2012-05-14T08:54:34-05:00 2011-06-30 990 2010-07-01 560552787 NORTH CAROLINA BAPTIST HOSPITAL NORT 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 JOHN D MCCONNELL MD 3367164445 2012-05-14 2010 2016-02-24 21:20:13Z JOHN D MCCONNELL MD 9401531259 0 X WWW.WAKEHEALTH.EDU X 1923 NC IMPROVING THE HEALTH OF OUR REGION, STATE AND NATION BY:SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS.GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE.TRAINING TOMORROW'S LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE. 25 22 8968 1487 2231838 1626588 1313535 3309877 939125091 1042076215 23721260 29680394 3514793 3619545 967674679 1078686031 157954 568909 0 0 448104945 489928433 0 0 308821 463568592 531040686 911831491 1021538028 55843188 57148003 1373130565 1461474196 611594543 499788836 761536022 961685360 X SEE SCHEDULE O FOR CONTINUATIONWAKE FOREST BAPTIST MEDICAL CENTER'S MISSION IS TO IMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY:SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS.GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE.TRAINING TOMORROW'S LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE. 0 0 899811575 568909 1037822092 SEE SCHEDULE O FOR COMPLETE DESCRIPTIONOVERVIEW: 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 "NCBH". THE MEDICAL CENTER OPERATES WAKE FOREST SCHOOL OF MEDICINE AND HAS A FACULTY PHYSICIAN PRACTICE OF ABOUT 860 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 DAVIE COUNTY 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 MORE THAN 200-ACRE, MIXED-USE BIOTECHNOLOGY PARK IN DOWNTOWN WINSTON-SALEM. THE PARK IS HOME TO MANY OF THE MEDICAL CENTER'S ACADEMIC AND RESEARCH PROGRAMS, INCLUDING THE WORLD-RENOWNED WAKE FOREST INSTITUTE FOR REGENERATIVE MEDICINE. 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, AND OPERATES BRENNER CHILDREN'S HOSPITAL, A 160-BED HOSPITAL WITHIN A HOSPITAL ON THE MAIN CAMPUS. THE MEDICAL CENTER INCLUDES 21 SUBSIDIARY OR AFFILIATE HOSPITALS, AND OPERATES MORE THAN 150 OUTREACH ACTIVITIES, INCLUDING SATELLITE SPECIALTY CLINICS, ACROSS NORTHWEST NORTH CAROLINA.THERE WERE 38,511 INPATIENT ADMISSIONS IN FY 2011, AND 913,474 OUTPATIENT ENCOUNTERS (EMERGENCY DEPARTMENT, DOWNTOWN HEALTH PLAZA, DAY HOSPITAL, AMBULATORY VISITS). THE TOTAL PATIENT ENCOUNTERS NUMBERED 951,985.2. 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 ANNUAL, FREE PROSTATE SCREENING. NEARLY 64,000 PATIENT VISITS WERE RECORDED AT THE PLAZA BETWEEN JULY 2010 AND JUNE 2011. COSTS ARE SUBSIDIZED BY THE MEDICAL CENTER. THE MEDICAL CENTER ALSO OPERATES NUMEROUS INNOVATIVE COMMUNITY OUTREACH PROGRAMS, MOST NOTABLY ITS BESTHEALTH CENTER AT THE REGION'S LARGEST SHOPPING MALL IN WINSTON-SALEM. BESTHEALTH REACHED MORE THAN 40,000 PEOPLE LAST YEAR THROUGH 439 HEALTH SCREENINGS AND EDUCATIONAL PROGRAMS.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. THE MEDICAL CENTER IN THE PAST YEAR INVESTED MORE THAN $50 MILLION IN THE EDUCATION OF TOMORROW'S HEALTH CARE AND BIOMEDICAL LEADERS. THAT INVESTMENT LAST YEAR SUPPORTED THE TRAINING OF 482 MEDICAL STUDENTS, 664 PHYSICIAN RESIDENTS AND FELLOWS, 323 GRADUATE STUDENTS AND 117 PHYSICIAN ASSISTANTS. THE NORTHWEST AREA HEALTH EDUCATION CENTER, PART OF WAKE FOREST SCHOOL OF MEDICINE, DURING THE SAME YEAR PROVIDED 2,102 CONTINUING MEDICAL EDUCATION ACTIVITIES FOR 37,876 PARTICIPANTS THROUGHOUT THE REGION. 899811575 1 1 0 1 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 1 221 0 1 8968 1 1 1 0 0 0 0 0 0 0 0 0 X 25 22 1 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X DOUG LISCHKE 3367164445 MEDICAL CENTER BLVD WINSTON SALEM NC 27157 X ROGER L COTHRAN 6.00 X 0 0 0 ARTHUR A GIBEL 13.00 X X 0 0 0 KATHRYN H HAMRICK 2.00 X 0 0 0 WILLIAM N HARTSELL 2.00 X 0 0 0 STEPHEN R LITTLE 2.00 X 0 0 0 GEORGE E STUBBINS SR 2.00 X 0 0 0 STANLEY R AESCHLEMAN PH D 2.00 X 0 0 0 A WILLIAM BLACKSTOCK JR MD 2.00 X 0 0 0 WILLIAM J IRELAND JR M DIV PH D 2.00 X 0 0 0 KENNETH W LEWIS 2.00 X 0 0 0 WILLIAM C WARDEN JR 2.00 X 0 0 0 SHEREE B WATSON 2.00 X 0 0 0 KATY M BOLES 2.00 X 0 0 0 RAY N HOWELL III D MIN 2.00 X 0 0 0 JOHN D KIMBERLY 2.00 X 0 0 0 STEPHEN L ROBERTSON 2.00 X 0 0 0 EDWIN L WELCH JR 2.00 X 0 0 0 R MICHAEL WELLS 2.00 X 0 0 0 LINWOOD L DAVIS 2.00 X 0 0 0 BRENDA B DIGGS 2.00 X 0 0 0 ERNEST L EVANS 2.00 X 0 0 0 RON KESSINGER 8.00 X X 0 0 0 PEDRO MARTINEZ 2.00 X 0 0 0 JERRY N BROOKS 2.00 X 496703 0 0 DALE M BROWN 2.00 X 0 0 0 JOSEPH R OVERBY JR MD 2.00 X 0 0 0 JOHN D MCCONNELL MD 20.60 X X 1875612 0 624197 H GREG BRAY 38.70 X 234799 0 40520 J MCLAIN WALLACE JR 35.00 X 378244 0 40349 KAREN H HUEY 26.00 X 229431 0 59613 KAREN Q TURNER 40.00 X 276515 0 51767 STEVE C SNELGROVE 39.00 X 357177 0 98423 RONALD H SMALL 39.00 X 552513 0 57788 MAUREEN E SINTICH 34.80 X 339629 0 55686 ROBERT S PARKER SR 38.00 X 353055 0 103645 DONNY C LAMBETH 36.00 X 749092 0 408315 SHARON ENGEBRETSON 36.00 X 139116 0 78306 JOANNE C RUHLAND 26.00 X 210942 0 35556 NORMAN D POTTER JR 26.00 X 222258 0 37771 CHERYL EH LOCKE 26.00 X 710536 0 34116 EDWARD G CHADWICK 21.00 X 730805 0 243782 THOMAS E SIBERT MD 26.00 X 740478 0 254655 RUSSELL M HOWERTON MD 20.00 X 580706 0 51108 DOUGLAS L EDGETON 1.00 X 613769 0 41279 LISA M WYATT 26.00 X 334084 0 30629 SHEILA M SANDERS 26.00 X 381555 0 45230 BETTY PETREE 40.00 X 269091 0 55527 MICHAEL RIKER 40.00 X 214113 0 38286 VANCE MCVAY JR 40.00 X 211792 0 36260 ERIC STIEFEL 40.00 X 196578 0 25372 CHARLES WARE 40.00 X 202543 0 78470 WILLIAM YATES 40.00 X 14392 0 -646 PAUL LARUSSO 40.00 X 13838 0 1221 A PATRICIA JOHNSON 40.00 X 258798 0 3695 G DOUGLAS ATKINSON 40.00 X 226026 0 10725 12085960 0 2641070 283 1 1 1 WAKE FOREST UNIVERSITY HEALTH SCIENCES MEDICAL CENTER BLVD WINSTON SALEM NC 27157 PHYSICIAN/OTHER PROFESSIONAL SERVICES 64434204 ARAMARK 2300 WARRENVILLE ROAD DOWNER GROVE IL 60515 MANAGEMENT SERVICES 3628454 MEDCOST LLC 3000 KIMEL PARK DRIVE WINSTON SALEM NC 27103 HEALTH INSURANCE ADMINISTRATOR 2557080 QUEST DIAGNOSTICS INC NICHOLS INSTITUTE DEPT 0065 LOS ANGELES CA 90084 LAB SERVICES 2341871 GE HEALTHCARE IITS USA CORP PO BOX 277475 ATLANTA GA 30384 MAINTENANCE CONTRACTS 1927187 84 3309877 81574 3309877 PATIENT SERVICE REVENU 621400 1029326624 1029249756 76868 DIETARY 722320 5185457 5175314 10143 MEDICAL/LAB SERVICE 621500 4254123 4026953 227170 COST RECOV. & OTHER 900099 3310011 1392354 1917657 1042076215 28191474 28191474 490294 202935 287359 287359 287359 8312156108 11975105 8311163788 11478505 992320 496600 1488920 1488920 GIFT SHOP REVENUE 453220 1384775 1384775 PARKING FEES 900099 1203949 1203949 TUITION 900099 203023 203023 540439 540439 3332186 1078686031 1039844377 2231838 33299939 455041 455041 113868 113868 12403054 982012 11112221 308821 137689 137689 380837917 341405417 39432500 19923156 14942367 4980789 49491294 42607426 6883868 27135323 20351492 6783831 1560160 14837 1545323 315249 315249 1807027 1356101 450926 95552556 70161086 25391470 3311559 1663448 1648111 293680331 278148047 15532284 9292707 4972810 4319897 349885 217499 132386 1145633 648397 497236 10933753 10933753 60904211 60295169 609042 6646651 5001841 1644810 BAD DEBT EXPENSE 45037022 45037022 CONTRIBUTION EXPENSE 270000 270000 RECRUITMENT/RELOCATION 233942 233942 1021538028 899811575 121417632 308821 27825998 18078386 58135794 73571292 165093603 200506544 11714276 13859819 1309605 5260718 1273730287 805326163 425391533 468404124 613361983 607124980 61847344 57732699 8450428 16935635 1373130565 1461474196 121810500 112118064 333993335 326149760 155790708 61521256 611594543 499788836 X 756152864 954381677 2146704 3916110 3236453 3387818 761536022 961685360 1373130565 1461474196 X 57148003 143001335 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 1 658007 0 0 658007 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: GOVERNMENT RELATIONS THE OFFICE OF GOVERNMENT RELATIONS WAS ACTIVELY INVOLVED WITH SEVERAL FEDERAL AND STATE ISSUES. THE OFFICE ASSISTED IN DEVELOPING POLITICAL ADVOCACY STRATEGIES REGARDING THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (P.L. 111-148) (A/K/A THE HEALTH CARE REFORM BILL), WHICH INCLUDED EXPANSION OF INSURANCE COVERAGE; MEDICARE AND MEDICAID PAYMENT CHANGES; PROVISIONS RELATED TO WORKFORCE SUPPLY AND GRADUATE MEDICAL EDUCATION TRAINING; FUNDING FOR COMPARATIVE EFFECTIVENESS RESEARCH, WELLNESS AND PREVENTION; KEY DELIVERY SYSTEM REFORMS INCLUDING ACCOUNTABLE CARE ORGANIZATIONS, VALUE BASED PURCHASING AND INCENTIVES TO IMPROVE CARE COORDINATION AND QUALITY; AND LANGUAGE DESIGNED TO REDUCE WASTE, FRAUD AND ABUSE IN THE MEDICARE AND MEDICAID PROGRAMS. STAFF WORKED ON THE FY2011 BUDGET; THE CENTER FOR MEDICARE AND MEDICAID SERVICE'S PROPOSED RULE REGARDING THE ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM AND SUBMITTED A COMMENT LETTER REGARDING ITS PROVISIONS; THE FY 2011 MEDICARE INPATIENT PROSPECTIVE PAYMENT SYSTEM (PPS) PROPOSED RULE; LEGISLATION REGARDING THE CREATION OF HEALTHCARE INNOVATION ZONES; MEDICARE PAYMENT ADVISORY COMMISSION'S DGME AND IME RECOMMENDATIONS; CHANGES TO THE MEDICARE POLICY KNOWN AS THE 72 HOUR RULE; LEGISLATION TO INCREASE RESIDENCY SLOTS; AND MEDICARE PHYSICIAN PAYMENTS (SGR ADJUSTMENTS). STAFF ALSO WORKED ON MANY OF THE FY 2011 APPROPRIATIONS BILLS AND PROPOSED LEGISLATION AND REGULATIONS THAT WERE INTRODUCED, INCLUDING REQUESTS IN THE DEPARTMENT OF TRANSPORTATION; DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF COMMERCE; STATE; JUSTICE; 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) END STAGE RENAL DISEASE PAYMENT SYSTEM PROPOSED RULE; (2) FAA REAUTHORIZATION BILL AMENDMENTS FOR AIR AMBULANCES; (3) EMPLOYEE FREE CHOICE BILL REGARDING UNIONIZATION; (4) IRS PROPERTY-TAX EXEMPTIONS FOR NONPROFITS GUIDELINES AND COMMUNITY BENEFITS ANALYSIS; (5) TAX BILL FOR EMPLOYEE PENSIONS, CHARITABLE DONATIONS; (6) NIH APPROPRIATIONS AND FUNDING FOR HEALTH PROFESSIONS AND AHEC AND THE REAUTHORIZATION OF THE NATIONAL SCIENCE FOUNDATION; (7) CHANGES PROPOSED BY HHS REGARDING CONFLICT OF INTEREST RULES; (8) THE IMPLEMENTATION OF THE TRUTH IN LENDING ACT REGARDING STUDENT LOANS; (9) FALSE CLAIMS ACT AMENDMENTS; AND (10) PATENTS AND INTELLECTUAL PROPERTY ISSUES. AT THE STATE LEVEL, EFFORTS WERE CONCENTRATED WITH THE FY 2010-11 MEDICAID BUDGET INCLUDING THE SIX MONTH EXPANSION OF FMAP FUNDING CONTAINED IN THE FEDERAL STIMULUS PACKAGE, 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; AND FUNDING FOR ALLIED HEALTH PROFESSIONAL TRAINING AT THE COMMUNITY COLLEGES, INCLUDING FORSYTH TECHNICAL COMMUNITY COLLEGE. 3918191 141511 396088 16623 4439167 3788351 68200 78265 16625 3918191 4470108 117064 -780842 17979 3788351 0.03000 0.76000 0.21000 1 0 11535276 11535276 650858378 369135178 281723200 7615567 5737023 1878544 537178371 430453962 106724409 66542695 66542695 468404124 OTHER LIABILITIES 45705970 PENSION LIABILITIES 11507142 DEFERRED COMPENSATION 309148 OTHER LONG-TERM LIABILITIES 3998996 61521256 1078686031 1021538028 57148003 72309986 38943 70652406 143001335 200149338 1217689568 72309986 38943 68731634 141080563 1076609005 2077026 2077026 1078686031 1019461001 0 1019461001 2077026 2077026 1021538027 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 SUPPORT AS DESIGNATED BY THE INDIVIDUAL DONORS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: NCBH AND ITS SUBSIDIARIES ARE TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)3 OF THE INTERNAL REVENUE CODE (THE "CODE"), AND ARE 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 CONSOLIDATED FINANCIAL STATEMENTS. UNRELATED BUSINESS INCOME OF NCBH IS REPORTED ON FORM 990-T. THE SYSTEM 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, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN PENSION LIABILITY: 77,335,733 NET GAIN FROM DISCOUNTINUED OPERATIONS: 1,064,813 CHANGE IN VALUE OF INTEREST RATE SWAP: 226,522 LOSS FROM AFFILIATES: -1,629,817 TRANSFER FROM AFFILIATES: -1,896,299 NET CHANGE IN RESTRICTED ASSETS: 1,920,769 CAPITAL CONTRIBUTION: 996,344 TRANSFER OF AFFILIATE TO INTEGRATED GROUP: -3,458,460 OTHER ADJUSTMENTS: -2,911,099 PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS FROM AFFILIATES: -1,629,817 TRANSFERS FROM AFFILIATES: -1,896,299 CHANGE IN PENSION LIABILITY: 77,335,733 CAPITAL CONTRIBUTION: 996,344 NET GAIN FROM DISCONTINUED OPERATIONS: 1,064,813 CHANGE IN VALUE OF INTEREST RATE SWAP: 226,522 TRANSFER OF AFFILIATE TO INTEGRATED GROUP: -3,458,460 OTHER: -2,910,858 PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION REVENUE: 270,000 PART XIII, LINE 2D - OTHER ADJUSTMENTS CONTRIBUTION REVENUE: 270,000 1 1 1 X 1 X 1 1 1 0 1 1 53167036 5357227 47809809 0.04900 157225696 143400711 13824985 0.01420 16551045 15675743 875302 0.00090 226943777 164433681 62510096 0.06410 3580158 0 3580158 0.00370 66003137 21832021 44171116 0.04520 4512644 0 4512644 0.00460 1645178 0 1645178 0.00170 1481303 0 1481303 0.00150 77222420 21832021 55390399 0.05670 304166197 186265702 117900495 0.12080 0 104821 104821 0.00010 127505 127505 0.00010 0 146558 146558 0.00020 0 46201 46201 0.00000 639184 639184 0.00070 0 1064269 1064269 0.00110 0 16978571 0 340177974 371950001 -31772027 X 1 1 2 1 NORTH CAROLINA BAPTIST HOSPITAL

MEDICAL CENTER BLVD WINSTON SALEM NC 27157

X X X X 2 NORTH CAROLINA BAPTIST HOSPITAL AMBULANC

MEDICAL CENTER BLVD WINSTON SALEM NC 27157

AMBULANCE SERVICES NA PER IRS ANNOUNCEMENT 2011-37 1 13 STRATFORD EXECUTIVE PARK ABDOMINAL ORGAN

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ABDOMINAL ORGAN TRANSPLANT PROGRAM DOWNTOWN HEALTH PLAZA

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FAMILY MEDICINE WAKE FOREST UNIVERSITY BAPTIST IMAGING

265 EXECUTIVE PARK BLVD WINSTONSALEM NC 27103

IMAGING CENTER WINSTON EAST PEDIATRICS

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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 COUNTRY CLUB DERMATOLOGIC SURGERY

4618 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

GENERAL DERMATOLOGY COUNTRY CLUB GENERAL DERMATOLOGY

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

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CARDIOLOGY NCBH OUTPATIENT ENDOSCOPY CENTER LLC

100 CHARLOIS BLVD SUITE 100 WINSTONSALEM NC 27103

OUTPATIENT ENDOSCOPY 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 50%, 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 2010 SCHEDULE H PART I, L7 COL(F): THE ORGANIZATION'S BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $45,037,022 FOR THE FISCAL YEAR. THIS AMOUNT HAS BEEN REMOVED FROM THE CALCULATION OF CHARITY CARE FOR PART I, LINE 7. PART II: THROUGH COMMUNITY BUILDING NORTH CAROLINA BAPTIST HELPS THE COMMUNITY BY OPERATING "BEST HEALTH" WHICH IS A RESOURCE CENTER LOCATED AT A LOCAL SHOPPING MALL. THERE, THE PUBLIC CAN RESEARCH A WIDE VARIETY OF HEALTH AND WELLNESS TOPICS. OUR COMMUNITY ALSO BENEFITS FROM OUR PHYSICIAN RECRUITMENT PROGRAM, COMMUNITY TRAINING AND NETWORKS AS WELL AS OUR PARTICIPATION IN THE LEADERSHIP WINSTON-SALEM PROGRAM. WE FURTHER HELP OUR COMMUNITY BYSUPPORTING OUR LOCAL GOODWILL ENDEAVORS 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 2010 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$8.6 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 ANYASSISTANCE, WHETHER THAT BE CHARITY, MEDICAID, OR OTHER PROGRAMS. PART VI, LINE 2: DATA IS COLLECTED THROUGH PRIMARY AND SECONDARY COLLECTION PROCESSES. POPULATION, PREGNANCY, BIRTH, MORTALITY, ANDMORBIDITY DATA IS REVIEWED TO ASSESS THE POPULATION'S HEALTH. PRIMARYDATA COLLECTION INCLUDES DOOR-TO-DOOR INTERVIEWS IN HIGH RISKCOMMUNITIES; FOCUS GROUPS; AND A COMMUNITY HEALTH OPINION SURVEY THAT ISCONDUCTED THROUGH THE SCHOOL SYSTEM. SECONDARY DATA IS COLLECTED THROUGHDATA FROM THE NC DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITALSTATISTICS, AND SURVEILLANCE REPORTS. OTHER COMMUNITY REPORTS SUCH AS THEUNITED WAY ANNUAL REPORT AND US CENSUS BUREAU COMMUNITY PROFILES AREREVIEWED AS WELL. WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC" - SEE SCHEDULE O, PAGE 66) ALSO REGULARLY PULLS MARKET DATA TO IDENTIFYWHAT HEALTH SERVICES ARE BEING USED BY THE PUBLIC AND TO GAUGE THEAVAILABILITY OF THOSE SERVICES WITHIN THE COMMUNITIES THEY LIVE.THE PURPOSE OF DATA COLLECTION IS TO IDENTIFY FACTORS THAT AFFECT THEHEALTH OF FORSYTH COUNTY'S POPULATION AND DETERMINE THE AVAILABILITY OFRESOURCES WITHIN THE COMMUNITY TO ADEQUATELY ADDRESS THESE FACTORS.WFUBMC PARTICIPATES IN A COLLABORATIVE PROCESS WITH OTHER COMMUNITYLEADERS, PUBLIC HEALTH AGENCIES, HOSPITALS, AND PRIVATE PRACTITIONERS TOANSWER THE KEY QUESTIONS OF (1) WHAT HEALTH CONCERNS OR NEEDS DOES THECOMMUNITY HAVE, AND (2) WHAT RESOURCES ARE AVAILABLE AND WHAT DO WE NEEDIN THE COMMUNITY TO ADDRESS THESE CONCERNS. WORKGROUPS WHICH INCLUDEMEMBERS FROM WFUBMC, ALONG WITH A STATISTICIAN FROM THE PUBLIC HEALTHDEPARTMENT, MEET TO DISCUSS THE PRIMARY AND SECONDARY DATA COLLECTED TOSYNTHESIZE TRENDS AND PRIORITIZE THE TOP NEEDS, SUCH AS "REDUCINGINFANT MORTALITY" AND "REDUCING THE INCIDENCE OF COLON CANCER." RATES AREMEASURED AGAINST PEER COUNTY AND STATE RANKINGS. STRATEGIES ARERECOMMENDED AND VOTED UPON BY THE COMMUNITY ASSESSMENT TASK FORCE, WHICHINCLUDES COMMUNITY LEADERS, PUBLIC HEALTH AGENCIES, HOSPITALS, PRIVATEPRACTITIONERS, AND OTHER NON-PROFIT AGENCIES. THE LAST ASSESSMENT WAS IN2009 AND THE LATEST ASSESSMENT OF COMMUNITY NEEDS WAS INITIATED IN OCTOBER2010. WORK IS PLANNED TO BE COMPLETED BY THE SUMMER OF 2012. WFUBMC HASSEVERAL REPRESENTATIVES ON THE TASK FORCE MANAGED BY THE FORSYTH COUNTYHEALTH DEPARTMENT AND SEVERAL EMPLOYEES PARTICIPATE DIRECTLY IN DATA WORKGROUPS AND ARE PART OF REVIEWING THE EXISTING AND COLLECTING NEW COMMUNITYSPECIFIC DATA. WFUBMC EMPLOYEES ARE ALSO ON VARIOUS COMMUNITY HEALTHBOARDS WORKING TO ADDRESS SPECIFIC COMMUNITY HEALTH NEEDS SUCH AS THEINFANT MORTALITY REDUCTION BOARD, FORSYTH FUTURES, AND UNITED WAY; ALL OFWHICH ADDRESS DIFFERENT HEALTH DISPARITIES IN FORSYTH COUNTY 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.IF A PATIENT QUALIFIES FOR 100% CHARITY CARE PRIOR TO THE ACCOUNT BEINGBILLED TO THE PATIENT, THE ACCOUNT IS CODED AND THE ADJUSTMENT IS TAKENTHE TIME THE BALANCE DROPS TO THE PATIENT AND WOULD NOT PROCEED THROUGHANY FURTHER STATEMENTS OR COLLECTION PROCESS. IF THE PATIENT QUALIFIESFOR PARTIAL CHARITY, THE ADJUSTMENT IS TAKEN AND THE REMAINING BALANCE ISBILLED TO THE PATIENT AND WOULD FOLLOW THE NORMAL COLLECTION PRACTICES ANDPOSSIBLE BAD DEBT PLACEMENT. IF THE PATIENT QUALIFIES FOR 100% CHARITYAFTER BEING BILLED, THE ACCOUNT IS CODED AND THE ADJUSTMENT IS TAKEN ATTHAT TIME AND THE PATIENT WOULD NO LONGER RECEIVE ANY STATEMENTS OR COLLECTIONACTIVITY. IF THE PATIENT QUALIFIES FOR PARTIAL CHARITY, THE ACCOUNT ISADJUSTED ACCORDINGLY AND HE/SHE WOULD STILL BE RESPONSIBLE TO THE REMAININGBALANCE AND CONTINUE TO RECEIVE STATEMENTS OR COLLECTION CALLS AND BESUBJECT FOR BAD DEBT PLACEMENT. PART VI, LINE 4: WAKE FOREST BAPTIST MEDICAL CENTER IS THE ONLY ACADEMIC MEDICAL CENTER SERVING A 24-COUNTY REGION IN NORTHWEST NORTH CAROLINA AND SOUTHWEST VIRGINIA. IT IS ONE OF TWO MAJOR MEDICAL CENTERS OPERATING IN FORSYTH COUNTY. THE POPULATION OF OUR 24-COUNTY REGION FOR 2011 WAS 2,522,841. ACCORDING TO STATISTICS FROM THE NORTH CAROLINA DEPARTMENT OF COMMERCE, IN OUR NARROWER, NINE-COUNTY PRIMARY SERVICE AREA, 15.5 PERCENT OF THE POPULATION IS AT OR BELOW THE POVERTY LINE. IN ADDITION, 69.9 PERCENT OF THE PRIMARY SERVICE AREA POPULATION IS WHITE, 20.8 PERCENT IS BLACK AND 9.3 PERCENT IS MADE UP OF OTHER RACES. THE UNEMPLOYMENT LEVEL IN THE PRIMARY SERVICE AREA AS OF THE THIRD QUARTER OF 2011 WAS 10.2 PERCENT. THE MEDIAN HOUSEHOLD INCOME WAS $43,645. THE 2010-11 GROWTH RATE OF THE PRIMARY SERVICE AREA WAS 0.8 PERCENT. PART VI, LINE 7: 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 $4,911 PHYSICIAN RECRUITMENT FEES 1,500,000COMMUNITY HEALTH/HEALTHCARE ACCESS 11,987 CHURCH COMMUNITY RELATIONS 341,551COMMUNITY HEALTH SALARIES 485,000PHYSICIANS COMMUNITY HEALTH ACCESS 213,773CARENET/PASTORAL COUNSELING 327,495ACCELERATED BSN PROGRAM 639,184COUNTY RENT ON CLEVELAND DENTAL 56,257TOTAL TO PART I, LINE 7E: 3,580,158 REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 AMERICAN HEART ASSOCIATION 101 CENTREPORT DRIVE STE 130 GREENSBORO NC 27409 135613797 501(C)3 35000 SPONSOR HEART AND STROKE BALL ARTS COUNCIL 305 W FOURTH STREET SUITE 1C WINSTON SALEM NC 27101 560526856 501(C)3 100000 TO HELP PROVIDE CULTURAL OPPORTUNITIES IN THE COMMUNITY CARINGBRIDGE 1715 YANKEE DOODLE ROAD SUITE 301 EAGAN MN 55121 421529394 6000 SUPPORT FOR PROGRAM DEVELOPMENT CHILDREN'S MUSEUM OF WINSTON SALEM 300 SOUTH LIBERTY STREET WINSTON SALEM NC 27101 562193634 25500 TO HELP PROVIDE CULTRUAL OPPORTUNITIES IN THE COMMUNITY CITY OF WINSTON SALEM GOV'T ENTITY 120000 TO SUPPORT FOR NEW FACILITIES NEED IN THE COMMUNITY FOUNDATION FOR NURSING EXCELLENCE PO BOX 2129 RALEIGH NC 27602 300105241 15000 SUPPORT FOR PROGRAM DEVELOPMENT HOSPICE & PALLIATIVE CARECENTER 101 HOSPICE LANE WINSTON SALEM NC 27103 581343313 501(C)3 14525 SUPPORT NEW FACILITY NEEDED IN COMMUNITY KOMEN NC TRIAD 1106 BURKE STREET WINSTON SALEM NC 27101 501(C)3 25000 FUNDRAISING EVENT SPONSORSHIP FOR CANCER RESEARCH MARCH OF DIMES 410 BROOKSTOWN AVENUE WINSTON SALEM NC 27101 501(C)3 6000 FUNDRAISING EVENT SPONSORSHIP FOR CANCER RESEARCH RONALD MCDONALD HOUSE 419 S HAWTHORNE ROAD WINSTON SALEM NC 27103 581454715 501(C)3 45500 FUNDRAISING EVENT SPONSORSHIP FOR CANCER RESEARCH UNITED WAY OF FORSYTH COUNTY 301 NORTH MAIN STREET SUITE 1700 WINSTON SALEM NC 27101 237357234 501(C)3 62516 PROGRAM SUPPORT FOR LOCAL PROGRAMS NEEDED IN THE COMMUNITY WHITEHEAD NURSING 42 38775 WHITEHEAD MED TECH 4 13000 WHITEHEAD NURSE ANESTHESIA 12 25000 WL CARTER SCHOLARSHIP 20 37093 OTHER INFORMATION: PART IV: SCHEDULE I, PART I, LINE 2: SCHOLARSHIPS ARE MONITORED TO ASSURE THE TERMS OF THE PROGRAM ARE MET. AN ANNUAL REPORT IS SENT TO THE ORGANIZATION STARTING THE USE OF THE FUNDS AND THE IDENTIFICATION OF BENEFICIARIES TO ASSURE COMPLIANCE WITH SCHOLARSHIP PROVISIONS. LETITE PATE WHITEHEAD DETAILS 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 REQUIREMENTS TO RECEIVE THIS SCHOLARSHIP, AN EMPLOYEE MUST BE ACCEPTED INTO AN APPROVED NURSING PROGRAM AND 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 X 1 1 X X X X X X 1 1 0 0 0 0 0 0 0 JERRY N BROOKS 0 0 0 0 496703 0 0 0 0 0 496703 0 0 0 JOHN D MCCONNELL MD 878909 0 500000 0 496703 0 606145 0 18052 0 2499809 0 0 0 H GREG BRAY 196539 0 33532 0 4728 0 24430 0 16090 0 275319 0 0 0 J MCLAIN WALLACE JR 252151 0 107878 0 18215 0 24458 0 15891 0 418593 0 0 0 KAREN H HUEY 185780 0 40206 0 3445 0 43498 0 16115 0 289044 0 0 0 KAREN Q TURNER 225760 0 41272 0 9483 0 36231 0 15536 0 328282 0 0 0 STEVE C SNELGROVE 249147 0 69521 0 38509 0 83334 0 15089 0 455600 0 0 0 RONALD H SMALL 224601 0 88558 0 239354 0 47428 0 10360 0 610301 0 0 0 MAUREEN E SINTICH 262421 0 60142 0 17066 0 40203 0 15483 0 395315 0 0 0 ROBERT S PARKER SR 202020 0 53529 0 97506 0 93471 0 10174 0 456700 0 0 0 DONNY C LAMBETH 537997 0 186261 0 24834 0 388496 0 19819 0 1157407 0 0 0 SHARON ENGEBRETSON 105226 0 30656 0 3234 0 44302 0 34004 0 217422 0 0 0 JOANNE C RUHLAND 152682 0 40500 0 17760 0 17507 0 18049 0 246498 0 0 0 NORMAN D POTTER JR 192124 0 27500 0 2634 0 16752 0 21019 0 260029 0 0 0 CHERYL EH LOCKE 340146 0 83700 0 286690 0 18848 0 15268 0 744652 0 0 0 EDWARD G CHADWICK 503663 0 200000 0 27142 0 219578 0 24204 0 974587 0 0 0 THOMAS E SIBERT MD 545517 0 166027 0 28934 0 231282 0 23373 0 995133 0 0 0 RUSSELL M HOWERTON MD 136091 0 427701 0 16914 0 26009 0 25099 0 631814 0 0 0 DOUGLAS L EDGETON 484360 0 111700 0 17709 0 18602 0 22677 0 655048 0 0 0 LISA M WYATT 265711 0 38300 0 30073 0 21246 0 9383 0 364713 0 0 0 SHEILA M SANDERS 313768 0 55100 0 12687 0 27014 0 18216 0 426785 0 0 0 BETTY PETREE 209780 0 37569 0 21742 0 47897 0 7630 0 324618 0 0 0 MICHAEL RIKER 208219 0 0 0 5894 0 16319 0 21967 0 252399 0 0 0 VANCE MCVAY JR 211592 0 0 0 200 0 19522 0 16738 0 248052 0 0 0 ERIC STIEFEL 196380 0 0 0 198 0 8706 0 16666 0 221950 0 0 0 CHARLES WARE 170426 0 27290 0 4827 0 66150 0 12320 0 281013 0 0 0 A PATRICIA JOHNSON 0 0 0 0 258798 0 0 0 3695 0 262493 0 0 0 G DOUGLAS ATKINSON 0 0 0 0 226026 0 0 0 10725 0 236751 0 0 0 PART I, LINE 1A 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. SUPPLEMENTAL INFORMATION PART III PART I, LINE 4A: SEVERANCE PAYMENTS: THE FOLLOWING FORMER EMPLOYEES RECEIVED COMPENSATION FROM A SEVERANCE PACKAGE IN 2010. PLEASE SEE PART II, COLUMN C FOR DETAILS: PATRICIA A. JOHNSON G. DOUGLAS ATKINSON SCHEDULE J, PART III DURING THE TAX PERIOD, THE FILING ORGANIZATION, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") AND WAKE FOREST UNIVERSITY HEALTH SCIENCES ("WFUHS") (AND WAKE FOREST UNIVERSITY ("WFU")) WERE OPERATING UNDER AN AGREEMENT THAT PROVIDED FOR THE OPERATION OF WFUHS AND NCBH BY WFUBMC. WFUBMC, WFUHS, AND THE FILING ORGANIZATION ARE ENTITIES WHICH TOGETHER HAVE COMBINED OPERATING REVENUES FOR THE TAX PERIOD OF $1.9 BILLION. 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 BOTH ORGANIZATIONS (NCBH AND WFUHS) IN THEIR TAX-EXEMPT MISSIONS, AS PARTICIPANTS IN A FULLY-INTEGRATED ACADEMIC MEDICAL CENTER. CERTAIN EXECUTIVES OF THE FILING ORGANIZATION (WHO EACH HOLD THE IDENTICAL OFFICES/TITLES IN WFUHS, WFUBMC, AND THE FILING ORGANIZATION) 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 1A - COMPENSATION BY UNRELATED ORGANIZATIONS: THE FOLLOWING INDIVIDUALS WERE COMPENSATED BY WFUHS FOR SERVICES PERFORMED JOHN D. MCCONNELL NORMAN D. POTTER, JR. EDWARD G. CHADWICK JOANNE C. RUHLAND CHERYL E.H. LOCKE THOMAS E. SIBERT RUSSELL M. HOWERTON DOUGLAS L. EDGETON LISA M. WYATT SHEILA M. SANDERS SCHEDULE J. PART I, LINE 3 - THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING AND APPROVING ALL OFFICER COMPENSATION. THE COMMITTEE UTILIZED INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS, AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICER'S COMPENSATION. AN EXTERNAL COMPENSATION CONSULTANT EXPERIENCED IN HEALTH CARE AND HIGHER EDUCATION COMPENSATION PRESENTS TOTAL COMPENSATION COMPARABILITY DATA FOR THE POSITIONS FOR WHICH CONPENSATION 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. SCHEDULE J. PART I, LINE 4 - CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE PAYMENTS FROM SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANS. THE DETERMINATION OF THE AMOUNT OF THE NON QUALIFIED RETIREMENT PLANS FOLLOWED THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE 990. NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HD67 2010-03-01 334002408 CURRENT REFUNDING 0 0 0 7705000 334002408 3307037 330695370 2010 1 0 1 1 0 0 1 DEUTSCHE BANK AG 5.000000000000 0 0 0 0 1 DAVID E BRANN FAMILY MEMBER OF DONNY LAMBETH 67063 COMPENSATION 0 SCOTT O JOHNSON FAMILY MEMBER OF A. PATRICIA JOHNSON 13383 COMPENSATION 0 THOMAS P JOHNSON FAMILY MEMBER OF A. PATRICIA JOHNSON 11846 COMPENSATION 0 JUDY M SLOCUM FAMILY MEMBER OF MAUREEN SINTICH 45397 COMPENSATION 0 HINSON & HALE MEDICAL TECHNOLOGY BOARD MEMBER WILLIAM WARDEN SERVED AS A DIRECTOR 157581 PURCHASE OF SUPPLIES 0 X 24081 FMV X 1 600 FMV X OTHER EQUIPMENT 9 56893 FMV 0 1 0 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 (WHICH ENTITY IS UNRELATED TO WFU) 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 A, LINE 4 ARTICLES OF INCORPORATION ADDS AS A PURPOSE THAT NCBH WILL CONDUCT ITS OPERATIONS AS A PART OF THE INTEGRATED HEALTH SYSTEM OF WFUBMC. AS REQUIRED BY THE STATE NONPROFIT CORPORATION ACT, INCLUDES PROVISION ON THE DELEGATION TO WFUBMC OF CERTAIN POWERS TO OPERATE NCBH; IT IS ALSO NOTED THAT POWERS NOT SO DELEGATED ARE RETAINED BY THE NCBH BOARD. BYLAWS ARTICLE V, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER: STATES THAT WFU AND NCBH ARE THE TWO MEMBERS, EQUAL IN ALL RESPECTS, OF WFUBMC, AND EACH ELECT ONE-HALF OF ITS VOTING BOARD MEMBERS. REFERENCES AND CHARACTERIZES THE MCIA, AND STATES THAT ALL OPERATIONS OF NCBH AND OF WFUHS (INCLUDING ALL SUBSIDIARIES OF BOTH) ARE UNDER THE AUTHORITY OF WFUBMC. WFUBMC IS DELEGATED CERTAIN POWERS TO OPERATE NCBH, AND ALL CORPORATE POWERS NOT SO DELEGATED ARE RETAINED BY THE NCBH BOARD. ARTICLE VI OFFICERS: THE CEO REPLACES THE PRESIDENT AS THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. AS PROVIDED IN THE MCIA, THE CORPORATE OFFICERS OF WFUBMC SERVE AS THE CORPORATE OFFICERS OF NCBH IN ADDITION TO THE CEO, THE PRESIDENT AND THE VICE PRESIDENTS. ARTICLE VII COMMITTEES: THE STANDING COMMITTEES OF THE NCBH BOARD ARE AN EXECUTIVE COMMITTEE (WHOSE MEMBERS ARE THE NCBH BOARD MEMBERS ELECTED TO THE WFUBMC BOARD), AN ARTICLES OF INCORPORATION AND BYLAWS COMMITTEE, AN AUDIT AND COMPLIANCE COMMITTEE, A GOVERNANCE AND NOMINATING COMMITTEE, AN INVESTMENT COMMITTEE AND A FAITH AND HEALTH MINISTRIES COMMITTEE. THE FINANCE AND BUSINESS AFFAIRS COMMITTEE, HEALTH SYSTEM OPERATIONS AND QUALITY COMMITTEE, FACILITIES COMMITTEE, RESEARCH PARK COMMITTEE AND ACADEMIC AFFAIRS COMMITTEE OF THE WFUBMC BOARD ARE ADDITIONAL STANDING COMMITTEES OF THE NCBH BOARD. THE NCBH BOARD HAS THE AUTHORITY TO APPOINT FROM AMONG ITS MEMBERSHIP NON-WFUBMC BOARD MEMBERS TO THE WFUBMC BOARD COMMITTEES. ARTICLE VIII MEDICAL STAFF: THE NCBH BOARD DELEGATES TO THE WFUBMC BOARD THE APPOINTMENTS AND REAPPOINTMENTS TO THE MEDICAL STAFF, ASSIGNMENT OF MEDICAL STAFF PRIVILEGES AND THE RIGHT OF APPROVAL OF THE MEDICAL STAFF BYLAWS, RULES AND REGULATIONS. 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 18 PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. 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, SECTION A THE FOLLOWING PERSONS WERE COMPENSATED DIRECTLY BY NORTH CAROLINA BAPTIST HOSPITAL, FILING ORGANIZATION, OR WAKE FOREST UNIVERSITY HEALTH SCIENCES, AS UNRELATED ORGANIZATION, FOR SERVICES PERFORMED FOR THE FILING ORGANIZATION. EACH PERSON'S POSITION IN EACH ORGANIZATION, AND THE AVERAGE HOURS PER WEEK THAT THEY DEVOTE TO EACH ENTITY, ARE SHOWN BELOW. JOHN D. MCCONNELL, M.D. DIRECTOR/CEO, NC BAPTIST HOSPITAL _20.6 HOURS PER WEEK CEO, WFUBMC _5__ HOURS PER WEEK DIRECTOR, CEO, WFUHS __11_ HOURS PER WEEK DIRECTOR, PIEDMONT TRIAD RESEARCH PARK __1__ HOUR PER WEEK DIRECTOR, PTRP DEVELOPMENT CORPORATION __1__ HOUR PER WEEK DIRECTOR, IDEALLIANCE __.2 _ HOURS PER WEEK DIRECTOR, IDEALLIANCE FOUNDATION __.2_ HOURS PER WEEK DIRECTOR/CHAIR, PRESIDENT, DIALYSIS CENTERS (GROUP RETURN) __.5_ HOURS PER WEEK PRESIDENT, DIALYSIS ACCESS GROUP OF WAKE FOREST UNIVERSITY, LLC __.5 _ HOURS PER WEEK H. GREG BRAY ASSISTANT TREASURER/ASSISTANT SECRETARY, FILING ORGANIZATION _38.7 HOURS PER WEEK TRUSTEE, CARENET, INC. __.1 _ HOURS PER WEEK SECRETARY, THE NURSING CENTER AT OAK SUMMIT (1/1 - 6/30) __.1 HOURS PER WEEK SECRETARY, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION (1/1 - 6/30) _.1 _HOURS PER WEEK TREASURER, HAWTHORNE INN & CONFERENCE CENTER __ 1 _ HOURS PER WEEK SHARON ENGEBRETSON INTERIM VP PASTORAL CARE, FILING ORGANIZATION __36_ HOURS PER WEEK TRUSTEE, CENTER FOR CONGREGATIONAL HEALTH __ 4 _ HOURS PER WEEK DOUGLAS L. EDGETON EXECUTIVE VICE PRESIDENT, FILING ORGANIZATION __1_ HOUR PER WEEK EXECUTIVE VICE PRESIDENT, WFUBMC __5__ HOURS PER WEEK EXECUTIVE VICE PRESIDENT, WFUHS __15_ HOURS PER WEEK DIRECTOR, PRESIDENT, PIEDMONT TRIAD RESEARCH PARK __10_ HOURS PER WEEK DIRECTOR, PRESIDENT, PTRP DEVELOPMENT CORPORATION ___5_ HOURS PER WEEK DIRECTOR, PRESIDENT, IDEALLIANCE __.2 _ HOURS PER WEEK DIRECTOR, PRESIDENT, IDEALLIANCE FOUNDATION __.2_ HOURS PER WEEK TRUSTEE, SECRETARY, TREASURER, THE MEDICAL FOUNDATION OF WFUHS AND NCBH __.1_ HOURS PER WEEK VICE PRESIDENT/TREASURER, DIALYSIS ACCESS GROUP OF WAKE FOREST UNIVERSITY, LLC __1__ HOUR PER WEEK DIRECTOR, VP/TREASURER, DIALYSIS CENTERS (GROUP RETURN) __3.5 HOURS PER WEEK EDWARD G. CHADWICK TREASURER, FILING ORGANIZATION _21 _ HOURS PER WEEK TREASURER, WFUBMC _ 5__ HOURS PER WEEK TREASURER, CFO, WFUHS _14__ HOURS PER WEEK J. MCLAIN WALLACE VP GENERAL COUNSEL/SECRETARY, FILING ORGANIZATION _ 35_ HOURS PER WEEK VP GENERAL COUNSEL/SECRETARY, WFUBMC _ 5__ HOURS PER WEEK RUSSELL M. HOWERTON, M.D. CHIEF MEDICAL OFFICER, WFU BAPTIST HEALTH SYSTEM, FILING ORGANIZATION __20_ HOURS PER WEEK CHIEF MEDICAL OFFICER, WFU BAPTIST HEALTH SYSTEM, WFUBMC __5_ HOURS PER WEEK CHIEF MEDICAL OFFICER, WFU BAPTIST HEALTH SYSTEM, WFUHS __15_ HOURS PER WEEK MEMBER, DAVIE COUNTY EMERGENCY HEALTH CORPORATION __ 1_ HOUR PER WEEK KAREN H. HUEY VP, FACILITIES, FILING ORGANIZATION __26 HOURS PER WEEK VP, FACILITIES, WFUBMC _ 5__ HOURS PER WEEK VP, FACILITIES, WFUHS _9 HOURS PER WEEK DONNY LAMBETH PRESIDENT, FILING ORGANIZATION __36_ HOUR PER WEEK PRESIDENT, WFUBMC COMMUNITY PHYSICIANS __ 1_ HOURS PER WEEK DIRECTOR, DAVIDSON HEALTHCARE, INC. __1_ HOUR PER WEEK DIRECTOR, LEXINGTON MEMORIAL HOSPITAL, INC. __1 HOUR PER WEEK DIRECTOR, LEXMEDICAL, INC. __1 _ HOUR PER WEEK CHAIRMAN, HAWTHORNE INN & CONFERENCE CENTER __.1 _ HOURS PER WEEK SECRETARY, THE NURSING CENTER AT OAK SUMMIT (7/1 - 12/31) __.1 HOURS PER WEEK SECRETARY, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION (7/1 - 12/31)__.1 _HOURS PER WEEK MEMBER, NORTHWEST COMMUNITY CARE NETWORK, INC. __.1 _ HOURS PER WEEK TRUSTEE, CARENET, INC. __.1 _ HOURS PER WEEK CHAIR, DAVIE COUNTY EMERGENCY HEALTH CORPORATION __ 1_ HOUR PER WEEK TRUSTEE, SECRETARY, TREASURER, THE MEDICAL FOUNDATION OF WFUHS AND NCBH __.1_ HOURS PER WEEK CHERYL E. H. LOCKE VP, CHIEF HUMAN RESOURCES OFFICER, FILING ORGANIZATION __26 HOURS PER WEEK VP, CHIEF HUMAN RESOURCES OFFICER, WFUBMC _ 5_ HOURS PER WEEK VP CHIEF HUMAN RESOURCES OFFICER, WFUHS _9 HOURS PER WEEK TRUSTEE, HAWTHORNE INN & CONFERENCE CENTER __.1 _ HOURS PER WEEK NORMAN B. POTTER, JR. VP, DEVELOPMENT AND ALUMNI AFFAIRS, FILING ORGANIZATION __26 HOURS PER WEEK VP, DEVELOPMENT AND ALUMNI AFFAIRS, WFUBMC _5_ HOURS PER WEEK VP, DEVELOPMENT AND ALUMNI AFFAIRS, WFUHS _ 9 HOURS PER WEEK ROBERT S. PARKER, SR. VP SPECIAL OPERATIONS/COMMUNITY, FILING ORGANIZATION _38 HOURS PER WEEK CHAIR, NORTHWEST COMMUNITY CARE NETWORK, INC. __2 _ HOURS PER WEEK JOANNE C. RUHLAND VP, GOVERNMENT AFFAIRS, FILING ORGANIZATION __26 HOURS PER WEEK VP, GOVERNMENT AFFAIRS, WFUBMC _ 5_ HOURS PER WEEK VP, GOVERNMENT AFFAIRS, WFUHS _ 9 HOURS PER WEEK SHEILA M. SANDERS VP, CHIEF INFORMATION OFFICER, FILING ORGANIZATION _26 HOURS PER WEEK VP, CHIEF INFORMATION OFFICER, WFUBMC _5_ HOURS PER WEEK VP, CHIEF INFORMATION OFFICER, WFUHS _9 HOURS PER WEEK THOMAS E. SIBERT, M.D. PRESIDENT AND COO, WFU BAPTIST HEALTH SYSTEM, FILING ORGANIZATION _26 HOURS PER WEEK PRESIDENT AND COO, WFU BAPTIST HEALTH SYSTEM, WFUBMC _5__ HOURS PER WEEK PRESIDENT AND COO, WFU BAPTIST HEALTH SYSTEM, WFUHS _8 HOURS PER WEEK TRUSTEE, WFUBMC COMMUNITY PHYSICIANS _ 1 HOUR PER WEEK MAUREEN E. SINTICH VP OPERATIONS/CNO, FILING ORGANIZATION _34.8 HOURS PER WEEK CHIEF NURSING OFFICER, WFUBMC __5 _ HOURS PER WEEK TRUSTEE, CARENET, INC. __.1 _ HOURS PER WEEK TRUSTEE, HAWTHORNE INN & CONFERENCE CENTER __.1 _ HOURS PER WEEK STEVEN C. SNELGOVE VP OPERATIONS, FILING ORGANIZATION _39 HOURS PER WEEK TRUSTEE, HAWTHORNE INN & CONFERENCE CENTER __.1 _ HOURS PER WEEK MEMBER, DAVIE COUNTY EMERGENCY HEALTH CORPORATION __ 1_ HOUR PER WEEK RONALD H. SMALL VP QUALITY & SERVICES EXCELLENCE, FILING ORGANIZATION _39 HOURS PER WEEK MEMBER, DAVIE COUNTY EMERGENCY HEALTH CORPORATION __ 1_ HOUR PER WEEK KAREN Q. TURNER VP SURGICAL SERVICES _40 HOURS PER WEEK LISA M. WYATT VP, FACILITIES, FILING ORGANIZATION _26 HOURS PER WEEK VP, FACILITIES, WFUBMC _5__ HOURS PER WEEK VP, CHIEF COMMUNICATIONS AND MARKETING OFFICER, WFUHS _9 HOURS PER WEEK ROGER COTHRAN TRUSTEE, FILING ORGANIZATION __6__ HOURS PER WEEK TRUSTEE, WFUBMC __2__ HOURS PER WEEK ERNEST L. EVANS TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK TRUSTEE, WFUBMC __2__ HOURS PER WEEK ARTHUR A. GIBEL TRUSTEE, FILING ORGANIZATION _13__ HOURS PER WEEK TRUSTEE, WFUBMC __2_ HOURS PER WEEK RON D. KESSINGER TRUSTEE, FILING ORGANIZATION __8__ HOURS PER WEEK TRUSTEE, WFUBMC __2__ HOURS PER WEEK STEPHEN L. ROBERTSON TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK TRUSTEE, WFUBMC __2__ HOURS PER WEEK MEMBER, DAVIE COUNTY EMERGENCY HEALTH CORPORATION __ 1_ HOUR PER WEEK WILLIAM C. WARDEN, JR. TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK TRUSTEE, WFUBMC __6__ HOURS PER WEEK SHEREE B. WATSON TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK TRUSTEE, WFUBMC __2__ HOURS PER WEEK MEMBER, THE NURSING CENTER AT OAK SUMMIT __.1 HOURS PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 _HOURS PER WEEK KATHRYN H. HAMRICK TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK MEMBER, THE NURSING CENTER AT OAK SUMMIT __.1 HOURS PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 _HOURS PER WEEK WILLIAM N. HARTSELL TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK STEPHEN R. LITTLE TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK GEORGE E. STUBBINS, SR. TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK STANLEY R. AESCHLEMAN, PHD TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK A. WILLIAM BLACKSTOCK, JR., M.D. TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK MEMBER, THE NURSING CENTER AT OAK SUMMIT __.1 HOURS PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 _HOURS PER WEEK WILLIAM J. IRELAND, JR. M. DIV PHD TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK KENNETH W. LEWIS TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK MEMBER, THE NURSING CENTER AT OAK SUMMIT __.1 HOURS PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 _HOURS PER WEEK KATY M. BOLES TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK MEMBER, THE NURSING CENTER AT OAK SUMMIT __.1 HOURS PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 RAY N HOWELL, III D. MIN. TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK MEMBER, THE NURSING CENTER AT OAK SUMMIT __.1 HOURS PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 _HOURS PER WEEK JOHN D. KIMBERLY TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK EDWIN L. WELCH, JR. TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK R. MICHAEL WELLS TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK CHAIR, THE NURSING CENTER AT OAK SUMMIT (1/1 - 6/30) _1 HOUR PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 _HOURS PER WEEK LINWOOD L. DAVIS TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK BRENDA B. DIGGS TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK PEDRO MARTINEZ TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK MEMBER, THE NURSING CENTER AT OAK SUMMIT __.1 HOURS PER WEEK MEMBER, NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION _.1 _HOURS PER WEEK JERRY N. BROOKS (7/1/ - 12/31) TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK DALE M. BROWN (7/1/ - 12/31) TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK JOSEPH R. OVERBY, JR., MD (7/1/ - 12/31) TRUSTEE, FILING ORGANIZATION __2__ HOURS PER WEEK CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 72,309,986. DONATED SERVICES AND USE OF FACILITIES: 38,943. CHANGE IN PENSION LIABILITY 77,335,733. NET GAIN FROM DISCONTINUED OPERATIONS 1,064,813. CHANGE IN VALUE OF INTEREST RATE SWAP 226,522. LOSS FROM AFFILIATES -1,629,817. TRANSFERS TO AFFILIATES -1,896,299. NET CHANGE IN RESTRICTED ASSETS 1,920,769. TRANSFER OF AFFILIATE TO INTEGRATED GROUP -3,458,460. OTHER ADJUSTMENTS -2,910,855. TOTAL TO FORM 990, PART XI, LINE 5: 143,001,335. 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 3540 CLEMMONS ROAD CLEMMONS NC 27012 561903275 HEALTHCARE NC 501(C)(3) LINE 3 WAKE FOREST UNIVERSITY HEALTH SCIENCES 1 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 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION A 210030 RECEIPT OF INTEREST WFUBMC COMMUNITY PHYSICIANS A 101293 RECEIPT OF INTEREST NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION C 15000 GRANT FUNDING WFUBMC COMMUNITY PHYSICIANS I 75610 RECEIPT OF PAYMENT THE HAWTHORNE INN & CONFERENCE CENTER INC J 227760 CHECK PAYMENT THE HAWTHORNE INN & CONFERENCE CENTER INC O 30925 CHECK PAYMENT CARENET INC P 2513900 ACCRUED EXPENSE CENTER FOR CONGREGATIONAL HEALTH INC P 11706 ACCRUED EXPENSE DAVIE COUNTY EMERGENCY HEALTH CORP P 666792 ACCRUED EXPENSE NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION P 477172 ACCRUED EXPENSE THE HAWTHORNE INN & CONFERENCE CENTER INC P 444076 ACCRUED EXPENSE WFUBMC COMMUNITY PHYSICIANS P 1613631 ACCRUED EXPENSE WFUBMC COMMUNITY PHYSICIANS Q 1218304 WIRE TRANSFER THE HAWTHORNE INN & CONFERENCE CENTER INC R 0 CASH NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION R 258453 NOTE PAYMENT WFUBMC COMMUNITY PHYSICIANS R 86720 NOTE PAYMENT