DAVIE MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- DAVIE MEDICAL CENTER (EIN 56-2276994)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201411349349300816
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
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 | 562276994 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIE COUNTY EMERGENCY HEALTH CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DAVI | NameControl |
| Phone | 3369981300 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANNY SQUIRES | Name |
| Title | CFO | Title |
| Phone | 3369981300 | 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
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | THOMAS E SIBERT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 11787582 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2001 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | PROVISION OF PATIENT-CENTERED HEALTHCARE SERVICES TO THE SURROUNDING AREA | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 185 | TotalNbrEmployees |
| Total Nbr Volunteers | 1 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 28165 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 29150 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 12065324 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 11723928 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 78072 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1302 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 30821 | OtherRevenuePriorYear |
| Other Revenue Current Year | 16471 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12202382 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11770851 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 500 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 100 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4964800 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4262235 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 23810 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8988115 | OtherExpensePriorYear |
| Other Expenses Current Year | 8099531 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13953415 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12361866 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1751033 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -591015 | RevenuesLessExpensesCY |
| Total Assets BOY | 2733773 | TotalAssetsBOY |
| Total Assets EOY | 3193663 | TotalAssetsEOY |
| Total Liabilities BOY | 4148507 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5199412 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -1414734 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -2005749 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11194367 | Expense |
| Grants | 100 | Grants |
| Revenue | 11727215 | Revenue |
| Description | 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 3,475 OUTPATIENT VISITS AND 6,345 EMERGENCY ROOM VISITS. IN ADDITION, THE HOSPITAL PERFORMED 121 CATARACT SURGERIES, 90 OTHER OUTPATIENT SURGERIES, AND 35 SLEEP STUDIES. | Description |
| Total Program Service Expense | 11194367 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 1 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | 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 | 1 | 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 | 30 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 185 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DANNY SQUIRES | NamePerson |
| Telephone Number | 3362384287 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| DAN BARRETT | ||||||||
| VICE CHAIR/TREAS | 2.00 | X | X | 0 | 0 | 0 | ||
| TERRY BRALLEY | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| KEN WHITE | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| DR RUSSELL HOWERTON | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| WILLIAM F JUNKER | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| RONALD SMALL | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 241797 | 6355 | 38.00 | ||
| STEVEN C SNELGROVE | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 379156 | 86678 | 38.00 | ||
| BETH DIRKS | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| DOUGLAS NELSON | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | 31.60 | ||
| HEATHER L HAYES | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 81432 | 13258 | 38.00 | ||
| LYNN PITMAN | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 205848 | 32271 | 38.00 | ||
| CHARLES TEGELER MD | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| STEPHEN ROBERTSON | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | 6.00 | ||
| DR THOMAS E SIBERT | ||||||||
| CHAIRMAN | 4.00 | X | X | 0 | 0 | 0 | 31.60 | |
| KEVIN WALSH | ||||||||
| CEO,ADMINISTRATOR | 40.00 | X | 0 | 126957 | 27054 | |||
| DANNY SQUIRES | ||||||||
| CFO | 15.00 | X | 187083 | 0 | 28813 | |||
| CLYDE BRISTOW | ||||||||
| CNO | 4.00 | X | 89757 | 0 | 0 | 0.00 | ||
| DONNY C LAMBETH | ||||||||
| FORMER OFFICER | 6.00 | 0 | 1137417 | 42640 | 34.00 | X | ||
| JOHNNY VEAL | ||||||||
| FORMER CNO | 4.00 | 0 | 196118 | 31362 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 276840 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2368725 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 268431 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| THE ERX COMPANY | |||||
| 9724 KINGSTON PIKE STE 406 | KNOXVILLE | TN | 37922 | PHYSICIAN FEES | 1377710 |
| MEDTRONIC USA | |||||
| PO BOX 409201 | ATLANTA | GA | 30384 | NERVE STIMULATOR SUPPLIER | 465557 |
| WAR EAGLE REHABILITATIVE SERVICES | |||||
| PO BOX 2091 | ADVANCE | NC | 27006 | CONTRACT PHYSICAL THERAPY | 242253 |
| SIGHTPATH MEDICAL INC | |||||
| 575 W OLD SHAKOPEE ROAD STE 90 | BLOOMINGTON | MN | 55437 | CATARACT SURGERY SUPPLIER | 203946 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 96485 | CHICAGO | IL | 60693 | CONTRACTED MRI SERVICES | 196462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Fundraising Events | 29150 | FundraisingEvents |
| Total Contributions | 29150 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 11723928 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11723928 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 11723928 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1302 | TotalRevenueColumn |
| Exclusion | $1,302 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 20165 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 20165 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20165 | TotalRevenueColumn |
