2014-05-14T07:36:58-05:00 2013-06-30 990 2012-07-01 562276994 DAVIE COUNTY EMERGENCY HEALTH CORPORATION DAVI 3369981300 223 HOSPITAL STREET MOCKSVILLE NC 27028 DANNY SQUIRES 3369981300 2014-05-09 2012 2015-11-30 17:44:51Z WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITAL THOMAS E SIBERT 223 HOSPITAL STREET MOCKSVILLE NC 27028 11787582 0 X WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL/ X 2001 NC PROVISION OF PATIENT-CENTERED HEALTHCARE SERVICES TO THE SURROUNDING AREA 14 10 185 1 0 0 28165 29150 12065324 11723928 78072 1302 30821 16471 12202382 11770851 500 100 0 0 4964800 4262235 0 0 23810 8988115 8099531 13953415 12361866 -1751033 -591015 2733773 3193663 4148507 5199412 -1414734 -2005749 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. 0 0 11194367 100 11727215 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. 11194367 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 30 0 1 185 1 0 0 0 0 0 1 1 0 0 0 0 X 14 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X DANNY SQUIRES 3362384287 223 HOSPITAL STREET MOCKSVILLE NC 27028 DAN BARRETT 2.00 X X 0 0 0 TERRY BRALLEY 2.00 X X 0 0 0 KEN WHITE 2.00 X 0 0 0 DR RUSSELL HOWERTON 2.00 X 0 0 0 WILLIAM F JUNKER 2.00 X 0 0 0 RONALD SMALL 2.00 38.00 X 0 241797 6355 STEVEN C SNELGROVE 2.00 38.00 X 0 379156 86678 BETH DIRKS 2.00 X 0 0 0 DOUGLAS NELSON 2.00 31.60 X 0 0 0 HEATHER L HAYES 2.00 38.00 X 0 81432 13258 LYNN PITMAN 2.00 38.00 X 0 205848 32271 CHARLES TEGELER MD 2.00 X 0 0 0 STEPHEN ROBERTSON 2.00 6.00 X 0 0 0 DR THOMAS E SIBERT 4.00 31.60 X X 0 0 0 KEVIN WALSH 40.00 X 0 126957 27054 DANNY SQUIRES 15.00 X 187083 0 28813 CLYDE BRISTOW 4.00 0.00 X 89757 0 0 DONNY C LAMBETH 6.00 34.00 X 0 1137417 42640 JOHNNY VEAL 4.00 X 0 196118 31362 276840 2368725 268431 0 1 1 1 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 5 29150 29150 PATIENT SERVICE REVENUE 621400 11723928 11723928 11723928 1302 1302 20165 0 20165 20165 20165 9750 29150 16731 -6981 -6981 MEDICAL RECORD TRANSCRIPTION 900099 3287 3287 3287 11770851 11727215 0 14486 X 100 100 3666605 3179680 486925 43224 37484 5740 552406 479047 73359 54780 54780 3338633 2885770 429053 23810 34292 34292 46430 14625 31805 104002 104002 472218 472218 24309 24309 4769 2319 2450 186497 186497 65796 63134 2662 BAD DEBT EXPENSE 2538012 2538012 MEDICAL SUPPLIES 1197187 1197187 MISCELLANEOUS EXPENSE 32606 32606 12361866 11194367 1143689 23810 432798 889043 1458704 1257549 132035 165328 6476 2281761 1849679 516758 432082 187002 449661 2733773 3193663 1238973 2780678 99940 2809594 2418734 4148507 5199412 X -1415746 -2006761 1012 1012 -1414734 -2005749 2733773 3193663 -591015 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2023 2023 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: 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. 2281761 1849679 432082 432082 OTHER RECEIVABLES 69485 ESTIMATED THIRD PARTY RECEIVABLES 380176 449661 DUE TO NC BAPTIST HOSPITAL 2418734 2418734 X 9675383 442544 442544 9232839 2538012 2538012 11770851 10266398 442544 442544 9823854 2538012 2538012 12361866 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. ANNUAL GOLF EVENT 38900 29150 9750 2200 1721 4900 4342 3568 38900 29150 9750 2200 1721 4900 4342 3568 16731 -6981 1 1 X 1 X 1 X 1 1 1 0 1 1 337099 337099 0.03430 1452576 906646 545930 0.05560 1789675 906646 883029 0.08990 1587 1587 0.00020 100 100 0.00000 1687 1687 0.00020 1791362 906646 884716 0.09010 1 1372418 2628166 2424933 203233 X 1 1 1 1 WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA

223 HOSPITAL STREET MOCKSVILLE NC 27028

WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL X X X X WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 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. WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA 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. 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. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 1 0 0 0 0 0 0 0 RONALD SMALL 0 0 0 0 0 241797 0 0 0 6355 0 248152 0 0 STEVEN C SNELGROVE 0 262908 0 59250 0 56998 0 69197 0 17481 0 465834 0 36276 LYNN PITMAN 0 183118 0 21089 0 1641 0 16223 0 16048 0 238119 0 0 KEVIN WALSH 0 120691 0 5353 0 913 0 9780 0 17274 0 154011 0 0 DANNY SQUIRES 176149 0 10934 0 0 0 10089 0 18724 0 215896 0 0 0 DONNY C LAMBETH 0 191296 0 134313 0 811808 0 27524 0 15116 0 1180057 0 99432 JOHNNY VEAL 0 181716 0 12456 0 1946 0 21837 0 9525 0 227480 0 0 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 SUPPLEMENTAL INFORMATION PART III COMPENSATION FROM UNRELATED ORGANIZATIONS: COMPENSATION FOR DANNY SQUIRES AND CLYDE BRISTOW WAS PROVIDED BY LEXINGTON MEDICAL CENTER, AN UNRELATED TAX-EXEMPT ORGANIZATION. PAMELA SMALL FAMILY MEMBER OF BOARD MEMBER RONALD SMALL 21110 COMPENSATION AS EMPLOYEE 0 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. OTHER FEES 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. 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 NORTH CAROLINA BAPTIST HOSPITAL 0 THE REHABILITATION & SKILLED NURSING FACILITY AT OAK SUMMIT MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561826396 HEALTHCARE (INACTIVE) NC 501(C)(3) LINE 9 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION 0 THE HAWTHORNE INN & CONFERENCE CENTER INC 420 HIGH STREET WINSTON SALEM NC 27101 561793617 LODGING/ CONFERENCE ACCOMMODATION NC 501(C)(3) LINE 11A, I NORTH CAROLINA BAPTIST HOSPITAL 0 CARENET INC 2000 WEST FIRST STREET SUITE 410 WINSTON SALEM NC 27104 561977341 HEALTHCARE NC 501(C)(3) LINE 11B, II NORTH CAROLINA BAPTIST HOSPITAL 0 CENTER FOR CONGREGATIONAL HEALTH INC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 237426944 HEALTHCARE NC 501(C)(3) LINE 9 NORTH CAROLINA BAPTIST HOSPITAL 0 DAVIE COUNTY HOSPITAL FOUNDATION 156 ROLAND RD MOCKSVILLE NC 27028 581477280 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11C, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1