WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN (EIN 90-0222618)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201401349349300815
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-05-14T07:36:58-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 900222618 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST UNIVERSITY HEALTH SCIENCES | BusinessNameLine1 |
| Business Name Line2 | GROUP RETURN | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WAKE | NameControl |
| Phone | 3367164445 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | MEDICAL CENTER BLVD | AddressLine1 |
| City | WINSTONSALEM | City |
| State | NC | State |
| ZIP Code | 27157 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN D MCCONNELL MD | Name |
| Title | PRESIDENT | Title |
| Phone | 3367164445 | Phone |
| Date Signed | 2014-05-09 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN D MCCONNELL MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | MEDICAL CENTER BLVD | AddressLine1 |
| City | WINSTONSALEM | City |
| State | NC | State |
| ZIP Code | 27157 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 72928533 | GrossReceipts |
| Group Return For Affiliates | 1 | GroupReturnForAffiliates |
| All Affiliates Included | 1 | AllAffiliatesIncluded |
| Group Exemption Number | 3884 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2003 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 3 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 69274142 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 72928533 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 64 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 69274206 | TotalRevenuePriorYear |
| Total Revenue Current Year | 72928533 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 351683 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 56287122 | OtherExpensePriorYear |
| Other Expenses Current Year | 56219445 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 56287122 | TotalExpensesPriorYear |
| Total Expenses Current Year | 56571128 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 12987084 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 16357405 | RevenuesLessExpensesCY |
| Total Assets BOY | 115752105 | TotalAssetsBOY |
| Total Assets EOY | 131042363 | TotalAssetsEOY |
| Total Liabilities BOY | 6772458 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5705311 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 108979647 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 125337052 | NetAssetsOrFundBalancesEOY |
| Mission Description | OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY AND AS A SUPPORTING ORGANIZATION EXCLUSIVELY FOR THE BENEFIT OF WAKE FOREST UNIVERSITY AND WAKE FOREST UNIVERSITY HEALTH SCIENCES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 49720032 | Expense |
| Grants | 351683 | Grants |
| Revenue | 72928533 | Revenue |
| Description | HEMODIALYSIS: THE CLINICS SERVE THE TEACHING AND RESEARCH PROGRAMS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES AND WAKE FOREST UNIVERSITY BY PROVIDING DIALYSIS TREATMENTS TO END STAGE RENAL DISEASE PATIENTS (1,319 INPATIENT AND 274 HOME DIALYSIS PATIENTS). | Description |
| Total Program Service Expense | 49720032 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 106 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 3 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTH SYSTEMS MANAGEMENT INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2293865505 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 7710 | AddressLine1 |
| City | TIFTON | City |
| State | GA | State |
| ZIP Code | 317937710 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| JOHN D MCCONNELL MD | ||||||||
| CHAIRMAN & PRESIDENT | 0.50 | 39.50 | X | X | 0 | 1370748 | 690944 | |
| BARRY I FREEDMAN MD | ||||||||
| DIRECTOR | 1.00 | 39.00 | X | 0 | 546734 | 42230 | ||
| TERRY L HALES JR | ||||||||
| DIRECTOR & ASST TREAS | 2.00 | 38.00 | X | X | 0 | 457618 | 105211 | |
| J REID MORGAN | ||||||||
| SECRETARY | 0.50 | 39.50 | X | 0 | 477612 | 120218 | ||
| WILLIAM B APPLEGATE MD | ||||||||
| FORMER DIRECTOR AND OFFICER | 0.00 | 40.00 | 0 | 853907 | 38889 | X | ||
| DOUGLAS L EDGETON | ||||||||
| FORMER DIRECTOR AND OFFICER | 0.00 | 40.00 | 0 | 606902 | 19712 | X | ||
| DONNA HAMILTON | ||||||||
| FORMER OFFICER | 0.00 | 40.00 | 0 | 167167 | 30527 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4480688 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1047731 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HSM DIALYSIS CENTERS LLC | |||||
| PO BOX 7710 | TIFTON | GA | 31793 | MANAGEMENT COMPANY | 6772486 |
| NEPHROLOGY ASSOCIATES | |||||
| 730 HIGHLAND OAKS DRIVE | WINSTONSALEM | NC | 27103 | MEDICAL DIRECTOR | 295000 |
| IREDELL NEPHROLOGY CENTER | |||||
| 2043 SIMONTON RD SUITE B | STATESVILLE | NC | 28625 | MEDICAL DIRECTOR | 109999 |
| METROLINA NEPHROLOGY ASSOC | |||||
| 1300 BAXTER ST SUITE 215 | CHARLOTTE | NC | 28204 | MEDICAL DIRECTOR | 106667 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICAL SERVICES | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 72928533 | TotalRevenueColumn |
| Related Or Exempt Function Income | 72928533 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 72928533 | TotalProgramServiceRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 72928533 | TotalRevenueColumn |
| Related Or Exempt Function Income | 72928533 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 351683 | Total |
| Program Services | 351683 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6752157 | Total |
| Management And General | 6752157 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52041 | Total |
| Management And General | 52041 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22011237 | Total |
| Program Services | 21964339 | ProgramServices |
| Management And General | 46898 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1034851 | Total |
| Program Services | 1034851 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 126033 | Total |
| Program Services | 126033 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2168304 | Total |
| Program Services | 2168304 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 247838 | Total |
| Program Services | 247838 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18586 | Total |
| Program Services | 18586 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127640 | Total |
| Program Services | 127640 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MEDICAL SUPPLIES | 17226288 | 17226288 |
| BAD DEBT | 5293075 | 5293075 |
| LABORATORY | 1161395 | 1161395 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56571128 | Total |
| Program Services | 49720032 | ProgramServices |
| Management And General | 6851096 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3899925 | BOY |
| EOY | 3879607 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10877172 | BOY |
| EOY | 9796836 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1405006 | BOY |
| EOY | 1465367 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15935 | BOY |
| EOY | 21486 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 99554067 | BOY |
| EOY | 115879067 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115752105 | BOY |
| EOY | 131042363 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6247458 | BOY |
| EOY | 5255311 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 525000 | BOY |
| EOY | 450000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6772458 | BOY |
| EOY | 5705311 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108979647 | BOY |
| EOY | 125337052 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108979647 | BOY |
| EOY | 125337052 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115752105 | BOY |
| EOY | 131042363 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 16357405 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|
| WAKE FOREST UNIVERSITY | ||||
| 560532138 | 2 | 1 | 1 | $0 |
| WAKE FOREST UNIVERSITY HEALTH SCIENCES | ||||
| 223849199 | 2 | 1 | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | WFUHS CAPITAL CONTRIBUTION | Description |
| Book Value | 115879067 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 115879067 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO WFU | Description |
| Amount | $450,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 450000 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 67635458 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 67635458 | RevenueSubtotal |
| Other Revenues Not Included | 5293075 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 5293075 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 72928533 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 51278053 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 51278053 | ExpensesSubtotal |
| Other Expenses Not Included | 5293075 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 5293075 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 56571128 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED. THE ORGANIZATION WAS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S STATEMENT OF OPERATIONS FOR THE YEARS ENDED JUNE 30, 2012 AND 2013. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RECLASS BAD DEBT 5,293,075. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RECLASS BAD DEBT 5,293,075. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| UNITED WAY OF FORSYTH COUNTY | |||||||
| 301 N MAIN STREET | WINSTON SALEM | NC | 27101 | 237357234 | 3 | 20000 | COMMUNITY SUPPORT |
| AMERICAN KIDNEY FUND | |||||||
| 11921 ROCKVILLE PIKE | ROCKVILLE | MD | 20852 | 237124261 | 3 | 331683 | FINANCIAL ASSISTANCE PROGRAM FOR QUALIFIED KIDNEY PATIENTS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE ORGANIZATION FOLLOWS THE MEDICAL CENTER'S CORPORATE POLICY USED IN REVIEWING ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF AMOUNTS DISBURSED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN D MCCONNELL MD | ||||||||||||||
| CHAIRMAN & PRESIDENT | 0 | 998061 | 0 | 334267 | 0 | 38420 | 0 | 670368 | 0 | 20576 | 0 | 2061692 | 0 | 0 |
| BARRY I FREEDMAN MD | ||||||||||||||
| DIRECTOR | 0 | 172504 | 0 | 372298 | 0 | 1932 | 0 | 21697 | 0 | 20533 | 0 | 588964 | 0 | 0 |
| TERRY L HALES JR | ||||||||||||||
| DIRECTOR & ASST TREAS | 0 | 366359 | 0 | 82919 | 0 | 8340 | 0 | 84618 | 0 | 20593 | 0 | 562829 | 0 | 0 |
| J REID MORGAN | ||||||||||||||
| SECRETARY | 0 | 414012 | 0 | 50000 | 0 | 13600 | 0 | 25000 | 0 | 95218 | 0 | 597830 | 0 | 0 |
| WILLIAM B APPLEGATE MD | ||||||||||||||
| FORMER DIRECTOR AND OFFICER | 0 | 548678 | 0 | 285943 | 0 | 19286 | 0 | 21697 | 0 | 17192 | 0 | 892796 | 0 | 0 |
| DOUGLAS L EDGETON | ||||||||||||||
| FORMER DIRECTOR AND OFFICER | 0 | 78648 | 0 | 91875 | 0 | 436379 | 0 | 5927 | 0 | 13785 | 0 | 626614 | 0 | 0 |
| DONNA HAMILTON | ||||||||||||||
| FORMER OFFICER | 0 | 166721 | 0 | 0 | 0 | 446 | 0 | 17254 | 0 | 13273 | 0 | 197694 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINES 4A-B | ReturnReference |
| Explanation | CERTAIN EXECUTIVES OF THE FILING ORGANIZATION DURING THE TAX PERIOD PARTICIPATED IN OR RECEIVED SEVERANCE PAYMENTS OR PAYMENTS FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS (ALL OF WHICH WAS PAID BY RELATED ORGANIZATIONS, WAKE FOREST UNIVERSITY HEALTH SCIENCES OR WAKE FOREST UNIVERSITY, AS PART OF THE INDIVIDUAL'S COMPENSATION FROM RELATED ORGANIZATIONS). THE FOLLOWING FORMER OFFICER AND DIRECTOR RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES: DOUGLAS L EDGETON $423,536 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | WAKE FOREST UNIVERSITY HEALTH SCIENCES IS THE PARENT ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION ARE APPOINTED BY THE GOVERNING BODY OF WAKE FOREST UNIVERSITY HEALTH SCIENCES OR BY A MEMBER OF THE GOVERNING BODY OR BY AN OFFICER OF WAKE FOREST UNIVERSITY HEALTH SCIENCES ACTING IN HIS OFFICIAL CAPACITY, IN ACCORDANCE WITH PROCEDURES PRESCRIBED BY THE BOARD OF DIRECTORS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES. | |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS OF THE ORGANIZATION'S GOVERNING BODY WHICH REQUIRE APPROVAL BY THE PARENT ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES, INCLUDE AMENDMENTS TO THE ORGANIZATION'S GOVERNANCE DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS), AND THE ELECTION AND REMOVAL OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW, THE REVISED FORM 990 IS REDISTRIBUTED PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A SUMMARY OF THE MODIFICATIONS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES ITS OFFICERS AND DIRECTORS TO DISCLOSE CONFLICTS OF INTEREST ANNUALLY, AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATION'S POLICY ON CONFLICTS OF INTEREST. | |
| THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS OR DIRECTORS; AS THE ORGANIZATION HAS NO EMPLOYEES, IT DOES NOT PAY ANY COMPENSATION TO ANY KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS AND DIRECTORS AND FORMER OFFICERS OR DIRECTORS WAS PAID BY RELATED ORGANIZATIONS. THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER BOARD IS (THROUGH AUTHORITY DELEGATED TO IT BY WAKE FOREST UNIVERSITY HEALTH SCIENCES - THE PARENT OF THE FILING ORGANIZATION) RESPONSIBLE FOR REVIEWING AND APPROVING MOST OFFICERS' COMPENSATION. THE COMMITTEE UTILIZES INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH SUCH OFFICERS'COMPENSATION. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES, AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. PART VII, SECTION A, COLUMN B, AVERAGE HOURS PER WEEK JOHN D MCCONNELL MD FILING ORG .5 RELATED ORG 18.9 UNRELATED ORG 20.6 BARRY I FREEDMAN FILING ORG 1.0 RELATED ORG 39.0 TERRY L HALES JR FILING ORG 2.0 RELATED ORG 16.5 UNRELATED ORG 21.5 J REID MORGAN FILING ORG .5 RELATED ORG 39.5 NORTH CAROLINA BAPTIST HOSPITAL IS AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION. PURSUANT TO THE TERMS OF A MEDICAL CENTER INTEGRATION AGREEMENT ENTERED INTO AMONG WAKE FOREST UNIVERSITY, WAKE FOREST UNIVERSITY HEALTH SCIENCES (BOTH RELATED ORGANIZATIONS OF THE FILING ORGANIZATION), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER AND NORTH CAROLINA BAPTIST HOSPITAL (AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION),CORPORATE OFFICERS OF THE MEDICAL CENTER ALSO SERVE AS THE CORPORATE OFFICERS OF NORTH CAROLINA BAPTIST HOSPITAL AND WAKE FOREST UNIVERSITY HEALTH SCIENCES. SEVERAL OF SUCH OFFICERS' HOURS ARE SHOWN HERE AS HOURS DEVOTED TO SUCH OTHER ORGANIZATIONS. | |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES & MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 21,964,339. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,964,339. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 46,898. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,898. | OTHER FEES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WFUBMC COMMUNITY PHYSICIANS | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 561903275 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | WAKE FOREST UNIVERSITY HEALTH SCIENCES | 0 | |
| WAKE FOREST UNIVERSITY HEALTH SCIENCES | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 223849199 | EDUCATION, RESEARCH, HEALTHCARE | NC | 501(C)(3) | LINE 2 | WAKE FOREST UNIVERSITY | 0 | |
| WAKE FOREST UNIVERSITY | |||||||||||
| BOX 7201 | WINSTON SALEM | NC | 27109 | 560532138 | EDUCATION | NC | 501(C)(3) | LINE 2 | 0 | N/A | |
| WAKE FOREST INNOVATION QUARTER MANGEMENT CO | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 061818498 | RESEARCH PARK DEVELOPMENT | NC | 501(C)(3) | LINE 11A, I | WAKE FOREST UNIVERSITY HEALTH SCIENCES | 0 | |
| WAKE FOREST INNOVATION QUARTER CDC | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 200177581 | RESEARCH PARK DEVELOPMENT | NC | 501(C)(3) | LINE 11A, I | WAKE FOREST UNIVERSITY HEALTH SCIENCES | 0 | |
| IDEALLIANCE FOUNDATION | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 562094060 | BUSINESS DEVELOPMENT ACTIVITIES | NC | 501(C)(3) | LINE 11A, I | WAKE FOREST UNIVERSITY HEALTH SCIENCES | 0 | |
| WAKE FOREST INNOVATION QUARTER DEVELOPMENT CO | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 562094067 | RESEARCH PARK DEVELOPMENT | NC | 501(C)(6) | WAKE FOREST UNIVERSITY HEALTH SCIENCES | 0 | ||
| DIALYSIS ACCESS GROUP OF WFU LLC | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 204241942 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | WAKE FOREST UNIVERSITY HEALTH SCIENCES | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |