2013-05-13T17:21:32-05:00 2012-06-30 990 2011-07-01 560552787 NORTH CAROLINA BAPTIST HOSPITAL NORT 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 JOHN D MCCONNELL MD 3367164445 2013-05-13 2011 2016-02-24 21:20:13Z JOHN D MCCONNELL MD MEDICAL CENTER BLVD WINSTONSALEM NC 27157 1272787906 0 X WWW.WAKEHEALTH.EDU X 1923 NC IMPROVING THE HEALTH OF OUR REGION, STATE AND NATION 18 18 9649 1200 2627299 1893532 3309877 3031792 1042076215 1186396254 29680394 77580140 3619545 3718388 1078686031 1270726574 568909 591467 0 0 489928433 539950281 0 0 0 531040686 629349396 1021538028 1169891144 57148003 100835430 1461474196 1619889593 499788836 671420988 961685360 948468605 X SEE 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. OUR MISSION IS TO IMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY: GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE; TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE; AND SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS. 0 0 1058075631 591467 1184437136 SEE 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 BAPTIST MEDICAL CENTER IS A CORPORATION WHOSE MEMBERS ARE WAKE FOREST UNIVERSITY AND NORTH CAROLINA BAPTIST HOSPITAL. THE MEDICAL CENTER OPERATES WAKE FOREST SCHOOL OF MEDICINE AND HAS A FACULTY PHYSICIAN PRACTICE OF ABOUT NEARLY 900 DOCTORS. 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 HOSPITAL (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 AND GROWTH OF PIEDMONT TRIAD RESEARCH PARK, A 200-ACRE, MIXED-USE BIOTECHNOLOGY PARK IN DOWNTOWN WINSTON-SALEM. BIOTECH PLACE, THE SIXTH BUILDING IN THE PARK, OPENED IN FEBRUARY 2012. THE $100 MILLION BIOTECH PLACE IS A 242,000-SQUARE-FOOT, STATE-OF-THE-ART MULTIPURPOSE BIOTECHNOLOGY RESEARCH AND INNOVATION CENTER. IT NOW HOUSES SEVERAL WAKE FOREST SCHOOL OF MEDICINE DEPARTMENTS AND PRIVATE BUSINESSES IN THE BIOTECH FIELD. IN ADDITION TO DRIVING INNOVATION IN BIOTECHNOLOGY, PTRP IS HOME OF THE WORLD-RENOWNED WAKE FOREST INSTITUTE FOR REGENERATIVE MEDICINE. THE RESEARCH PARK ALSO IS A GOOD EXAMPLE OF PRIVATE-CIVIC PARTNERSHIP AS IT DRIVES NEW DEVELOPMENT IN THE EASTERN PORTION OF DOWNTOWN 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 MEDICAL CENTER INCLUDES 19 SUBSIDIARY OR AFFILIATE HOSPITALS, AND OPERATES MORE THAN 80 OUTREACH ACTIVITIES, INCLUDING SATELLITE SPECIALTY CLINICS, ACROSS NORTHWEST NORTH CAROLINA.IN THE PAST FISCAL YEAR, WAKE FOREST BAPTIST OPENED TWO STATE-OF-THE-ART CLINICAL SITES, MEDICAL PLAZA AT COUNTRY CLUB AND MEDICAL PLAZA AT CLEMMONS. THE COUNTRY CLUB LOCATION BECAME HOME TO A WAKE FOREST BAPTIST AFFILIATE OF THE JOSLIN DIABETES CENTER, AN INTERNATIONAL LEADER IN DIABETES RESEARCH, CARE AND EDUCATION THAT HAS BEEN PART OF HARVARD MEDICAL SCHOOL SINCE ITS FOUNDING IN 1898. THE JOSLIN PRACTICE MODEL OFFERS THE FULL RANGE OF DIABETES SERVICES IN A SINGLE LOCATION WITH CONVENIENT SCHEDULING AND EASY ACCESS TO RELATED MEDICAL SERVICES. MEDICAL PLAZA AT COUNTRY CLUB ALSO INCLUDES SPECIALTY SERVICES IN DERMATOLOGY, CARDIOLOGY AND WEIGHT MANAGEMENT, AMONG OTHERS. MEDICAL PLAZA AT CLEMMONS OFFERS URGENT CARE, A WOMEN'S CENTER, PEDIATRICS AND NUMEROUS OTHER SPECIALTY SERVICES. OVERALL IN FY 2012, WAKE FOREST BAPTIST HAD 38,601 INPATIENT ADMISSIONS AND 1,034,842 OUTPATIENT ENCOUNTERS (EMERGENCY DEPARTMENT, DOWNTOWN HEALTH PLAZA, DAY HOSPITAL, AMBULATORY VISITS). THE TOTAL PATIENT ENCOUNTERS NUMBERED 1,073,443.2. 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 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 BIRTHWEIGHT BABIES. MORE THAN 68,073 PATIENT VISITS WERE RECORDED AT THE PLAZA BETWEEN JULY 2011 AND JUNE 2012. COSTS ARE SUBSIDIZED BY THE MEDICAL CENTER. THE MEDICAL CENTER ALSO OPERATES NUMEROUS INNOVATIVE COMMUNITY OUTREACH PROGRAMS, MOST NOTABLY, BESTHEALTH, WHICH OFFERS HEALTH SEMINARS LED BY WAKE FOREST BAPTIST HEALTH EXPERTS, HEALTH SCREENINGS, COOKING AND FITNESS CLASSES, AND ONLINE HEALTH RESOURCES. FREE MEMBERSHIP IS OFFERED TO JOIN BESTHEALTH, AND MEMBERS RECEIVE ADDITIONAL BENEFITS SUCH AS MEMBERS-ONLY EVENTS AND SCREENINGS, DISCOUNTS AT LOCAL BUSINESSES AND HEALTH RISK APPRAISALS.