| Exclusion | $20,165 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 9750 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 29150 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 16731 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -6981 | TotalRevenueColumn |
| Exclusion | -$6,981 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICAL RECORD TRANSCRIPTION | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 3287 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3287 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3287 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11770851 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11727215 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $14,486 | 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 | 100 | Total |
| Program Services | 100 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3666605 | Total |
| Program Services | 3179680 | ProgramServices |
| Management And General | 486925 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43224 | Total |
| Program Services | 37484 | ProgramServices |
| Management And General | 5740 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 552406 | Total |
| Program Services | 479047 | ProgramServices |
| Management And General | 73359 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54780 | Total |
| Management And General | 54780 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3338633 | Total |
| Program Services | 2885770 | ProgramServices |
| Management And General | 429053 | ManagementAndGeneral |
| Fundraising | 23810 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34292 | Total |
| Program Services | 34292 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46430 | Total |
| Program Services | 14625 | ProgramServices |
| Management And General | 31805 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104002 | Total |
| Program Services | 104002 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 472218 | Total |
| Program Services | 472218 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24309 | Total |
| Management And General | 24309 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4769 | Total |
| Program Services | 2319 | ProgramServices |
| Management And General | 2450 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 186497 | Total |
| Program Services | 186497 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65796 | Total |
| Program Services | 63134 | ProgramServices |
| Management And General | 2662 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 2538012 | 2538012 | |
| MEDICAL SUPPLIES | 1197187 | 1197187 | |
| MISCELLANEOUS EXPENSE | 32606 | 32606 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12361866 | Total |
| Program Services | 11194367 | ProgramServices |
| Management And General | 1143689 | ManagementAndGeneral |
| Fundraising | 23810 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 432798 | BOY |
| EOY | 889043 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1458704 | BOY |
| EOY | 1257549 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 132035 | BOY |
| EOY | 165328 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6476 | BOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2281761 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1849679 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 516758 | BOY |
| EOY | 432082 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 187002 | BOY |
| EOY | 449661 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2733773 | BOY |
| EOY | 3193663 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1238973 | BOY |
| EOY | 2780678 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 99940 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2809594 | BOY |
| EOY | 2418734 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4148507 | BOY |
| EOY | 5199412 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1415746 | BOY |
| EOY | -2006761 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1012 | BOY |
| EOY | 1012 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1414734 | BOY |
| EOY | -2005749 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2733773 | BOY |
| EOY | 3193663 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -591015 | 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) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $2,023 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2023 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| 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 $2,023. | Explanation |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2281761 | OtherCostOrOtherBasis |
| Depreciation | 1849679 | Depreciation |
| Book Value | 432082 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 432082 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 69485 |
| ESTIMATED THIRD PARTY RECEIVABLES | 380176 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 449661 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO NC BAPTIST HOSPITAL | Description |
| Amount | $2,418,734 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2418734 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 9675383 | TotRevenueEtcAuditedFinclStmt |
| Donated Srvc And Use Of Facilities | 442544 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 442544 | RevenueNotRptdF990 |
| Revenue Subtotal | 9232839 | RevenueSubtotal |
| Other Revenues Not Included | 2538012 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 2538012 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 11770851 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 10266398 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 442544 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 442544 | ExpensesNotRptdF990 |
| Expenses Subtotal | 9823854 | ExpensesSubtotal |
| Other Expenses Not Included | 2538012 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 2538012 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 12361866 | 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 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, 2013. 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. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 2,538,012. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 2,538,012. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | ANNUAL GOLF EVENT | NameOfEvent1 |
| Gross Receipts Event1 | 38900 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 29150 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 9750 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 2200 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 1721 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 4900 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 4342 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 3568 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 38900 | GrossReceiptsTotal |
| Charitable Contributions Total | 29150 | CharitableContributionsTotal |
| Gross Revenue Total Events | 9750 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 2200 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 1721 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 4900 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 4342 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 3568 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 16731 | DirectExpenseSummaryEvents |
| Net Income Summary | -6981 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 337099 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 337099 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03430 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1452576 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 906646 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 545930 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05560 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1789675 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 906646 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 883029 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08990 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1587 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1587 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 100 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 100 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1687 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1687 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1791362 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 906646 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 884716 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,372,418 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 2628166 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2424933 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 203233 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 2012 SCHEDULE H. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2538012. | ||
| 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. THE ORGANIZATION HAS A THOROUGH PROCESS OF EVALUATING BAD DEBT ACCOUNTS AS INFORMATION BECOMES AVAILABLE AND RECLASSIFIES BAD DEBT ACCOUNTS AS CHARITY CARE AS PROVIDED BY THE CHARITY CARE POLICY. 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 2012 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST TO CHARGES RATIO USED TO CALCULATE BAD DEBT AT COST. | ||
| PART III, LINE 8: DAVIE HOSPITAL IS A CRITIAL ACCESS HOSPITAL AND IS REIMBURSED 100% TO 101% OF MEDICARE COSTS. | ||
| 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 V, SECTION B, LINE 3: 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 5C: THE HOSPITAL'S CHNA AND CHNA IMPLEMENTATION STRATEGY CAN BE FOUND AT WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS/COMMUNITY-BENEFITS.HTM. | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | |
| PART V, SECTION B, LINE 14G: IF PATIENTS WERE IDENTIFIED AS A "STOREHOUSE FOR JESUS" PATIENT, THE FINANCE DEPARTMENT WOULD MAIL AN APPLICATION TO THE PATIENT IF THERE WAS NO APPLICATION ON FILE. | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | |
| 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 IS A CRITICAL ACCESS HOSPITAL SERVING DAVIE COUNTY, NORTH CAROLINA AND THE SURROUNDING AREAS. THE HOSPITAL IS THE ONLY ONE LOCATED IN THE COUNTY. 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. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO ALL OF ITS DEPARTMENTS. | ||
| PART VI, LINE 6: THE MEMBER OF THE ORGANIZATION IS NORTH CAROLINA BAPTIST HOSPITAL. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RONALD SMALL | ||||||||||||||
| BOARD MEMBER | 0 | 0 | 0 | 0 | 0 | 241797 | 0 | 0 | 0 | 6355 | 0 | 248152 | 0 | 0 |
| STEVEN C SNELGROVE | ||||||||||||||
| BOARD MEMBER | 0 | 262908 | 0 | 59250 | 0 | 56998 | 0 | 69197 | 0 | 17481 | 0 | 465834 | 0 | 36276 |
| LYNN PITMAN | ||||||||||||||
| BOARD MEMBER | 0 | 183118 | 0 | 21089 | 0 | 1641 | 0 | 16223 | 0 | 16048 | 0 | 238119 | 0 | 0 |
| KEVIN WALSH | ||||||||||||||
| CEO,ADMINISTRATOR | 0 | 120691 | 0 | 5353 | 0 | 913 | 0 | 9780 | 0 | 17274 | 0 | 154011 | 0 | 0 |
| DANNY SQUIRES | ||||||||||||||
| CFO | 176149 | 0 | 10934 | 0 | 0 | 0 | 10089 | 0 | 18724 | 0 | 215896 | 0 | 0 | 0 |
| DONNY C LAMBETH | ||||||||||||||
| FORMER OFFICER | 0 | 191296 | 0 | 134313 | 0 | 811808 | 0 | 27524 | 0 | 15116 | 0 | 1180057 | 0 | 99432 |
| JOHNNY VEAL | ||||||||||||||
| FORMER CNO | 0 | 181716 | 0 | 12456 | 0 | 1946 | 0 | 21837 | 0 | 9525 | 0 | 227480 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 SEVERANCE AND/OR NON-QUALIFIED RETIREMENT PLAN PAYMENTS FOLLOW THE RELATED ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THEIR FORM 990. NON-QUALIFIED SEVERANCE - DONNY C. LAMBETH $501,126 $253,846 - RONALD SMALL $251,360 - STEVE SNELGROVE $36,276 | |
| PART III | COMPENSATION FROM UNRELATED ORGANIZATIONS: COMPENSATION FOR DANNY SQUIRES AND CLYDE BRISTOW WAS PROVIDED BY LEXINGTON MEDICAL CENTER, AN UNRELATED TAX-EXEMPT ORGANIZATION. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PAMELA SMALL | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | FAMILY MEMBER OF BOARD MEMBER RONALD SMALL | Relationship |
| Amount Of Transaction | 21110 | AmountOfTransaction |
| Description Of Transaction | COMPENSATION AS EMPLOYEE | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | EXECUTIVE COMMITTEE: 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. | |
| 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. | |
| FORM 990, PART IX, LINE 11G | MEDICAL FEES: PROGRAM SERVICE EXPENSES 1,305,328. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,305,328. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,362,835. MANAGEMENT AND GENERAL EXPENSES 428,617. FUNDRAISING EXPENSES 23,810. TOTAL EXPENSES 1,815,262. OUTSIDE CONTRACT FEES: PROGRAM SERVICE EXPENSES 217,607. MANAGEMENT AND GENERAL EXPENSES 436. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 218,043. | OTHER FEES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |
| CENTER FOR CONGREGATIONAL HEALTH 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 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 | 0 | 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 | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |