DAVIE MEDICAL CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- DAVIE MEDICAL CENTER (EIN 56-2276994)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-13
- IRS object ID
- 201301339349303290
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-13T14:12:38-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 562276994 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIE COUNTY EMERGENCY HEALTH CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DAVI | NameControl |
| Phone | 3367518100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANNY SQUIRES | Name |
| Title | CFO | Title |
| Phone | 3367518100 | Phone |
| Date Signed | 2013-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | THOMAS E SIBERT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12220756 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2001 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | PROVISION OF PATIENT-CENTERED HEALTHCARE SERVICES TO THE SURROUNDING AREA | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 205 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 12412 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 28165 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11299132 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 12065324 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 14563 | InvestmentIncomePriorYear |
| Investment Income Current Year | 78072 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 60195 | OtherRevenuePriorYear |
| Other Revenue Current Year | 30821 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11386302 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12202382 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 850 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 500 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4643897 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4964800 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8140117 | OtherExpensePriorYear |
| Other Expenses Current Year | 8988115 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12784864 | TotalExpensesPriorYear |
| Total Expenses Current Year | 13953415 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1398562 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1751033 | RevenuesLessExpensesCY |
| Total Assets BOY | 3240109 | TotalAssetsBOY |
| Total Assets EOY | 2733773 | TotalAssetsEOY |
| Total Liabilities BOY | 3367638 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4148507 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -127529 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -1414734 | NetAssetsOrFundBalancesEOY |
| Mission Description | DAVIE HOSPITAL PROVIDES PATIENT-CENTERED HEALTH CARE SERVICES FOR THE RESIDENTS AND INDUSTRIES OF THE COUNTY AND SURROUNDING COMMUNITIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12751136 | Expense |
| Grants | 500 | Grants |
| Revenue | 12065324 | Revenue |
| Description | DAVIE HOSPITAL PROVIDED MEDICAL, EMERGENCY, AND OUTPATIENT CARE SERVICES TO THE RESIDENTS OF DAVIE COUNTY, NORTH CAROLINA, AND THE SURROUNDING AREAS. DURING THE FISCAL YEAR, THE HOSPITAL HAD 5,878 OUTPATIENT VISITS AND 9,069 EMERGENCY ROOM VISITS. IN ADDITION, THE HOSPITAL PERFORMED 180 CATARACT SURGERIES, 104 OTHER OUTPATIENT SURGERIES, AND 63 SLEEP STUDIES. | Description |
| Total Program Service Expense | 12751136 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 26 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 205 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DANNY SQUIRES | NamePerson |
| Telephone Number | 3362384287 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| DONNY C LAMBETH | ||||||
| CHAIRMAN | 6.00 | X | X | 0 | 2328700 | 143909 |
| DAN BARRETT | ||||||
| VICE CHAIRMAN | 6.00 | X | X | 0 | 0 | 0 |
| TERRY BRALLEY | ||||||
| TREASURER / SECRETARY | 6.00 | X | X | 0 | 0 | 0 |
| KEN WHITE | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| DR RUSSELL HOWERTON | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| WILLIAM F JUNKER | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| RONALD SMALL | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 333441 | 16199 | |
| STEVEN C SNELGROVE | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 329647 | 115765 | |
| BETH DIRKS | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| DOUG NELSON | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| HEATHER L HAYES | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 75425 | 12967 | |
| LYNN PITMAN | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 202798 | 40143 | |
| CHARLES TEGELER MD | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| STEPHEN ROBERTSON | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| KEVIN WALSH | ||||||
| ADMINISTRATOR | 40.00 | X | 0 | 124467 | 24229 | |
| DANNY SQUIRES | ||||||
| CFO | 40.00 | X | 37500 | 0 | 0 | |
| JOHNNY VEAL | ||||||
| CNO | 40.00 | X | 0 | 208131 | 5161 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 37500 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3602609 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 358373 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| THE ERX COMPANY | |||||
| 9724 KINGSTON PIKE STE 406 | KNOXVILLE | TN | 37922 | PHYSICIAN FEES | 1155170 |
| MEDTRONIC USA | |||||
| PO BOX 409201 | ATLANTA | GA | 30384 | NERVE STIMULATOR SUPPLIER | 670040 |
| SIGHTPATH MEDICAL INC | |||||
| 575 W OLD SHAKOPEE ROAD STE 90 | BLOOMINGTON | MN | 55437 | CATARACT SURGERY SUPPLIER | 202252 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 96485 | CHICAGO | IL | 60693 | CONTRACTED MRI SERVICES | 180061 |
| WAR EAGLE REHABILITATIVE SERVICES | |||||
| PO BOX 2091 | ADVANCE | NC | 27006 | CONTRACT PHYSICAL THERAPY | 132228 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Fundraising Events | 24466 | FundraisingEvents |
| All Other Contributions | 3699 | AllOtherContributions |
| Total Contributions | 28165 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 12065324 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12065324 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 12065324 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1414 | TotalRevenueColumn |
| Exclusion | $1,414 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 36225 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 36225 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 36225 | TotalRevenueColumn |
| Exclusion | $36,225 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 72859 | Securities |
| Other | 3799 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 72859 | Securities |
| Other | 3799 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 76658 | TotalRevenueColumn |
| Exclusion | $76,658 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 11356 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 24466 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 18374 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -7018 | TotalRevenueColumn |
| Exclusion | -$7,018 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MEDICAL RECORD TRANSCR | 900099 | 1288 | $1,288 |
| MEALS | 722210 | 326 | $326 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1614 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12202382 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12065324 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $108,893 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 500 | Total |
| Program Services | 500 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75000 | Total |
| Management And General | 75000 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17230 | Total |
| Program Services | 17230 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4124922 | Total |
| Program Services | 3550600 | ProgramServices |
| Management And General | 574322 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 446716 | Total |
| Program Services | 377934 | ProgramServices |
| Management And General | 68782 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 300932 | Total |
| Program Services | 254597 | ProgramServices |
| Management And General | 46335 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 257 | Total |
| Management And General | 257 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14450 | Total |
| Management And General | 14450 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2513443 | Total |
| Program Services | 2301186 | ProgramServices |
| Management And General | 212257 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45783 | Total |
| Program Services | 45783 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 468282 | Total |
| Program Services | 381757 | ProgramServices |
| Management And General | 86525 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104800 | Total |
| Program Services | 20560 | ProgramServices |
| Management And General | 84240 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 696332 | Total |
| Program Services | 696332 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22898 | Total |
| Program Services | 17266 | ProgramServices |
| Management And General | 5632 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8095 | Total |
| Program Services | 8095 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 208008 | Total |
| Program Services | 208008 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61137 | Total |
| Program Services | 58845 | ProgramServices |
| Management And General | 2292 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 3510474 | 3510474 | |
| MEDICAL SUPPLIES | 1290637 | 1290637 | |
| MISCELLANEOUS EXPENSE | 43519 | 11332 | 32187 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13953415 | Total |
| Program Services | 12751136 | ProgramServices |
| Management And General | 1202279 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8960 | BOY |
| EOY | 432798 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1655160 | BOY |
| EOY | 1458704 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123546 | BOY |
| EOY | 132035 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6269 | BOY |
| EOY | 6476 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2179941 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1663183 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 684583 | BOY |
| EOY | 516758 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 761591 | BOY |
| EOY | 187002 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3240109 | BOY |
| EOY | 2733773 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2971085 | BOY |
| EOY | 1238973 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 196553 | BOY |
| EOY | 99940 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200000 | BOY |
| EOY | 2809594 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3367638 | BOY |
| EOY | 4148507 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -135637 | BOY |
| EOY | -1415746 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8108 | BOY |
| EOY | 1012 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -127529 | BOY |
| EOY | -1414734 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3240109 | BOY |
| EOY | 2733773 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1751033 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 463828 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $1,460 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1460 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). A PORTION OF THE MEMBERSHIP DUES PAID ARE ALLOCATED TO LOBBYING EFFORTS BY THOSE ORGANIZATIONS ON BEHALF OF THEIR MEMBERSHIPS. THE CURRENT PORTION OF MEMBERSHIP DUES ALLOCATED TO LOBBYING IS APPROXIMATELY $1,460. | Explanation |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2179941 | OtherCostOrOtherBasis |
| Depreciation | 1663183 | Depreciation |
| Book Value | 516758 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 516758 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 159778 |
| ESTIMATED THIRD PARTY RECEIVABLES | 27224 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 187002 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO NC BAPTIST HOSPITAL | $2,418,734 |
| ESTIMATED COST REPORT LIABILITY | $390,860 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2809594 | TotalOfAmounts |
| Total Revenue | 12202382 | TotalRevenue |
| Total Expenses | 13953415 | TotalExpenses |
| Excess Or Deficit For Year | -1751033 | ExcessOrDeficitForYear |
| Donated Services And Facilities | 463828 | DonatedServicesAndFacilities |
| Total Adjustments | 463828 | TotalAdjustments |
| Excess Or Deficit Per FS | -1287205 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 9155736 | TotRevenueEtcAuditedFinclStmt |
| Donated Srvc And Use Of Facilities | 463828 | DonatedSrvcAndUseOfFacilities |
| Other Revenues | -3510474 | OtherRevenues |
| Revenue Not Rptd F990 | -3046646 | RevenueNotRptdF990 |
| Revenue Subtotal | 12202382 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12202382 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 10442941 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 10442941 | ExpensesSubtotal |
| Other Expenses Not Included | 3510474 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 3510474 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 13953415 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -3,510,474. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 3,510,474. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | ANNUAL GOLF EVENT | NameOfEvent1 |
| Gross Receipts Event1 | 35822 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 24466 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 11356 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 1221 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 4760 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 3723 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 8670 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 35822 | GrossReceiptsTotal |
| Charitable Contributions Total | 24466 | CharitableContributionsTotal |
| Gross Revenue Total Events | 11356 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 1221 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 4760 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 3723 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 8670 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 18374 | DirectExpenseSummaryEvents |
| Net Income Summary | -7018 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 190.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 81315 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 81315 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00780 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1723813 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1436715 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 287098 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02750 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1805128 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1436715 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 368413 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03530 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4458 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4458 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 552 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 552 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5010 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5010 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1810138 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1436715 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 373423 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03580 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,677,493 | BadDebtExpenseAmount |
| Amount Attributable To | 1258120 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3168515 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2927909 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 240606 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 223 HOSPITAL STREET | AddressLine1 |
| City | MOCKSVILLE | City |
| State | NC | State |
| ZIP Code | 27028 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 190.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: DAVIE HOSPITAL USES 190% OF THE FPG TO DETERMINE ELIGIBILITY FOR FREE CARE. IF INCOME FALLS BELOW 190%, THE PATIENT'S BALANCE IS WRITTEN OFF TO CHARITY CARE. THERE ARE NO SLIDING SCALES TO DETERMINE ELIGIBLITY. DAVIE HOSPITAL OFFERS A 10% DISCOUNT TO PRIVATE PAY ACCOUNTS PAID WITH IN 30 DAYS OF DISCHARGE. | ||
| PART I, LINE 7: THE ORGANIZATION USED A METHODOLOGY FROM THE NORTH CAROLINA HOSPITAL ASSOCIATION COMMUNITY BENEFITS GUIDELINE TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE FINANCIAL ASSISTANCE BENEFITS AND UNREIMBURSED MEDICAID AT COST. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3510474. | ||
| PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE - PATIENT ACCOUNTS RECEIVABLE REPRESENT THE ESTIMATED NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. A SUBSTANTIAL PORTION OF THE PATIENTS SEEN BY THE HOSPITAL ARE COVERED BY MEDICARE/MEDICAID OR COMMERCIAL INSURANCE, AND THE HOSPITAL'S RECEIVABLES ARE ESTIMATED TO BE PAID BY THESE THIRD-PARTY PAYORS. ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS ARE COMPUTED BASED ON HISTORICAL COLLECTION EXPERIENCE AND A REVIEW OF THE CURRENT STATUS OF EXISTING RECEIVABLES. THE HOSPITAL GRANTS CREDIT TO PATIENTS WITHOUT COLLATERAL OR OTHER PROOF OF ABILITY TO PAY, SUBSTANTIALLY ALL OF WHOM ARE FROM DAVIE AND SURROUNDING COUNTIES.THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBTS. ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER FOUR STATEMENTS AND TWO COLLECTION LETTERS HAVE BEEN SENT. THE ACCOUNT IS NOT WRITTEN OFF BEFORE 120 DAYS AFTER THE INSURANCE PAYS. IF PAYMENT IS MADE WITHIN THE LAST 60 DAYS THE ACCOUNT IS NOT WRITTEN OFF TO BAD DEBT.THE ORGANIZATION USED WORKSHEET 2 OF THE 2011 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE BAD DEBT AT COST. | ||
| PART III, LINE 8: DAVIE HOSPITAL IS A CRITIAL ACCESS HOSPITAL AND IS REIMBURSED 100 TO 101% OF COSTS. | ||
| PART III, LINE 9B: EACH PATIENT IS SENT FOUR STATEMENTS FOR COLLECTION-- ONE EVERY 28 DAYS. PHONE CALLS ARE MADE AFTER THREE STATEMENTS HAVE BEEN SENT OUT. AFTER THE FOURTH STATEMENT, TWO "COLLECTION" LETTERS ARE SENT. IF THERE IS NO RESPONSE, THE ACCOUNT IS SENT TO AN OUTSIDE COLLECTION AGENCY. THE HOSPITAL DOES NOT PLACE GARNISHMENTS, LIENS, OR PERSONAL ATTACHMENTS ON PATIENTS. A 10% DISCOUNT IS OFFERED TO PRIVATE PAY PATIENTS WHO PAY THEIR BILL IN FULL WITHIN 30 DAYS. PRIVATE PAY PATIENTS ARE OFFERED A CHARITY CARE APPLICATION AND TOLD ABOUT PAYMENT PLANS AT REGISTRATION. THE CHARITY CARE APPLICATION IS AVAILABLE ONLINE AND OFFERED TO PRIVATE PAY PATIENTS AT REGISTRATION. PERSONAL FACE TO FACE MEETINGS ARE AVAILABLE MONDAY THROUGH FRIDAY 8 AM TO 5 PM. PAYMENT PLANS ARE OFFERED TO ALL PATIENTS WHEN INITIAL PHONE CONTACT IS MADE. | ||
| PART V, SECTION B, LINE 11H: DAVIE HOSPITAL USES 190% OF THE FPG TO DETERMINE ELIGIBILITY FOR FREE CARE. IF INCOME FALLS BELOW 190%, THE PATIENT'S BALANCE IS WRITTEN OFF TO CHARITY CARE. THERE ARE NO SLIDING SCALES TO DETERMINE ELIGIBLITY. DAVIE HOSPITAL OFFERS A 10% DISCOUNT TO PRIVATE PAY ACCOUNTS PAID WITH IN 30 DAYS OF DISCHARGE. | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | |
| PART V, SECTION B, LINE 13G: IF PATIENTS WERE IDENTIFIED AS A "STOREHOUSE FOR JESUS" PATIENT, THE FINANCE DEPARTMENT WOULD MAIL AN APPLICATION TO THE PATIENT IF THERE WAS NO APPLICATION ON FILE. | WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA | |
| PART VI, LINE 2: REPRESENTATIVES FROM THE ORGANIZATION ATTEND HEALTH FAIRS AND SENIOR HEALTH FAIRS AROUND THE COUNTY. NO COMMUNITY NEEDS ASSESSMENT HAS BEEN DONE AS OF THE END OF THE 2011 TAX YEAR; HOWEVER, AN ASSESSMENT WILL BE CONDUCTED IN THE NEAR FUTURE SO AS TO BE IN COMPLIANCE WITH THE FEDERAL REQUIREMENTS. | ||
| PART VI, LINE 3: INFORMATION ABOUT THE FINANCIAL ASSISTANCE APPLICATION PROCESS IS AVAILABLE ON THE HOSPITAL'S WEBSITE AND IS MENTIONED AT THE PATIENT REGISTRATION STAGE. REGISTRATION AND BUSINESS OFFICE STAFF ARE TRAINED TO EDUCATE PATIENTS ON ASSISTANCE POLICIES. COPIES OF THE APPLICATION ARE WIDELY AVAILABLE THROUGH THE INTERNET, REGISTRATION DESK, AND BUSINESS OFFICE DESK. BUSINESS OFFICE STAFF WILL DIRECT PATIENTS TO SOCIAL SERVICES IF THEY QUALIFY FOR ASSITANCE. | ||
| PART VI, LINE 4: DAVIE HOSPITAL IS A CRITICAL ACCESS HOSPITAL SERVING DAVIE COUNTY, NORTH CAROLINA AND THE SURROUNDING AREAS. THE HOSPITAL IS THE ONLY ONE LOCATED IN THE COUNTY. THE POPULATION OF DAVIE COUNTY IS APPROXIMATELY 42,000 ACCORDING TO THE U.S. CENSUS BUREAU. 11.7 % OF THE POPULATION IS AT OR BELOW THE POVERTY LEVEL. 87.5% OF THE POPULATION IS WHITE, 6.3% IS AFRICAN AMERICAN, AND 6.2% IS OTHER DEMOGRAPHICS. THE UNEMPLOYMENT RATE IN MARCH 2011 WAS 9.7%. THE MEDIAN INCOME IS $59,503. THE GROWTH RATE OF THE COMMUNITY IS 1.9%. | ||
| PART VI, LINE 5: HOSPITAL REPRESENTATIVES ATTEND NUMEROUS HEALTH FAIRS AND PERFORMS CHOLESTROL SCREENING CHECKS. THE HOSPITAL ALSO INVITES THE COMNUNITY TO ATTEND ITS LADIES' NIGHT OUT EVENT TO PROMOTE BREAST HEALTH AND BREAST CANCER AWARENESS. THE HOSPITAL IS INVOLVED WITH THE LOCAL SENIOR CENTER AND PROVIDES HEALTH EDUCATION ON VARIOUS TOPICS THROUGH OUT THE YEAR. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO ALL OF ITS DEPARTMENTS. | ||
| PART VI, LINE 6: THE MEMBER OF THE ORGANIZATION IS NORTH CAROLINA BAPTIST HOSPITAL. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DONNY C LAMBETH | |||||||||||||
| 0 | 495595 | 0 | 181988 | 0 | 1651117 | 0 | 128399 | 0 | 15510 | 0 | 2472609 | 0 | 349414 |
| RONALD SMALL | |||||||||||||
| 0 | 147324 | 0 | 60658 | 0 | 125459 | 0 | 9427 | 0 | 6772 | 0 | 349640 | 0 | 0 |
| STEVEN C SNELGROVE | |||||||||||||
| 0 | 251155 | 0 | 61652 | 0 | 16840 | 0 | 81277 | 0 | 34488 | 0 | 445412 | 0 | 0 |
| LYNN PITMAN | |||||||||||||
| 0 | 177840 | 0 | 20808 | 0 | 4150 | 0 | 25589 | 0 | 14554 | 0 | 242941 | 0 | 0 |
| JOHNNY VEAL | |||||||||||||
| 0 | 179881 | 0 | 22830 | 0 | 5420 | 0 | 4317 | 0 | 844 | 0 | 213292 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINES 4A-B | CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE PAYMENTS FROM SEVERANCE AND SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS PROVIDED BY A RELATED ORGANIZATION. THE DETERMINATION OF THE AMOUNT OF THE SEVERANCE AND/OR NON-QUALIFIED RETIREMENT PLAN PAYMENTS FOLLOW THE RELATED ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THEIR FORM 990. NON-QUALIFIED SEVERANCE - DONNY C. LAMBETH $ 1,623,420 -0- - RONALD SMALL 17,822 93,096 | |
| PART III | COMPENSATION FROM UNRELATED ORGANIZATIONS: COMPENSATION FOR DANNY SQUIRES WAS PROVIDED BY LEXINGTON MEDICAL CENTER, AN UNRELATED TAX-EXEMPT ORGANIZATION. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PAMELA SMALL | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | FAMILY MEMBER OF BOARD MEMBER RONALD SMALL | Relationship |
| Amount Of Transaction | 17230 | AmountOfTransaction |
| Description Of Transaction | COMPENSATION AS EMPLOYEE | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | EXECUTIVE COMMITTEE: AS ESTABLISHED IN THE ORGANIZATIONS BYLAWS, THE BOARD OF TRUSTEES MAY ESTABLISH AN EXECUTIVE COMMITTEE CONSISTING OF THREE OR MORE TRUSTEES, THE MAJORITY OF WHOM SHALL BE NORTH CAROLINA BAPTIST HOSPITAL (NCBH) TRUSTEES AND THE REMAINDER SHALL BE DAVIE HOSPITAL TRUSTEES. DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF TRUSTEES, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE THE POWERS OF THE BOARD OF TRUSTEES IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION; PROVIDED THAT THE EXECUTIVE COMMITTEE MAY NOT TAKE ANY ACTION THAT WOULD REQUIRE A SUPERMAJORITY VOTE OF THE BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS NORTH CAROLINA BAPTIST HOSPITAL, A NORTH CAROLINA NONPROFIT CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER OF THE ORGANIZATION SHALL HAVE THE RIGHT AT ALL TIMES, WITH RESPECT TO THE ORGANIZATION, TO ELECT AND REMOVE THE TRUSTEES, AS PROVIDED IN THE ORGANIZATION'S BYLAWS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER OF THE ORGANIZATION SHALL HAVE THE RIGHT AT ALL TIMES, WITH RESPECT TO THE ORGANIZATION, TO APPROVE OF THE SALE, LEASE, OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, AS PROVIDED IN THE ORGANIZATION'S BYLAWS. THE SOLE MEMBER MAY ACT WITHOUT A MEETING. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES COPIES OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. THE AUDIT AND COMPLIANCE COMMITTEES OF THE GOVERNING BOARDS OF WFUHS AND NCBH REVIEW IN ADDITIONAL DETAIL THE FILING ORGANIZATION'S FORM 990 WITH THE ORGANIZATION'S CHIEF FINANCIAL OFFICER OR HIS DESIGNEE, WHO ANSWERS QUESTIONS AND ADDRESSES CONCERNS RAISED BY SUCH COMMITTEE MEMBERS OR OTHER FILING ORGANIZATION DIRECTORS. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL DIRECTORS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES ITS OFFICERS, DIRECTORS AND ANY KEY EMPLOYEES TO REVIEW THE CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL CONFLICTS OF INTERESTS ANNUALLY AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATION'S POLICY ON CONFLICTS OF INTEREST. | |
| THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS OR KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS AND DIRECTORS AND FORMER OFFICERS AND DIRECTORS WAS PAID BY RELATED ORGANIZATIONS. COMPENSATION PAID TO THESE INDIVIDUALS ARE REVIEWED AND APPROVED IN ACCORDANCE WITH THE RELATED ORGANIZATION'S COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICERS' AND DIRECTORS' COMPENSATION. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | |
| FORM 990, PART VII, LINE 1, COLUMN (B): | THE ORGANIZATION HAS CERTAIN EXECUTIVES THAT PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE WAKE FOREST BAPTIST MEDICAL CENTER. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE MEDICAL CENTER. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE MEDICAL CENTER. | AVERAGE HOURS FOR RELATED ORGANIZATIONS: |
| FORM 990, PART XI, LINE 5: | DONATED SERVICES AND USE OF FACILITIES: 463,828. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH CAROLINA BAPTIST HOSPITAL | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 560552787 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | N/A | 0 | |
| NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 561685120 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| THE REHABILITATION & SKILLED NURSING FACILITY AT OAK SUMMIT | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 561826396 | HEALTHCARE (INACTIVE) | NC | 501(C)(3) | LINE 9 | 0 | NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION | |
| THE HAWTHORNE INN & CONFERENCE CENTER INC | |||||||||||
| 420 HIGH STREET | WINSTON SALEM | NC | 27101 | 561793617 | LODGING/ CONFERENCE ACCOMMODATION | NC | 501(C)(3) | LINE 11A, I | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| CARENET INC | |||||||||||
| 2000 WEST FIRST STREET SUITE 410 | WINSTON SALEM | NC | 27104 | 561977341 | HEALTHCARE | NC | 501(C)(3) | LINE 11B, II | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| CENTER FOR CONGREGATIONAL HEALTH INC | |||||||||||
| MEDICAL CENTER BLVD | WINSTON SALEM | NC | 27157 | 237426944 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | 0 | NORTH CAROLINA BAPTIST HOSPITAL | |
| DAVIE COUNTY HOSPITAL FOUNDATION | |||||||||||
| 156 ROLAND RD | MOCKSVILLE | NC | 27028 | 581477280 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11C, III-FI | N/A | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |