2015-05-14T14:00:32-05:00 2014-06-30 990 2013-07-01 020774853 NORTHWEST COMMUNITY CARE NETWORK INC NORT 3367162698 2000 WEST 1ST STREET NO 704 WINSTON SALEM NC 27104 JIM GRAHAM EXECUTIVE DIRECTOR 3367162698 2015-05-13 2013 2016-03-07 17:11:31Z JIM GRAHAM 2000 WEST 1ST STREET NO 704 WINSTON SALEM NC 27104 12927096 0 X WWW.NWCOMMUNITYCARE.ORG X 2006 NC DEVELOPING, IMPLEMENTING AND EVALUATING ENHANCED MANAGED CARE STRATEGIES FOR MEDICAID RECIPIENTS. 14 14 0 10 0 0 644702 1923959 11647851 10993684 3187 1553 0 7900 12295740 12927096 624954 751234 0 0 0 0 0 0 0 11331599 12999553 11956553 13750787 339187 -823691 5440200 5092185 603573 1079249 4836627 4012936 X NORTHWEST 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. 0 0 10054555 751234 11001584 DURING 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. 10054555 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 35 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 0 0 0 0 X STEPHANIE HALL 3367162344 2000 WEST 1ST STREET SUITE 704 WINSTON SALEM NC 27104 SUZANNE WRIGHT BOARD MEMBER 2.00 X 0 0 0 SAMANTHA ANGE SECRETARY 2.00 X X 0 0 0 ANN ABSHER BOARD MEMBER 2.00 X X 0 0 0 EDDIE WOOTEN BOARD MEMBER 2.00 X 1890 0 0 MARLON HUNTER TREASURER 2.00 X X 0 0 0 SCOTT LENHART BOARD MEMBER 2.00 X 0 0 0 MONECIA RENA THOMAS BOARD MEMBER 2.00 X 0 0 0 DAVID SWANN BOARD MEMBER 2.00 X 0 0 0 SCOTT L VOGLER MD BOARD MEMBER 2.00 X 0 0 0 SU ALBERT MD BOARD MEMBER 2.00 X 8950 0 0 BILL SEBASTIAN BOARD MEMBER 2.00 X 0 0 0 TOM SIBERT MD CHAIRMAN 2.00 6.50 X 0 0 0 DICK STEVENSON BOARD MEMBER 2.00 X 0 0 0 RICHARD LORD BOARD MEMBER 2.00 X 0 0 0 JIM GRAHAM EXECUTIVE DIRECTOR 40.00 0.00 X 109329 0 11678 120169 0 11678 0 0 0 1 JENNIE BYRNE COGNITIVE CARE PSYCHIATRY 1200 ENVIRON WAY STE 1200 CHAPEL HILL NC 27517 PSYCHIATRY SERVICES 110129 1 1007560 916399 1923959 CASE MANAGEMENT FEES 624100 10993684 10993684 10993684 1553 1553 OTHER INCOME 621400 7900 7900 7900 12927096 11001584 0 1553 751234 751234 17251 17251 1202540 1094372 108168 156058 119823 36235 6503 6503 228006 26309 201697 149528 149528 76380 76380 80690 80690 17518 17518 NCCN OPERATIONAL COSTS 5227732 1877600 3350132 SERVICE REIMBURSEMENTS 4282378 4282378 PROJECT RESERVES 1497600 1497600 MEDICAL SUPPLIES 57369 57369 13750787 10054555 3696232 0 1973516 576787 3105397 3497497 4500 171272 60129 939602 153102 356787 786500 5440200 5092185 603573 1079249 603573 1079249 X 4730261 3934317 106366 78619 4836627 4012936 5440200 5092185 -823691 0 X 0 1 X 1 0 X 1036150 749864 646025 644702 1923959 5000700 1036150 749864 646025 644702 1923959 5000700 5000700 62006 19437 4076 3187 1553 90259 7900 7900 5098859 42217368 0.98070 0.96630 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2013 AMOUNT: $ 7,900. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 624758 68934 555824 314844 84168 230676 786500 X 12923730 0 12923730 3366 3366 12927096 13747421 0 13747421 3366 3366 13750787 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. 1 COMMUNITY CARE CENTER FOR FORSYTH COUNTY 2135 NEW WALKERTOWN RD WINSTON SALEM NC 27101 581403699 501(C)(3) 96725 HEALTH NET GRANT WILKES COUNTY HEALTH DEPARTMENT 306 COLLEGE STREET WILKESBORO NC 28697 566000350 GOV'T ENTITY 82753 HEALTH NET GRANT SURRY COUNTY HEALTH AND NUTRITION 118 HAMBY ROAD DOBSON NC 27017 566000341 GOV'T ENTITY 48900 HEALTH NET GRANT STOKES FAMILY HEALTH PO BOX 187 DANBURY NC 27016 566000340 GOV'T ENTITY 40302 HEALTH NET GRANT IMPRINTS FOR FAMILIES INC 502 N BROAD STREET WINSTON SALEM NC 27101 560949178 501(C)(3) 50000 CHILD DEVELOPMENT SPECIALIST PROGRAM HUGH CHATHAM MEMORIAL HOSPITAL 180 PARKWOOD DRIVE ELKIN NC 28621 560642846 501(C)(3) 9000 PATIENT CENTERED HOME PROGRAM CERTIFICATION WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD WINSTON SALEM NC 27157 510190238 501(C)(3) 104050 PATIENT CNTR HOME PGM CERT, PRENATAL & DIABETES CARE PGM SOUTHSIDE UNITED HEALTH CENTER 3009 WAUGHTOWN STREET WINSTON SALEM NC 27117 050589120 501(C)(3) 6504 TECHNOLOGY HEALTH EDUCATION PROJECT FOR ASTHMA AND DIABETES PATIENTS DAVIE COUNTY HEALTH DEPARTMENT 210 HOSPITAL STREET MOCKSVILLE NC 27028 566000295 GOV'T ENTITY 20000 CHRONIC PAIN INITIATIVE HOSPICE OF SURRY COUNTY (MTN VALLEY HOSPICE) 401 TECHNOLOGY LANE MT AIRY NC 27030 561346589 501(C)(3) 50000 PALLIATIVE CARE PROJECT DAVIDSON COUNTY HEALTH DEPARTMENT 915 GREENSBORO STREET LEXINGTON NC 27293 566000294 GOV'T ENTITY 20000 CHRONIC PAIN INITIATIVE SCHOOL HEALTH ALLIANCE FORSYTH CNTY 2135 NEW WALKERTOWN RD WINSTON SALEM NC 27101 912020462 501(C)(3) 193000 PSYCHIATRY SERVICES, BEHAVIORAL HEALTH PROVIDER & HEALTH EXAMS FOR FORSYTH CNTY STUDENTS PROJECT LAZARUS INC PO BOX 261 MORAVIAN FALLS NC 28654 562087110 501(C)(3) 30000 PRESCRIPTION OVERDOSE & CHRONIC PAIN PROGRAMS 13 PART I, LINE 2: THE ORGANIZATION DISTRIBUTES GRANT MONEY THAT HAS BEEN PRE-APPROVED TO DESIGNATED COUNTIES. ANY QUESTIONS ARE DIRECTED TO THE OFFICE OF RURAL HEALTH. 0 0 0 0 0 0 0 0 0 COMPENSATION FROM AN UNRELATED ORGANIZATION: JIM 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. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A ITS 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 11 THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW, THE REVISED FORM 990 IS REDISTRIBUTED PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A SUMMARY OF THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES 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 15 THE 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 19 THE 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. WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD WINSTON SALEM NC 27157 510190238 HEALTHCARE NC 501(C)(3) LINE 11A, I 0 LEXINGTON MEDICAL CENTER 250 HOSPITAL DRIVE LEXINGTON NC 27292 560543238 HEALTHCARE NC 501(C)(3) LINE 3 0 LEXINGTON MEDICAL CENTER FOUNDATION 250 HOSPITAL DRIVE LEXINGTON NC 27292 581876553 FUNDRAISING NC 501(C)(3) LINE 11B, II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0