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NORTH CAROLINA BAPTIST HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
NORTH CAROLINA BAPTIST HOSPITAL (EIN 56-0552787)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-14
IRS object ID
201441349349300824
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

FieldValueIRS element (for citing)
Timestamp2014-05-14T07:36:58-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN135565207EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1300 NORTH GREENE STREETAddressLine1
CityGREENSBOROCity
StateNCState
ZIP Code27401ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN560552787EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTH CAROLINA BAPTIST HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone3367164445Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1MEDICAL CENTER BLVDAddressLine1
CityWINSTONSALEMCity
StateNCState
ZIP Code27157ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN D MCCONNELL MDName
TitleCEOTitle
Phone3367164445Phone
Date Signed2014-05-12DateSigned
Authorize Third Party0AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
PTINP00008888PTIN
Phone3362753394Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN D MCCONNELL MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1MEDICAL CENTER BLVDAddressLine1
CityWINSTONSALEMCity
StateNCState
ZIP Code27157ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1268161053GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WAKEHEALTH.EDUWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1923YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionIMPROVING THE HEALTH OF OUR REGION, STATE AND NATIONActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees10138TotalNbrEmployees
Total Nbr Volunteers1000TotalNbrVolunteers
Total Gross UBI3483187TotalGrossUBI
Net Unrelated Business Txbl Income2085085NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3031792ContributionsGrantsPriorYear
Contributions Grants Current Year3462376ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1186396254ProgramServiceRevenuePriorYear
Program Service Revenue CY1218479632ProgramServiceRevenueCY
Investment Income Prior Year77580140InvestmentIncomePriorYear
Investment Income Current Year42423781InvestmentIncomeCurrentYear
Other Revenue Prior Year3718388OtherRevenuePriorYear
Other Revenue Current Year3626103OtherRevenueCurrentYear
Total Revenue Prior Year1270726574TotalRevenuePriorYear
Total Revenue Current Year1267991892TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year591467GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1278528GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year539950281SalariesEtcPriorYear
Salaries Etc Current Year547352388SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year629349396OtherExpensePriorYear
Other Expenses Current Year712232895OtherExpensesCurrentYear
Total Expenses Prior Year1169891144TotalExpensesPriorYear
Total Expenses Current Year1260863811TotalExpensesCurrentYear
Revenues Less Expenses Prior Year100835430RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7128081RevenuesLessExpensesCY
Total Assets BOY1619889593TotalAssetsBOY
Total Assets EOY1778311980TotalAssetsEOY
Total Liabilities BOY671420988TotalLiabilitiesBOY
Total Liabilities EOY815813924TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY948468605NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY962498056NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE O FOR CONTINUATIONTHE ORGANIZATION IS PART OF WAKE FOREST BAPTIST MEDICAL CENTER, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. WAKE FOREST BAPTIST MEDICAL CENTER'S MISSION IS TO IMPROVE THE HEALTH OF THE REGION, STATE AND NATION BY:- SERVING AS THE PREMIER HEALTH SYSTEM IN THE REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS.- GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE.- TRAINING TOMORROW'S LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense1147158690Expense
Grants1278528Grants
Revenue1215255766Revenue
DescriptionSEE SCHEDULE O FOR COMPLETE DESCRIPTIONTHE HOSPITAL IS AN INTEGRAL PART OF WAKE FOREST BAPTIST MEDICAL CENTER, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. WAKE FOREST BAPTIST MEDICAL CENTER IS NORTHWEST NORTH CAROLINA'S SOLE ACADEMIC MEDICAL CENTER, BRINGING TO THE REGION THE RESOURCES OF ONE OF AMERICA'S TOP HOSPITALS AND INNOVATIVE RESEARCH CENTERS AND A PREMIER MEDICAL SCHOOL. WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER IS A CORPORATION WHOSE MEMBERS ARE WAKE FOREST UNIVERSITY AND NORTH CAROLINA BAPTIST HOSPITAL. WAKE FOREST BAPTIST MEDICAL CENTER OPERATES WAKE FOREST SCHOOL OF MEDICINE AND HAS A FACULTY OF 1,165, INCLUDING PHYSICIANS AND BASIC SCIENTISTS. THE MEDICAL CENTER HAS 1,004 ACUTE CARE AND REHABILITATION BEDS OPERATIVE ACROSS THE SYSTEM, WHICH ENCOMPASSES ITS MAIN CAMPUS (885 BEDS), BRENNER CHILDREN'S HOSPITAL (160 BEDS, INCLUDED IN MAIN CAMPUS TOTAL); WAKE FOREST BAPTIST HEALTH-LEXINGTON MEDICAL CENTER (94 BEDS); AND WAKE FOREST BAPTIST HEALTH-DAVIE MEDICAL CENTER (25 BEDS). THE MEDICAL CENTER PRIMARILY SERVES A 24-COUNTY REGION IN NORTHWESTERN NORTH CAROLINA AND SOUTHWESTERN VIRGINIA, BUT DRAWS PATIENTS FROM ACROSS THE STATE AND NATION FOR SELECT SERVICES.WAKE FOREST SCHOOL OF MEDICINE IS THE DRIVING FORCE BEHIND THE ESTABLISHMENT OF WAKE FOREST INNOVATION QUARTER, A FAST-GROWING HUB FOR BIOMEDICAL AND MATERIAL SCIENCES AND INFORMATION TECHNOLOGY IN DOWNTOWN WINSTON-SALEM. IN 2014, THE INNOVATION QUARTER WILL WELCOME INMAR, AN INFORMATION SERVICES COMPANY THAT WILL HAVE 900 EMPLOYEES AT ITS NEW HOME IN A RENOVATED FORMER R.J. REYNOLDS TOBACCO CO. BUILDING. IT WILL BE IN ONE OF TWO NEW BUILDINGS TO BE OPENED IN THE INNOVATION QUARTER; THE SECOND BUILDING WILL BE HOME BOTH TO WAKE FOREST SCHOOL OF MEDICINE'S DIVISION OF PUBLIC HEALTH SCIENCES, ITS PHYSICIAN ASSISTANT PROGRAM AND TO A NEW CENTER FOR EMERGING TECHNOLOGIES THAT WILL BE OPENED BY FORSYTH TECHNICAL COMMUNITY COLLEGE. THE BUSINESS, ACADEMIC AND RESEARCH CORE AT THE INNOVATION QUARTER COMBINES WITH OTHER OFFERINGS SUCH AS A PUBLIC PARK (OFFERING OUTDOOR YOGA, A FILM SERIES AND MORE) AND A BRANCH OF THE YMCA TO MAKE IT A DIVERSE AREA OF GROWTH IN WINSTON-SALEM.1. CLINICAL SERVICES WAKE FOREST BAPTIST MEDICAL CENTER IS NATIONALLY RECOGNIZED FOR CLINICAL EXCELLENCE AND INTERNATIONALLY KNOWN FOR PIONEERING RESEARCH AND CLINICAL INNOVATION. IT OFFERS EXPERTISE IN MORE THAN 100 AREAS OF MEDICINE, ENCOMPASSING COMPREHENSIVE PREVENTIVE AND HIGHLY SPECIALIZED CARE FOR ALL AGES. THE WAKE FOREST BAPTIST MEDICAL CENTER INCLUDES 42 SUBSIDIARIES, JOINT VENTURES AND AFFILIATE HOSPITALS, AND OPERATES ABOUT 80 OUTREACH ACTIVITIES, INCLUDING SATELLITE SPECIALTY CLINICS, ACROSS NORTHWEST NORTH CAROLINA.IN THE PAST FISCAL YEAR, WAKE FOREST BAPTIST MEDICAL CENTER COMPLETED A $125 MILLION EXPANSION OF ITS COMPREHENSIVE CANCER CENTER, WHICH CONSOLIDATED INPATIENT AND OUTPATIENT SERVICES INTO A SINGLE LOCATION. THE NEW CENTER OFFERS 530,600 SQUARE FEET OF SPACE TO PATIENTS, MAKING IT THE LARGEST INTEGRATED CANCER CENTER IN NORTH CAROLINA. ALSO IN 2013, WAKE FOREST BAPTIST MEDICAL CENTER OPENED A NEW STATE-OF-THE-ART CLINICAL CAMPUS, DAVIE MEDICAL CENTER - BERMUDA RUN, WHICH INCLUDES A 24/7/365 EMERGENCY DEPARTMENT, AND A NEW WEIGHT MANAGEMENT CENTER AT ITS MEDICAL PLAZA - COUNTRY CLUB SITE THAT COMBINES MEDICAL AND SURGICAL WEIGHT LOSS PROGRAMS IN ONE LOCATION. OVERALL IN FY 2013, WAKE FOREST BAPTIST MEDICAL CENTER HAD 38,696 INPATIENT ADMISSIONS AND 1,051,359 OUTPATIENT ENCOUNTERS (EMERGENCY DEPARTMENT, DOWNTOWN HEALTH PLAZA, DAY HOSPITAL, AMBULATORY VISITS). THE TOTAL PATIENT ENCOUNTERS NUMBERED 1,090,055.2. OUTREACHTHE DOWNTOWN HEALTH PLAZA IS A FULL-SERVICE, OUTPATIENT MEDICAL CLINIC THAT SERVES MANY OF FORSYTH COUNTY'S UNINSURED AND UNDERINSURED RESIDENTS WITH A STATE-OF-THE-ART MEDICAL HOME. EXPERTS FROM 12 WAKE FOREST BAPTIST MEDICAL CENTER DEPARTMENTS PROVIDE COORDINATED CARE THAT INCLUDES ADULT MEDICINE, PEDIATRICS, OBSTETRICS AND GYNECOLOGY, AS WELL AS AN ONSITE PHARMACY, LABORATORY AND RADIOLOGY SERVICES (INCLUDING MAMMOGRAPHY). THE DOWNTOWN HEALTH PLAZA PLAYS A SIGNIFICANT ROLE IN COMMUNITY HEALTH, PROVIDING COMMUNITY HEALTH FAIRS, DIABETES EDUCATION AND A CENTERING PREGNANCY PROGRAM THAT IS REDUCING THE INCIDENCE OF LOW BIRTH-WEIGHT BABIES. A TOTAL OF 65,541 PATIENT VISITS WERE RECORDED AT THE PLAZA BETWEEN JULY 2012 AND JUNE 2013. COSTS ARE SUBSIDIZED BY WAKE FOREST BAPTIST MEDICAL CENTER. WAKE FOREST BAPTIST MEDICAL CENTER ALSO OPERATES NUMEROUS INNOVATIVE COMMUNITY OUTREACH PROGRAMS, INCLUDING:- BESTHEALTH, WHICH OFFERS HEALTH SEMINARS LED BY WAKE FOREST BAPTIST HEALTH EXPERTS, HEALTH SCREENINGS, COOKING AND FITNESS CLASSES, AND ONLINE HEALTH RESOURCES.- FAITHHEALTHNC, AN INITIATIVE THAT CONNECTS THE CARING STRENGTHS OF CONGREGATIONS, THE CLINICAL EXPERTISE OF PROVIDERS AND A NETWORK OF COMMUNITY RESOURCES TO EASE THOSE ON THE JOURNEY TO HEALTH AND HEALING, STRENGTHENING COMMUNITIES IN THE PROCESS.- BE INVOLVED, AN ONLINE RESOURCE THAT ALLOWS THE PUBLIC ACCESS TO INFORMATION ABOUT HUNDREDS OF CLINICAL STUDIES. THE SITE ALLOWS PEOPLE TO REGISTER TO BE NOTIFIED WHEN STUDIES BEGIN THAT COULD MATCH CONDITIONS THEY FACE.3. EDUCATIONAL MISSION AND ACCOMPLISHMENTS THE CONSTITUENT ORGANIZATIONS OF WAKE FOREST BAPTIST MEDICAL CENTER OPERATE A BROAD RANGE OF EDUCATIONAL PROGRAMS, GRADUATING SKILLED PRACTITIONERS. IT ATTRACTS SOME OF THE WORLD'S MOST COMPETITIVE MEDICAL STUDENTS, RESIDENTS AND FELLOWS, AS WELL AS STUDENTS IN CLINICAL PASTORAL CARE, NURSE ANESTHESIA AND OTHER AREAS. IN THE PAST YEAR, WAKE FOREST BAPTIST MEDICAL CENTER INVESTED MORE THAN $56 MILLION IN THE EDUCATION OF TOMORROW'S HEALTH CARE AND BIOMEDICAL LEADERS. THAT INVESTMENT SUPPORTED THE TRAINING OF 469 MEDICAL STUDENTS, 683 PHYSICIAN RESIDENTS AND FELLOWS, 308 GRADUATE STUDENTS AND 124 PHYSICIAN ASSISTANTS. ALSO LAST YEAR, THE NORTHWEST AREA HEALTH EDUCATION CENTER, PART OF WAKE FOREST SCHOOL OF MEDICINE, PROVIDED 1,910 CONTINUING MEDICAL EDUCATION ACTIVITIES FOR 33,518 PARTICIPANTS THROUGHOUT THE REGION.Description
Total Program Service Expense1147158690TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities1ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096186NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees10138NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNCStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DOUG LISCHKEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3367164445TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1MEDICAL CENTER BLVDAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27157ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (48 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
ROGER L COTHRAN
VICE - CHAIRMAN2.004.00XX000
RON KESSINGER
CHAIRMAN2.006.00XX000
ARTHUR A GIBEL
TRUSTEE2.004.00X000
KATHRYN H HAMRICK
TRUSTEE2.002.00X000
A LEE HERRING
TRUSTEE2.00X000
J WAYNE MEREDITH M D
TRUSTEE2.002.00X000
STANLEY R AESCHLEMAN PH D
TRUSTEE2.00X000
A WILLIAM BLACKSTOCK JR MD
TRUSTEE2.002.00X000
KENNETH W LEWIS
TRUSTEE2.002.00X000
WILLIAM C WARDEN JR
TRUSTEE2.004.00X000
SHEREE B WATSON
TRUSTEE2.004.00X000
KATY M BOLES
TRUSTEE2.002.00X000
RAY N HOWELL III D MIN
TRUSTEE2.002.00X000
JOHN D KIMBERLY
TRUSTEE2.00X000
STEPHEN L ROBERTSON
TRUSTEE2.006.00X000
EDWIN L WELCH JR
TRUSTEE2.004.00X000
R MICHAEL WELLS
TRUSTEE2.006.00X000
LINWOOD L DAVIS
TRUSTEE2.00X000
BRENDA B DIGGS
TRUSTEE2.00X000
ERNEST L EVANS
TRUSTEE2.004.00X000
LOUIS B BALDWIN JR
TRUSTEE2.00X000
GEORGE D RENFRO
TRUSTEE2.004.00X000
JOHN D MCCONNELL MD
TRUSTEE & CEO20.0020.00XX13707480690944
H GREG BRAY
ASST. TREASURER/ASST. SECR30.209.80X231473037925
J MCLAIN WALLACE JR
VP GENERAL COUNSEL/SECR17.7022.30X5166580110280
KAREN H HUEY
VP FACILITIES33.706.30X363748071481
ERIC TOMLINSON
CHIEF INNOVATION OFFICER5.0035.00X266943031786
NORMAN D POTTER JR
VP DEVELOPMENT & ALUMNI AF20.0020.00X348231083878
CHERYL EH LOCKE
VP CHIEF HUMAN RESOURCES23.4016.60X439652097854
EDWARD G CHADWICK
EXECUTIVE VP CFO/TREASURER29.8010.20X7099710246494
THOMAS E SIBERT MD
PRESIDENT/COO - HEALTH SYS26.6013.40X8854830141102
LISA M WYATT
VP CHIEF COMM & MARKETING18.1021.90X386954075110
SHEILA M SANDERS
VP CHIEF INFORMATION OFFIC26.0014.00X4789040104120
EDWARD ABRAHAM MD
DEAN, SCHOOL OF MEDICINE5.0035.00X6697780181890
BETTY PETREE
DIRECTOR NURSE ANESTHESIA40.00250470037328X
MICHAEL RIEKER
DIRECTOR OF NURSE ANESTHES40.00242909045099X
VANCE MCVAY JR
CLINICAL INSTRUCTOR CRNA40.00231310039322X
ERIC STIEFEL
CLINICAL INSTRUCTOR CRNA40.00193145033982X
CHARLES WARE
ASSOCIATE VP INFRASTRUCTUR40.00220774039020X
JOANNE C RUHLAND
FORMER OFFICER20.0020.00255643071023X
RUSSELL M HOWERTON MD
FORMER OFFICER20.0020.006021780155013X
DOUGLAS L EDGETON
FORMER OFFICER1.0039.00606902019712X
STEVE C SNELGROVE
FORMER OFFICER0.0040.00379156086678X
RONALD H SMALL
FORMER OFFICER0.002.0024179706355X
MAUREEN E SINTICH
FORMER OFFICER34.006.00390731087080X
ROBERT S PARKER SR
FORMER OFFICER0.000.0011758904468X
DONNY C LAMBETH
FORMER OFFICER20.0020.001137417042640X
SHARON ENGEBRETSON
FORMER OFFICER35.005.00173949067457X
FieldValueIRS element (for citing)
Total Reportable Comp From Org11712513TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation2608041TotalOtherCompensation
Number Individuals GT100 K437NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
INTELLECT RESOURCES INC
3824 N ELM STREETGREENSBORONC27455TECHNOLOGY6597090
FASTAFF INC
6399 S FIDDLERS GREENGREENWOOD VILLAGECO80111NURSING5058061
MEDCOST
165 KIMEL PARK DRIVEWINSTON SALEMNC27103TPA3253732
ARAMARK
2300 WARRENVILLE ROADDOWNER GROVEIL60515MANAGEMENT SERVICES2864085
ORACLE AMERICA INC
500 ORACLE PKWYREDWOOD SHORESCA94065TECHNOLOGY2557598
FieldValueIRS element (for citing)
Number Of Contractors GT100 K120NumberOfContractorsGT100K
Related Organizations405031RelatedOrganizations
Government Grants1022052GovernmentGrants
All Other Contributions2035293AllOtherContributions
Noncash Contributions73316NoncashContributions
Total Contributions3462376TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENUE62140011988977911198897791
COST RECOV. & OTHER9000991010898977204512388538
MEDICAL/LAB SERVICE621500488894838284421060506
DIETARY7223204583904454976134143
FieldValueIRS element (for citing)
Total Program Service Revenue1218479632TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column13994366TotalRevenueColumn
Exclusion$13,994,366ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real659246Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real659246Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column659246TotalRevenueColumn
Exclusion$659,246ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities28598576Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other169161Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities28598576Securities
Other-169161Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column28429415TotalRevenueColumn
Exclusion$28,429,415ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
GIFT SHOP REVENUE4532201458318$1,458,318
PARKING FEES9000991249218$1,249,218
TUITION900099259321259321
FieldValueIRS element (for citing)
Total Other Revenue2966857TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1267991892TotalRevenueColumn
Related Or Exempt Function Income1215255766RelatedOrExemptFunctionIncome
Unrelated Business Revenue3483187UnrelatedBusinessRevenue
Exclusion$45,790,563ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total799335Total
Program Services799335ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total479193Total
Program Services479193ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4460290Total
Program Services2577907ProgramServices
Management And General1882383ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total430641699Total
Program Services389943893ProgramServices
Management And General40697806ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total21691102Total
Program Services16268172ProgramServices
Management And General5422930ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total58535634Total
Program Services52773005ProgramServices
Management And General5762629ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total32023663Total
Program Services24017749ProgramServices
Management And General8005914ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total25243Total
Program Services25243ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total284953Total
Program Services2369ProgramServices
Management And General282584ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total562889Total
Program Services562889ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total169243636Total
Program Services142854750ProgramServices
Management And General26388886ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3662270Total
Program Services2181481ProgramServices
Management And General1480789ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total46597147Total
Program Services37699439ProgramServices
Management And General8897708ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total22864019Total
Program Services17682465ProgramServices
Management And General5181554ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total31073685Total
Program Services23874048ProgramServices
Management And General7199637ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total511803Total
Program Services338771ProgramServices
Management And General173032ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1816624Total
Program Services1355404ProgramServices
Management And General461220ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total11947910Total
Program Services11947910ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total63671136Total
Program Services63671136ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total7274052Total
Program Services7255280ProgramServices
Management And General18772ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES2526123722514618111150561
INCOME TAXES653680653680
BAD DEBT7333223773332237
PROVIDER ASSESSMENT2592024925920249

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total178990Total
Program Services133954ProgramServices
Management And General45036ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1260863811Total
Program Services1147158690ProgramServices
Management And General113705121ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY25325467BOY
EOY18762350EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY38604347BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY303304584BOY
EOY350307047EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY32041387EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY17078515BOY
EOY22269612EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY7131300BOY
EOY4712483EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1451087502LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec807483628LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY553420299BOY
EOY643603874EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY608352455BOY
EOY627932795EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY41336484BOY
EOY65673237EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY25336142BOY
EOY13009195EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1619889593BOY
EOY1778311980EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY159427458BOY
EOY272033669EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY317847467BOY
EOY494400200EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY96476032BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY97670031BOY
EOY49380055EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY671420988BOY
EOY815813924EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY940380300BOY
EOY957729652EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4535459BOY
EOY2797220EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3552846BOY
EOY1971184EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY948468605BOY
EOY962498056EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1619889593BOY
EOY1778311980EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7128081ReconcilationRevenueExpenses
Reconciliation Unrealized Invest882818ReconciliationUnrealizedInvest
Reconcilation Other Changes6018552ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$510,138DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$52,751OtherActivitiesAmount
Total Lobbying Expenditures IIB562889TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationGOVERNMENT RELATIONS THE OFFICE OF GOVERNMENT RELATIONS WAS ACTIVELY INVOLVED WITH SEVERAL FEDERAL AND STATE ISSUES. THE OFFICE ASSISTED IN DEVELOPING POLITICAL ADVOCACY STRATEGIES REGARDING THE CENTERS FOR MEDICARE & MEDICAID SERVICES' (CMS) POLICY ON REBILLING PART A CLAIMS; CMS' IMPLEMENTATION OF THE "TWO-MIDNIGHT" POLICY REGARDING PATIENT STATUS; CUTS TO PAYMENTS FOR EVALUATION AND MANAGEMENT SERVICES AND CERTAIN OTHER PROCEDURES PROVIDED IN HOSPITAL OUTPATIENT DEPARTMENTS (HOPD'S); REDUCTIONS TO PAYMENTS FOR GRADUATE MEDICAL EDUCATION (GME); CHANGES TO THE 340B DRUG DISCOUNT PROGRAM; REDUCTIONS IN PAYMENTS TO HOSPITALS FOR ASSISTANCE TO LOW-INCOME MEDICARE BENEFICIARIES (BAD DEBT); RESTRICTIONS ON MEDICAID PROVIDER ASSESSMENTS; REALIGNMENT OF MEANINGFUL USE STAGE 2 REQUIREMENTS TO ENSURE A SAFE, ORDERLY TRANSITION; MODIFICATIONS TO THE HOSPITAL READMISSIONS REDUCTION PROGRAM (HRRP); CHANGES TO THE HOSPITAL-ACQUIRED CONDITION (HACS) REDUCTION PROGRAM AND GUIDANCE REGARDING SEQUESTRATION FOR MEDICARE AND THE NIH. STAFF WORKED ON THE FY2014 BUDGET; FY 2014 MEDICARE INPATIENT PROSPECTIVE PAYMENT SYSTEM (PPS) PROPOSED RULE; CY2014 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (HOPPS)/AMBULATORY SURGICAL CENTERS (ASC) PROPOSED RULE AND THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE. THEY ALSO WORKED ON TAX REFORM REGARDING INVESTMENT TAX CREDITS AND MEDICARE PHYSICIAN PAYMENTS INCLUDING ADJUSTMENTS AND POSSIBLE REPEAL OF THE SUSTAINABLE GROWTH RATE (SGR). STAFF ALSO WORKED ON MANY OF THE FY 2014 APPROPRIATIONS BILLS AND PROPOSED LEGISLATION AND REGULATIONS THAT WERE INTRODUCED, INCLUDING DEPARTMENT OF DEFENSE; DEPARTMENT OF HEALTH AND HUMAN SERVICES; AND VETERANS AFFAIRS (VA) RESEARCH AND MEDICAL CARE FUNDING; THE "TRAINING TOMORROW'S DOCTORS TODAY ACT" (HR 1201), THE "RESIDENT PHYSICIAN SHORTAGE REDUCTION ACT OF 2013" (S577), THE "MEDICARE AUDIT IMPROVEMENT ACT" (HR 1250, S 1-12); THE "DSH REDUCTION RELIEF ACT" (HR 1920)AND THE "FAIRNESS IN HEALTH CARE CLAIMS, GUIDANCE AND INVESTIGATIONS ACT" (HR 2931). THE OFFICE ASSISTED WITH THE FOLLOWING: (1) IRS PROPERTY-TAX EXEMPTIONS FOR NONPROFITS GUIDELINES AND COMMUNITY BENEFITS ANALYSIS; (2) NIH APPROPRIATIONS AND FUNDING FOR HEALTH PROFESSIONS; (3) DELAY OF THE COMPLIANCE DATE FOR ICD-10-CM AND ICD-10-PCS MEDICAL DATA CODE SETS; AND (4) PATENTS AND INTELLECTUAL PROPERTY ISSUES. AT THE STATE LEVEL, EFFORTS WERE CONCENTRATED ON FUNDING FOR THE WAKE FOREST INSTITUTE FOR REGENERATIVE MEDICINE; LEGISLATION REGARDING ADDITIONAL FUNDING FOR AUTOPSIES; THE FEDERALLY RUN INSURANCE EXCHANGE AND MEDICAID EXPANSION UNDER THE AFFORDABLE CARE ACT; THE FY 2014-5 MEDICAID BUDGET, THE MEDICAID REIMBURSEMENT INITIATIVE AND UPPER PAYMENT LIMIT PROVISIONS; ON LEGISLATION REGARDING CERTIFICATE-OF-NEED LAWS, BUSINESS INCENTIVE TAX LAWS, INCLUDING THE MILL TAX CREDIT FOR THE PIEDMONT TRIAD RESEARCH PARK; MENTAL HEALTH ISSUES, TRANSPARENCY AND REFORMING THE TAX CODE INCLUDING SALES TAX REFUND PROTECTION PROVISIONS. PART II-B, LINE 1J - PRORATA PORTION OF DUES PAID TO STATE AND LOCAL 501(C)(6) ORGANIZATIONS THAT REPRESENTS LOBBYING ON BEHALF OF ITS MEMBERS.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance8088305BeginningOfYearBalance
Contributions616961Contributions
Investment Earnings Or Losses185112InvestmentEarningsOrLosses
Other Expenditures4121974OtherExpenditures
End Of Year Balance4768404EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance7303928BeginningOfYearBalance
Contributions1221778Contributions
Investment Earnings Or Losses-65209InvestmentEarningsOrLosses
Grants Or Scholarships124978GrantsOrScholarships
Other Expenditures709300OtherExpenditures
Administrative Expenses-462086AdministrativeExpenses
End Of Year Balance8088305EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5383158BeginningOfYearBalance
Contributions841681Contributions
Investment Earnings Or Losses576477InvestmentEarningsOrLosses
Grants Or Scholarships113868GrantsOrScholarships
Other Expenditures738112OtherExpenditures
Administrative Expenses-1354592AdministrativeExpenses
End Of Year Balance7303928EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5437445BeginningOfYearBalance
Contributions446548Contributions
Investment Earnings Or Losses259105InvestmentEarningsOrLosses
Grants Or Scholarships110679GrantsOrScholarships
Other Expenditures649261OtherExpenditures
End Of Year Balance5383158EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4470108BeginningOfYearBalance
Contributions117064Contributions
Investment Earnings Or Losses-780842InvestmentEarningsOrLosses
Other Expenditures17979OtherExpenditures
Administrative Expenses-1649094AdministrativeExpenses
End Of Year Balance5437445EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.41340PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.58660TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis12409538OtherCostOrOtherBasis
Book Value12409538BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis681801862OtherCostOrOtherBasis
Depreciation416279094Depreciation
Book Value265522768BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis393730OtherCostOrOtherBasis
Depreciation93844Depreciation
Book Value299886BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis556678663OtherCostOrOtherBasis
Depreciation381076068Depreciation
Book Value175602595BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis199803709OtherCostOrOtherBasis
Depreciation10034622Depreciation
Book Value189769087BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings643603874TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
OTHER LIABILITIES$33,312,862
PENSION LIABILITIES$14,478,459
CAPITAL LEASE$1,588,734
FieldValueIRS element (for citing)
Total Of Amounts49380055TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE HOSPITAL'S ENDOWMENT FUNDS ARE USED TO PROVIDE SUPPORT FOR EDUCATION, SCHOLARSHIPS, INDIGENT CARE, AND OTHER DEPARTMENTAL FUNDING.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:THE ORGANIZATION HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS FISCAL YEARS ENDED JUNE 30, 2013 AND 2012, INCLUDING A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2013 AND 2012.

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCENTRAL AMERICA AND THE CARIBBEANRegion
Number Of Offices0NumberOfOffices
Number Of Employees0NumberOfEmployees
Type Of Activities ConductedINVESTMENTSTypeOfActivitiesConducted
Total Expenditures65020409TotalExpenditures
FieldValueIRS element (for citing)
Subtotal Number Of Offices0SubtotalNumberOfOffices
Subtotal Number Of Employees0SubtotalNumberOfEmployees
Cont Number Of Offices0ContNumberOfOffices
Cont Number Of Employees0ContNumberOfEmployees
Total Number Of Offices0TotalNumberOfOffices
Total Number Of Employees0TotalNumberOfEmployees
Subtotal Amount Spent65020409SubtotalAmountSpent
Cont Amount Spent0ContAmountSpent
Total Amount Spent65020409TotalAmountSpent
Transfer To Foreign Corp1TransferToForeignCorp
Interest In Foreign Trust0InterestInForeignTrust
Own Foreign Corp1OwnForeignCorp
Passive Foreign Invest Co0PassiveForeignInvestCo
Foreign Partnership0ForeignPartnership
Boycott Countries0BoycottCountries

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense52840837TotalCommunityBenefitExpense
Direct Offsetting Revenue7148924DirectOffsettingRevenue
Net Community Benefit Expense45691913NetCommunityBenefitExpense
Percent Of Total Expense0.03620PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense213271887TotalCommunityBenefitExpense
Direct Offsetting Revenue221113529DirectOffsettingRevenue
Net Community Benefit Expense-7841642NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense27741302TotalCommunityBenefitExpense
Direct Offsetting Revenue18462791DirectOffsettingRevenue
Net Community Benefit Expense9278511NetCommunityBenefitExpense
Percent Of Total Expense0.00740PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense293854026TotalCommunityBenefitExpense
Direct Offsetting Revenue246725244DirectOffsettingRevenue
Net Community Benefit Expense47128782NetCommunityBenefitExpense
Percent Of Total Expense0.04360PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense2150873TotalCommunityBenefitExpense
Net Community Benefit Expense2150873NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense70673253TotalCommunityBenefitExpense
Direct Offsetting Revenue21482929DirectOffsettingRevenue
Net Community Benefit Expense49190324NetCommunityBenefitExpense
Percent Of Total Expense0.03900PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1504434TotalCommunityBenefitExpense
Net Community Benefit Expense1504434NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense13346735TotalCommunityBenefitExpense
Net Community Benefit Expense13346735NetCommunityBenefitExpense
Percent Of Total Expense0.01060PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense876907TotalCommunityBenefitExpense
Net Community Benefit Expense876907NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense88552202TotalCommunityBenefitExpense
Direct Offsetting Revenue21482929DirectOffsettingRevenue
Net Community Benefit Expense67069273NetCommunityBenefitExpense
Percent Of Total Expense0.05320PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense382406228TotalCommunityBenefitExpense
Direct Offsetting Revenue268208173DirectOffsettingRevenue
Net Community Benefit Expense114198055NetCommunityBenefitExpense
Percent Of Total Expense0.09680PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense105489TotalCommunityBuildingExpense
Net Community Building Expense105489NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense270326TotalCommunityBuildingExpense
Net Community Building Expense270326NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense248782TotalCommunityBuildingExpense
Net Community Building Expense248782NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense624597TotalCommunityBuildingExpense
Net Community Building Expense624597NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$28,000,801BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare376979402AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare440408271CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-63428869MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTH CAROLINA BAPTIST HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1MEDICAL CENTER BLVDAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27157ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NORTH CAROLINA BAPTIST HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities1OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed0AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Other FactorsXOtherFactors
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities30NumberOfOtherFacilities

Other Facilities OtherFacilities (30 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
STRATFORD EXECUTIVE PARK ABDOMINAL ORGAN
140 CHARLOIS BOULEVARDWINSTONSALEMNC271031522ABDOMINAL ORGAN TRANSPLANT PROGRAM
DOWNTOWN HEALTH PLAZA
1200 N MARTIN LUTHER KING JR DRIVEWINSTONSALEMNC271013006FAMILY MEDICINE
WAKE FOREST UNIVERSITY BAPTIST IMAGING
265 EXECUTIVE PARK BLVDWINSTONSALEMNC27103IMAGING CENTER
WINSTON EAST PEDIATRICS
2295 EAST 14TH STREETWINSTONSALEMNC271056804PEDIATRICS
STRATFORD EXECUTIVE PARK INTERNAL MEDICI
500 SHEPHARD STREET SUITE 300WINSTONSALEMNC271031633IM MULTISPECIALTY CLINICS
MEDICAL PLAZA COUNTRY CLUB DERMATOLOGIC
4618 COUNTRY CLUB ROADWINSTONSALEMNC271043520GENERAL DERMATOLOGY
MEDICAL PLAZA COUNTRY CLUB GENERAL DERMA
4618 COUNTRY CLUB ROADWINSTONSALEMNC271043520DERMATOLOGIC SURGERY
STRATFORD EXECUTIVE PARK OBGYN
500 SHEPHARD STREET SUITE 201WINSTONSALEMNC271031633OB/GYN
WAKE FOREST BAPTIST HEALTH FAMILY MEDICI
1920 W FIRST STREETWINSTONSALEMNC271044220FAMILY MEDICINE
STRATFORD EXECUTIVE PARK MATERNAL-FETAL
500 SHEPHARD STREET SUITE 200WINSTONSALEMNC271031633MATERNAL-FETAL MEDICINE
NCBH OUTPATIENT ENDOSCOPY CENTER LLC
100 CHARLOIS BLVD SUITE 100WINSTONSALEMNC27103OUTPATIENT ENDOSCOPY
MEDICAL PLAZA COUNTRY CLUB - JOSLIN ADUL
4610 COUNTRY CLUB ROADWINSTONSALEMNC271043520ADULT DIABETES CENTER
MEDICAL PLAZA COUNTRY CLUB - JOSLIN PEDI
4610 COUNTRY CLUB ROADWINSTONSALEMNC271043520PEDIATRIC DIABETES CENTER
MEDICAL PLAZA COUNTRY CLUB - UNIVERSITY
4614 COUNTRY CLUB ROADWINSTONSALEMNC271043520INTERNAL MEDICINE
MEDICAL PLAZA COUNTRY CLUB - CARDIOLOGY
4614 COUNTRY CLUB ROADWINSTONSALEMNC271043520CARDIOLOGY
MEDICAL PLAZA COUNTRY CLUB - WEIGHT MANA
4614 COUNTRY CLUB ROADWINSTONSALEMNC271043520WEIGHT MANAGEMENT
MEDICAL PLAZA CLEMMONS - BLDG 2311 GENER
2311 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012PEDIATRICS
MEDICAL PLAZA CLEMMONS - BLDG 2311 SPECI
2311 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012PEDIATRIC SPECIALTIES
MEDICAL PLAZA CLEMMONS - BLDG 2311 IMPR
2311 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012INTERNAL MEDICINE & PRIMARY CARE
MEDICAL PLAZA CLEMMONS - BLDG 2311 ALLER
2311 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012ALLERGY, ASTHMA & IMMUNOLOGY
MEDICAL PLAZA CLEMMONS - BLDG 2311 HEMO
2311 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012ONCOLOGY
COMP REHAB
131 MILLER STREETWINSTONSALEMNC27103REHABILITATION
MEDICAL PLAZA CLEMMONS - BLDG 2341
2341 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012BREAST CARE SERVICES
MEDICAL PLAZA CLEMMONS - BLDG 2341
2341 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012ENT/HEAD AND NECK SURGERY - CLEMMONS
MT AIRY HEMATOLOGY & ONCOLOGY
450 PRICE STREETMT AIRYNC27030HEMATOLOGY AND ONCOLOGY
MEDICAL PLAZA CLEMMONS - BLDG 2341
2341 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012NEUROLOGY - CLEMMONS
MEDICAL PLAZA CLEMMONS - BLDG 2341
2341 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012OB/GYN
PAIN CENTER BROOKSTOWN
605 COTTON STREETWINSTONSALEMNC27101PAIN CLINIC AND SERVICES
MEDICAL PLAZA CLEMMONS - BLDG 2341
2341 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012SPINE CENTER - CLEMMONS
MEDICAL PLAZA CLEMMONS - BLDG 2341
2341 LEWISVILLE-CLEMMONS ROADCLEMMONSNC27012VEIN SERVICES - CLEMMONS

Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: THE ORGANIZATION ALSO EVALUATES CERTAIN CREDIT FILE DATA ELEMENTS TO IDENTIFY 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 COMMERCIAL 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 7B MEDICAID DIRECT OFF SETTING REVENUETHE HOSPITAL PARTICIPATES IN A PROVIDER ASSESSMENT PROGRAM ADMINISTERED BY THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES. UNDER THE PROGRAM, A FEE IS ASSESSED AGAINST NON-MEDICAID NET PATIENT SERVICE REVENUES OF PRIVATE HOSPITALS. THE FEDERAL GOVERNMENT MATCHES THE ASSESSMENT ON A 2 TO 1 BASIS AND THESE AMOUNTS ARE ALLOCATED TO NORTH CAROLINA HOSPITALS ON A QUARTERLY BASIS.
PART I, L7 COL(F): THE ORGANIZATION'S PATIENT BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $73,332,237 FOR THE FISCAL YEAR ENDED JUNE 30, 2013. THIS AMOUNT HAS BEEN REMOVED FROM THE CALCULATION OF CHARITY CARE FOR PART I, LINE 7.
PART II: THE HOSPITAL IS RESPONSIVE TO THE COMMUNITIES IT SERVES THROUGH A NUMBER OF ACTIVITIES, PROGRAMS AND INITIATIVES. THE HOSPITAL IS CURRENTLY ALIGNED WITH THE FORSYTH COUNTY HEALTH DEPARTMENT AND LEADS AND/OR PARTICIPATES IN A WIDE VARIETY OF PARTNERSHIPS AND LOCAL COALITIONS. THESE INCLUDE THE BE HEALTH- OBESITY COALITION, HEAT- HEALTH DISPARITIES AND THE CHRONIC DISEASE COALITION. COLLECTIVELY THESE COALITIONS ARE TASKED WITH IMPROVING THE HEALTH STATUS OF THE COMMUNITIES THEY SERVE WITH A SPECIFIC FOCUS ON CHRONIC DISEASE, PHYSICAL ACTIVITY/ NUTRITION AND TOBACCO USE. SPECIFICALLY, THE COALITIONS ARE WORKING COLLABORATIVELY TO 1) REDUCE THE CARDIOVASCULAR DISEASE MORTALITY RATE, 2) DECREASE THE INCIDENCE OF DIABETES, 3) INCREASE THE PERCENTAGE OF ADULTS REPORTING GOOD, VERY GOOD OR EXCELLENT HEALTH, 4) INCREASE THE PERCENTAGE OF HIGH SCHOOL STUDENTS WHO ARE NEITHER OVERWEIGHT NOR OBESE, 5) INCREASE THE PERCENTAGE OF ADULTS WHO REPORT THAT THEY CONSUME FRUITS AND VEGETABLES FIVE OR MORE TIMES PER DAY, 6) INCREASE THE PERCENTAGE OF ADULTS GETTING THE RECOMMENDED AMOUNT OF PHYSICAL ACTIVITY, AND 7) DECREASE THE PERCENTAGE OF HIGH SCHOOL STUDENTS REPORTING CURRENT USE OF ANY TOBACCO PRODUCT. THE HOSPITAL IS SPECIFICALLY RESPONSIVE TO THE CHRONIC HEALTH NEEDS OF THE COMMUNITY BY PROVIDING FREE CARE TO ITS RESIDENTS AND PROVIDES $4 MILLION IN SUBSIDY FUNDING FOR THE DOWNTOWN HEALTH PLAZA, A LEVEL 3 NCQA SITE AND NATIONAL HEALTH SERVICE CORP SITE. DOWNTOWN HEALTH PLAZA SERVES APPROXIMATELY 65,000 PATIENT VISITS PER YEAR INCLUDING 28,000 ADULTS, 29% OF WHICH ARE SELF-PAY; 19,000 ARE OB/GYN PATIENTS, 51% ARE SELF-PAY; AND 18,000 PEDIATRIC PATIENTS, 3% OF WHICH ARE SELF-PAY. MANY OF THE SELF-PAY PATIENTS ARE MANAGING CHRONIC DISEASES SUCH AS DIABETES, KIDNEY FAILURE AND HEART FAILURE, AND DHP PROVIDES CARE AND COUNSELING AT NO COST FOR THESE CONDITIONS. SPECIFICALLY DHP PROVIDES SIGNIFICANT BENEFIT TO THE COMMUNITY THROUGH THE FOLLOWING INITIATIVES: COLLABORATION WITH NORTHWEST COMMUNITY CARE NETWORK THROUGH ONSITE PEDIATRIC AND INTERNAL MEDICINE CASE MANAGERS; AS A PARTICIPATING WIC SITE; PROVIDES A COMMUNITY GARDEN PROVIDING FRESH VEGETABLES AND HERBS TO PATIENTS; PROVIDES A FREE FOOD PANTRY TO PATIENTS; OFFERS A CO-LOCATED MENTAL HEALTH COUNSELOR FOR CHILDREN IN PARTNERSHIP WITH THE CHILDREN'S HOME; AND A CO-LOCATED PARENT EDUCATOR PROGRAM IN PARTNERSHIP WITH IMPRINTS TO HELP FAMILIES ADDRESS DEVELOPMENTAL DELAYS. DHP ALSO COORDINATES WITH NORTHWEST COMMUNITY CARE NETWORK AND CENTERPOINT TO PROVIDE AN INNOVATIVE COMPREHENSIVE CARE MANAGEMENT FOR A HIGH RISK POPULATION (INCLUSIVE OF THE UNINSURED) THROUGH AN INTENSIVE CARE COORDINATION PROGRAM (HIGHER RISK FOR READMISSIONS AND ED VISITS). DHP ALSO PROVIDES AN ANNUAL SHARE THE HEALTH FREE HEALTH FAIR, PROVIDING FREE HEALTH SCREENINGS AND OTHER HEALTH-RELATED SERVICES AVAILABLE TO EVERYONE (ADULTS AND CHILDREN) REGARDLESS OF AGE, INSURANCE COVERAGE, AND INCOME LEVEL OR IMMIGRATION STATUS. THE HEALTH FAIR SERVES APPROXIMATELY 650 CHILDREN AND ADULTS ON AN ANNUAL BASIS. THE HOSPITAL ALSO PROVIDES A NUMBER OF PUBLIC EDUCATIONAL PROGRAMS THROUGH BEST HEALTH. BEST HEALTH IS THE COMMUNITY WELLNESS OUTREACH PROGRAM OF WAKE FOREST BAPTIST HEALTH AND IN FY 2013 IT PROVIDED 18 SUPPORT GROUP SESSIONS PRIMARILY FOR STROKE AND OBESE PATIENTS, 28 NUTRITION/HEALTHY COOKING CLASSES, 32 EXERCISE CLASSES FOR HEART/VASCULAR PATIENTS, AND 16 HEART HEALTH SCREENING IN THE COMMUNITY. BRENNER FIT (FAMILIES IN TRAINING) HAS THE LONGEST TRACK RECORD AND THE MOST EXPERIENCE IN PROVIDING PREVENTION AND TREATMENT PROGRAMS FOR OVERWEIGHT AND OBESE POPULATIONS IN THE HOSPITAL'S SERVICE AREA. OVER THE PAST FIVE YEARS, BRENNER FIT HAS ACCOMPLISHED THE FOLLOWING:- PROVIDED TREATMENT FOR MORE THAN 500 CHILDREN THROUGH THE BRENNER FIT CLINIC, MANY OF WHOM ARE UNINSURED/UNDERINSURED, REPRESENTING APPROXIMATELY 2000 DIFFERENT FAMILY MEMBERS FROM OUR COMMUNITY; - GAVE OVER 150 COMMUNITY PRESENTATIONS, REACHING AN ESTIMATED AUDIENCE OF 25,000; - PUBLISHED 30 JOURNAL ARTICLES, RESEARCH PAPERS AND BOOK CHAPTERS, AND HAVE BEEN REPRESENTED IN MULTIPLE ON-LINE MEDICAL RESOURCES;- PRESENTED OVER 60 TIMES TO ACADEMIC OR CLINICAL AUDIENCES;- FEATURED OVER 80 TIMES IN REGIONAL AND NATIONAL MEDIA;- TRAINED 15 STUDENTS, FELLOWS, AND INTERNS, IN ADDITION TO DEVELOPING A MEDICAL STUDENT WORKSHOP;AND-DEVELOPED 22 NEW PROGRAMS FOCUSED ON CHILDHOOD OBESITY PREVENTION AND TREATMENT.AS A HEART AND VASCULAR CENTER OF EXCELLENCE, THE HOSPITAL ALSO SPONSORS SEVERAL HEART RELATED SCREENINGS EACH YEAR INCLUDING FREE EKG SCREENINGS, HEART HEALTH TALKS, FREE COMMUNITY CPR CLASSES AND HEART AND STROKE PREVENTION CLASSES AT COUNTY GOVERNMENT WORKSITES. FINALLY, AS A CANCER CENTER OF EXCELLENCE AND AN NCI DESIGNATED CANCER CENTER, OUTREACH TO THE COMMUNITY IS A VITAL COMPONENT TO SERVING PATIENTS AND FAMILIES. OUTREACH AND COLLABORATIONS INCLUDE ANNUAL SKIN CANCER SCREENINGS , NUTRITION CLASSES, COORDINATION WITH THE BE HEALTHY COALITION TO ENCOURAGE PHYSICAL ACTIVITY AMONG ALL FORSYTH COUNTY RESIDENTS THROUGH A TWO-MONTH PROGRAM WITH STEP UP FORSYTH, A FREE COMMUNITY WIDE PROGRAM COLLABORATION WITH THE YMCA, A 6 WEEK CHRONIC DISEASE MANAGEMENT WORKSHOP , FREE YOGA FOR BREAST CANCER PATIENTS AND SURVIVORS, AS WELL AS SEVERAL FREE LUNCH AND LEARN WORKSHOPS ON CANCER AWARENESS AND PREVENTION.CURRENTLY THE HOSPITAL IS AN ACTIVE PARTICIPANT IN THE FORSYTH BEHAVIORAL HEALTH COALITION WHICH INCLUDES REPRESENTATIVES FROM WAKE FOREST BAPTIST MEDICAL CENTER, FORSYTH MEDICAL CENTER, CENTERPOINT AND NORTHWEST COMMUNITY CARE NETWORK (NCCN). THE COALITION IS ACTIVELY WORKING WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION ON A COMPREHENSIVE PLAN TO TAKE TO THE NORTH CAROLINA STATE LEGISLATURE WITH THE FOLLOWING PRIORITIES:- DEVELOPMENT AND OBTAIN FUNDING FOR A COUNTY ED CRISIS INTERVENTION PROGRAM, AS THERE IS NO CURRENT CRISIS INTERVENTION SUPPORT IN FORSYTH OR SURROUNDING COUNTIES; AND- OBTAIN LEGISLATIVE SUPPORT FOR A WET SHELTER PROGRAM.THE COALITION IS ALSO WORKING TO ENSURE THAT WE HAVE STRUCTURES AND PROCESSES IN PLACE TO IMPROVE THE PATIENT FLOW AND TO ELIMINATE DUPLICATION OF SERVICES. LASTLY, NCCN IS WORKING WITH CENTERPOINT TO ENSURE THE BIDIRECTIONAL FLOW OF ELECTRONIC INFORMATION.
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: THE HOSPITAL USES AN OVERALL COST TO CHARGE RATIO CALCULATION BASED ON AUDITED FINANCIAL STATEMENTS BUT REMOVES COST ASSOCIATED WITH BAD DEBT, GME, COMMUNITY BUILDING, AND CHARITY CARE SO AS NOT TO COUNT THOSE COSTS TWICE.
PART III, LINE 9B: PATIENT FINANCIAL RESOURCES SERVICES WORKS WITH THE PATIENT FOR ANY PATIENT LIABILITY. OUR MAIN FOCUS IS PRIOR TO SERVICESAND/OR DISCHARGE; HOWEVER, WE DO WORK WITH PATIENTS AFTER SERVICES HAVEBEEN RECEIVED AND BILLED. PATIENT FINANCIAL RESOURCES SERVICES IS REALLYTWO AREAS IN ONE--THE RESOURCE RECOVERY SPECIALIST/RRS (FORMERLY FINANCIALCOUNSELING) AND THE MEDICAID ELIGIBILITY TEAM/MPS. THESE TWO AREAS WORKTOGETHER TO FIND A RESOLUTION TO PATIENT LIABILITY, SELF PAY OR INSURED.THE RRS WORKS TO NOTIFY THE PATIENT OF ANY PATIENT LIABILITY AND ASK FORPAYMENT FOR THAT LIABILITY. IF THE PATIENT INDICATES THAT HE/SHE NEEDSASSISTANCE, THEN THE RRS WILL COMPLETE A FINANCIAL STATEMENT ON THEPATIENT. WHILE TAKING THAT FINANCIAL STATEMENT THE RRS IS LOOKING FORINFORMATION THAT COULD QUALIFY THE PATIENT FOR MEDICAID OR FOR OTHERAGENCY PROGRAMS THAT ARE AVAILABLE TO THE MEDICAL CENTER. WHEN THATINFORMATION IS IDENTIFIED THE RRS WILL LET THE PATIENT KNOW THAT AREFERRAL WILL BE MADE FOR MEDICAID OR OTHER ASSISTANCE AND A MPS WILL BEIN TOUCH WITH HIM/HER. THE RRS ALSO EXPLAINS TO THE PATIENT OR FAMILY THATCHARITY CARE IS A LAST RESORT AND THEY MUST COOPERATE WITH ANY OTHERASSISTANCE PROGRAMS THAT WE HAVE IDENTIFIED AND BE FOUND INELIGIBLE BEFORECHARITY CARE WILL BE APPROVED/APPLIED. IT IS ALSO COMMUNICATED WITH THEPATIENT 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: COMMUNITY INPUT WAS OBTAINED THROUGH THREE SOURCES OF PRIMARY DATA COLLECTION; (1) DOOR TO DOOR SURVEY; (2) NINE FOCUS GROUPS WITH UNDERSERVED, LOW INCOME AND MINORITY COMMUNITIES; AND (3) A YOUTH RISK BEHAVIOR SURVEY. THE HOSPITAL WORKED WITH PUBLIC HEALTH EXPERTS FROM THE FORSYTH COUNTY DEPARTMENT OF HEALTH AND FORTY ONE COMMUNITY LEADERS REPRESENTING THE FAITH COMMUNITY, PRIVATE BUSINESS, HEALTHCARE, HIGHER EDUCATION, PUBLIC SAFETY, SOCIAL SERVICES, MENTAL HEALTH, GOVERNMENT AND PRIVATE AND PUBLIC FOUNDATIONS.NORTH CAROLINA BAPTIST HOSPITAL
PART V, SECTION B, LINE 4: THE HOSPITAL'S CHNA WAS CONDUCTED IN COLLABORATION WITH FORSYTH MEMORIAL HOSPITAL (DBA FORSYTH MEDICAL CENTER), A TAX-EXEMPT HOSPITAL IN FORSYTH COUNTY.NORTH CAROLINA BAPTIST HOSPITAL
PART V, SECTION B, LINE 5C: THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CHNA IMPLEMENTATION STRATEGY CAN BE LOCATED ON ITS WEBSITE AT WWW.WAKEHEALTH.EDU/COMMUNITY-HEALTH.HTM. IN ADDITION, A COPY OF THE HOSPITAL'S CHNA IS AVAILABLE AT THE FORSYTH COUNTY HEALTH DEPARTMENT.NORTH CAROLINA BAPTIST HOSPITAL
PART V, SECTION B, LINE 7: MATERNAL AND INFANT HEALTH WAS NOT INCLUDED IN THE HOSPITAL'S TOP PRIORITIZED HEALTH NEEDS BECAUSE THE HOSPITAL DOES NOT DELIVER BABIES, EXCEPT IN EMERGENCY SITUATIONS. FORSYTH MEMORIAL HOSPITAL IS THE PRIMARY PROVIDER OF MATERNITY SERVICES IN THE COMMUNITY.NORTH CAROLINA BAPTIST HOSPITAL
PART V, SECTION B, LINE 10: THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE CARE. INDIVIDUALS AT OR BELOW 200% OF THE FEDERAL PROVERTY GUIDELINES ARE ELIGIBLE FOR FREE CARE. THE ORGANIZATION EVALUATES CERTAIN CREDIT FILE DATA ELEMENTS TO IDENTIFY 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 COMMERCIAL CREDIT ACCOUNTS THAT ARE BEING SERVICED IN A MANNER THAT SUGGESTS ADDITIONAL SOURCES OF INCOME, ARE NOT AUTOMATICALLY GRANTED PRESUMPTIVE CHARITY CARE.NORTH CAROLINA BAPTIST HOSPITAL
PART V, SECTION B, LINE 11: THE ORGANIZATION USES A SLIDING SCALE OF THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE. INDIVIDUALS BETWEEN 201% AND 300% OF THE FEDERAL POVERTY GUIDELINES ARE GRANTED A 75% DISCOUNT AND INDIVIDUALS BETWEEN 301% AND 400% OF THE FEDERAL PROVERTY GUIDELINES ARE GRANTED A 60% DISCOUNT.NORTH CAROLINA BAPTIST HOSPITAL
PART V, SECTION B, LINE 12H: RESIDENT OF THE MEDICAL CENTER'S 19 COUNTY SERVICE AREA.NORTH CAROLINA BAPTIST HOSPITAL
PART VI, LINE 2: TO COMPLETE A COMPREHENSIVE ASSESSMENT OF THE NEEDS OF THE COMMUNITY, AN INTERNAL COMMUNITY HEALTH TEAM RELIED ON THE ASSOCIATION FOR COMMUNITY HEALTH IMPROVEMENT'S (ACHI) 6-STEP COMMUNITY HEALTH ASSESSMENT PROCESS ALONG WITH PARTICIPATION IN THE NORTH CAROLINA DIVISION OF PUBLIC HEALTH ASSESSMENT PROCESS AS ORGANIZING METHODOLOGIES. A COMMUNITY WIDE TEAM COMPRISED OF THE FORSYTH COUNTY HEALTH DEPARTMENT, WAKE FOREST BAPTIST MEDICAL CENTER, FORSYTH MEDICAL CENTER AND VARIOUS COMMUNITY GROUPS INCLUDING THE UNITED WAY, THE YMCA, YWCA AND THE COUNTY GOVERNMENT AMONG MANY OTHERS HAS CONVENED TO CONDUCT A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS WITH INPUT FROM KEY COMMUNITY LEADERS, THE ACADEMIC COMMUNITY, THE SCHOOL DISTRICT, THE PUBLIC AND OTHERS. FOUNDED ON THE PRINCIPLES OF COLLABORATION, COMMUNITY MOBILIZATION AND EMPOWERMENT, THE COMMUNITY HEALTH ASSESSMENT PROCESS IS USED TO IDENTIFY PRIORITY HEALTH ISSUES AND TO PLAN INTERVENTIONS TO BUILD HEALTHIER COMMUNITIES WITH THE ULTIMATE GOAL OF MAKING NORTH CAROLINA, INCLUDING FORSYTH COUNTY, ONE OF THE HEALTHIEST STATES IN THE NATION. TO ENSURE A COMPLETE ASSESSMENT, THE HOSPITAL'S INTERNAL TEAM HAS ADOPTED THE ACHI PROCESS TO ENSURE BOTH PUBLIC HEALTH AND THE NEWLY REQUIRED COMMUNITY HEALTH NEEDS ASSESSMENT REQUIREMENTS INCLUDED IN THE AFFORDABLE CARE ACT WOULD BE MET. THE ASSESSMENT PROCESS CONSISTS OF COLLECTING PRIMARY AND SECONDARY DATA FOR EACH OF THE FOLLOWING COMPONENTS: A) COMMUNITY PERSPECTIVE B) HEALTH EXPERTS C) COMMUNITY LEADERS D) SOCIAL DETERMINANTS OF HEALTH (SDOH) E) HEALTH STATISTICS/INDICATORS F) WFBMC DATA-ED AND INPATIENT CHRONIC DISEASE DATA
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: IN FISCAL YEAR 2013, THE MEDICAL CENTER PROVIDED CARE TO A NINETEEN COUNTY SERVICE AREA WHICH COMPRISES 3.5% OF TOTAL INPATIENT DISCHARGES FOR NORTH CAROLINA. THE PRIMARY AND SECONDARY SERVICE AREA INCLUDE:PRIMARY SERVICE AREA COUNTIES - FORSYTH, DAVIE, DAVIDSON, STOKES, SURRY, YADKINSECONDARY SERVICE AREA COUNTIES - ROCKINGHAM, GUILFORD, RANDOLPH, ROWAN, IREDELL, CATAWBA, ALEXANDER, WILKES, ALLEGHANY, ASHE, WATAUGA, CALDWELL, BURKE PERCENT OF UNINSURED INPATIENTS 7.3%PERCENT OF INPATIENTS WHO ARE MEDICAID RECIPIENTS 20.4%THE HOSPITAL IS LOCATED IN CENTRAL FORSYTH COUNTY, WHICH COMPRISES THE SINGLE LARGEST COUNTY IN TOTAL INPATIENT DISCHARGES, ACCOUNTING FOR 13,142 OR 29.6% OF ALL DISCHARGES IN FY 13. ACCORDINGLY, THE HOSPITAL SERVES A WIDE SERVICE AREA; HOWEVER, IT IS RESOURCE PROHIBITIVE TO PARTICIPATE AND FUND HEALTH ASSESSMENTS IN EACH COMMUNITY/COUNTY FROM WHICH ITS PATIENT POPULATION ORIGINATES. THEREFORE, THE PRIMARY COMMUNITY BENEFIT SERVICE AREA (CBSA)IS FORSYTH COUNTY, NORTH CAROLINA.BELOW IS A DEMOGRAPHIC SNAPSHOT OF FORSYTH COUNTY BASED ON 2010 CENSUS DATA: POPULATION AND GEOGRAPHY TOTAL POPULATION 350,670POPULATION CHANGE SINCE 2000 + 12.7%LAND AREA 408.1 SQUARE MILESPOPULATION DENSITY 859.5 PERSONS PER SQUARE MILE POPULATION BY RACE/ETHNICITYWHITE 58.7%BLACK/AFRICAN-AMERICAN 25.5%HISPANIC 11.9%ASIAN 1.8%AMERICAN INDIAN/ 0.3%ALASKA NATIVE NATIVE HAWAIIAN/ 0.04%PACIFIC ISLANDERMULTIRACIAL 1.5%OTHER 0.2% POPULATION BY AGE DISTRIBUTIONUNDER 5 YEARS OLD 6.8%UNDER 18 YEARS OLD 24.4%= 65 YEARS OLD 13.0%MEDIAN AGE 37.5 YEARS POPULATION BY SEXMALE 47.5%FEMALE 52.5% POPULATION BY EDUCATIONAL ATTAINMENT PERCENT OF PERSONS = 25 YEARS OLD WHO HAVE:< HIGH SCHOOL DIPLOMA OR GED 13.8%A HIGH SCHOOL DIPLOMA OR GED 28.2%A BACHELOR'S DEGREE 20.7%GRADUATE DEGREE 10.0%PERCENTAGE OF FAMILIES LIVING BELOW POVERTY LEVELALL FAMILIES 11.0%FAMILIES WITH A HOUSEHOLDER WHO IS:WHITE 4.6%BLACK/AFRICAN AMERICAN 21.6%HISPANIC 31.4%ASIAN 6.6%AMERICAN INDIAN/ 17.2%OTHER RACE 34.7 PERCENTAGE OF POPULATION LIVING BELOW POVERTY LEVELCHILDREN (0-17YR OLD) 22.8%ADULTS (18-64YR OLD) 12.9%SENIORS (= 65YR OLD) 7.1% COUNTY SCHOOLSK-12 ENROLLMENT 53,627GRADUATION RATE 72.7% UNEMPLOYMENT UNEMPLOYMENT RATE 9.9%LOST JOBS & LAYOFFS 1,900 INCOMEMEDIAN FAMILY HOUSEHOLD $55,075MEDIAN NON-FAMILY HOUSEHOLD $28,023
PART VI, LINE 6: WAKE FOREST BAPTIST MEDICAL CENTER'S MISSION IS TOIMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY:1) GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREATDISEASE.2) TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE.3) SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFICCENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CAREDESTINATIONS. THE HOSPITAL, WHICH IS THE INPATIENT COMPONENT OF WAKE FOREST BAPTIST MEDICAL CENTER, OPERATES THE FOLLOWING PROGRAMS CONSTITUTING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS REPORTED ON PART I,LINE 7E:WINSTON-SALEM/FORSYTH CTY SCHOOLS'ALLIED HEALTH PROGRAM $4,889COMMUNITY HEALTH/HEALTHCARE ACCESS $1,500 CHURCH COMMUNITY RELATIONS $401,995COMMUNITY HEALTH SALARIES $343,925PHYSICIANS COMMUNITY HEALTH ACCESS $371,418CARENET/PASTORAL COUNSELING $294,399ACCELERATED BACHELOR OF SCIENCE IN NURSING PROGRAM $395,004COUNTY RENT ON CLEVELAND AVE DENTAL CLINIC $111,559DIABETIC EDUCATION $79,284BRENNER FIT $141,358FAMILY RESOURCES $5,542TOTAL TO PART I, LINE 7E: $2,150,873
NCREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (16 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
ALLIANCE FOR NORTH CAROLINA NONPROFITS
2501 BLUE RIDGE ROADRALEIGHNC27607461358968501(C)3100000COMMUNITY SUPPORT
AMERICAN HEART ASSOCIATION
101 CENTREPORT DRIVE STE 130GREENSBORONC27409135613797501(C)350000COMMUNITY SUPPORT
ARTS FOR LIFE
PO BOX 5132WINSTON SALEMNC27113562250962501(C)325000COMMUNITY SUPPORT
CANCER SERVICES
3175 MAPLEWOOD AVEWINSTON SALEMNC27103560656375501(C)310000COMMUNITY SUPPORT
EL BUEN PASTOR LATINO COMMUNITY SERVICES
4637 TIM ROADWINSTON SALEMNC27106203751959501(C)37000COMMUNITY SUPPORT
FORSYTH TECHNICAL COMMUNITY COLLEGE
2100 SILAS CREEK PARKWAYWINSTON SALEMNC27103560792614501(C)368360GREENE HALL EXPANSION
JDRF PIEDMONT TRIAD CHAPTER
312 N EUGENE STREET SUITE DGREENSBORONC27401231907729501(C)325000COMMUNITY SUPPORT
MAKE A WISH FOUNDATION
212 S TRYON ST SUITE 1080CHARLOTTENC28281860481941501(C)36000COMMUNITY SUPPORT
MARCH OF DIMES
410 BROOKSTOWN AVENUEWINSTON SALEMNC27101131846366501(C)37500COMMUNITY SUPPORT
NC TRIAD AFFILIATE - SUSAN G KOMEN FOR THE CURE
1106 BURKE STREETWINSTON SALEMNC27101751835298501(C)325000COMMUNITY SUPPORT
RONALD MCDONALD HOUSE
419 S HAWTHORNE ROADWINSTON SALEMNC27103581454715501(C)312500COMMUNITY SUPPORT
SENIOR SERVICES
2895 SHOREFIELD DRIVEWINSTON SALEMNC27105561085968501(C)330000COMMUNITY SUPPORT
THE WOMEN'S FUND OF WINSTON SALEM
860 W FIFTH STREETWINSTON SALEMNC27101566037615501(C)310000COMMUNITY SUPPORT
WINSTON SALEM FOUNDATION
860 W FIFTH STREETWINSTON SALEMNC27101566037615501(C)315000COMMUNITY SUPPORT
WS FORSYTH COUNTY SCHOOLS
PO BOX 2513WINSTON SALEMNC27102560795164GOV'T ENTITY250000COMMUNITY SUPPORT
YMCA
301 N MAIN STREETWINSTON SALEMNC27101560530015501(C)310000COMMUNITY SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants16TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (3 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrant
LETTIE PATE WHITEHEAD SCHOLARS5739500
WSSU NURSING395004
MEDICAL SCHOLARSHIPS2944689

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.:PART I, LINE 2:SCHEDULE I, PART I, LINE 2: THE HOSPITAL FOLLOWS THE MEDICAL CENTER'S CORPORATE POLICY USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE HOSPITAL MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS DISBURSED.
SCHEDULE I, PART IIIGRANTS & OTHER ASSISTANCE TO INDIVIDUALS IN THE U.S.THE HOSPITAL FOLLOWS WAKE FOREST BAPTIST MEDICAL CENTER'S POLICY USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING SCHOLARSHIPS. THE HOSPITAL MONITORS THE ACADEMIC PERFORMANCE AND OTHER ACHIEVEMENTS OF STUDENTS RECEIVING SCHOLARSHIP FUNDS TO ENSURE THAT THE SCHOLARSHIP REQUIREMENTS ARE BEING MET BY THE STUDENTS. LETTIE PATE WHITEHEAD SCHOLARSHIPS THE LETTIE PATE WHITEHEAD FOUNDATION PROVIDES SCHOLARSHIPS TO TAX-EXEMPT HOSPITALS OR INSTITUTIONS FOR THE CARE OF INDIGENT CHRISTIAN WOMEN IN SPECIFIED STATES, INCLUDING NORTH CAROLINA. THE FINANCIAL NEED IS ESTABLISHED BY THE COLLEGES THAT THE STUDENTS ATTEND. NAMES OF THE STUDENTS ARE PROVIDED TO OUR STAFF DEVELOPMENT DEPARTMENT. THE WHITEHEAD FUNDS ARE REVIEWED AND ADMINISTERED BY A FUND CUSTODIAN.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (26 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JOHN D MCCONNELL MD
TRUSTEE & CEO9980610334267038420067036802057602061692000
H GREG BRAY
ASST. TREASURER/ASST. SECR208575020988019100198310180940269398000
J MCLAIN WALLACE JR
VP GENERAL COUNSEL/SECR39118207465905081709109701918306269380313860
KAREN H HUEY
VP FACILITIES24808305542606023904965502182604352290303460
ERIC TOMLINSON
CHIEF INNOVATION OFFICER199154050000017789027667041190298729000
NORMAN D POTTER JR
VP DEVELOPMENT & ALUMNI AF279198061828072050622970215810432109000
CHERYL EH LOCKE
VP CHIEF HUMAN RESOURCES358614075494055440804190174350537506000
EDWARD G CHADWICK
EXECUTIVE VP CFO/TREASURER533120015238502446602254930210010956465000
THOMAS E SIBERT MD
PRESIDENT/COO - HEALTH SYS6900810164710030692011999602110601026585000
LISA M WYATT
VP CHIEF COMM & MARKETING292924070218023812067097080130462064000
SHEILA M SANDERS
VP CHIEF INFORMATION OFFIC3656140797000335900853970187230583024000
EDWARD ABRAHAM MD
DEAN, SCHOOL OF MEDICINE478061013688505483201583640235260851668000
BETTY PETREE
DIRECTOR NURSE ANESTHESIA212853020485017132028803085250287798000
MICHAEL RIEKER
DIRECTOR OF NURSE ANESTHES218222023626010610212930238060288008000
VANCE MCVAY JR
CLINICAL INSTRUCTOR CRNA22314300081670203780189440270632000
ERIC STIEFEL
CLINICAL INSTRUCTOR CRNA182037000111080164780175040227127000
CHARLES WARE
ASSOCIATE VP INFRASTRUCTUR196162018409062030253110137090259794000
JOANNE C RUHLAND
FORMER OFFICER234968000206750532970177260326666000
RUSSELL M HOWERTON MD
FORMER OFFICER479102010246402061201261970288160757191000
DOUGLAS L EDGETON
FORMER OFFICER786480918750436379059270137850626614000
STEVE C SNELGROVE
FORMER OFFICER26290805925005699806919701748104658340362760
RONALD H SMALL
FORMER OFFICER000024179700063550248152000
MAUREEN E SINTICH
FORMER OFFICER31575805262402234906949701758304778110119580
ROBERT S PARKER SR
FORMER OFFICER153701160520000044680122057000
DONNY C LAMBETH
FORMER OFFICER19129601343130811808027524015116011800570994320
SHARON ENGEBRETSON
FORMER OFFICER1072170277360389960198880475690241406000

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 1ACERTAIN OFFICERS RECEIVE, AS PART OF THEIR APPROVED COMPENSATION PACKAGE,TAX INDEMNIFICATION AND GROSS-UP PAYMENTS, RELOCATION ASSISTANCE INCLUDING A HOUSING ALLOWANCE, AND HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES. BELOW IS A SUMMARY OF THE BENEFITS INCLUDED IN THE OFFICERS' COMPENSATION FOR THE FISCAL YEAR ENDED JUNE 30, 2013: - TAX INDEMNIFICATION AND GROSS UP PAYMENTS - $1,486 FOR ONE FORMER OFFICER; - RELOCATION ASSISTANCE, INCLUDING A HOUSING ALLOWANCE - $117,601 FOR FOUR OFFICERS AND ONE FORMER OFFICER; AND - DUES AND INITIATION FEES - $285 FOR ONE OFFICER
PART I, LINE 3THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING AND APPROVING ALL WFUBMC OFFICERS' COMPENSATION. THE COMMITTEE UTILIZE AN INDEPENDENT, EXTERNAL COMPENSATION CONSULTANT FIRM EXPERIENCED IN HEALTH CARE AND HIGHER EDUCATION COMPENSATION THAT BASED RECOMMENDATIONS ON COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICER'S COMPENSATION. THESE COMPENSATION CONSULTANTS PRESENT TOTAL COMPENSATION COMPARABILITY DATA FOR THE POSITIONS FOR WHICH COMPENSATION IS BEING DETERMINED. THE DATA IS REVIEWED BY THE EXECUTIVE COMMITTEE OF WFUBMC'S GOVERNING BOARD AT ITS MEETING; NONE OF THE MEMBERS OF THAT COMMITTEE ARE EMPLOYEES OF THE FILING ORGANIZATION. MINUTES OF THE DELIBERATIONS OF THE COMMITTEE ARE CONTEMPORANEOUSLY RECORDED. IN THE EVENT THAT ANY MEMBER OF THE EXECUTIVE COMMITTEE HAS A CONFLICT OF INTEREST, THAT COMMITTEE MEMBER DOES NOT PARTICIPATE IN THE DELIBERATION OR APPROVAL PROCESS, AND THEIR ABSTENTION FROM THE PROCESS IS REFLECTED IN THE MINUTES.
PART I, LINES 4A-BNAME SEVERANCE NON-QUAL RETIRE RONALD H SMALL 251,360 MAUREEN E SINTICH 20,648 ROBERT S PARKER, SR. 115,769 DONNY C LAMBETH 253,846 501,126 DOUG EDGETON 423,536 JERRY M WALLACE, JR. 31,386 KAREN H HUEY 58,468 STEVEN C SNELGROVE 36,276
PART I, LINE 7OFFICERS, KEY EMPLOYEES AND FACULTY MEMBERS HAVE INCENTIVE COMPENSATION COMPONENTS CONTAINED IN THEIR EMPLOYMENT AGREEMENTS. THESE ARE OFTEN GOAL-BASED AND ARE DETERMINED IN THE COURSE OF EVALUATION OF THE INDIVIDUAL'S PERFORMANCE BY HIS/HER DEPARTMENT CHAIR, SUPERVISOR OR THE COMPENSATION COMMITTEE OF THE BOARD, AS APPLICABLE. OTHER NON-FIXED PAYMENTS MAY INCLUDE SUMS FOR RELOCATION AND/OR TEMPORARY HOUSING THAT ARE TYPICALLY INCLUDED AS A PROVISION IN THE EMPLOYMENT AGREEMENT. ALL SUCH PAYMENTS ARE REFLECTED ON THE INDIVIDUAL'S W-2.
PART IIISCHEDULE J, PART III IN JULY OF 2010, WAKE FOREST UNIVERSITY HEALTH SCIENCES (WFUHS), NORTH CAROLINA BAPTIST HOSPITAL (NCBH), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER (WFUBMC) AND WAKE FOREST UNIVERSITY (WFU)) APPROVED A MEDICAL CENTER INTEGRATION AGREEMENT THAT ALLOWS FOR THE LEVERAGING OF COMBINED RESOURCES OF NCBH AND WFUHS TO FULFILL A SINGLE MISSION OF IMPROVING HEALTH, OPTIMIZING PERFORMANCE WHILE BALANCING PATIENT CARE, EDUCATION AND RESEARCH. NCBH, WFUBMC, WFUHS AND THEIR SUBSIDIARIES HAVE COMBINED OPERATING REVENUES OF APPROXIMATELY $2 BILLION FOR THE FISCAL YEAR ENDED JUNE 30, 2013. IN GENERAL, EXECUTIVES PERFORMING KEY MANAGEMENT FUNCTIONS FOR THE MEDICAL CENTER ARE SOUGHT AND HIRED AFTER NATIONAL SEARCHES IN A HIGHLY COMPETITIVE ENVIRONMENT, AND ONLY INDIVIDUALS AT THE HIGHEST LEVELS OF ABILITY ARE HIRED AND GIVEN THE TASK OF OPTIMIZING THE EFFECTIVENESS OF THE MEDICAL CENTER AND ITS TAX-EXEMPT MISSION. CERTAIN EXECUTIVES HOLD THE IDENTICAL OFFICES/TITLES IN WFUHS, NCBH AND WFUBMC AND ARE ELIGIBLE TO RECEIVE INCENTIVE COMPENSATION AT THE END OF EACH FISCAL YEAR. THE INCENTIVE STRUCTURE IS BASED UPON GOALS ESTABLISHED BY THE EXECUTIVE COMMITTEE ON BEHALF OF THE FILING ORGANIZATION'S BOARD AT THE BEGINNING OF THE YEAR, INCLUDING MEASURES OF CLINICAL QUALITY, PATIENT SATISFACTION, AND FINANCIAL OPERATING PERFORMANCE. THE DETERMINATION OF THE AMOUNT OF INCENTIVE COMPENSATION IS SUBJECT TO THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE 990. SCHEDULE J. PART I, LINE 4 - CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE SEVERANCE PAYMENTS AND/OR PAYMENTS FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS. THE DETERMINATION OF THE AMOUNT OF THE SEVERANCE AND/OR NON-QUALIFIED RETIREMENT PLAN PAYMENTS FOLLOW THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED ABOVE AND IN PART VI, SECTION B, LINE 15 OF THE FORM 990. FORM 990, PART VII, LINE 5 - COMPENSATION FROM UNRELATED ORGANIZATION THE FOLLOWING INDIVIDUALS WERE COMPENSATED BY WAKE FOREST UNIVERSITY HEALTH SCIENCES FOR SERVICES PERFORMED FOR THE HOSPITAL. SEE PART VII AND SCHEDULE J, PART II, FOR THEIR COMPENSATION: JOHN D MCCONNELL MD JOANNE C RUHLAND NORMAN D POTTER, JR. CHERYL E.H. LOCKE EDWARD G CHADWICK THOMAS E SIBERT, MD RUSSELL M HOWERTON, MD DOUGLAS L EDGETON LISA M WYATT SHEILA M SANDERS EDWARD ABRAHAM, MD ERIC TOMLINSON, DCS, PHDSUPPLEMENTAL INFORMATION

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
NORTH CAROLINA MEDICAL CARE COMMISSION
A52130940265820HD672010-03-01334002408CURRENT REFUNDING000
NORTH CAROLINA MEDICAL CARE COMMISSION
B521309402NONEAVAIL2012-12-3180000000VARIOUS CAPITAL PROJECTS000
NORTH CAROLINA MEDICAL CARE COMMISSION
C52130940265821DMM02012-11-15122822821VARIOUS CAPITAL PROJECTS000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Bond ReferenceBondReferenceCdAmount RetiredAmountRetiredTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapital ExpendituresCapitalExpendituresAmount UnspentAmountUnspent
A25240591334002408330703733069537020101011
B80000000100000016289324617105754
C122822821248520130001122820336

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUse
A0000001
B00000010.000000.000000.00000
C01000010.000000.000000.00000

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqs
DEUTSCHE BANK AG
A0100015.00000000000000001
(no name)
B010010001
(no name)
C010000001

Form990 Schedule K Part V Form990ScheduleKPartV (3 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A1
B1
C1

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PART I, LINE A, COLUMN FCURRENT REFUNDINGTHE 2010 ISSUE CURRENTLY REFUNDED PRE 12/31/2002 ISSUES.
PART II, COLUMN A, LINE 11OTHER SPENT PROCEEDSTHE OTHER SPENT PROCEEDS LISTED ARE THE CURRENT REFUNDING PROCEEDS OF THE ISSUE.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
DAVID E BRANN
FAMILY MEMBER OF DONNY LAMBETH108782COMPENSATION0
JUDY M SLOCUM
FAMILY MEMBER OF MAUREEN SINTICH56256COMPENSATION0
MEDCOST
BOARD MEMBER EDWARD CHADWICK2130677THIRD PARTY ADMINISTRATOR0
ROBIN LEWIS
FAMILY MEMBER OF KENNETH LEWIS69438COMPENSATION0

Schedule M IRS990ScheduleM

Books And Publications BooksAndPublications

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9901735NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9905729NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F9901093NoncashContribsRptdF990

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionMEDICAL EQUIPDescription
Number Of Contributions9NumberOfContributions
Noncash Contribs Rptd F99064759NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierMETHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS:Identifier
Return ReferencePART I, COLUMN (B):ReturnReference
ExplanationTHE ORGANIZATION DETERMINES THE NUMBER OF CONTRIBUTIONS BY USING THE TOTAL NUMBER OF NON-CASH ITEMS RECEIVED PER DONOR PER OCCURANCE.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2EDWARD G. CHADWICK AND H. GREGORY BRAY HAVE A BUSINESS RELATIONSHIP THROUGH THEIR BOARD/LEADERSHIP POSITION IN MEDCOST, LLC, A JOINT VENTURE IN WHICH THE HOSPITAL HOLDS A 50% MEMBERSHIP INTEREST.
FORM 990, PART VI, SECTION A, LINE 3EFFECTIVE JULY 1, 2010, THE GOVERNING BOARDS OF FOUR NORTH CAROLINA NONPROFIT CORPORATIONS (WAKE FOREST UNIVERSITY, NORTH CAROLINA BAPTIST HOSPITAL, WAKE FOREST UNIVERSITY HEALTH SCIENCES, AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER) ENTERED INTO AN AGREEMENT (THE MEDICAL CENTER INTEGRATION AGREEMENT OR MCIA) UNDER WHICH THE OPERATION OF EACH OF NORTH CAROLINA BAPTIST HOSPITAL (NCBH) AND WAKE FOREST UNIVERSITY HEALTH SCIENCES (WFUHS) WAS DELEGATED TO WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER (WFUBMC). WFUHS IS A WHOLLY-CONTROLLED SUBSIDIARY ENTITY OF WAKE FOREST UNIVERSITY (WFU). WFUBMC IS NOW A MEMBERSHIP NONPROFIT CORPORATION WHOSE TWO EQUAL MEMBERS ARE NCBH AND WFU. THIS CONSOLIDATION OF MANAGEMENT IN WFUBMC OF THE VARIOUS ACADEMIC MEDICAL CENTER OPERATIONS, SUBJECT TO SUBSTANTIAL RESERVED POWERS IN EACH OF THE CONSTITUENT MEMBERS' (OR IN WFUHS') BOARDS, MANDATED CHANGES IN THE GOVERNANCE DOCUMENTS OF EACH ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVE A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. THE AUDIT AND COMPLIANCE COMMITTEE OF THE GOVERNING BOARD OF WFUBMC, COMPRISED OF THE AUDIT AND COMPLIANCE COMMITTEES 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 BOARD MEMBERS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS.
FORM 990, PART VI, SECTION B, LINE 12CON AN ANNUAL BASIS (AND AS THEY ARISE), ALL TRUSTEES AND OFFICERS OF THE FILING ORGANIZATION ARE ASKED TO REVIEW THE APPLICABLE CONFLICTS OF INTEREST POLICY AND TO DESCRIBE ANY POTENTIAL CONFLICTS OF INTEREST THEY MAY HAVE. UPON COMPLETION OF THE CONFLICTS OF INTEREST SURVEY, THE LEGAL DEPARTMENT REVIEWS THE COMPLETED QUESTIONNAIRES ON BEHALF OF THE FILING ORGANIZATION. ANY CONFLICTS IDENTIFIED ARE COMMUNICATED TO THE FILING ORGANIZATION'S CHAIRMAN OF THE BOARD AND ARE PRESENTED TO THE AUDIT AND COMPLIANCE COMMITTEE. ALL CONFLICTS OF INTEREST ARE RESOLVED BY MANAGEMENT PLANS DEVELOPED BY THE FILING ORGANIZATION BOARD'S AUDIT AND COMPLIANCE COMMITTEE AND THE INTERNAL AUDIT AND COMPLIANCE OFFICES. THE AUDIT AND COMPLIANCE COMMITTEE'S CHAIR PRESENTS AN ANNUAL REPORT ON CONFLICTS TO THE FULL BOARD OF THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 15THE FILING ORGANIZATION HAS DELEGATED TO THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER'S BOARD OF DIRECTORS THE FUNCTION OF THE COMPENSATION COMMITTEE OF THE BOARD OF THE FILING ORGANIZATION AND AS SUCH, THAT COMMITTEE REVIEWS AND APPROVES THE APPOINTMENT AND COMPENSATION OF THE SENIOR EXECUTIVES OF WFUHS, WFUBMC, AND THE FILING ORGANIZATION. THE EXECUTIVE COMMITTEE RELIES UPON AN EXTERNAL, INDEPENDENT COMPENSATION CONSULTANT EXPERIENCED IN HEALTHCARE TO PROVIDE THE COMMITTEE WITH COMPENSATION COMPARABILITY DATA FOR NEW EXECUTIVE POSITION APPOINTMENTS AND FOR COMPENSATION REVIEWS FOR EXISTING EXECUTIVES. THE CONSULTANT, WHICH IS RETAINED DIRECTLY BY THE EXECUTIVE COMMITTEE, PROVIDES THIRD-PARTY INFORMATION AND EVALUATES THE COMPETITIVENESS AND REASONABLENESS OF EXECUTIVE COMPENSATION AND BENEFITS PROGRAMS IN RELATION TO MARKET PRACTICES FOR SIMILARLY-SITUATED NONPROFIT HEALTHCARE ORGANIZATIONS. THE COMMITTEE MAKES ITS DECISIONS WITH RESPECT TO EXECUTIVE COMPENSATION IN ACCORDANCE WITH THE FILING ORGANIZATION'S (AND WFUHS AND NCBH) POLICIES, IRS REGULATIONS, AND STANDARD CORPORATE GOVERNANCE PRACTICES. SUCH POLICIES INCLUDE ADHERENCE TO: BOARD-ESTABLISHED EXECUTIVE COMPENSATION PHILOSOPHY AND REVIEW PROCESSES; PROCESSES ENSURING EXECUTIVE COMMITTEE MEMBER AND COMPENSATION CONSULTANT INDEPENDENCE; USE OF VALID MARKET COMPARISONS OF DATA FROM PEER ACADEMIC MEDICAL CENTERS OF SIMILAR ORGANIZATIONAL STRUCTURE, SIZE, AND COMPLEXITY; CAREFUL DOCUMENTATION OF ALL COMPENSATION DECISIONS; AND ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS, PER IRS GUIDELINES. MINUTES OF THE DELIBERATIONS OF THE EXECUTIVE COMMITTEE ARE CONTEMPORANEOUSLY MAINTAINED AND THAT COMPARABILITY DATA IS MAINTAINED IN THE MEDICAL CENTER'S OFFICE OF EXECUTIVE COMPENSATION SERVICES. IN THE EVENT THAT A MEMBER OF THE EXECUTIVE COMMITTEE HAS A CONFLICT OF INTEREST RELATED TO EXECUTIVE APPOINTMENT OR COMPENSATION, THAT MEMBER DOES NOT PARTICIPATE IN THE DELIBERATION OR APPROVAL OF APPOINTMENT OR COMPENSATION AND SUCH ABSTENTION IS NOTED IN THE COMMITTEE'S MEETING MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE 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 - OFFICERS' AND FORMER OFFICERS' AVERAGE HOURS FOR RELATED ORGANIZATIONS H GREG BRAY FILING ORG 30.2 RELATED ORG 4.3 UNRELATED ORG 5.5 J MCLAIN WALLACE, JR FILING ORG 17.7 RELATED ORG 6.6 UNRELATED ORG 15.7 KAREN H HUEY FILING ORG 33.7 RELATED ORG 6.3 ERIC TOMLINSON FILING ORG 5.0 RELATED ORG 5.0 UNRELATED ORG 30.0 STEVE C SNELGROVE FILING ORG 0 RELATED ORG 6.0 UNRELATED ORG 34.0 MAUREEN E SINTICH FILING ORG 34.0 RELATED ORG 6.0 DONNY C LAMBETH FILING ORG 20.0 RELATED ORG 14.0 UNRELATED ORG 6.0 SHARON ENGEBRETSON FILING ORG 35.0 RELATED ORG 5.0 JOANNE C RUHLAND FILING ORG 20 RELATED ORG 5 UNRELATED ORG 15 NORMAN D POTTER, JR. FILING ORG 20 RELATED ORG 5 UNRELATED ORG 15 CHERYL E.H. LOCKE FILING ORG 23.4 RELATED ORG 5.3 UNRELATED ORG 11.3 EDWARD G CHADWICK FILING ORG 29.8 RELATED ORG 7.0 UNRELATED ORG 3.2 THOMAS E SIBERT, MD FILING ORG 26.6 RELATED ORG 7.0 UNRELATED ORG 3.2 RUSSELL M HOWERTON, MD FILING ORG 20 RELATED ORG 2 UNRELATED ORG 18 DOUGLAS L EDGETON FILING ORG 1.0 UNRELATED ORG 39.0 LISA M WYATT FILING ORG 18.1 RELATED ORG 6.8 UNRELATED ORG 15.1 SHEILA M SANDERS FILING ORG 26 RELATED ORG 5 UNRELATED ORG 9 JOHN D MCCONNELL, MD FILING ORG 20.0 RELATED ORG 5.0 UNRELATED ORG 15.0 EDWARD ABRAHAM, MD FILING ORG 5 RELATED ORG 5 UNRELATED ORG 30 WAKE FOREST UNIVERSITY HEALTH SCIENCES IS AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION AND THE INFORMATION CONCERNING HOURS DEVOTED TO IT ARE NOT REQUIRED TO BE REPORTED, BUT ARE INCLUDED BECAUSE OF THE STRUCTURE OF WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, OF WHICH THE FILING ORGANIZATION AND WAKE FOREST UNIVERSITY HEALTH SCIENCES ARE PRINCIPAL PARTS. THE CORPORATE OFFICERS OF THE MEDICAL CENTER ALSO SERVE AS THE CORPORATE OFFICERS OF NORTH CAROLINA BAPTIST HOSPITAL AND WAKE FOREST UNIVERSITY HEALTH SCIENCES.
FORM 990, PART IX, LINE 11GMCIA: PROGRAM SERVICE EXPENSES 36,156,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,156,000. MEDICAL FEES: PROGRAM SERVICE EXPENSES 67,268,456. MANAGEMENT AND GENERAL EXPENSES 1,710,086. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,978,542. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 39,430,294. MANAGEMENT AND GENERAL EXPENSES 24,678,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,109,094.OTHER FEES
FORM 990, PART XI, LINE 9:CHANGE IN PENSION LIABILITY 29,278,783. CHANGE IN VALUE OF INTEREST RATE SWAP -560,284. AFFILIATE EARNINGS & TRANSFERS -22,699,947.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CLEMMONS MEDICAL PARK LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1MEDICAL CENTER BLVDAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27157ZIPCode
FieldValueIRS element (for citing)
EIN800870210EIN
Primary ActivitiesREAL ESTATE HOLDING COMPANYPrimaryActivities
Legal Domicile StateNCLegalDomicileState
Total Income597732TotalIncome
EOY Assets30423819EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTH CAROLINA BAPTIST HOSPITALBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION
MEDICAL CENTER BLVDWINSTON SALEMNC27157561685120SUPPORTING ORGANIZATIONNC501(C)(3)LINE 11A, INORTH CAROLINA BAPTIST HOSPITAL1
THE REHABILITATION & SKILLED NURSING
MEDICAL CENTER BLVDWINSTON SALEMNC27157561826396HEALTHCARE (INACTIVE)NC501(C)(3)LINE 9NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION1
THE HAWTHORNE INN & CONFERENCE CENTER INC
420 HIGH STREETWINSTON SALEMNC27101561793617LODGING/CONFERENCE ACCOMODATIONNC501(C)(3)LINE 11A, INORTH CAROLINA BAPTIST HOSPITAL1
CARENET INC
2000 WEST FIRST STREET SUITE 410WINSTON SALEMNC27104561977341HEALTHCARENC501(C)(3)LINE 11B, IINORTH CAROLINA BAPTIST HOSPITAL1
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
MEDICAL CENTER BLVDWINSTON SALEMNC27157510190238HEALTHCARENC501(C)(3)LINE 11A, I0N/A
CENTER FOR CONGREGATIONAL HEALTH INC
MEDICAL CENTER BLVDWINSTON SALEMNC27157237426944HEALTHCARENC501(C)(3)LINE 9NORTH CAROLINA BAPTIST HOSPITAL1
DAVIE COUNTY EMERGENCY HEALTH CORPORATION
223 HOSPITAL STREETMOCKSVILLENC27028562276994HEALTHCARENC501(C)(3)LINE 3NORTH CAROLINA BAPTIST HOSPITAL1
MEDICAL FND OF WFUHS & NCBH
MEDICAL CENTER BLVDWINSTON SALEMNC27157566036688HEALTHCARENC501(C)(3)LINE 11A, I0N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (11 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION
A168344COST
THE HAWTHORNE INN & CONFERENCE CENTER INC
K227760COST
THE HAWTHORNE INN & CONFERENCE CENTER INC
P42133COST
CARENET INC
Q2723473FMV
CENTER FOR CONGREGATIONAL HEALTH INC
Q289726FMV
DAVIE COUNTY EMERGENCY HEALTH CORP
Q1342906FMV
NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION
Q281385FMV
THE HAWTHORNE INN & CONFERENCE CENTER INC
S200000COST
NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION
S300139COST
NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION
C405031COST
THE HAWTHORNE INN & CONFERENCE CENTER INC
Q384069FMV