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. WAKE FOREST BAPTIST IN THE PAST YEAR INVESTED MORE THAN $57 MILLION IN THE EDUCATION OF TOMORROW'S HEALTH CARE AND BIOMEDICAL LEADERS. THAT INVESTMENT LAST YEAR SUPPORTED THE TRAINING OF 486 MEDICAL STUDENTS, 665 PHYSICIAN RESIDENTS AND FELLOWS, 322 GRADUATE STUDENTS AND 127 PHYSICIAN ASSISTANTS. THE NORTHWEST AREA HEALTH EDUCATION CENTER, PART OF WAKE FOREST SCHOOL OF MEDICINE, DURING THE SAME YEAR PROVIDED 2,110 CONTINUING MEDICAL EDUCATION ACTIVITIES FOR 40,674 PARTICIPANTS THROUGHOUT THE REGION. 1058075631 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 522 0 1 9649 1 1 1 0 0 0 0 0 0 0 0 0 X 18 18 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X DOUG LISCHKE 3367164445 MEDICAL CENTER BLVD WINSTON SALEM NC 27157 X ROGER L COTHRAN 4.00 X 0 0 0 ARTHUR A GIBEL 6.00 X X 0 0 0 KATHRYN H HAMRICK 4.00 X 0 0 0 WILLIAM N HARTSELL 4.00 X 0 0 0 STEPHEN R LITTLE 4.00 X 0 0 0 GEORGE E STUBBINS SR 4.00 X 0 0 0 STANLEY R AESCHLEMAN PH D 4.00 X 0 0 0 A WILLIAM BLACKSTOCK JR MD 4.00 X 0 0 0 KENNETH W LEWIS 4.00 X 0 0 0 WILLIAM C WARDEN JR 4.00 X 0 0 0 SHEREE B WATSON 4.00 X 0 0 0 KATY M BOLES 4.00 X 0 0 0 RAY N HOWELL III D MIN 4.00 X 0 0 0 JOHN D KIMBERLY 4.00 X 0 0 0 STEPHEN L ROBERTSON 4.00 X 0 0 0 EDWIN L WELCH JR 4.00 X 0 0 0 R MICHAEL WELLS 4.00 X 0 0 0 LINWOOD L DAVIS 4.00 X 0 0 0 BRENDA B DIGGS 4.00 X 0 0 0 ERNEST L EVANS 4.00 X 0 0 0 RON KESSINGER 6.00 X X 0 0 0 JOHN D MCCONNELL MD 20.30 X X 1406491 0 638363 LOUIS B BALDWIN JR 4.00 X 0 0 0 GEORGE D RENFRO 4.00 X 0 0 0 H GREG BRAY 30.00 X 233573 0 44420 J MCLAIN WALLACE JR 35.00 X 397129 0 94398 KAREN H HUEY 24.00 X 269934 0 72133 MAUREEN E SINTICH 33.00 X 401366 0 88127 DONNY C LAMBETH 10.00 X 2328700 0 143909 JOANNE C RUHLAND 20.00 X 218060 0 33991 NORMAN D POTTER JR 20.00 X 297291 0 45278 CHERYL EH LOCKE 26.00 X 549595 0 34974 EDWARD G CHADWICK 23.00 X 741340 0 238080 THOMAS E SIBERT MD 20.00 X 897345 0 238466 RUSSELL M HOWERTON MD 20.00 X 614047 0 42978 DOUGLAS L EDGETON 1.00 X 671069 0 39660 LISA M WYATT 18.00 X 394305 0 30732 SHEILA M SANDERS 26.00 X 425038 0 39505 EDWARD ABRAHAM MD 5.00 X 670675 0 88901 KAREN Q TURNER 40.00 X 298285 0 60707 BETTY PETREE 40.00 X 269215 0 58294 MICHAEL RIEKER 40.00 X 248491 0 36892 VANCE MCVAY JR 40.00 X 216271 0 40243 ERIC STIEFEL 40.00 X 207270 0 41188 CHARLES WARE 40.00 X 218194 0 95127 STEVE C SNELGROVE 30.00 X 329647 0 115765 RONALD H SMALL 40.00 X 333441 0 16199 ROBERT S PARKER SR 40.00 X 255953 0 7674 SHARON ENGEBRETSON 36.00 X 164613 0 59657 GINA B RAMSEY 0.00 X 121928 0 0 13179266 0 2445661 389 1 1 1 ARAMARK 2300 WARRENVILLE ROAD DOWNER GROVE IL 60515 MANAGEMENT SERVICES 3194424 QUEST DIAGNOSTICS NICHOLS INST DEPT 0065 LOS ANGELES CA 90084 LAB 2356864 GE HEALTHCARE IITS USA CORP PO BOX 277475 ATLANTA GA 90084 MAINTENANCE CONTRACTS 2192932 ORACLE AMERICA INC 500 ORACLE PKWY REDWOOD SHORES CA 94065 TECHNOLOGY 1645619 CROSS COUNTRY TRAVCORPS 6551 PARK OF COMMERCE BLVD BOCA RATON FL 33487 TRAVEL NURSING 1536009 76 3031792 45666 3031792 PATIENT SERVICE REVENU 621400 1167544127 1167544127 COST RECOV. & OTHER 900099 10625068 8339261 2285807 DIETARY 722320 5018142 5016781 1361 MEDICAL/LAB SERVICE 621500 3208917 2868786 340131 1186396254 12304631 12304631 534416 183978 350438 350438 350438 66053018 1099845 0 1877354 66053018 -777509 65275509 65275509 PARKING FEES 900099 1384988 1384988 GIFT SHOP REVENUE 453220 1314781 1314781 TUITION 900099 222325 222325 445856 445856 3367950 1270726574 1184437136 2627299 80630347 466469 466469 124998 124998 12403054 12403054 428613154 386188812 42424342 11781178 8835883 2945295 56593279 49558734 7034545 30559616 22919712 7639904 273201 10875 262326 1475864 1106898 368966 163162045 143910854 19251191 3662594 1912758 1749836 3511431 2360260 1151171 40695540 34737874 5957666 13506155 7508287 5997868 295955 193910 102045 1055957 610142 445815 11193718 11193718 60328350 59725066 603284 9069830 6815734 2254096 MEDICAL SUPPLIES 285056680 285056680 PROVIDER ASSESSMENT 34162866 34162866 INCOME TAXES 959845 959845 OTHER 939365 675101 264264 1169891144 1058075631 111815513 0 18078385 25325467 73571292 38604347 200506544 303304584 13859819 17078515 5260718 7131300 1320403035 766982736 468404124 553420299 607124980 608352455 57732699 41336484 16935635 25336142 1461474196 1619889593 112118064 159427458 326149760 317847467 96476032 61521256 97670031 499788836 671420988 X 954381677 940380300 3916110 4535459 3387818 3552846 961685360 948468605 1461474196 1619889593 X 100835430 -114052185 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 1 479982 0 1 46365 526347 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: GOVERNMENT RELATIONS THE OFFICE OF GOVERNMENT RELATIONS WAS ACTIVELY INVOLVED WITH SEVERAL FEDERAL AND STATE ISSUES. THE OFFICE ASSISTED IN DEVELOPING POLITICAL ADVOCACY STRATEGIES INCLUDING THE REVIEW OF THE JUNE, 2012 U.S. SUPREME COURT RULING REGARDING THE INDIVIDUAL MANDATE AND REVISIONS TO THE MEDICAID EXPANSION PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (P.L. 111-148) (A/K/A THE HEALTH CARE REFORM BILL), AND IMPLEMENTATION OF THE PROVISIONS REGARDING THE COMMUNITY HEALTH NEEDS ASSESSMENT, VALUE BASED PURCHASING, ESSENTIAL HEALTH BENEFITS FOR STATE HEALTH EXCHANGES, RESIDENCY SLOT REALLOCATION, HOSPITAL READMISSIONS, HOSPITAL ACQUIRED INFECTIONS AND THE MEDICAL DEVICE TAX. STAFF WORKED ON THE VARIOUS DEBT CEILING AND DEFICIT REDUCTION LEGISLATION, INCLUDING THE BUDGET CONTROL ACT OF 2011, AND THE JOINT SELECT COMMITTEE ON DEFICIT REDUCTION (A/K/A THE SUPER COMMITTEE). THEY ALSO WORKED ON THE FY2013 BUDGET; THE CENTER FOR MEDICARE AND MEDICAID SERVICE'S PROPOSED RULE REGARDING THE ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM PHASE 2 AND MEANINGFUL USE AND SUBMITTED A COMMENT LETTER REGARDING ITS PROVISIONS; THE FY 2013 MEDICARE INPATIENT PROSPECTIVE PAYMENT SYSTEM (PPS) PROPOSED RULE; AND VARIOUS PIECES OF LEGISLATION INCLUDING THE FOOD AND DRUG SAFETY AND INNOVATION ACT OF 2012 RELATING TO THE DRUG SHORTAGE CRISIS; TAX REFORM REGARDING INVESTMENT TAX CREDITS AND MEDICARE PHYSICIAN PAYMENTS (SGR ADJUSTMENTS). STAFF ALSO WORKED ON MANY OF THE FY 2013 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 OFFICE ASSISTED WITH THE FOLLOWING: (1) FAA REAUTHORIZATION BILL AMENDMENTS FOR AIR AMBULANCES; (2) IRS PROPERTY-TAX EXEMPTIONS FOR NONPROFITS GUIDELINES AND COMMUNITY BENEFITS ANALYSIS; (3) CHARITABLE DONATIONS; (4) NIH APPROPRIATIONS AND FUNDING FOR HEALTH PROFESSIONS AND AHEC (5) CHANGES PROPOSED BY HHS REGARDING CONFLICT OF INTEREST RULES; DELAY OF THE COMPLIANCE DATE FOR ICD-10-CM AND ICD-10-PCS MEDICAL DATA CODE SETS; 340(B) PROGRAM EXPANSION AND (6) PATENTS AND INTELLECTUAL PROPERTY ISSUES. AT THE STATE LEVEL, EFFORTS WERE CONCENTRATED WITH THE FY 2012-3 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 ISSUE AND STATUTORY FLEXIBILITY FOR STATE LICENSURE INSPECTIONS OF HOSPITALS. 7303928 1221778 -65209 124978 709300 -462086 8088305 5383158 841681 576477 113868 738112 -1354592 7303928 5437445 446548 259105 110679 649261 5383158 4470108 117064 -780842 17979 -1649094 5437445 0.43930 0.56070 0 0 11661377 11661377 665411236 389202208 276209028 7554181 5896502 1657679 475239965 371884026 103355939 160536276 160536276 553420299 OTHER LIABILITIES 48230119 PENSION LIABILITIES 46889549 DEFERRED COMPENSATION 315710 OTHER LONG-TERM LIABILITIES 2234653 97670031 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: 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. 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 X 1 X 1 1 1 0 1 1 61086625 6152576 54934049 0.04700 214694033 231369983 -16675950 0.00000 20157196 16939585 3217611 0.00280 295937854 254462144 41475710 0.04980 1986297 1986297 0.00170 73712960 21779779 51933181 0.04440 5875989 5875989 0.00500 20859421 20859421 0.01780 645976 645976 0.00060 103080643 21779779 81300864 0.06950 399018497 276241923 122776574 0.11930 64900 64900 0.00010 82742 82742 0.00010 213444 213444 0.00020 232455 232455 0.00020 593541 593541 0.00060 0 14467243 371791808 411293211 -39501403 X 1 1 1 1 NORTH CAROLINA BAPTIST HOSPITAL

MEDICAL CENTER BLVD WINSTON SALEM NC 27157

X X X X NORTH CAROLINA BAPTIST HOSPITAL 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X 1 0 1 X 0 0 24 STRATFORD EXECUTIVE PARK ABDOMINAL ORGAN

140 CHARLOIS BOULEVARD WINSTONSALEM NC 271031522

ABDOMINAL ORGAN TRANSPLANT PROGRAM DOWNTOWN HEALTH PLAZA

1200 N MARTIN LUTHER KING JR DRIVE WINSTONSALEM NC 271013006

FAMILY MEDICINE WAKE FOREST UNIVERSITY BAPTIST IMAGING

265 EXECUTIVE PARK BLVD WINSTONSALEM NC 27103

IMAGING CENTER WINSTON EAST PEDIATRICS

2295 EAST 14TH STREET WINSTONSALEM NC 271056804

PEDIATRICS STRATFORD EXECUTIVE PARK INTERNAL MEDICI

500 SHEPHARD STREET SUITE 300 WINSTONSALEM NC 271031633

IM MULTISPECIALTY CLINICS CANCER CENTER OF DAVIDSON COUNTY LLC

107 WEST MEDICAL PARK DRIVE SUITES 101 LEXINGTON NC 27292

CANCER CENTER MEDICAL PLAZA COUNTRY CLUB DERMATOLOGIC

4618 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

GENERAL DERMATOLOGY MEDICAL PLAZA COUNTRY CLUB GENERAL DERMA

4618 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

DERMATOLOGIC SURGERY STRATFORD EXECUTIVE PARK OBGYN

500 SHEPHARD STREET SUITE 201 WINSTONSALEM NC 271031633

OB/GYN WAKE FOREST BAPTIST HEALTH FAMILY MEDICI

1920 W FIRST STREET WINSTONSALEM NC 271044220

FAMILY MEDICINE STRATFORD EXECUTIVE PARK MATERNAL-FETAL

500 SHEPHARD STREET SUITE 200 WINSTONSALEM NC 271031633

MATERNAL-FETAL MEDICINE WAKE FOREST BAPTIST HEART CENTER

755 HIGHLAND OAKS SUITE 204 WINSTONSALEM NC 271037106

CARDIOLOGY NCBH OUTPATIENT ENDOSCOPY CENTER LLC

100 CHARLOIS BLVD SUITE 100 WINSTONSALEM NC 27103

OUTPATIENT ENDOSCOPY MEDICAL PLAZA COUNTRY CLUB - JOSLIN ADUL

4610 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

ADULT DIABETES CENTER MEDICAL PLAZA COUNTRY CLUB - JOSLIN PEDI

4610 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

PEDIATRIC DIABETES CENTER MEDICAL PLAZA COUNTRY CLUB - UNIVERSITY

4614 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

INTERNAL MEDICINE MEDICAL PLAZA COUNTRY CLUB - CARDIOLOGY

4614 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

CARDIOLOGY MEDICAL PLAZA COUNTRY CLUB - WEIGHT MANA

4614 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

WEIGHT MANAGEMENT MEDICAL PLAZA CLEMMONS - BLDG 2311 GENER

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

PEDIATRICS MEDICAL PLAZA CLEMMONS - BLDG 2311 SPECI

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

PEDIATRIC SPECIALTIES MEDICAL PLAZA CLEMMONS - BLDG 2311 IMPR

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

INTERNAL MEDICINE & PRIMARY CARE MEDICAL PLAZA CLEMMONS - BLDG 2311 ALLER

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

ALLERGY, ASTHMA & IMMUNOLOGY MEDICAL PLAZA CLEMMONS - BLDG 2311 HEMO

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

ONCOLOGY COMP REHAB

131 MILLER STREET WINSTONSALEM NC 27103

REHABILITATION PART I, LINE 3C: THE ORGANIZATION USES A SLIDING SCALE OF THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE BETWEEN 201% AND 300%, THE DISCOUNT IS 75%. BETWEEN 301% AND 400%, THE DISCOUNT IS 60%, AT 200% OR BELOW, THE INDIVIDUAL IS ELIGIBLE FOR FREE 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 2011 SCHEDULE HPART 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. AS THIS IS A NEW PROGRAM, THE NET PROVIDER ASSESSMENT REVENUES RECORDED AS A DIRECT REVENUE OFFSET INCLUDE PAYMENTS FOR 6 MONTHS OF FISCAL YEAR 2011 AND 12 MONTHS OF FISCAL YEAR 2012. PART I, L7 COL(F): THE ORGANIZATION'S PATIENT BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $39,732,160 FOR THE FISCAL YEAR ENDED JUNE 30, 2012. 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) DECREASING THE INCIDENCE OF DIABETES, 3) DECREASING THE PERCENTAGE OF ADULTS REPORTING GOOD, VERY GOOD OR EXCELLENT HEALTH, 4) INCREASING THE PERCENTAGE OF HIGH SCHOOL STUDENTS WHO ARE NEITHER OVERWEIGHT OR OBESE, 5) INCREASING THE PERCENTAGE OF ADULTS WHO REPORT THAT THEY CONSUME FRUITS AND VEGETABLES FIVE OR MORE TIMES PER DAY, 6) INCREASING THE PERCENTAGE OF ADULTS GETTING THE RECOMMENDED AMOUNT OF PHYSICAL ACTIVITY, AND 7) DECREASING 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 70,000 PATIENTS VISITS PER YEAR INCLUDING 32,000 ADULTS, 29% OF WHICH ARE SELF-PAY; 20,000 ARE OB/GYN PATIENT, 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 PROVIDE 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 WITH 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 IS ALSO COORDINATING 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 2012 IT PROVIDED 18 SUPPORT GROUP SESSIONS PRIMARILY FOR STOKE AND OBESITY 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 WHICH ARE UNINSURED/UNDERINSURED, REPRESENTING APPROXIMATELY 2000 DIFFERENT FAMILY MEMBERS FROM OUR COMMUNITY; - GIVE OVER 150 COMMUNITY PRESENTATIONS, REACHING AN ESTIMATED AUDIENCE OF 25,000; - PUBLISHED 30 JOURNAL ARTICLES, RESEARCH PAPERS, BOOK CHAPTERS, AND HAS 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 INCLUDES ANNUAL SKIN CANCER SCREENINGS , NUTRITION CLASSES, COORDINATION WITH THE BE HEALTHY COALITION TO ENCOURAGE PHYSICAL ACTIVITY AMONG ALL FORSYTH COUNTY RESIDENTS THROUGH TWO MONTH PROGRAM WITH STEP UP FORSYTH, A FREE COMMUNITY WIDE PROGRAM COLLABORATING WITH THE YMCA, A 6 WEEK CHRONIC DISEASE MANAGEMENT WORKSHOP , FREE YOGA FOR BREAST CANCER PATIENTS AND SURVIVORS, AS WELL AS SEVERAL FEE LUNCH AND LEARN WORKSHOPS ON CANCER ON AWARENESS AND PREVENTION. 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 ORGANIZTION 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: FOR THE FISCAL YEAR, THE PORTION OF PAYORS FOR WHICHMEDICARE WAS THE PRIMARY SOURCE OF PAYMENT WAS 29.5%. OF THAT PORTION OFPATIENTS, 27.3% WERE FOUND TO HAVE ALSO QUALIFIED FOR MEDICAID AS ASECONDARY INSURANCE; THEREFORE BASED ON THIS RATIO, APPROXIMATELY 27%, OR$10.7 MILLION, OF THE MEDICARE SHORTFALL MAY BE CONSIDERED A COMMUNITYBENEFIT. 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. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 9: 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. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 10: 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 11H: RESIDENT OF THE MEDICAL CENTER'S 19 COUNTY SERVICE AREA. PART VI, LINE 2: TO COMPLETE A COMPREHENSIVE ASSESSMENT OF THE NEEDS OF THE COMMUNITY, AN INTERNAL COMMUNITY HEALTH TEAM RELIES 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, WFBMC, 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, AND THE PUBLIC AMONG 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 AND 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 HEALTHCARE 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 EDUCATEAND INFORM PATIENTS OF THEIR CHARITY CARE OPTIONS, INCLUDING INFORMATIONON A WEBSITE, BILLING PAMPHLETS AVAILABLE IN CLINICAL OFFICES AND THEBUSINESS OFFICE, SIGNS IN CHECK-IN AREAS, INFORMATION ON PATIENT BILLSTATEMENTS, AND FROM STAFF MEMBERS DURING CONVERSATIONS CONCERNING APATIENT'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 2012, THE MEDICAL CENTER PROVIDED CARE TO A NINETEEN COUNTY SERVICE AREA WHICH COMPRISES 85% 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 7.5%PERCENT OF INPATIENTS WHO ARE MEDICAID RECIPIENTS 19.9%THE HOSPITAL IS LOCATED IN CENTRAL FORSYTH COUNTY, WHICH COMPRISES THE SINGLE LARGEST COUNTY IN TOTAL INPATIENT DISCHARGES, ACCOUNTING FOR 13,192 OR 40% OF ALL DISCHARGES IN FY 12. IT IS IMPORTANT TO NOTE THAT NO OTHER COUNTY IN THE SERVICE AREA OR STATE REFLECTS MORE THAN 10% IN INPATIENT VOLUME. ACCORDINGLY, THE HOSPITAL SERVES A WIDE SERVICE AREA, HOWEVER, IT IS RESOURCE PROHIBITIVE TO PARTICIPATE AND FUND HEALTH ASSESSMENTS IN EACH COMMUNITY/COUNTY THAT ITS PATIENT POPULATION ORIGINATES FROM. 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 OPERATES THE FOLLOWING PROGRAMS CONSTITUTING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS REPORTED ON PART I,LINE 7E:WS/FC SCHOOLS ALLIED HEALTH PROGRAM $5,166 COMMUNITY HEALTH/HEALTHCARE ACCESS 11,500 CHURCH COMMUNITY RELATIONS 340,529COMMUNITY HEALTH SALARIES 580,024PHYSICIANS COMMUNITY HEALTH ACCESS 245,584CARENET/PASTORAL COUNSELING 163,894ACCELERATED BSN PROGRAM 531,735COUNTY RENT ON CLEVELAND DENTAL 107,865TOTAL TO PART I, LINE 7E: 1,986,297 REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 ABC OF NC CHILD DEVELOPMENT CENTER 3904 OLD VINEYARD ROAD WINSTON SALEM NC 27104 300111894 501(C)3 10000 COMMUNITY SUPPORT AMERICAN HEART ASSOCIATION 101 CENTREPORT DRIVE STE 130 GREENSBORO NC 27409 135613797 501(C)3 45000 COMMUNITY SUPPORT BOY SCOUTS OF AMERICA - OLD HICKORY COUNCIL 6600 SILAS CREEK PARKWAY WINSTON SALEM NC 27106 560529985 501(C)3 10000 COMMUNITY SUPPORT FORSYTH TECHNICAL COMMUNITY COLLEGE 2100 SILAS CREEK PARKWAY WINSTON SALEM NC 27103 560792614 501(C)3 99292 GREENE HALL EXPANSION JDRF PIEDMONT TRIAD CHAPTER 312 N EUGENE STREET SUITE D GREENSBORO NC 27401 231907729 501(C)3 30000 COMMUNITY SUPPORT MAKE A WISH FOUNDATION 212 S TRYON ST SUITE 1080 CHARLOTTE NC 28281 860481941 501(C)3 6000 COMMUNITY SUPPORT MARCH OF DIMES 410 BROOKSTOWN AVENUE WINSTON SALEM NC 27101 131846366 501(C)3 10000 COMMUNITY SUPPORT NC TRIAD AFFILIATE - SUSAN G KOMEN FOR THE CURE 1106 BURKE STREET WINSTON SALEM NC 27101 751835298 501(C)3 25000 COMMUNITY SUPPORT RONALD MCDONALD HOUSE 419 S HAWTHORNE ROAD WINSTON SALEM NC 27103 581454715 501(C)3 12500 COMMUNITY SUPPORT SCIWORKS 400 W HANES MILL ROAD WINSTON SALEM NC 27105 560815746 501(C)3 10000 COMMUNITY SUPPORT SENIOR SERVICES 2895 SHOREFIELD DRIVE WINSTON SALEM NC 27105 561085968 501(C)3 30000 COMMUNITY SUPPORT THE WOMEN'S FUND OF WINSTON SALEM 860 W FIFTH STREET WINSTON SALEM NC 27101 566037615 501(C)3 10000 COMMUNITY SUPPORT UNITED WAY OF FORSYTH COUNTY 301 NORTH MAIN STREET SUITE 1700 WINSTON SALEM NC 27101 237357234 501(C)3 11849 COMMUNITY SUPPORT WS FORSYTH COUNTY SCHOOLS PO BOX 2513 WINSTON SALEM NC 27102 560795164 GOV'T ENTITY 10000 COMMUNITY SUPPORT YMCA 301 N MAIN STREET WINSTON SALEM NC 27101 560530015 501(C)3 7500 COMMUNITY SUPPORT 15 0 WHITEHEAD NURSING 146 47522 WHITEHEAD MED TECH 3 13000 WHITEHEAD NURSE ANESTHESIA 8 25000 WL CARTER SCHOLARSHIP 17 39476 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 III GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IN THE UNITED STATES THE HOSPITAL FOLLOWS THE MEDICAL CENTER'S POLICY USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE HOSPITAL MONITORS THE ACADEMIC PROGRESS AND OTHER ACHIEVEMENTS OF STUDENTS RECEIVING SCHOLARSHIP/FELLOWSHIP FUNDS TO ENSURE THAT ADEQUATE PROCESS IS MAINTAINED BY THE STUDENT. LETTIE PATE WHITEHEAD SCHOLARSHIPS THE LETTIE PATE WHITEHEAD FOUNDATION PROVIDES SCHOLARSHIPS TO TAX-EXEMPT, NON-PROFIT 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 STUDENTS ARE PROVIDED TO OUR STAFF DEVELOPMENT DEPARTMENT. THE WHITEHEAD FUNDS ARE REVIEWED AND ADMINISTERED BY A FUND CUSTODIAN. W.L. CARTER SCHOLARSHIP SCHOLARSHIP RECIPIENTS/EMPLOYEES MUST BE ACCEPTED INTO AN APPROVED NURSING PROGRAM AND BE RECOMMENDED BY HIS/HER MANAGER WITH SATISFACTORY PERFORMANCE EVALUATION AND ATTENDANCE. IN EXCHANGE FOR THE SCHOLARSHIP, THE EMPLOYEE AGREES TO MAKE ADEQUATE ACADEMIC PROGRESS TO COMPLETE HIS/HER DEGREE. X X X 1 1 X X X X X X 1 1 0 0 0 0 0 0 0 JOHN D MCCONNELL MD 983777 0 384203 0 38511 0 619002 0 19361 0 2044854 0 0 0 H GREG BRAY 203513 0 24045 0 6015 0 27684 0 16736 0 277993 0 0 0 J MCLAIN WALLACE JR 298581 0 79784 0 18764 0 50729 0 43669 0 491527 0 0 0 KAREN H HUEY 219062 0 46557 0 4315 0 55150 0 16983 0 342067 0 0 0 MAUREEN E SINTICH 299332 0 77535 0 24499 0 52111 0 36016 0 489493 0 5334 0 DONNY C LAMBETH 495595 0 181988 0 1651117 0 128399 0 15510 0 2472609 0 349414 0 JOANNE C RUHLAND 199124 0 0 0 18936 0 16008 0 17983 0 252051 0 0 0 NORMAN D POTTER JR 232664 0 58825 0 5802 0 23670 0 21608 0 342569 0 0 0 CHERYL EH LOCKE 353441 0 97552 0 98602 0 18602 0 16372 0 584569 0 0 0 EDWARD G CHADWICK 527216 0 189929 0 24195 0 216774 0 21306 0 979420 0 0 0 THOMAS E SIBERT MD 631297 0 234540 0 31508 0 216925 0 21541 0 1135811 0 0 0 RUSSELL M HOWERTON MD 295714 0 300786 0 17547 0 19588 0 23390 0 657025 0 0 0 DOUGLAS L EDGETON 490485 0 162367 0 18217 0 18602 0 21058 0 710729 0 0 0 LISA M WYATT 282972 0 83494 0 27839 0 21549 0 9183 0 425037 0 0 0 SHEILA M SANDERS 333961 0 89145 0 1932 0 20247 0 19258 0 464543 0 0 0 EDWARD ABRAHAM MD 199490 0 375000 0 96185 0 81000 0 7901 0 759576 0 0 0 KAREN Q TURNER 230949 0 59365 0 7971 0 44793 0 15914 0 358992 0 0 0 BETTY PETREE 221427 0 30692 0 17096 0 51119 0 7175 0 327509 0 0 0 MICHAEL RIEKER 214156 0 28298 0 6037 0 14717 0 22175 0 285383 0 0 0 VANCE MCVAY JR 215950 0 0 0 321 0 22607 0 17636 0 256514 0 0 0 ERIC STIEFEL 207062 0 0 0 208 0 23290 0 17898 0 248458 0 0 0 CHARLES WARE 189593 0 21760 0 6841 0 82519 0 12608 0 313321 0 0 0 STEVE C SNELGROVE 251155 0 61652 0 16840 0 81277 0 34488 0 445412 0 0 0 RONALD H SMALL 147324 0 60658 0 125459 0 9427 0 6772 0 349640 0 0 0 ROBERT S PARKER SR 10840 0 21677 0 223436 0 198 0 7476 0 263627 0 15763 0 SHARON ENGEBRETSON 96570 0 27192 0 40851 0 49859 0 9798 0 224270 0 0 0 GINA B RAMSEY 0 0 0 0 121928 0 0 0 0 0 121928 0 0 0 PART I, LINE 1A CERTAIN EXECUTIVES 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. PART I, LINE 3 THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING AND APPROVING ALL MEDICAL CENTER OFFICERS' COMPENSATION. THE COMMITTEE UTILIZED 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-B NAME SEVERANCE NON-QUAL RETIRE RONALD H SMALL 93,096 17,822 MAUREEN E SINTICH 8,787 ROBERT S PARKER, SR. 198,462 21,449 DONNY C LAMBETH 1,623,420 GINA B RAMSEY 121,928 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART III LAST YEAR, 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 TO FULFIL A SINGLE MISSION OF IMPROVING HEALTH, OPTIMIZING PERFORMANCE WHILE BALANCING PATIENT CARE, EDUCATION AND RESEARCH. NCBH, WFUBMC, WFUHS AND ITS SUBSIDIARIES HAVE COMBINED OPERATING REVENUES OF APPROXIMATELY $2 BILLION FOR THE FISCAL YEAR ENDED JUNE 30, 2012. IN GENERAL, EXECUTIVES PERFORMING KEY MANAGEMENT FUNCTIONS WERE SOUGHT AND HIRED AFTER NATIONAL SEARCHES IN A HIGHLY COMPETITIVE ENVIRONMENT, AND ONLY INDIVIDUALS AT THE HIGHEST LEVELS OF ABILITY WERE SOUGHT, GIVEN THE TASK OF INITIATING AND IMPLEMENTING THE NEW MANAGEMENT STRUCTURE DESIGNED TO OPTIMIZE THE EFFECTIVENESS OF THE MEDICAL CENTER AND ITS TAX-EXEMPT MISSION. CERTAIN EXECUTIVES HOLD THE IDENTICAL OFFICES/TITLES IN WFUHS, NCBH AND WFUBMC 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 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 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HD67 2010-03-01 334002408 CURRENT REFUNDING 0 0 0 16154941 334002408 3307037 330695370 2010 1 0 1 1 0 0 0 0 1 0 0 1 DEUTSCHE BANK AG 5.000000000000 0 0 0 0 1 X DAVID E BRANN FAMILY MEMBER OF DONNY LAMBETH 96443 COMPENSATION 0 JUDY M SLOCUM FAMILY MEMBER OF MAUREEN SINTICH 52583 COMPENSATION 0 MEDCOST BOARD MEMBER EDWARD CHADWICK 3275698 THIRD PARTY ADMINISTRATOR 0 X 4003 FMV X OTHER EQUIP 4 41663 FMV 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): NUMBER OF CONTRIBUTORS WAS USED IN PART I, COLUMN (B). FORM 990, PART VI, SECTION A, LINE 2 EDWARD G. CHADWICK, H. GREGORY BRAY, AND STEVEN C. SNELGROVE HAVE A BUSINESS RELATIONSHIP THROUGH THEIR BOARD/LEADERSHIP POSITION IN MEDCOST, LLC, AN UNRELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE 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 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 ON AN ANNUAL BASIS (AND AS THEY ARISE), ALL DIRECTORS 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 APPLICABLE INTERNAL AUDIT AND COMPLIANCE OFFICES REVIEW THE COMPLETED QUESTIONNAIRES ON BEHALF OF THE FILING ORGANIZATION. ANY CONFLICTS IDENTIFIED ARE COMMUNICATED TO THE FILING ORGANIZATION'S CEO AND ARE PRESENTED TO THE APPLICABLE AUDIT AND COMPLIANCE COMMITTEES (ANY POTENTIAL CONFLICT REPORTED BY THE CEO IS COMMUNICATED TO THE FILING ORGANIZATION'S BOARD CHAIR). ALL CONFLICTS OF INTEREST ARE RESOLVED BY MANAGEMENT PLANS DEVELOPED BY SUCH BOARDS' AUDIT AND COMPLIANCE COMMITTEES AND THE APPLICABLE INTERNAL AUDIT AND COMPLIANCE OFFICES. THE AUDIT AND COMPLIANCE COMMITTEES' CHAIRS PRESENT AN ANNUAL REPORT ON CONFLICTS TO THE FULL BOARDS OF THE APPLICABLE ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION'S EXECUTIVE COMMITTEE OF ITS BOARD OF DIRECTORS FUNCTIONS AS THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS AND PURSUANT TO A DELEGATION BY SUCH OTHER ENTITIES, 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 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 FOR RELATED ORGANIZATIONS ARTHUR A GIBEL FILING ORG 6 RELATED ORG 2 KATHRYN H HAMRICK FILING ORG 4 RELATED ORG 2 ERNEST L EVANS FILING ORG 4 RELATED ORG 2 R MICHAEL WELLS FILING ORG 4 RELATED ORG 2 A WILLIAM BLACKSTOCK, JR. MD FILING ORG 4 RELATED ORG 2 KENNETH W LEWIS FILING ORG 4 RELATED ORG 2 WILLIAM C WARDEN, JR. FILING ORG 4 RELATED ORG 6 SHEREE B WATSON FILING ORG 4 RELATED ORG 2 KATY M BOLES FILING ORG 4 RELATED ORG 2 RAY N HOWELL, III D. MIN FILING ORG 4 RELATED ORG 2 RON KESSINGER FILING ORG 6 RELATED ORG 2 STEPHEN L ROBERTSON FILING ORG 4 RELATED ORG 2 EDWIN L WELCH, JR. FILING ORG 4 RELATED ORG 2 H GREG BRAY FILING ORG 30 RELATED ORG 10 J MCLAIN WALLACE, JR FILING ORG 35 RELATED ORG 5 KAREN H HUEY FILING ORG 24 RELATED ORG 5 UNRELATED ORG 11 STEVE C SNELGROVE FILING ORG 30 RELATED ORG 10 MAUREEN E SINTICH FILING ORG 33 RELATED ORG 7 DONNY C LAMBETH FILING ORG 10 RELATED ORG 30 SHARON ENGEBRETSON FILING ORG 36 RELATED ORG 4 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 26 RELATED ORG 5 UNRELATED ORG 9 EDWARD G CHADWICK FILING ORG 23 RELATED ORG 7 UNRELATED ORG 10 THOMAS E SIBERT, MD FILING ORG 20 RELATED ORG 11 UNRELATED ORG 9 RUSSELL M HOWERTON, MD FILING ORG 20 RELATED ORG 5 UNRELATED ORG 15 DOUGLAS L EDGETON FILING ORG 1.0 UNRELATED ORG 39.0 LISA M WYATT FILING ORG 18 RELATED ORG 5 UNRELATED ORG 17 SHEILA M SANDERS FILING ORG 26 RELATED ORG 5 UNRELATED ORG 9 JOHN D MCCONNELL, MD FILING ORG 20.3 RELATED ORG 10.7 UNRELATED ORG 9 EDWARD ABRAHAM, MD FILING ORG 5 UNRELATED ORG 35 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -77,306,216. CHANGE IN PENSION LIABILITY -39,886,400. CHANGE IN VALUE OF INTEREST RATE SWAP 54,648. AFFILIATE EARNINGS & TRANSFERS 3,085,783. TOTAL TO FORM 990, PART XI, LINE 5: -114,052,185. NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561685120 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11A, I NORTH CAROLINA BAPTIST HOSPITAL 1 THE REHABILITATION & SKILLED NURSING MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561826396 HEALTHCARE (INACTIVE) NC 501(C)(3) LINE 9 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION 1 THE HAWTHORNE INN & CONFERENCE CENTER INC 420 HIGH STREET WINSTON SALEM NC 27101 561793617 LODGING/CONFERENCE ACCOMODATION NC 501(C)(3) LINE 11A, I NORTH CAROLINA BAPTIST HOSPITAL 1 CARENET INC 2000 WEST FIRST STREET SUITE 410 WINSTON SALEM NC 27104 561977341 HEALTHCARE NC 501(C)(3) LINE 11B, II NORTH CAROLINA BAPTIST HOSPITAL 1 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD WINSTON SALEM NC 27157 510190238 HEALTHCARE NC 501(C)(3) LINE 11A, I N/A 0 CENTER FOR CONGREGATIONAL HEALTH INC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 237426944 HEALTHCARE NC 501(C)(3) LINE 9 NORTH CAROLINA BAPTIST HOSPITAL 1 DAVIE COUNTY EMERGENCY HEALTH CORPORATION 223 HOSPITAL STREET MOCKSVILLE NC 27028 562276994 HEALTHCARE NC 501(C)(3) LINE 3 NORTH CAROLINA BAPTIST HOSPITAL 1 MEDICAL FND OF WFUHS & NCBH MEDICAL CENTER BLVD WINSTON SALEM NC 27157 566036688 HEALTHCARE NC 501(C)(3) LINE 11A, I N/A 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION A 189966 COST THE HAWTHORNE INN & CONFERENCE CENTER INC J 227760 COST THE HAWTHORNE INN & CONFERENCE CENTER INC O 43271 COST CARENET INC P 2690773 ACCRUED EXPENSE CENTER FOR CONGREGATIONAL HEALTH INC P 174633 ACCRUED EXPENSE DAVIE COUNTY EMERGENCY HEALTH CORP P 986224 ACCRUED EXPENSE NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION P 354472 ACCRUED EXPENSE THE HAWTHORNE INN & CONFERENCE CENTER INC R 500000 COST DAVIE COUNTY EMERGENCY HEALTH CORP K 62512 COST NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION R 468483 COST