAS, INFORMATION ON PATIENT BILL STATEMENTS, AND FROM STAFF MEMBERS DURING CONVERSATIONS CONCERNING A PATIENT'S LIABILITY FOR SERVICES. THE HOSPITAL EMPLOYS A ROBUST 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 ASSIST THE PATIENT WITH ENROLLMENT. |
| PART VI, LINE 4: | DAVIE HOSPITAL SERVES DAVIE COUNTY, NORTH CAROLINA AND THE SURROUNDING AREAS. THE POPULATION OF DAVIE COUNTY IS APPROXIMATELY 42,000 ACCORDING TO THE U.S. CENSUS BUREAU. 11.7 % OF THE POPULATION IS AT OR BELOW THE POVERTY LEVEL. 87.5% OF THE POPULATION IS WHITE, 6.3% IS AFRICAN AMERICAN, AND 6.2% IS OTHER DEMOGRAPHICS. THE UNEMPLOYMENT RATE IN MARCH 2011 WAS 9.7%. THE MEDIAN INCOME IS $59,503. THE GROWTH RATE OF THE COMMUNITY IS 1.9%. |
| PART VI, LINE 5: | HOSPITAL REPRESENTATIVES ATTEND NUMEROUS HEALTH FAIRS AND PERFORM CHOLESTROL SCREENING CHECKS. THE HOSPITAL ALSO INVITES THE COMMUNITY TO ATTEND ITS LADIES' NIGHT OUT EVENT TO PROMOTE BREAST HEALTH AND BREAST CANCER AWARENESS. THE HOSPITAL IS INVOLVED WITH THE LOCAL SENIOR CENTER AND PROVIDES HEALTH EDUCATION ON VARIOUS TOPICS THROUGH OUT THE YEAR. |
| PART VI, LINE 6: | THE MEMBER OF THE ORGANIZATION IS NORTH CAROLINA BAPTIST HOSPITAL. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NC |
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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LYNN PITMAN | ||||||||||||||
| BOARD MEMBER | $0 | $189,013 | $0 | $8,057 | $0 | $489 | $0 | $5,067 | $0 | $15,750 | $0 | $218,376 | $0 | $0 |
| CHAD BROWN | ||||||||||||||
| PRESIDENT | $0 | $126,408 | $0 | $30,000 | $0 | $20,422 | $0 | $15,471 | $0 | $12,334 | $0 | $204,635 | $0 | $0 |
| J MCLAIN WALLACE JR | ||||||||||||||
| SECRETARY | $0 | $398,920 | $0 | $39,900 | $0 | $19,432 | $0 | $86,901 | $0 | $18,851 | $0 | $564,004 | $0 | $0 |
| H GREGORY BRAY | ||||||||||||||
| ASSISTANT TREASURER | $0 | $213,217 | $0 | $7,608 | $0 | $854 | $0 | $5,711 | $0 | $18,714 | $0 | $246,104 | $0 | $0 |
| DANNY SQUIRES | ||||||||||||||
| VP - CFO | $195,375 | $0 | $15,000 | $0 | $0 | $0 | $4,597 | $0 | $19,713 | $0 | $234,685 | $0 | $0 | $0 |
| DONNY C LAMBETH | ||||||||||||||
| FORMER OFFICER | $0 | $0 | $0 | $0 | $0 | $272,778 | $0 | $0 | $0 | $6,504 | $0 | $279,282 | $0 | $0 |
| BRET NICKS MD | ||||||||||||||
| FORMER OFFICER | $249,181 | $0 | $164,745 | $0 | $180 | $0 | $5,693 | $0 | $22,237 | $0 | $442,036 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINES 4A-B | CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE PAYMENTS FROM SEVERANCE AND SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS PROVIDED BY A RELATED ORGANIZATION. THE DETERMINATION OF THE AMOUNT OF THE FOLLOWING SEVERANCE PAYMENTS FOLLOW THE RELATED ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THEIR FORM 990. SEVERANCE - DONNY C. LAMBETH $272,778 - HEATHER HAYES $16,158 |
| FORM 990, PART VII, LINE 5 | COMPENSATION FROM UNRELATED ORGANIZATIONS LISTED IN PART VII AND SCHEDULE J, PART II -DANNY SQUIRE'S COMPENSATION WAS PROVIDED BY LEXINGTON MEDICAL CENTER, AN UNRELATED TAX-EXEMPT ORGANIZATION. -BRETT NICKS M.D.'S COMPENSATION WAS PROVIDED BY WAKE FOREST UNIVERSITY HEALTH SCIENCES, AN UNRELATED TAX-EXEMPT ORGANIZATION. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | AS ESTABLISHED IN THE ORGANIZATIONS BYLAWS, THE BOARD OF TRUSTEES MAY ESTABLISH AN EXECUTIVE COMMITTEE CONSISTING OF THREE OR MORE TRUSTEES, THE MAJORITY OF WHOM SHALL BE NORTH CAROLINA BAPTIST HOSPITAL (NCBH) TRUSTEES AND THE REMAINDER SHALL BE DAVIE HOSPITAL 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 NORTH CAROLINA BAPTIST HOSPITAL, 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 | 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, AS PROVIDED IN THE ORGANIZATION'S BYLAWS. THE SOLE MEMBER MAY ACT WITHOUT A MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES COPIES OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. THE AUDIT AND COMPLIANCE COMMITTEES OF THE GOVERNING BOARDS OF WFUHS AND NCBH REVIEW IN ADDITIONAL DETAIL THE FILING ORGANIZATION'S FORM 990 WITH THE ORGANIZATION'S CHIEF FINANCIAL OFFICER OR HIS DESIGNEE, WHO ANSWERS QUESTIONS AND ADDRESSES CONCERNS RAISED BY SUCH COMMITTEE MEMBERS OR OTHER FILING ORGANIZATION DIRECTORS. 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 | THE ORGANIZATION REQUIRES ITS OFFICERS, DIRECTORS AND ANY KEY EMPLOYEES TO REVIEW THE CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL CONFLICTS OF INTERESTS 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, DIRECTORS OR KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS AND DIRECTORS AND FORMER OFFICERS AND DIRECTORS WAS PAID BY RELATED ORGANIZATIONS. COMPENSATION PAID TO THESE INDIVIDUALS ARE REVIEWED AND APPROVED IN ACCORDANCE WITH THE RELATED ORGANIZATION'S COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICERS AND DIRECTORS' COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH CAROLINA BAPTIST HOSPITAL | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 560552787 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | N/A | 0 | |
| NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 561685120 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| THE REHABILITATION & SKILLED NURSING FACILITY AT OAK SUMMIT | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 561826396 | HEALTHCARE (INACTIVE) | NC | 501(C)(3) | LINE 9 | 0 | NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION | |
| THE HAWTHORNE INN & CONFERENCE CENTER INC | |||||||||||
| 420 HIGH STREET | WINSTON SALEM | NC | 27101 | 561793617 | LODGING/ CONFERENCE ACCOMMODATION | NC | 501(C)(3) | LINE 11A, I | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| CARENET INC | |||||||||||
| 2000 WEST FIRST STREET SUITE 410 | WINSTON SALEM | NC | 27104 | 561977341 | HEALTHCARE | NC | 501(C)(3) | LINE 11B, II | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| FAITHHEALTH INNOVATIONS INC | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 237426944 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| DAVIE COUNTY HOSPITAL FOUNDATION | |||||||||||
| 156 ROLAND RD | MOCKSVILLE | NC | 27028 | 581477280 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11C, III-FI | N/A | 0 | |
| 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 | 0 | 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 | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |