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NORTHWEST COMMUNITY CARE NETWORK INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
NORTHWEST COMMUNITY CARE NETWORK INC (EIN 02-0774853)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-05-14
IRS object ID
201521349349305327
Schema version
2013v4.0
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

FieldValueIRS element (for citing)
Return2015-05-14T14:00:32-05:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN020774853EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NORTHWEST COMMUNITY CARE NETWORK INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlNORTBusinessNameControlTxt
Phone3367162698PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 WEST 1ST STREET NO 704AddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27104ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJIM GRAHAMPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone3367162698PhoneNum
Signature2015-05-13SignatureDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJIM GRAHAMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 WEST 1ST STREET NO 704AddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27104ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$12,927,096GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.NWCOMMUNITYCARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2006FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionDEVELOPING, IMPLEMENTING AND EVALUATING ENHANCED MANAGED CARE STRATEGIES FOR MEDICAID RECIPIENTS.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$644,702PYContributionsGrantsAmt
CY Contributions Grants$1,923,959CYContributionsGrantsAmt
PY Program Service Revenue$11,647,851PYProgramServiceRevenueAmt
CY Program Service Revenue$10,993,684CYProgramServiceRevenueAmt
PY Investment Income$3,187PYInvestmentIncomeAmt
CY Investment Income$1,553CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$7,900CYOtherRevenueAmt
PY Total Revenue$12,295,740PYTotalRevenueAmt
CY Total Revenue$12,927,096CYTotalRevenueAmt
PY Grants And Similar Paid$624,954PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$751,234CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$11,331,599PYOtherExpensesAmt
CY Other Expenses$12,999,553CYOtherExpensesAmt
PY Total Expenses$11,956,553PYTotalExpensesAmt
CY Total Expenses$13,750,787CYTotalExpensesAmt
PY Revenues Less Expenses$339,187PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$823,691CYRevenuesLessExpensesAmt
Total Assets BOY$5,440,200TotalAssetsBOYAmt
Total Assets EOY$5,092,185TotalAssetsEOYAmt
Total Liabilities BOY$603,573TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,079,249TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,836,627NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,012,936NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionNORTHWEST COMMUNITY CARE NETWORK OPERATES A PRIMARY CARE CASE MANAGEMENT PROGRAM (PPCM) THAT IS DESIGNED TO PROVIDE A MORE EFFICIENT AND EFFECTIVE HEALTHCARE DELIVERY SYSTEM FOR MEDICAID RECIPIENTS. IT BRINGS TOGETHER PRIMARY CARE PROVIDERS, HOSPITALS, HEALTH DEPARTMENTS, DEPARTMENT OF SOCIAL SERVICES AND OTHER COMMUNITY PROVIDERS TO MANAGE THE HEALTH CARE NEEDS OF MEDICAID RECIPIENTS. ITS SERVICE AREA INCLUDES THE COUNTIES OF DAVIE, DAVIDSON, FORSYTH, STOKES, SURRY, WILKES AND YADKIN. THESE COUNTIES COMPRISE THE NETWORK MEMBERS. ITS CARE MANAGERS ASSIST IN DEVELOPING, IMPLEMENTING AND EVALUATING ENHANCED MANAGED CARE STRATEGIES FOR MEDICAID RECIPIENTS. IT RECEIVES A MONTHLY FEE TO PERFORM THE SERVICE FROM THE STATE OF NORTH CAROLINA'S MEDICAID PROGRAM FOR EACH MEDICAID RECIPIENT ENROLLED.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$10,054,555ExpenseAmt
Grant$751,234GrantAmt
Revenue$11,001,584RevenueAmt
DescDURING OUR CURRENT FISCAL YEAR, WE CONTINUE TO COORDINATE, FACILITATE AND MANAGE THE DELIVERY OF MEDICAID SERVICES TO 127,000 CLIENTS IN THE NORTHWEST PIEDMONT AREA OF NORTH CAROLINA. WE HAVE BEEN SUCCESSFUL IN IMPROVING THE QUALITY OF MATERNITY CARE AND RELATED OUTCOMES FOR MOTHERS AND BABIES,AND REDUCING MEDICAL CARE COST FOR 5,400 CLIENTS. IN ADDITION, WE FOCUSE ON INDIGENT CARE THROUGH MEDICAID SERVICES IN THE NORTHWEST PIEDMONT AREA OF NORTH CAROLINA FOR 23,200 MEDICAID CLIENTS. OUR ANCHOR PROGRAM IS REDUCING MEDICARE READMISSIONS TO THE LOCAL HOSPITALS AND ITS BENEFITS CONTINUE TO GROW THROUGHOUT OUR AREA.Desc
Total Program Service Expenses$10,054,555TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document35IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STEPHANIE HALLBusinessNameLine1
FieldValueIRS element (for citing)
Phone3367162344PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 WEST 1ST STREET SUITE 704AddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27104ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
SUZANNE WRIGHT
BOARD MEMBER2.00Yes (X)$0$0$0
SAMANTHA ANGE
SECRETARY2.00Yes (X)$0$0$0Yes (X)
ANN ABSHER
BOARD MEMBER2.00Yes (X)$0$0$0Yes (X)
EDDIE WOOTEN
BOARD MEMBER2.00Yes (X)$1,890$0$0
MARLON HUNTER
TREASURER2.00Yes (X)$0$0$0Yes (X)
SCOTT LENHART
BOARD MEMBER2.00Yes (X)$0$0$0
MONECIA RENA THOMAS
BOARD MEMBER2.00Yes (X)$0$0$0
DAVID SWANN
BOARD MEMBER2.00Yes (X)$0$0$0
SCOTT L VOGLER MD
BOARD MEMBER2.00Yes (X)$0$0$0
SU ALBERT MD
BOARD MEMBER2.00Yes (X)$8,950$0$0
BILL SEBASTIAN
BOARD MEMBER2.00Yes (X)$0$0$0
TOM SIBERT MD
CHAIRMAN2.00Yes (X)$0$0$06.50
DICK STEVENSON
BOARD MEMBER2.00Yes (X)$0$0$0
RICHARD LORD
BOARD MEMBER2.00Yes (X)$0$0$0
JIM GRAHAM
EXECUTIVE DIRECTOR40.00$109,329$0$11,678Yes (X)0.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org$120,169TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$11,678TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JENNIE BYRNE COGNITIVE CARE PSYCHIATRYBusinessNameLine1

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line11200 ENVIRON WAY STE 1200AddressLine1
CityCHAPEL HILLCity
StateNCState
ZIP Code27517ZIPCode
FieldValueIRS element (for citing)
ServicesPSYCHIATRY SERVICESServicesDesc
Compensation$110,129CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$1,007,560GovernmentGrantsAmt
All Other Contributions$916,399AllOtherContributionsAmt
Total Contributions$1,923,959TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescCASE MANAGEMENT FEESDesc
Business624100BusinessCd
Total Revenue Column$10,993,684TotalRevenueColumnAmt
Related Or Exempt Func Income$10,993,684RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$10,993,684TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,553TotalRevenueColumnAmt
Exclusion$1,553ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business621400BusinessCd
Total Revenue Column$7,900TotalRevenueColumnAmt
Related Or Exempt Func Income$7,900RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$7,900OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,927,096TotalRevenueColumnAmt
Related Or Exempt Func Income$11,001,584RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,553ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$751,234TotalAmt
Program Services$751,234ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$17,251TotalAmt
Program Services$17,251ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,202,540TotalAmt
Program Services$1,094,372ProgramServicesAmt
Management And General$108,168ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$156,058TotalAmt
Program Services$119,823ProgramServicesAmt
Management And General$36,235ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$6,503TotalAmt
Program Services$6,503ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$228,006TotalAmt
Program Services$26,309ProgramServicesAmt
Management And General$201,697ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$149,528TotalAmt
Program Services$149,528ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$76,380TotalAmt
Program Services$76,380ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$80,690TotalAmt
Program Services$80,690ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$17,518TotalAmt
Program Services$17,518ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
NCCN OPERATIONAL COSTS$5,227,732$1,877,600$3,350,132
SERVICE REIMBURSEMENTS$4,282,378$4,282,378
PROJECT RESERVES$1,497,600$1,497,600
MEDICAL SUPPLIES$57,369$57,369

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$13,750,787TotalAmt
Program Services$10,054,555ProgramServicesAmt
Management And General$3,696,232ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,973,516BOYAmt
EOY$576,787EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,105,397BOYAmt
EOY$3,497,497EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,500BOYAmt
EOY$171,272EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$60,129EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$939,602LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$153,102LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$356,787BOYAmt
EOY$786,500EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$5,440,200BOYAmt
EOY$5,092,185EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$603,573BOYAmt
EOY$1,079,249EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$603,573BOYAmt
EOY$1,079,249EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,730,261BOYAmt
EOY$3,934,317EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$106,366BOYAmt
EOY$78,619EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,836,627BOYAmt
EOY$4,012,936EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,440,200BOYAmt
EOY$5,092,185EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$823,691ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,036,150CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$749,864CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$646,025CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$644,702CurrentTaxYearMinus1YearAmt
Current Tax Year$1,923,959CurrentTaxYearAmt
Total$5,000,700TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,036,150CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$749,864CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$646,025CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$644,702CurrentTaxYearMinus1YearAmt
Current Tax Year$1,923,959CurrentTaxYearAmt
Total$5,000,700TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$5,000,700PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$62,006CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$19,437CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,076CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,187CurrentTaxYearMinus1YearAmt
Current Tax Year$1,553CurrentTaxYearAmt
Total$90,259TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year$7,900CurrentTaxYearAmt
Total$7,900TotalAmt
FieldValueIRS element (for citing)
Total Support$5,098,859TotalSupportAmt
Gross Receipts Rltd Activities$42,217,368GrossReceiptsRltdActivitiesAmt
Public Support CY1700.98070PublicSupportCY170Pct
Public Support PY1700.96630PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Schedule A Part IV Form990ScheduleAPartIVGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationOTHER INCOME - 2013 AMOUNT: $ 7,900.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$624,758OtherCostOrOtherBasisAmt
Depreciation$68,934DepreciationAmt
Book Value$555,824BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$314,844OtherCostOrOtherBasisAmt
Depreciation$84,168DepreciationAmt
Book Value$230,676BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$786,500TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$12,923,730TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$12,923,730RevenueSubtotalAmt
Other Revenues Not Included$3,366OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$3,366RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$12,927,096TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$13,747,421TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$13,747,421ExpensesSubtotalAmt
Other Expenses Not Included$3,366OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$3,366ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$13,750,787TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE COMPANY 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 COMPANY HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS FISCAL YEARS ENDED JUNE 30, 2014 AND 2013, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2014 AND 2013.
PART XI, LINE 4B - OTHER ADJUSTMENTS:TEMPORARILY RESTRICTED OTHER EXPENDITURES 3,366.
PART XII, LINE 4B - OTHER ADJUSTMENTS:TEMPORARILY RESTRICTED OTHER EXPENDITURES 3,366.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (13 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
COMMUNITY CARE CENTER FOR FORSYTH COUNTY
2135 NEW WALKERTOWN RDWINSTON SALEMNC27101581403699501(C)(3)$96,725HEALTH NET GRANT
WILKES COUNTY HEALTH DEPARTMENT
306 COLLEGE STREETWILKESBORONC28697566000350GOV'T ENTITY$82,753HEALTH NET GRANT
SURRY COUNTY HEALTH AND NUTRITION
118 HAMBY ROADDOBSONNC27017566000341GOV'T ENTITY$48,900HEALTH NET GRANT
STOKES FAMILY HEALTH
PO BOX 187DANBURYNC27016566000340GOV'T ENTITY$40,302HEALTH NET GRANT
IMPRINTS FOR FAMILIES INC
502 N BROAD STREETWINSTON SALEMNC27101560949178501(C)(3)$50,000CHILD DEVELOPMENT SPECIALIST PROGRAM
HUGH CHATHAM MEMORIAL HOSPITAL
180 PARKWOOD DRIVEELKINNC28621560642846501(C)(3)$9,000PATIENT CENTERED HOME PROGRAM CERTIFICATION
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
MEDICAL CENTER BLVDWINSTON SALEMNC27157510190238501(C)(3)$104,050PATIENT CNTR HOME PGM CERT, PRENATAL & DIABETES CARE PGM
SOUTHSIDE UNITED HEALTH CENTER
3009 WAUGHTOWN STREETWINSTON SALEMNC27117050589120501(C)(3)$6,504TECHNOLOGY HEALTH EDUCATION PROJECT FOR ASTHMA AND DIABETES PATIENTS
DAVIE COUNTY HEALTH DEPARTMENT
210 HOSPITAL STREETMOCKSVILLENC27028566000295GOV'T ENTITY$20,000CHRONIC PAIN INITIATIVE
HOSPICE OF SURRY COUNTY (MTN VALLEY HOSPICE)
401 TECHNOLOGY LANEMT AIRYNC27030561346589501(C)(3)$50,000PALLIATIVE CARE PROJECT
DAVIDSON COUNTY HEALTH DEPARTMENT
915 GREENSBORO STREETLEXINGTONNC27293566000294GOV'T ENTITY$20,000CHRONIC PAIN INITIATIVE
SCHOOL HEALTH ALLIANCE FORSYTH CNTY
2135 NEW WALKERTOWN RDWINSTON SALEMNC27101912020462501(C)(3)$193,000PSYCHIATRY SERVICES, BEHAVIORAL HEALTH PROVIDER & HEALTH EXAMS FOR FORSYTH CNTY STUDENTS
PROJECT LAZARUS INC
PO BOX 261MORAVIAN FALLSNC28654562087110501(C)(3)$30,000PRESCRIPTION OVERDOSE & CHRONIC PAIN PROGRAMS
FieldValueIRS element (for citing)
Total501c3 Org13Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION DISTRIBUTES GRANT MONEY THAT HAS BEEN PRE-APPROVED TO DESIGNATED COUNTIES. ANY QUESTIONS ARE DIRECTED TO THE OFFICE OF RURAL HEALTH.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceCOMPENSATION FROM AN UNRELATED ORGANIZATION:FormAndLineReferenceDesc
ExplanationJIM GRAHAM WAS COMPENSATED BY AN UNRELATED/AFFILIATED ORGANIZATION, NORTH CAROLINA BAPTIST HOSPITAL, FOR HIS SERVICES AS EXECUTIVE DIRECTOR OF THE ORGANIZATION. TOTAL COMPENSATION WAS $121,007.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE MEMBER, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7AITS SOLE MEMBER, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, SHALL APPOINT ONE DIRECTOR. THE BOARD OF DIRECTORS SHALL APPOINT ONE DIRECTOR WHO IS A RESIDENT OF, OR IS OTHERWISE ASSOCIATED WITH, EACH OF THE COUNTIES THAT THE ORGANIZATION SERVES.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE ORGANIZATION REQUIRES OFFICERS, DIRECTORS AND KEY EMPLOYEES TO ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND DETERMINE ANY POTENTIAL CONFLICTS OF INTEREST. ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO DETERMINE AND REPORT POTENTIAL CONFLICTS 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 15THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS OR KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS, DIRECTORS AND KEY EMPLOYEES WAS PAID BY AN AFFILIATED/UNRELATED ORGANIZATION. COMPENSATION PAID TO THESE INDIVIDUALS IS REVIEWED AND APPROVED IN ACCORDANCE WITH THE AFFILIATED/UNRELATED ORGANIZATION'S COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICERS', DIRECTORS' AND KEY EMPLOYEES' COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S RESTATED 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationInd
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
MEDICAL CENTER BLVDWINSTON SALEMNC27157510190238HEALTHCARENC501(C)(3)LINE 11A, I0
LEXINGTON MEDICAL CENTER
250 HOSPITAL DRIVELEXINGTONNC27292560543238HEALTHCARENC501(C)(3)LINE 30
LEXINGTON MEDICAL CENTER FOUNDATION
250 HOSPITAL DRIVELEXINGTONNC27292581876553FUNDRAISINGNC501(C)(3)LINE 11B, II0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd