2013-05-13T12:55:36-05:00 2012-06-30 990 2011-07-01 900222618 WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN WAKE 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 JOHN D MCCONNELL MD 3367164445 2013-05-13 2011 2016-02-25 16:41:14Z JOHN D MCCONNELL MD MEDICAL CENTER BLVD WINSTONSALEM NC 27157 69274206 1 1 3884 X N/A X 2003 NC OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY. 3 0 0 0 0 0 0 0 63338388 69274142 982 64 0 0 63339370 69274206 0 0 0 0 0 0 0 0 0 51630336 56287122 51630336 56287122 11709034 12987084 104213267 115752105 8220704 6772458 95992563 108979647 OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY AND AS A SUPPORTING ORGANIZATION EXCLUSIVELY FOR THE BENEFIT OF WAKE FOREST UNIVERSITY AND WAKE FOREST UNIVERSITY HEALTH SCIENCES. 0 0 52885238 69274142 HEMODIALYSIS: THE CLINICS SERVE THE TEACHING AND RESEARCH PROGRAMS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES AND WAKE FOREST UNIVERSITY BY PROVIDING DIALYSIS TREATMENTS TO END STAGE RENAL DISEASE PATIENTS (1,569 PATIENTS). 52885238 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 81 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NC X HEALTH SYSTEMS MANAGEMENT INC 2293865505 PO BOX 7710 TIFTON GA 317937710 X JOHN D MCCONNELL MD 0.50 X X 0 1406491 638363 BARRY I FREEDMAN MD 1.00 X 0 625040 44581 DOUGLAS L EDGETON 3.50 X X 0 671069 39660 TERRY L HALES JR 2.00 X X 0 466489 51249 J REID MORGAN 0.50 X 0 421023 110325 DONNA H HAMILTON 1.00 X 0 173393 32045 WILLIAM B APPLEGATE MD 0.00 X 0 713865 68830 0 4477370 985053 0 1 1 0 HSM DIALYSIS CENTERS LLC PO BOX 7710 TIFTON GA 31793 MANAGEMENT COMPANY 6576889 NEPHROLOGY ASSOCIATES 730 HIGHLAND OAKS DRIVE WINSTONSALEM NC 27103 MEDICAL DIRECTOR 289638 IREDELL NEPHROLOGY CENTER 2043 SIMONTON RD SUITE B STATESVILLE NC 28625 MEDICAL DIRECTOR 110000 HEALTH INFORMATICS 2810 NORTH PARHAM RD RICHMOND VA 23294 SOFTWARE MAINTENANCE 106477 4 MEDICAL SERVICES 621300 69274142 69274142 69274142 64 64 69274206 69274142 0 64 106959 106959 39943 39943 27624885 24262944 3361941 416861 416861 18530286 18530286 2614418 2614418 149578 149578 30037 30037 78051 78051 MEDICAL SUPPLIES 6696104 6696104 56287122 52885238 3401884 0 3512180 3899925 11434872 10877172 1325650 1405006 85498 15935 87855067 99554067 104213267 115752105 6731410 6247458 1489294 525000 8220704 6772458 X 95992563 108979647 95992563 108979647 104213267 115752105 12987084 0 X 0 1 1 X 0 X X X 0 0 0 WAKE FOREST UNIVERSITY 560532138 2 1 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES 223849199 2 1 0 2 0 0 WFUHS CAPITAL CONTRIBUTION 99554067 99554067 DUE TO WFU 525000 525000 69274206 56287122 12987084 20872 20872 13007956 62597612 0 62597612 6676594 6676594 69274206 49589656 -20872 -20872 49610528 6676594 6676594 56287122 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION WAS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S STATEMENT OF OPERATIONS FOR THE YEARS ENDED JUNE 30, 2012 AND 2011. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS BAD DEBT 6,676,594. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECLASS BAD DEBT 6,676,594. 0 1 0 0 0 0 0 0 0 JOHN D MCCONNELL MD 0 983777 0 384203 0 38511 0 619002 0 19361 0 2044854 0 0 BARRY I FREEDMAN MD 0 170111 0 452997 0 1932 0 23763 0 20818 0 669621 0 0 DOUGLAS L EDGETON 0 490485 0 162367 0 18217 0 18602 0 21058 0 710729 0 0 TERRY L HALES JR 0 358464 0 97628 0 10397 0 30371 0 20878 0 517738 0 0 J REID MORGAN 0 358673 0 50000 0 12350 0 24500 0 85825 0 531348 0 0 DONNA H HAMILTON 0 172631 0 0 0 762 0 17887 0 14158 0 205438 0 0 WILLIAM B APPLEGATE MD 0 529239 0 158184 0 26442 0 47498 0 21332 0 782695 0 0 PART I, LINE 4B CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE PAYMENTS FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS. THE DETERMINATION OF THE AMOUNT OF THE NON-QUALIFIED RETIREMENT PLAN PAYMENTS FOLLOWS THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE FORM 990. FORM 990, PART VI, SECTION A, LINE 6 WAKE FOREST UNIVERSITY HEALTH SCIENCES IS THE PARENT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION ARE APPOINTED BY THE GOVERNING BODY OF WAKE FOREST UNIVERSITY HEALTH SCIENCES OR BY A MEMBER OF THE GOVERNING BODY OR BY AN OFFICER OF WAKE FOREST UNIVERSITY HEALTH SCIENCES ACTING IN HIS OFFICIAL CAPACITY, IN ACCORDANCE WITH PROCEDURES PRESCRIBED BY THE BOARD OF DIRECTORS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE ORGANIZATION'S GOVERNING BODY WHICH REQUIRE APPROVAL BY THE PARENT ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES, INCLUDE AMENDMENTS TO THE ORGANIZATION'S GOVERNANCE DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS), AND THE ELECTION AND REMOVAL OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES 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 BOARD OF WFUHS REVIEWS 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 AND DIRECTORS TO DISCLOSE CONFLICTS OF INTEREST ANNUALLY, AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATION'S POLICY ON CONFLICTS OF INTEREST. THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS OR DIRECTORS; AS THE ORGANIZATION HAS NO EMPLOYEES, IT DOES NOT PAY ANY COMPENSATION TO ANY KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS AND DIRECTORS AND FORMER OFFICERS OR DIRECTORS WAS PAID BY RELATED ORGANIZATIONS. THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER BOARD IS (THROUGH AUTHORITY DELEGATED TO IT BY WAKE FOREST UNIVERSITY HEALTH SCIENCES - THE PARENT OF THE FILING ORGANIZATION) RESPONSIBLE FOR REVIEWING AND APPROVING MOST OFFICERS' COMPENSATION. THE COMMITTEE UTILIZES INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH SUCH OFFICERS'COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES, AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. PART VII, SECTION A, COLUMN B, AVERAGE HOURS PER WEEK JOHN D MCCONNELL MD FILING ORG .5 RELATED ORG 18.9 UNRELATED ORG 20.6 BARRY I FREEDMAN FILING ORG 1.0 RELATED ORG 39.0 DOUGLAS L EDGETON FILING ORG 3.5 RELATED ORG 35.5 UNRELATED ORG 1.0 TERRY L HALES JR FILING ORG 2.0 RELATED ORG 16.5 UNRELATED ORG 21.5 J REID MORGAN FILING ORG .5 RELATED ORG 39.5 DONNA H HAMILTON FILING ORG 1.0 RELATED ORG 39.0 WILLIAM B APPLEGATE MD FILING ORG 0 RELATED ORG 40 NORTH CAROLINA BAPTIST HOSPITAL IS AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION. PURSUANT TO THE TERMS OF A MEDICAL CENTER INTEGRATION AGREEMENT ENTERED INTO AMONG WAKE FOREST UNIVERSITY, WAKE FOREST UNIVERSITY HEALTH SCIENCES (BOTH RELATED ORGANIZATIONS OF THE FILING ORGANIZATION), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER AND NORTH CAROLINA BAPTIST HOSPITAL (AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION),CORPORATE OFFICERS OF THE MEDICAL CENTER ALSO SERVE AS THE CORPORATE OFFICERS OF NORTH CAROLINA BAPTIST HOSPITAL AND WAKE FOREST UNIVERSITY HEALTH SCIENCES. SEVERAL OF SUCH OFFICERS' HOURS ARE SHOWN HERE AS HOURS DEVOTED TO SUCH OTHER ORGANIZATIONS. WFUBMC COMMUNITY PHYSICIANS MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561903275 HEALTHCARE NC 501(C)(3) LINE 3 WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES MEDICAL CENTER BLVD WINSTON SALEM NC 27157 223849199 EDUCATION, RESEARCH, HEALTHCARE NC 501(C)(3) LINE 2 WAKE FOREST UNIVERSITY 0 WAKE FOREST UNIVERSITY BOX 7201 WINSTON SALEM NC 27109 560532138 EDUCATION NC 501(C)(3) LINE 2 N/A 0 PTRP DEVELOPMENT CORPORATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 061818498 RESEARCH NC 501(C)(3) LINE 11A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 PIEDMONT TRIAD RESEARCH PARK MEDICAL CENTER BLVD WINSTON SALEM NC 27157 200177581 RESEARCH NC 501(C)(3) LINE 11A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 IDEALLIANCE FOUNDATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 562094060 RESEARCH NC 501(C)(3) LINE 11A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 IDEALLIANCE MEDICAL CENTER BLVD WINSTON SALEM NC 27157 562094067 RESEARCH NC 501(C)(6) WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 DIALYSIS ACCESS GROUP OF WFU LLC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 204241942 HEALTHCARE NC 501(C)(3) LINE 9 WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1